How Could This Chiropractic Study Possibly Be A Double-blind Study?

[Eban]

The primary author of this study, Dr. George Bakris, was interviewed on Good Morning America this morning. He said that the study was a "double-blind study." A double-blind study requires that all participants who have contact with the research subjects have no knowledge about which administered treatment is the control(placebo) and which is the actual treatment being studied.The treatment under study in this case required very specialized chiropractic skills.How could it possibly be a double-blind study?http://www.uchospitals.edu/news/2007/20070314-atlas.html

[Reade]

The first requirement is not telling the patient the theory about which specific bone supposedly causes their illness. Since there is no obvious way for them to know this, that part is pretty secure.  Even if they knew the difference between the C-1 and C-2, they wouldn?t know which one is supposedly going to cure their hypertension.   The part that sounds tricky, administering the treatment blindly, really isn?t.  The person who administers the treatment does not have to be the same as the person who later examines the patients to see which ones have improved.  With drug treatments, it is easy to hand someone a pill without knowing what is in it, but the important detail is that the person assessing the patient?s progress not know.  So it?s OK if the chiropractor knows if he is doing the "real" treatment or the "sham" treatment, as long as he isn?t the one who decides whether or not it "worked".   We don?t know for sure if they did do the experiment correctly, but they could have.   BUT...   I have to note some other problems with this article(as published by the University of Chicago Medical Center).  I can?t directly assess the original article because the Journal of Human Hypertension wants $32 for it.   Two big problems, if the UC article is an accurate report of the published results: They claim the treatment of the C-1 vertebra was equal to blood pressure medication, but there is no indication that any patients in this study were given any blood pressure medication.  If they didn?t test the drug treatment in the same conditions, with an equivalent test group, as the C-1 treatment group, this is NOT an outcome of the experiment performed. They don?t say what happened to the "sham" group.  Comparing the test group to the placebo group is the primary purpose of this sort of experiment--if the placebo group experienced the same results, the whole thing is a wash. They don?t mention the real results, and make a major point of results that are not necessarily to be inferred from such an experiment(again, as reported by UC).

[Blane]

It's not "double-blind". It's "single-blind". Bakris misspoke. lucaspa 79 months ago Please sign in to give a compliment. Please verify your account to give a compliment. Please sign in to send a message. Please verify your account to send a message.

[Hreinn]

This is simple. First, the study is double blind, not placebo controlled. A type of "placebo" was in fact administered, though. If you read the entire article, two things are obvious right away.   1. None of the patients had any idea why they were receiving this particular treatment, nullifying the "placebo" effect. One?s body, nor mind can mimic an effect for which they have no suggested influence. Therefore, the placebo effect does not come into play.   Some quotes from the articlee to support that theory:   "Those with high blood pressure and misaligned C-1 were enrolled in the study. Data from the assessment were used by the chiropractor to plan the alignment. Half of the patients received a carefully tailor-made adjustment based on their results. Half received a "sham intervention," which was designed to be indistinguishable to the patient from an authentic alignment, possible only because of the delicacy of the procedure. "     Therefore, sufficient control was in fact used. The study is double blind because none of the participants either knew if they were receiving a particular treatment, nor weere they aware of the desired outcome. Sources: YEARS of reading medical and exercise science research BrainBuilder_is_gone 79 months ago Please sign in to give a compliment. Please verify your account to give a compliment. Please sign in to send a message. Please verify your account to send a message.

[Kirwin]

Mr_M_told_U_so said: 2 The study you site is not double blind as written. I was expecting to see a mix of patients, some with high blood pressure and some without, undergoing EITHER the sharm treatment OR the real treatment(unknown to the therapists), but I didn't see that either. It said all subjects had high BP. So, I don't know. 79 months ago

[Coburn]

It could be done, but that's not the problem with this experiment. The first requirement is not telling the patient the theory about which specific bone supposedly causes their illness. Since there is no obvious way for them to know this, that part is pretty secure.  Even if they knew the difference between the C-1 and C-2, they wouldn?t know which one is supposedly going to cure their hypertension.   The part that sounds tricky, administering the treatment blindly, really isn?t.  The person who administers the treatment does not have to be the same as the person who later examines the patients to see which ones have improved.  With drug treatments, it is easy to hand someone a pill without knowing what is in it, but the important detail is that the person assessing the patient?s progress not know.  So it?s OK if the chiropractor knows if he is doing the "real" treatment or the "sham" treatment, as long as he isn?t the one who decides whether or not it "worked".   We don?t know for sure if they did do the experiment correctly, but they could have.   BUT...   I have to note some other problems with this article(as published by the University of Chicago Medical Center).  I can?t directly assess the original article because the Journal of Human Hypertension wants $32 for it.   Two big problems, if the UC article is an accurate report of the published results: They claim the treatment of the C-1 vertebra was equal to blood pressure medication, but there is no indication that any patients in this study were given any blood pressure medication.  If they didn?t test the drug treatment in the same conditions, with an equivalent test group, as the C-1 treatment group, this is NOT an outcome of the experiment performed. They don?t say what happened to the "sham" group.  Comparing the test group to the placebo group is the primary purpose of this sort of experiment--if the placebo group experienced the same results, the whole thing is a wash. They don?t mention the real results, and make a major point of results that are not necessarily to be inferred from such an experiment(again, as reported by UC). newbie2510701 79 months ago Please sign in to give a compliment. Please verify your account to give a compliment. Please sign in to send a message. Please verify your account to send a message.

[Stevie]

JC, thank you for your answer. Here are some definitions for your reference:A placebo is a treatment which is not expected to have intrinsic therapeutic value, but which is administered as if it were a therapy.A single-blind study is where the research subjects(the patients) do not know which treatment they are receiving or whether they are receiving a placebo control. This type of study was begun when researchers discovered that patients' conditions could be effected simply by their minds' awareness of receiving treatment(the placebo effect).Later, researchers found that those who administered the treatment(either a placebo control or the actual treatment) could unconsciously communicate this to the patients(with body language, etc.), and the patients could respond via the placebo effect even though they were not explicitly told which treatment they received.To counteract this, the double-blind study was created. In a double-blind study, not only are the patients unaware of which treatment they are receiving, but those in direct contact with the patients also do not know so that they cannot unconsciously communicate it to the patients.I guess it's a subtle difference, but key to my question.In the cited article, it is unclear whether the patients knew why they were receiving treatment. It only says that they were referred to a chiropractor for treatment. If they were referred by the Hypertension Center at UC, presumably they would think they were being treated for hypertension. I don't have access to the study itself yet, so we don't know the protocol details.Although the study was placebo controlled, for the study to be double-blind, those actually providing treatment to the patients could not have known whether they were administering the actual treatment or not. I just don't see how that is possible if the treatment was administered by highly trained chiropractors.

[Markus]

First, the study is double blind, not placebo controlled. A type of "placebo" was in fact administered, though. If you read the entire article, two things are obvious right away.   1. None of the patients had any idea why they were receiving this particular treatment, nullifying the "placebo" effect. One?s body, nor mind can mimic an effect for which they have no suggested influence. Therefore, the placebo effect does not come into play.   Some quotes from the articlee to support that theory:   "Those with high blood pressure and misaligned C-1 were enrolled in the study. Data from the assessment were used by the chiropractor to plan the alignment. Half of the patients received a carefully tailor-made adjustment based on their results. Half received a "sham intervention," which was designed to be indistinguishable to the patient from an authentic alignment, possible only because of the delicacy of the procedure. "     Therefore, sufficient control was in fact used. The study is double blind because none of the participants either knew if they were receiving a particular treatment, nor weere they aware of the desired outcome.

[Gamli]

darana said: 3 JC, thank you for your answer. Here are some definitions for your reference:A placebo is a treatment which is not expected to have intrinsic therapeutic value, but which is administered as if it were a therapy.A single-blind study is where the research subjects(the patients) do not know which treatment they are receiving or whether they are receiving a placebo control. This type of study was begun when researchers discovered that patients' conditions could be effected simply by their minds' awareness of receiving treatment(the placebo effect).Later, researchers found that those who administered the treatment(either a placebo control or the actual treatment) could unconsciously communicate this to the patients(with body language, etc.), and the patients could respond via the placebo effect even though they were not explicitly told which treatment they received.To counteract this, the double-blind study was created. In a double-blind study, not only are the patients unaware of which treatment they are receiving, but those in direct contact with the patients also do not know so that they cannot unconsciously communicate it to the patients.I guess it's a subtle difference, but key to my question.In the cited article, it is unclear whether the patients knew why they were receiving treatment. It only says that they were referred to a chiropractor for treatment. If they were referred by the Hypertension Center at UC, presumably they would think they were being treated for hypertension. I don't have access to the study itself yet, so we don't know the protocol details.Although the study was placebo controlled, for the study to be double-blind, those actually providing treatment to the patients could not have known whether they were administering the actual treatment or not. I just don't see how that is possible if the treatment was administered by highly trained chiropractors. 79 months ago

[Benett]

The study you site is not double blind as written. I was expecting to see a mix of patients, some with high blood pressure and some without, undergoing EITHER the sharm treatment OR the real treatment(unknown to the therapists), but I didn't see that either. It said all subjects had high BP. So, I don't know.