Published Dec 16, 2016
Phillip Ebrall


Objective: To present an objective interpretation of the literature reporting evidence based medicine or practice and to raise discussion points based on those findings which, if explored, may advance the chiropractic profession in both its academic and clinical activities. Data Sources and Synthesis: The indexed literature and URLs identified by on-line searching. A contextual narrative identifies specific points that may be worthy of formal discussion, either by individual authors preparing papers for publication, or by symposia. Conclusion: Evidence based medicine is thought by some to have had its day. The concept of best practice seems embedded within chiropractic education. Whether they appreciate it or not, most chiropractors practice a rich form of evidence based practice into which they inject their experience as a chiropractor and the characteristics including preferences of the patient. (Chiropr J Australia 2016;44:308-319)
Abstract 167 | PDF Downloads 345



Evidence-Based Medicine, Chiropractic, Medical Education

1. Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ 1996:312: 71–72
2. Crowther H, Lipworth W, Kerridge I (2011) Evidence-based medicine and epistemological imperialism: narrowing the divide between evidence and illness. J Eval Clin Pract 17: 868–872
3. Ghosh AK (2007) Clinical applications and update on evidence-based medicine. J Assoc Physicians India 55: 787–794
4. Lohmander LS, Roos EM. The evidence base for orthopaedics and sports medicine: Scandalously poor in parts [Editorial]. BMJ 2014; 350:g7835 doi: 10.1136/bmj.g7835 (Published 2 January 2015)
5. Walker BF. The new chiropractic. Chiropractic & Manual Therapies. 2016;24: 26
6. Queensland Government. Health Practitioner Regulation National Law Act 2009. URL: https://www.legislation.qld.gov.au/LEGISLTN/CURRENT/H/HealthPracRNA09.pdf Accessed July 17, 2016
7. Ebrall PS. Commentary: Is EBM damaging the social conscience of chiropractic? Chiropr J Aust. 2016: … insert …
8. European Schools Sign Anti-Subluxation Position Statement. News. The Chronicle of Chiropractic. Foundation for Vertebral Subluxation. May 17, 2015 - 14:43. http://chiropractic.prosepoint.net/113734 Accessed June 19, 2016
9. World Federation of Chiropractic. News. https://www.wfc.org/website/index.php?option=com_content&view=article&id=314%3Awfc-athens-congress-a-huge-success&catid=56%3Anews--publications&Itemid=27&lang=en Accessed June 19, 2016
10. Anderson JD. David Sackett 1934-2015: the father of evidence-based medicine. [Obit] Int J Prosthodont. 2015 Jul-Aug;28(4):343-4
11. Sackett DL. Commentaries should be evidence based too [Letter, Reply]. BMJ. 1966;312: 380
12. Sackett DL. Campaign to revitalise academic medicine BMJ. 2004:329; 924
13. Bellomo R. The dangers of dogma in medicine. Med J Aust. 2011;195(7):372-3
14. Greenhalgh T, Howick J, Maskrey N. Evidence based medicine: a movement in crisis? BMJ 2014;348:g3725. URL: http://www.bmj.com/content/348/bmj.g3725 Accessed July 17, 2016
15. Fuller J, Flores LJ, Upshur REG, Goldenberg MJ. Renaissance or reformation for evidence based medicine? BMJ 2014;349:g4902. URL: http://www.bmj.com/content/349/bmj.g4902 Accessed July 17, 2016
16. Haavik H. The reality check. URL: http://www.heidihaavik.com/products/the-reality-check Accessed July 17, 2016
17. Iimura K, Watanabe N, Masunaga K, Miyazaki S, Hotta H, Kim H, Hisajima T, Takahashi H, Kasuya Y. Effects of a gentle, self-administered stimulation of perineal skin for nocturia in elderly women: A randomized, placebo-controlled, double-blind crossover trial. PLoS One. 2016; 11(3): e0151726. URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803221/ Accessed July 17, 2016
18. Hotta H, Watanabe N, Piche´ M, Hara H, Yokawa T, Uchida S. Non-noxious skin stimulation activates the nucleus basalis of Meynert and promotes NGF secretion in the parietal cortex via nicotinic ACh receptors. J Physiol Sci (2014) 64:253–60
19. Canadian Chiropractic Research Foundation. Dr Greg Kawchuk DC, PhD. J Can Chiropr Assoc. 2005 Jun; 49(2): 76–77. URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1840011/ Accessed July 17, 2016.

20. Jaffer U, Camerson AEP. Deceit and fraud in medical research. Int J Surg. 2006;4(2): 122–6. DOI: http://dx.doi.org/10.1016/j.ijsu.2006.02.004
21. Novella S. The Lancet retracts Andrew Wakefield’s article [posting]. Science-based Med. 2010;29. https://www.sciencebasedmedicine.org/lancet-retracts-wakefield-article/ Accessed Jun 19, 2016
22. Zwolsman S, te Pas E, Hooft L, Wieringa-de Ward M, van Dijk N. Barriers to GPs' use of evidence-based medicine: a systematic review. Br J Gen Prac. 2012;62(200): e511-e21
23. Tonelli MR. The philosophic limits of evidence-based medicine. Acad. Med. 1998; 73:1234-40
24. Tonelli MR, Callahan TC. Why alternative medicine cannot be evidence-based. Acad. Med. 2001; 76:1213–1220
25. Lim HC, Adie S, Naylor JM, Harris IA. Randomised trial support for orthopaedicsSurgical procedures. PLoS ONE 9(6): e96745. doi:10.1371/journal. pone.0096745. UR: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0096745 Accessed July 17, 2016
26. Chiropractors Association of Australian. CPD and Events. 2016 Sports Chiropractic Symposium. URL: http://chiropractors.asn.au/education-a-events/sports-chiropractic-symposium-2016. Accessed July 17, 2016
27. American Chiropractic Association. Sports Council home page. URL: http://www.acasc.org Accessed July 17, 2016
28. McCarthy M. Too much scrutiny is bad for general practice: The UK is almost alone in Europe with its micromanagement of primary care. BMJ 2016;353:i2151 doi: 10.1136/bmj.i2151
29. Carson AJ, Stone J, Hansen CH, DuncanR, Cavanagh J, Matthews K, Murray G, Sharpe M. Somatic symptom count scores do not identify patients with symptoms unexplained by disease: a prospective cohort study of neurology outpatients. J Neurol Neurosurg Psychiatry 2015;86:295–301. doi:10.1136/jnnp-2014-308234
30. Australian Commission of Safety and Quality in Health Care. Australian Atlas of Healthcare Variation. URL: http://www.safetyandquality.gov.au/atlas/ Accessed July 17, 2016
31. Petty NJ. Becoming an expert: A Masterclass in developing clinical expertise. Int J Osteopathic Med. 2015;18: 207e21
32. Johnson C. Best Practices in Syllabus Writing: Contents of a learner-centered syllabus. J Chiropr Educ. 2006;20(2): 139–144
33. Triano JJ. What constitutes evidence for best practice? (J Manipulative Physiol Ther 2008;31:637-643
34. Rosner AL. Evidence-based medicine: Revisiting the pyramid of priorities. J Bodywork Movement Thera. 2012;16: 42-9. URL: http://www.bodyworkmovementtherapies.com/article/S1360-8592(11)00075-1/abstract Accessed July 17, 2016
35. Laika’s MedLibLog. URL: https://laikaspoetnik.wordpress.com/tag/levels-of-evidence/ Accessed July 18, 2016
36. US Department of Health and Human Services. Agency for Healthcare Research and Quality. URL: https://guideline.gov Accessed July 18, 2016
37. Amorin-Woods LG, Beck RW, Parkin-Smith GF, Lougheed J, Bremner AP. Adherence to clinical practice guidelines among three primary contact professions: a best evidence synthesis of the literature for the management of acute and subacute low back pain. J Can Chiropr Assoc. 2014 Sep;58(3):220-37. URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4139767/ Accessed July 17, 2016

38. Alcantara J. Evidence-Informed Pediatric Chiropractic: Investigational or Experimental? J. Pediatric, Maternal Fam Health. 2015;Jan 28:26-32
39. Palmer BJ. Suggestion. The Chiropractor. Palmer School of Chiropractic, IA. 1905;1(10): 22
40. Harrison E. Remarks upon the different appearances of the back, breast and ribs, in persons affected with spinal diseases: and on the effects of spinal distortion on the sanguineous circulation. London Medical Physicians J. 1820; 14:365-378
41. Palmer BJ. The Chiropractor. Palmer School of Chiropractic, IA. 1905;1(4): 13
42. Rome PR. Usage of chiropractic terminology in the literature: 296 ways to say ‘subluxation: Complex issues of the vertebral subluxation. Chiropr Tech. 1996; 8(2):49-60
43. Smith M, Corber LA. Survey of US Chiropractor Attitudes and Behaviors about Subluxation. J Chiropr Humanit 2008;15: 19-26