Ep 26: Australian Chiropractor Dr. John Reggars on the Crossroads of Science Vs. Subluxation

American chiropractors are frequently directed to countries in Europe and Scandinavia for examples of science based, well integrated chiropractic. Many people assume Australia's 3700 chiropractors must be practicing in a similar situation. What is chiropractic like down under?

Dr. John Reggars is a chiropractor in Australia who is mad as hell about the current state of affairs. The profession is at yet another crossroads with a history of making the wrong decision and he wants people to stand up and declare their intolerance for the fundamentalist anti-science. His article titled "Chiropractic at the Crossroads - or are we just going around in circles?" is sure to ruffle some feathers both down under and around the globe.

In this episode of On The Other Hand, Dr. Reggars speaks with Dr. Brett Kinsler about what has him as mad as hell and why he won't take it anymore!

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  • Anon

    As a fairly recent graduate of Macquarie University (Australia), I am appalled at colleagues and new graduates with same evidence based education getting ‘re-trained’ from their first associate jobs to preach vertebral subluxation complex, which they just accept without much question.

    May 8, 2011 at 7:41 am
  • Samuel Homola

    Kudos to Dr. John Reggars for a sensible, frank, and objective analysis of the chiropractic subluxation problem.

    May 8, 2011 at 10:46 am
  • Mark Szlazak, DC

    Dr. Reggars touches on the problems like misrepresentation of research and so on. This is a problem but one you will find in many “orthodox” places as well. However, it can be taken to extremes and that is a problem.

    Notions about used care sales people made me chuckle a bit since there is an assumption it doesn’t happen elsewhere in health care and that sales always means something “bad.”

    One thing I would like to point out is on Dr. Reggars interpretation of the Brennan study. If it hasn’t been done already, a follow up needs to be done to see if there is a differential responses to thrusts in different spinal areas and to different regions of the body.

    An immune respiratory bust being a defense mechanism in the body IS KEY and this does not mean that hitting someone in the back with a 2-by-4 will ONLY cause the same reaction!

    No one claimed in that study pain responses after SMT similar to getting hit with a 2-by-4 nor any other clinically meaningful pain. This is just not analogous and an exaggeration which leads to logical fallacies.

    I seriously doubt that the adjustments are causing malignant traumas, they are likely benign traumas that can be beneficial effects in restarting a stalled self-healing response.

    This IS an important study and please do not dismiss it.

    Other scientists are looking at the bodies ability to heal itself, wanting to know how self-healing is activated and many suspect that pseudo-traumas can act to initiate this response in beneficial ways.

    Think of this analogy which is taught world-wide in all kinds of disciplines that deal with musculoskeletal injuries. Scar tissue forms during healing and can be a source of dysfunction. The treatment rational is basically a benign trauma to breakdown anomalous cross-link formation, etc.

    However, the problem as always is over-generalization. But the other problems are quick dismissal and in the case I mention, not realizing the scientific work in other fields that is going on exactly in the areas of self-healing processes.

    Also, this interview brings up the case of vague definitions that have validity when looked at the right way (innate intelligence, self-healing) with chiropractic specific ideas or implications that don’t necessarily have the scope that they do (e.g, chiropractic subluxations as a major cause of disease). A conflation or baby with bathwater issue.

    I have a BIG problem with Dr. Reggars restriction of scope to musculoskeletal conditions. This is a mistake.

    Again, think people need to read more widely outside chiropractic literature on self-healing. Work is being done on this and more work needs to be done in healthcare but there are problems of funding and working against a dominant biomedical paradigm that looks mostly at drug development and lines that lead to making pharma or medical device dollars.

    Dr. Reggars could have been less selective with his testimonials of things he disagrees with but if this is just about his political advocacy then I understand where he is coming from.

    Chiropractic specific problems can be helped by better educating chiropractic students on the strengths and weaknesses of all competing views in as unbiased way as possible.

    Dr, Reggars also mentions issues on ethics and placebo but seems not to realize that this issue isn’t as simple as he thinks. Also, government position papers have had political and ideological bias with regards to the evidence before, whether they are from NIH, NAS or whatever. I would take them at face value.

    Lastly, progress isn’t always entirely away from a past position. Trajectories can and have step back because further evidence leads that way. Reading the history and philosophy of science literature will make one much less certain about where things will or should go. Don’t be surprised that “progress” happens in a 2 steps forward with 1 step back manner with regards to core concepts and be mindful of dismissing out of hand any view that has had problem before because they can a do come back again in modified and more accurate ways.

    I any case, I’m with Dr. Reggar’s in spirit but not necessarily in details, thank him for writing his article and giving this interview.

    May 8, 2011 at 2:13 pm
  • Richard E Vincent DC

    It is obvious that our profession is part of a world community and it is imperative that we must raise our voices and support for the new pardigm. I am not sure that we have what it takes to be true movers and shakers…. there is so much inertia in the profession…………….thank you Dr Reggar.

    May 9, 2011 at 10:10 am
  • Dr Andrew Kinsella MBBS

    Maybe someone reading this might be interested in the experience of a patient on this matter. My experience is that I am a conventional allopathic GP working full time, qualified in 1985. I had always regarded this spinal subluxation stuff as complete garbage.

    Then I happened upon information that showed me how to diagnose the problem in myself. I had the treatment (not via a chiropractor) within a week of discovering the treatment (Atlas Profilax). The improvement in my condition was immediate and dramatic, and I am perfectly happy to forward a copy of the testimonial I gave to any taker.

    Quite frankly my attitude is that the obfuscation and stupidity around this condition has caused me serious injury. I feel fortunate to have had the problem corrected before the consequences of it caused irreversible injury. If I could identify a specific individual/group responsible for the suppression of this knowledge I would gladly launch legal action, as a public service.

    What shocked me more than anything else was that once I knew what I was looking for I was quickly able to learn how to identify the common clinical presentations of subluxation of the atlas on the skull, how to identify the physical signs of this condition and how to demonstrate it on CT scan.

    What is worse, the clinical complications of the condition are all perfectly comprehensible to anyone who has a basic understanding of anatomy and biomechanics in a moving person (as opposed to a cadaver).

    All I can say is that the knowledge of this condition and its treatment is now spreading uncontrollably, courtesy of this great democratising instrument called the internet.

    If us health practitioners do not wish to suffer from a serious relevance deficit syndrome it is time we all stopped siding with the academic authoritarians in our midst and looked afresh at the ample evidence that is available websites I can recommend if you contact me.

    Dr Andrew Kinsella andrewk1901@gmail.com

    May 10, 2011 at 6:33 am
  • Phillip Ebrall

    It is embarrassing to read supposedly informed comment from people who are obviously unfamiliar with the literature. Before you bleat for evidence, please make sure you know what already exists.

    May 18, 2011 at 8:42 am
  • Phillip Ebrall

    Oh, and if you wish to know from where Reggars took the theme about ‘crossroads’ the reference is:

    Ebrall PS. The crossroad was really a fork [Editorial]. Chiropr J Aust 2009; 39:45.

    May 18, 2011 at 8:45 am
  • Tony Croke

    Selectively quoting and/or mis-quoting the literature. Dogmatically clinging to unfounded beliefs in the absence of evidence to support those beliefs. Fundamental flaws in logic. Living in the past and failing to keep up to date with current research. Omission of significant facts that don’t fit one’s world-view.

    Thanks for being such a shining example, John.

    May 18, 2011 at 7:44 pm
  • Bruce Walker

    I was so impressed with this podcast. It covered many topics relevant to chiropractic in Australia and indeed worldwide. John Reggar’s is across these topics and spoke with authority about them. I hope his desire to have chiropractors (who have had enough of the early 20th century nonsense) stand up and be counted is successful. I for one agree with the thrust of his propositions and will stand up. Unfortunately there are no windows in my office that will open! But I will think of other ways to help :) .

    Well done John for expressing your opinion so convincingly. Let’s hope the dark side of the profession engage in the debate. Let’s all prepare and help bring the profession into the 21st Century.

    May 19, 2011 at 10:05 pm
  • Joseph Ierano DC

    I have problems with MANY diagnoses. Here are just some:

    Irritable Bowel Syndrome: Mainstay of the gastroenterologist abdominal pain, cramps and bowel motion changes comes and goes symptoms vary may get worse or better unknown causes fibre can help or make worse drugs may help or make worse avoid large meals, or whatever food makes it worse

    Fibromyalgia: Pain specialist pain in at least 11 out of 18 predesignated points on the body for more than 3 months medically unexplained no known cure a diagnosable disorder with no cure or consensus as to whether it exists

    Multiple Sclerosis: Neurologists nightmare? first described in 1868 and not much clearer since no cause no cure its name means ‘lots of hardened scars or tissues’ which describes very little can be benign, disappear, or lead to the steady demise of a person

    Vertebral Subluxation is just another term to describe some observed phenomenae that I accept and live with. As a chiropractor I treat patients, not just symptoms like subluxation and sprains. This is all mental diversion with the greatest energy wasted on dis-proof.

    Chiropractic will always help people. And children: fact. And the comment about ‘atlas profilax’ is a courageous one. Congrats to the MD who spoke up in support. However, the AProf amateurs need to read beyond some guy in Switzerland and look at the history of atlas manipulation. There was a guy called Hippocrates, Palmer, Still and a few hundred others before these unqualified zealots began toying with upper cervical anatomy (albeit getting results, in the above, probably illegal, ‘testimonial’).

    ‘The sun will rise tomorrow’ will always be true. Except when one day it is not. Whatever you call a ’subluxation’ it will still be treated by someone tomorrow who calls it how he sees it.

    May 23, 2011 at 8:29 am
  • John MacPhee

    I am a new graduate and am already sick of this tired argument. I would consider myself one of the ‘moderate majority’ mentioned in the full-text article and I can attest that I dislike the position expounded by Reggars EQUALLY as much as I dislike the fear-mongering extremist-subluxationists. ‘We’ (I loosely include myself and my more moderate contemporaries) have spent so much time and energy arguing within about how ‘wrong and embarrassing’ the “other side” is instead accepting that the answer or correct/appropriate position is most likely somewhere down the middle. (ie Evidence informed practice while accepting that there’s still a whole lot we can’t adequately explain with science but that is still observable and repeatable.)

    My opinion is that Reggars’ perspective is EQUALLY as dogmatic as a passionate subluxationist. ‘Science/evidence or bust’ is equally as unhealthy/detrimental as ‘Subluxation is the root of all disease.’ And so goes the story of every major conflict. If I’m not willing to accept ANYTHING to do with your story, then how can I expect you to accept ANYTHING to do with mine?

    I would argue that Dr Reggars (and his fellow extreme conservatives at COCA and similar parties) is EQUALLY responsible for the unravelling of the chiropractic profession as any subluxationist. For example, it could be argued that a primary reason for the increasing mistrust of Chiropractic is directly related to individuals like Reggars (and the organizations they represent) repeatedly and publicly bashing their own Colleagues in articles such as this. If there’s no trust WITHIN the profession, how can we ever expect the public to trust us? Worse yet, contrary to the intent of these ultra-conservatives to pander to and seek approval from other ‘more astute and well-regarded’ health professionals, these types of attacking, slanderous articles surely have a net-negative effect on their (other professionals) level of trust for Chiropractic.

    So I would challenge Dr Reggars: At any of the previous ‘Crossroads’ did polarizing the profession work to improve our collective position in the public’s view? Has name-calling and slandering ever succeeded in arriving at a satisfying conclusion in ANY conflict (political or otherwise)? I certainly don’t have the acumen to adequately answer these questions but I am quite certain that there must be a better way.

    Jun 2, 2011 at 11:55 am
  • John MacPhee

    And seemingly to make my point, the comment by Bruce Walker above, Editor in Chief of the same journal that published this article (and intrisically linked to COCA/Reggars): “Let’s hope the Dark side engages…” Seriouly: ‘Dark Side’? how can you expect a reaction of anything other than “pitchforks, torches and storming (of) castles” when you use terms like this? It’s dissapointing to read such immature language from a scholar such as yourself. and presumably you consider your “side” to be somehow ‘brighter’? This coming from the professor who took great satisfaction in telling his impressionable 3rd year students that they should take solace in “knowing that the treatment you provide for low back pain has been shown to be no worse than any other treatment” (in summarizing the conclusions of the cochrane review he authored on chiropractic and LBP). That doesn’t sound very ‘bright’ to me.

    Jun 2, 2011 at 12:25 pm
  • Jo-Anne Maire

    The problem with this ‘one extreme or the other’ argument is that everyone thinks of himself as a ‘moderate’. There are those who believe in vitalism, or that subluxations cause disease, or that vaccines do more harm than good, and yet think of themselves as ‘moderates’. I personally require a modicum of biological plausibility before subscribing to any health care paradigm to which I will subject my patients. If a health care provider wants to believe in a mysterious, supernatural power in the body that somehow ‘flows from above, down, inside out’ (and backwards), that’s fine (sort of). If he or she also wants to believe in leprechauns, dragons, and Keynesian economics, that’s fine too. The problem is when said practitioner starts to ‘educate’ his or her patients about such beliefs. We’re not at liberty as a professional person to put our religious or philosophical beliefs onto to our patient. A patient has the right to expect honesty and integrity from us.

    I was told recently about a local chiropractic gathering (I won’t call it a conference) where the oft repeated catchphrase was “Take no credit. Take no blame.” in the context of results of chiropractic care. How is this responsible health care? How can we ever expect to be taken seriously by anyone with such utter nonsense being bandied about? Did anyone at the ‘gathering’ stand up and say “Enough is enough”, or “I’m not going to take this anymore?” – Not one! In cases like this silence is consent. I must take a stand and declare proudly that I’m with John Reggars on this one - - I’m mad as hell and I’m not going to take it (quietly) anymore.

    Jun 2, 2011 at 10:22 pm