Respectful Insolence

Say it ain’t so, Barack! Again.

I realize that I made perhaps the biggest splash I’ve made on this blog in a very, very long time when I wrote about the news reports and rumors that Robert F. Kennedy, Jr. was being seriously considered for a high ranking post in the new Obama Administration. Fortunately, this is not yet another post about RFK, Jr. There’s only so much antivaccinationist and pseudoscientific lunacy I can take. Unfortunately, however, it’s another touch of woo associated with the new administration. Even though I don’t think it means much, chiropractors seem to be interpreting it as a nod of support:

I am glad to have this opportunity to again share my thoughts on the role doctors of chiropractic play in the American health care system. As I have said before, doctors of chiropractic play an important role in our health care system, and my commitment to you and your patients remains strong.

As I have said, I believe steps should be taken to acknowledge the important care provided by doctors of chiropractic. We need to knock down unreasonable barriers of access and discriminatory insurance coverage so Americans in need of quality chiropractic care can access it without difficulty. We need to expand the range of chiropractic services covered by Medicare, facilitate integration of doctors of chiropractic into the health care systems of the Department of Veterans Affairs and Department of Defense, and allow commission of doctors of chiropractic as officers in the Commissioned Corps of the U.S. Public Health Service. And again, under my health care plan, many, if not all, chiropractic services would be included in the benefit package offered in the public plan.

Ugh. His health care plan would cover “many, if not all” chiropractic services? This is not what I want to hear from a new President. I realize that I won’t like everything Obama does, but this pandering to unscientific health care modalities does not bode particularly well. As I’ve said before, chiropractors are in essence physical therapists with delusions of grandeur. A good physical therapist is worth a gaggle of chiropractors.

But I’m curious. What did Obama mean by “all services”? Depending on the flavor of chiropractic, chiropractic services can range from fairly evidence-based manipulation that is not far removed from straight physical therapy to total woo like craniosacral manipulation, “touchless” chiropractic, and all manner of “chiropractic treatment” for allergies, infections, and all manner of diseases and conditions for which there’s no science-based reason to think that spinal manipulation will do one whit of good. Will Obama’s plan pay for such woo?

This letter was probably the usual politician sending a letter to a group whose support he wants or whom he at least doesn’t want to piss off too badly. Even so, I find it a little disturbing. A pro-science administration would be very, very careful about what chiropractic services it pays for. The more mundane, physical therapy-like services might merit coverage, but the woo does not.

Comments

  1. #1 TexDoc
    November 14, 2008

    Oh Dear God, no. I’ve seen quackopractors who insist mammograms fall within the spectrum of their services. I’m afraid we’re going from an administration of deranged religious fundamentalism to crackpot woo mongering.

  2. #2 bob
    November 14, 2008

    Ugh. All I keep telling myself is that “it’s better than it could have been.” American politics truly is a depressing lesser-of-evils game. We need some skeptical thinkers in politics, and we need to figure out how to keep them from getting spanked in elections like poor Hal Bidlack did.

  3. #3 teej
    November 14, 2008

    They might take their guidelines from existing insurance companies – Blue Cross allows my wife to get chiropractic manipulation for her chronic neck issues (broke a tendon in childhood), and they allow a half hour of massage with it. No woo, no electro-stimulation, nothing else. The clinic we go to has a direct relationship with Blue Cross, too, so I assume they’re vetted in some way. As far as I can tell, it’s a pretty decent division between the useful chiropractic and the woo.

  4. #4 Moopheus
    November 14, 2008

    Obama is a smart guy. He has surrounded himself with some smart people, has made a lot of encouraging noises about science policy, clearly wants to have a “reality-based” government. But he is not, himself, a scientist, or have any particular science training, as far as I know. Which means, unfortunately, he will, like any other politician, not be perfect and make mistakes in that regard. This is not by itself a reason to despair or give up hope for improvements over our current situation (an administration openly hostile to science and rationality). But it does mean we need to speak up as much as we can (surely, with all the science folks hanging out here, there must be somebody who knows somebody, if you know what I mean) and not assume anything.

    And, yeah, he’s not going to give an address to the chiropractors, and say outright, you’re all a useless bunch of loonies.

  5. #5 anon
    November 14, 2008

    Well, it depends what he means by chiropractic, though. It could be that he means the physical therapy stuff. I doubt he has any advisors specializing in the minute details of every type of woo.

  6. #6 marilove
    November 14, 2008

    I agree with anon. Not all chiropractic services are woo.

  7. #7 AnnR
    November 14, 2008

    One idea I read that was attributed to Karl Rove was the notion that when you win by a small margin it’s an advantage because you don’t owe so many chips.

    Well, Obama won by a big margin. There are a lot of chip holders out there and they aren’t all nice well documented types.

    RFK Jr. was still on the list of possible EPA heads in the Washington Post yesterday.

  8. #8 Prometheus
    November 14, 2008

    While not all services offered by chiropractors are “woo”, those chiropractic services that aren’t “woo” are also offered by physiotherapists (“physical therapists” in the US). On the other hand, the “woo” therapies offered by chiropractors are generally not offered by physiotherapists.

    Chiropractors like to point to studies showing that massage and manipulation – which they practice in common with physiotherapists – are helpful in treating muscular low back pain. They use these studies to “prove” that their services are effective and essential.

    However, the “services” that are unique to chiropractic (e.g. manipulation of the spine to treat diabetes) have not been shown to be effective.

    As for Mr. Obama, I have no doubt that he will view this issue as most politicians do – he will support chiropractic if he thinks it will earn him more votes than opposing it will. Given the general public’s acceptance of chiropractic (at least in the US), I suspect that Mr. Obama will not oppose their inclusion in his health plan.

    I’m afraid that I have a very cynical view of the relationship between science and politics. Mr. Obama’s opposition to “political manipulation of science” was the result of the Republicans’ very blatant (i.e. they got caught at it) manipulation of science. If it had been the Democrats who had been caught manipulating science (e.g. RFK, Jr.) he would not have mentioned that in his campaign.

    If Mr. Obama feels that “the people” want chiropractic, acupuncture, naturopathy or homeopathy in their health plan (i.e. if he feels that will get him more votes in 2012), then I expect that he will insist that those be part of the health plan. If we don’t want them in the US health plan, we need to convince him that including them will cost him votes. Not that they are scientifically unsound or a waste of time and money – that he will get more votes by opposing them than he will by supporting them.

    Personally, I don’t hold out much hope.

    Prometheus

  9. #9 TheProbe
    November 14, 2008

    Chiropractors as commissioned officers in the military? Hmmm…

    Hey doc, could you adjust that IED so it won’t go off?

  10. #10 dean
    November 14, 2008

    “Not all chiropractic services are woo”

    no, they pretty much are. statistical results indicate that people feel good having someone rub, massage them, but there is no MEDICAL improvement to the underlying problem.

  11. #11 Becca
    November 14, 2008

    dean- why is feeling good not medically relevant? Doctors generally care about signs and symptoms of disease, right?

    What strikes me as utterly illogical here, is the undercurrent of “chiropractic services are useless woo, ergo, any success from a chiropractic treatment isn’t really being done by chiropractors”.

    Aside from that, some subset of it probably is ‘woo’. However, the number of doctors (good “evidence based” MDs) that proscribe placebos is non-neglible. You have to remember, the FDA was created to eliminate snakeoil treatments about the same time we started having useful drugs. Chiropractic treatment will continue to prevail until we find more effective treatments.

    Orac- your dislike of Obama and chiropractors is blinding you. Making sure injured Vets can get physical treatments that help them feel better is generally a Good Thing.

  12. #12 AlexS
    November 14, 2008

    Becca – the theory underlying chiropractic is at best highly unlikely to be true. It is useful (beyond placebo) in certain cases such as the back pain mentioned above. However, the fact that chiropractic works for back pain and makes people feel better doesn’t vindicate the whole discipline, or justify expanding insurance coverage for pseudotreatments.

  13. #13 Kimball Atwood
    November 14, 2008

    Part of the problem, unfortunately, is that chiropractors in Illinois have more political clout than elsewhere in the US. As discussed recently on Science-Based Medicine,[1]

    “in Illinois, chiropractors are subject to the same practice act that regulates MDs,[2] and as such may (and do) hold themselves out to the public as ‘primary care physicians’.”[3]

    Thus Obama–along with many other reasonable people in Illinois who don’t know much about science and medicine–may think of chiropractors as both scientifically legitimate and politically astute. Only the second point, of course, is true.

    KA

    [1] http://www.sciencebasedmedicine.org/?p=235
    [2] http://law.justia.com/illinois/codes/chapter24/1309.html
    [3] http://www.accessmylibrary.com/coms2/summary_0286-5696888_ITM

  14. #14 bob
    November 14, 2008

    Why is feeling good alone not medically relevant? I don’t know, perhaps because it’s completely subjective and does nothing for any underlying diseases, injuries, or conditions? If you are “suffering” from something that can be relieved by just a backrub and someone talking nicely to you, you shouldn’t be in the damn hospital.

    Most benefits from chiropractic can be accomplished by a masseuse, and any actual medical benefits chiropractors stumble upon (and more!) are available from real doctors and physical therapists MUCH more safely and appropriately. What about this are you people not understanding?

  15. #15 Mekei
    November 14, 2008

    This is Oprah-woo influence… Maybe we’ll see Dr. Oz for Surgeon General?

  16. #16 jb
    November 14, 2008

    Apparently all you folks don’t have back issues. Or other issues that trace to the spinal column end of that so unimportant “Central Nervous System.” Chiropractic isn’t physical therapy, no physical therapist adjusts spines as a regular aspect of their work.

    Given the number of people whom chiropractic has helped, and the number of insurers that already cover chiropractic treatment, it would seem that you could investigate the realities instead of the urban myths you appear to accept so readily.

  17. #17 Danio
    November 14, 2008

    jb:

    no physical therapist adjusts spines as a regular aspect of their work.

    There’s an excellent reason for that, principally because spinal ‘adjustment’ is a pointless, useless and potentially injurious non-treatment.

    My health insurance covers chiropractic. It also covers acupuncture and naturopathy. Practitioners in these fields are doing a roaring trade in my part of the globe, and the insurance companies, I assume, want a piece of the action. If you think this legitimizes the practices from any medical standpoint, though, you’re quite mistaken.

    it would seem that you could investigate the realities instead of the urban myths you appear to accept so readily.

    One of us does indeed need to investigate reality, but it isn’t me. I recommend you begin here.

  18. #18 Annie2
    November 14, 2008

    It looks like a form letter, where they insert a noun, sprinkle it through the letter of support and add mention the association once and bingo, a letter. I bet that same letter went out to unions, and various groups that have offered support during his election. Lot of thank you notes going out this week.

    The second comment on the letter is very very funny. >>pseudo-skeptic, anti-chiropractor, anti-alterntives, pro-vaccination, chemical and pharmaceutical public <<

    Please what does pseudo skeptic mean?

    I just hope they don’t go over board on the preventive health stuff to the detriment of the already sick. Which is one of the health options offered by a friends business. You get paid if you are healthy.

    Speaking of healthy, I lost 20 pounds in 6 weeks by getting off steriods. The creepy compliments I am getting makes me puke. All the diet and exercise did nothing and now they still don’t believe it was the medication. maybe I will sit around and eat cake and still lose another 10 pounds.

    Annie

  19. #19 Sandy
    November 14, 2008

    Bwhahahahahahaha! Suckers!!!!

  20. #20 Art
    November 15, 2008

    Working construction I have torn up my back up numerous times.

    I have tried both routes.
    I have gone to a regular MD. The first choice is either the ER, up to twelve hours waiting and an extra $400, or having to beg my way in, on a ‘space available’ basis, minimum two hours waiting, at an office and $150 for the privilege.

    Either way this gets me a MD who is entirely disinterested in my case, that I can’t work or rest, or that I have the posture of Quasimodo. They might do a couple of X-rays, $70 extra, which invariable are ‘inconclusive’. Sometimes the MD will suggest an MRI, $1200 last time I asked, while also admitting that they also tend to be inconclusive, or worse, tend to spot unrelated non-issues.

    In the end they write a script for muscle relaxers, usually Placidil, and a pain killer. Anything from plain Ibuprofen 600mg, vastly overpriced for what I can get OTC, Tylox, hydrocodone or Darvocet depending on the doc. They advise me to use heat/ice therapy and to rest.

    I go home and alternate between pill induced zombie and actively crying in pain for three days. I call in to the job and tell them I can’t work. After three days I go to work and struggle through the pain because I can’t do the job doped up on pills. there is no choice because I can’t afford to lose the income and if i stay out longer they replace me.

    I once was referred to a orthopedic surgeon, $400 more, who looked at the X-rays and wanted to immediately operate. Suggesting that failure to operate would mean I might not be able to walk some time in near the future. Later another doc, an acquaintance I had done work for, told me the surgeon was a hack and that my back was in good shape. Twenty years later, and still doing construction, I have fewer back problems than most men my age and better back strength and ROM than many kids half my age.

    With a chiropractor I call them up and I’m in in under an hour. They examine me. Sometimes an X-ray, $25 extra, always inconclusive, and then it is heat, massage and a quick adjustment that cuts pain and immediately allows some ROM. They suggest heat/ice therapy and that I take it easy. They tell me I can work as long as it is light duty and provide a letter saying as much.

    Most of them at some point try to get into some sort of woo riff involving nutrition, supplements, energy flow or other crap. Most of them suggest that regular visits, independent of injury, will make for a happier and more fulfilled life. After they are done with their song and dance, while I look on with a blank stare, they realize I’m not interested. So I pay the bill for $70 and go home for ibuprofen and heat/ice therapy. Come morning I limp into work tender but not debilitated and do my light duty.

    I did it a couple of time each way before I gave up on conventional medicine. The chiropractors have been both cheaper and more effective at getting me back to work. Sure they have a lot of BS outside their core competency. But the adjustment worked for me. So I let them do their adjustments and then decline on having my chakras aligned, aroma therapy or riki.

    I really don’t care that their adjustments don’t seem to change anything on an MRI. Medicine has already noted that MRIs and X-rays are pretty much useless in spotting anything but an obviously slipped disc or displaced structure. You can be screaming in agony and it is entirely possible for an MRI to see nothing wrong. Quite frankly I also don’t care if it is placebo effect even though I doubt it is.

    What I want is reasonably priced therapy that will get me out of pain without drugs that make me a zombie, enough ROM to function, and to be able to get back to work ASAP. Chiropractors get it done. The regular docs don’t.

  21. #21 jayh
    November 15, 2008

    Art
    There is so much inconsistency in your account. You seem more concerned by how quickly and cheaply you are treated than whether the actual problems are being addressed.

    The doctors you describe are actually trying to determine what is the CAUSE of your problem, though with the tools at hand, they have been unsucessful. But they are required by law to be honest about that. When you demand something they give you a relaxant (which ofen does work, this has been PROVEN), but every doctor I’ve ever talke to about that type of problem never discouraged the use of massage if it works.

    the chiropractor actually has no clue what’s wrong with you. So he does what amounts to a high priced massage (actually worse becaus of their obsession with ‘cracking’, there are many cases of people actually injured by chiropractors). But after warmth and massage you do feel better. But that, like the muscle relaasant, is a pallative. Your underlying problem is still there (else why would you be going back?)

    Chiropractors do not understand the body well at all, indeed have some very wrongheaded ideas (one, a relative, actually insisted that if something was from a plant, it was not a drug — listen up stoners!). They don’t validate and follow up (as drug makers are required to do); but studies that were done have shown that patients in the long run did NO better than those with no treatment or those with massage treatement.

  22. #22 Bronze Dog
    November 15, 2008

    Becca:

    However, the number of doctors (good “evidence based” MDs) that proscribe placebos is non-neglible.

    He’s covered that.

  23. #23 ML
    November 15, 2008

    I can believe that there are decent chiropractors out there who can relieve pain and help people heal with massage. A friend of mine swears by her chiropractor, who has helped her with some stubborn soft tissue problems.

    But what chiropractors don’t seem to do is to realize their limitations. I started seeing my friend’s chiropractor for some stubborn back soreness, and was initially really pleased as the massage was definitely helping. I also liked that his fees were lower than those at my old sports medicine clinic, although my treatments were much briefer as well, maybe 5-10 minutes. I considered that a feature, not a bug, because if it took just a little time to make me feel better, that was just fine.

    He said I shouldn’t bother with Advil or anything like that, that stretching and massage were all that I needed. I was especially happy that after the third treatment, he told me just to go home and stretch daily and to come back and see him in 3-4 weeks. He obviously wasn’t trying to get every penny out of me.

    But after I developed an acute injury in the same (weakened, stressed) area a few days later, he wasn’t able to shift gears. I got more massage and some acupuncture (which, as I had found from previous injuries, does nothing for me at all), but I kept getting worse. I started feeling really uncomfortable going to his office, as he seemed very frustrated that he couldn’t make me better.

    After a few more visits and increasing frustration on both our parts, I finally went back to my usual sports medicine clinic, where my doctor prescribed some sweet, sweet Naproxen that rapidly reduced the inflammation. My physiotherapist at the clinic listened to me when I said that acupuncture hadn’t worked for me before, and in our thirty minute sessions, only slightly more expensive than the flying visits to the chiropractor, used massage, ultrasound and some simple postural corrections, adding in very simple and gentle exercises one by one. None of the massage hurt, none of the exercises hurt, and I got better.

    There’s something to be said for an eclectic approach to therapy, but chiropractors can be as rigid and limited as some doctors.

  24. #24 Kim
    November 15, 2008

    Whether or not chiropractic is legitimate, there’s plenty of demand for it. It also seems to me that for some segment of the population, chiropractors are serving as a sort of de facto primary care provider. I don’t think we can just wish this away while access to better alternatives is so poor.

    Think about it: I don’t know if I would even be allowed to self-refer to a physical therapist under my insurance plan. I hear time and again that getting in to see a PCP is difficult and even *having* a PCP is increasingly atypical. And, as Art’s story demonstrates, most people with back complaints don’t even know the physiatry specialty exists. Partly I think it’s just that there are so many chiropractors — they surely outnumber PM&R physicians — and partly I think it’s because chiropractors *advertise*.

  25. #25 Danio
    November 15, 2008

    Partly I think it’s just that there are so many chiropractors — they surely outnumber PM&R physicians — and partly I think it’s because chiropractors *advertise*.

    I think you’re right, Kim. Many years ago I was on the front end of a rear-end collision MVA. Wracked with pain and without a PCP, I thumbed through the yellow pages and noted the number of Chiropractors that advertised ‘specialties’ in MVA injuries. I had heard murmurs of quackery, and had encountered a few students enrolled in Chiropractic college who were way into the ‘adjustments can fix every damn ailment under the sun, so throw your prescriptions away!’ school of thought, but I thought perhaps a Chiropractor who knew his/her limitations would be a valid choice for someone in my situation. I even picked someone with a clinic close to the hospital, thinking that proximity might equal legitimacy.

    Perhaps not surprisingly, the guy was a complete crank, and I couldn’t get out of there fast enough. His receptionist called me at home to try to schedule additional appointments, and when I declined, saying that my lawyer prefered me to see a MD, the Chiropractor called me back and yelled at me, basically trying to shame me into making more appointments, whining that he could have healed me, accusing my lawyer must be some kind of lying hack to make such a recommendation, etc. Needless to say, this did not earn him back my business, and all that I have since learned about the field, its assumptions, liberties and dangers, makes me really angry that they garner as much legitimacy as they do. It’s quite outrageous, really (and yes, I’m bloody pissed that my insurance premiums go toward supporting them, and the acupuncturists, and the naturopaths. Stupid, woo-friendly Oregon. *mutter*)

  26. #26 Art
    November 15, 2008

    Simple strains like that are not a mystery. They are very, debilitateingly, painful until the spasms stop and the inflammation goes down.

    I have been down this road many times over the decades so I know what works for me. I will never go to another MD for a strained back. Then again I will never go to a chiropractor for a major infection or broken leg. Building things you learn to use the right tool for the job.

    I’m doing something right because even though I have had my share of injuries from working in bad positions I’m one of the few people without chronic back pain. Most of the bean counters, and a considerable numbers of MDs, live in pain all the time. Go figure.

    jayh – “You seem more concerned by how quickly and cheaply you are treated than whether the actual problems are being addressed.”

    You, and the MDs I have tried, fail to listen. The problem was I was in pain and unable to work. A comparison of “how quickly and cheaply” the problem I identify is solved is as direct and fair a metric as any I can think of.

  27. #27 Joe
    November 16, 2008

    @Teej,

    The problem with chiro treatment for neck pain is they can disable and kill people that way, and they are no more effective than PTs and masseurs who do not maim and kill. Look at http://www.chirobase.org where you will find an article titled (something like) “chiropractic’s dirty secret.”

    Concerning chiro vs. PT neck manipulation and injury, see http://www.ptjournal.org/cgi/content/full/79/1/50 “… The most frequently reported injuries involved arterial dissection or spasm, and lesions of the brain stem. Death occurred in 32 (18%) of the cases. Physical therapists were involved in less than 2% of the cases, and no deaths have been attributed to MCS provided by physical therapists. …”

  28. #28 mandydax
    November 17, 2008

    Orac, do you have a link to the Obama letter that’s on a non-credulous site? I can’t seem to find one that isn’t on a proquack site, and I’m wondering if someone among them has just made it up. The Googles, they do nothing! I’m a little skeptical of the genuineness of that document. :\

  29. #29 PhD
    June 5, 2009

    Manipulation is safe and it works – this is the science. Over and over it has been found to be safe and as effective or more effective than whatever it is compared to. Stroke? No greater risk going to a chiro than going to an MD. (Cassidy et al’ – Spine 2008).

    Mainstream medicine pretty much has nothing for back pain. Cortisone injections – no better than placebo, surgery – very high failure rates, very high expense and high risks. All those expensive imaging tests – the costs go up but outcomes don’t change.
    (J of the Am Board of Fam Med 03/10/09)

    For anyone who thinks back pain is no big deal – actually it is. After heart disease and cancer it is the most expensive disorder in the western world.

    As for placebo – I’ll share a little secret with you, even pain meds are mainly placebo…
    (Van Tulder MW, Spine 2000;25:2501-2513.)

    BTW – didn’t notice a single reference to hard science amongst all the head in the sand medieval dogma lapdoggery and poppycock y’all are sprouting… have a nice day :)

  30. #30 PhD
    June 5, 2009

    Manipulation is safe and it works – this is the science. Over and over it has been found to be safe and as effective or more effective than whatever it is compared to. Stroke? No greater risk going to a chiro than going to an MD. (Cassidy et al’ – Spine 2008).

    Mainstream medicine pretty much has nothing for back pain. Cortisone injections – no better than placebo, surgery – very high failure rates, very high expense and high risks. All those expensive imaging tests – the costs go up but outcomes don’t change.
    (J of the Am Board of Fam Med 03/10/09)

    For anyone who thinks back pain is no big deal – actually it is. After heart disease and cancer it is the most expensive disorder in the western world.

    As for placebo – I’ll share a little secret with you, even pain meds are mainly placebo…
    (Van Tulder MW, Spine 2000;25:2501-2513.)

    BTW – didn’t notice a single reference to hard science amongst all the head in the sand medieval dogma lapdoggery and poppycock y’all are sprouting… have a nice day :)

  31. #31 Greg
    August 25, 2009

    Chiropractors are clinically and economically the most effective specialist doctors at treating the majority of back problems, which I believe is one of the most common reasons people seek professional medical care for in the USA. In addition, they treat a host of other musculoskeletal conditions involving the shoulders, arms, legs feet, etc….and are very successful at cost effectively treating and resolving these conditions as well. If you have a spine related problem and have visited an evidence based good chiropractic doctor, I am most sure you would come to the same conclusion. I believe this is a political and financial issue between the professions and that the facts based on study after study that I have read, it sure seems like we would save an awful lot of money expanding the roles of the chiropractic doctors rather than continue much more expensive and less clinically effective medical services as currently being promoted by some. Equally as important, we will be able to reduce the amount of suffering and resulting disabilities from the epidemic of ill advised surgical procedures that are performed on peoples spines each year. Not to mention, we will save an even larger amount of money on the drug pushing of pain medications that has become a larger problem than illicit drug use in this country. I am not saying that there aren’t times when the drugs and surgeries aren’t needed, however, in the majority of cases a better outcome and a more cost effective approach would be achieved by visiting a good chiropractic doctor. Also, to set the record straight, in my opinion visiting chiropractors and therapists through the years for my spine condition, the physical therapists, at best, are trying to fill the role that chiropractors are much more specialized and expert at treating. Of course, physical therapists have their place at rehabilitation and treating some other conditions but leave the majority of the back problems to the chiropractic doctors and if they are not able to resolve their patients problem, then a referral to an orthopaedic or neurosurgeon should be considered. This approach makes much more common sense and will surely save a lot of health care dollars and achieve better outcomes for the citizens of the United States. The above is not just my opinion, it is the opinion of almost all of the largest evidence based studies on the subject in the past 30 years. Thanks so much for writing this article, as I believe you have uncovered an area that, in all probability, will be a major part of health care reform that will be positive in significantly improving the economical and financial medical/ health care crisis existing today, with much better patient outcomes for their health.

  32. #32 Michael
    August 27, 2009

    I have a biased opinion on this subject because I am a chiropractor and have been in private practice for 15 years. I started out in college thinking I’d go into physical therapy but because pt programs were discriminating against white males in the early nineties, I decided to look into chiropractic. I can tell every one who has read (or will read) this thread that chiropractic school is very difficult and that we take the same classes in all the sciences that md’s and do’s take. I can readily assure you all that pt’s (until maybe recently since some programs offer doctorates) have not nearly the education that we chiropractors have. In addition, chiropractors actually have more education in subjects such as radiology, and in some cases, anatomy, than the average physician. So, those of you who have posted thoughts on the line of “chiropractors are just glorified physical therapists” havne’t a clue about chiropractic education.

    Now, let me shed some light on our practices. In our profession, there are some quacks…I’ll readily admit that. But in saying that, I’ll propose that, regarding ratios, there are no more quacks in our profession than there are in mainstream medicine. I know this because in fifteen years of practice I’ve heard and seen it all from both sides of healthcare. I once watched a general surgeon remove a healthy uterus from a patient because, in his words, “well, she’s over 50, she’s having pain, and we’re here, so we might as well take it out”. I was there because he was (and is) a friend of mine and he had invited me to observe. He readily admitted that there was nothing wrong with the uterus. The reason he removed it was because the insurance company had okay’ed the surgery and he had to do something while he was there! I’ve heard and seen so many evidences of quackery in medicine and physical therapy that I can’t begin to remember half of them. So don’t go labeling chiropractors alone with that word. Most chiropractors are just like most md’s. We want to help people and we want to be successful in practice. You can’t have one without the other. If you don’t help people, how can you stay in business? If you’re not successful, how can you stay in business long enough to help people? So don’t blame chiropractors for wanting to make money. Yes, there are dishonest chiropractors who will tell you that you have to come in x number of times for x number of weeks. This is not always necessary. Yet, sometimes it is. Generally speaking, soft tissue injuries heal within 6 to 8 weeks. So, a chiropractor telling you to come in 2 times a week for 6 to 8 weeks is certainly reasonable. Outside of that, be careful. But on the other hand, it can depend on the injury. For instance, a broken sternum can take up to a year to heal properly. I separated my left shoulder and it was 6 months before it stopped hurting. Likewise, I’ve treated people with disc injuries that required many months to heal. So, don’t always assume that the doctor just wants you to come in so he can make lots of money…just use your judgment. But please, be fair in your judgement of the chiropractic profession. We have very noble-minded and caring people in our profession. What we do is scientific and has been validated by many studies in many countries the world over. If not, then why do I see md’s and pt’s picking up on the positive effects of our profession’s care by implementing manipulation into their practices? Why does my orthopedic surgeon (treated my shoulder) send me his trouble cases? Why does he send his daughters and wife to me? Why does he let me work on his arthritic neck? Why do his colleagues send me their patients? Why does the flight surgeon at the local air base refer to me? Why do the two pt’s from the local hospital come to see me as well as refer to me? Why is the local pain management doctor at my doorstep asking me for referals? The obvious answer is because I am a good doctor, because I make good decisions regarding my patient’s health, because I care, and ultimately, because chiropractic does work!

  33. #33 Jason
    April 20, 2010

    and chiropractic goes way beyond treatment of pain symptoms. We aren’t back and neck doctors, we are neurological specialists. I’m a chiropractic student who grew up in a family of 7 chiropractors. If you are blind to the shift from medical patient visits to “alternative” care providers, then you are definitely blind in your devotion in where you hold your truths. The fact is that the medical profession is one of the top 3 causes of death in the United States, our health care is worsening at the same rates of medical interventions such as Rx, surgery, and vaccinations. Add in clinical nutritionists and dieticians who are educated by the corrupt food industry, look at the rates of obesity and diabetes in this country. The body is the smartest doctor in the world while we hold a cultural truth in the medical profession as all-knowing. The medical profession hasn’t created one cell from scratch yet our body makes billions a day. OBGYNs schedule and reschedule C-sections so they can go on vacation. The body knows when it is best to birth a child, and the physiology that surrounds that event is vital to a child’s health. I’ve seen what people call miracles in chiropractic, but they aren’t miracles, they’re every-day occurances. My dad brought a girl out of a 6 month coma when the doctors told the parents to pull the plug. They were out of insurance or funding options. Two adjustments and she woke right up. Chiropractic reconnects the vital energy and communication within the body that is essential for function and ultimately survival.
    I’m meeting Obama this weekend in Asheville, NC. He’s coming to a chiropractic convention all weekend and he’s staying at my hotel. When I shake his hand, I will tell him to open to chiropractic and to fund more research and lead healthcare in prevention instead of treatment. Chiropractic is not a treatment, it’s a lifestyle. We don’t wait for degeneration and degradation to set in the body and hope for a miracle-curing drug or surgery. We stop the degenerative processes that ultimately lead to dysfunction, atrophy, and dis-ease.
    You can detest chiropractic in your limiting educated minds, or you can open to the millions of those who have benefited from it. I challenge you to go to a seminar, sit in with a chiropractor and learn what we’re about, or maybe accept the fact that you yourself are subluxated. Chiropractic wouldn’t be where it is at now if it wasn’t a success story. 115 years and counting and growing stronger every year.
    Chiropractic influences patient involvement in their healthcare responsibility and it influences epigenetics too. The low cost and regular intervention that chiropractors give save millions if not billions of dollars that would be spent on medical care.
    Oh, and our educational requirements rivals almost all medical fields. We have so many specific courses on top of all the science courses. The only education we don’t have that medical students do is pharmaceuticals and surgery.

  34. #34 Jason
    April 20, 2010

    and chiropractic goes way beyond treatment of pain symptoms. We aren’t back and neck doctors, we are neurological specialists. I’m a chiropractic student who grew up in a family of 7 chiropractors. If you are blind to the shift from medical patient visits to “alternative” care providers, then you are definitely blind in your devotion in where you hold your truths. The fact is that the medical profession is one of the top 3 causes of death in the United States, our health care is worsening at the same rates of medical interventions such as Rx, surgery, and vaccinations. Add in clinical nutritionists and dieticians who are educated by the corrupt food industry, look at the rates of obesity and diabetes in this country. The body is the smartest doctor in the world while we hold a cultural truth in the medical profession as all-knowing. The medical profession hasn’t created one cell from scratch yet our body makes billions a day. OBGYNs schedule and reschedule C-sections so they can go on vacation. The body knows when it is best to birth a child, and the physiology that surrounds that event is vital to a child’s health. I’ve seen what people call miracles in chiropractic, but they aren’t miracles, they’re every-day occurances. My dad brought a girl out of a 6 month coma when the doctors told the parents to pull the plug. They were out of insurance or funding options. Two adjustments and she woke right up. Chiropractic reconnects the vital energy and communication within the body that is essential for function and ultimately survival.
    I’m meeting Obama this weekend in Asheville, NC. He’s coming to a chiropractic convention all weekend and he’s staying at my hotel. When I shake his hand, I will tell him to open to chiropractic and to fund more research and lead healthcare in prevention instead of treatment. Chiropractic is not a treatment, it’s a lifestyle. We don’t wait for degeneration and degradation to set in the body and hope for a miracle-curing drug or surgery. We stop the degenerative processes that ultimately lead to dysfunction, atrophy, and dis-ease.
    You can detest chiropractic in your limiting educated minds, or you can open to the millions of those who have benefited from it. I challenge you to go to a seminar, sit in with a chiropractor and learn what we’re about, or maybe accept the fact that you yourself are subluxated. Chiropractic wouldn’t be where it is at now if it wasn’t a success story. 115 years and counting and growing stronger every year.
    Chiropractic influences patient involvement in their healthcare responsibility and it influences epigenetics too. The low cost and regular intervention that chiropractors give save millions if not billions of dollars that would be spent on medical care.
    Oh, and our educational requirements rivals almost all medical fields. We have so many specific courses on top of all the science courses. The only education we don’t have that medical students do is pharmaceuticals and surgery.

  35. #35 Prometheus
    April 20, 2010

    Nasty little outbreak of chiro-spam you’ve got there, Orac. Might want to put a little Woo-be-gone on it before it spreads.

    Prometheus

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