Respectful Insolence

In the past, I’ve characterized chiropractors, at least the ones who claim to be able to treat anything other than back pain, as “physical therapists with delusions of grandeur who don’t know their limitations.” It appears that Panda Bear, MD agrees with me, and he’s particularly disturbed about such chiropractors increasingly targeting the pediatric population:

Apparently chiropracty can resolve asthma, ear infections, colic, allergies, and headaches to name just a few. What then, exactly, are pediatric chiropractors doing if it’s not treating conditions or diseases…or is your poor Uncle Panda, lumbering asian bear-mammal as he is, just lost in the semantics? In their mealy-mouthed way, chiropractors are trying to make an end-run around the ridiculousness of their profession to become your child’s pediatrician, a job for which they are singularly unqualified for many reasons the most important of which is that they have no training in pediatrics (the real kind, I mean).

Look at it this way. For the sake of the argument lets say that all chiropractors decide that subluxation theory is idiotic and henceforth devote their lives to evidence-based physical therapy. That’s kind of the angle the so-called “reform” chiropractors take in opposition to their “straight” brethren who ascribe almost every pathology including infectious diseases to subluxations. Would you take your child to a Physical Therapist for routine health maintenance, well child checks, or even something as serious as asthma? Of course not. And no Physical Therapist would touch your child in this capacity for the same reason I don’t perform abdominal surgery, namely that it is well outside of my training and my legitimate scope of practice.

Indeed. We’re in agreement that this aspect of chiropractic is nothing more than stealth medicine. I’d also make one suggestion, based on another part of his post: His ER should put the coffee machine away from where patients can see. (Read the rest of his post, and you’ll see what I mean.)

Comments

  1. #1 heddle
    November 20, 2007

    Off topic:

    Do you plan to write anything on the “wi-fi causes autism” story?

    See here.

    Sounds nutso to me, especially given that the explosion in autism diagnoses preceded the advent of wide-spread wi-fi.

  2. #2 Joe
    November 20, 2007

    There are reform chiropractors (members of the American Association of Chiropractic Medicine) who eschew subluxations and focus on evidence-based procedures. It might seem to make them super PTs. However, I wonder where they learn EBM; certainly not in school. In short, I question whether they know as much as PTs. Moreover, PTs do not diagnose (chiros claim that ability); yet, chiros have little-to-no experience in diagnosis when they are licensed.

    Chiropractic is a cult with no meaningful standards. If you manage to find one who has a reliable background in diagnosis and EBM- it is plain, outstanding luck.

    Anyone who has not read the Panda article cited above- go and do so. The first part is quite compelling.

  3. #3 Andrew Dodds
    November 21, 2007

    Heddle -

    I can see why saturation wireless internet access might make adolescents even less likely to communicate with their parents.. but I’m not quite sure that this is what they are after..

  4. #4 Eric
    November 21, 2007

    The physical therapy profession is continually challenged by chiropractors looking to expand their scope of practice. It is a very dangerous and expensive prospect for physical therapists to deal with. Check out my response to this post at NPA Think Tank, with some recently published works exploring this issue. Thanks for the positive PT words, Orac!

  5. #5 Joe
    November 21, 2007

    @Eric,

    Your post reminded me of the case a few years ago in Arkansas where the chiro governing body fined a PT for doing an “adjustment” rather than a “manipulation.” The last I heard, the state supreme court let the fine stand- so that is the final word. You can find some information at http://www.chirobase.org it is on the right, under “Hot Topics”

  6. #6 Elf M. Sternberg
    November 21, 2007

    Eric: I pointed Carlo out to Orac a couple of weeks ago, when he was making the rounds on, of all things, Air America. He doesn’t claim that WiFi causes autism, oh no, his claim is much more significant. Carlo claims that WiFi activates the heavy metals in your body that cause autism, and it is interference from WiFi and cell phones that are causing chelation therapy to fail in children who need it to cure their autism.

  7. #7 wfjag
    November 23, 2007

    “In the past, I’ve characterized chiropractors, at least the ones who claim to be able to treat anything other than back pain, as ‘physical therapists with delusions of grandeur who don’t know their limitations.’” [and] “We’re in agreement that this aspect of chiropractic is nothing more than stealth medicine.”

    Actually, I think you’re much too conservative in your assessment. For the past 40 or so years in the US, CAM in general, and chiropractic in particular, seems to have followed a strategy of obtaining acceptance by legislation (including promulgation of favorable regulations), litigation and popular articles touting its benefits by satisfied (and usually unidentified) customers. It goes well beyond overlap with PT. As an example I cite you to some of Missouri’s laws regulating chiropractic. Missouri Code of State Regulations Title 20 CSR 2070-2.032 allows the Missouri State Board of Chiropractic Examiners to establish and recognize “Specialty Certifications”. Title 20 CSR 2070-2.081 establishes the criteria for “Postgraduate Education” . . . “as a program which provides instruction in, but not limited to, the following: general anatomy, physiology, general diagnosis, microbiology, hygiene and sanitation, X-ray and radiation protection, biochemistry, neurology, orthopedics, spinal anatomy, pathology, principles of chiropractic, chiropractic adjusting and jurisprudence. *** The term postgraduate study may be used interchangeably with the terms continuing education and postgraduate education.”

    When you read the two regulations together, you’ll see that if the Chiropractic Continuing Education course [use of singular deliberate] is in any area that the Mo. State Board of Chiropractic Examiners has designated as a Specialty Certification, the DC can claim to be a “specialist” and practice in that area as a specialist.

    Further, Mo. Revised Statutes Title §376.423 provides that for consultants retained by insurers to review and deny, in whole or in part, claims for payment of chiropractic services under any “under any policy of accident and sickness insurance or membership contract”, such consultants shall be licensed/practicing D.C.s (generally in the same geographic area as the D.C.’s whose bill is under review) and have completed a licensing course for such consultants established and run by the Missouri State Board of Chiropractic Examiners.

    I know of no laws or regulations anywhere in the US granting similar powers to state boards regulating the practices of MDs, DOs, PTs, or any other health care profession.

  8. #8 Dr. B
    December 18, 2007

    Hold on, I’m still giggling at these comments.

    Chiropractors, at least the ones I respect, are NOT PTs in the slightest. If you sprain your knee, go to a PT, don’t see a chiropractor. Are we on the same page?

    When you have been to every damn doctor in the country and your child’s hypersensitivity is out of control, they’re on 8 meds, and you don’t know what to do…who do you turn to?

    We as chiropractors get these types of patients ALL THE TIME. Why? Could it be, now this is only a possibility, that the body’s ability to communicate with itself has somehow been disrupted. Do not even dare to call this woo. You have a brain, a spinal cord, and nerves for a reason.

    Proprioceptive, negatively reinforced, afferent bombardment through the system and up the brain HAS to have a negative effect on the body, eventually. Every process in the body is a result of a stimuli from the environment, or as a result with the organism’s contact with its environment.

    If these negative stimuli are being generated at the neuro-spinal junction, then we as chiropractors can detect this, using OUR techniques, and correct it. Simple. It is NOT PT, I actually find that offensive. If I wanted to be a soft tissue technician, I would have done so. My liscense affords me this ability but I don’t want it in my practice, I simply refer it out to a PT that doesn’t think he/she is a doctor. Was that an illusion of grandeur?

    Why do my patients lower their BP meds, their insulin intake, their statins, their pain meds, their allergy/asthma meds, with just the adjustment being the main difference in their care?

    I think what drives ‘evidence basers’ nuts, is that patient A and patient B, both with, let’s say asthma, will have different methods of adjustment and both may get better. I say “may”, because chiropractic does NOT cure anything. If I gave you fresh air because you breathed in smog at home and work all day, and you get better, would you say I cured you? Of course not, we gave the body what it NEEDS, and it healed itself.

    I think once doctors realize that only one thing ‘cures’ us as animals, and that’s US, ourselves, the world would be a much better place.

    Before I go, there’s one great line I’m sure some of you have said in the past. “the operation was a success but the patient died” Did you have your nurse tell the family that one?

  9. #9 Dr.B
    December 18, 2007

    I’m sorry, I have a typo or two. ‘a stimuli’ should be stimulus and one very important thing I must distinguish:

    Chiropractic does not aim to cure or treat disease. In thhe asthma example above, the patients may have had these complaints but they would NOT have been treated for them. A chiropractic exam, locating any areas that need to be addressed would be performed. That is why patient A might have cervical/brain stem issues, while patient B may have autonomic dysfunction in the thoracics and be adjusted there. Yet both may see resolution of some of their complaints.

  10. #10 Joe
    December 18, 2007

    I always doubted chiros were sufficiently educated to pass for PTs, now I feel somewhat exonerated. However, I think Mr. B represents the minority, “straight” faction. Still, with delusions of grandeur that he can “give bodies what they need to heal themselves.”

    And he tries to advance his grandeur with his new-age mumbo-jumbo and rhetoric, and his conversational medicine (proprioceptors, etc.).

  11. #11 Dr. J
    January 3, 2008

    The people posting comments here should be ashamed of themselves. How much do you know about what it takes to be a chiropractor? And Joe, who made the “new-age, mumbo-jumbo and rhetoric” and “conversational medicine”, how much do you know about medicine. There is a lack of understanding because there is a lack of education. I know MDs who became chiropractors because with enough biology background, especially neurology, which is the mumbo-jumbo you speak of, they realized that while a MD will try to affect someone’s health with drugs and surgery, a chiropractor can address certain health issues by addressing the nervous system of the body. Note that I use the word “certain”. Chiropractors do not cure people of their ailments. They exam and address issues concerning a person’s nervous system and the bony structures that contain them and the muscular structures that they may pass through. They can achieve what seem to be “miracle” cures because without education, the patients present that process of their progress in an inadequate way. Some chiropractors, and shame on them too, tote their success with too much credit to themselves. There are bad chiropractor just like there are bad medical doctors just like there are bad people everywhere. I have a neurologist friend who is now a part of the chiropractor neurology program, which is one of the few post graduate programs sanctioned by the US government and exonerated by a “diplomat” status to those who pass it’s rigorous examination. I asked him why he wanted to be a chiropractic neurologist and he replies,”Neurologists examine you, diagnose you, and then have 7 drugs to treat you with. Chiropractic is the only profession I know of that starts you on the right path to begin to consider affecting a person’s health from a clinical perspective.” And a word about their diagnostic capabilities, if you compared the education from a USC med student and a chiropractic student, you would find that the number of hours spent learning diagnosis is more with a chiropractic education vs. and MD as is the neurology, thus why many MD think little of chiropractors because they themselves lack sufficient education to understand the basis of chiropractic care. MD get more hours in pharmacy and surgery, but then again these things are not within the scope of practice for a chiropractor anyways (and one of the reasons some become chiropractors in the first place). Please, these forum are also a joke to me. They always seem to be filled with people who judge too quickly and harshly. But you guys don’t matter. The only thing that matters are the patients that respond to chiropractic care and have their lives changed because of it. The research is on it’s way, don’t worry yourselves.

  12. #12 Dr. J
    January 3, 2008

    The people posting comments here should be ashamed of themselves. How much do you know about what it takes to be a chiropractor? And Joe, who made the “new-age, mumbo-jumbo and rhetoric” and “conversational medicine”, how much do you know about medicine. There is a lack of understanding because there is a lack of education. I know MDs who became chiropractors because with enough biology background, especially neurology, which is the mumbo-jumbo you speak of, they realized that while a MD will try to affect someone’s health with drugs and surgery, a chiropractor can address certain health issues by addressing the nervous system of the body. Note that I use the word “certain”. Chiropractors do not cure people of their ailments. They exam and address issues concerning a person’s nervous system and the bony structures that contain them and the muscular structures that they may pass through. They can achieve what seem to be “miracle” cures because without education, the patients present that process of their progress in an inadequate way. Some chiropractors, and shame on them too, tote their success with too much credit to themselves. There are bad chiropractor just like there are bad medical doctors just like there are bad people everywhere. I have a neurologist friend who is now a part of the chiropractor neurology program, which is one of the few post graduate programs sanctioned by the US government and exonerated by a “diplomat” status to those who pass it’s rigorous examination. I asked him why he wanted to be a chiropractic neurologist and he replies,”Neurologists examine you, diagnose you, and then have 7 drugs to treat you with. Chiropractic is the only profession I know of that starts you on the right path to begin to consider affecting a person’s health from a clinical perspective.” And a word about their diagnostic capabilities, if you compared the education from a USC med student and a chiropractic student, you would find that the number of hours spent learning diagnosis is more with a chiropractic education vs. and MD as is the neurology, thus why many MD think little of chiropractors because they themselves lack sufficient education to understand the basis of chiropractic care. MD get more hours in pharmacy and surgery, but then again these things are not within the scope of practice for a chiropractor anyway (and one of the reasons some become chiropractors in the first place). Please, these type of forums for complainers are always a joke to me. They always seem to be filled with people who judge too quickly and harshly. But you guys don’t matter. The only thing that matters are the patients that respond to chiropractic care and have their lives changed because of it. The research is on it’s way, don’t worry yourselves.

  13. #13 Robster, FCD
    January 3, 2008

    “Dr.” J, Are you a chiropractor? If so, as a chiropractor, do you agree with the Germ Theory of Disease? Or do you believe that human illness and malady is due to misalignments of the spine?

  14. #14 Joe
    January 4, 2008

    Mr. J,

    Your notion that chiros learn more diagnosis is laughable. While you may have more classroom hours devoted to “diagnosis,” subluxations and innate intelligence do not count. Furthermore, chiros can graduate and get a license to practice without having seen an ill person (to meet the quota for clinical examinations, they usually recruit healthy friends and family to attend the clinic).

    On the other hand, after graduation, an MD must spend a further 4-6 years in a hospital setting before obtaining a license to practice. The chiro claim to better training is a joke.

    As for judging too quickly, I have been asking chiros for reliable evidence that they help with anything, besides low back pain or some headaches, for thirty years. When they bother to answer (rare) they offer anecdote, and studies that are inferior and/or irrelevant. How much more patient should I be?

  15. #15 Freddy the Pig
    January 4, 2008

    “Dr/” J – “The research is on it’s way”

    How often have heard that one from quacks of all stripes?
    And how long have we been waiting?