Protecting Chiropractic

Written by: James Demetrious, DC, DABCO

Board Certified Chiropractic Orthopedist

Chiropractic is Under Attack…Again

I object to the conclusions cited in a new Cochrane Review about spinal manipulation. Cochrane reviews have been subject to bias, making their conclusions irrelevant:

1. Industry Funding and Conflicts of Interest

A study published in the JAMA found that among 509 RCTs included in 29 meta-analyses, 69% received industry funding, and 69% had authors with financial ties to the industry. Despite this, only 7% of the meta-analyses reported RCT funding sources, and none disclosed author-industry ties, suggesting a lack of transparency in acknowledging potential conflicts of interest.

2. Selection Bias in Included Studies

An article in BMJ highlighted that Cochrane reviews have been criticized for not being sufficiently critical in the selection of trials and for including too many of low quality. This approach may lead to biased conclusions, as the inclusion of low-quality studies can compromise the reliability of the review’s findings.

3. Over-Reliance on RCTs

Critics argue that Cochrane’s strict focus on RCTs may exclude valuable real-world evidence. For instance, a study in the Journal of Evaluation in Clinical Practice noted that while RCTs are considered the gold standard, they may not always be feasible or ethical, and over-reliance on them can limit the applicability of systematic reviews to everyday clinical practice.

4. Author Bias or Ideological Influence

Internal disputes within Cochrane have raised concerns about ideological biases. In 2018, Peter C. Gøtzsche, a member of Cochrane’s Governing Board, was expelled, leading to resignations and criticisms about a growing top-down authoritarian culture and an increasingly commercial business model within Cochrane.

5. Inconsistencies in Quality

A 2001 assessment published in BMJ evaluated the quality of Cochrane reviews and found variability, with some reviews containing inconsistencies in data interpretation and outdated information. This suggests that while Cochrane aims for high-quality reviews, there can be significant differences in the rigor and reliability of individual reviews.

6. Slow Updating of Reviews

A study in Annals of Internal Medicine found that of 100 systematic reviews monitored, 7% needed updating at the time of publication, another 4% within a year, and another 11% within 2 years. This indicates that some Cochrane reviews may become outdated, potentially leading to the dissemination of obsolete information.

7. Bias Through Omission

An article in The Cochrane Database of Systematic Reviews discussed the importance of assessing conflicts of interest in included trials, noting that transparent and structured assessments should be a routine component of Cochrane systematic reviews. Failure to adequately address these conflicts may lead to bias through omission.

Protecting Chiropractic

  1. It is essential to actively challenge and correct false narratives about chiropractic care through evidence-based education and public awareness.
  2. Chiropractors must unify their voice to advocate for the profession and highlight its contributions to non-invasive, patient-centered healthcare.
  3. Promoting transparency, clinical research, and patient outcomes helps protect chiropractic from misinformation and reinforces its credibility.

At PostGradDC.com, we seek to help chiropractic physicians improve patient outcomes. We seek to protect and elevate the chiropractic profession. We seek the truth.