

A critique of "evidence-based medicine" (UK's NHS approves acupuncture) - tptacek
http://crookedtimber.org/2009/06/04/if-this-is-evidence-based-medicine-i-want-my-old-job-back/

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tptacek
Money quote:

 _It’s a phenomenon that’s very familiar to economists under the name
“Goodhart’s Law”. Basically, Goodhart’s Law says that “any economic
relationship which is used for policy purposes, ceases to be valid”._

~~~
gojomo
Indeed; it's also considered a factor in the banking crisis, where once
ratings agencies' tiers were written into bank regulations the inventives to
game them became overwhelming.

For example --
[http://www.marginalrevolution.com/marginalrevolution/2008/12...](http://www.marginalrevolution.com/marginalrevolution/2008/12/words-
of-wisdom.html) \-- where the first comment also mentions "Goodhart's Law".

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Zak
Claims that conditions other than back pain and closely related discomfort can
be treated by spinal manipulation are obviously bogus. That said, spinal
manipulation has the same effect as cracking your knuckles, which does result
in pain relief and increased range of motion[0].

There is also significant evidence for the efficacy of accupuncture for
treating several conditions, including migranes[1], nausea/vomiting resulting
from chemotherapy[2] and improving success rates in in-vitro fertilization[3]

Most of the objections seem to be centered around the fact that modern science
has no explanation for how these things work. We don't even know what makes
the noise when joints are cracked[4]. The scientific and medical communities
tend to be understandably reluctant to accept things as true without plausible
explanations for how they work. That said, it's probably harmful to deny
patients treatments that have been demonstrated effective simply due to a lack
of understanding the mechanism of action.

[0]
[http://www.jmptonline.org/article/S0161-4754(07)00059-0/abst...](http://www.jmptonline.org/article/S0161-4754\(07\)00059-0/abstract)

[1] <http://www.cochrane.org/reviews/en/ab001218.html>

[2] <http://www.cochrane.org/reviews/en/ab002285.html>

[3] <http://www.ncbi.nlm.nih.gov/pubmed/18258932>

[4] <http://en.wikipedia.org/wiki/Cracking_joints>

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BigZaphod
This is slightly OT, but since the article seems to imply that chiropractic
care is quackery, I have to ask: What do people have against chiropractors? Do
most of them suck or something? I've only got experience with one family
practice (mother/daughter), but my relief has been quite measurable and very
significant at times.

Antidote: A few years ago, something strange happened in my back while
standing for the morning SCRUM meeting and I could no longer stand without
searing, intense pain. I was almost-literally carried into the chiropractic
office by a coworker and came out walking and feeling like nothing had
happened about 20 minutes later. It's not magical and obviously doesn't cure
all ails, but to say it's junk seems to reek of improper study or prejudiced
"debunkers."

~~~
tokenadult
_since the article seems to imply that chiropractic care is quackery, I have
to ask: What do people have against chiropractors?_

I don't know anyone who has much against chiropractors PERSONALLY, as persons
making a living, but the practice of chiropractic makes factual claims about
how many disease conditions can be treated by manipulation of the spine, and
those claims are bogus. The state I live in treats chiropractors as one of
several kinds of state-licensed healing practitioners, and I think the major
health insurance networks here do "evidence-based" evaluation of treatments
and reimburse for chiropractic treatment of back pain. But there would be no
evidence-based reason to reimburse chiropractic treatment for high blood
pressure or arthritis or many other things that a chiropractic training
program (there is one in my state) might claim that chiropractic treatment can
help. In some cases there are public agencies that pay for people's
treatments, and it is important that the payers get right which treatments
work for which conditions.

<http://www.csicop.org/si/2008-01/thyer.html>

<http://www.layscience.net/node/566>

<http://www.chirobase.org/01General/message.html>

[http://medicareupdate.typepad.com/medicare_update/2009/05/me...](http://medicareupdate.typepad.com/medicare_update/2009/05/medicarechiropractorsoigreport.html)

P.S. to the OP: what's causing the stupid horizontal scrolling of the
interesting original post you kindly submitted? I had to downsize the font to
a degree hard on my eyes to see all the text on screen at the same time.

~~~
dave_au
I have a sister and a step-sister who are both chiropractors. Apparently there
are two disjoint schools of thought within chiropractry, at least in
Australia.

My sister does the science based stuff that's mostly about the back and very
closely related things, while the camp my step-sister belongs to believes that
all ills come from and can be cured through the spine - including cancer, etc
...

They went to different universities, one university having the what I call the
"science" focus and the other one having what I call the "crazy" focus. My
sister chose the science focused university because the crazy focused
university scared the hell out of her.

A bit strange that their qualifications are the same on paper.

