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      A united statement of the global chiropractic research community against the pseudoscientific claim that chiropractic care boosts immunity

      letter
      1 , 2 , 3 , , 4 , 5 , 3 , 6 , 7 , 8 , 9 , 2 , 10 , 11 , 12 , and more than 140 signatories# call for an end to pseudoscientific claims on the effect of chiropractic care on immune function
      Chiropractic & Manual Therapies
      BioMed Central
      Chiropractic, Spinal manipulation, Immunity, Pseudoscience, Coronavirus

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          Abstract

          Background

          In the midst of the coronavirus pandemic, the International Chiropractors Association (ICA) posted reports claiming that chiropractic care can impact the immune system. These claims clash with recommendations from the World Health Organization and World Federation of Chiropractic. We discuss the scientific validity of the claims made in these ICA reports.

          Main body

          We reviewed the two reports posted by the ICA on their website on March 20 and March 28, 2020. We explored the method used to develop the claim that chiropractic adjustments impact the immune system and discuss the scientific merit of that claim. We provide a response to the ICA reports and explain why this claim lacks scientific credibility and is dangerous to the public. More than 150 researchers from 11 countries reviewed and endorsed our response.

          Conclusion

          In their reports, the ICA provided no valid clinical scientific evidence that chiropractic care can impact the immune system. We call on regulatory authorities and professional leaders to take robust political and regulatory action against those claiming that chiropractic adjustments have a clinical impact on the immune system.

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          Most cited references5

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          Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of UK evidence report

          Background This systematic review updated and extended the "UK evidence report" by Bronfort et al. (Chiropr Osteopath 18:3, 2010) with respect to conditions/interventions that received an 'inconclusive’ or 'negative’ evidence rating or were not covered in the report. Methods A literature search of more than 10 general medical and specialised databases was conducted in August 2011 and updated in March 2013. Systematic reviews, primary comparative studies and qualitative studies of patients with musculoskeletal or non-musculoskeletal conditions treated with manual therapy and reporting clinical outcomes were included. Study quality was assessed using standardised instruments, studies were summarised, and the results were compared against the evidence ratings of Bronfort. These were either confirmed, updated, or new categories not assessed by Bronfort were added. Results 25,539 records were found; 178 new and additional studies were identified, of which 72 were systematic reviews, 96 were randomised controlled trials, and 10 were non-randomised primary studies. Most 'inconclusive’ or 'moderate’ evidence ratings of the UK evidence report were confirmed. Evidence ratings changed in a positive direction from inconclusive to moderate evidence ratings in only three cases (manipulation/mobilisation [with exercise] for rotator cuff disorder; spinal mobilisation for cervicogenic headache; and mobilisation for miscellaneous headache). In addition, evidence was identified on a large number of non-musculoskeletal conditions not previously considered; most of this evidence was rated as inconclusive. Conclusions Overall, there was limited high quality evidence for the effectiveness of manual therapy. Most reviewed evidence was of low to moderate quality and inconsistent due to substantial methodological and clinical diversity. Areas requiring further research are highlighted.
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            Spinal manipulative therapy reduces inflammatory cytokines but not substance P production in normal subjects.

            To examine the effect of a single spinal manipulation therapy (SMT) on the in vitro production of inflammatory cytokines, tumor necrosis factor alpha, and interleukin (IL) 1beta, in relation to the systemic (in vivo) levels of neurotransmitter substance P (SP). Sixty-four asymptomatic subjects were assigned to SMT, sham manipulation, or venipuncture control group. SMT subjects received a single adjustment in the thoracic spine. Blood and serum samples were obtained from subjects before and then at 20 minutes and 2 hours after intervention. Whole-blood cultures were activated with lipopolysaccharide (LPS) for 24 hours. Cytokine production in culture supernatants and serum SP levels were assessed by specific immunoassays. Over the study period, a significant proportion (P
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              Elevated Production of Nociceptive CC Chemokines and sE-Selectin in Patients With Low Back Pain and the Effects of Spinal Manipulation

              Background: The involvement of inflammatory components in the pathophysiology of low back pain (LBP) is poorly understood. It has been suggested that spinal manipulative therapy (SMT) may exert anti-inflammatory effects. Purpose: The purpose of this study was to determine the involvement of inflammation-associated chemokines (CC series) in the pathogenesis of nonspecific LBP and to evaluate the effect of SMT on that process. Methods: Patients presenting with nonradicular, nonspecific LBP (minimum pain score 3 on 10-point visual analog scale) were recruited according to stringent inclusion criteria. They were evaluated for appropriateness to treat using a high velocity low amplitude manipulative thrust in the lumbar-lumbosacral region. Blood samples were obtained at baseline and following the administration of a series of 6 high velocity low amplitude manipulative thrusts on alternate days over the period of 2 weeks. The in vitro levels of CC chemokine ligands (CCL2, CCL3, and CCL4) production and plasma levels of an inflammatory biomarker, soluble E-selectin (sE-selectin), were determined at baseline and at the termination of treatments 2 weeks later. Results: Compared with asymptomatic controls baseline production of all chemokines was significantly elevated in acute (P=0.004 to <0.0001), and that of CCL2 and CCL4 in chronic LBP patients (P<0.0001). Furthermore, CCL4 production was significantly higher (P<0.0001) in the acute versus chronic LBP group. sE-selectin levels were significantly higher (P=0.003) in chronic but not in acute LBP patients. Following SMT, patient-reported outcomes showed significant (P<0.0001) improvements in visual analog scale and Oswestry Disability Index scores. This was accompanied by a significant decline in CCL3 production (P<0.0001) in both groups of patients. Change scores for CCL4 production differed significantly (P<0.0001) only for the acute LBP cohort, and no effect on the production of CCL2 or plasma sE-selectin levels was noted in either group. Conclusions: The production of chemotactic cytokines is significantly and protractedly elevated in LBP patients. Changes in chemokine production levels, which might be related to SMT, differ in the acute and chronic LBP patient cohorts.
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                Author and article information

                Contributors
                pierre.cote@uoit.ca
                Andre.Bussieres@uqtr.ca
                david.cassidy@utoronto.ca
                jhartvigsen@health.sdu.dk
                gkawchuk@ualberta.ca
                clyde@health.sdu.dk
                smior@cmcc.ca
                mjs5@pitt.edu
                Journal
                Chiropr Man Therap
                Chiropr Man Therap
                Chiropractic & Manual Therapies
                BioMed Central (London )
                2045-709X
                4 May 2020
                4 May 2020
                2020
                : 28
                : 21
                Affiliations
                [1 ]Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
                [2 ]Centre for Disability Prevention and Rehabilitation at Ontario Tech University and CMCC, Oshawa, Canada
                [3 ]GRID grid.17063.33, ISNI 0000 0001 2157 2938, Division of Epidemiology, Dalla Lana School of Public Health, , University of Toronto, ; Toronto, Canada
                [4 ]GRID grid.265703.5, ISNI 0000 0001 2197 8284, Département chiropratique, , Université du Québec à Trois-Rivières, ; Trois-Rivières, Canada
                [5 ]GRID grid.14709.3b, ISNI 0000 0004 1936 8649, School of Physical and Occupational Therapy, , Faculty of Medicine McGill University, ; Montreal, Canada
                [6 ]GRID grid.10825.3e, ISNI 0000 0001 0728 0170, Department of Sports Science and Clinical Biomechanics, , University of Southern Denmark, ; Odense, Denmark
                [7 ]GRID grid.420064.4, ISNI 0000 0004 0402 6080, Nordic Institute of Chiropractic and Clinical Biomechanics, ; Odense, Denmark
                [8 ]GRID grid.17089.37, Faculty of Rehabilitation Medicine, , University of Alberta, ; Edmonton, Canada
                [9 ]GRID grid.10825.3e, ISNI 0000 0001 0728 0170, Institute for Regional Health Research, , University of Southern Denmark, ; Odense, Denmark
                [10 ]GRID grid.418591.0, ISNI 0000 0004 0473 5995, Canadian Memorial Chiropractic College, ; Toronto, Canada
                [11 ]GRID grid.21925.3d, ISNI 0000 0004 1936 9000, School of Health and Rehabilitation Sciences, , University of Pittsburgh, ; Pittsburgh, USA
                [12 ]GRID grid.21925.3d, ISNI 0000 0004 1936 9000, Clinical and Translational Science Institute, , University of Pittsburgh, ; Pittsburgh, USA
                Article
                312
                10.1186/s12998-020-00312-x
                7197358
                f5df31ea-de5c-4592-ae9b-cf124c5a3a0e
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 6 April 2020
                : 15 April 2020
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                © The Author(s) 2020

                Complementary & Alternative medicine
                chiropractic,spinal manipulation,immunity,pseudoscience,coronavirus

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