Smoke Screen to Distract From Flawed Science: A Response to Côté et al. Over Criticisms to Their Deficient ‘Rapid Review’ on Chiropractic X-Ray Utility

Abstract

Côté et al. attempted to review the clinical utility of X-ray within chiropractic (1910( -Nov. 25, 2019. 1 After reviewing only 9 articles, the most recent dated by 15 years, they concluded "Given the inherent risks of ionizing radiation, we recommend that chiropractors do not use radiographs for the routine and repeat evaluation of the structure and function of the spine." 1 We recently showed dozens of chiropractic studies that were missed according to their own very strict inclusion/ exclusion criteria, as well as over 100 others that definitively show the clinical utility of X-ray use in the screening, assessment, diagnosis, and follow-up of patients seen in routine chiropractic practice. 2 We also showed that current evidence substantiates that X-rays are a harmless diagnostic tool. 2 Herein, we are pleased to respond to the Cote et al. letterto-the-editor 3 regarding our extensive and exhaustive critical commentary of their recent rapid review.Côté et al. 3 cling to a single aspect of our lengthy and meticulous critique of their flawed review by claiming "ad hominem" criticism. The verification of author bias by Corso and Côté, we argue, is not ad hominem if true, which is indisputable. 2 More importantly, however, is the fact that they failed to address the majority of our numerous and valid criticisms of their flawed review including: 2

Can Low-Level Ionizing Radiation Do Us Any Harm?

“…In view of its evident lack of biological plausibility and the accumulated evidence to the contrary, the motives behind continuing to base radiation protection of the LNT hypothesis are not easily discernible but they may include ethical improbity, dogmatic policy assumptions, institutional inertia and comfort, the love of money and power, conventional respect, and even corruption and fraud (reviewed in Refs. 6,9,11,76,77). Apart from the scientists, policy makers and advisory bodies, the blame is certainly shared by the radiation protection community which has been recently downrightly accused of ‘choosing not to speak up against the excessiveness that has come to define the public conversation surrounding radiation’ , 78 this decision assuring continued radiophobia.…”

The treatment and rationale for the correction of a cervical kyphosis spinal deformity in a cervical asymptomatic young female: a Chiropractic BioPhysics^® case report with follow-up

“…In the manual therapies literature, there has been debate as to the usefulness of radiographic screening of the sagittal spinal curves 12 , 13 , 14 , 15 , 16 , 17 ) . For instance, Christensen and Hartvigsen concluded that “Evidence from epidemiological studies does not support an association between sagittal spinal curves and health including spinal pain,” even though the authors found several health conditions having statistically significant odds ratios in the presence of altered spine alignment, including death, they claimed the relationships are ‘unlikely to be causal’ 12 ) .…”

“…Jenkins et al 14 ) ; Corso et al. 15 ) ), but fail to accurately interpret the very studies that they referenced that actually provide high-level, supportive evidence and rationale for utilizing spine re-alignment treatments (and therefore X-rays) 16 , 17 ) .…”

“…As it turns out, the few that argue against routine imaging in spine care 12 , 14 , 15 ) , use recurring themes of flawed debate including radiophobic fear-mongering, misappropriation of medical references and dismissing relevant data 16 , 17 , 18 ) . The current spine literature, however, including manual therapies and spine surgery domains, points to routine spine imaging being an ethical, evidence-based approach to contemporary spine care 19 , 20 , 21 , 22 , 23 , 24 , 25 ) .…”

The Future of Radioactive Medicine

“…As various fields in medicine increasingly take advantage of newly developed diagnostic technologies, which include some form of low dose radiation exposure, reticence within the public to accept these new diagnostics and even established diagnostics such as X rays, CT scans and mammograms remains a significant challenge in medicine ( 97–99 ). There is an intrinsic and disproportionate fear of radiation because it is a member of a class of agents known as “dreaded risk” agents.…”