Here's a rather interesting wrinkle in the regulation of chiropractors. This time, it's New Jersey:
A recent state court decision has hundreds of chiropractors across the state bent out of shape because it sharply limits what they can legally do.
And while the decision is being appealed to the state Supreme Court and state legislators have proposed amending state law to return the field to where it was, changes are not expected for months.
In the meantime, the decision "definitely wiped out a source of income, because we were able to bill for the extremity adjustment before and now we can't," Ventnor chiropractor Michael T. Sherman said. "We can't do it. It's ridiculous. It's ridiculous is what it is."The U.S. government calls chiropractors medical professionals who treat patients with health problems associated with the body's muscular, nervous and skeletal systems, especially the spine.
Chiropractors frequently treat problems by physically adjusting the spine or working a joint through a range of motion. The field takes a generally holistic view toward overall health.
You know, I've always had a bit of a problem with that characterization of chiropractors, at least the ones who claim to be able to do more than just treat the musculoskeletal system, such as treating allergies and other diseases with chiropractic adjustment. Such chiropractors are in essence physical therapists with delusions of grandeur who don't know their limitations, which is one reason why I like physical therapists much more than I like chiropractors. Physical therapists generally don't claim to be able to do any more than what they can do, and most of them do it well; indeed, a good physical therapist is probably more valuable than a horde of chiropractors. Better, physical therapists. don't invoke "adjustments" of nonexistent "subluxations" as a means of curing disease or claim that their treatment can cause people to come off their antianxiety medications, as one of the chiropractors in this article did. From my perspective, I find it rather risible that a profession many of whose members tie all manner of unrelated diseases and health issues to a single structure (the spine) to be "holistic" in anything.
But I digress. After a little mention of those nasty "skeptical doctors" who "question the science" behind chiropractic, the article explains how this came to pass:
Chiropractors' current problems started with a malpractice case.A patient named Carol Bedford claimed her longtime chiropractors Anthony L. Riello and Peter E. Lowenstein from Brick's Coastal Chiropractic tore cartilage in her left knee when they adjusted it in 1999.
The initial trial court found for Riello, Lowenstein and Coastal Chiropractic. But Bedford appealed, asking whether they should even been allowed to manipulate any part of the body other than the "spine and related structures."Taking a broad view, chiropractors have for years treated joints and limbs because they said they were related to the spine. A sprained ankle, for instance, could change the way a person walks thereby misaligning their spine and leading to discomfort.
On April 18, the state appellate court ruled in Bedford's favor, narrowly interpreting a 1953 state law that limited chiropractors to problems related to the spine. "We conclude that the scope of chiropractic in New Jersey is limited to adjustments of the spinal column and does not include the adjustment of other joints," the opinion read. It allowed a new trial.
Like much of state regulation of alternative medicine, I'm of two minds on this. While it is probably better that such practitioners be regulated rather than unregulated, their regulation by the state gives them more of a sense of respectability than they deserve, as if there were actual science to support what they do. Another drawback is that controversies like this break out periodically over the scope of each "discipline's" practice. The problem is, there's no science to support either position
More like this
I'll go with Eddie Izzard:
Thanks for this-----we at one point found ourselves in the Staten Island office of a chiropractor who was really more of a "faith healer"; we had been looking into cranio-sacral therapy for our son and felt dubious about the whole enterprise, yet went through with it. And knew, once was more than enough!
Early chiro response: "N.J. Court Rules Against Extraspinal Adjusting" http://www.chiroweb.com/archives/25/11/13.html
"The ANJC recommends that until this decision is overturned or a new chiropractic scope of practice is enacted, New Jersey chiropractors should refrain from performing manipulation of joints outside the spinal column."
Now: "ANJC Tries to Reverse Bedford Ruling" http://www.chiroweb.com/archives/25/16/03.html
This can be very effective. The chiros will tell their customers "If you don't write your representatives, I may be prevented from providing the services you expect." That is how they obtained licensing, in the first place.
There is an irony in this. A group of chiros (<5%) that renounces subluxation and tries to work as though they are physical therapists, will be curtailed. Whereas, the quackiest of chiros ("straights," ca. 20%) who only adjust spines for every complaint will be unaffected.
My last paragraph was garbled:
There is an irony in this. A group of chiros (under 5%) renounce subluxation and try to act as physical therapists, they will be curtailed. Whereas, the quackiest chiros ("straights," ca, 20%) who only adjust spines for any complaint will be unaffected.
It seems like criticizing chiropractors is almost as bad as criticizing fundies. The whole "subluxation" thing is a lot of woo. I have had patients who refused vaccinations and medications because their chiropractors told them to.
I used to work in the library of a chiropractic college, and I saw how the faculty and students expressed themselves, time and again, in terms that can only be likened to those of a cult. The memorial service for the founder of the college, which I attended along with the rest of the staff, was downright creepy in the way it was conducted at the school, consisting largely of railing against the medical establishment and singing the praises of chiropractic. Such antiscientific and magical thinking as chiropractic training fosters makes its adherents prone to believing many other kinds of woo as well -- iridology, for example.
Chiropractic IS a cult in many respects, and I fear it will prove to be about as persistent as any widespread religious cult. I am glad for any curtailing of its pernicious influence, however small.
~David D.G.
aside from whether chiropractic is useful for manipulating extremities, the fact that they managed to take in a patient with a slight ache in her knee and send her away with a torn cartiledge really doesn't say much for the quality of treatment...
I am not sure if this some degree of irony, or if it is just sad. My brother has made a pretty good living selling thins like electrical acu-pressure devices to chiropractors, along with all kinds of vitamins and supplements. There is no arguing with him about chiropractic, he won't budge on his belief that it is a suppressed medicine and that the AMA has a stranglehold on the FDA. But he cites "Study after study" which proves the efficacy of chiropractic and acupuncture, and since I never have access to the real facts whenever we argue his rhetorical tricks manage to (literally)shout down my objections. I have given up by now, and he is making good money at what he is doing.
I was at a party one night, and had a discussion with an unemployed chiropractor. He cite "undeniable evidence" that our agricultural practices have so depleted the soil that the food we eat only has 5% of the necessary nutrients that it did even 50 years ago. The only way that the human body can get its necessary nutrients is through macro-biotic shakes. (I would have to be very drunk to swallow that.) But the most disturbing thing to me was his claim that a friend of his had cured a couple's infertility through subluxation correction.
And the idea of desperate couples running to chiropractors to induce fertility almost made me cry, as they reached out in despair to a quack for help in conceiving. (Especially with so many children waiting to be adopted, but that is another issue.)
Chiropractic, like any other form of quackery, is not harmless. It encourages people to eschew testable treatments; and when I point this out to my brother he has a ready list of unethical doctors (such as plastic surgeons who pump up lips and tits for vanity) to try to counter my arguments.
Please don't lump chiropracty and acupuncture together. I'm a third year acupuncture student, and the two are VASTLY different. Oriental medicine has been practiced for over 2000 years, and we don't do any physical adjustments to anyone. There have also been very extensive studies on the effectiveness of acupuncture and herbal medicine (we use 400 actual herbs in varying prescriptions). People try to prove us wrong all the time, and we come out on top because it does work (take a look at Elizabeth Wakefield and her fertility treatments). It's not a cure for everything, but treatments are extremely effective for a wide range of conditions. We don't say we're going to cure people of cancer or some other terminal disease, but treating their pain and many of the adverse side effects of many medications they're on and symptoms they have are very effective. People come to us as a last resort and are generally pleased every time because something finally works for them.
What's laughable is that chiropractors often try to get us to not be able to practice since they see it as money out of their pockets. In some states, it's illegal for a licensed acupuncturist to even prescribe herbs, yet a chiropractor can even though they've never studied them (this can be extremely dangerous especially if you don't know how the herbs may interact with any of the patient's medications). Also, some chiropractor lobbies are trying to make it so they can practice acupuncture (and ironically enough so that acupuncturists cannot), which is not only scary but also extremely dangerous since 100 hours of acupuncture study is nothing compared to the over 2000 acedemic hours and over 1000 clinical hours that are required for us to complete before we can even graduate. It's a 4 year degree, and my school requires an undergraduate Bachelor's degree before one can even be admitted into the college. We not only have to learn Oriental medicine, but Western medicine as well. It's an extensive course of study, it IS effective, and we're not going to be using the same treatments on every patient--using the same treatment on even 4 patients is very rare since everyone is different.
If something doesn't work, it's not going to be around and being used for 2,000 years. We are NOT in the same group with chiropractors.
Who are you guys kidding, with your deprication of chiropractic? I have a bad back and chiropractic is the *only* thing that has worked. I suspect that neither the commenters, the NJ legislature, nor your local M.D. have any direct knowledge the things mentioned in the article or comments.
I do have personal experience. I presented at clinic of a major teaching hospital after injuring my back gardening. They diagnosed me as having a muscle strain and sent me to a physical therapist. After months of this nonsense and a worsening condition (I couldn't sit without pain and bending over was out of the question), I finally saw a chiropractor and got some relief in two sessions. It wasn't a muscle strain, it was a disc injury (slight compression) of L5, as x-rays showed.
So, not only did standard medicine fail in diagnosis and treatment, they don't have anything in their arsenal remotely as effective as chiropractic for the type of L5 disc injury that I have. Subsequent x-rays confirmed an increase in the L5 disc thickness after 6 months of chiropractic treatment. I still go in once a week to keep the joint loose.
But the real issue here is contempt! If you have power (as do medical doctors), contempt for your adversaries passes for common sense. If you are out of power (as in chiropractic), contempt for the powerful appears to be mental instability.
You have one woman with a knee problem in NJ where chiropractic failed her somehow and now you want to ban who whole deal. What's up with that? No matter how many times knee and back surgery makes the condition worse, you posters would never think of banning those procedures! So rather than argue relative merits, let's just say there's quackery on both sides of this argument, gentleposters.
J.D.,
Are you telling us then that you're one bit of anecdotal proof should counteract any rational thought or verifiable proof on the subject?
Puh-lease. Glad it worked for you, though. It's your money.
P.S.
When you ask for the name of a good surgeon to treat your next joint injury, keep in mind that you are asking for "anecdotal evidence" without "verifiable proof". Life is like that sometimes. How else does one find a good woman? They're not going to submit to a battery of tests :)
"There is an irony in this. A group of chiros (under 5%) renounce subluxation and try to act as physical therapists, they will be curtailed. Whereas, the quackiest chiros ("straights," ca, 20%) who only adjust spines for any complaint will be unaffected."
Joe has it right. Reform minded DCs in NJ would likely move to another state. On the other hand, NUCCA practitioners will keep quacking away.
J.D., I'm delighted that you finally got better treatment for your back, and I'm sorry that conventional medicine did so poorly by you on that occasion. But as powerful as your own experience must be for you (understandably), don't make the mistake of generalizing chiropractors' skills beyond their proper scope.
I spent several years working in the library of a major chiropractic college, even allowing myself to be used as a training subject by the students (which I now regret). I became fairly familiar with the treatment methods and the alleged rationale behind them.
I tend to agree with Orac's assessment of chiropractors: They are, essentially, specialized physical therapists with delusions of grandeur (I freakin' love that phrase, Orac!) and no awareness of their limitations. They are not completely without value in what they do; they are back injury specialists, and when they deal with JUST that sort of thing, they are often quite effective, sometimes on a par with real doctors. This means that they will be better than even some real doctors in such cases, assuming they are reasonably astute in their judgments.
As you say, however, one gets both good and bad in both disciplines. (The old joke is true: What do you call the guy who finishes medical school last in his graduating class? "Doctor.") However, chiropractic takes what starts as potentially sensible and plausible physical medicine and extrapolates well beyond its purview, both in theory and in practice. Furthermore, its paranoid arrogance toward actual medicine makes its practitioners vastly more sympathetic toward other "alternative" treatments and diagnostic practices (in a sort of misplaced "the enemy of my enemy must be my friend" kind of attitude), regardless of the level of merit to the claims for such treatments. This means that chiropractors start off already badly tainted ideologically, with respect to medicine, in an almost mediaeval direction. The best chiropractor is surely better than the worst doctor, in the area of his specialization (i.e., back injuries). But all other things being equal, the chiropractor is at best a pretender to the title of "doctor."
~David D.G.
1. Chiropractic is pure, unadulterated quackery.
2. The government has no business telling people what kind of health care they can obtain from whom. If I want to go to a witch doctor and have my bunions cured by having chicken blood splattered on me, that's my affair and nobody else's.
Chiropractic can't hold a candle to lawyering for who has the most woo and does the most damage.
Chiropractors are fine if you realize:
"Holistic" = "Sham"
Please refer the wonderful South Park episode with Miss Information....
Testimonials, vs actual evidence from studies, is one of the hallmarks of woo. Testimonials are stories (albeit important to that person)--not evidence.
I have been to several chiropractors in my life. I've had back problems for 15 years and can attest to the effectiveness of chiropractic treatment. I think the disconnect here is that there are many quack chiropractors, and then there are the ones who know the limits of their treatments. I've personally been to both. It's too bad the quacks are ruining it for the ones who actually help people. My cousin is an anesthesiologist who specializes in back pain. He runs three back pain centers in the Midwest and is extremely well respected in the medical field for his work. At each of his practices he keeps a physical therapist and chiropractor on hand.
What people fail to see is that many chiropractors do know what they are doing and actually help people. They wouldn't be in business if no one was benefiting. For those of you who have never been, you really have no right to speak out. For those of you who have been and have been disappointed, I'd suggest looking for a different practitioner. Just like any other profession, there are going to be some who are better than others. And there are quacks in EVERY field, even in politics....
There are quacks in every branch of medicine. The trick is to find the good ones. Chiropractic cannot cure colds, or appendicitis, or allergies, or any other disease, and any chiropractor who says he/she can is a quack. But they can dramatically improve your quality of life and alleviate your pain. For many people, myself included, chiropractic care has made the difference between a life of constant pain and one where pain can be alleviated without the use of drugs. Chiropractors have helped me countless times when my regular doctors were unable to do anything to relieve the cause of my pain. I sprained my wrist and went to an orthopedist - I was in a cast, then a brace for a total of 12 weeks and it still hadn't healed. The chiropractor replaced the displaced bones and it healed almost immediately. I fell and sprained my ankle very badly - my chiropractor replaced the displaced bones in my foot and the healing time was cut to a few days. My neck "goes out" and I suffer intractable headaches, neck pain and find turning my head in any direction to be extremely painful - my chiropractor fixes the problem and I am out of pain and can turn my head easily. My back goes out and he fixes that too. Jammed ankles, subluxed metatarsals, displaced ribs, knees out of alignment, whatever I need help with, I tell HIM what I need to have fixed as I can FEEL what is out of place, not the other way round. Chiropractic IS a valid medical field, but like any other, you have to USE COMMON SENSE and choose your doctors, and your treatments, very carefully.
Actually, a valid medical field is one where the "doctors" have MEDICAL DEGREES. Why would you go to someone with a practice that has little, if any, proof of doing good (lots of proof of doing HARM), instead of going to a real doctor that can treat you effectively?
The history of chiropractic (and, sadly for one poster above) acupuncture is based on deception and lies. It has long been known that many of the things chiropractors claim they detect do not exist. By couching medically worthless, possible damaging, manipulations in pseudo-medical language, the practitioners take advantage of those who have problems. The same is true for acupuncture, and the scientific truth is that there has never been any well-designed study that shows efficacy for either "treatment". At best, they come up equivalent to placeboes, with no long-term medicinal influence from either (simple description: the results from "real" acupuncture are consitantly no different than those obtained by sticking the subjects in random positions with the same instruments). It is also interesting to note that many of the procedures taught as "traditional" Chinse acupuncture were actually codified in the 1800s.
The scientific message is simple: when approached by any pusher of "holistic" treatments: run away.
You know, I suffered from back pain from when I was in middle school. Some five years ago, when I was preparing to get married, it had gown to be so intense in my lower back that I couldn't stand for too long. I went to doctors, who prescribed painkillers, "didn't see anything wrong with" the xrays and MRIs they did, and said "well, if it doesn't get better we can operate."
In desperation, worried that I wouldn't be able to stand through my own wedding ceremony, I went to a chiropractor. He checked me out - no xray or anything, just a physical exam - and did one adjustment, and I was ~80% better immediately.
So I can't speak for "subluxation" and all that, but I can give a hearty "blow me" to all the "chiropracty is just a scam" people. I have many friends I saw through medical school and into doctor-hood, and there are no fewer cult-like beliefs there - that the pharmaceutical industry and cutting on people are all-purpose good things. "Oh, just have a Caeserian, it's safer *and* more convenient!" Doctors accusing others of playing God is certainly the pot calling the kettle...
Chiropractic is total quackery. I met one of those ultra-religious, I-can-cure-anything chiropractors. The guy was a total jerk. He kept wanting me to believe in Jesus and go through all these adjustments to fix my back. He kept going on and on about how the medical establishment was holding back the truth of chiropractic. These people are nothing more than the rejects medical schools turn away with a history of paranoid-schizophrenia. I had a partial herniation of L5-S1. I went to an anesthesiologist, he injected some cortisone around the disc, and it got all better. Chiropractors are absolutely worthless.
Ernest,
Save your prattle about chiropractic for CureZone and all of the other alt-med boards you lurk on.
Bill A-4416, sponsored by Assemblyman Wilfredo Caraballo, puts patients at risk. As you are aware, this bill intends to extend the scope of Chiropractic. This extension is unwarranted, subjecting patients to sub-standard treatment which is a burden to their bodies and our healthcare system. By allowing unqualified personnel to profit from a provision of inadequate and potentially hurtful services, it will further tax a healthcare/insurance system that already faces a plentitude of challenges. The argument for the increased scope of practice for chiropractors is entirely illogical. In fact, it is completely self-defeating! Chiropractic is predicated on a philosophical thought system that was promulgated by, and attributed to, D.D. Palmer (a grocer) in at the turn of the 20th-century. A simple, yet accurate, representation of the "science" of chiropractic is as follows: 1) Bodily health requires the unimpeded flow of "Innate Intelligence" [a spiritual construct] throughout the nervous system. 2) Interrupted flow of neural energy/Innate Intelligence is the primary cause of all human disease (dubbed "The Silent Killer" by chiropractors). 3) Malpositioned vertebrae, or "subluxations," can impede the flow of Innate Intelligence by compression of nerve roots. 4) Correction, or adjustment, of spinal subluxations is the primary modality for the restoration of health in cases of all human disease and dysfunction. This unique thought system was, and still is, the hallmark of chiropractic care. The presumed ability to detect and correct subluxations of the vertebral column is the foundation of their profession. Herein lies some unavoidable difficulties. Firstly, this model of human health is completely separate from, and in contradistinction to, the basic sciences that modern medicine is based upon. Human disease has been found to be caused by a nearly inexhaustible number of factors (eg, viruses, bacteria, carcinogens, etc.). There is not a single scientist, physician or health care provider (outside of chiropractic) that would acknowledge a "spinal subluxation" (and resultant impediment to Innate Intelligence) as a causative agent in any form of human disease. The subluxation construct is entirely untenable in the face of current biomedical science. Secondly, a spinal subluxation is conceptual entity and not a physical one. Chiropractors have struggled mightily to define the ever-elusive subluxation because the renditions are so often easily dismantled by empirical study. In fact, they have defined subluxation in such a way that is totally different than the connotation of the term in medicine. Over 1,000 versions of subluxation definitions have been proposed without the chiropractic profession able to embrace any one of them. In order for them to treat peripheral (non-spinal) joints, it would have to be under the guiding principle of subluxation identification and correction. How can you have a subluxation (as defined by chiropractic) in a peripheral joint (it is a construct of neural flow and spinal column alignment)? By way of this legislature, Chiropractors would be "diagnosing" peripheral subluxations (given their distinct elusive definition) that truly don't exist. Subluxation is a legitimate medical term but it is entirely different than the chiropractic definition. In truth, a true subluxation is an absolute contraindication to manipulation! Along with "diagnosis" of peripheral joint subluxations, they would be administering a highly specific intervention (the crux of their profession), manipulation, to "correct" it. No all joints need manipulation and the comprehensive, appropriate treatment of any joint condition is most often multi-modal (ie, including many different types of treatment). Thirdly, why could a chiropractor adjust a peripheral (not the spine) joint when their foundational "science" declares that it is aberrations in the spinal column that are the problem? To treat a condition in periphery (not the spine) is to acknowledge a premise that is devastating to their central argument--skeletal dysfunction can develop in any articulation, or joint, from a multitude of factors and is often completely unrelated to spine. You can support one (ie, all disease stems from spinal subluxation) or the other (ie, disease causation is multi-factorial) but not both.
Given the above considerations, it is readily apparent that this legislation is rife with insurmountable problems. It is unjustified and unjustifiable.
FYI, "subluxation" is an actual medical term. It's used to describe (among other things) when a bone partially dislocates from the joint, typically such that it allows the joint to move in a manner it isn't supposed to. A lot of people who are "double jointed" just have joints that can easily sublux. (My little brother, for example, could sublux both shoulders and bend them back on themselves. I used to catch him sleeping on the couch, on his back, using his biceps as a pillow)
Anyway, it's a real term, but that's where the real medicine ends as far as chiropractors go. You can't "adjust" a subluxing joint (as far as I know) since it's usually caused by the surrounding muscles being loose. You sure as hell can't cure someone's allergies by fixing it either, unless they somehow got a peanut shell stuck in there or something.
A.S. wrote (emphasis mine):
That emphasized claim is the very pinnacle of naivete. You could try to make the same claim for every Tarot reader, palmist, and other variety of alleged psychic. Absolutely NONE of them have ever proved their so-called abilities, but they continue to thrive. I know of several such businesses in my area that have been running for decades. That doesn't mean that they can tell the future; it means that there is no shortage of gullible customers.
The problem is that many people possess an almost limitless ability for self-deception, and people like "psychics" and other woos are frauds who know how to take advantage of that -- or, sometimes, are equally deluded people attracting customers who believe as they do. Chiropractors can fall into either category also; however, I think that most of them fall into the latter category of the sincere, but sincerely deluded. Sure, they may still do some good; even a stopped clock gives the correct time twice a day. But that doesn't mean that they know what they're doing as well as they think they do.
~David D.G.
Reason #8437 why ALL laws requiring people to be licensed to do things should be scrapped. And they call this a free country. The people responsible for this law should be deported to North Korea, where they can live in a government-controlled paradise.
If you had a real job like me (BRICKLAYER) you would thank god for the training these DOCTORS recieve! But in all fairness there are good and bad examples in all types of carreers. You have shown witch you are.
Yeah! We should get rid of all those stupid laws that say I need eyes to drive a car, or that I need basic knowledge of the human body to do surgery! If a blind man wants to drive a truck at high speeds down the wrong side of the road, he should be able to![/sarcasm]
While I won't claim to speak for ALL chiros, I quit the profession after three years. I couldn't make a living without doing things I felt were immoral and/or illegal. I'm left with well over $100,000 in student loans, but I can sleep at night. I was a hell of a diagnostician, but if you don't feel every patient needs treatment for the rest of their life, it's tough getting by. Spending fifteen to twenty minutes per patient, referring patients out and having a treatment plan in mind doomed me to failure. I graduated from NYCC (New York Chiro) one of the less nutty schools and the vast majority of profs were bat-shiat insane. If you do see a DC, ask what the treatment plan is. If you don't get an answer involving reevaluation and an eventual end to treatment, run like hell.
My neck hurts, my back hurts. I go to the chiropractor and he manipulates my neck and back. I feel better. He doesn't claim to cure diseases. He just makes me feel better. Any idiot who believes that cracking their spine will cure their allergies deserves to be taken advantage.
I'm right on board with MetEnkeph. I left the profession after 6 years. I worked for one guy who sold Thousands of dollars of supplements to every patient or dropped them from care. Another guy went to jail for treating outside of normal limits and having a kickback scheme with an attorney.
In my experience, for every one good Chiro you find, you'll find at least ten crooks, charlatans, whackos, and cultists. Like Met, I referred a lot of people out, treated what I could and offered a lot of advice. Chiropractic is not a cure-all. Most of the seminars and elective courses out there are designed to bilk people out of money and maximize profits.
When you finish Chiro school you have a choice: You either stick to what you learned in school and fail with your conscience intact... OR, you abandon your morality and buy into the bullcrap of these so-called "Practice Management Groups". If your doctor belongs to one of these groups, RUN. Run now and run fast.
Having studied acupuncture for three years (no $, a trade-off for the teacher learning English), and being very familiar with all and sundry new age types 20 yrs ago, I must say that in the the "final analysis" learning how to give a good massage has many benefits. David DG, right on. CTD and Lizzard Lipps,wtf, extreme lais-sez faire libertarianism...you go girl. There was a major dividing of ranks in this city years ago re. proposed gov't regulation, among the shiatsu practitioners. Being in Canada, if it was gov't listed, you could get paid as a practitioner if it was recommended as "medical treatment", but it was "monitored" in a sense; thus the division. All of this stuff is based on the shifting sands of some philosophy, but there's no denying that a good is massage is a good thing. (This posting follows several pints).
Should it be a big deal to let Chiros manipulate extremities? In my opinion, no. It's a desperate move on their part. They are losing spinal manipulation, slowly, due to their dogmatic treatment (subluxation theory). And grasping at ways to maintain their hold on their pt base. This is also seen by their efforts to fight for the right to own the word 'manipulation' in terms of treatment. Can you imagine the APTA fighting (at the legislative level) chiros from using the word musculoskeletal or therapeutic exercise?
Physical therapists are doing the research, learning who, when and how manipulation should be used. We are also finding that it (contrary to the "physician" chiro mantra to the public) is:
1. Non specific. Pushing on T2 move T2 but also T3, 4, 5 and cephalicaly too.
2. It doesn't take an 'expert' clinician who has had years of training to have effective outcome from manipulation.
3. Not necessary to experience a 'pop' (cavitation) to receive good results.
4. Only a sub-group of pt's respond to manipulation (in regards to LBP).
The vast majority of this research on manipulation is coming from (and has come from in the past) physical therapists. Do a search for Cleland, Childs, Fritz, Flynn, Rainer, Delitto and more and it can be easily seen the effort our profession is putting into understanding this manual technique and how to properly apply it to a population to optimize outcomes.
Here is one example published in the Annals of Internal Medicine.
Please don't lump chiropracty and acupuncture together. I'm a third year acupuncture student, and the two are VASTLY different. Oriental medicine has been practiced for over 2000 years, and we don't do any physical adjustments to anyone. There have also been very extensive studies on the effectiveness of acupuncture and herbal medicine (we use 400 actual herbs in varying prescriptions). People try to prove us wrong all the time, and we come out on top because it does work (take a look at Elizabeth Wakefield and her fertility treatments). It's not a cure for everything, but treatments are extremely effective for a wide range of conditions. We don't say we're going to cure people of cancer or some other terminal disease, but treating their pain and many of the adverse side effects of many medications they're on and symptoms they have are very effective. People come to us as a last resort and are generally pleased every time because something finally works for them.
On balance (I think, although more evidence is needed) it seems that acupuncture does provide some minor pain relief. I'm not sure if there's any evidence is this is greater than that obtained by taking a normal painkiller, though. To my knowledge, there is absolutely no evidence that acupuncture do anything other than this minor pain relief, and no reason why there should ever be any.
Anyway, as long as acupuncture retains the chi energy and meridian-type crap, which are just purely unsubstantiated ancient dogma, it will never be scientifically respected. If acupuncture works, it is because of physical interactions with the body, not metaphysical woo. A scientific version of acupuncture would immediately shed such concepts but, as far as I'm aware, acupuncture still always comes with a good side-order of woo.
I certainly don't believe that anyone without proper medical training should be allowed to prescribe active drugs such as herbal medicine, which can have bad side-effects when combined with other standard medication, as well as having inconsistent dosing and, in some cases, being prescribed in doses above that which are known to be safe.
For all you non-believers check out pub-med for legitimate research in the area of CAM. As with all research there is some that supports and some that does not. I can attest to my personal success with chiropractic medicine when medical doctors failed. If you check the statistics of success for surgery of chronic pain associated with spinal issues you would run to the nearest chiropractor long before ever having surgery. The evidence is available as to the efficacy of CAM. I would never wish chronic pain on anyone, but in the event you ever experience such pain you may find yourself chewing your own toe nails.
@Hughb,
Sad to say, PubMed has been forced, through political pressure, to index a lot of uninformative magazines; i.e., those supporting quackery. One needs more than an internet browser to find reliable material there- one needs some basic understanding of the subject.
I'd also like to come to the defence of chiropractors, although I'm Australian and it sounds like there are some differences in training and regulation between here and the USA.
First off, I have a bachelor degree in medical science, so I generally like to see good scientific evidence supporting any therapy, and I usually agree with Orac's views of other forms of woo. However I have been seeing chiropractors regularly since I was very young, following my parents experiences with it dealing with their long term back pain, and I wouldn't want to go without it now.
I agree with a post above that the real key is to find a good chiro. Mine have always been very clear about the limits of what they can do, and have always referred myself and my family on to other professions (GP, physiotherapist, etc) if they found that the problem was not within their scope. There are some chiros here in Australia that also practice accupuncture or natural therapies, although I prefer the ones that stick to re-aligning my spine and other joints. They never claim to fix any problem that isn't clearly related to misalignments of the spine and associated impingement of the nerves. I've never heard any of mine use the term "subluxation" either.
I've had problems with lower back and neck pain, including one extremely painful episode with a pinched nerve in my neck that left me stuck looking over my left shoulder, that my chiros have dealt with quickly and surprisingly easily. I'm pretty sure all my GP would have done is give me painkillers, which would have been a temporary solution at best.
I'm not sure exactly what the differences in training are between Australia and the US, but I get the impression that chiros over there are able to get away with more outlandish claims than they can here. Like most professions there are certainly bad ones out there, but there are also a lot of good ones, you just have to find them.
The evidence is available as to the efficacy of CAM.
You apparently have never read this blog before.
I do think chiros help with ACUTE pain. My husband (a PT) uses spinal manipulation to help those who are in pain and it does tend to help some of these people. It is NOT however, a good long term treatment. That's why people feel good for a few days and need another adjustment. It's like giving someone an aspirin and telling them it's 'curing' their brain tumor because the pain is lessened!
I equate chiropractors to optomitrists. Many of them aren't skilled enough to operate, so they become "unskilled" labor in their "field."
I had a bad experience with an optimist, and I will NEVER go back to one.
I had a bad experience with a chiropractor, and I will NEVER go back to one.
Before you make an appointment with a chiropractor, go see an osteopath (bone) doctor, and ask him what he thinks of chiropractors. If he has a positive attitude towards them, then ask him to recommend one to you.
CTS,
The only things for which chiropractic may work are acute low back pain, and some headaches. In these, it seems as effective as PT or massage.
However, you have brought up a problem. What is a PT "manipulation" vs. a chiro "adjustment?" In 2005, the Arkansas supreme court upheld a $10,000 fine levied by the chiropractic board on a PT. He said he manipulated the patient's back; but they claimed he "adjusted" it.
Joe, I don't think there are a lot of differences. It's a matter of what a provider is *claiming* here. This was an argument of semantics. It makes perfect sense that the chiros want complete control over spinal adjustments and they have a lot of power to keep it that way. PTs are trained in spinal manipulation but do not claim it is the 'cure all' that chiros do. It is usually just one tool of many that they use. I believe in this case the chiros were caught bribing the law makers making this decision as well. So there's that.
CTS
Emma said (but with my emphasis):
Emma, I'm delighted that your manipulations Down Under (egad, that sounds dirty -- sorry!) have been helpful to you. It seems that the chiropractors you've dealt with are relatively aware of their limitations -- certainly far more so than those who claim that ANY AND ALL maladies are "clearly related to misalignments of the spine and associated impingement of the nerves." I have known quite a few who claimed exactly that.
But these people are hardly an aberration in the field, and I don't think it's confined to the U.S, because it's part of the core philosophy of chiropractic. The ones who hold this notion get it from their chiropractic teachers and textbooks. There are some who still accept the germ theory of disease as well, but it's frightening to see how many have decided it's just a scam perpetuated by Big Medicine and that subluxations (whether referred to by that term to the patient or not) are the only real cause of illness.
~David D.G.
I think it's unfair to lump all Chiropractors together as quacks. Many in the profession will distance themselves from those who claim Chiropractic can and will cure disease, allergies, etc. We don't claim that all MD's are quacks because many often times misdiagnose patients, or prescribe medication that does no good for the patient.
Hubby and his relatives see chiropractors, and are fairly convinced of their efficacy. (His aunt is totally loopy with the alt-med stuff, but everybody tries to ignore her when she gets on a rant. She's different.) Hubby has a congenital fusion in his spine that has always given him trouble; it's not really something worth fixing, but it does give him some pain, and chiropractors have been helpful in helping him with the acute pain when it gets bad. But I've heard them espouse things that are complete garbage, and I know they're learning it at school. The shallowness of their educational background is sometimes quite shocking. One clearly had no awareness of the germ theory, not even realizing that an infection could cause a sinus headache. He thanked me for mentioning that (it was really an offhand comment) and said he'd keep that in mind.
Amazing.
I can believe that an ethical chiropractor will have a hell of a time putting food on the table. That will probably only get worse as insurers start to cover it (ironically) for the same reason that family practice MDs are having trouble now. Those general services get negotiated by the insurer to be very cheap, and so you can only make up the loss with higher-return procedures. X-rays, bloodwork, etc. Chiropractors have a much shorter list of procedures that they can bill for, and an ethical one will have problems exploiting that particular revenue stream (and with good reason).
It's a catch-22. We want the bad chiropractors to be caught and shamed out of business like the charlatans they are, but it's really only the good ones that end up suffering (in part because the bad ones are unscrupulous enough to compensate).
The good quacks practice procedures that are about 2000 years out of date.
I am currently a practicing licensed chiropractor and by looking at the majority of the comments on this board most of you people are just plain ignorant. Sure some chiros are quacks, but to label all chiros quacks is completely uncalled for. Check out the prerequisites just to get into chiropractic school http://www.bridgeport.edu/pages/2575.asp . First of all you need a 4 year college degree. I am guessing a large percentage of you who wrote negative comments on this board do not even qualify. The first 2 years of chiro school are basically the same curriculum as an accredited medical school- to see the curriculum go here http://www.bridgeport.edu/pages/2563.asp The last two years are just as rigorous but focus on clinical work. A four part national board test is required to pass in order to obtain a doctor of chiropractic degree. A doctor of chiropractic is recognized in all 50 states of the US. There is plenty of research that shows that chiropratic is an excellent treatment for acute and chronic low back and neck symptoms. Of course as in any profession you have to know your limitations and if a chiro tells you that he can treat cancer, asthma, colds, flus, viruses, infertility, smoking, brain/ organ problems, etc., then tell him to go fuck himself and shoot himself because he is why the chiropractic profession gets a bad name.
Chiropractors are specialists in low back and neck problems. Your primary care Medical doctors are not, however you don't know this. So 90% of you with neck or low back pain will go to your own medical doctor set up an appointment, wait an hour in his waiting room then in five minutes he will look at you and write you a prescription for anti inflammatories and tell you to see an orthopedist. So you take the pills and go see your orthopedist (who is the expert "god" of neck/low back pain). However, he is a surgeon he makes his money doing surgeries, and like with all professions business comes into play. He will send you to get an xray, then MRI, then give you injections into your spine (epidurals).
If you don't want to take meds, get injections into your spine get ulcers from meds, and want to see if there is anything non invasive that can be done first then you should see a chiropractor or physical therapist. But better yet you should find a facility that has both together. The chiropractor will do a full examination, take the proper x-rays and determine what is causing your problem. If the xrays do not show what the problem is, the chiro can write a prescription for an MRI. Physical therapists do not do this. The "good" chiro will then determine what your problem is i.e. herniated disc, bulging disc, sciatica, radiculopathy.... then individualize a treatment program and a time table with re-evaluations every 4 weeeks. If there is no improvement during this time the chiropractor will then refer out to an orthopedist. The good news is that 90% of patients with low back pain do not need surgery, though unfortunately most see the surgeon first and have unsuccessful surgery before going to see a chiropractor or physical therapist. It's sad that chiropractors get this bad rap when we have the best non invasive therapies that are very effective and more cost effective than surgeries or needles.
P.S. For those people who think that adjustments of the spine and extremities are quackery despite the research, Physical therapists commonly manipulate and so do medical doctors known as known as doctors of osteopathy. Many of you have gone to your medical doctor and you may not have even noticed that he is really a DO not an MD. A DO can do anything an MD can but a DO commonly manipulates patients. Some MD's manipulate patients also- it is not referred to as adjusting, it is referred as an osteopathic manipulative therapy. In order for an MD to get certification he has to go to a class for one weekend. Then he can adjust you. Chiropractors happen to be experts in the adjustment/ manipulation of the spine or extremities. Chiros have had extensive training hours in manipulation techniques where as any other professions have had a fraction of the training, yet they still perform these techniques on their patients.
JP, see a major survey of chiros, by chiros: William P. McDonald, et al "Seminars in Integrative Medicine" 2004, Vol 2 No, 3, pp. 92-98. The survey showed 90% thought subluxations are real and that adjustments should not be limited to the musculoskeletal system. In other words, 90% make the rest look bad.
Go to Quackwatch and read more. The articles include undercover investigations and telephone surveys showing rampant quackery in the chiropractic cult.
"Students often enter chiropractic school with a Bachelor's degree, but, in 2005, only one chiropractic college required this as an admission requirement. [7] The minimum prerequisite for enrollment in a chiropractic college set forth by the CCE is 90 semester hours, and the minimum cumulative GPA for a student entering is 2.50." -from Wikipedia.
And why aren't any chiro schools associated with regular colleges? Hummmm.
Here's a good website: www.chirobase.org/01General/skeptic.html
"Know before you write" wrote (URLs snipped):
I have personal experience that says otherwise. I worked at Parker Chiropractic College, which at the time claimed to be the third-largest chiropractic college in the world. There was normally an entrance requirement of a 4-year degree, but I personally knew several students there who had associate's degrees (either including the necessary biology classes or adding them on, which is the main thing the school wanted people to have had training in) and had obtained waivers for the rest, so this "requirement" was not set in stone. One only needed the proper papers to obtain a waiver: lots of them, with little portraits of dead presidents on them. The school was loath to turn away anyone who could afford to pay tuition, whatever their previous academic accomplishments.
The comment suggesting that many of us commenting on this board "might not even qualify" for chiropractic college is not only a cheap shot, but wildly irrelevant as well.
Also, Parker College had a 3-year degree plan for its students. Supposedly they just crammed a 4-year plan into three years, but I never bothered to do a comparison with traditional medical school requirements.
However, it's a comparatively minor issue, since the real problem is the drivel that the chiropractic college itself teaches (either institutionally or simply from some of the more wild-eyed professors), not the level of education the student had obtained beforehand, which in all probability was better grounded in reality.
Thank you for recognizing this. Unfortunately, many of your colleagues believe otherwise, and some have even had official brainwashing of this sort from their teachers (or have been the teachers doing the brainwashing). However, chiropractic was only ever two steps away from witchdoctoring to start with, so it's not surprising that its practitioners often have no inner "BS detector" to recognize when a concept is even more deeply steeped in woo than chiropractic itself.
Riiiiight, unlike chiropractors, who merely expect you to come in for regular adjustments for a lifetime -- nothing there motivated by capitalism whatsoever.[/sarcasm] Come on! "Business" concerns are going to influence medical doctors no more than they are going to influence chiropractors, at least as a class. There undoubtedly are some who are larcenous, but don't try to claim that this doesn't apply at least equally to chiropractors.
~David D.G.
David, great comments. I'm still laughing!
CTS
"Joe, I don't think there are a lot of differences. It's a matter of what a provider is *claiming* here."
CTS, I had tried to reply to this in my post to JP, but the system rejected it. I agree with you. This is the second time that a character string in something I wrote was rejected.
Go back and read the posts made by myself and MetEnkeph. We've lived it!
I went originally decided to go to Chiro school because I wanted to help people without subscribing to the doctrine of the pharmaceutical lifestyle. I thought I could really help people without messing with their internal chemistry and a lifetime of drugs.
I still believe that, but to a much more limited extent. Do manual manipulations work? Yes. Does anybody really know why? Not really. You can read all the articles in JMPT, NEJM, and all the others... but nobody really, truly understands how it works. Of course, aspirin was originally a folk remedy as well.
I think it all boils down to two things:
1. Chiropractors absolutely suck at research. The majority of the profession is stuck in the dogmatic teachings of the past and lack an eye for the future. If you want to make the claims, then you have to prepare the detailed notes and research studies like the MD's and PT's do. You can tell me you did it, but be prepared to tell me how you did it as well.
2. Chiropractors are their own worst enemies. For all the good that can be done, you see at least twice as much negative. It makes me sick to hear all the stories of "three visits a week forever" and "he said he could cure AIDS". I provided acute care and then drastically cut down the schedule of care. I believe the human body needs the occasional "tune-up", based on your lifestyle and activities. I also believe that we need to consult our physicians regularly, watch what we eat, exercise, and get 8 hours of sleep. Yes, the occasional manipulation can help "un-do" some of the postural things we do to ourselves, but it is never the exclusive solution to the equation.
ProfT, others-
When people talk about the sudden relief from chiropractic - note well it's not chiropractic "homeopathy" or "applied kinesiology" they're talking about - it's spinal manipulation.
This is a treatment used by DOs and DPTs as well - but they use it as just one tool in a larger bag of tricks and they use it in a scientifically responsible way in accordance with the evidence (of which the best is designed, conducted, and reported by physical therapists).
So, the one good treatment they offer is administered in a responsible way by others. Plus by all accounts they administer several other crazy treatments.
To respond to "Know before you write" - who claims that a chiro will diagnose your disk or joint problem with imaging studies...the preponderance of literature shows that imaging tests aren't useful in treatment or diagnosis of mechanical low back pain, and that imaging early usually leads to earlier and more frequent surgical treatment (which has a very poor track record).
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&T…
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&T…
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&T…
So why does the medical system need chiropractors???
For the most part, I do not like to comment on issues that carry emotional tone and use experiences for fact.
However, as a chiro (also with an MBA before chiro college) I can make a few hopefully rational comments. I for one am a chiro that thinks the subluxation concept is BS. It is a drawback to the days of DD Palmer's son, BJ Palmer who unfortunately turned the profession, or at least a part of it, into a philosophy driven one. Fortunately, the heavy duty philosophy part of the profession is a minority. Unfortunately, the majority of the profession gets lumped with them. THe old 20% rule-20% of the people cause 80% of your problems.
1. The subluxation concept is antiquated and even as a syndrome it detracts from what the profession does.
2. Yes, as an ethical chiro I have always struggled financially. I fix patients and send them on their way and refer them to MDs/DOs when appropriate. I don't have magical visits as promulgated by practice management gurus.
3. Manipulation is an effective treatment modality for mechanical joint problems-it must be even the PTs and MDs are jumping on the band wagon. Research by chiros has been limited by their lack of access to funding-controlled by the medical establishment and pharmaceutical industries. When research does come out in support, the money and control elements of the medical establishment start claiming they are the ones who should do the manipulation. Generally speaking, research shows chiros do most of the manipulations in this country and are probably better skilled at it - if only they'd keep their mouths shut about the philosophy BS.
4. THe profession must change and eliminate its bad apples and stop claiming crap it can't do.
5. The profession will struggle to survive if it does not upgrade its image.
6. Chiros do stupid things. So do MDs, PTs, massage therapists, etc. etc. Unfortunately, chiros say more stupid things than MDs, DOs and PTs do. I had a nurse recently tell me that a chiro she was seeing did not belive in medicine and she did herbal treatments for lymes disease for 4 months. I hear that "I don't believe in" chiros, MDs ,etc. BS a lot. It is not a belief system-it's a health care system for crying out loud. It either works or it doesn't-allopathic or chiropractic. I told her he was irresponsible as this needed antibiotics and no CAM procedures I know of have been shown to fix lymes disease. Fortunately, she finally got on antibiotics. The chiro was stupid. Chiros do kill less people being stupid than other professions.
7. THe push for the buck is prevalent in all professions. How many unnecessary surgeries are done every year just so some MD can buy his Mercedes? I see a lot. Surgical professions have cut happy doctors as well.
8. I see one of the chiros problems as bying into a philosophy without really understanding of what a philosophy of health care is all about.
9. There is a lot of research emerging supportive of manipulation as an effective treatment modality. THere is no research emerging showing chiropractic philosophy as an effective treatment modality. The philosophical group has purpose and passion obfuscated by BS most of the time.
10. Unfortunately, lack of integration with the mainstream medical establishment has made chiros have to drive for patients and research.
11. By the way, the chirobase readers should be highly cautious of their BS-these guys are not objective in any way, shape or form. THey are on a mission and do point out our bad apples but they are not rational nor objective and were even censured by the NZ people. You basically have an organization on a quest. Don't get me wrong, they make a lot of good points. But objective they are not. Numerous research studies could come out and they'd still continue their poison. They need to get a life.
For the most part, I do not like to comment on issues that carry emotional tone and use experiences for fact.
However, as a chiro (also with an MBA before chiro college) I can make a few hopefully rational comments. I for one am a chiro that thinks the subluxation concept is BS. It is a drawback to the days of DD Palmer's son, BJ Palmer who unfortunately turned the profession, or at least a part of it, into a philosophy driven one. Fortunately, the heavy duty philosophy part of the profession is a minority. Unfortunately, the majority of the profession gets lumped with them. THe old 20% rule-20% of the people cause 80% of your problems.
1. The subluxation concept is antiquated and even as a syndrome it detracts from what the profession does.
2. Yes, as an ethical chiro I have always struggled financially. I fix patients and send them on their way and refer them to MDs/DOs when appropriate. I don't have magical visits as promulgated by practice management gurus.
3. Manipulation is an effective treatment modality for mechanical joint problems-it must be even the PTs and MDs are jumping on the band wagon. Research by chiros has been limited by their lack of access to funding-controlled by the medical establishment and pharmaceutical industries. When research does come out in support, the money and control elements of the medical establishment start claiming they are the ones who should do the manipulation. Generally speaking, research shows chiros do most of the manipulations in this country and are probably better skilled at it - if only they'd keep their mouths shut about the philosophy BS.
4. THe profession must change and eliminate its bad apples and stop claiming crap it can't do.
5. The profession will struggle to survive if it does not upgrade its image.
6. Chiros do stupid things. So do MDs, PTs, massage therapists, etc. etc. Unfortunately, chiros say more stupid things than MDs, DOs and PTs do. I had a nurse recently tell me that a chiro she was seeing did not belive in medicine and she did herbal treatments for lymes disease for 4 months. I hear that "I don't believe in" chiros, MDs ,etc. BS a lot. It is not a belief system-it's a health care system for crying out loud. It either works or it doesn't-allopathic or chiropractic. I told her he was irresponsible as this needed antibiotics and no CAM procedures I know of have been shown to fix lymes disease. Fortunately, she finally got on antibiotics. The chiro was stupid. Chiros do kill less people being stupid than other professions.
7. THe push for the buck is prevalent in all professions. How many unnecessary surgeries are done every year just so some MD can buy his Mercedes? I see a lot. Surgical professions have cut happy doctors as well.
8. I see one of the chiros problems as bying into a philosophy without really understanding of what a philosophy of health care is all about.
9. There is a lot of research emerging supportive of manipulation as an effective treatment modality. THere is no research emerging showing chiropractic philosophy as an effective treatment modality. The philosophical group has purpose and passion obfuscated by BS most of the time.
10. Unfortunately, lack of integration with the mainstream medical establishment has made chiros have to drive for patients and research.
11. By the way, the chirobase readers should be highly cautious of their BS-these guys are not objective in any way, shape or form. THey are on a mission and do point out our bad apples but they are not rational nor objective and were even censured by the NZ people. You basically have an organization on a quest. Don't get me wrong, they make a lot of good points. But objective they are not. Numerous research studies could come out and they'd still continue their poison. They need to get a life.
Quiet Chiro-
I've been hearing this "chiropractic is at the crossroads" and "it's just a few bad apples" routine for a long time now. If your profession hasn't changed by now, do you honestly think it "ever" will?
The largest chiropractic schools are still the ones most heavily into philosophy. For example, Life University. Even if you say you reject subluxation dogma, you still are no better prepared to address a wide variety of needs of your patients in the physical medicine realm since the treatment is focused on manipulation, which we know through research will only help a certain percentage of those with back pain anyway. If all you've got is a hammer, everything looks kind of "nail-ish", right?
The folks at the Chirotalk discussion board are all former DCs and they are even more critical than the fairly even-tempered group here. They are no more biased than chirobase - they adhere to HONCode procedures and nothing i've read on Chirobase wasn't verifiable. The truth hurts, etc.
We probably need to realize that the "good chiros" got that way in spite of, and not because of, their education. The question for the health and licensure systems is "why put up with this woo if they don't offer anything useful and unique?"
It's the same basic argument put forth by Sam Homola DC in his recent article about chiropractic here:
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&T…
Any takers on answering that big question?
At this forum http://72.32.2.238/forumlive/forumdisplay.php?f=7 we have a thread on "chiropractic woo." Maybe the chiros posting here would like to register there, and start a thread "chiro is not woo."
That's just the problem, Joe. At least half, if not 3/4 of it is WOO.
I was talking with a friend of mine who is working on a doctorate in PT. We discussed the merits of manipulation, et al. What follows is her opinion: "Manipulation, particularly of the spine, is valuable and Chiropractors are undoubtedly the most skilled manipulators. The problem is in the actual practice of Chiropractic".
Let me expand: The training Chiros receive in manipulation is the most extensive and comprehensive in the medical and quasi-medical realm. Chiro students being learning the skills of palpation and manipulation on literally the first day of classes. The problem lies in the execution of those skills. I have a close relationship with the Chief of Staff at one of the larger / older Chiro schools in the country. We've had long discussions and compared notes -- He works as an expert witness and I do some work as in Insurance Reviewer -- and our findings are shocking. The majority of DC's out there have strayed from their training and the mainstream of the academic community. The profession is rife with hucksters, snake oil salesman, and flat-out con artists. I'm doing my part to limit the damage, but less than 5% of all claims ever get reviewed.
On a side note: Joe, I couldn't access the alternative thread you posted. I'd like to participate in the Chiro is Woo thread -- if only to help separate the Woo from the Non-Woo within the field.
@ ProfT,
Sorry, the link works for me. If you google the "James Randi Educational Foundation" or try http://www.randi.org/ you should be able to find the forum. The discussion is also known as the "JREF Forum." The appropriate subforum (IMO) is "Science, Mathematics, Medicine, and Technology."
Prof T-
While chiros certainly get more training in manipulation than others, there's no evidence that extensive training makes any difference AT ALL in outcomes - in fact the manual diagnosis methods you refer to are notoriously low in reliability and the most powerful evidence for the efficacy of manipulation (again, done by DPTs) shows that these techniques weren't necessary in deciding who could benefit from a simple manipulative technique:
Childs JD, Fritz JM, Flynn TW, Irrgang JJ, Johnson KK, Majkowski GR, Delitto A.
A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study.
Ann Intern Med. 2004 Dec 21;141(12):920-8.
This validation study (and the original randomized controlled trial that came before it with similar results) shows a few things of interest to the group:
1. manipulation can be used in one subgroup of patients with low back pain to great effect
2. it doesn't work for everyone, and a physical exam can predict who will improve and who won't
3. extensive manual diagnosis (and DOs and DPTs have these skills as well) techniques did not aid in the prediction or use of the manipulation, which can be learned in about 30 min.
4. Like many things in medicine, it isn't the actual application of the treatment that matters, it's knowing who to use it on and when and why that's important. Only a scientific and evidence-based approach to manipulation can provide this, and chiropractic's approach of "one size fits all" is not only counterproductive, but clearly in opposition to the published research.
If DOs and DPTs do manipulation more responsibly and do the good research on it anyway, then why should the health care system keep the chiros?
Thanks JLS
I think you missed the point of my comments. I'm not saying that training is the entire equation, merely a part of it. There are countless studies that like to link cervical manipulation with stroke and dissection of the vertebral basilar artery. Proving that you can prove anything with statistics, the people who quote these studies often overlook the source of the manipulation.
Yes. Chiropractors do, on occasion, produce this phenomenon. The incidence relative to number to actual manipulations is extremely low. In fact PT's, MD's, DO's Massage Therapists, Hair Dressers, Karate Teachers, Dentists, and scores of others have higher rates of causing strokes and VBAI incidents.
As stated many times before, I'm NOT a supporter of the profession. I'm a disgruntled former Chiro who hates the professional aspect of the discipline. Let me draw a parallel. I'm no fan of my first divorce attorney, or the majority of them... but I can still see the value of the discipline. Yes, other lawyers could effectively litigate the average divorce case but sometimes its better left to someone who has seen it a little more.
@ ProfT, if you want to look at the "chiropractic woo" thread, it is under "General Skepticism and the Paranormal" http://72.32.2.238/forumlive/showthread.php?t=85436
You wrote "Yes. Chiropractors do, on occasion, produce this phenomenon [stroke, Joe]. The incidence relative to number to actual manipulations is extremely low. In fact PT's, MD's, DO's Massage Therapists, Hair Dressers, Karate Teachers, Dentists, and scores of others have higher rates of causing strokes and VBAI incidents." It is incumbent on you to cite reliable literature demonstrating those assertions. And demonstrate that the neck-snap does something important that cannot be achieved, otherwise, more safely (a risk/benefit analysis).
You also wrote "That's just the problem, Joe. At least half, if not 3/4 of it is WOO." Above, I cited a study of chiros, by chiros, that the figure is closer to 90% woo.
Let me address your criticism one point at a time.
1. Regarding Literature: My response was brief and made while I was literally on my way out the door. It was not intended to be a definitive dissertation on the subject. If you want definitive research, view any and all of the literature produced by the National Chiropractic Mutual Insurance Company (NCMIC). While it is fair to say we can't always trust the AMA, I think we can safely trust the stats generated by this company regarding stroke. After all, it is their MONEY that is at stake in these claims.
2. Regarding Statistics: I will not debate the statistics with you. Any approximation of "WOO" is, by definition, non-scientific. The "BEST PRACTICES MANUAL" has been in the works for several years and will serve as the new defining standard within the profession. That still does nothing to combat "WOO" because "WOO" is a non-specific term. Not long ago things like aspirin and germ theory were "WOO". I will agree that many practices currently used are bogus, but establishing an exact co-efficient of "WOO" is tied more to your personal beliefs than scientific fact.
3. Regarding Manipulation: I realize this is inductive logic, but IF there is such little benefit to manual manipulation of the spine and extremities I must ask: WHY is there such a rush within the PT and MD circles to embrace the practice? Many people on this thread are extolling the virtues of the DO. Do you realize that less than a century ago the MD's tried to wipe out the "Bonesetters" until they relented and were absorbed into the medical mainstream? The bottom line is that manipulation has shown benefit and is a viable means of treatment in SOME cases of back or joint pain.
4. Regarding Calculus: I keep reading about "long-term outcomes". YES, in the long-term one treatment is as good as another. Manipulation is as good as rest, drugs, prayer, or PT... in the long-term. What we are overlooking is the INTERIM OUTCOME. That is, we need to reference the calculus term "area under the curve". While the beginning and end points are the same, patients who were manipulated (regardless of practitioner) show more relief on a more immediate timetable. I apologize for not having the specific reference here -- I am busy with other obligations -- but these specific references can be found in the materials for Logan College's Insurance Consultant / Peer Review course as taught by Dr. Scott Hainz. I realize it is easy to throw out concepts and courses, but also promise to look for these materials at my earliest convenience.
5. Regarding Chiropractic Woo: I believe we have missed one key concept thus far in this discussion. There is a profound difference between what is taught and practiced in the schools and what is practiced in the "Real World". Many of the schools are tightly regulated by the Council of Chiropractic Education and State Educational Boards. Many of the schools have formed partnerships with local Medical Schools. Logan College near St. Louis, MO shares faculty with Barnes-Jewish Hospital, St. Louis University, Washington University Medical School, and the Greater St. Louis Veteran's Administration Hospital. The WOO comes from Practice Management Groups and Proprietary Technique Peddlers. These two groups have muddied the waters to the point where the profession is beyond redemption. The schools produce well-educated, scientifically-based practitioners who are far outnumbered the the existing charlatans, con artists, and salesmen. These new docs are blank slates who see the success of these cons and are often lured in by the call of "easy money" wrapped in the guise of providing care and helping people.
Unless I find the necessary references in my library, this will be my last post on this thread. While never a fan of the profession, I find my self backed into the position of defending Chiropractic. With this parting shot, I ask you all to PLEASE separate the Concept from the Practitioner. While many doctors out there are absolute quacks, I'd like to set that aside and have an intelligent discussion about the potential merits of manipulation as a treatment modality. All else is promenade.
Hello ProfT.
First, I'm with Joe in that if you;re going to make claims in direct opposition to the published medical research (regarding chiros and incidence of stroke) then you're going to have do more than make vague allusions to research located in a chiropractic school.
Second, on the woo topic - your contention of the scientifically trained well meaning DC limited to physical medicine being the rule and not the exception has also been refuted by several "chiropractic" authors. Especially regarding your contention of good information being passed in school and then people being poisoned by the few "evil practice management groups". If you ignore your own internal data from other DCs which has been published, then I'm not sure what can be said to convince you. Perhaps you feel what you've said is true just because you've said it. Fair enough, I suppose.
Third, on manipulation - PTs and MDs have been doing this for a long while, and it goes back at least to 1921 (published) in the PT world. How is that a "rush to embrace"? I agree with your bottom line of manipulation being useful in some patients, but you haven't answered the basic criticism of who takes a scientific and evidenced based approach to it (PTs) and who doesn't (DCs).
Fourth, on education - your citation of a few chiro schools having a few weeks of field trips to real hospitals in unconvincing. Both PTs and MDs/DOs spend time in real hospitals with real sick people practicing treatment and patient management while being supervised. Chiro internship consists primarily of people the student pays to come in to the intern clinic. I'm not kidding about this, and it's been documented elsewhere extensively.
Sources and interesting reading can be found at this published article here:
http://jmmtonline.com/documents/v15n2/EditorialV15N2.pdf
Fair warning, it contains published peer-reviewed evidence that directly contradicts what ProfT has stated here. Other interesting resources have been collected at the Chirotalk discussion board by current/former chiropractors as well.
Regarding your parting shot of separating the concept from the practitioner - science already has done this. Manipulation is used in a scientifically responsible way by some groups (DOs, DPTs) already. So the question stands, why do we put up with the chiropractic sham?
@JLS
Please limit your sarcasm and name-calling. I was trying to bring the perspective of an insider to this debate. I was trying to add some detail from someone who has lived this struggle. I have already apologized for not having my research immediately available. Please allow me a little time and COURTESY to search my library for the necessary materials.
Also, I don't know if you actually read my posts or skim them and make attacks, but I'm actually ANTI-CHIROPRACTIC. That is correct, I am against nearly everything the profession stands for, represents, portrays, and markets. Furthermore, I have made the contention that the MAJORITY of active chiros in this and other countries are hucksters, etc. It is my belief that only about 5% of the active docs out there are doing it the right way. I'm sorry I don't have a formal study or notarized note from my Mommy... that is just my opinion, formed through a decade of schooling, six years of practice, and countless paper reviews.
Regarding the "rush to embrace" - That phrasing and belief comes from a colleague of mine who is actively pursuing her DPT. Manipulation has become a hot trend in PT seminars and has been expanded in the curricula. It is a trend dictated by market dynamics -- Chiros make money doing it, but the PT's feel they can do it just as well and work better within the medical establishment. I think they are right. I have elected to defer to someone more expert than I. I find it insulting that you automatically assume that all PT's take a science-based approach and all DC's are non-scientific in nature. Blanket statements like that are the exact sort of thing you rail against myself and others for making. Where, in fact, is your study or reference documenting your statement? PT's are just as susceptible to the god complex as DC's.
The Chiro School Intern program, in most cases is a joke. I cannot contest that. Each school has multiple locations, run by multiple practitioners. A few are good, a few are acceptable, and most are a disgrace. I was unqualified when I left school. Most of my classmates will tell you the same thing. I chose to work for established docs and didn't lay a hand on a patient for six months after I graduated. Sadly, that is not the consensus in the profession. The real truth is that I didn't know my head from my butt (figuratively, not literally) for about two years after I graduated. On this point, you are absolutely correct. I have actively lobbied my alma mater to change the process to no avail.
Personally, I think that the chiropractic profession will be dead in ten years. It should have died a long time ago. The love affair with dogma and "belief" has worn out its welcome. The schools are full of objective, evidence-based docs whose checks are signed by philosophers and salespeople. Quoting one chiro college Chief of Staff: "You know the problem with Chiropractic? It's the damn Chiropractors."
@ ProfT,
Your posts present a mind-boggling array of self-contradiction, and unsupported claims. I keep trying to get you, and any other chiro proponent, to move to a forum where there is a more robust process for discussion (http://forums.randi.org/forumindex.php).
I was prepared to compose, here, a comprehensive critique of your posts; but a blog is not set up to facilitate that. Also, I am beginning to doubt that you will benefit from educated reason.
To whom it may concern,
Please excuse little ProfT and allow him a little time to search his library for the necessary research materials. He had it all prepared on time but was attacked by a vicious skeptic on the way home from school.
ProfT will stay in his room all weekend or as long as it takes for him to complete the assignment.
Sincerely,
Mrs. ProfT
ProfT-
I agree that you and I are essentially on the same page re: chiropractic, however my pointing out that you are making contradictory statements and that the published research doesn't support several of your points hardly qualifies as an attack. I concede the sarcasm. :)
I'm hard pressed, in rereading my posts, to find even a disagreeable tone, however. Such is the nature of online communication, I suppose.
My reference the relative approach of PTs vs DCs in manipulation is reflective of the research in the area, and I didn't imply an all or nothing approach. All "god complex" aside, I think it's fair to judge this matter by the relevant published research and the established content of educational curricula - don't you?
Chiropractic is about improving our health and it is well-rounded. IF you research the subject you may find this out. It involves encouraging our nation and world to engage in exercise, improve nutrition, prevent health problems, etc. Manipulation is part of it but not the whole picture and Chiropractors will agree. Health is a multi-variable subject - there are many areas to condsider. Movement is beneficial for the human body. When joints and muscles lose the ability to work correctly, many health problems may result in time -You don't need scientific journals to prove this.
From -
Concerned Man
Chiropractic is about improving our health and it is well-rounded. If you research the subject you may find this out. It involves encouraging our nation to engage in exercise, improve nutrition, prevent health problems, etc. Manipulation is part of it but not the whole picture. Health is a multi-variable subject. Movement is beneficial for the human body. When joints and muscles lose the ability to work correctly, many health problems may result in time - You don't need scientific journals to prove this.
From -
Concerned Man