Respectful Insolence

I’ve been writing about the attempts of proponents of various pseudoscience, quackery, and faith-based religious “healing” modalities to slip provisions friendly to their interests into the health care reform bill that will be debated in the Senate beginning today. If you want to know what’s at stake, check out the first press release of a newly formed institute designed to promote science-based medicine in academia and public policy, the Institute for Science in Medicine.

It’s an embryonic institute, only recently formed by 42 physicians and scientists, but it’s jumping right into the fray. This is what the ISM is:

The ISM is a non-profit educational organization dedicated to promoting high standards of science in all areas of medicine and public health. We are a watchdog group of medical professionals who believe the best science available should be used to determine health policy and establish a standard of care that protects and promotes the public health. We oppose legislation that seeks to erode the science-based standard of care and expose the public to potentially fraudulent, worthless, or harmful medical practices or products.

Given how, when faced with science going against them, purveyors of unscientific medicine and medical beliefs try to win in politics where they can’t win in science, the ISM has its work cut out for it.

Comments

  1. #1 Janet Camp
    November 30, 2009

    Well, finally, something concrete to combat this menace to science and the entire enlightenment! Their work is cut out for them as the menace is so widespread by now.

  2. #2 Anthro
    November 30, 2009

    I noticed one David Gorski, MD, PhD as the Treasurer. Hmmmm, now where have I heard that name before?

    A finer group of skeptics could not have been assembled, including many of my heroes, the inimitable Mark Crislip of my beloved QuackCast podcasts.

    Almost all the names jumped out at me, so I have to hope that, as a group, all these untiring skeptics will be able to accomplish great things as a group.

  3. #3 Donna B.
    November 30, 2009

    I believe they’ve already slipped the provisions in. This is too little, too late.

  4. #4 Todd W.
    November 30, 2009

    I generally don’t adhere to or support any particular -ISMs, but this is one ISM I can. :P

  5. #5 Heather
    November 30, 2009

    Too late, I’m afraid. Medicare — and thus our tax dollars — has been paying for “treatment” at Christian Science nursing facilities for years.

  6. #6 Hank
    November 30, 2009

    Featuring not one but several of the energizer bunnies of skepticism in medicine no less!

  7. #7 DrWonderful
    November 30, 2009

    This is sooo helpful, thank you.

    You do realize the ISM Board really is not a very credible lot themselves, however? Jann Bellamy? You can’t be serious.

  8. #8 Natalie
    November 30, 2009

    Well, just because Medicare currently covers faith healing and other nonsense doesn’t mean that can’t change. The ISM will have their work cut out for them indeed, but it’s never too late to try, IMO.

  9. #9 Richard
    November 30, 2009

    Maybe it will be like the NCSE, only to counter quackery. I hope so.

  10. #10 titmouse
    November 30, 2009

    Make link on that site for donations.

    Idea for inspiring donations: invite people to flag their gifts to specific tasks, e.g., “Please comment on X book, bill, article, website, product…”

    Create a web page listing requests in a table with a column showing funds donated for the task. Tasks with the most cash behind them at the top of the list.

    Second idea: create a “thank you” page listing doners either by name or pseudonym. Send doners membership cards and a bumper sticker.

    Third idea: sell swag such as coffee mugs, wrist bands, pins, t-shirts. Students often can’t afford to be openly critical of woo faculty. But they can wear a bit of swag to signal their feelings to like minded peers.

  11. #11 Science Mom
    November 30, 2009

    You do realize the ISM Board really is not a very credible lot themselves, however? Jann Bellamy? You can’t be serious.

    Coming from a chiro, that’s a pretty subjective assessment… that fails in the credibility department.

  12. #12 D. C. Sessions
    November 30, 2009

    “Dr. Wonderful:”

    You do realize the ISM Board really is not a very credible lot themselves, however? Jann Bellamy? You can’t be serious.

    Coming from you, that’s high praise indeed — although you did forget to mention those like Drs. Novella and Gorski. How could you forget them?

    Off to a good start! I’m looking forward to the endorsements from AoA, Mike Adams, etc.

  13. #13 Joseph C.
    November 30, 2009

    I noticed Steve Barrett, the original web quackbuster, is on there. Is he still active? He barely updates his site.

  14. #14 DrWonderful
    November 30, 2009

    DC Session- never heard of those two blokes. I’m sure they are just lovely people.

    The list does, however, read like a “Who’s Who” of known chiro-hunters who lack any credibility. Why do they lack credibility? Because they refuse to acknowledge evidence that proves them wrong when it is presented to them. The evidence for the efficacy of chiropractic treatment of musculoskeletal conditions is substantial. It’s the saeme xact stuff PT’s, some orthos, some PMR guys, and Osteopaths do. It’s basic physical medicine but yet, according to these clowns, it is fraudulent only when a chiro does it? Blah, blah, blah.

    By the way…has this group even read the bills or are they just cherry picking sections out that can be miscontrued to fit their pre-detrmined agenda and give their ego’s the platformt hey desire? It states very clearly in the bill that coverage is mandated for procedures that have “A” or “B” level of evidence (hah! most chiro procedures!) and in certain cases “C” evidence will be covered. Do you think faith healing will meet that threshold?

  15. #15 Joseph C.
    November 30, 2009

    @DrWonderful,

    Why does every chiro that comments online have an obvious case of “small penis syndrome”?

    My favorite chiro:

    http://www.youtube.com/watch?v=-WlNb3j1llc

  16. #16 DrWonderful
    November 30, 2009

    Joey- Not sure what your link is all about but again demonstrates you cannot have an objective discussion on this subject. You’re really just a bit of an asshole, aren’t you/ Do you see me putting shit like that up? BUt yet you are more ceredibly than I am?

    I think a more appropriate question is why do Bellamy, Barrett, Ernst et al think cervical manipulation is only unsafe and ineffective when performed by a chiropractor? Yet it is valid, safe, and effective when performed by a physical therapist, orthopedist or osteopath. Does that sound like a credible position? One that is based on evidence? Or does it sound like a discriminatory attack on chiropractors that perform the same procedures as many other provider groups? Who’s the quack?

    I think it’s great to see all these wackos connected.

  17. #17 Joseph C.
    November 30, 2009

    @DrW,

    Hint: Ratchet the defensiveness down a notch or two.

  18. #18 TennesseeParamedic
    November 30, 2009

    @DrW:
    “I think a more appropriate question is why do Bellamy, Barrett, Ernst et al think cervical manipulation is only unsafe and ineffective when performed by a chiropractor? Yet it is valid, safe, and effective when performed by a physical therapist, orthopedist or osteopath. Does that sound like a credible position? One that is based on evidence? Or does it sound like a discriminatory attack on chiropractors that perform the same procedures as many other provider groups? Who’s the quack?”

    Generally when it’s done in an acute care setting, it’s done because of a legitimate surgical reason to manipulte the position of the vertebral column (Vertebral dislocation, etc), and is confirmed by CT/MRI scan and done under careful, controlled conditions.

    Most chiropractors I know don’t even have an X-Ray scanner, let alone a CT or constant fluroscopy.

  19. #19 DrWonderful
    November 30, 2009

    Joseph- you are right. I have bene a bit defensive. When you guys just attack, attack, attack and simply determine you are correct without even looking at, or understanding, the evidence it gets quite hostile. As a matter of fact people here have been much more hostile toward me as soon as I reveal I am a chiropractic physician. I have always felt the entire point of evidenced based medicine was to clear the way and avoid discriminatory practices. Yet the people in here are the most discriminatory I’ve ever seen. Quite hypocritical.

    You see, the chiropractic profession on the whole readily embraces evidenced based care. We know we have the procedural evidence!!! We also know it will sift out the crap. Love it. Can’t wait. It will totally elevate the profession to where it should be. The problem is the chiro hunters refuse to see the evidence or try to separate us out from our physical medicine counterparts. It the same procedures!

    I’ve been clear about the type of chiro I am, yet as soon as someone sees I am a chiro they totally jump ugly as if I am supposed to cower and apologize. That is blind and ignorant discrimination.

  20. #20 DrWonderful
    November 30, 2009

    TN Paramedic- actually you’re not correct. The need for manipulation is not to be determined by x-ray. X-ray is not a screening tool, it is a diagnostic tool. It is used in a chiropractors office to differetnially diagnose a scondition when inidcated, exactly like it would be in an ortho’s office. X-ray does not to determine the appropriateness of of a particular manual procedure.

    Also, you are incorrect when you say a chiropractors only performs manipulation to correct a subluxation. We estimte less than 10% adhere to that way of practice, or nomenclature, and it is shrinking every year. Even still it is a musculoskeletal lesion they are finding and treating. Indictions for manipulation are pain, loss of symmetrical movement, inflammation, muscle spasm, loss of normal daily functions, etc. The same exact indications as when a PT, ortho, osteopath or PMR does it.

    It very rarely is done in an acute setting such as what you describe and for completely different reasons. Although, as a paramedic it may be what you are primarily exposed to. It’s actually a completely different type of manipulation.

  21. #21 Adam_Y
    November 30, 2009

    @DrW
    So you have never heard of David Gorski? I just want to make sure that you have never heard of David Gorski. How the hell can you not know who he is? Also, why is it that you ignore the numerous papers that actually supports the idea that chiropractics actually increases the risk of stroke?

  22. #22 DrWonderful
    November 30, 2009

    TN Paramedic- my apologies. You did not try to tie all chiro’s the the subluxation nomenclature as I indicated. I was thinking of someone else.

  23. #23 daijiyobu
    December 1, 2009

    It’s the anti-ism ISM.

    -r.c.

  24. #24 Richard Eis
    December 1, 2009

    -Also, you are incorrect when you say a chiropractors only performs manipulation to correct a subluxation-

    then are you really still a chiropractor? Instead of just a specialist sports therapist.

    The chiro hunters have three problems with chiro.
    The fact that it often goes hand in hand with other woo, the fact that it was originally based on subluxations and the fact that people are going for unnecessary and dangerous mutliple neck manipulations from some chiro’s.

    It may be a few bad chiros mixing in woo and performing what amounts to last century medicine but it is this which the chiro-hunters are annoyed about. As well they should be.

  25. #25 the bug guy
    December 1, 2009

    We know we have the procedural evidence!!! We also know it will sift out the crap. Love it. Can’t wait. It will totally elevate the profession to where it should be.

    Can’t wait?

    Chiropractors have been around how long and you’re still waiting for the evidence?

    Why have they not gathered the evidence first?

  26. #26 Anthro
    December 1, 2009

    Omigod, I got censored! Somebody else got through with a similar comment. Really, this is childish. Let me just say that I am impressed with the names of the Board of Directors for the new group. I, too, would like to see a “donate” button at the site. The group will have to raise a lot of money if it is to make a start on this mess.

    To the angry chiro: Hey, you forgot to mention a big difference between chiros and others using these techniques: THEY went to medical, PT, etc. school–you did not.

    It seems to me that the root problem is that the states ever started licensing anyone who has not been to medical/nursing/physical therapy school to treat people. Only those with science-based training should be laying their hands on people.

  27. #27 DrWonderful
    December 1, 2009

    Bug Guy- the procedural evidence is already very clear. There are nearly five time more studies showing the efficacy of spinal manipulative therapy than there are regarding the treatment of dental caries. Also, SMT is not the only procedure we use or have developed. Ther eis some overlap with PT and the two fields scientifically are overlapping quite well. A great combo when working together on a patient.

    One reason you may not have seen the studies is because they rarely use the word “chiropractic.” The term “chiropractic” is a profession and not a procedure.

    What I “can’t wait” for is a reformed system that is based on evidence instead of arrogance and discrimination, which is what we currently have.

  28. #28 DrWonderful
    December 1, 2009

    Anthor- your ignorance is showing. Chiropractic schools are an additional 5 years after undergrad and include all levels of differential diagnostic course work. A patient is much safer and treated at a higher level of competency than with any physcal therapist. We are licensed physicians.

  29. #29 the bug guy
    December 1, 2009

    Dr. Wonderful, how about references to some of this procedural evidence that’s been around for so long instead of recent pilot studies like you did in another thread?

    The problem is that chiropractors have long been practicing without the evidence and are only recently trying to play catch-up. That’s why many of us have a difficult time taking you seriously.

    I’m not impressed with your claim that “less than 10%” of chiropractors follow the subluxation concept. Instead, I find it disturbing that even that many would still follow such nonsense and that the profession seems to tolerate them.

    If subluxation is to out of favor, why is it still being taught in chiropractic schools, such as The Palmer College?

    Palmer College of Chiropractic maintains that the science of chiropractic emphasizes the relationship between structure, primarily of the spinal column and the nervous system, and how that relationship affects function and health. Implicit within this statement is the significance of the nervous system to health and the effect of the subluxation complex upon the nervous system and, therefore, the body.

    (emphasis mine)

    I give chiropractic the credit with efficacy for some skeleto-muscular issues, but it has a long way to go to garner better support and to prove itself beyond that. That isn’t a result of discrimination against chiropractors, that is a result of the history of the practice.

  30. #30 DrWonderful
    December 1, 2009

    Richard- yes, I am still a chiropractor even if I do not use the subluxation nomenclature. The term, by the way, has been draining out of the profession for the last 20 years. We’ve also been reducing the unfounded “claims” chiro’s make in their advertising and when discussing treatment with patients as we also move toward evidenced based patient center care. The schools, state associations and major national association have taken the lead.

    We estimate approximately 10% of the chiro’s practicing today still use the subluxation terminology and adhere to the yet to be proven belief that spinal misalignment can lead to more than a musculoskeletal compaint.

    Now, mind you the findings of a “subluxation” as some chiro’s still call it still represents a musculoskeletal lesion…pain, inflammation, asymmetrical movement, loss of ability to perform normal daily activites, etc. Just an old school term that has been updated by various professions, including ours, over the past century.

    The question is…can a structural distortion cause poor health in addition to poor function? The answer is yes, and this is generally accepted by everyone who treats the human frame. Except maybe an ortho surgeon who really has only 1-2 encounters per diagnosis and may not see or hear this type of testimony because they are so focused on parts and procedures (Thank God too, because we need that). They should not discredit, however, what those of whom have 12-18 encounters per diagnosis might experience over that extended period of exposure.

    The problem is the possible mechanism by which health might be improved is certainly not defined or worked up by science. Most of us understand that and like you say do not practice in what we call the “chiro stone age.” Most evidence that health improves as musculoskeletal conditions are corrected is purely based on patient testimony over the course of a hundred plus years. There are siome preliminary studies in certain cases but nothing conclusive or overarching. You’ll find, however, that PT and Osteopathic patients reporting the same thing. This certainly is not valid science but also cannot altogether be dismissed especialyl as moreand more typeso providers are reporting the same types of htings now that they employ the same type of spinal manipulative therapy. PT and Osteopaths are mroe responsbile in their reporting and advertising, true.

    I hope this helps. I would ask that when discussing the chiropractic profession that we no longer only equate the name of the provider with the procedure being discussed. Multiple provider groups are doing the exact same procedures.

  31. #31 Harriet Hall
    December 1, 2009

    Dr. Wonderful sets up a straw man. Most critics of chiropractic acknowledge that there is scientific evidence for limited benefits of spinal manipulation therapy. When chiropractors provide SMT appropriately for patients with musculoskeletal conditions, they are doing the same thing that PTs and DOs also do, and that is legitimate. None of the other things they do under the name of “chiropractic” are supported by any credible evidence. When they adjust necks for symptoms in other parts of the body, or for “health maintenance” they are providing a treatment with no known benefit and a very small but potentially deadly risk of vertebral artery dissection.

  32. #32 DrWonderful
    December 1, 2009

    Boy you’re a real genius Ms. Hall. Thank you for repeating what I have been saying for the last few weeks and, of course, taking credit yourself. You chiro hunters are something else. Thanks for trying to tackle an issue we already tackled 20 years ago! And why do you refer to the evidence of efficacy as “limited”? I guess that’s your own personal bias coming through? Along with everyone else, I’d say it’s substantial.

    I do take exception with your conclusion that cervical manipulation has been tied directly by science to the incidence of VAD. You do realize the one study you guys constantly roll out has already been debunked and oh, by the way, in that study the vast majority of the post manipulation injuries were performed by PT’s and MD’s!!! What was it? Oh yeah..chiropractors performed 80% of the manipulation in the study and caused 4% of the injuires while PT’s and MD’s performed 20% of the manipulation and caused 96% of the injuries!!!! You never seem to disclose that one little fact, however. The study concludes manipulation is perfomed safely when done by a chiropractic physician!!! Yet you seem to twist it the other way? Talk about a lack credibility!

  33. #33 Scott
    December 1, 2009

    Why don’t you provide some actual EVIDENCE that the problems have been tackled? You know, to offset the massive piles of well-documented cases of chiropractors offering anti-scientific garbage, and chiro schools teaching subluxations?

  34. #34 Scott
    December 1, 2009

    Just to illustrate, I Googled for chiropractors in the Boston area, where I live. Here’s a rundown of the top hits (skipping duplicates):

    1. Offers acupuncture. Site has a detailed explanation of subluxations.

    2. Claims to be able to treat allergies, mood swings, digestive disorders, among other things. Again explicitly explains subluxations as the cause of all ills.

    3. Cannot be evaluated, no meaningful web page.

    4. Again embraces subluxations. Actually does not appear to offer services other than manipulation.

    5. Yep, subluxations again. Claims to treat ADHD, allergies, asthma, bedwetting, and PMS among other things.

    6. 404 error.

    7. Not a chiropractor.

    8. More subluxations. Offers acupuncture. Sells various recommended products on their website – note that this would be considered grossly unethical by real doctors!

    9. Also says that subluxations are what chiropractic is all about. Offers to treat headache.

    10. More acupuncture, no information regarding subluxations.

    11. Subluxations again. Claims to treat headache and concussion.

    12. More subluxations, offers to treat fibromyalgia.

    13. Acupuncture, “holistic” medicine including what sounds like reiki. Subluxations.

    So of the top 10 sites which offered any actual information, nine explicitly endorsed subluxations. None rejected them. Similarly, nine offered completely invalid treatments and/or treatments for conditions for which chiropractic has no demonstrated applicability. None of the 10 passed both tests.

    So tell us again about how few chiropractors embrace this garbage?

  35. #35 Just curious...
    December 1, 2009

    DrWonderful, have you been following the Simon Singh-BCA case? Care to comment?

  36. #36 DrWonderful
    December 1, 2009

    Scott- The skeptic would say “small sample” (hah!) but still the fact that some chiropractors use acupunture is not a shock to anyone. It does work. Why? How? when? I have no clue. I understand why you’re skeptical. I do not use it in practice but have had it done to me 2 times. I was amazed it worked for a acutely sprained arch in my foot and wrist pain after playing tennis. Both times I was unresponsive over many weeks to chiro, PT, anti-inflammatories and one injection in the wrist. Each time one acupunture treatment knocked it out. I hear it a lot form patients of mine who ask to try something else if they are not reaching their goals with me. Again. I understand the skeptical view. Btw, some lasting effects of concussion are treated through all sorts of neuro rehab techniques that both PT’s and Chiro’s do regularly…not only manipulation.

    Regarding the subluxation, you may be seeing the term being used interchangeably with musculoskeletal complaints, here. I have no idea what you are really reading.

    However, you may be suprised to learn that chiro’s do treat many ailments naturally but not neccesarily through spinal manipulation or even by attributing the conditions to subluxations. Can cholesterol be lowered without manip or meds? Yes. Can allergies, at least symptomatically, be affected without manip or meds? Yes. Can chronic asthma (not an acute attack) be affected without manip or meds? Yes. Can headaches be treated effectively with manip, meds or without either?…absolutely! In many cases very effectively. There’s even quite a bit of evidence about manip and heachaches. You’d be suprised how neuros refer to chiros for headache treatment. Increases every year. Do I understand why you are skeptical? Yes, I do. Do I agree you should have drawn such strict and definitive conclusions yet? Nope.

    But you’d be shocked how much of what we do is evidenced based. Will you find it by searching for example “cholesterol and chiropractic”? No. How about looking at diet, natural lifestyle modifications, Omega-3, Niacin, Green Tea extract, Vit D, smoking cessation, exercise parameters, behavioral modifications…. It’s not all subluxation and manipulation in our offices. Some offices are that straight…maybe 10%. The rest are looking at all natural health care options for patients.

    Listen, not all of these offices you cite are automatically tied to the subluxation as the cause or manipulation as the cure. They are not writing their advertisement for you, or even me. They are writing them for the general public and could a better job. I’ll bet you they are doing a much better jobin their offices than you assume. .

    So, of your small sample size maybe 20% actually tie subluxation to to cause of disease and manipulaiton as the only cure. Not good enough but nearly as bad y’all make it sound. You cited 13 websites. There are 1900 chiros in Mass. Would you call your study well designed?

    I think one of the problems is that all you know about chiropractic is the term subluxation and the procedure of manipulation so you put everything through that 2 dimensional prism. There’s more. A lot more. Sorry, but you’re knowledge here is very narrow.

    Foregetting th very broad array of musculoskeletal protcols we employ we’ll take one easy exmple for both of us to digest…do you think I can help a person with Type II Diabetes? The answer is no if all you know about me is your pre-assumed and uneducated conclusion of “chiropractic only equals subluxation removal via manipulation.”

    However, the answer is “yes” if you understood I have a very high level of expertise in the natural and well evidenced management of diet, exercise and behavior modfication. You may not be familiar with all the evidence surrounding natural manageent of Type II diabetes but do not immediately discredit the fact that I might! Most of it is common knowledge at the physician level, isn’t it?

    So, how can Type II diabetes be managed naturally even without manipulation as the primary procedure? Do you know? If so, why can I not do it? We’ve been doing it for 100 years. About 90 years longer than allopathy by the way. Then play the same game with cholesterol, chronic asthma, obesity, some heart disease….

  37. #37 Joseph C.
    December 1, 2009

    Then play the same game with cholesterol, chronic asthma, obesity, some heart disease.

    Why not throw in HIV and leukemia while you’re at it?

  38. #38 Todd W.
    December 1, 2009

    From a press release on the American Chiropractic Associations web site – http://www.acatoday.org/press_css.cfm?CID=3247 – (emphasis added):

    Studies are beginning to show that chiropractic can help children not only with typical back and neck pain complaints, but also with issues as varied as asthma, chronic ear infections, nursing difficulties, colic and bedwetting.

    From this quote, and the context in which it appears, it would seem they are suggesting that manipulation, not counseling or other non-manipulation strategies, can treat the bolded conditions. These are the same kind of things that Simon Singh called out for not being supported by proper studies.

    Perhaps, DrWonderful, you have some links to the studies the ACA mentions? The ACA didn’t include any.

  39. #39 DrWonderful
    December 1, 2009

    Joseph- I did not suggest those conditions, you did. I would say acute infectious disease, viruses, and cancer are out of reach. I was tlaking more along the lines of poor lifestyle issues that are typically associated with diabetes, obesity, smoking, etc. However, the argument could be made that helping patients achieve higher overall health goals through natural means, not spinal manipulation, may help them. Again, you may be falling into the trap of possibly searching for “chiropractic and leukemia” and coming up blank. If I had leukemia I would do my best to simply be healthier through natural means while letting the experts manage the disease.

  40. #40 Scott
    December 1, 2009

    Scott- The skeptic would say “small sample” (hah!)

    True, which is why I presented it only as an example. I can’t help but notice, though, that it’s more data than I’ve seen you present.

    but still the fact that some chiropractors use acupunture is not a shock to anyone. It does work.

    The science says otherwise.

    I do not use it in practice but have had it done to me 2 times. I was amazed it worked for a acutely sprained arch in my foot and wrist pain after playing tennis. Both times I was unresponsive over many weeks to chiro, PT, anti-inflammatories and one injection in the wrist. Each time one acupunture treatment knocked it out.

    Now, see, if you understood science you’d recognize that this is meaningless.

    Regarding the subluxation, you may be seeing the term being used interchangeably with musculoskeletal complaints, here. I have no idea what you are really reading.

    All nine quite explicitly said that subluxations, defined as minute displacements of the vertebrae, are the cause of most/all illness.

    However, you may be suprised to learn that chiro’s do treat many ailments naturally but not neccesarily through spinal manipulation or even by attributing the conditions to subluxations.

    The claims were to treat those conditions via manipulation because they are caused by subluxations. Anyway, if not manipulation, what’s the point of having a chiropractor do it instead of someone who DOESN’T claim that their practice is based on magic?

    You’d be suprised how neuros refer to chiros for headache treatment. Increases every year.

    Argumentum ad populum.

    Do I understand why you are skeptical? Yes, I do. Do I agree you should have drawn such strict and definitive conclusions yet? Nope.

    What this argument fails to recognize is that offering such treatment is effectively drawing a strict and definitive conclusion that they are safe and effective. Without such evidence, it is grossly unethical to offer the treatment. Absence of evidence can ONLY serve as an argument AGAINST! THAT is the “strict and definitive” conclusion I draw in many of the referenced cases; that there is no evidence to support it.

    But you’d be shocked how much of what we do is evidenced based. Will you find it by searching for example “cholesterol and chiropractic”? No. How about looking at diet, natural lifestyle modifications, Omega-3, Niacin, Green Tea extract, Vit D, smoking cessation, exercise parameters, behavioral modifications…. It’s not all subluxation and manipulation in our offices. Some offices are that straight…maybe 10%. The rest are looking at all natural health care options for patients.

    If you want to make a claim of 10%, provide data. In all cases I looked at, the office provided manipulation and woo. May there be some evidence-based interventions there too? Sure. But that’s not the point. The point is that the offering of interventions not supported by proper evidence is a major problem, and when such seems so widespread it more than justifies indicting the entire profession.

    Listen, not all of these offices you cite are automatically tied to the subluxation as the cause or manipulation as the cure. They are not writing their advertisement for you, or even me. They are writing them for the general public and could a better job. I’ll bet you they are doing a much better jobin their offices than you assume.

    So you’re justifying it by claiming that they’re engaging in false advertising. I hope you’ll excuse me if I don’t find that a meaningful defense.

    So, of your small sample size maybe 20% actually tie subluxation to to cause of disease and manipulaiton as the only cure.

    100% either make such a tie, or offer even more discredited treatments. Again, “only 20% are at the least invalid end of the spectrum” is an indictment, not a defense.

    Not good enough but nearly as bad y’all make it sound. You cited 13 websites. There are 1900 chiros in Mass. Would you call your study well designed?

    I would call it well designed but without much power. I would also say it has more power than the evidence you’ve prevented to back your assertions.

    I think one of the problems is that all you know about chiropractic is the term subluxation and the procedure of manipulation so you put everything through that 2 dimensional prism. There’s more. A lot more. Sorry, but you’re knowledge here is very narrow.

    Again, you don’t quite get the point I’m making. Offering more treatments is NOT any better when those treatments have even less validity than manipulation! And offering actual evidence-based interventions is NOT an adequate defense to the charge of offering treatments that are either unsupported or actively discredited!

    Foregetting th very broad array of musculoskeletal protcols we employ we’ll take one easy exmple for both of us to digest…do you think I can help a person with Type II Diabetes?

    Let me phrase the question a bit differently, if I might. (For clarity, I’ll agree that the answer to your specific question is Yes.) Do I think that anything you do that’d different from what a real doctor does can help a person with type II diabetes? No. Do I think that being able to offer standard advice on diet and exercise is a meaningful consideration relative to the offering of unsupported, discredited, and/or dangerous interventions? No.

    So, how can Type II diabetes be managed naturally even without manipulation as the primary procedure? Do you know? If so, why can I not do it? We’ve been doing it for 100 years. About 90 years longer than allopathy by the way. Then play the same game with cholesterol, chronic asthma, obesity, some heart disease….

    Allopathy does not exist, first of all. And mainstream medicine has been offering the same diet and exercise recommendations for a hell of a lot longer than 10 years. And if you’d like to claim that chiropractors have been offering such recommendations longer than mainstream medicine, I’m going to have to demand evidence.

  41. #41 Scott
    December 1, 2009

    Editing failure alert. The above should read in part

    In all cases I looked at, the office provided manipulation and/or woo.

    Apologies for my error.

  42. #42 DrWonderful
    December 1, 2009

    Todd- I am not a spokeperson for the ACA so I really cannot comment on their web site. I would say that some of our more extreme evidenced based purists (yes we have a range as does Medicine) might cringe. I know we can help those conditions but I do not have the research on hand. You’ll have to aks them yourself. When I treat those conditions, usually at the request of a parent or pediatrician, I always disclose that I do know knw the lit well in these areas and we’re going to try a course of therapy. I wish more chiros would do the same.

    I, however, see no references to manipulation in your piece as being the primary treatment protocol. The term “chiropractic” represents a profession and not a procedure. All of the conditions listed there do have safe, effective, and evidenced based natural protocols associated with them. All chiropractors are licensed to do such things. Off the subject… my wife drank a bottle of dark beer every night when nursing. Her Ob told her to do that, not her chiropractor. It worked, I guess.

    Ear infections have long been known to respond to nutritional therapies and environmental modifications and there is much anecdotal evidence, and some clinical evidence, associated with spinal manipulation to break up the chronicity. Same could be said for enuresis. Osteopaths attribute this to strucural distortions in the sacral plexus. Chiro’s are not alone! Acute ear infections, I feel, should be co-managed with a pediatrician. My son’s pediatrician told me he sends the bed wetters to a chiro in town that treats a lot of kids and is amazed by the results.

    As far as Mr Singh is concerned I’m not too familiar with his situation. what little I know makes me believe he likely fell into the trap of commenting on “chiropractic” as if it represented just one procedure (manipulation) with just one goal (subluxation removal) instead of understanding we are physicians that specialize in natural health care with an obvious emphasis on structure. He commented on Chiro circa 1910 and had no idea we evolved so much beyond what he accused us of. His fault, not ours. I beleive nbut am not sure that he also grossly, horribly, over exagerated the risks associated with cervical manipulation as performed only by a chiropractor to the point where it slandeered the profession. If what I hear is true he has been very irresponsible and inaccurate in his expressed views of the chiropractic profession.

    As far as the studies are concerned… well I am just a grunt. I treat my 30 patients a day, many of whom are referred by allopathic colleagues, and go home to my family. I used th evidence to guide my practice via continuing education but I do not have it stacked up on my desk. I am well read but I do not every lit on the tip of my hand to fire off to you. I also am not getting into a lit spit match with you guys. I am not getting bogged down in the structure of the studies, etc. Forget it. I worry about what works in my office. You are the skeptics, you do the research.

    I will say there is much more evidence than you know though. First you need to stop only using the word “chiropractic” when you search. It is not a procedure or treatment protocol. It is a profession so it does not appear in the data often. You also need to understand that chiropractors are very well trained in a wide array of physical medicine modalities, neuro rehab protocols, and natural medicine protocols.

    For example…the ample growing evidence showing how important Vit D is allows us to use it more in our practices… but you’ll never find a paper on “Vitamin D and Chiropratic” but will you find other papers that would be applicable by a chiro in a natural health patient population. Same for Omega 3. Niacin. etc, etc, etc. Correct?

  43. #43 qwerty
    December 1, 2009

    The term “chiropractic” represents a profession and not a procedure.

    It’s a nice slogan, but it’s clearly bogus. The defining characteristic of your profession is the muskuloskeletal manipulations derived from pseudoscientific vitalism. A practicing “chiropractor” is always expected to be educated in and perform these manipulations. Whatever else you or others may tack on in an amalgam of naturopathy, homeopathy, acupuncture, etc. is just gravy…but it doesn’t mean it’s chiropractice. Selling megadoses of vitamin D doesn’t give any credibility to chiropractic manipulation, whether or not vitamin D does what is claimed. It’s quite the bait-and-switch.

    All of the conditions listed there do have safe, effective, and evidenced based natural protocols associated with them.
    And you’ve provided none of the safety and efficacy evidence you say exists. Please do so.

    I will say there is much more evidence than you know though. First you need to stop only using the word “chiropractic” when you search.
    This is typically argued such that chiropractors can try to take credit for favorable evidence in PT or osteopathic research, which isn’t the same.

  44. #44 DrWonderful
    December 1, 2009

    Querty- you’re having hard time understanding all this, aren’t you?

  45. #45 DrWonderful
    December 1, 2009

    Scott- I understand where you;re coming from for the most part. I really do. I guess my point has been to make sure people here do not automatically replace the word chiropractic with the assumed procedure…manipulation. And certainly do not tie all chiropractors to the old theory of subluxation. Also, when looking for evidence do not make the mistake of only looking for “chiropractic” evidence as the manual techniques employed by Chiro’s PT, Do’s and Md’s all have varying nomenclature with much overlap.

    I will disagree with you definitively on one point. Chiropractic physicians have been the forerunnners on natural health care and natural solutions to many basic unhealthy situations for many more years than our allopathic counterparts. There is quite clear literture in chiropractic texts and articles written by chiropractors in magazines dating back to the early 1920′s talking about nutrition, exercise, psychoemotional balance, etc as a way maintain optimum health. I believe it has only been in the last decade or two where this has even been accepted as part of a formal medical education let alone medical practice.

    Much of todays “wellness” programs that have popped up, yes as recently as 10 years ago, which are offered by nurses, allopaths or in hospital based programs almost identically mirror the types of things chiropractors were doing back in the early 20′s.

    The same can be said for much of what PT does today. The first known rehab gym was built as Palmer College in something like 1912. The first provider that specialized in sports medicine was a chiropractor that worked for the New York Yankees at the request of Babe Ruth himself. That chiro did alot more than manipulation. he provided nutritional advice, exercise training and treated injuries. Ruth claled him the “secret weapon” of the dominant Yankees teams of the time. Major league baseball teams have employed chiro’s ever since. This is 20-30 years before physical therapy was ever created.

    You are looking at the creators here of much of what medicine is just now employing today…nutrition in practice, health lifestyle counselling, rehab, optimal structural performance and correction (think Olympics), patient centered care (yes, putting the patient in charge of their health, not disease), wellness, gait analysis and correction, distortion pattern evaluation and correction, dynamic traction, post isotonic relaxation techniques, well evidenced soft tissue protocols, work station ergonomics (Dr. Greenwalt in Iowa in 1930-something wrote the first occupational health textbook employing injury prevention and structural care programs) and more …all originated in the chiropractic profession and now is being borrowed and in some cases improved upon by others. Fine, but don’t shit on us for it.

    We’ll be damned if yours/theirs/whomevers organzied movement is going to cop all this without our due recognition as pioneers in much of this. We know the plan is to discredit us, call us unsafe, then cop our stuff. We know what is happening. The alternative would be take our stuff and elevate us with it, which is obviously unacceptable because of the discrimination that exists. Very hard to hammer us for 100 years and then take our stuff and call it ours and admit you were wrong about us for the most part.

    Again, you seemingly have no idea what has been going on inside this profession for 100 years. All you know is the advertising and claims, which suck, I agree. But my point here is that there sooooo much more and much of it is fantastic and wonderful.

  46. #46 Scott
    December 2, 2009

    I believe it has only been in the last decade or two where this has even been accepted as part of a formal medical education let alone medical practice.

    Evidence please. People griping about their doctors harping on about them about diet and exercise has been commonplace for much longer than the last decade or two in my experience…

    Maybe it will help if I step back and explain from the beginning precisely what my problems with the practice of chiropractic are, since I think I have failed to communicate clearly. Essentially they fall into two categories.

    The first is the persistent and widespread use of non-evidence-based treatments. This includes the use of manipulation for conditions it cannot help (e.g. allergies, high blood pressure); general treatment for conditions where chiropractors cannot provide adequate care (e.g. high cholesterol – standard basic diet and exercise advice is all well and good, but without, for instance, the training and ability to effectively prescribe statins, including knowing when they are needed and monitoring of their use and effects, such care cannot be considered adequately comprehensive in the general case); and the offering of treatments that have no established efficacy beyond placebo for anything at all – acupuncture, homeopathy, etc. A particularly dangerous form of this is the advocacy of anti-vaccinationism.

    In its direct form, this is only an indictment of the particular chiropractors who practice these methods, which I agree is not all. However, the fact that the practices persist demonstrates that the chiropractic profession is not effectively self-regulating to protect patients from unsafe and ineffective “treatments.” And that is an indictment of the entire profession. More, so long as these practices remain in force throughout much of the profession, the general practice of chiropractic cannot be considered to be safe or effective. Even when there are properly evidence-based chiropractors available, how is the average layperson supposed to distinguish them from the quacks?

    The second big problem I have is, let’s say that all of that could be dealt with. A chiropractor who restricts his practice to being properly evidence-based essentially becomes a PT with more restricted scope and a pile of anti-scientific baggage. And then one has to ask, what’s the point? Subluxations and woo are really all chiropractors have to bring to the table to distinguish them. Take those away, and there’s really nothing unique to offer, and the motivation for the profession to exist vanishes.

    I’ll finally comment that anything chiropractic was able to accomplish in the 30s, much less earlier, impresses me not at all. Before mainstream medicine became thoroughly and properly science-based, it had a lot less to recommend it. But today, the power and efficacy of science-based medicine is so great that alternatives have a much steeper slope to climb in order to have any relevance at all.

  47. #47 Dong
    December 19, 2009

    To Scott

    Your listing of Chiropractors offering Acupuncture in the State of Mass, Boston area? Very interesting

    If this is so, they had better have a Masters in Oriental Medicine or DAOM degree. As this is the only way they would be able to practice Acupuncture in the State of Mass. If they do not and are in fact performing Acupuncture. Then you have an legal obligation to report them to the Mass State Board of Medicine. As they would be breaking the law and be held liable for possible felony conviction.

    Mass is very clear on this, in fact crystal clear.

    This is something I just do not understand. In that why are Chiropractors advertising for something they are not? I see them advertise as Radiologist/Internal Medicine/Family Medicine/Neurologists/and now even Pediatrics. How dangerous is that? Why can’t they just be happy being a Chiropractor? It makes me sick and disgusted.

    Most Acupuncturists esp in Mass who attend school will have a MD teach classes. They are taught that the MD is the leader and most importantly a reliable source of knowledge. They don’t make outrageous claims either. Maybe that is why Tufts/Havard/Dana Farber allow Acupuncturists to have an opportunity to learn from MD’s.

    Something needs to be done with Chiropractors making themselves out to be something they are not. How in the world can a Chiro claim to be as qualified as a MD? That is just crazy. Even worse dangerous

    Remember to report unethical advertising it is your duty.

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