Terra Sigillata

This is not at all funny but I guess ironic might be a better word.

The science blogosphere has been alight this past week with the recognition of naturopathy by the state of Minnesota as well as other aspects of alternative medicine.

As if the risks of going to an alternative practitioner are not enough, here is an alarming case from Sacramento, CA, of a patient dying at the hands of someone posing as a chiropractor:

Authorities said Antonio Arellano, 76, was taken into custody on suspicion of homicide after operating his clinic in the 4000 block of Washington Avenue.

On Tuesday, a 66-year-old man was accompanied by his wife during a trip to Arellano’s home to get a physical adjustment to relieve pain, police Sgt. Matt Young said.

Arellano adjusted the victim’s neck, seriously injuring him. Police said the man was driven to the UC Davis Medical Center and placed on life support.

The victim, whose name was not provided, was eventually declared brain dead, Young said.

Again, not to make light of this tragedy, but how is a patient to know whether a charlatan is posing as a charlatan?

Ryan Lillis in The Sacramento Bee provides us with more information regarding this “practice:”

Arellano had run an unlicensed chiropractic business out of his garage for some time and the victim had gone there to receive treatment to alleviate pain in his extremities, police said. [emphasis mine]

The comment thread at the SacBee is running pretty hot with readers debating whether the case reflects the need for affordable health care vs. blind belief in alternative medicine. Commenter sirrebral writes:

The fact that someone can offer health services in his garage…and that people are actually willing to pay for those services…lends credence to the argument that this country has a need for an affordable health care program. People do some crazy things when they can’t afford the alternatives.

To me, however, this case extends our discussion on the risks of allowing unqualified individuals to use the title of “Doctor.”

[Clarification to my Ph.D. colleagues: yes, we use the term "Doctor" in our respective disciplines but outside of psychologists, none of us do so with the intent to treat patients. My views are still mixed on whether Pharm.D.s should be using the term "Doctor."]

Comments

#1 Art
June 15, 2008

Sounds to me like evidence of a need for national health care.
The man was in pain. If he could afford to go to an actual doctor and felt he could both get relief and afford the treatment he would have. As it is he went to a cheap quack. And paid with his life.

It must be assumed that if we had national health care he would have gone down to a clinic and been treated by an actual doctor.

Lacking funds people will seek the best health care they can afford. The tragedy is not that quacks exist. But that people are forced to go to them for financial reasons.
#2 Jane
June 15, 2008

From what I’ve read, it seems like doctors are often more concerned with catching drug-seeking than treating pain, especially persistent pain. Was this a factor in the case?
#3 MarkH
June 15, 2008

This is problematic. However, even licensed chiropractors still do neck adjustment despite no proven benefit and a long known risk of vertebral artery injury/dissection causing strokes, paralysis and death. It is an intervention with zero benefit and obvious risk, yet they still do it.

Yet another major hit for me against chiropractic, despite possible modest benefits in treatment of low back pain. That and because many still claim subluxation as a cause of disease.
#4 PalMD
June 15, 2008

Hmm…i have a bit to say on this when i get back from work…i see this quite a bit.
#5 Mike Haubrich, FCD
June 15, 2008

I have neither the use nor time for “alternative medicines,” and I am concerned that the health plans to which I have subscribed deny benefits on the flimsiest of pretense while at the same time accepting billing from chiropractic.

That being said, we are stuck with a society in which a sizable portion of people use their services. So, I am divided about licensing chiropractors, or naturopaths for that matter.

I think that some licensing should be necessary to demonstrate that they know their “limits.” Many don’t, of course and regulating chiropractic is a tricky business, but at least some oversight has its place.
#6 ManoDogs
June 15, 2008

I agree with Jane. Particularly since those of us with chronic pain conditions have to go to pain clinics where they still treat us like junkies. By the time you get to that point, you’ve already been through a string of doctors and specialists and a battery of tests, so you shouldn’t have to face further mistrust.
#7 NickG
June 15, 2008

While I agree wholeheartedly that we need single payer national health insurance (SPNHI), I doubt that this was the primary cause of this man’s using the unlicensed chiroquackter. First and foremost, the victim was 66 – it is very likely that he had Medi-Care, and if not that he had Medi-Cal (California’s Medicaid provider.)

In addition, I’m an ER physician and I work in Davis, CA – about 10 miles west of Sac. While county clinics and non-profit organizations don’t replace SPNHI, if you are uninsured in this area, you can get care through these types of providers. That’s one of the reasons I moved to the area (from Louisiana) – I was tired of having my soul sucked out of my eyeballs every time I treated people in the ER who basically had no hope for real treatment for their problems. I could write them an rx for diabetes medicine for a while or partially set their fractures, but there was no means for them to get the follow-up care necessary to really treat their condition. Or seeing the person with an appendiceal abscess who had waited until they were at death’s door to come in because of their fear of the bill they would get if they came to the hospital.

Its by no means perfect here, but its way better than many other parts of the US. So I doubt this was due to lack of access to care…. more that it was an unlicensed quack who did something that is a known dangerous procedure – especially in elderly patients – chiroquacktic neck adjustment. I hope they bring the guy up on negligent homicide charges.
#8 juniorprof
June 15, 2008

Particularly since those of us with chronic pain conditions have to go to pain clinics where they still treat us like junkies

It always saddens me to hear this, and I have to say that I hear it all too often. As a researcher trying to discover new ways to treat pain and as the husband of a health care professional that spends a large amount of time with pain patients, I can at least say that there are a large number of health care professionals out there that want to help people with chronic pain. Chronic pain is a disease and, like many other diseases it is under-treated and the research money available is a small pot that is drying up.

It is unacceptable for any practicioner to treat a patient like a junkie. If you can go to another pain clinic, do so. Nationalized health care can help too, I think. Write your congress person and let them know how woefully pain patients are treated in your area. Finally, it cannot hurt to ask that congress increase funding for pain research. The American Pain Society has been trying to get Congress to put language into the NIH roadmap that makes treating pain and pain research a priority for years now. Despite our best effort (and this includes my efforts) we have not succeeded in doing this. A little push from constituents can go a long way!

Finally, the International Association for the Study of Pain, which is an arm of the World Health Organization, considers pain relief to be a basic human right. I think this is worth considering when you encounter objections to therapies that can alleviate your pain.
#9 Ed Darrell
June 16, 2008

In a creationist world, how would anyone establish that this fake chiropractor did anything wrong?
#10 Citizen Deux
June 17, 2008

It may be a cultural issue which brought the individual to see the unlicensed practitioner. There is little evidence that alternative care is less expensive than conventional therapy. Many counties have good clinics which can and do provide routine treatments. The issue, as mentioned by the former LA ER doc, is one of follow up and simple lack of information among patients.

There are venues for uninsured to obtain care, but it requires engaging the social services network. This brings a social stigma that some patients would rather not take on themselves. Drug seeking is real, anyone who has worked in an ER or urgent care clinic have dealt with patients who are clearly seeking narcotics.

Finally, there is the issue of patient compliance. Is the 67 yo female, with a 3rd grade education, who is morbidly obese, suffering from Type I diabetes, angina, and hypertension really going to adhere to the lifestyle which will improve her life?
#11 Teri
June 17, 2008

A more accurate report would have been Unlicensed Chiropractor Causes Death”. It was not alternative medicine that caused this death it was a man posing as a doctor.

The sensational headline implies alternative medicine is at fault. Dishonest people also pose as doctors and have caused pain and death to patients especially in the plastic surgery field.

The media tends to overstate, and distort headlines to boost their profits. This man could also be charged with “elder abuse” for taking advantage of an older person, who may not know where to look for a legitimate listing of licensed chiropractors. The patient is at fault for trusting and if there are no regulations, enforcement or methods of protecting the public from these parasites, then the law should be fully applied and this should be treated as a willful murder.

In terms of numbers of deaths, doctors who basically push drugs for pain relief cause more deaths from the operating table to misdiagnosing and malpractice.

These news reports sound distorted and is derogatory to the whole field of alternative medicine which happened to have saved my life from cancer, which was caused by a drug called Prempro, also prescribed by my doctor.

A national heathcare system although very needed and necessary would not have avoided this type of death.
#12 Joe
June 17, 2008

Teri wrote “It was not alternative medicine that caused this death it was a man posing as a doctor.” “The patient is at fault for trusting …”

That’s really harsh, would you adopt that position, about the customer, if he were your father? Chiropractors always pose as doctors. As for your ignorant tuo quoque, and your anecdote, I am tired of addressing them.
#13 Debbie Brumley
May 21, 2010

Hi I have a story like this…there is this chiropractor named Joan Karnas that treated my father who didn’t know he had Cancer but she kapt treating him never once referring him to a medical doctor to see what was really wrong with him…he eventually died, very much in pain… Had I known…I would have taken him to a proper professional but she always said he was just mis-alinged…what a bunch of bull shit.. If anyone reading this please don’t go to this woman..she works in the Indianapolis area
My father may still be alive if I only knew I would have taken him else where….please be aware.