The silliest kerfuffle ever?

I'm Dr. Horrible. I have a PhD in Horribleness!

I'm Dr. Horrible. I have a PhD in Horribleness!

Is that the new catch phrase?

I'm a medical doctor. I never use my title outside the context of medicine. Patients call me "Doctor" but the parents of my son's little league teammates call me "David." I'm perfectly happy addressing a PhD in education as "Doctor" when the discussion is education-related. But people who expect to be respected in all aspects of life based on a narrow accomplishment are arrogant.

Makes me think of Ducks Breath Mystery Theater's "Ask Dr. Science"
"and remember, he's not a real doctor"
"I have a master's degree...In science"

I'd bet my bottom dollar that if it was Sen.Biden himself they would be more than happy to call him 'doctor'.
This smacks of sexism to me I'm afraid. Still socially unacceptable for a woman to appear more educated than her husband when they are in a prominent public position.

Context. Damn it, how about a little context?

The AP guide is founded, way back when, on a pretty reasonable idea: that honorifics are contextual. It really doesn't matter, if you're visiting an aircraft carrier, that you hold an Army commission at rank O3 -- in that context, "Captain" has one and only one meaning, and every single dude with Navy eagles on his uniform can find another title while aboard unless he is the Captain.

Likewise in an academic environment -- Orac's medical credentials aren't the ones that count, but his PhD does. In a hospital it's the other way 'round, since calling someone "Doctor Isis" might lead to confusion where there's a lot at stake.

Then there's the general public ...

The AP rule was based on the notion that the only doctoral title that the general public regularly deals with is the medical one. Makes sense -- you wouldn't have wanted my childhood buddy's father Chaz addressed as "Doctor" in a social context, never mind the PhD in physics. Someone might take his casual comments about health seriously -- not a good idea [1].

If you're on a plane and the Captain (there's that word again) comes on and asks "Is there a doctor aboard [2]," I don't think it matters if the current Nobel Physics laureate is in Row Five. On the other hand, Dr. Isis should probably ring the call button -- but that's because she's worked as an emergency medic, not because of the PhD [3].

[1] Actually, I take his opinions quite seriously -- sharp dude. But not in any authoritative sense.

[2] Some of that "is there a doctor aboard" is getting a bit dated. Fact is that a lot of MDs aren't terribly well prepared to do emergency field work. $HERSELF recently shared a "Call 911!" moment at the grocers with a pediatrician; the MD was taking vitals while $HERSELF maintained airway and spinal stabilization, then helped the FD crew pack the victim for transport. No reflection on the MD: she's doubtless a wonderful pediatrician, but fieldwork is something else again. I'm somewhat curious regarding Orac's self-confidence for situations like highway accidents.

[3] Been there, done that. Talk about the Flight From Hell, several hours out over the Atlantic.

I thought the most ridiculous kerfuffle ever was when Jews fell out with Mormons for posthumously baptising their dead. No part of that made any sense.

Growing up in a society that's really high on titles (and not getting them right was a big social doo doo) I was very surprised (taken aback, insulted, bothered by) how the Dr. in the US is commonly only used to address your doctor, or maybe for a university professor. Especially if you slaved away in grad school for years earning a real scientist's title, as compared to most MDs who spent three months of chart comparison to get the title to go with the education, that's a bit of a downer.
To illustrate the different attitudes, I remember the big discussion in my hometown whether professors at the new local 4 year school (without the rights to give advanced degrees) actually justified the Prof. title ;).

All the etiquette I've ever heard says that it's horribly rude to refer to the holder of a PhD as "Mr./Ms./Mrs./etc." in the absence of particular guidance from that individual, and that they should always be referred to as Dr. in any situation calling for an honorific, unless they are also entitled to a higher honorific.

Of course, it's *also* rude for the PhD to make a point of insisting on it.

'Doctor" is supposed to mean an person who has studied a lot in any field. The original meaning had nothing to do with treating sick people or being a physician. I agree that it is more rude to NOT call a PhD 'Dr.' unless they request it.

In German you title would be Herr Professor Doktor Orac. However, the doctor title would be due to you PhD, not your MD. Without the PhD it simply would be Herr Professor Orac. Of coarse I am assuming since you teach you hold the professor title.

It really doesn't matter, if you're visiting an aircraft carrier, that you hold an Army commission at rank O3 -- in that context, "Captain" has one and only one meaning, and every single dude with Navy eagles on his uniform can find another title while aboard unless he is the Captain.

This situation, though, actually serves to illustrate the OPPOSITE of your point, since an Army captain on board ship is properly addressed as Major. When greater clarity is required between holders of the same honorific, one of them is granted a courtesy promotion. Etiquette does not allow demotions for such a purpose - and etiquette does consider Dr. to Mr. to be a demotion.

"This smacks of sexism to me I'm afraid. Still socially unacceptable for a woman to appear more educated than her husband when they are in a prominent public position."

This is probably a just a manifestation of Pareidolia generated a gender studies or women's studies degree.

Don't feel bad. It is a common problem for bogus and soft majors like many *studies majors that are built upon or have sufferred a heavy infusion of improper postmodernism.

It is not an common happening. I've read and seen people who'll babble about "colonialist" or "racist" attitudes that allegedly drive white people to despise cat eating while ignoring the fact white people also mock weird animal eating by other white people or who fail to remember the United States or Australia were also colonies.

The best cure is a 4-5 year of course of study in a useful discipline.

German custom would be to address him as Prof. Orac; you only use the "highest" title. If he'd be formally introduced, both the PhD and the MD count equally, as Prof. Dr. Dr. (based on the fact that in Germany the medical license is independent of the Dr. title, you have to pass a State Exam to practice medicine, the Dr. med is the academic title). Btw, in Germany the Dr. is part of the name (in your passport) and the it's a criminal offense to use the title without it being conferred by an accredited university. That degree from the University of southern North Dakota doesn't fly there.

Mu: Especially if you slaved away in grad school for years earning a real scientist's title, as compared to most MDs who spent three months of chart comparison to get the title to go with the education, that's a bit of a downer.

Three months?

Mu wrote: "Btw, in Germany the Dr. is part of the name (in your passport) and the it's a criminal offense to use the title without it being conferred by an accredited university. That degree from the University of southern North Dakota doesn't fly there."
Or any American University based on current law. My brother-in-law is an MD in Germany, but never completed his PhD, thus not called doktor. A well respected researcher I know, who is a professor with two PhDs, in formal settings is introduced as Herr Prof. Dr. Dr. {FirstName} { Lastname}

Perhaps this reveals the grim and sooty evil running through my veins, but I do look forward to getting my Ph.D (philosophy) in a few years. Someone keels over in the street and I'll be able to, err, summarise the Gettier problem, debunk intelligent design and explain Davidson's Slingshot Argument.

Little misunderstanding there - he's not an MD in the German sense (assuming he's German). He finished medical school, and became an "Arzt"(doctor). He didn't finish a Dr. med., so he's not a Dr. There was a period during the 70's when it was popular in certain political groups to not get your Dr.; not having one is probably not the best sales tactic, but it doesn't prohibit you from practicing.
In the US, the MD and the license to practice medicine are inevitably linked.
Regarding the mentioning of titles, it used to be the only professors were those who where teaching at a university, and to do that you needed the follow the proscribed path of "Promotion-Habilitation-Berufung" (roughly dr. title, assistant professor, tenured professor). Again, during the above mentioned time of "get rid of titles", or at least make them count less, a lot of people were appointed professor who didn't follow that path. Therefor, the formal mentioning of Prof. Dr. titles is the polite way of saying "he's a real professor".

I think I've related elsewhere on Scienceblogs (hell, it may have even been here) about the prof at my college that worked amusingly with his title. He was known as "Uncle Jim" to everyone with the slightest sense of humor, and deserved the appelation. Upon earning his doctorate, he insisted the title become "Doctor Uncle Jim". I don't think anyone failed to address him as such. His children were encouraged, at least in public, to refer to him as "Doctor Daddy". I don't recall exactly how long this period lasted, but the seasons changed at least once.

If you realize that the letter salad by your name isn't who you are, people are a lot more likely to respect you for it. However, respect and propriety have little to do with each other, and use of the title, where appropriate, should be automatic.

Vermonter here. We are a very small state. In various contexts, I have spoken to Howard Dean over the years. Sometimes I called him "Governor", once "Doctor", and usually "Howard" Vermont is a rather civil, yet informal, culture. I am sad to report that my state licenses frakking naturopaths, but happy to note that Medicaid here will no longer cover chiropractic.

Bruce: Yes, it can be as few as three months in Germany. Different from other sciences, medical students can even start their phd before even passing their exams, and often the work is neither a lot nor challenging.
Many don't want the doctorate for doing science, but simply because patients sometimes react strange if their "Doktor" isn't really a Dr. It's more a matter of prestige than anything else.
Of course, there are others, who plan to do research after they're done studying, and those take longer for their phd, but they aren't the majority.

Marion

There is no reason someone who's spent the time mastering a PhD field should not be addressed as "Doctor", I agree.

My problem is when people who have an academic doctorate abuse it to deliberately try to make people think they're actually medical doctors, in order to gain some perceived higher status. My dad holds a PhD in chemistry, and any time he interacts with medical professionals, such as when he's visiting someone in the hospital, he'll introduce himself to the nurses as "Doctor", with slight emphasis on the word. He isn't a medical doctor, but it's clear that he expects people in that specific setting to assume he is, and he wants them to treat him with extra deference. It might not be outright unethical, but it's certainly pretty damn shady.

Any time someone uses their doctorate to try and gain extra credibility in an area in which their doctorate is meaningless, it bugs me. "I'm a PhD in Physics, so you should give my statements about economics extra weight."

Dr. Biden though, and everyone else who's put in the work to get that status, deserves the address in general conversation, no question.

Though I would clear up some of the confusion about European medical "Herr Doktors".

In the German medical system, the exiting medical school exam, which is set at State level, is the qualifying exam to practice medicine. People with this qualification alone are formally referred to as "Artzt" (physician) but very rarely as "Herr/Frau Doktor" - indeed, for them to call themselves "Doktor" would be regarded as very bad form, since they have not earned a doctoral title. People like this with just the German medical degree (exam) will typically write their qualification after their name as:

"State Med Exam (name of State)"

However, German medical students commonly also do an optional extended research project, which can be lab or clinical research, and which is written up as a kind of "minor PhD thesis". This, once ratified, gives them the title "MD" and means they can call themselves "Herr/Frau Doktor".

Some debate often arises over the taxing-ness of this project and Thesis. Most people do a lot of the work at evenings and weekends, and quite a few spend a full-time period doing it / finishing it after they complete their formal medical training (and pass the medical exam). I have met people who had done the equivalent of at least two years full time lab work, and published several papers; but equally I would not be surprised if some people in some medical schools got it for doing less taxing things like chart review. So in Germany you might say that there are MDs and MDs - but anyone with this kind of a formal MD is entitled to call themselves "Herr Doktor". The point of "Herr Doktor" in the German setting is thus closer to what Orac wrote in the original post about "an original piece of research that is summarised and justified in a Thesis".

So anyway, the take home message is that all German medical doctors are NOT "MD" (or "Herr Doktor"), but that anyone who has earned the German degree of MD genuinely IS entitled to call themselves "Doktor". If that's not too confusing.

D.C. Sessions explained that very well. Better, in fact, than I could have.

This is common newspaper usage. The newspaper I work for reserves "Dr." for physicians, surgeons and dental surgeons.

That avoids the problem of deciding whether naturopaths and chiropractors are equivalent to physicians and surgeons.

No newspaper ever called George McGovern "doctor" although he has a Ph.D.

My sister-in-law had a PhD, but couldn't use the Dr. honourific when working within her specialty.... her PhD was in nursing and I guess it would have challenged the authority of the MDs she worked with, or maybe it would have confused the patients. I think physicians should be called that and leave Dr to the PhDs... and no, I don't qualify for the honourific in either sense.

Any time someone uses their doctorate to try and gain extra credibility in an area in which their doctorate is meaningless, it bugs me.

Sort of like Dr. Laura?

I do the exact opposite of your dad, Terry. If I'm at a hospital I don't want anyone calling me doctor (PhD in materials science), since I don't want to be confused with a physician.

Oops - sorry, see a couple of other people had already explained the Deutsche Titelsystem less verbosely.

BTW, if you want to see an example of an AltMed type insisting on being addressed by the "Doctor" title, even though it turns out they are actually a Chiropractor, and also endlessly dissing other people with higher degrees by pointedly calling them "Mr" (including, inter alia, UK National Academy member - FRS, strictly - Professor David Colquhoun), try reading some of Dr (Chiropractic) Molly Robinson's slightly overwrought postings on this thread. Apparently she works for the World Health Organisation. Really.

Sorry, but if it's common usage it's not adhered to very consistently. Which would make it NOT common usage. PhDs are routinely referred to as Dr. in most newspapers I've ever seen. Some very quick checking turned up examples in the New York Times and Wall Street Journal, among others.

Your example is also completely beside the point; referring to Senator McGovern as Dr. McGovern would be inappropriate in general anyway. (An example of the "use the highest applicable honorific" principle.)

In a medical setting (hospital, clinic, office) the term "doctor" is invaluable for identifying those who can diagnose and treat. Other health professionals do have legit doctorates; but, using the title is just confusing.

Outside of health-care, the use of the honorific should be restricted to avoid confusion. It only makes sense in specific contexts, such as when one would distinguish an amateur from a professional.

I think calling VP Biden's wife "doctor" is pretentious; but it is no skin off my back.

This reminds me of the one character who is simply known as The Doctor. I am referring to Doctor Who.

I am reminded of an incident when he was asked "well, what kind of doctor are you?" and his reply was "every kind of doctor".

There was other incident was when a human had become infected by a Krynoid and required some serious kind of amputation which he refused to do, delegating it to one of the humans. Some one did turn to him and ask him why wasnât he doing it, after all, he was a doctor, and he said that he wasnât that kind of doctor.

As one of my Profs so eloquently put it; "Lawyers were doctors when Doctors were barbers."

I am a medical student in the UK. Several of my peers already have non-medical academic doctorates, but are prohibited from being referred to as "doctor" in the hospital as this would unjustifiably confuse patients as to the extent of their knowledge.

Ironically, surgeons here are called "Mr." according to tradition, and the title is definitely used in a way that makes it sound like an honorific.

Dr. Biden has earned her title, especially considering that she isn't just sitting on the degree but is teaching. It's not pretentious in the least, earning a PhD is a lot of hard work and to deny her the title.

There does seem to be an under current in the article that it's unseemly for a man's wife to bring attention to having a higher education than he does.

RE:

PhDs are routinely referred to as Dr. in most newspapers I've ever seen. Some very quick checking turned up examples in the New York Times and Wall Street Journal, among others.

The NYT and WSJ have their own stylebooks. Newspapers that follow the AP Stylebook don't use any honorifics other than Dr., and it's reserved exclusively for medical doctors unless, as Dr. Biden has done, the person in question "prefers" that they be referred to in that fashion.

The NYT does not follow the AP Stylebook, and it uses honorifics for EVERYONE. If you notice, on second reference, the Times always says "Mr. So-and-so," or "Ms. Whats-her-name," while papers that follow AP only use "So-and-so" or "Whats-her-name" on second reference.

The AP Stylebook is the style bible for roughly 90 percent of papers in America, and most that have their own still follow largely on the AP Stylebook's lead. The NYT and WSJ are exceptions on the use of honorifics.

This is actually an excellent teaching moment regarding why social and academic conventions don't always concur.

I've learned to use the term "physician" as the broadest synonym for "medical doctor," and that was shortly before I married an M.D. and long before I earned a Ph.D.; it's because I worked in an academic environment that included people with both professional and research doctorates. Also, since other health professionals like dentists and veterinarians also hold earned professional doctorates, it seems almost rude to use an expression like "doctors and dentists" when "physicians and dentists" is more appropriate.

Conspicuously missing from some of the discussion of academic doctorates is the fact that there are a lot of Ph.D.s who are teaching at universities in temporary positions without holding even an adjunct professorship. I'm by nature almost rabidly informal, so when I taught introductory biology as a temporary lecturer, I told students they could call me either "Dr. Stahlhut" or "Julie", but that "Professor Stahlhut" was not my correct title.

And I most certainly would not answer a classroom request addressed to "Hey, you." Informal, yes. Doormat, no.

Dr. Orac wrote, It's mighty hard to see how one would do original research of any validity based on pseudoscience,

First, you have to lower the standards. Then you have the blinding procedure, that is probably similar to the Oedipus method, but the eyes are chosen randomly - at least the first eye would be chosen randomly. The second eye would be chosen by default, but double blinding is the standard. Perhaps best to just ignore the ridiculous claims of pseudoscientific research.

As for the titles, would I go with Dr. Rogue Medic, Rogue Dr. Medic, or Rogue Medic Dr.? Well, I'll never be a doctor anyway, unless somebody gives me an honorary doctorate. I can guess that the insistence on being addressed as doctor for an honorary doctorate would lead to an even more amusing comment stream. :-)

Did anyone who has a problem with her going by the title Doctor actually attend a university of any kind???

Any instructor at the universities I attended insisted on being called Doctor if they had PhD, unless they were actual professors, and then they insisted on being addressed as Professor, since there were fewer professors than PhD's.

Nobody ever mistook Dr. Fannin (Head of Freshman Engineering at U MO Rolla) for a medical doctor because of his title.

The only gray area I can think of is do we address lawyers as Doctor because they have their JD's?

This has been pointed out on other sites, but did anyone ever have a problem with Dr. Martin Luther King or Dr. Henry Kissinger?

Those media sources don't refer to Nobel winning theoretical physicists as MR. XXX do they?

Maybe it is a medical thing. Consider Dr. Evil; you know, he didn't spend six years attending evil medical school to be called mister, thank-you very much.

Not only should all doctors be referred to as Doctor, but all holders of Master's degrees should be called "Massa."

I can't help but think, based on the comments on German usage and law, that it's rather amusing when a gathering of Nobel laureates in physics and chemistry can't legally call each other "Dr. Soandso" for lack of qualifications.

Thank you for this, Orac. This is the nail on the head:

After all, I never insist on the use of my title (indeed, in general I actually discourage it), except in a very few circumstances where I think it is professionally warranted, for example, when a nurse or an aide is speaking to me in front of a patient.

There are professional situations where the title is appropriate. I value everyone in my lab group and we are all on a first name basis. The undergraduates call me "Isis." That being said, I think it entirely appropriate to see "Dr. Isis" in the seminar announcement for a talk I am giving Friday.

Karl, the JD is very similar to the MD; a US title conferred upon finishing law school. Most German jurists for example don't carry a Dr. title, since the Dr. jur. is one of the more arduous titles to get. Usually, the honors go from Dr. ing > Dr. jur > Dr. rer. nat. > Dr. phil > Dr. med., based from the (perceived or real) difficulty to obtain them.
On a side note, in Germany, asides from the MDs, it was the chemists that were most likely to finish with a PhD, due to the absolute dominance of PhD level chemists in the German chemical industry prior to the 1990's.

"The only gray area I can think of is do we address lawyers as Doctor because they have their JD's?"

Oh God, please let's not. It's bad enough when lawyers get ostentatious about the suffix "Esq."

I did once work with another lawyer who referred to other lawyers as "Dr. So-and-so." This was the same guy who once admonished me that "people at other law firms are lawyers. People at this firm are attorneys."

I never did figure out if he was being serious on either count.

On the other hand, it would be amusing to tell certain older lawyers who have LL.B.s instead of a J.D. that they don't get the "Dr." title.

Orac,
We've broached this subject before and again I ask, because you have an MD, PHD, should we be calling you Doctor, Doctor?

I'm with Dr Isis on titles. I tell the undergrad students that I answer happily to either "Dr Aust" or just "Aust", as they prefer, but not to "Hey you" or "dude". Interestingly, the medical students are far more likely to stick to "Dr Aust" than the science students. No idea why.

I DO, however, tell the people I encounter when I access the medical system as a patient that I have a PhD in Physiology and am married to a (medical) doctor. I mainly do this since it improves the consultation - and because when I didn't do it, I got increasingly frustrated with the pre-set standard spiel designed for people with no scientific or medical knowledge / background.

The ND after a naturopath's name stands for Not a Doctor.

Also, if a homeopath claims to have a PhD, it's understood that it stands for Phony Doctor.

"And that's Doctor Evil. I didn't go to Evil Medical School for 6 years to be called Mister!"

Doctor, Doctor! It hurts when I do this.

Don't forget Dr. Funkenstein!

http://www.youtube.com/watch?v=99pY1wcXTh4

Doctor, Doctor! It hurts when I do this.

Then don't do that.

Fundamentally it seems that problem is that physicians co-opted the title of "doctor" to mean "physician" instead of its original meaning of "learned." Perhaps we could promulgate a new honorific for physicians to limit the confusion . . . or maybe everyone should just call people by their respective degrees. "Doctor of Medicine Smith" or "Doctor of Philosophy" Jones. Hmmm . . . that might be a little awkward.

Where I went to college, almost all of the professors (regardless of preference) were called "doctor." I think they liked to emphasize how most of the instructors were PhDs. I did have one visiting professor who wanted to be called "Professor" instead of her earned title of "doctor." No one did that, of course.

As for D.C. Sessions, my wife (a doctor . . . err . . . a physician) was told in medical school to stay quiet when the "is there a doctor in the house?" question came up. Frankly, without a crash cart at hand, an ACLS trained physician is of little more use than a first aid trained high school dropout. I know more about what to do for heart attacks than some pediatricans ("Call 911!" "Chew up this aspirin!"). My wife is training in Med-Peds, so these kind of things come up when she is on the peds side. A recent meeting at her children's hospital in regards to codes concluded that the best course of action is to call the ER at the adult hospital.

This is common newspaper usage. The newspaper I work for reserves "Dr." for physicians, surgeons and dental surgeons.

But what do you do instead? If you referred to me as "Mr. O'Hara", I would feel you were either ignorant of my status, or being insulting. OTOH, if you referred to me as "O'Hara", I wouldn't have a problem (well, assuming the context was right to not use titles).

Incidentally, my "proper" title is Docent, but that's relatively obscure. I only mention this because it means that you should call me Doc. O'Hara.

(I'm not a medical doctor, although my PhD is in pathology. Of cereals)

I am also a physician, and I agree with Orac. Outside of work situations involving direct patient care I strongly prefer "John" or "you jerk" to "Dr. Melville." When someone outside of work remembers and bothers to use the "correct" honorific, I take it as what it is -- a compliment.

I do find it amusing, however some of the people who neglect to call me doctor.

The California medical board, for example, persistantly addresses letters to "Mr. Melville" despite having copies of my medical diploma, board scores, and every other credential I own. Or a physician (who didn't know me and wanted a BIG favor) who addressed me as "John" and then signed the email as Dr. Xxxx Yyyy, MD, FABFP (or whatever.)

An honorific is an honor, asking to be called doctor is just snooty. It isn't an honor of you have to ask for it.

After reading these comments, I think that anyone intelligent or hardworking enough to understand the Germany system of degrees and titles deserves whatever the highest German title is.

Well, lots of stuff has been written about how the Germans would call Orac. But the most important point has been left out. Wouldn't they write his name with a k ?

"Doctor doctor please, oh the mess I'm in"

It's all very simple.

If you are a medical doctor you are always a doctor. Even if you are retired - or dead.

If you have a doctorate in geophysics then you are a doctor in the geophysics department you work in. You can be a doctor outside of academia but it makes you a pretentious twat.

If you are a nurse with a Ph.D you are not called doctor in the hospital to avoid the obvious confusion.

If you have a doctorate from a mail order college (like our very own Gillian McKeith) then you are a quack and a charlatan.

If you claim to have a doctorate in homeopathy or some such nonsense then you are also a quack and a charlatan. You cannot possibly research something which does not exist. Full stop.

(I will make a concession here for stuff like theology on the basis that is is part of anthropology/social science. It's still rubbish though).

If you are a professor you do not need the doctor title as in general a Professorship trumps a doctorate (and in any case the latter is usually a pre-requisite for the former).

In general non-medicos calling themself doctor outside of an academic environment is a bit naff and, like cliches, should be avoided like the plague.

Simple.

Mrs Biden can call herself anything she wants - as long as she is entitled to the honorific. It may obviously reflect on our view of her ego though. I would have though that in the social standing stakes Mrs Vice President was pretty much a trump card but maybe she doesn't want the reflected glory.

Except "Mrs./Ms. Vice President" isn't a real title. The wife of the president or vice president is just Mrs./Ms. whatever her last name is.

Why then does the Times say Dr. Martin Luther King and Dr. Henry Kissinger?
Dr. Jean Kirkpatrick pointed this sexism out a long time ago.

Dr. BB

My father was an academic and so we were used to hearing him addressed as doctor, although he once remarked (as my brother was introducing him to one of my teachers who started gushing about how great it was that he was a doctor), "I'm not the kind of doctor who does anybody any good."

Hurrah for Dr. Biden. As John Nance Garner put it, the vice-presidency isn't worth a bucket of warm spit, and the wife of the vice president has traditionally been a bit of a null. Glad she is trying to maintain some sense of identity.

I appear to be the only dinosaur on this board. But in every institution of higher learning I attended, the Doctor Professors followed the rule I was taught by my uncle, who was himself one of them: namely, that it was silly, pretentious, and simply Not Done to use the "Doctor" title when one was the holder of a Ph.D. (Or a dozen of them, for that matter.) Not socially, and not in the classroom, not ever. The rule covered men and women, the distinguished and the less distinguished alike. The reason, he explained, was that one simply assumed that one's colleagues had doctorates, and there was no call to make a display of it.

To insist on the title yourself, therefore, marked you as a pretentious twit. To use it to an academic degree-holder by accident was to make it clear that you didn't know the rules, and people would flinch and, if possible, correct you quietly where you could avoid too much embarrassment.

It's just a social convention, of course, and entitled to no higher standing than any other social convention. But to this day, I prefer the reverse-snobbery of the implicit, "Everyone here either has a doctorate or is capable of having one, so let's not make a fetish of it" of the old rule to the implicit (and sometimes not so implicit), "I worked hard for this degree, and people had goddamned well better acknowledge my work and high rank in their form of address to me" of the new one.

Jane Fairfax and other people believing only MD's should be called doctors, so what is the point of calling MD's doctors? (Why bother publicly identifying them as physicians?)

I don't buy the concept that in a medical emergency, someone is going to find medical help by quietly scanning a guest or passenger list in the hopes of finding someone with a "Dr." in front of their name. Is it the contention that medical doctors are special, and that anyone with a "plain old PhD" isn't worthy of the respect given by the title doctor?

Why not just go by "Mr. John Smith, or Mr. John Smith, MD if you feel the social obligation to identify yourself as an MD in the event that you name is on a list of people someone is looking through to find an MD"?

What about a PsyD? Should a Doctor of Psychology be allowed to use the title Doctor?

The title of doctor wasn't invented for the purpose of identifying MD's to the world. It was granted a as a title of honor to recognize academic accomplishment. PhD's were doctors before physicians were doctors.

How about going by either "Dr. John Smith, MD" or "Dr. John Smith, PhD"? That way the MD's who need to can still feel set apart from all the "other" doctors.

From the NorthJersey.com article

Vice President Joe Biden often joked on the campaign trail about his wife's lofty educational achievements. She had two master's degrees and had already worked for nearly a quarter-century as a community college instructor. But he had a better idea.

"Why don't you go out and get a doctorate and make us some real money?" he said he told her. That was always good for a laugh, especially in university towns.

In 2007, at age 55, Jill Biden did earn a doctorate â in education, from the University of Delaware. Since then, in campaign news releases and now in official White House announcements, the prefix "Dr." is used before her name. This strikes some people as perfectly appropriate and others as slightly pompous, a quality often ascribed to her voluble husband.

Last week, the White House announced that Jill Biden has returned to the classroom â believed by some who study the presidency and vice presidency to be a historical first. Biden is teaching two courses at Northern Virginia Community College, the second-largest community college in the U.S. She began teaching before the inauguration, but the announcement was delayed out of respect for that event.

"She's just really excited to be back in the classroom," said her spokeswoman, Courtney O'Donnell. "Teaching is such a huge passion and a joy for her."

I have been taking classes at our local community college. It's not quite correct, but I tend to address the teachers as "Professor XYZ" or "Doctor ABC" (if they have a Ph.D). I'm often the oldest person in the classroom, including the teachers.

Most of my classmates don't have a clue about academic formality -- many are the first in their families to go to college, if not to graduate from high school. Being pointedly, excessively formal was another kind of teaching. I know at least one of my cc teachers appreciated it.

In most situations, I ask someone how they wish to be addressed.

Their title, their name, their choice.

Mr. Withakay: I can't speak for anyone else, but for my own part, I fear that I must have been less than clear. I didn't mean to argue that there was any point at all to physicians using the "doctor" title. It's just a social convention, and as far as I know not one in controversy. (I do object to it, or would, if physicians demanded to be called "Doctor" while using the first names of those from whom they're demanding it. But happily, I haven't encountered that particular and obnoxious phenomenon.)

Is it the contention that medical doctors are special, and that anyone with a "plain old PhD" isn't worthy of the respect given by the title doctor?

Not as far as I'm concerned. It's more the reverse-snobbery, aristocratic sense that no one worthy of respect needs a special title to remind themselves or those around them of their status. I grant that I'm old-fashioned about this, but in the world I come from giving the person with that Ph.D. the title "doctor" is not in fact to show them respect. And at worst -- that is, where they've made it clear it matters to them -- it's to condescend to their pathetic insecurity. Which is not something I like to do to people whom I think worthy of respect.

...and just to complicate matters further...

In Italy, any university degree, including undergraduate degrees, entitles its recipient to the title of "Dottore", which of course comes from the Latin word meaning "teacher". My B.A. diploma states very clearly that I'm entitled to be called "Dottor Aureola Nominee".

For this very same reason, there's practically no chance that people in Italy might assume that I'm a medical professional. If a physician was required, the call would go out for a "medico" (M.D.), not for a "dottore" (degree holder).

O'Hara, in my paper, you'd be O'Hara.

We've pretty much gotten away from using honorifics for anybody, not even Rev. for preachers, and -- to my surprise -- not Father for Catholic priests.

Dunno why. The only written policy is as I've stated above.

An architect friend of mine tried to get 'A.I.A' used as a standard whenever talking of 'real' architects, and I think there is a genuine need to distinguish between professional engineers and garbage engineers, and I occasionally use 'P.E.,' but most people don't know what it represents.

Random Comments:

I graduated with a B.S. in Physics and then went to law school: I used to tease my former roommate (who also had a B.S. in Physics) that I'd be a doctor before he was, since it took me three years to get a J.D. and him slightly more to get his Ph.D.

I have used the line, "Technically, I'm a doctor too, but I don't like to make a fuss" with people who have been obnoxious about it once or twice. I used to use "Esq." while the ink was still wet on my license but I don't bother anymore, nor do I put "J.D." (or, Bog help us, "B.S." as I have seen some people do) after my name. I refer to anyone who has an M.D., a D.O., or a Ph.D. as "Doctor," unless I'm deliberately trying to be obnoxious (which is never unprovoked.) I also usually refer to holders of the LL.M. (the Master of Laws, which is the postgraduate degree in law - we do it the other way round from everyone else) as "Doctor" as a courtesy.

When I was in college, there was a Ph.D. math professor who some of my classmates didn't like (because he made us work. I liked him, he had a wonderful sense of humor and once played a tape of the Witch Trial from "Monty Python and the Holy Grail" in our Mathematical Logic class.) For a while some of them started blatantly addressing him as "Mister." My roommate and I found this incredibly offensive, especially since he was smarter than the lot of them (and me, but not my roommate :)) and made a point to refer to him as "Doctor" every time we spoke, even though we normally just called our professors, well, "Professor." He didn't seem to care one way or another, though, so perhaps that was just youthful sensitivity.

M

I was surprised that my JD qualified me for a graduate program that required a doctoral degree. I always assumed it was an accident of antiquity that the D in JD stood for Doctor - would never in a million years have thought to address a holder of a JD as Dr. Anything. Law school is just not comparable to a true doctoral program.

I'm learning a lot in these comments, actually. Didn't know some consider Professor a greater honorific than Dr. - I always thought of it as more an occupational designation.

On the pompousness question, I'm with the commenter who wrote that it's polite to use the title a person prefers, but not polite for that person to make a stink about it if you don't.

Wow, I got bashed on here without even being involved and was even misrepresented. Thank you, Dr. Aust. To be honest, I have no idea how I was dragged into this in the first place, but I would encourage anyone interested enough to actually follow Dr. Aust's link to the thread. There they will notice that I actually call Prof. Colquhoun "Professor", which is the title he himself uses, as opposed to "Mr", as I was accused of disrespectfully doing. In any case, what does that have to do with the comments here?

With regard to the thread, I also feel that it is the correct behavior to refer to someone by the title they may legally claim if they so choose to. I also agree that in the absence of further directive, when in doubt, use the title! It is a mark of courtesy and respect. I, personally, use my title in professional settings, when having a conversation in which the educational background of the participants is pertinent, etc. I do not use it in personal settings; i.e. my teammates don't call me doctor, nor do my colleagues or friends. I do, and have, taken offense, however, when someone unqualified to judge or in the spirit of malice takes it upon themselves to decide that anyone is "not the right kind" of doctor.

I, personally, have called my instructors "professor" or "doctor" or have used their first name, as per their stated preference. If Dr. Biden prefers to be so addressed, that is her right and privilege. Perhaps that is how she defines herself outside of being "the second lady", and who are any of us to disparage her in that? After all, she is the one who put in 6-9 years to earn that title. Man or woman, DC, MD, or PhD. . . she has earned the right to call herself "Dr." and those of a courteous nature will respect that and do so.

Actually "Dr Robinson", outside strictly academic circles (and often within) I much prefer 'David' or 'DC' to 'professor'. Titles sound so pompous.

Dr Aust is referring in part, to my comment (at the bottom of page 3), on an article in the Economist.

"Anyone who has been following this dialogue, would, I think,have supposed that âDr Robinsonâ was a medical graduate of the distinguished Northwestern University Medical School."
. . .
"it seems that she is not medical at all, but a chiropractor who is a graduate of a quite different organisation, the Northwestern Health Sciences University, which encompasses the Northwestern College of Chiropractic and the Minnesota College of Acupuncture and Oriental Medicine."

The real problem arises because of the corruption of universities that allows them to give degrees with names like "Doctor of Chiropractic" in the first place. Once that has been done there it is, I suppose, legal to use the title. But in many places, it is illegal to use the title so as to give the impression that you have are qualified in medicine when you are not. I have noticed before that chiropractors are very touchy about this. When it was discussed in the New Zealand Medical Journal, threatening letters arrived from lawyers. Luckily the feisty journal fended them off.

Hmm, I wonder what, if anything, that comment has to do with the conversation here? Seems like a rather random personal attack, but perhaps I am misinterpreting.

Can anyone provide me with a link to any evidence of any jurisdiction in which it is illegal for the graduate in possession of a D.C. degree to call themself "Doctor"? I have been unable to locate anywhere where it might be illegal for me to use my title, yet a few individuals seem to be making that claim. Can it be supported? Or is that just baseless prejudice and propaganda?

Can anyone else tell me what, in any case, it has to do with the conversation here on this thread?

The question of the strict legality (or otherwise) of using a title is not exactly the same as the question of whether its use is misleading, either intentionally or unintentionally. The latter is context-dependent.

In many countries, the chiropractic colleges formally graduate practitioners with Bachelor degrees, e.g. styled "B Applied Sci (Chiro)". For such folk to style themselves "Dr" would be grossly misleading and - in many countries - illegal. Even for practitioners with "doctoral" degrees in CAM modalities like chiropractic, they are still NOT the conventional physician that most members of the public would be expecting if they fetched up at a medical-looking office with the sign "Dr Wotsisname" hung over the door. So to say "Dr" in a healthcare setting, without any further information, is misleading. Unless, of course, you are a conventional MD (or equivalent), which is the "default" assumed meaning of "Dr" in a healthcare setting.

Many of the practitioner associations officially endore this position: for instance, the New Zealand Chiropractic Board's Code of Ethics says:

2.3 The use of the title âDoctorâ must be qualified, for example, John Doe, Dr of Chiropractic or Dr John Doe, Chiropractor. Failure to qualify the use of the title âDoctorâ may contravene the provisions of this Code.

The point of the articles that are linked from David Colquhoun's blog (links above) is that the practitioners of acupuncture, osteopathy and especially chiropractic routinely contravene such rules - in one recent study in New Zealand, 80% of all chiropractors surveyed (most of who have BAppSci degrees) simply styled themself "Dr" in their advertising, with no qualification of this whatsoever.

It is obviously a less critical setting, but posting repeatedly on a forum discussing alternative medicine as "Dr", and never making clear that it is a doctorate of chiropractic, might also strike some people as potentially likely to mislead.

If anyone is still following this (which I doubt), I again invite them to read through the posts on the Economist thread (again, link in David Colquhoun's post above), and see who they think "doth protest too much".

Hey Dr. Aust. You and Dr. Robinson sign your names exactly the same! Are you a "conventional MD or equivalent"? Can you shoot an x-ray? do an annual physical? deliver a baby?

I know this was already asked, but since it was ignored, let's ask again! Can we see any support that it would be illegal for a doctor of chiropractic to refer to themself as such in any particular country? If there are many, as was claimed, it should not be hard to supply this information for, say. . . three?

Also, did you know that in the UK (and Australia, Bangladesh, The Republic of China, Hong Kong, India, and a few dozen more) a "Bachelor of Medicine - BM" or "Bachelor of Surgery - BS" is the primary degree conferred at medical school
(even Oxford
http://www.medsci.ox.ac.uk/study/medicine/courses
and Cambridge!
http://www.admin.cam.ac.uk/univ/camdata/ubmed.html)

To quote the relevant passage:

"In the countries that award bachelors' degrees in medicine, however, Doctor of Medicine denotes a holder of a higher doctorate and is reserved for medical practitioners who undertake research and submit a thesis in the field of medicine. Nevertheless, those holding Bachelor of Medicine, Bachelor of Surgery are usually referred to by the courtesy title of "Doctor" and use the prefix "Dr"."

Saints preserve us from all of the unqualified "doctors" running around after graduation at Oxford!

I only ask my students to call me Doctor. I'm still young enough to need either a tie or title to distinguish myself from some of my students. And I won't wear ties due to being around lovely chemicals, plus they are disgusting means of transferring pathogens. Next time you see a "real doctor" (as the public often refers to MDs) ask when they last washed the tie was. The one that they wear to see all of their patients, day in, day out. Bleah.

My close family members use doctor sometimes as a loving tease. Outside of class, though, I'm Robert to pretty much everybody, unless they demand to be called Doctor.

Of course, if I were interviewed for a newspaper, and it was relevant, I would expect to be called either Dr. or have PhD appended to my name.

------------

"Another Chiropractic Physician"

You are not a physician without an MD. You are a quack. You "practice" a non-scientific medical scam. How a 19th century magical belief can claim to be a medical profession is a failure of the law to protect the consumer from fraud.

Call yourself a doctor if you want, but it is just another grab for legitimacy for a snake oil profession. A master electrician is closer to being a doctor than a chiropractic or naturopath or homeopath (soo soo suk to Dune readers).

"Another Chiropractic Physician":

Yep, I am a PhD - it say so on the front page of my blog, a click away from any of my online comments. And I never pretend to be anything else. When it becomes relevant to a blog discussion, I even say it clearly for emphasis - "I am not a medical doctor" or equivalent - just for those who don't click.

Your fellow-chiropractor never indicated to us what she was really qualified as, even when it was clearly germane. That is the central point.

Re some of your other comments:

Can you shoot an x-ray?

No, but I don't claim I can, and equally that means I don't bilk folks for unnecessary ones - unlike, it seems, a fair number of your chiropractic colleagues.

Do a physical?

Nope. My wife is the medical doctor in the family and she does the physicals - lots and lots of them. On the other hand, she can't measure the pH inside single cells, referee physiology research papers or teach three hundred students about action potentials. Each to their own.

Deliver a baby?

Are you for real? In my admittedly wholly personal opinion, a chiropractor who thinks they are the best person to deliver a baby should be de-licenced for being floridly delusional. And anyone who would let a chiropractor deliver their kid, rather than an Ob-Gyn - or an experienced midwife with full Ob-Gyn back-up on hand if needed - is flat-out nuts. Just because something might be legal does not make it sensible.

Back in the 1800's, it is true that chiropractic could not explain how it worked. . . any more than medicine could. It is ridiculous to say that the practice of chiropractic has not advanced since then. Plus, chiropractic never claimed to be magic, that was medicine. Medicine was the profession that used to ascribe various maladies to the malice of the local witch and would treat fevers by bloodletting. Both professions have come a long way, but both still have a long way to go. If you think medicine is perfect, please fill me in on how to cure cancer, eradicate HIV, and counteract the effects of Trisomy 21. Nobody is perfect, but we're trying. Only a completely uneducated . . . . . would refuse to look for or acknowledge the relevant information.

Okay, in the United States, the term "physician" is used for Cardiologists, Chiropractors, Dentists, Family and General Practitioners, Oncologists, Osteopaths, Podiatrists, Rheumatologists, and a whole laundry list of doctors. Looks like chiropractic is there! As an exercise, I suggest that the next time you go to the hospital, you grab a list of all of the doctors practicing there. If you aren't planning a visit to the hospital any time soon, check out the "meet the doctors" section of their website. Then, call up all of the ones who have "DO" after their name instead of "MD" and tell them that they are not real doctors or "physicians". Come on, it'll be fun.

Dr. Aust. So, we can look you up and see that you are a PhD and not a physician. As opposed to Dr. Robinson, who we can look up, and see that he is a DC and not an MD. Wait, how is this different?

How is what KIND of doctor one is germane to a conversation about Dr. Biden asking the press to refer to her as "Dr"? How is what KIND of doctor one is germane to a conversation about acupuncture? Or homeopathy? Unless one happens to be a Doctor of Acupuncture (trained in China) or homeopathy or whatever? The first comment about chiropractic was NOT made by Dr. Robinson, he was talking about acupuncture! Last time I checked, neither he nor Professor Colquhoun nor you have any training in acupuncture. . . so how is ANY of your training pertinent?

Although your reference is by an individual who has been repeatedly discredited in scientific circles, I actually agree that the chiropractic profession may overutilize x-ray. It may stem from the fact that Medicare (and other insurances) used to REQUIRE that x-rays be taken as a part of the exam prior to treatment. Sure, too many doctors of chiropractic still use these old guidelines. There might even be some that do it for the money. Can you tell me how many pediatricians prescribe antibiotics on the first visit for children with middle ear pain even though the American Academy of Pediatrics states, clearly, that this treatment is NOT recommended? http://www.aap.org/publiced/BR_EarFluid.htm
Or how many general practitioners immediately prescribe antihypertensives, even though the guidelines say that the initial approach should be diet and lifestyle modifications for between 6 weeks and 6 MONTHS depending upon the case? Might this have anything to do with the $13 billion spent on advertising and "physician education" (including luncheons, cruise conferences, and free gifts and prizes) by the companies that sell the antibiotics and antihypertensives? I don't think that the majority of medical doctors (or doctors of osteopathy or dentists or whatever) can be accused of this type of accepted unethical behavior, nor can the majority of doctors of chiropractic. I think the majority are trying to help people, and they all get a bad name from the few bad ones. Maybe I am idealistic, and all of the doctors really are bad. Wow, that's a scary picture.
We, chiropractors, are trying to work to improve our profession, and we are doing it without the major drug company funding that pays for tons of research for medicine. So when you are perfect, you can point a finger at me, but until then, you have to acknowledge that we are all working on it. This includes the surgeon doing the laminectomy (which does not have evidential support) and the chiropractor doing his adjustment and providing stretching exercises (which has some, but not enough, evidential support), both of whom are doing their best to relieve a patient's low back pain.

And if you still can't read the studies or examine the evidence, then at least get a life.

I always love how chiropractors defend their profession by listing all of the alleged ills of real medicine. That has always made me chuckle.

To begin with, I am female.

Please be careful to clarify that the ability of a doctor of chiropractic to function cooperatively with an obstetrician or in solo capacity is NOT a standard component of the basic education, any more than it is part of the basic education of a general practice MD. Sure, we all get the minimum outline and could "catch" if need be, but to actually be qualified to deliver a baby requires additional education beyond the preliminary 8 years. In addition to the extra educational requirements, there is a limited number of jurisdictions where this is permissable within the scope of chiropractic practice.

Everyone is pointing fingers at each other, and that is neither warranted nor productive. I am really not interested in being drawn into it, and would appreciate if I could be left out of it. Thank you.

Did I step on a duck?

Imagination time physician,

First, my apologies to the DOs and other real physicians, a group that does not contain chiropractics, acupuncturists, homeopaths, etc. Is my training in toxicology relevant to the discussion? It isn't necessary, as anybody with basic scientific literacy and a good skeptical toolkit would come to the same conclusions.

Second, the imperfection of real medical science does not act as support for alternative medicine. Alternative medicine needs to gather real evidence that it actually works, is not a placebo, before it becomes real medicine. Can chiropractic "cure cancer, eradicate HIV, and counteract the effects of Trisomy 21?" Real medicine can actually speak of cures for some cancers, successful treatment of others. There are real medical treatments for HIV. There are real evidence based treatments that help some Down syndrome children move successfully move into society.

Could you put forward, from a real medical journal, a study that demonstrates the efficacy of chiropractic in anything besides causing strokes?

Finally, if you were honestly interested in improving chiropractic, you could work to get your field to make choices such as accepting well demonstrated concepts such as the germ theory of medicine, good hygienic practices, or that comparatively few medical disorders and diseases are caused by misalignment of the spine. Medicine left the four humors behind. Why hasn't chiropractic left behind a similarly ascientific concept behind?

Robster. . . why are you specifically being intentionally and deliberately rude? Have I said anything to make you believe that I am "ascientific", other than that I am a doctor of chiropractic? You call me a "quack" and say ridiculous things like "Did I step on a duck?", but do you know ANYTHING about the way I practice? I am working to improve the chiropractic profession. What are you working on in this regard besides being a jerk? I don't know you, and you don't know me. . . so let's try to focus on the debate at hand.

I was not implying that the faults within medicine are support for CAM. I was calling for all of these practices to have to support themselves with evidence, including medicine. We are willing to do it. Are you? It looks to me like you want to sit there and point out all of the weaknesses of CAM and use them as support for medicine. I say, let them all do the research and we'll see who comes out best for each condition. It won't be chiropractic for everything, but I know it will be for some.

Actually, there is still no medical cure for cancer. Any doctor (any one who actually provides patient care) will tell you that the best you can hope for is remission, but that the cancer is not gone and can re-emerge at any time.

There are medical drug treatments for HIV, but a 2005 study done by UNAIDS found that 2/3 of HIV patients in developing countries (where HIV infection is highest) and an unknown percentage of those in industrialized nations still successfully use CAM for symptomatic relief and for the management of opportunistic infections. Wanna go tell that AIDS patient that the health care helping him survive is fake?

Articles you might enjoy, from real medical journals!!!!
Spine Volume 33, Number 4S, Supplement to February 15, 2008
- this entire journal reviews the neck pain task force report completed at the request of the UN and WHO reviwing ALL types of treatment for neck pain and associated conditions in response to the UN's declaration of 2000-2010 as the Bone and Joint Decade. Two of the articles, begining on pages S170 and S176 respectively, show that there is no greater association between chiropractic visist and VBA strokes than between allopathic visits and VBA strokes, and that the associations of both are really low. Looks like you are the one using outdated and incorrection information here.

The Spine Journal Volume 8, Number 1
- This is also a supplemental issue, this time dealing with Evidence-Informed Management of Chronic Low Back Pain. This reviews spinal manupulative therapy for the treatment of CLBP, but also adjuctive analgesics, epidural steroid injections, facet injections, intradiscal electrothermal therapy, lumbar extensor strengthening exercises, lumbar stabilization exercises, massage, minimally invasive nuclear decompression, prolotherapy, certain types of surgery, etc. Then, it compares all of these treatment options. . . and guess what?!? SMT comes out among the best of the options.

Before you try to dismiss these, note that the research was NOT done only by DCs, but by MDs and PTs and DOs and PhDs and DCs; some of the best and most respected individuals in their fields spending YEARS on these studies, and the two journals listed are international and integrative.

And hey, who denied anything about germ theory or the benefits of good hygienic practices? Do you have a lot of chiropractors promoting or engaging in bad hygienic practice around where you live? Seriously? A bunch of smelly chiropractors running around?

So, to recap:
- real medical journals show that chiropratic works for the conditions indicated
- real medical journals show that chiropractic does not cause strokes
- modern practice of chiropractic has come a long way in the last 100+ years
- saying ridiculous and unsupported things like this make you look like an uneducated jerk. If you want to claim "basic scientific literacy", try reading something on the topic before you shoot your mouth off.

aCP,

This may have escaped you, but the internet is not the most polite place. It is serious business. Also, you should know that there are some jokes mixed into my writing that you may just not be picking up on. "Did I step on a duck?" is one of the Rodney Dangerfield's funniest lines out of Caddyshack, and shame on you for not laughing. Sheesh, I guess not getting no respect is hard on you.

I am also not giving you much respect because, as a chiropractor, a sCAM artist, you don't deserve it. I admit that my frustration with the antivax Dawn's comments are likely spilling over, but selling a quack therapy, and acting as a nonproductive drain on the economy wouldn't put us on friendly ground anyway. Also, real medicine can speak of cures for some cancers, including most testicular cancer types and many childhood solid tumors. Its a minor, but important detail.

Chiropractic, by definition, is based on the magical and ascientific belief that human disease is based in misalignment of the spine, and does not allow for the germ theory. Straight chiropractic does deny the germ theory of disease, while mixed chiropractic at least admits to being grounded in nonsense and ignores the sillier parts of their practice. You identify yourself as a chiropractor, a group of "healthcare" providers that are notoriously antivaccination (germs don't cause disease, so why vaccinate) and have poor professional hygiene (germs don't cause disease, so why wash hands between seeing patients).

If you are a reformer, moving away from subluxation and the fraud that Palmer perpetrated, accepting hygiene and the germ theory, recommending vaccination, etc, then good for you, but why didn't you get a degree in real medicine? You must know that many of your colleagues hold these views, so why not admit it is a problem here and pledge to fight against it? Further, if you find yourself among the mixed practice chiropractors, using physical therapy treatments in place of treating subluxation, you aren't performing chiropractic, but practicing physical therapy without a license. That you seem ignorant of these issues makes it much more likely that you are more interested in covering up the nonscientific practices of your fellow chiropractors than to act as a force for chance.

On the other hand, if you consider progress to be adding acupuncture or placebo based supplements, then you are at most, a cross training quack.

As to stroke risks, Stephen Barret gives a good review of the literature. Strokes following neck manipulation by chiropractor are a known and admitted risk among chiropractics, but not discussed much outside of their community. If it weren't, when why does it amount to 9% of malpractice insurance for chiropractors, along with a multitude of tests meant to limit this risk. Among the elderly, the effect is harder to detect, but in young adults, insulting the vertebral artery via neck manipulation definitely is a risk factor for stroke.

Back and neck pain reporting is subjective, and wax and wane on their own, especially as stress levels change. Back and neck pain often gets better on its own, so I have to ask if the studies controlled were for the placebo effect, or confirmation bias, or were they more like a customer satisfaction survey? Just saying that it works without solid evidence can easily fall into the pragmatic fallacy.

I have a very full day of teaching and grading, so you will understand if pulling back issues of spine is not on my radar. You should feel lucky, perhaps honored, that I am taking time from my lunch hour to write this. (I'll point out that that is supposed to be playing at pomposity, sort of like a chiropractor calling him/herself a physician)

Yes, I am a jerk, but I am also technically correct, which is the best kind of correct (Futurama reference).

Robster
Where did you get your definition of chiropractic from? It is not one that I heard in 8 years of studying to be one, in 15 years of practice, nor one I can find in any reputable source or through internet search engines. How can you present this as "THE DEFINITION" when it appears that you just made it up?

There are no more "antivaccination" doctors of chiropractic than "antivaccination" average people. There are the loud people who scream and everyone hears, and then there is everyone else. I have never told a patient not to vaccinate their child, but I have a lot of patients who come to me, their doctor, for advice on the issues they hear about them. I, like my colleagues, provide information and tell the parent that it is a choice they need to make for themselves.

Chiropractors don't wash their hands between patients? What?!? That is not true of any of the chiropractors that I know. What are you basing your accusation on? Plus, if you can find a doctor of chiropractic (or medical doctor or doctor of osteopathy or dentist) who is lazy and negligent and doesn't, how can you infer from this that they don't believe in germ theory? I would say that they are just lazy and lousy doctors.

There are bad practitioners in all fields. I am working to improve the standards and thus elimiate the "bad ones" in my profession. I happen to love what I do, however, which is why I have a "real" degree as a Doctor of Chiropractic. This is like asking a dentist why they didn't become a shrink. Maybe because they don't want to.

I am licensed to perform physiological therapeutics, which is not the same as Physical Therapy, but does include some similar things like exercise and some rehab. A major difference is that a doctor of chiropractic is a federally recognized, primary care, portal of entry physician and a physical therapist is not, (whether they are still working based on an old bachelor's degree, a masters, or the relatively new Doctor of Physical Therapy degree). This is based on additional years of education in things like diagnosis, neurology, pharmacy (yes, we learn it, even though we don't prescribe) and is the reason why you don't need a referral to see a chiropractor and you do need one if you need to see a PT, or to see the PT for more than a month, in some states.

Stephen Barret is a joke, and everyone knows it. Previous literature shows an assocation between chiropractic adjustments and VBA stroke, but even the old stuff doesn't show a causative relationship. Plus, the association is higher between GPs and stroke than chiropractic and stroke; (for those without basic scientific literacy, this means that people who have neck pain and headaches because they are having a stroke or one is pending often go to see doctors, and that they may go choose to see a chiropractor, not that the chiropractor or medical doctor they are going to see actually caused the stroke). That is old news.

The research I referenced were high quality studies. They were comprehensive reviews of all common treatment options for neck pain and low back pain, respectively. This includes both allopathic and complementary options. They were all reviewed independently, and then comparatively. They also accounted for both pragmatic and fastidious trials.

I think the point has been made, however. You are "too busy" to verify that what you are saying is false. You think that you can just make up whatever you want based on limited or very old information and even on rumors. You have your prejudices, and they alter your perception of reality. Trying to dicuss this with you is like trying to reason with an antisemite or a KKK member or any other person with a baseless prejudice. I think we should maybe just be done now.

Sorry, aCP, you are in plain denial of the disease within your own discipline, even if it is limited to the "straights." I can understand that you feel a need to defend your profession, but do you really not know about the ineffective tests to attempt to screen out possible stroke victims?

Here are a couple papers I bookmarked a couple days ago. Antivaccine views are not rare among your colleagues, so you either don't know many other chiropractors or are covering for them.

http://pediatrics.aappublications.org/cgi/content/full/105/4/e43
http://www.cmaj.ca/cgi/content/full/166/12/1531

Great, you practice in a federally recognized field. If it gets you away from offering snake oil spinal adjustments, then at least you can do some good. But state approval doesn't mean that it is an evidence based therapy. Some states recognize naturopaths. All that means is that your lot lobbied some scientifically illiterate politicians for a law. Sort of like how chiropractic groups managed to force the VA to accept chiropractors.

Feel free to attack Barret, if you like, but the argument that they were already having a stroke or would have had the stroke anyway sounds like a post hoc rationalization. I'll take a look at that paper tomorrow, I have too many lab reports to grade today to do it, but at first glance, I'm still with those mean old "allopaths."

And seriously, dentists practice an evidence based methodology. I think you missed my point.

I'm glad to know that pointing out the views of your fellows makes me a nazi. You do know what Godwin's law is, don't you?

Yes, the tests historically used to "screen out" potential stroke victims have been found to be pretty darn useless. This is because there are very few cases in which a chiropractic adjustment could possibly cause a VBA stroke! You have a higher risk of having a stroke when looking over your shoulder when backing out of your garage! If chiropractic DOESN'T cause strokes (any more than routine angioplasty does. . . and actually, even less), then how are you supposed to test for patients in whom chiropractic adjustments might cause strokes?!? This is a ridiculous argument. This is like saying that allergen tests are useless because they don't detect my allergy to peanuts because I don't have an allergy to peanuts!

Your first bookmarked article says that there is a "vocal element" within chiropractic that is anti-vaccine, but that this is a "minority" of chiropractors. Your second article is a incredibly unscientific, self-reported survey of Canadian Students. The survey questions were not even included as an annex! Even that one found that, "most students reported that in general they agreed with vaccination" and "most students reported positive attitudes toward vaccination". Is this not exactly what I said? How in the world do you think that these articles support your opinion? Did you even read them? I know a lot of chiropractors and, like your articles support, the majority of them are not anti-vaccination.

Chiropractic services are now a part of the VA system based on a study conducted by the Department of Defense medical service (the allopaths!) examining the cost-effectiveness and efficacy of chiropractic care in a study that took place within the VA service over 2 years. When the report of the study came back so overwhelmingly positive, the DOD decided to include chiropractic services. Looks like this was the allopaths who forced politicians to include chiropractic.

Well, your "post hoc rationalization" is exactly what the allopaths say, too, when one of their patients has a VBA stroke in their office or within the next week, or even in the waiting room before being seen. Guess the professions are in agreement on that point.

Chiropractors practice evidence based methodology, too. There is actually a significant body of quality research out there on the efficacy of chiropractic treatment. I would like to see more, of course, but my profession is working on it.

I did not call you a nazi. I said you had a blind, unjustifiable prejudice which you would refuse to reconsider even when presented with irrefutable evidence that you are wrong. There is a difference. Hitler was malicious, not stupid.

One can look here http://www.sciencebasedmedicine.org/ and click on the "chiropractic" category to find several articles on strokes. One could say that the bilateral vertebral-artery dissection is chiro's unique contribution to humanity.

Robster's characterization of chiro as "based on the magical and ascientific belief that human disease is based in misalignment of the spine ..." is in their current 'paradigm' http://www.chirocolleges.org/paradigm_scopet.html "Chiropractic is Concerned with the preservation and restoration of health, and focuses particular attention on the subluxation." Said subluxations do not exist. Yet, their survey (âHow chiropractors think and practiceâ William P. McDonald et al âSeminars in Integrative Medicineâ 2004 V.2 #3 92-98) shows that 90% believe in them. I guess they make the other 10% look bad.

A recent overview of chiropractic (Ernst, E. Journal of Pain and Symptom Management Volume 35, Issue 5, May 2008, Pages 544-562) concluded "With the possible exception of back pain, chiropractic spinal manipulation has not been shown to be effective for any medical condition. Manipulation is associated with frequent mild adverse effects and with serious complications of unknown incidence. Its cost-effectiveness has not been demonstrated beyond reasonable doubt. The concepts of chiropractic are not based on solid science and its therapeutic value has not been demonstrated beyond reasonable doubt." [Bold Added]

I don't see why the chiros here are boasting about spending eight years in a (4-year) chiropracty program. Oh wait, they are claiming that they also have undergrad degrees. Well, that's nothing to crow about- almost 2/3 of chiros do, too (McDonald, loc. cit.).

The problem with chiros who try to work like PTs is that they are not as well-educated. A major survey of neck manipulation found that PTs were responsible for less than 2% of injuries, and no deaths (http://www.ptjournal.org/cgi/content/full/79/1/50). The PTs are better at choosing whom to work on and how to do it (42 min. video- http://ph-ms.ouhsc.edu/ah/rehab/kinsinger.wmv).

So, chiros do cause strokes, chiro is still operating under the old superstitions, and chiros are not well-educated. The Triple Threat.

aCP, If you could show me irrefutable evidence, I would change my mind, but you haven't done that. You have offered a couple papers and your own word, against that of the verified existence of several large "straight" chiropractic organizations.

The existence of those papers does not mean that the link to stroke is debunked, only that there are competing views within the scientific literature. You also seem to be horrified that I consider my students and their training in the biological sciences to be more important than your ego.

As back pain often has a cyclical pattern, and not much is good for its treatment, with many placebo based methods having similar levels of effect, I'm not sure that I would be using that as an example of accomplishment.

So, please do educate me as to what you have integrated into your practice to make it more scientific other than imitating PT? Acupuncture, supplements, homeopathy, oriental medicine?

Concerning the topic of the thread, a four-year education in subluxations is not a "doctoral" level pursuit.

Well, I stopped by the library on my way home and emailed myself a few articles, and lo and behold, the emails came through sans attachments. I'll try the same with a thumb drive tomorrow. Bleah. I have a feeling that it will be an interesting read, though, from the glance I did get to take.

Unfortunately, learning nonsense for a rather short period of time doesn't disqualify DC degree holder from being called doctor.

Doctors of various churches have been wielding the title for many many years before PhDs were invented by the ever helpful Germans. The difference is that the doctors of the churches (Doctor of Divinity or Doctor of Theology for instance) had to make up some new knowledge of their own and defend it publically whereas professional degree holders don't bother. And I include MDs in this classification.

There has never been any justification for the title doctor in any of these professional degrees because they have failed to teach the world anything and have simply been inculated with the existing knowledge base.

@antipodean,

That is why it is a silly kerfuffle. We really don't have a standard. As a practical matter, it helps to limit the honorific to medical professionals. As has been pointed out, in an emergency people calling for a doctor are not seeking an English major. Nor, in a serious emergency, would one want to be tended by a chiro.

Okay, I would like to point out that NONE of this is related to the thread. This has become a tabloid slander site, at best.

Old articles on stroke do not prove a causative relationship, just an associated one. Look at the supporting evidence used to make claims, and you will see that there is a leap of logic made here that is NOT concurrently made in allopathic medical literature. If you want to make ANY treatment look bad, you can do it by twisting the literature. Ernst has been discredited many times in a number of scientific circles for doing just this. He presents conclusions that are unsupported, or even contrary to, the evidence base.

Subluxations do exist. Grab any standard medical dictionary and look it up. The definition changed in (I think) about the 1970s, so if you grab an old one and a new one, you can see both.

Med school is considered a 7 year program, 4 years of undergrad and 3 years of med school, with subsequent internships, residencies, etc. This is, of course, in the U.S. because in other countries, like the UK and Australia, it is a 5 year program if you include both undergrad and med school. Doctor of Osteopathy and Doctor of Chiropractic programs are considered 8 year programs, with 4 years of undergrad and 4 years of Osteopathic or Chiropractic school with subsequent internships and residency/preceptorships in the US, also 5 year programs in the UK. These are standard statements made about health care education.

A bachelors degree is actually not a prerequisite to applying for medical school, osteopathic school, or chiropractic school. The schools have prerequisite requirements for specific classes. Some states may require a bachelor's degree, but most do not, specifically. However, the vast majority of applicants to MD, DO, and DC programs do already have, or concurrently aqcuire, a bachelors or associates degree.

I have a PT who works for me. She's good, graduated top 5 in her class, but is not qualified (nor licensed as) a primary care physician. It is funny, however, that you are willing to trust a study about stroke by PTs who say "we didn't do it" but not studies done by chiropractors and medical doctors and PhDs who say "the chiropractors didn't do it, either".

The papers I referred you to are considered to be the authoritative works by the United Nations and the international health community. They say, flat out, that these papers displace all previous literature, as nothing with this scope, duration, and depth has EVER been done before. Excuse me for preferring the higher quality information. Read the studies, when you have the time, and see what you think then.

Again, the idea that back pain is cyclical and "not much is good for treatment" is a really old concept, and one that even allopathic literature began refuting about 15 years ago.

I don't consider the time spent teaching your students more important than my ego, but I am pretty disgusted that you would hide behind them and use them as an excuse why you are undereducated on a subject and then presume to say that I am the one with something to be ashamed of.

My practice is evidence-based. I treat conditions for which my care is indicated in the literature and documented experience. I hire other professionals with different areas of expertise to supplement my abilities, and refer when concurrent management or alternate treatments are advisable. This is what any doctor in any discipline in private practice should do.

another Chiropractor February 24, 2009 7:04 AM

Not surprisingly, you are profoundly ignorant.

For starters, yes, subluxations exist; just not the chiropractic kind. Chiros were forced to admit that in the 1960s.

To continue, med school is four years after the undergrad years you would count; plus another 4 (or more) years of specialization before one can be licensed. You morons can be licensed to play doctor (after four years, often sans an undergad degree) without ever treating a sick patient.

Yes, PTs are not licensed as primary care physicians; but you, less-educated chiros, don't deserve that appellation, either. You just have it because of political clout and, even more ignorant, legislators.

Do you think that DD Palmer cured deafness by adjusting the thoracic spine? That is the enduring foundation of your cult.

Your "doctorate" is as realistic as a "doctorate" in astrology (which point may be lost on you).

I cited Ernst's review claiming chiro is useless, why not cite reliable information showing he is wrong. I won't hold my breath.

Actually Joe we do have a standard. Or at least we used to.

The standard is research-based higher degrees are doctorates. You have to teach the world something new.

This has been subverted by the medical profession and more broadly by US-based universities handing out doctorates for undergraduate level learning for already existing knowledge. MDs from the ancient universities were at least required to produce knowledge. In the English and Scottish system the professional medical degree is now a double bachelor because they are not required to add to the knowledge base.

Unfortunately professional doctorates have now spread into the common-law countries and we have increasing numbers of people running around calling themselves doctors.

It's the lack of knowledge production in these professional 'doctorates' that should disallow the awarding of doctoral level degrees. They simply do not meet the basic requirements.

@antipodean "Actually Joe we do have a standard. Or at least we used to.

The standard is research-based higher degrees are doctorates. You have to teach the world something new."

That standard is no longer operational. Today, most doctorates are technicians whose "something new" derives from the professor for whom they work. That was a result of the government recognizing (after WWII) that we won because of our advanced science/technology.

They (the Feds) started providing money for research, and the professors began needing bodies in their labs. Anybody who is willing to work for a pittance (for a while) qualifies for a PhD today in many "militarily useful subjects".

I find it useful to know that someone I call "doctor" can diagnose and treat an illness.

Now now, don't scare of aCP by being such meanies. Can't we be polite microfascists for once? Heh.

Ooh, this Spine article is truly delicious. I'm not giving a hyperlink, not to disrespect the journal, but because I don't want to get stuck in the spam filter, and unless you have subscriber access, you can't get it anyway, but here are the details.

Risk of Vertebrobasilar Stroke and Chiropractic Care
Results of a Population-Based Case-Control and Case-Crossover Study
Spine. 2008 Feb 15;33(4 Suppl):S176-83.
by Cassidy JD, Boyle E, Côté P, He Y, Hogg-Johnson S, Silver FL, Bondy SJ.

A relative risk ratio of 12 is not low, but it certainly gets played off as such. Seriously, that means that for individuals under 45, your risk of stroke goes up twelvefold for having a stroke. Did aCP even read past the abstract? Its right there in the discussion and in one of the tables!

And the methods? Crapola. The authors don't even bother trying to determine if a patient had a neck cracking procedure done on them, meaning that the real relative risk should be higher than 12, as not all patients would have had that treatment.

I'm embarrassed for the lack of the titular virtue of said journal. Yes, it lacks a certain vertebral fortitude, nay, it may even have a serious case of a mythical subluxation. (To aCP, I'm saying that the editors of Spine lack, well, spine. This is funny, and you should laugh now.)

It took me a bit to recognize this article from a podcast I heard not so long ago, but then it popped out at me. This was the same paper shredded by Mark Crislip. What can I say that Dr. Crislip can't say better? I'm sure that aCP will dismiss him with another line about being ignored in scientific circles, etc, but Mark is a real doctor (Awww, was that too mean? Sorry).

So, as for neck popping manipulations... Does it sometimes work to relieve pain? Yes. Is it above placebo? Perhaps. But is it justified, when other techniques exist with similar efficacy without the risks of stroke and other associated risks of injury? Never, no never. Do chiropractors have a reputation of performing such procedures without even an attempt of offering informed consent? Oh yeah. If this is the kind of activity you want to reform and remove from your discipline, good on you. Sounds more like you prefer to just read the abstract and ignore it.

But it certainly seems that aCP got the memo on denying the real risk. Similar to turning your head to look behind you while backing up? Bull. That is nothing like having your neck forcibly twisted from a relaxed position. It certainly sounds like a line from a certain pamphlet from a chiropractic organization discussed here.

Joe,
You are actually completely incorrect. Historically, there was only one definition of subluxation, and it was the allopathic profession which changed the definition. They didn't deny the old definition, they just wanted to change it. Check the article "The search for subluxation: An Investigation of medical literature to 1985" by Dr. Terrett. The article was written in 1987, and I apologize, but I can't remember where it was from.

Sorry, but you're wrong on the med school thing. One of my friends from undergrad went to the Creighton Medical school, started the same week I did, and she was done in 3 years. At that point, she had never treated a patient. From there, she was known as "Dr. xxxxx" and began her internship, followed by residency, during which she learned to work with actual people. This is exactly what I said. Following a 4 year undergrad course, Chiropractic school was 5 semesters of academic classes, then 2 years of classes while simultaneously treating patients in University based clinics and then public clinics (the hours of class decresing and hours in clinic increasing each semeter) and then a semester of clinic, only, where I was practicing but still under the license of a supervising physician. After that, I graduated. I was required to take 5 different licensure exams (4 written, one practical - check out www.nbce.org) and I was licensed and could call myself "doctor". (Wait! My friend could call herself "doctor" BEFORE ever treating a patient and I couldn't do it until after 2 1/2 years of working with live patients!) I then began a two-year preceptorship, in which I was a doctor, but was still working with another, more experienced physician. After that, I was able to practice on my own. Try actually knowing something about the educational systems before you make comment, or you just look like an idiot.

You give my profession way too much credit if you think we have that kind of political clout. We are a small group of practitioners, most of whom are not politically active, so how would we have "clout"? Less than 1/3 of chiropractors are in ANY professional association, and in 2005 the American Chiropractic Association donated about $350,000 to various political campaigns while the lobbyists for the American Physical Therapist Association donated just shy of $1,000,000 and the American Medical Association trumped us all with over $6,000,000 in donations to politicians. I won't assume that you can do basic math, so I'll let you know that in comparison, we have no shot of buying clout when you compare those numbers, because 6 million is much, much larger than 350,000. The advances in health care legislation with regard to chiropractic have occured in spite of political clout, not because of it.

Robster,
I did read past the abstract, but I think that we have proven that you can't read. The table you are referring to did not say that the patient was 12 times more likely to have a stroke due to chiropractic manipulation, but that of the 818 VBA strokes occuring in Canada over the course of the 5 year period, 12% of those under the age of 45 had seen a chiropractor within 24 hours preceding their stroke (note that not all of these 12% would have received manipulative treatment) as compared to the 11.21% of those patients under 45 of the 818 patients who had VBA stroke who had seen their allopathic doctor within the 24 hours preceding their stroke (check the table on the next page). This means that the risk of having a stroke is, statistically significantly, the SAME whether you see a chiro or an allopath, not 12 times as much. This is what the discussion says, as well as the statement that 'in the month before their stroke, only 2% of the cases had seen only a chiropractor, 2.4% had seen a chiropractor and an allopath, and 51% had just only seen an allopath.' The remaining 44.6% had not seen a doctor in the month before their stroke. Oh my God! If I were too stupid to understand these results, I might be able to convincingly argue that you are 25 times more likely to have a stroke upon visiting your allopath than your chiropractor! Agh! In truth, the the association is about the same, just that about 25 times the number of patients who had prior symptoms choose to see an allopath than a chiropractor.

Your comment on the methods is just shockingly stupid. The methods were designed to examine standard chiropractic and allopathic practice, accounting for the variety of options a physician might pursue. Perhaps we will have to agree to disagree on this point, but I am going to stick to my opinon that the methods are pretty good, as it is backed up by 139 editors, 7 highly respected authors (none of whom is "just a DC") and the 14+ national health care agencies and universities who thought the methods were good; rather than you, the guy who can't even appear to read the discussion of the article, let alone interpret the data.

I am not familiar with Dr. Crislip, but I'll be sure to check that out when I have time. I'll even give you that he's a real doctor (although I don't know yet) because in my opinion, a real doctor is who who helps patients through diagnosis and treatment, like I and Dr. Crislip may do, and you don't. Funny that you should accuse me of just reading the abstract, when you are the one who didn't even read that first article, let alone the others. Oh, and while we're on that topic, your link to Mark Crislip is actually to an article by Harriet Hall which MENTIONS Crislip. The article is anti-chiropractic, no bones about it (see, I can make stupid jokes, too. . . but no one is laughing) but even that article says in the very first paragraph that "The risk is very small".

Perhaps you should read the rest of the spine articles. Having already addressed the risk of serious complications (again and again and again), the other articles will speak to the statistically significantly superior efficacy of certain treatments (chiropractic among them)to the other options examined and found to be lacking.

If what I said sounds like what came from the FCER pamphlet, it is probably because WE ARE QUOTING THE SAME STUDY! Good God, do you read anything before you try to post it up here? In that vein, do you have any response to my comments about the last two articles you posted here? The ones about antivaccination beliefs within the chiropractic profession? In case you forgot, those were the two that completely supported my point and not yours.

Can you PLEASE read a few things and try to get it right before posting things on this thread? It is getting pretty old just having to fact-check and correct you every single day. This isn't even a discussion anymore, and it's getting boring. I love having animated discussions with people with opposing views, it's interesting, and helps stretch the mind. . . I don't argue with my 5 year old niece, however, because she doesn't really have the necessary skills yet because, well, she's 5.

ANOTHER CHIRO QUACK:

So much quackery, so little time. You Tennet reference is in one of you quack magazines Chiropr Hist. 1987 Jul;7(1):29-33. It only serves to prove that chiros feel ill-served by science. How hard did you look for that? Only the chiro definition of subluxation has changed since your irrational claims were exposed.

In a previous post, you claimed your practice is evidence-based, your evidence is unconvincing. As is your argument about your "education" comparing favorably to that of health professionals. We know the facts. Here is a chiro admitting his incompetence when he got his license and hung out his shinglehttp://www.dynamicchiropractic.com/mpacms/dc/article.php?id=53681

Quackwatch has a report of chiro students suing their school for not giving them adequate clinical experience. In common with most chiro school clinics, they had to bribe/cajole healthy young friends to pose as patients for their "clinical experience." They lost the case, not because they got adequate clinical experience (they did not); but because the school had not (contractually) offered adequate training.

I cited a comprehensive, 2008 review that chiro is just wishful thinking, and you rebut with ... wishful thinking.

I am not impressed.

Try the first link, aCQ. Internet = serious business.

Bawwwww some more. Table 3. Highest odds ratio is for individuals under 45 seeing a chiropractor within 24 hours. People under 45 should not be having strokes. But hey, nice appeals to authority there. Just because something gets past editors does not mean that it is correct. In this case, Spine should be embarrassed. If you could be embarrassed, you would be. Check the introduction, as well. Seeing a chiropractor is noted in a previous study to be associated with VBA strokes.

Finally, in respect to introduction, the authors point out that others have suggested that VBA stroke patients may seek care from a chiropractor because of neck pain and headaches. I'll just say this. If chiropractors are not able to recognize a stroke and don't immediately respond by sending a patient to the ER, then they are not worthy of being called physicians. It still sounds more like a post hoc rationalization to me.

As to the Busse article, where vaccination attitudes of chiropractic students were surveyed, they became more antivaccination over their time in the program. How a student can go through a supposedly medical based program and go from a disappointing 40% antivax attitude to an astounding 60% antivax is beyond me. The percentage that are solidly antivax went up quite a bit as well.

Do they not include such things as basic biology or micro in these programs? I would be stunned if a single student to come out of my bio dept would be so scientifically illiterate. Do you think that you could find a medical school in the US where half of the students don't think vaccination is a good idea? Chiropractic students simply don't know their biology, and they apparently aren't getting it at chiropractic schools. You may be the exception, but wow, you guys start out not so bright and go down from there.

If you want the specific questions, email the authors. It isn't that uncommon for people to not include the survey questions in the body of the article. Methodologically, a Likert-type scale would have been more useful, but thats a design issue that they didn't look into.

Tell ya what, if you chiropractors could manage to look at the same xray and pick out the same "subluxation," you might have some credibility. Thats why you are a quack in a quack field. Instead, you (OK, maybe just the bad chiropractors, not angelic you) just run through a script about how the patient needs to keep coming back forever for adjustments.

Complaining that those mean old allopaths changed the definition on you is an excuse. As science advances, we refine definitions to remove false information. You still believe that chriropractic subluxations are real.

You keep complaining about how we are a bunch of girly preskool nazis, but you just can't stay away. You know you love it. (I'd say don't quit your day job and leave the jokes to us, but chiropractic is the joke, just lacking a certain stroke of genius. lots of strokes, though) Oh, and I am a real doctor, with a real PhD in a real academic medical field, but I don't pretend at being a physician. You on the other hand, pretend at being a reformer in a practice made up by a magnetic healing scam artist.

I am curious, though, and as I asked earlier, what else have you incorporated beyond PT into your practice? Homeopathic remedies, supplements, accupunture? You attacked me for not knowing about how you practice, so now I am asking.

I'm working my way through some of the articles you suggested, and I'm not too impressed with some of them, and despite what you may think, I don't check to see if the author is a dC or PhD or MD before I read it.

Joe,
You're an idiot. If you disagree with a review of the literature, that is fine. Offer me something showing support for your view of the evolution of the term "subluxation". I am not looking for something from people sitting around now and pointing out the discrepancies. Show me something that justifies why one definition is more viable than the other.

The doctor in the article from dynamic chiropractic didn't say that he was incompetent in any insane stretch of plausible interpretation. He said that there is no substitute for practical experience, and that there is a world of difference between practicing simulations on healthy people and those with real conditions. Find me an allopath who felt much differently when they had to do the first appendectomy on a live patient after only ever simulating it or working on models. Oh, the chiropractor in the article did say that he practiced / learned with / learned on people who did not have good manual skills, but again, there are good ones and ones who need a little (or a lot) more work in all professions.

If you are referring to the Ernst article as your "comprehensive, 2008" review, I am just going to laugh. No one familiar with research in any field would read that article and say that it was "comprehensive". Try the articles I suggested, instead. See how they compare. (oh, and they really exist. I don't just "wish" that they did or "wish" that they supported my point).

Ahh, Robster, try again. Chiropractic visits are not associated with strokes, it is strokes that are associated with chiropractic visits, just as they are associated with allopathic vists. Let me try this one more time. I know that logic is tough, but stick with me. If I have a headache, neck pain, dizziness, nausea, or any of a host of other syptoms, I might go see a doctor. Because these symptoms are non-specific, it is possible that the doctor might not think to look for a VBA stroke (as they are UNBELIEVABLY rare - and we are trained (and by we, I mean real doctors who treat patients) to look for the more common condition). By all means, hold us responsible for finding this unbelievably rare condition when a patient presents with a headache, but then you must also hold the other practitioners responsible for it, as well. Unless you feel that chiropractors are somehow more qualified and consequently should be held to higher standards.

Strokes should never happen, but check your statistics. The idea that a stroke is a "disease of the old" is not held in ANY circle. Strokes are highest in categories including women on oral contraceptives (known to cause clots) smokers (known to damage arterial walls) pregnant women (again with the clots), etc. Each of these categories (how many old women do you know who are pregnant or on birth control?), independently, has higher stroke rates than "old people". This has nothing to do with anything other than your ignorant statement that "People under 45 should not be having strokes". No one SHOULD be having strokes, but the sad fact is that people at all ages ARE having strokes.

Once again, 12% of patients who had VBA strokes saw chiropractors, 11.21% saw allopathic doctors. In a condition where there were only 818 cases in a population of 35 million people, that means the less-than-a-percent difference is not statistically significant. This is emphasized when you consider the incidence in the population as a whole (whether they see chiropractors or not) is .00002337. This means it is two ten thousandths of a percent. This condition is unbelievably rare, and people are no more likely to have it after visiting a chiropractor than after visiting an allopath. This is not "post hoc rationalization", (hmm, you really like that phrase. Do you think it makes you sound smarter?) this is verifiable, scientific fact.

Read your Busse article again. The percentage of students who were anti-vaccine was still less than half (not 60%) and although your article does say that the percentage increased throughout school, your other article clearly shows that the pendulum swings back the other way when they get back into practice. A lot of doctors in a lot of fields have "idealistic" or "crazy" or "whatever you want to call it" ideas when they get out of school. They mature and calm down. . . read your other article again.

Actually, you can find decent numbers of MDs who are concerned about the risks of vaccines, but many are young and aware of newer research. Everyone is getting all riled up about Gardasil, however, and if you google it or check out the AVAERS website, you can see why. I am not weighing in on it specifically, because that is pretty far beyond the scope of this conversation. You're not going to find too many doctors, chiropractor or allopathic, however, who have an issue with the polio vaccine, or tetanus, or small pox.

Check out the research on inter-rater reliability in the detection of subluxation (both manually and on radiograph) coming out of Health Canada and the university system. Actually, the reliability is pretty high. What are you basing your claims on?

What is the name / are the names of the doctors of chiropractic by whom you have been treated? If you are seeing someone is practicing in a way that is unethical or immoral or unprofessional (i.e. running a scam practice "reading scripts about how the patient needs to keep coming back for adjustments forever") than that person should be reported to the state board. I know you're busy, so if you list the names here, I'll even get you the contact information for the state board. Seriously. Give me the names. Granted, if you have never actually been treated by a chiropractor or are just making stuff up, you would be culpable for libel, but I am sure that you are justified and telling the truth here, even if no where else.

I never said anything about "mean old allopaths" changing the definition (can you see why I liken this to arguing with a 5 year old?). Both definitions have advanced and been refined. I am simply saying that two definitions for the same word have evolved. . . and who is the ultimate authority who has the right to say which one is "right"? God? Excuse me, but I don't think religion has too much place in health care. The allopathic definition of subluxation is a physical definition, the chiropractic definition is a functional one. It is equivalent to the definition of headache, or limp, or depression, which are things not found on x-ray or in bloodwork, etc.

I don't appreciate you putting words in my mouth, but I understand that the normal rules of human behavior and interaction don't apply to you. I have not called you "girly" or a "nazi". I did imply/say that you were immature, uneducated, and rude, but I don't know if we need to discuss this, as there is hardly a viable defense for it. I don't love the conversation here, but I am also not interested in having strangers wander across this site (like they do across the Barret or the Colquhoun site, etc) and think that what you are spewing is actually scientific. You will not change your opinion, but perhaps someone else can at least see that the prejudiced, old propaganda is just that. We will have to disagree on your educational background, because I don't happen to think that a PhD is a "real" doctor. You know what they say, those who can't do, teach.

I don't pretend to be a reformer, because I am not. I am seeking to improve my profession from within and elimiate the less-than-desirable elecment that may exist. . . which makes me normal. I think that most practitioners in most fields feel this way. Perhaps I am more active than some of the others, but that is just because I place pretty high importance on professional responsibility.

I don't know anything about magnetic healing, homeopathy, naturopathy, or acupunture. I do know a Doctor of Acupuncture (trained in China) to whom I have referred for pain management, and I do know about nutritional counseling (as do all Doctors of Chiropractic). I choose not to sell supplements, myself, as I think this is a conflict of interest. I do try to identify sources of quality supplements, however, if my patients truly cannot eat a health diet, as supplements are better than nothing, even if the real food would be better. I have told you how I practice. I treat within my area of evidence-supported expertise, and refer for other conditions as indicated. I aknowledge the "regular check-up" philosophy, but I don't like when my dentist demands I visit twice a year, so I don't demand that my patients come at regular intervals. (Please note that I do go in for a dental cleaning approximately every six months, but I do this because I choose to be concerned with dental health, not because my dentist has read me a script about how gingivitis will kill me). Can you really not understand this? I am not using big words.

Wow, you're not impressed with articles that don't specifically confirm what you already believe?!? I am shocked! I should probably sit down!

Let's try something simple. You have made accusations about the entire chiropractic profession. A few of these were:
- don't wash their hands between patients
- read "scripts" to scam patients into too much treatment
- don't believe in germ theory
- are anti-vaccination (more than the general population)

Well, I am a chiropractor, and without speaking about anything else, I can say, factually, that none of these things are true about me. They are not true of the doctors that I know in the area. I do not believe that they are true about the majority of chiropractic practitioners. If you do, and you want to make this claim, I challenge you to support it. There are about 60,000 doctors of chiropractic in the US. I won't even ask that you prove that they all do it (as you allege) as that is already obviously false. Can you prove that even 10 of them do? Come one, it should be easy, you only need 6,000. Clearly I am not asking you to do the research yourself, as we are all aware of how busy you are, but please share with us the legitimate work that anyone else has done. Obviously you must already have it, as you have been presenting as fact your opinion about a profession in which you appear to have no actual experience, so you must at least have excellent RCTs, etc. to back up your stance. . . or maybe you're just making it up based on your own uneducated opinion.

I may express my opinion here, but at least I am IN the profession, which means that maybe I know a little more about it than you do. I, at least, know how I was taught, what I learned, and what I do in practice. Have you ever even gone to see a chiropractor?

aCQuack wrote "I may express my opinion here, but at least I am IN the [cult], which means that maybe I know a little more about it than you do." Sure, and psychics know more about their business than you do (in all probability). It doesn't make them factually correct. As far as knowing your cult, I have been following it more than 30 years.

Don't get me wrong, when chiros are not snapping necks and causing strokes, they may be competent masseurs (masseuses). It is the delusions of grandeur (and, extra cost) to which I object.

I may be an idiot; but I would never waste time and money "studying" fairy-tale subluxations, as you have. At least, I have evidence for the tooth fairy (there was a dime under my pillow for every tooth I lost). There is not even that much evidence for the chiro subluxation. And, no, whatever you think, it is not visible on X-ray.

If you are referring to the Ernst article as your "comprehensive, 2008" review, I am just going to laugh.

Yes, only literature approved by aCQ is to be accepted into this discussion.

You're still not a real physician or a real doctor. I don't pretend to be a physician, but I do have a doctorate. If the question was asked, is there a toxicologist in the house, I would step forward, but if a doctor (physician) was called for, I would not offer false hope of treatment by raising my hand.

Unlike you, I don't throw a fit over the "not a real doctor" line. Your niece might say, "Uncle Another, don't let them bother you so much."

The Brusse article clearly demonstrates that students are becoming indoctrinated in non scientific beliefs over their training at that specific school. From the second survey mentioned in said article, that school has some of the more realistic properties of a mixer program, but invites quite a few outside "straight" speakers. If this is corrected by real world experience, then it is the real world that is to be thanked, not the schools. You would never find 50% of medical students questioning the value of vaccination. That you rationalize it this way only shows that you don't want to admit that there is something very very wrong with this situation. And saying that there are some dumb MDs does not excuse this, either. Estimates of antivax and anti germ theory belief in chiropractic range from 10 to 30%. Albeit said studies had low sample number, so their value is limited, but even if the low number is correct, one in ten complete idiots playing at medicine is far too many. I suspect the higher number to more accurate, from the Brusse article.

Furthermore, the two largest chiropractic (American Chiropractic Association and International Chiropractic Association) trade associations hold the antivax -but -hiding -it attitude of being against compulsory vaccination. Pediatric Chiropractic, a peds textbook, has a chapter on vaccination, focusing on rare adverse events instead of positive effects across the population.

Before supporters of real medicine accept you, you need to fix your educational system, include classes and training by real doctors on organic disease processes, some microbiology and biochemistry would be nice, add a residency requirement, standardize practices, get rid of invented subluxations and adjustments, drop treatments that are not evidence based (adjustments for asthma), clear house of those pushing "innate intelligence" and "nerve energy", and accept that there are real risks associated with manipulations. If a treatment has no risks, it probably doesn't do anything.

Is it possible that chiropractors could become real doctors and physicians? Yes, but you have a long way to go as a profession, and you really should admit that these are real problems as a first step. Others in your profession do.

That you use an appeal to authority of actually seeing patients is useless. A good friend of mine is a naturopath, and he "sees" patients, but is a complete and total quack. And he calls himself a "doctor," too. Is he a con artist? No, he really believes that he is doing the right thing in an ethical manner. Of course, his "patients" talk about how well he listens to them, but since he has no real medical knowledge, what can he do but listen, even to details that are irrelevant to a real diagnosis?

I don't think you are getting the underlying truth of the stroke article. The odds ratio is 12. In under 45 patients. Right there in table 3. Yes, real doctors saw lots of stroke patients too, but a better explanation of the data is that the real docs were treating strokes but the chiropractors weren't. In the under 45 group, they were causing them. The authors are either not aware of this possibility (bad author! bad editor! bad reviewer!) or avoided it intentionally. But how would a chiropractor treat a stroke? You can't prescribe drugs. You can't adjust or manipulate it away. Is the SOP to call 911?

What are the supposedly non specific symptoms of a VBA stroke? As Mark Crislip quotes from E-Medicine âIpsilateral facial dysesthesia (pain and numbness) - Most common symptom, Dysarthria or hoarseness (cranial nerves [CN] IX and X), Contralateral loss of pain and temperature sensation in the trunk and limbs, Ipsilateral loss of taste (nucleus and tractus solitarius), Hiccups, Vertigo, Nausea and vomiting, Diplopia or oscillopsia (image movement experienced with head motion), Dysphagia (CN IX and X), Disequilibrium, Unilateral hearing loss, headacheâ

I wouldn't miss that, and I'm not a physician (and I don't play one on TV), but I have also recently watched my father deteriorate from a series of minor cerebellum strokes, and the shared signs between the two would be clear and immediately alarming. A trained medical worker should pick that out in no time.

It isn't surprising that the over 45 group doesn't show this risk. They have far more risks for having a stroke, so it shouldn't be surprising that a rare effect would be hidden within the older of the two groups. So either those under 45 greatly prefer to go to chiropractors, or an activity, where a relaxed neck is twisted abruptly and violently, is directly causing torn arteries. Since this is exactly the kind of activity that we know can cause such an injury, I am flummoxed as to why you deny any possibility of causation.

Again, the key is to look at the under 45 population. They are the ones being injured.

And I use names of logical fallacies not to sound smart, but because they should be pointed out, and why not use the correct term? And while they are anecdotes, and the plural of anecdote is not data, you should google "whats the harm" and look at a handful of chiropractic induced strokes.

I'm glad that you don't mix forms of quackery, that at least shows some principle, and I admire that you don't push supplements like many of your colleagues. That must hurt your bottom line in comparison, but it is the right thing to do. I would not see a chiropractor because I don't want to take the time to figure out if said chiropracter is a complete quack (like Palmer, who founded the field with a faked claim of healing deafness), or just operates in a field notorious for quackery (and admits it like Homola). These faults are described in depth here by Mark Sanders, who is a DC, and freely admits to the problems in his discipline. Since I cannot comment on chiropractic without being a chiropractor (anybody wanna play name the logical fallacy there?) perhaps Sanders is allowed to talk about chiropractic subluxations, practice building scripts and programs, inappropriate diagnoses, that the great majority of back pain is self correcting, etc etc.

Instead, I want the best therapy possible. My personal back pain has nothing to do with any imaginary subluxation, but from a torn muscle I acquired in high school. I don't need my spine adjusted, but a few naproxen over a year and the occasional backrub from my wife. Compare the cost benefit analysis on that, and I come out ahead.

From the meta analysis in both Spine and The Spine Journal (meta analysis are always subjective based on the author's ratings, and while they have value, they should not be given great weight), we can see that the authors believe that chiropractic works.

You put a lot of stock in the authority of the authors, but I try not to put stock in any author, but in the totality of the research. I may get excited to see the latest research from a particular lab, but only because it is an area I am interested in it. I look at the evidence and how it is presented. Being a well respected, highly published author can lead to weak scholarship, as editors are more willing to take you at face value and assume that all the details you are writing down are correct. There are Nobel prize winners that believe that HIV does not cause AIDS. They did one very important thing very well, once. Everything else may be a mistake.

So what do we learn from these two journals?

Of the two, Spine is much better. The primary literature is mixed on the efficacy of chiropractic. Especially important is that randomized clinical trials with sham treatment arms were determined to be mixed, as in some positive studies and some sham treatment and real treatment producing similar results. From that, I would say that the results are or tend to be inconclusive. Comparative trials tended to support chiropractic's efficacy, so between the two (and the others categories also being mixed, trending positive), I would say that I am justified in claiming that not much is really that good for back pain. While the authors interpret this as a positive, I would say that the literature delivers an emphatic "meh."

From all that the meta analysis in Spine came out supporting the use of chiropractic as effective for treating some forms of back pain. Hence, I will do something that you will not do. I will admit that my previous understanding appears to be incorrect. Chiropractic may have some effect on some forms of back pain, and should be studied further, with more RCTs with sham arms. Is there a bias in the authors? Probably so. Is it superior? Probably not by much, if at all, and not that much more than other evidence based methods. I still consider chiropractic to be a field of moderate usefulness with lots of quackery mixed in. I would also never let a chiropractor touch my neck, as I can get similar or better efficacy treatment from many other places with no risk of stroke.

I can get equivalent therapy from a PT, with more trust in the expertise and scientific literacy of the practitioner, and know that they probably did not face indoctrination from a non-scientific school.

The Spine Journal's review is junk. It reviews multiple forms of CAM (along with some real medical treatments) and the authors seem to have no concept of placebo effect or are not willing to suggest that things don't work. It gives too much plausibility to far too many demonstrably placebo based methods such as homeopathy and acupuncture. With such inability call spades at least a form of shovel, determining what is real and what is not is rendered pointless. If I wanted to be part of the evidence based medicine family, I would not have brought that particular volume of that particular journal up. Thats just from a quick readthru, but I'd be surprised if it improves.

OK, on to the stinky smelly chiropractors...

First, the most damning piece is from Chiropractic & Osteopathy, titled "Assessment and risk reduction of infectious pathogens on chiropractic treatment tables." Pathogenic bacteria including MRSA were found on tables with an easily cleaned vinyl coating. They didn't test cloth covered tables, but we can assume that the porous surfaces were much worse.

If basic clinical hygiene isn't a problem, then why is this journal in your own field pointing out that these tables should be cleaned and non-vinyl surfaces should be replaced. It even suggests that hand washing and hand disinfectant stations be installed, and gloves be used. I can't imagine a doctor's office being allowed to operate without these basic items, but the authors apparently did, and point out a lack of, in the words of the authors, "systematic infection control protocol" for the chiropractic industry. At least the Chiropractic and Osteopathic College of Australasia has a pamphlet on infection control, but this teaching facility apparently didn't read it. I would consider it common sense, but with such uncommon beliefs as innate intelligence and subluxations and germ theory denial from the "straights," it seems the authors know better than to trust their fellows.

Next up, "The role of chiropractic adjusting tables as reservoirs for microbial diseases." Am J Infect Control. 2006 Apr;34(3):155-7. (subscription required so no link). In this study, examining tables at the National University of Health Sciences (Lombard, IL) were sampled, and found to be contaminated with bacteria, including MRSA, and basic sterile technique and cleaning was suggested to protect patients. Seriously. Just cleaning the tables and chairs, but they failed this. Wow. You may clean your tables, but these schmucks didn't.

Also of interest is an outbreak of amebiasis some 30 years ago, documented in NEJM, where colonic irrigation equipment was not cleaned and sterilized properly, and it was further found to be heavily contaminated with fecal coliform bacteria. So not only was hygiene not adhered to, spreading disease, the said practice was was exhibiting pure crank magnetism of mixing colonic irrigation with other forms of woo, so this isn't a new problem. Of course, outside of the question of why get your colon rinsed in the first place, what person would so disrespect their patient so much as to not clean a hose that had just been in another patient's ass?

So I would say that while you may be sparkly clean, shaved bald with an earing, your colleagues have some work to do.

So, two articles documenting a lack of basic clinical hygiene and infection control practices at two teaching hospitals... Does that meet your requirements or is it time for more hand waving?

How Can Chiropractic Become a Respected Mainstream Profession? http://www.chirobase.org/01General/respect.html A lament and criticism by chiros.

They could drop all the quackery and almost be massagers. (Massagers need to recognize some conditions that should be referred to a doctor.) Or, they could hire competent faculty and train for PT licensure. I don't think the typical chiro is able to qualify for the latter.

Author! Author!

(That's going out to Robster, BTW)

Joe,
Do you think that changing my quote makes you more credible? Also, the use of the [] marks in a quote are to change the tense to allow the quote to flow more correctly in the larger context, not to just change whatever you want to change. . . so I guess we know that you're an idiot who also doesn't know how to speak / write English.

Robster,
I reject the article from Ernst not just because I deem it to be unacceptable, but because it has been discredited by a large group of physicians and researchers due to it's clear bias and lack of scientific credibility or integrity. Even if it was just me, however, I would point out that if you feel you have the right to dismiss some of the research I have proposed, then I also have the right to dismiss some of the research that you have proposed.

I will make a note of your opinion that I am not a real doctor, but my doctoral degree, license, training, and the laws of my jurisdiction say that you are wrong. I won't expect you to change your mind, but I'll be glad that you have no basis for your opinion other than your bias, and your opinion in this realm doesn't count for diddly-squat.

If a patient presented with ALL of the symptoms of a VBA stroke, or presented WHILE they were having the stroke (which is when all of those symptoms emerge) then yes, any trained practitioner should be able to recognize them. As the majority of patients present PRIOR to their stroke, however, when they may just be having a headache or dizziness, then it seems a little more reasonable that it could be missed. Also, you might know this if you actually treated patients, but it is not reasonable to make the assumption that patients seeing allopaths were going in for their strokes anymore than it is reasonable to assume they would be seeing the chiropractors for the same reason. Patients present with symptoms (i.e. headache or neck pain), not diagnoses. Patients don't think, "Hmm, I have a headache, most likely a stroke! Better take myself in. . ." Patients present with prodromal symptoms, that is how it works in the vast majority of the very few cases in which this occurs.

The percentage of patients who had a stroke within a day after seeing their practitioner was statistically the same whether they chose to see a chiropractor or an allopath. The assumption that they were seeing the allopath for treatment for that stroke is unsupported in the literature, and even if it was true, then all it does is say that allopaths do a crappy job of treating these patients as they all went ahead and had strokes anyway. If that is the case, then no one can treat them, and I don't happen to believe that this is true. Either way, however, neither of us have evidential support for our opinions, all we have is the fact that the association is the same between chiropractic and allopathic practitioners with regard to this type of stroke.

I am glad that you can admit that your original interpretation of the Spine articles was incorrect. I have alleged that you would never admit that you were at all incorrect, so I stand corrected. I am not sure why you accuse me of being unable to make the same admission, however, as I have never said or done anything to support that accusation. Perhaps we are just back in the playground, and you're rubber and I am glue.

Perhaps you say The Spine Journal is junk because you want to have it be junk. Remember that you said the same thing about the Spine task force report at first, too. I never expected you to aknowledge the evidence, so if you are willing to admit that this is legitimately done research which allows you to, begrudgingly, admit that chiropractic "may work for some kinds of back pain" (even though the articles you are willing to give minimal credence to are about neck pain and the associated conditions) then I am content.

You say we need to fix our educational system by including, "classes and training by real doctors on organic disease processes, some microbiology and biochemistry would be nice, add a residency requirement", etc. Excellent! Then we are in agreement. I was taught by real doctors (PhDs, MDs, some mutiple degree holders, including some DC, PhDs). I had several years of study on diagnosis, pathology, clinical pathology, immunology, infectious disease, etc . . .all taught by two instructors, one who was an MD and the other who was a DC,PhD pathologist. I had microbiology, taught by a PhD in Micro, although the lab instructor was a Masters in micro with a PhD in education. My Biochem instructor was a PhD biochemist, although I will admit that in lab she also had a DC to assist, and I am not aware of that DC having another degree, as well. As we have already established, we do complete internships, externships, and residencies. So now there is no reason not to "accept" me, right? I feel so loved. As far as "adjustments" go, Doctors of Osteopathy do something that is somewhat similar, and they are "accepted", so I think we are good there. Also, there is a difference between something lacking evidence, and something else which has evidence against it. I will admit that there is only anecdotal evidence (case studies) supporting chiropractic treatment for asthma. Consequently, I do not make this claim and treat this condition in my clinic. There is not evidence saying that it doesn't help control symptoms, however, so I will refrain from making the accusation that this is a sham for the time being. Perhaps when there is some funding available for research, we can know the answer with any certainty at all.

Hmmm, innate intelligence, the idea that the body has the ability to heal itself. This is not a phrase that I like or use, as it has horrible connotations and history. It is, however, an idea that is rooted into the philosophies of all physicians. My grandmother had a hip replacement, and the surgeon cut her open, chopped out a chunk of bone, replaced it with metal and plastic, and stiched her back up secure in the knowledge that her skin and tissue would grow back, the blood vessels would reroute, and that her body would "heal" itself. Casting a broken bone is the same idea. . . create an environment in which the body will heal itself (the bone will re-join) most correctly. The bones will heal over if they are not casted, but most likely not in the right way. Should I call up the guy who casted my mother's arm and accuse him of quackery because he just expected that bone to heal itself? I agree that some people take it too far, or say things that are just stupid because either they believe it or because they don't know how to express it correctly. I think that the people who take it too far are doing a disservice, both to patients and to those of us who practice correctly and are forced to share the same title.

Okay, on to dirty tables.

Both of your studies are on teaching clinics, one at Parker, the other at National. In both of these situations, it is the responsibility of the custodial staff to clean the tables, much like at any other hospital. When was the last time you saw your GP scrubbing down a table? Don't get me wrong, I am not trying to pass the buck here. I was taught to wipe down the table and wash my hands between patients, and I did so. I still do! Perhaps the instructors and students should be reprimanded for being lazy, and the custodial staff should be dismissed. Much as I would dismiss the custodial staff and reprimand the doctors presented in the article, "An outbreak of methicillin-resistant Staphylococcus aureus in a large medical center.", Am Surg. 1983 Apr;49(4):179-81, and "An outbreak of infection with a gentamicin and methicillin-resistant Staphylococcus aureus in a neonatal unit." J Hosp Infect. 1980 Sep;1(3):221-8, or "Outbreak of gentamicin-methicillin-resistant Staphylococcus aureus infection in an intensive care unit for children.", J Hosp Infect. 1986 Jan;7(1):21-5. or "Gentamicin-methicillin-resistant Staphylococcus aureus: epidemiology and containment of an outbreak.", J Hosp Infect. 1986 Mar;7(2):130-6. They are all guilty of being lazy, whether chiro or allopath, and should all be held accountable.

Thank you for bringing out the article about colonic irrigation. I have never had to have this done, thank goodness, but as the age for colonoscopy approaches, I am not looking forward to it. Colonic irrigation (a.k.a. enema) is not a part of the chiropractic scope of practice in colorado, so although the article you mention (NEJM 1982) is in a chiropractic clinic, it is good to note that the licensure under which the procedure was done was not a chiropractic one. I appreciate you taking the time to point out that there are lazy, dirty practitioners in all physician professions. This doesn't make it better, as no one should be guilty of this offense, but I appreciate you making the point that the laziness is a characteristic of the person, not the profession. There are lazy, dirty people. Unfortunately, some of them happen to be doctors.

I have not said that you cannot make comment on chiropractic. I have only said that in the absence of personal experience or a resonable background understanding, you should be careful about presenting your opinion as fact when you have no support for it. You may choose to not go see a chiropractor, and you can say that this is because you don't want to waste the time to find a good one. Although the odds would be in your favor, as the majority are "good ones", that is your choice. Why do you feel that you are so important that you have the right to demand that other people agree with you? Especially when you have no actual experience with it? I do not demand that people seek chiropractic care, but as I have scientific evidence (even moderately acceptable to your standards) that my treatment is beneficial to some individuals with some kinds of pain conditions, I will continue to offer this care to individuals who seek it. If they want what I can do, I will be here, with clean hands, a clean table, good technique, and an ethical practice.

I wish you well with the rest of your life, and ask only that you remember that there is research out there, even if you are too busy or just uninterested, and refrain from initiating this kind of ridiculous, unprofessional attack again in the future.

aCQ,

You still don't get it.

You still can't admit it.

Table 3. Odds ratio. The numbers for under 45 are different. After this many times of pointing this out to you, and you not being able to comprehend it, either you simply cannot get past your own bias, or you know you are wrong.

The violent twisting of a neck can cause VBA stroke. We both agree on this, right? This is what I am trying to pry out of you. Why won't you admit that this includes neck "manipulations?" Its right there in the data. Several papers are out there discussing this possibility, and a positive odds ratio is there supporting this is several papers. I admit there is a possibility that manipulation may work for some back pain, but the neck should be off limits from violent twists by chiropractic practitioners. If there was a drug for neck pain that had a rare complication of causing stroke, it would be off the market. Maybe thats why you can't admit the possibility of causation.

So, where is Erntz so roundly discredited?

The Spine Journal is junk because it does not separate known placebos from treatments with some weak evidence based support and those with strong support. How on earth can a journal claim quality when it gives serious credence to homeopathy and acupuncture?

Your response to the phrase "innate intelligence" is, well, odd, and rather straw mannish. (warning, expository dialog) Straight chiropractors have a non scientific idea that is remarkably like chi, where the flow of this can be blocked by otherwise undetectable subluxations that only they can find and correct. You conflate this with growth and repair mechanisms, which really exist. I'm not sure why you choose to do this, but you do take an important first step here, by obliquely admitting that you share your title of dC with complete quacks.

If clean tables and hand washing stations are not available in a teaching hospital, you can blame it on the low pay maintenance staff, but it really reflects the priorities of the people running the clinic, which they pass along to those being trained there. When there are outbreaks of resistant strains of bacteria, it means that the infection control system failed. Those two papers demonstrate that such a system doesn't even exist for those two teaching hospitals.

You may have gotten a quality education, but before we in the evidence based medicine world will accept chiropractic as a real medical field, the whole lot of you need that. If your experience is the rule instead of the exception, then why do your fellow dCs point out the failings of chiropractic training and that it needs serious overhaul. You say it isn't needed, but they say it does. It may be my bias, but since you claim that there isn't a problem with antivax views or basic hygiene or even a possibility that chiropractic neck manipulation may be a cause of some VBA strokes, I'll take those who have honestly reflected on their faults.

You can accuse me of making ridiculous unprofessional attacks, but I'm not the one practicing a medical unprofession, worthy of ridicule. In some areas a naturopath is a doctor, so degree and laws don't have anything to do with my opinion. Osteopaths do some manipulation based therapies, and I think that if they are not strongly evidence based, they should stop. But they do and are licensed to do things other than manipulation, and other than people within the DO community saying that they should drop manipulation altogether, nobody is saying that the educational system needs complete overhaul.

Why do you feel that you are so important that you have the right to demand that other people agree with you?

What? You are hallucinating. I'd refrain from doing self manipulation, if I were you. (ha ha, double entendre)

The evidence that chiropractic is better than other treatments is weak, especially since it can't even beat shams most of the time. You may think that is a strong approval, as Spine does, but it still doesn't pass the test. More study is needed, but since negative results are positive to you, I have a feeling that future results will only support both of our positions. So far, I'd say that the evidence suggests that the skeptical interpretation is correct. Chiropractors are physical therapists with delusions of grandeur.

Robster,

Good God, I thought I had tried to end this conversation courteously respecting difference of opinion, but here you are, still on the attack. Do you really have nothing better to do with your time? I thought you were so busy with your students? If this is really a desire to continue discussion, that is one thing. If you are just desperate to have the last word, can you please just let me know? I promise, it's not that big of a deal to me.

You continue to misread, misinterpret, and misrepresent the information in the study. What I have said, and will say again, is that in the under 45 group, the odds of having a stroke within a day of seeing a health care practitioner are statistically the same whether the practitioner seen was a chiropractor or an allopath. This is all I have said, and I say it based on the information contained in table 3 (related to visits to chiropractors) AND table 4 (related to visits from non-chiropractors). Do you really not know how to read a study or is this intentional? Ignoring data which is inconvenient is an old trick by unethical researchers used to manipulate statistics to support a conclusion which would be otherwise unsupported. Can you draw a conclusion based on ALL of the data (or even just tables 3 and 4) or do you want to continue to insist on only telling half of the story? How am I wrong when I talk about the association and how it compares to the parallel associations? What is it that you want me to admit? That the odds are higher in those under 45 than those over 45? That is a ridiculous comparison because they are two totally different patient populations. Compare the under 45's with the under 45's and the over's with the over's. It is pretty easy to look up, try WebMD.com, but the risk of VBAI stroke dramatically decreases in individuals over the age of 45 due to decreased flexibility of the spine following the dessication of the nucleus pulposis beginning around the age of 40. I assume that this is why the division in patient populations was made at that particular age.

It is plausible that a violent twisting of a neck (a la ninja style) could damage a vertebral artery leading to a VBAI stroke. This is not proven, however, as it would be pretty unethical to have a trial group in which you tried to induce damage in them. Independent research supported by Health Canada has measured the forces applied during the cervical adjustment, and when done properly there is no way that they would be considered "violent". . . not even when I was back in school and was the practice patient for people just starting out. It is also possible that a very mild movement could dislodge atherosclerotic build-up or exacerbate a pre-existing aneurysm resulting in a stroke. These mild movements may include leaning your head back into a salon sink, doing yoga, basic range of motion tests performed by a PT, or yes, a chiropractic cervical adjustment.

Your assessment of the "clean tables" articles do not extend to hand washing. In none of the articles did they check to see if the practitioners had clean hands. As far as non-sterile environment is concerned, this is clearly a universal problem, as the other papers I offered show. I am not denying that this is a problem, but I will insist that it is not a uniquely chiropractic problem.

My response to the phrase "innate intelligence" is what I was taught in school, and is the fundamental understanding of nearly every chiropractor I have ever talked to about it. . . although I will admit that this is not many as we don't all get together and discuss "innate". You admit that my understanding is plausible and based in known science, but say that the "straights" think differently. How would you know? You admit that you've never seen one. If there are some "wackos" out there blogging or writing their own newspapers to say something different, what makes them uniquely chiropractic? There are blogs out there about building bombs and time travel and supporting hate crimes. The vocal minority is not the standard on which a society is judged, nor should it be the standard on which a profession is judged. There have been a few paedophile priests and pastors. . . do you assume that everyone associated with a church is a danger to your child?

I did get a quality education and as I went to school with several thousand other students over the course of the 10 terms quite a few years ago, I am clearly not the only one. The standards have been improving in chiropractic schools across the country and the world for decades. Not all of them are perfect yet, but they are being directed to improve or be shut down. Your statements are based on rumors that weren't even really true when they were first started 40 years ago, and they really are not applicable today. Note, I completely agree that improvement of educational standards in chiropractic is of priority, and I support the development of education in all health care professional fields. Get better, or get out. . . but I apply that standard to everyone.

" You can accuse me of making ridiculous unprofessional attacks, but I'm not the one practicing a medical unprofession, worthy of ridicule."

Wow, way to make my point for me. You are engaged not in debate but ridiculous, unprofessional attacks unsupported by any legitimate evidence.

You still have not answered by questions as to why you think your personal, unsupported opinion is so important that you should be able to demand that other people agree with you. Your eloquent response "What?" followed by a personal insult was not quite sufficient to address the actual question of on what do you base your pretended authority?

You admit that the results are positive, but qualify them as weak. That is fine. I would hold that you clearly don't know how to read or analyze literature, but in any case, how does weakly positive become negative when you accuse me by saying "negative results are positive to you"? If it is positive, however weakly you may (incorrectly) allege, then how am I holding negative to be positive? It is already positive!

You are making a completely false statement when you say a pharmaceutical with a rare risk of stroke would be removed from the market. 30% is considered the reasonably acceptable range for "moderate to severe" complications as a result of appropriate use of pharmaceuticals according to the FDA. This is why things like Gardasil and every single statin drug is still in the market. Since Gardasil was released in 2007, there have been 3,461 "moderate" or higher adverse events reported that were deemed to be "associated" (not to mention however many were reported that showed insufficient evidence of association) and there have been at least 8 deaths. Not only is Gardasil still on the market, it has been mandated for females under the age of 14 in various jurisdictions, despite the fact that the only safety data is on women between the ages of 18-25. Every single statin has the KNOWN complication of rarely causing the debilitating disease Rhabdomyolisis, in which the body's muscle tissue is autoconsumed, resulting in major complications including death as the body eats it's own heart. Blood pressure can be controlled with diet and lifestyle in nearly every case, yet statin prescriptions are handed out like candy . . . despite the serious but rare side effect. If you knew anything about pharmacology, you would never make such a moronic statement. You cannot possibly really be a toxicologist, which means that this entire conversation has been ridiculous because you are, fundamentally, a liar.

another chiro quack,

Why do you find it important to post here?

Then walk away aCQ. You can't because you like the abuse. I do admit that it is getting boring, bringing you to your discipline's leavings on the carpet, rubbing your nose in it, and seeing no practical understanding.

I looked over the article (yet again), and think you should look at how the stats were computed. Primary care physicians (PCP) numbers are computed differently than chiropractic numbers. They don't compare the way you think they do. The authors even point this out, including the point that the PCPs are probably treating strokes, while the chiropractors may be causing them. Since other papers have come to similar conclusions, I will go with the totality of the research. Chiropractic practice is an important and avoidable risk factor for the rare event of VBA stroke by dissection.

Yes, the populations of under 45 vs over 45 are different, which is why table 3 is so incredibly important. A rare event would disappear in the over 45 group, due to the naturally increased risk. Since strokes are so incredibly rare in the under 45 group, they are a more sensitive demographic to injury. Compare the table 3 and 4. In table 3, your risk of stroke decreases the longer it has been since chiropractic visit, suggesting that the injury more often than not occurs at the visit. This makes sense, as VBA dissection, a torn artery, is something that should show up very, very soon. On the other hand, risk of stroke goes up dramatically as time goes by post PCP visit, which suggests that the injury is not happening at the doctor's office.

Furthermore, if a stroke happens sometime during the year, at random, you would expect the chances of it happening to increase as time passes. A careful reading of the paper will reveal this. I'm not sure why it escaped the authors, but have a strong suspicion why it does for you. Your bias is a perversion of the Hippocratic oath. Instead of "First, do no harm," it has become, "We can do no harm."

A further weakness of this study is that we don't know about the patient history of said individuals. Are the patients visiting the physicians high risk to start with, and the patients of the chiropractors, are they the worried well?

So, how many Newtons are required to complete a passive hanging (no drop, commonly used in suicides, often causes death due to VBA injury)? 686. How many Newtons go into a Chiropractic adjustment? The number I have found is a mean of 264 Newtons over 145 milliseconds for all adjustments. Thats 41.4% of a fatal hanging, all in 1/8 of a second, but without the muscle resistance that comes with an unrelaxed neck. The good news is that that isn't enough to kill all the patients, but the bad news is that it is likely to result in killing some. Now, if you happen to have specific numbers as to the mean force of cervical manipulations, I'd be happy to use more specific calculations.

How would I know what straight chiropractors believe, when I haven't met one? I have read what they write, and think that anybody so completely divorced from reality should not be able to practice medicine. Chiropractic needs to excise this anti scientific tumor from its educational system, something that obviously is not being done, based on the Brusse paper. With estimates of active antivax chiropractors between 10 and 30%, and students leaving a supposedly mixer school with a 60% negative view of vaccination, and the two largest chiropractic associations having a stealth antivax position, you need to fix this issue, not act as though it is a surprise to learn that it exists. Your response to learning of quackery is a tolerant, out of sight, out of mind attitude that it occurs in all fields, not that said quacks need to lose their right to practice. Do you not have any care for the dignity of your practice? The Brusse article is not a rumor, even though 50% of students over an entire school with no understanding of the value of vaccines to public health is apparently fine and dandy to you.

I nowhere demand that anybody agree with me. Like I said, you are hallucinating, and your self manipulation has destroyed your sense of humor.

I may not have been clear enough for you. RCT with sham arms are the best tool for examining these procedures. RCT with sham procedures tend to come out negative, which is typical for a procedure with a weak or placebo based effect. These are the strongest tools we have for separating placebo based pseudoscience from real effects. Comparative studies are a weak positive, which combined with RCT with sham studies says that not much is that good for treating back and neck pain. I see this as an overall negative with the occasional bright spot, which suggest that we need more research into the area, while you see it as a resounding success. I expect more RCT with shams to be negative, which you will ignore, and a mix of weak ups and downs for comparative studies, which will be complete validation from your viewpoint.

I'm also not alone in this view, as other meta analysis studies are out there which find no significant effect for treating lower back pain with manipulation, Assendelft et al (Ann Intern Med. 2003;138:871-881) for example. Because these authors are capable of separating placebo from real, it is of far more value than The Spine Journal, and shows that the weak positive trumped by Spine is just as validly interpreted as a negative. Meta analysis is useful in getting a feel for the field, but you need to look at the study design and not just the conclusions.

On to your assault on my area of expertise. I study cancer drugs and how to make them less toxic by combination chemotherapy and dosing patterns. My area is not the bureaucratic end, so I am curious as to where you got the 30% figure, as it doesn't jive with what I remember from my classes. Mind you, we didn't spend our times memorizing rules that we could look up if it was cogent to our field. Also, pharmacology is the study of how drugs work, not how they are regulated, but since you can't prescribe, like a real doctor could, I'm not surprised that your training would tend to be about the evils of drugs instead of the benefits and mechanisms of action, along with possible side effects.

The cost and benefit have to be compared, so a competitor for let's say, aspirin, when properly used, would need to have a very low risk profile, as the benefit is small (aches, pain, migraine, fever, anti-platelet). Hence, COX2 inhibitors flopped because they had higher risks for rare but serious cardiac events. However, more serious disease processes, such as cancer or HIV/AIDS, would warrant a much higher risk of serious side effect. Also, I fully expect statins to go out of style because they just don't work all that well for most people.

Even if this is a guideline for basic approval (which I severely doubt), it certainly doesn't apply to real world, post marketing phase of study.

Since nothing works as well as chiropractic (haha, sham treatment = nothing), the risk of stroke is a factor that would seriously call into question the practice of chiropractic neck manipulations. The risk benefit ratio is enough that a drug company would likely start a recall out of fear of litigation, or even due to it, although it might take a few years to get the ball rolling. This is especially true when other treatments with similar efficacy and cost (PT) and less severe side effects are available.

Thats why I don't think your 30% is a hard and fast rule. I'd accept 30% moderate to severe side effects for an excellent anticancer drug, but not for a headache or back pain drug.

Also, your Gardasil lines sound suspiciously like they were cribbed from an antivax source. Hmmmm. A closet antivax chiropractor? Inconceivable. (Don't worry, you won't get that quote. You would need a sense of humor.) Perhaps you need to go back and look at that data as well. Would you mind citing your source on this as well? I have seen similar figures, but with clinical explanations on why said events occurred, and whether they were truly linked to the vaccination.

But hey, I'm just a 5 year old, lying, goose stepping "allopath" supporter.

Just epic, Robster.

Some parts bypassed the LOL LD50, e.g., "Yes, I am a jerk, but I am also technically correct, which is the best kind of correct."

Tiny fix: US med schools, including Creighton, have two pre-clinical years and two years of rotations through various medical specialties involving direct patient care. The "M4" student mentioned at the Creighton link is a fourth year med student.

another Chiropractic Physician:

Sorry, but you're wrong on the med school thing. One of my friends from undergrad went to the Creighton Medical school, started the same week I did, and she was done in 3 years. At that point, she had never treated a patient.

ORLY?

From the Creighton web site regarding the clinical years:

Students will average no more than 80 hours per week during a clinical rotation.
Students will average at least one day off (24 hours) in every seven while on a clinical rotation
Post call (over night) students must be excused from clinical responsibilities after required teaching sessions are completed. Students must be allowed a minimum of 10 hours off after overnight call for rest.

Only 80 hours a week? What pussies! In my day it was every third or every second night call, and no one bothered to do the math for the hours cuz we LOVED EVERY MINUTE OF IT!!!!111!!!!

Chirodude, it is my clinical impression that your pants just caught fire.

From there, she was known as "Dr. xxxxx" and began her internship, followed by residency, during which she learned to work with actual people. This is exactly what I said.

Phallus flambée!

Following a 4 year undergrad course, Chiropractic school was 5 semesters of academic classes, then 2 years of classes while simultaneously treating patients in University based clinics and then public clinics...

Sounds hardcore! You wuz prolly up all night monitoring unpredictable subluxations, getting stat pages to the ER for acute drops in qi, making agonizing decisions with family members over whether to crack a back or maybe just crack a back a little...

Admit it aCP: You're full of poo.

Oh, some part of your story is true. Perhaps you're applying to chiro school, or you're currently a student, or your SO is a chiro...

Well it has been fun following along.

Okay, in the United States, the term "physician" is used for Cardiologists, Chiropractors, Dentists, Family and General Practitioners, Oncologists, Osteopaths, Podiatrists, Rheumatologists, and a whole laundry list of doctors. Looks like chiropractic is there!

A confusion of category levels here. It would have been more accurate to say, "medical doctors, dentists, podiatrists, chiropracters." The set of medical doctors includes specialists such as cardiologists, family and general practitioners, rheumatologists, etc.

The "doctor of osteopathy" has become nearly equivalent to the "doctor of medicine" in the US but not in the UK. US DOs train in the same residency programs as MDs.

I guess the argument being made is: "So many sorts of doctors out there, no big deal to throw chiropracters into the bunch!" This is pre-rational, associative thinking. Useful in advertising. Elsewhere, not so much.

Robster,
Each one of us is asking the other why they keep writing, but clearly you are as involved as this as I am.

You are deliberately making claims that the paper in question does not support. You are also throwing out inccorrect statements, such as, "if a stroke happens sometime during the year, at random, you would expect the chances of it happening to increase as time passes". This stroke is less common in older individuals. Furthermore, if a patient presents to a practitioner with "impending stroke symptoms", it is more likely that the event would occur soon. The ones who had an event 2-4 weeks later are representative of that part of the population for whom the stroke came on suddenly without symptoms. Not even you could argue that a chiropractor had torn a vertebral artery with his "vicious" cervical adjustment and the patient bled from the vertebral artery for 30 days before finally having their stroke.

If 686 Newtons is the absolute minimum needed to kill oneself, then it is self-evident that 41% of that minimum force would not successfully kill oneself, not even just "some" of them. However, those numbers are not even correct, as manipulations (depending upon grade, I-V) vary in force but never come close to 264 N. "Manual forces applied during cervical mobilization" JMPT 2007 quotes, "Mean peak forces (grade I, 21.8 N; SD, 15.0; grade II, 34.9 N; SD, 20.9; grade III, 58.2 N; SD, 27.5; grade IV, 61.0 N; SD, 29.9)". Meaning that a Grade IV manipulation rings in at just about 11% of the force you say will kill someone (with a SD of 2%, of course). Personally, I don't think I have ever gone above a grade III in a neck, and even that felt like I was really working the guy over to me. Another article, "The effective forces transmitted by high-speed, low-amplitude thoracic manipulation", in Spine 2001 shows grade V's in the Thoracic Spine show force of 238.2 N, although of course that is not in the neck. Now where did you get your number from? And was that study done on cervical spine adjustments? I think this data shows that I am correct in my statement that a cervical spine adjustment is far from "violent".

A greater proportion of the general population is anti-vaccination than the proportion of chiropractors. You know this as well as I do. Chiropractors are still people, and they have the right to believe as they like. I actually don't know any anti-vaccination chiropractors, but I do know they exist and have never denied it. It is a far smaller proportion of the practitioner population than you allege, however, and as you have yet to provide data to the contrary, perhaps we can agree to disagree.

Both chiropractic professional organizations contain within their constitutions language saying that we recognize the benefit of immunization to public health, but are against MANDATORY vaccination. This is not a stealth anti-vaccination stance, but rather support of transparency in health care and patient rights. Would you like it if the AMA tried to mandate chiropractic adjustments for the care and prevention of headaches? No, of course not. Basic patient rights dictate that no individual is required to submit to any medical procedure. This is the same bill of rights that the AMA supports.

With regard to my statements about the FDA, try reading their Code of Federal Regulations, Title 21, Volume V, Part 314. It's a fascinating read. As to my comments about Gardasil, as I have stated, I don't actually know any anti-vaccination chiropractors, and that data comes from the Vaccine Adverse Event Reporting System website, under the Health and Human Services Division. I won't put the link here, as always, but it is a pretty easy dot-gov site to find. They have a searchable database where you can check out each of the more than 240,000 events that have been reported since Gardasil was released. Of course, not all of these are "moderate to severe" or "severe", so we won't worry about most of them. Clearly, I didn't learn any of this in my pharmacology class at school all those years ago, as regulation is not a fundamental part of that subject, although it is related, of course. Guess my any "evil drug" leanings I have didn't come from my training. . . and since I haven't actually made any "evil drug" statements, I don't know what you're basing your allegations on. My reporting of statistics is in response to your statement (the one I called "moronic"), and as it says at the top of this page, "a statement of fact cannot be insolent".

Oh, and I never said you WERE a 5 year old, just that you are acting like one. I did say you are a liar, and that statement still holds, since acceptable levels of adverse events is a pretty core component of the science end of toxicology. The beaurocrats may determine which level is "acceptable", but it is still up to the science side to make that number happen. If you were dealing with combination drug toxicology, you would be aware of what the acceptable levels are.

Is this sufficient sourcing of my facts?

Dr. Benway,
Your Creighton link talks about the clinical activity limitations. . . the part done after the academic coursework. I never said that Creighton students didn't do clinical activity, nor did I cast aspersions on their work ethic. How, therefore, is this quote related at all to the conversation? Furthermore, if you check the page on the med school curriculum, it will run you through the 4 years prior to residency (check the quote "Having been exposed to the breadth of medicine in the third year, the fourth year prepares students for residency and provides a chance to explore their own interests in specialized areas of medical practice.") which outlines the three years of academic coursework, the year of internship, and the subsequent residency.

Admit it, it kind of sounds like you're the one full of poo, huh. God, I love when I'm right.

Oh, and as we have already established, I am a chiropractor who has been in practice for nearly a decade. Not sure why you think I am an applicant or a student, but I assume it's because of your apparent limitations.

As to the confusion of category levels. . . first of all, it is alphabetical, not intending to indicate any particular level (see alphabet for confirmation). With regard to the idea that it recognizes some professions by degree (i.e. Doctor of Chiropractic) and others by specialization (i.e. cardiologist), this is something I noticed as well. However, I assume they were looking to list "kinds" of doctors, (and all D.C.s happen to be Doctors of Chiropractic) not necessarily degrees (which is why they have "General Practitioner" not "M.D."). However, since this is a federal regulation document and I haven't had the chance to call up the U.S. Surgeon General to ask why they did it this way, I guess I will admit that my assumption is no more likely to be right than any of the crap that you just posted. . . although it is considerably more logical and courteous.

Oh, and Robster, before I forget. . .

You say that if I could prescribe like a "real doctor". . . but then you claim to be a real doctor. . . Hmm, are you using that PhD that you claim to have to write out scrips?

Oh, and I am still waiting for the name of a single chiropractor that you know, personally, who is practicing in an unethical or illegal way. Just like a courtroom, hearsay doesn't count. Give me a name of a single bad chiropractor about whom you have first hand knowledge and against whom would be willing to sign the complaint.

aCP:

which outlines the three years of academic coursework, the year of internship, and the subsequent residency.

You are confused. Med school is four years: two pre-clinical, two clinical involving direct care of sick patients. One graduates with an MD after 4 years.

Residency is entirely separate. There is no internship or residency during medical school.

Med students apply to residency programs in their third year. Just like applying to med school, it's a long process involving flying around the country for interviews, letters of recommendation, essays, and so on.

The first year of residency, aka "pgy1" or "post graduate year 1" is also called the "internship" year. Residency programs vary in length from 3 to 6 years.

In summary:
4 years of college
4 years of med school (2 basic science, 2 clinical)
4 years of residency (1 year internship, 3 years residency)

This "friend" of yours who finished med school in 3 years without treating any patients wasn't a close friend, I take it.

Your Creighton link talks about the clinical activity limitations. . . the part done after the academic coursework.

Just to be extra sure I'm explaining everything: that link about 80 hour work limits describes the "M3" year at Creighton, the first clinical year that starts after the two basic science years. The M4 year is much the same, except students can select some specialized elective rotations.

Third and fourth year med students rotate through clerkships in hospitals. They care for patients directly under the supervision of residents and attendings. They suture wounds in the ER, catch babies, write orders, work up new admits, scrub in for surgery, and so on.

It's nothing like chiropractic school.

I am always amused to receive the alumni correspondence from the university from which I obtained my PhD. It addresses me as Miss. Link! If they can't even get that right, what hope is there for the rest of society?

Wow aCQ, You should really try reading for comprehension. Go back to what I wrote about the time from visit to when stroke occurred. Try again. Tell you what. I'll just be blunt this time. Thinking is not among your strengths.

Source for manipulation force: http://www.aetna.com/cpb/medical/data/100_199/0107.html

I am comparing chance of certain death with possible injury. Chiropractors are injuring patients. Not all of them, but some. Its partly based on chance, patient variation, etc.

Brusse article shows indoctrination over time. And you are happy with that.

Great, you know a rule. But you don't understand real world application. Not surprised. I'm embarrassed for you.

VAERS is useless in getting an actual hold on numbers of real adverse events, and it never was. It was designed as an early warning system to see if something might be wrong with a vaccine or batch of product. It has turned into an ambulance chaser system, and is used almost exclusively to support antivax conspiracy theories.

Opposing mandatory vaccination is stealth antivax. Those trade associations are trying to find a position that prevents them from being strongly criticized, and provide cover to their members. Same as Jenny McCarthy with her call for completely safe vaccines or none, it is a very bad policy that has in the past lead to outbreaks of preventable diseases. And you support this. Its good to know that you are pro vaccine preventable disease.

Good non existent gods are you dim. The real doctors (physicians) prescribing was an insult directed at fake doctors (chiropractors) like you. TSIB.

Unethical dCs. I just opened up the google machine. Put in my city, state, chiropractic and started looking.

First result. Wide variety of antivax BS, claims antibiotics can cause autism, promotes adjustment for kids and especially newborns, lots of innate intelligence and nerve energy mentions, evils of fluoride, support for using manipulations to treat EAR INFECTIONS FFS! Oh yeah, lots of those mythical subluxations that only chiropractors seem to be able to find.

That didn't take long. Try it yourself! But you won't. You want to remain ignorant of fraud.

Second link (that worked) more innate intelligence, already sets up the expectation of lifelong bilking with monthly visits, I mean treatment, warnings that if you stop treatment you will see lots of "subluxations" and health problems come back, more calls for starting treatment at birth (completely disgustingly unethical). This one repeats the fraudulent claim that Palmer healed a deaf guy.

Third seems reasonable, but there isn't much in the way of personal philosophy.

Fourth, a bit odd, not much info, spinal homunculus on on display, subluxations are pushed.

Fifth, one that sells enzyme pills and supplements, beyond that, not much info.

Finally, one that claims that chiropractic can be used to treat asthma, colic (more abuse of infants), bedwetting, menstrual cramps, vision and hearing issues, lifelong bilking (compares stopping treatment to stopping brushing your teeth), chiropractic helps CD4 count of AIDS patients, autism from vaccines and lots more antivax BS.

So of the working links on the first page, three quacks, one supplement pusher (unethical even to you), one thats a bit odd, one that seems legit.

----------

Dr. Benway, thanks. I can't claim credit for the technically correct line. Its from Futurama.

Dr. Benway,
Your link doesn't indicate "M3" on it anywhere, and since we obviously don't care what the other person thinks, I would suggest that we leave it at this and allow any interested party to follow the link themselves and read it. As for my friend, I am going to go ahead and trust the person who actually went there, rather than some random guy of unknown credentials who is posting randomly on a blog, sound good? If your statement is correct, and the 4 years of "med school" is actually only 2 years of classes followed by 2 years of "clerkships" / "rotations", then you're right, it is nothing like chiropractic school. . . since following my 4 years of undergraduate college, I had to spend a hell of a lot more than just two years in classes learning how to be a doctor.

Robster,
Are you just starting to name call because you can't actually defend your position? I present evidence, and point out your failings, so you just call me "a quack" or any of the other insults you have thrown out? As a hint, from one professional to someone who really wishes that they were, insults don't actually support and argument, and they don't really make you look good, either. I will suggest to you, as well, that we are unlikely to change the other person's mind, so why don't we let the smart people go read it themselves and draw their own conclusions, you can have your interpretation, and I together with all of the rest of the people will have ours. The horse is dead, let it be.

I love that your "scienctific sources" is the practice act on the website of an insurance company! What, you couldn't actually find the study? Regardless, the for-profit insurance company's website does actually reference a study, so let's talk about that one. . . The website does quote that "the mean force of all manual applications was 264 Newtons" including more than just cervical adjustments. As the studies which are actually a little more specific, you can see that this is about right for a thoracic adjustment, much, much greater than a cervical adjustment, and much lower than a lumbar adjustment . . . which makes sense given the size of the bones in that area and the associated structures including variability of tissue thickness. Trust me, you need a lot less force to adjust the low back of a 19 year-old college track athlete than to adjust the low back of a 250 lb truck driver. You'll have to trust me, I guess, as you have no experience or expertise in this area.

You say chiropractors are injuring patients. . . but you also said that the force of a cervical adjustment was 264 Newtons, so I guess we know that you're full of crap. If you want to claim that chiropractors are hurting people, I say prove it.

Hmm, I know a rule. . . but didn't you already admit that you have no knowledge in the application of the laws to the science of pharm? And since I clearly do (and can back up my statements with verifiable references) isn't the logical conclusion that it is I who know the real world application and not you? Does it hurt you to be so wrong all the time? To have it clearly proven that you are a liar who knows nothing about the topic?

The VAERS system was designed a long time ago by the allopathic profession together with Health and Human Services to improve post-marketing surveillance and improve patient safety. It is actually very useful in getting an actual hold on adverse event reports, as that is the purpose it was designed for. Seriously, go to the site and numbers of reports and the reports themselves are all right there. You can't argue it is the "mean old chiropractors" who are making it up, as we are not the ones filing the reports! It is used primarily by the FDA to regulate and track post-marketing surveillance. Are you seriously suggesting that the Health and Human Services division has been in a 40-year-long conspiracy to promote an anti-vaccination stance to the benefit of the crazy chiropractors? If you were speaking out loud, I would suggest that you think first and then speak, but I am not sure how best to translate that for the written word. Maybe think before turning on the computer?

In your highly irrelevant opinion (as you don't work with patients), mandatory vaccination is a "stealth cover" for being antivaccination. For people with doctoral degrees who work with patients, this is the exact verbiage used on the federal patient bill of rights. You can check it out online, or do what you seem to prefer to do and just make stuff up.

You know nothing about me, and as such, I would prefer that you not attribute your verbiage to me. In the first place, you sound reasonably uneducated most of the time. After that, I would just say that as you don't know me, you shouldn't pretend to understand me. I would not personally get a flu shot, as even allopathic doctors know that it is pretty useless and the big push comes from the pharmaceutical companies, not the medical community. Most allopathic doctors I know don't get one, either. I do agree that things like the polio vaccine did have benefit which outweighed the risk, and I even financially support the R&D fund trying to create a vaccine for HIV. This is a little more sophisticated than what you said, so I'll understand if it's a little over your head, but the other people can probably understand.

Nice, you are back to the allegations that all DCs are unethical. Here I thought we had made such progress. Looks like you are back to just mudslinging and slander. Even I admit that there are as many unethical doctors of chiropractic as there are medical doctors. Looks like you can't even prove that.

With regard to your claims about anti-vaccination, forgive me if I call your bluff on this one, as you think the patient bill of rights used by the AMA is a "stealth anti-vaccination stance". I can't find any claims of antibiotics causing autism, except on another blog thread, which accuses chiropractors of making this claim. Can't actually find a chiropractor making it, though. Wow, a doctor providing health care for kids. That clearly is scandalously unethical. Innate intelligence has already been discussed, and you agreed that the explanation given was representative of real processes. Nerve energy is a component of the study of phychneuroimmunology, which I know is way beyond your IQ. Even dentists stop using fluoride in kids over the age of 16, and that is just the dentists who still use it at all. Check out the stance of the dentists on the ADA website. Adjustments can relieve middle ear pressure, but no one is saying they can eliminate a bacterial infection. Of course, most kids with earaches don't actually have bacterial infections, according to the American Academy of Pediatrics position on their website.

Second link. . . we have already discussed innate. I don't personally recommend "monthly check-up visits", but those who do sound remarkably like the dentists who recommend that you come in every 6 months or you will get cavities and gingivitis, etc. When the dentists first started doing this, everyone thought they were crazy, too. (Why go to the dentist? Nothing hurts and needs to be pulled yet!)

I was not around 115 years ago when D.D. Palmer adjusted Harvey Lillard, so I guess I can't say what happened. Were you? I do know that there is testimony from the time from Mr. Lillard himself, and the people around him, who all said he had been deaf and could now here. I have never had personal experience like that. There were actually two fairly recent news stories, however, that you can find in on youtube, which are similar. In one, a guy went blind in one eye for years and allopathic medicine couldn't figure out what was wrong and fix it, and then when he got adjusted, his eye started watering and a few hours later he got vision back. The other one is also someone who was deaf. If those are legitimate (and I am not speaking for or against them) then they would be incredibly rare situations, but you can't call someone unethical for repeating them. Are you unethical when you reference historical testimony, too?

Oh, and with regard to the "non-existent subluxations", check out the definition on the Aetna page you referenced. Seems like your source thinks they exist.

So the 3rd, 4th, and 5th meet your standards. ( I didn't say selling supplements in office is unethical. I said that I personally that I don't do it because I see it as a conflict of interest. I feel the same about the physical therapists who sell therabands, etc. to their patients. This is not considered unethical, I just find it personally distasteful.)

The 6th site seems to refer to a lot of case studies. Do they give references? I realize that most websites don't, but maybe they are better than most. If you check the literature there are case studies about chiropractic in all of these cases. Clearly they are not definitive evidence, but a website that references published, peer-reviewed case studies can hardly be called unethical. The stuff on CD4 count comes specifically from an ongoing study at the University of Toronto, I do know that. The Autism-Vaccine link is a widely held hypothesis (I personally reserve judgment, as it is yet unproven), and we have already addressed your reading of "anti-vax BS".

However, since you haven't actually provided any references or actual names, despite multiple requests, it is just as likely that you are once again just making it up.

Maybe we are working with a difference in terminology. Did you know that unethical is defined (in the dictionary) as "not conforming to approved standards of social or professional behavior."? This means if the behavior exhibited does conform to the approved standards (i.e. the law, the scope of practice, etc) then it is not unethical. Hmm, is that still too complicated? Try this: Something is not unethical just because you don't like it. You are not the authority. Almost no one cares what you personally think.

aCP:

Your link doesn't indicate "M3" on it anywhere, and since we obviously don't care what the other person thinks, I would suggest that we leave it at this and allow any interested party to follow the link themselves and read it. As for my friend, I am going to go ahead and trust the person who actually went there, rather than some random guy of unknown credentials who is posting randomly on a blog, sound good?

No need to trust me. Click around that Creighton site. Admittedly it's confusing to navigate. Here's a link to a curriculum outline. From there you can find out a little more about the FOUR YEARS of med school training.

If your statement is correct, and the 4 years of "med school" is actually only 2 years of classes followed by 2 years of "clerkships" / "rotations", then you're right, it is nothing like chiropractic school. . . since following my 4 years of undergraduate college, I had to spend a hell of a lot more than just two years in classes learning how to be a doctor.

LOL you crack me up. Initially you made a big deal about med students not taking care of patients. Now they spend too much time with patients and not enough time in class!

BTW, it is possible to continue studying while caring for patients. I do it all the time.

One of my friends from undergrad went to the Creighton Medical school, started the same week I did, and she was done in 3 years. At that point, she had never treated a patient.

HAHAHAHAHAHAHA!

@another Chiropractic "Physician",

They've clearly got your goat. Please continue digging.

aCP,

Are you just starting to name call because you can't actually defend your position?

No, because you deserve to be made fun of, and my interpretation of the totality of the research is most likely to be correct, as multiple studies have demonstrated correlation between neck manipulations and VBA stroke. To you, any movement of the neck except for one done by a chiropractor could cause a stroke. I think that is odd position to maintain.

BTW, it isn't an ad hominem attack if its true. I have pointed out to you that there are trends in the time from visit to time of stroke that strongly suggest that chiropractors are causing injury. You say it isn't there. I point out that the way that the statistics are derived are different between the two groups (dC and PCP), you ignore it. I attempt to explain that the under 45 group is the sensitive group where we should see the most increase in risk, and that there are likely different risk factors between those seeing doctors and those seeing not doctors for treatment, you completely miss it. It is not an ad hom attack to say that thinking is not among your strengths but a valid observation. I think your reason for wanting to leave this dead horse alone is that you are stunned that it could possibly be dead at all, and are embarrassed by your own puzzlement. But fine. I and the scientific community will go with the totality of evidence, including anecdotes of real people with real injuries, and several studies, that cervical manipulation is a risk factor for a rare event.

I love that your "scienctific sources" is the practice act on the website of an insurance company!

Yeah, so I asked if you had better information. You offered it.

Regardless, the for-profit insurance company's website does actually reference a study, so let's talk about that one. . .

So your annoyance is fake. Surprise surprise. Insurance agencies are like a Vegas casino. They know the real odds because they know the literature, and like a casino, you never beat the odds. Since you are a for profit chiropractor, I don't really see the reason to make that a point of dissension.

The website does quote that "the mean force of all manual applications was 264 Newtons" including more than just cervical adjustments. As the studies which are actually a little more specific, you can see that this is about right for a thoracic adjustment, much, much greater than a cervical adjustment, and much lower than a lumbar adjustment . . . which makes sense given the size of the bones in that area and the associated structures including variability of tissue thickness.

Which is why I asked you for better information. I didn't expect the Spanish Inquisition. (again, you won't get the reference)

Trust me, you need a lot less force to adjust the low back of a 19 year-old college track athlete than to adjust the low back of a 250 lb truck driver. You'll have to trust me, I guess, as you have no experience or expertise in this area.

Makes sense. So, perhaps the question we need an answer to now is how much force is required to cause a VBA dissection one out of 100k times in a relaxed neck. I would expect that to be a fair bit less than 686, as the cause of death in passive hangings by VBA disection is about one in four. So a grade IV manipulation is 11% of the force needed to kill an individual with a stressed neck, but what is the percentage of a relaxed neck? With patient variation due to genetics and personal history, is it possible that 11% of a stressed neck could injure one out of 100k? The totality of the evidence says that it is very likely.

Hmm, I know a rule. . . but didn't you already admit that you have no knowledge in the application of the laws to the science of pharm? And since I clearly do (and can back up my statements with verifiable references) isn't the logical conclusion that it is I who know the real world application and not you?

Ah, no. Because 30% moderate to severe would not be acceptable for commonly used drugs for treatment where viable low risk alternatives with similar efficacy and cost are available. If it was a cancer drug that took non small cell lung cancer from a 10-15% 5 year survival rate to one of 95%, it would be more than acceptable. But since nothing is as good as chiropractic (Sham = nothing, still funny the second time around), I can see why you hold to a rule, but remain stubbornly ignorant of how the market and courts would and have responded (COX2 inhibitors) to such drugs in the past. On the other hand, sCAM is notoriously difficult to regulate, since it typically refuses to police itself or allow outside regulation.

Does it hurt you to be so wrong all the time? To have it clearly proven that you are a liar who knows nothing about the topic?

Have you ever heard of the concept of projection? Actually, I like it when someone proves me wrong, as it means I have learned something. Here, I have learned how much force is used to perform different grades of neck adjustment, and so, will not use the higher force figure again. Its part of being a scientist. A good experiment is designed to prove you wrong, which is why the Spine article fails. They can't admit that they failed to reject their null hypothesis, that manipulations are a risk factor for VBA stroke.

(VAERS) is actually very useful in getting an actual hold on adverse event reports, as that is the purpose it was designed for. Seriously, go to the site and numbers of reports and the reports themselves are all right there.

And yet, it is routinely abused by antivax advocates and the like to make unfounded claims of vaccine safety. Did you know that nobody ever checks to see if individual reports are correct? VAERS is profoundly unreliable, but since you obviously haven't kept up on the BS claims that autism is caused by vaccinations, I'm not surprised that you missed this.

It is used primarily by the FDA to regulate and track post-marketing surveillance.

I already pointed this out, nice of you to repeat it. And if there is a blip, HHS checks it out and takes appropriate action.

Are you seriously suggesting that the Health and Human Services division has been in a 40-year-long conspiracy to promote an anti-vaccination stance to the benefit of the crazy chiropractors?

Nope. Just for you. You are the only one to benefit from this massive conspiracy. Sorry to let you in on the joke, but we all got together, checked it out, and it was officially time for you to be the last one to know.

Do you get up in the morning, look in the mirror, and say, "What is the dumbest thing I can say today?"

VAERS can be easily abused, and it has been, to promote antivax quackery. It is a fault in how the database was designed and how data is entered but not checked.

If you were speaking out loud, I would suggest that you think first and then speak, but I am not sure how best to translate that for the written word. Maybe think before turning on the computer?

See above, but you are getting better at this.

In your highly irrelevant opinion (as you don't work with patients), mandatory vaccination is a "stealth cover" for being antivaccination. For people with doctoral degrees who work with patients, this is the exact verbiage used on the federal patient bill of rights. You can check it out online, or do what you seem to prefer to do and just make stuff up.

Really? Another appeal to authoritah. I can see you now, sitting in front of your computer, yelling, "RESPECT MAH AUTHORITAH!" (You won't get that either) Naturopaths see patients. Homeopaths see patients. Acupuncturists see patients. This doesn't help your argument.

I see a full partner in decision making clause, but nothing about a non mandatory vaccination clause. If you don't vaccinate, and there is not an opt out clause, then you lose access to certain benefits. Again, you are hallucinating.

You know nothing about me, and as such, I would prefer that you not attribute your verbiage to me.

You are a dC, and operate in a field heavily infested with quackery. And you seem fine with that. Oh, and your sense of humor is piss poor.

In the first place, you sound reasonably uneducated most of the time.

Riiiiiiight.

I would not personally get a flu shot, as even allopathic doctors know that it is pretty useless and the big push comes from the pharmaceutical companies, not the medical community. Most allopathic doctors I know don't get one, either.

You are a complete and total idiot (not an ad hom this time, but a blatant statement of fact). The flu shot is of variable efficacy, but it can and does work well to limit the spread of the flu, especially to highly sensitive individuals. The flu can and does kill, especially in the very young and very old, as well as those with immune dysfunction. Those who do not get vaccinated risk spreading the flu to said individuals. It seems that while you don't know any quack chiropractors (although you are more likely to ignore and tolerate it) you certainly have a crank magnetism for real MDs and DOs that don't have good infection control practices.

I do agree that things like the polio vaccine did have benefit which outweighed the risk,

Oh wow, huge concession! Polio was bad! Well, Einstein, how about Hib, chickenpox, mumps, measles, rubella, pertussis, HepA and B, tetanus, diphtheria, etc.

and I even financially support the R&D fund trying to create a vaccine for HIV. This is a little more sophisticated than what you said, so I'll understand if it's a little over your head, but the other people can probably understand.

Bad pick there. HIV is profoundly a bad choice for vaccine research, and many groups have abandoned looking for one. HIV is simply too mutable for a vaccine to be effective. This is the same reason why we need a new flu vaccine every year, and why it may not work if there is a mutation before the virus gets to you.

Nice, you are back to the allegations that all DCs are unethical.

And you have dropped back to a third grade reading level. Not all dCs, but enough that your the pool needs some chlorine.

Even I admit that there are as many unethical doctors of chiropractic as there are medical doctors. Looks like you can't even prove that.

Do MDs and DOs sell supplements from their offices at ridiculous markup? None that I know of, but it is common enough among dCs that even closeted you are aware of this.

With regard to your claims about anti-vaccination, forgive me if I call your bluff on this one, as you think the patient bill of rights used by the AMA is a "stealth anti-vaccination stance".

See above. Patient participation is not a statement against mandatory vaccination. Being against, or not having mandatory vaccination, on the other hand, is a good way to decrease the community immunity to the point that infectious diseases return. We have already seen this occur where it is easy to get out of vaccination. This is what you (perhaps?), the ACA and ICA (definitely) are in favor of, either because they are antivax, or want to corner the market on parents with no capacity to examine the real risks of contracting infectious diseases.

Patients of chiropractic practices used to be one of the more common focal groups for vaccine preventable outbreaks, but it has been improving. If people start taking their kids to see antivax peds chiropractors, it will come back, and I hope that the ICA and ACA are sued as having contributed to the condition.

I can't find any claims of antibiotics causing autism, except on another blog thread, which accuses chiropractors of making this claim. Can't actually find a chiropractor making it, though.

Look harder.

Wow, a doctor providing health care for kids. That clearly is scandalously unethical.

Really? How many kids really need "adjustment?" Its just a market quacks want to tap into, and by swapping real medical care for quackery, you endanger children. Will those kids be getting regular, unnecessary chest Xrays? That would be truly shameful.

That quack neonatal chiros push some kind of insane "traumatic birth" hypothesis, with no evidence, that claims that babies need adjustment to repair their bodies after birth is sheer and total fraud.

Will manipulation clear an earache? It may relieve pressure as you claim, but you sure get to charge for it, regardless. A doc who is up on the most recent research would restrain from immediately going for antibiotics, but manipulation does nothing that other less expensive and less risky treatments could accomplish for inner ear pressure.

Innate intelligence has already been discussed, and you agreed that the explanation given was representative of real processes.

And yet, there are those that treat it like some kind of magical source that flows from the spine.

Nerve energy is a component of the study of phychneuroimmunology, which I know is way beyond your IQ.

But the spelling of psychneuroimmunology is way beyond yours. "Nerve energy," from the point of view of the straights is a chi like concept, where nerves carry a mystical power to heal and manipulation renews this flow. Complete bullshit, of course.

Oh, and I'm quaking in my boots, but you are still quacking in those cute little webbed feet of yours.

Even dentists stop using fluoride in kids over the age of 16, and that is just the dentists who still use it at all. Check out the stance of the dentists on the ADA website.

Oh, no, I'm talking about fluoride in the water supply. When someone believes in one extremely unlikely concept, they probably believe in lots of them.

I don't personally recommend "monthly check-up visits", but those who do sound remarkably like the dentists who recommend that you come in every 6 months or you will get cavities and gingivitis, etc.

That would be true, if chiropractic subluxations were real. But they aren't, so charging someone for a once monthly visit is medical fraud.

I was not around 115 years ago when D.D. Palmer adjusted Harvey Lillard, so I guess I can't say what happened. Were you? I do know that there is testimony from the time from Mr. Lillard himself, and the people around him, who all said he had been deaf and could now here.

Its fake. Sorry. Fake and fraudulent. Iridologists have similar messianic tales of their founders healing an owl and observing changes in the birds iris. And it isn't like he wasn't already a fraud, using magnets for healing. It was sCAM from day one.

But for argument's sake, how would a cranial nerve be affected by spinal adjustment?

I have never had personal experience like that. There were actually two fairly recent news stories, however, that you can find in on youtube, which are similar. In one, a guy went blind in one eye for years and allopathic medicine couldn't figure out what was wrong and fix it, and then when he got adjusted, his eye started watering and a few hours later he got vision back. The other one is also someone who was deaf. If those are legitimate (and I am not speaking for or against them) then they would be incredibly rare situations, but you can't call someone unethical for repeating them.

The plural of anecdote is not data. And I can find people claiming all kinds of ridiculous things on youtube. Doesn't make it real. If it were a verified case study, it would be marginally better. But again, how would adjustment of the spine affect the transmission of signals from the eye to the brain? I can see how it might cause stimulation of the lachrymal gland (eye watering) if it hurt (or the chiropractor had just been cutting up an onion), but it sounds like a duck to me. Selling false hope is unethical.

Are you unethical when you reference historical testimony, too?

If I was repeating a lie, then yes. Since you have already compared me to a nazi, I feel that it is uniquely within my expertise to point out that there are those who claim that the holocaust didn't happen, and use lies and false testimony to make their arguments. Its still a lie and it is still unethical.

Oh, and with regard to the "non-existent subluxations", check out the definition on the Aetna page you referenced. Seems like your source thinks they exist.

dCs have to be insured by law. Someone has to sell that that insurance. And the law, fallible as it is, recognizes many pseudo-scientific professions and beliefs. Least they can do is humor you and use your magical language.

So the 3rd, 4th, and 5th meet your standards.

Which puts the lie to your claim that I consider all dCs to be unethical. What I do say is that enough of you are unethical that the field needs to be cleaned out. My highly unscientific study turned up three of six that raised real concerns.

How about an RDC (real doctor of chiropractic) designation for those that can be determined to not have their head completely up their ass. You might even qualify for this, as you don't follow many of the more offensive methods. Perhaps you should start an accreditation process. Nah. You like it the way it is.

If you check the literature there are case studies about chiropractic in all of these cases.

Case studies are clinical anecdotes, and certainly don't correct for placebo.

Clearly they are not definitive evidence, but a website that references published, peer-reviewed case studies can hardly be called unethical.

Knowingly selling placebo is ripping people off. If you don't know and you do sell, you are a willing dupe.

The stuff on CD4 count comes specifically from an ongoing study at the University of Toronto, I do know that.

Does it correct for sham? Placebo? Real antiviral therapy? I'll look it up later. Just like a good joke, you don't seem to know what a placebo is.

The Autism-Vaccine link is a widely held hypothesis (I personally reserve judgment, as it is yet unproven), and we have already addressed your reading of "anti-vax BS".

If you had been paying attention to the literature, the autism vaccine link is not only unproven, it is wholly unsupported by the evidence. It is disproven. One of the main proponents of the link just got nailed for probably faking his data. I'll be nice and just say you haven't been paying attention, and not suggest that you remain willfully ignorant.

However, since you haven't actually provided any references or actual names, despite multiple requests, it is just as likely that you are once again just making it up.

Or, you could google your own area and see what you find, as I suggested. I am confident that you will find a significant amount of antivax and pseudoscience, pediatric health fraud, practice building patient bilking, etc. This is a game that everybody can play at home. I don't think you'll make it to the lightning round though. You see no evil, hear no evil, and are aware of no evil.

Maybe we are working with a difference in terminology. Did you know that unethical is defined (in the dictionary) as "not conforming to approved standards of social or professional behavior."? This means if the behavior exhibited does conform to the approved standards (i.e. the law, the scope of practice, etc) then it is not unethical.

Conflict of interest isn't unethical? Hmmm. Selling placebo snake oil isn't unethical? Performing procedures for no purpose isn't unethical? Setting up patients for lifelong bilking isn't unethical?

If your discipline doesn't take a stand against this, then your discipline itself is tolerating a lack of ethics, and this is why you are not accepted by the evidence based community. Clean house, then we'll talk.

Stay tuned! There is a comment waiting for approval by the resident supercomputer. Good travels, Orac.

Same duck time, same duck channel!

This isn't said post in waiting, but I finally got around to watching an old Scientific American Frontier program from 02 on chiropractic. aCQ, is what is described and depicted in the sections where dC instructors demonstrate techniques and tools in any way similar to what you practice?

If so, jumpin Jesus on a pogostick, you guys are more quacky than I ever thought.

Do you really measure skin temperature on opposite sides of the spine to make a diagnosis? That is some serious woo. Legs of different length? Couldn't be the ideomotor effect, could it? It looks like using a ouija board to diagnose. And that little spring loaded jobbie. I have the same thing in my workshop for my hobby metalwork, but I call it a center punch, and it comes to a point. Do you guys really think that does something?

And those neck cracking motions don't have any risk associated with them?

Yes, you hate Stephen Barret even more than you hate me, but ignore him for a minute and just tell me, is what the instructors and administrators demonstrate correct, is this what chiropractors really believe?

Yours with extreme incredulity,

Robster

Dr. Benway. - Yes, as the link you provided says, in the 4th year the student is prepared for residency through choosing "one critical care selective from an approved list, either one additional critical care selective or a primary care sub-internship, one surgery selective from an approved list, and twenty-four elective weeks."(note this was a bulleted list that I converted to text format) Hmm, looks like 3 years of classes followed by year four composed of selectives and internship, followed by residency. Oh, and I never changed my opinion to "Now they spend too much time with patients and not enough time in class!" I said that you were claiming that. That is what is meant by starting the sentence with "If your statement is correct. . ." both preceded and followed by statements to the effect that your statement is NOT correct.
Robster - You say I deserve to be made fun of, but what is that if not a personal attack? Oh, and I don't say that if you saw patients you would know X as an appeal to my authority, but in an attempt to courteously allow you an excuse for your otherwise inexcusable ignorance.
You accuse me of holding the position that, "any movement of the neck except for one done by a chiropractor could cause a stroke." I have never said this. I have repeatedly stated that a chiropractic adjustment is no MORE likely to be a contributing factor than other, similarly rated motions. Is this really that unclear or are you deliberately misunderstanding? You claim that the under 45 group is somehow the answer, based on statistics that you are twisting, when in patient care this is clearly not the case. The under 45 goups is not "more sensitive". Perhaps I want to leave the dead horse alone both because I am embarrassed for you and because I don't have time to walk you through Stats 101.
What part of "I love" indicates annoyance for you? I was serious. I love that in this conversation in which you think you are more "scientifically minded" than I am, your source of information is Google! This is not annoyance, it was glee. Okay, however, it is fine. We both agree that I provided you with satisfactorily "better" information. On what, however, do you base the claim that ¼ hanging deaths is due to VBA disection (when annecdotal evidence says that the vast majority are actually due to suffocation)? For that matter, from where did you get the number 686 as the force of drop causing death in a suicindal hanging? Who did the study assisting people with suicide so that they could measure the Newtons of force during the process? Also, what the heck do you mean by "stressed neck"? Are you talking about muscle tension? Sources are good, if you please. Also, I understand that we have clearly established that basic statistics are beyond you, but if the 686 number is the minimum amount of force required (presuming that is a good study which took into account genetics and personal history) then no, 11% is not sufficient to kill anyone. Let's try this again. If 686 newtons is the MINIMUM to kill you, then 61 newtons, being MUCH LESS THAN THE MINIMUM will not be sufficient, ever, as it is no where even close to the minimum. This is what minimum means. How can you possibly say that the totality of the evidence supports you when not even your own evidence does.
Oh, and we already provided references for the 30% adverse acceptance rule, which is the standard in post-marketing surveillance testing results presentation to the FDA. I provided you with a link, in writing, to the FDA website that says this, verbatim, in clear language which requires no interpretation. Have you just not had a chance to read it yet? Or are you directly and deliberately lying here? Also, on what are you basing the accusation that chiropractic refuses to police itself or allow others to do so? We were thrilled to be a part of NCCAM, and we are constantly applying for federal funding to do research. Those of us who are ethical are the most outspoken against the unethical, as they are ruining our reputations. What the hell are you talking about?
The claims submitted to the VAERS system are (presumably) regulated by the doctor who submitted them. As these doctors are allopaths, presumably you are alleging that these MDs and DOs are "stealth anti-vaccination opinion holders" who are submitting fraudulent reports. Oh, and as it appears to be your opinion that the VAERS system is profoundly unreliable, and the rest of the health care community still uses it, perhaps we'll just have to let that one go.
Okay, now you say a bunch of stuff that is just dumb and irrelevant. Oh, and I am crushed that you insulted my sense of humor, as it is particularly relevant to the conversation at hand. I am aware of the movies "The Princess Bride" the show "South Park" and a bunch of the other stuff you have referenced. I will admit that I am less familiar with Futurama and Caddy shack. I am sorry that I don't watch TV and I don't think that quotes from such sources are relevant or funny in an academic debate. I will refrain from being shocked that the person who claims to be too busy to find evidence to support their claims has time to sit around and watch profane adult cartoons.
Actually patient participation is the definition of a statement against mandatory vaccination. If the patient gets to decide, it is not mandatory. If it is mandatory, then the patient gets no say and is therefore not participating in the health care decision. Can you please at least join me up here at the 3rd grade reading comprehension level?
Practice standards in all professions, chiropractic included, dictate that x-raying in children should only be done if absolutely necessary, as in to visualize a fracture. Also, it is a chest film if shot one way (with a different kVp and MaS) and a bone film if shot with different settings. I realize that you know nothing about radiology, but chiropractors would only shoot a chest film for something like pneumonia or a suspected pancoast tumor, if they had not already referred these cases. To the next statement, as children are as likely to be in car accidents as much as the parents who are driving them and are more likely to be hurt given that the seatbelts are not designed for the smaller frame, I would say that yes, some children can benefit from chiropractic care. Children also fall out of trees, get injured in sports, and lots of other stuff, too.
Yes, if the earache is due to increased middle ear pressure, releasing that ear pressure will remove the cause of the earache. Oh, and the average cost of a chiropractic visit in Connecticut, for example, is $38, including assessment and treatment. The base cost for 15 minutes with an allopath, not including any tests that might be performed or prescriptions that might need to be paid for separately is $76. Hmm, that looks like chiropractic is cheaper. . . much cheaper. Check out a few more insurance company websites and get their fee schedules. This shows how much is paid to each practitioner for each service rendered.
Oh my God, I had a typo and wrote "phychneuroimmunology" when it is "psychoneuroimmunology". Clearly I am a moron. The consolation for me will have to be that at least you are, too, as you misspelled it, too, and forgot the first "o". With regard the concept, however, I suggest you check out the work of Candace Pert, PhD, pharmacologist graduate from the Johns Hopkins University School of Medicine. This, of course, if you decide to take a break from watching cartoons.
"When someone believes in one extremely unlikely concept, they probably believe in lots of them." WHAT?!? That is like saying that someone who believes in Vishnu probably believes in Zeus and the divinity of Jesus. That is so stupid that I don't even know how to respond.
Thank goodness, I have found the person who was actually there, performing the modern scienctific inquiry, and can tell us the true story of D.D. Palmer! Yes, they are anecdotes, but to claim that a person referring to the anecdotes is unethical is ridiculous. Anecdotes in healthcare, by definition, are non-case-study "experience" used in conjunction with things like published research to design health care. Go ask your friend the local MD if s/he relies on both published research and his experience and "annecdotal evidence" (taken with a grain of salt, of course) to provide care, and I am pretty sure he or she is going to say yes. Oh, and I didn't direct you to youtube as a scientific source, but just as the easiest place I knew of for you to find the archived news reports. News reports are not science, but they sometimes try to report on science. It is not perfect, and there is always bias to be accounted for. . . but I figured that someone who watches "South Park" was probably pretty familiar with youtube and would be able to use it as a tool.
Yes, false testimony is unethical, but there is no evidence that this testimony (either the old, Lillard stuff, or the new stuff out in the last six months) is false. . . other than the fact that you, with your infinite authority, say that it is.
DCs do not have to "be insured by law". Yes, we have to carry malpractice insurance like every other doctor, but a chiropractor must voluntarily choose to sign a contract with an insurance company to be paid by that insurance company. A doctor, any doctor, can choose to only be paid in cash and then either allow the patient to bill their insurance company for reimbursement or just handle the costs. Most of us choose not to do this, however, despite the fact that insurance companies are notoriously difficult to work with regardless of what profession you are in, because we want to make things more convenient for the patient. There is no law which dictates that the insurance company must recognize chiropractic. I hate to say it again, but if you treated patients and worked with insurance companies, or even took the time to look up a statement before you just spit it out there, you would know this.
Actually, there is a movement within the chiropractic profession to split the profession into "chiropractors" and "chiropractic physicians", much like we have "osteopathic physicians" in the U.S. and some in the U.K. and "osteopaths" for the rest of the U.K. and the rest of the world. I would prefer to see the entire profession improve, but in the absence of that, I support the split. I have clearly stated my views about the distasteful element in my profession, but you continue to ignore that and say whatever you want, so I am probably wasting my time writing it again here.
I wait with baited breath for you to turn off "Futurama" and look into the Canadian HIV study. As I said, however, it is ongoing, so you won't find concrete results just yet.
Some studies disprove the autism-vaccine link, and some studies prove it. Rather than doing what you do and choosing to believe just what conforms to the opinions I already hold, I will maintain that it is a hypothesis still in study, and hopefully time will tell. I take no side on the issue, currently, as DEFINITIVE evidence is not yet available. Is this not similar to your rejection of the Spine articles, in part, because old studies with shorter duration and smaller patient size say something else?
Conflict of interest, by definition, is not unethical. This is why research papers have a section where the researchers are obliged to disclose any interest they might have in the results (i.e. one of the researchers previously worked for the company producing the product under review.) Conflict of interest is something that must be accounted for to compensate for bias and ensure ethical behavior. As far as useless procedures and unethical billing practices are concerned, I agree that these are unethical behaviors. Where we disagree, however, is in what you consider to be "useless", however. I will continue to work from the available evidence base, and you can do that thing that you are doing.
As I have stated, I very rarely watch TV, and as such am not familiar with the show you have referenced. If I have time, I will see about tracking it down. I have been so busy reading case studies, RCTs, and federal case regulations, and addressing your unfounded and false statements here, however, that I haven't had time to keep up with your intense viewing schedule. With regard to the activator, there is research on that, quality research and RCTs, because it is easy to account for the placebo effect there since you can more easily perform a "sham" adjustment with that instrument than in traditional manual adjusting. I don't know what the video says (and as a quick question, do you know how old it is?), but there is a little background for you to look into. . . after you get through all of the rest of this stuff, of course.

Hmm, looks like 3 years of classes followed by year four composed of selectives and internship, followed by residency.

Training at US medical schools is standardized. Roughly speaking, basically all schools follow the same time line:

-2 years of pre-clinical education (classroom/lab courses).
-After completing the pre-clinical years, students must pass Step 1 of the USMLE.
-2 years of clinical education, which is variable, but typically the third year is the most intensive.

Some schools mix some early clinical education into the first two years, but this is basically a token compared to the clinical beating students take in the third year.

As I said, however, it is ongoing, so you won't find concrete results just yet.
Some studies disprove the autism-vaccine link, and some studies prove it. Rather than doing what you do and choosing to believe just what conforms to the opinions I already hold, I will maintain that it is a hypothesis still in study, and hopefully time will tell.

The two specific hypotheses studied were MMR-autism and thimerosal-autism. Both of these were supported by some really lousy studies that were later refuted by much stronger ones. Tell me, do you consider Wakefield's Lancet paper to be good science?

Wow. This thread is rapidly becoming an epic... and so protracted as to resemble the Chiropractic equivalent of the Battle of Stalingrad (with aCP playing the German Army). It really needs to be preserved somewhere as a monument to the scale of Back-cracker putting-the-telescope-to-your-bad-eye-and-claiming-"I-don't-See-A-Thing" - or indeed to the blind-eyed-ness of AltMed "professionals" in general.

I'd love to try and appropriate the credit for initially annoying our Chiropractic friends about a month (!) ago (and here), but really have to take my hat off to Robster for his eloquence and indefatigability - kudos, brother.

As to the natural (or in my case irresistible) tendency to get facetious / sarcastic with people like aCP, the quote I like to wheel out for such occasions comes from the 1920s Nobel Laureate in physiology A.V. Hill:

"Laughter is the best detergent of nonsense".

PS For a brief account of the circumstances under which Hill made this remark, check this obituary of Hill's pupil, Nobel Laureate Bernard Katz - end of p 2 and start of p 3.

aCP

Hmm, looks like 3 years of classes followed by year four composed of selectives and internship, followed by residency.

Go click the "M3" link at Creighton. I will wait.

aCQ,

You claim that the under 45 group is somehow the answer, based on statistics that you are twisting, when in patient care this is clearly not the case. The under 45 goups is not "more sensitive". Perhaps I want to leave the dead horse alone both because I am embarrassed for you and because I don't have time to walk you through Stats 101.

Ummm, yes, under 45 is more sensitive. Over 45 has more strokes by nature. Lots more. So a rare event would be hidden by the bigger number. My common sense is tingling...

I was perusing comments on another blog and came across some details that are very interesting. First, Cassidy, the first author of the paper under discussion, has admitted to causing a stroke (lateral medullary syndrome) in a patient of his. That sounds like an excellent reason to try to sweep the truth under the rug.

Second, he was sued for asking an employee to manipulate (heh) the stats in a paper to produce the results he wanted.

"in or about September 1998, and contrary to all normal and appropriate practices and procedures in regards to independent medical research, she was instructed by Cassidy to produce certain statistical results that would support the end conclusion desired. Specifically . . . Cassidy instructed her to produce results and graphs that would support the conclusion that an injured person's time (date) of settlement is a good proxy for the person's time (date) of recovery" (Statement of Claim, In the Court of Queen's Bench for Saskatchewan, Judicial Centre of Saskatoon, between Dr. Emma Bartfay, plaintiff, and The University of
Saskatchewan and Dr. J. David Cassidy, Defendants. Filed May 21, 1999, Q.B. #1679 of 1999)."

The insurance company that paid for the study to be performed allegedly attempted to influence the study as well. "Yong-Hing alleged that SGIâ the province's only motor vehicle injury insurer, which funded the studyâ wanted its contributions to pay for certain study expenses in a way that "could well be interpreted as an attempt by SGI to disguise the destination of Saskatchewan residents' money" (Letter from Dr. Ken Yong-Hing, Professor and Head of Orthopedic Surgery, University of Saskatchewan, to Colin
Clackson, President, Saskatchewan Trial Lawyers Association (Nov. 3, 1996) (on file with author)."

But for some reason, Barret and Erntz are the vilest of enemies to science, a claim for which you only hint at support for, but never explain.

Add this to the simple fact that the author's methodology is of exceptionally poor design, looking not at patient's records, but at billing records, and we can conclude that this paper isn't all that impressive. I suggest that it hides the truth, but not very well. Its all right there to see in table 3.

Who did the study assisting people with suicide so that they could measure the Newtons of force during the process?

Study? Thats just physics. 70kg average human male, so 70*9.8=686 Newtons. Passive no drop hanging. Is that a minimum to kill, no. But this also means that a type IV manipulation is 11% of a fatal passive hanging.

On what, however, do you base the claim that ¼ hanging deaths is due to VBA disection (when annecdotal evidence says that the vast majority are actually due to suffocation)?

Forensic Sci Int. 1984 Aug;25(4):265-75. 1/4 still leaves lots of room for suffocation. But I can understand how a chiropractor would salivate at finding people that actually want to join a study on hanging. You would get to actually hang people instead of simulating it! I'm sorry to not have pointed out your misinterpretation of this detail sooner. 686 will do the job, but is it what you call the "minimum?" Obviously not, or chiropractors wouldn't be causing strokes.

Also, what the heck do you mean by "stressed neck"? Are you talking about muscle tension?

Muscle tension, yes, whatever. Muscle tension would increase the amount of force needed to cause injury. Without it, our heads would flop around. Relaxation would decrease the force needed.

Oh, and we already provided references for the 30% adverse acceptance rule, which is the standard in post-marketing surveillance testing results presentation to the FDA. I provided you with a link, in writing, to the FDA website that says this, verbatim, in clear language which requires no interpretation.

And you still don't understand cost and risk vs benefit. The market won't accept higher risk in comparison to what is already already available. The market wants what you are doing to have similar or better efficacy than what is already available. Since you can get similar effect from similar cost PT, or even sham treatment, the risk is unacceptable. In fact, no benefit above sham makes a small risk of stroke become a risk/benefit ratio approaching infinity when compared to low risk treatment. Chiropractors should not be allowed to adjust the neck in this manner.

I will refrain from being shocked that the person who claims to be too busy to find evidence to support their claims has time to sit around and watch profane adult cartoons.

Sorry. I'm just cooler than you, and it isn't often that a geek gets to say that to somebody. Sometimes I have lots of papers or exams to grade, sometimes I don't.

Also, on what are you basing the accusation that chiropractic refuses to police itself or allow others to do so?

http://www.sciencebasedmedicine.org/?p=3
http://www.sciencebasedmedicine.org/?p=196

We were thrilled to be a part of NCCAM, and we are constantly applying for federal funding to do research. Those of us who are ethical are the most outspoken against the unethical, as they are ruining our reputations. What the hell are you talking about?

Thrilled to be part of NCCAM. Are you really trying to argue that you are worthy of being part of the EBM world or that you are worthy of scorn? You are happy to be alongside the worst of pseudoscience scams? If chiropractic were real, do you really have to compete with homeopaths? You are willingly and proudly associating with a the best example of crap ever.

Actually patient participation is the definition of a statement against mandatory vaccination. If the patient gets to decide, it is not mandatory. If it is mandatory, then the patient gets no say and is therefore not participating in the health care decision. Can you please at least join me up here at the 3rd grade reading comprehension level?

Sorry, second grade. I gave you too much credit. I really don't think you are even capable of getting this. The decision may be made in the doctor's office by the patient, but the mandatory part is external to the doctor/ patient relationship.

Practice standards in all professions, chiropractic included, dictate that x-raying in children should only be done if absolutely necessary, as in to visualize a fracture. ⦠To the next statement, as children are as likely to be in car accidents as much as the parents who are driving them and are more likely to be hurt given that the seatbelts are not designed for the smaller frame, I would say that yes, some children can benefit from chiropractic care. Children also fall out of trees, get injured in sports, and lots of other stuff, too.

Glad to know that those kids arenât getting XRays, but without them, how do you find the mythical subluxation? Nervometer? Checking leg length? Touch alone? Obviously, none of these work, and abusing a child by neck cracking when PT is available is a bad choice. PT treats real problems without resorting to making up spinal issues. If chiropractors could tell the difference between before and after xrays, you might have something.

Yes, if the earache is due to increased middle ear pressure, releasing that ear pressure will remove the cause of the earache. Oh, and the average cost of a chiropractic visit in Connecticut, for example, is $38, including assessment and treatment. The base cost for 15 minutes with an allopath, not including any tests that might be performed or prescriptions that might need to be paid for separately is $76. Hmm, that looks like chiropractic is cheaper. . . much cheaper. Check out a few more insurance company websites and get their fee schedules. This shows how much is paid to each practitioner for each service rendered.

So? You could also teach a parent how to help relieve pressure once, give a pamphlet, not need to see the patient again unless the earache progresses to a much more serious condition, and never need the risk of neck cracking in a kid.

Oh my God, I had a typo and wrote "phychneuroimmunology" when it is "psychoneuroimmunology". Clearly I am a moron.

Finally, we agree on something.

With regard the concept, however, I suggest you check out the work of Candace Pert, PhD, pharmacologist graduate from the Johns Hopkins University School of Medicine.

Does she believe that a magical, undetectable energy flows through nerves to induce healing and effect magical cures? No? But âstraightâ quacks sure do. But good for slipping in another appeal to authority.

"When someone believes in one extremely unlikely concept, they probably believe in lots of them." WHAT?!? That is like saying that someone who believes in Vishnu probably believes in Zeus and the divinity of Jesus. That is so stupid that I don't even know how to respond.

No. But if you believe in one non scientific thing, you do tend to believe in others. So Jesus leads to miracles, intercessory prayer, and in more extreme cases, possession, spiritual warfare, etc. 911 truthism leads to chemtrails, HAARP, etc.

Thank goodness, I have found the person who was actually there, performing the modern scienctific inquiry, and can tell us the true story of D.D. Palmer! Yes, they are anecdotes, but to claim that a person referring to the anecdotes is unethical is ridiculous.

How does a spinal manipulation restore function of a cranial nerve? Why hasnât anybody else done this? Because Palmer was a scam artist before he invented chiropractic and after he invented it.

Go ask your friend the local MD if s/he relies on both published research and his experience and "annecdotal evidence" (taken with a grain of salt, of course) to provide care, and I am pretty sure he or she is going to say yes.

But if said anecdotal evidence (personal or otherwise) violates basic anatomical concepts and the doctor gives it more weight than science, said doctor is a quack. Jay Gordon is a quack, and considers personal anecdotal experience more important than everything else.

Oh, and I didn't direct you to youtube as a scientific source, but just as the easiest place I knew of for you to find the archived news reports.

So there arenât even documented case reports. No, but you seem to believe this stuff is possible and perhaps real. Why else would you bring it up?

Yes, false testimony is unethical, but there is no evidence that this testimony (either the old, Lillard stuff, or the new stuff out in the last six months) is false. . . other than the fact that you, with your infinite authority, say that it is.

Then why persist in pushing the existence of subluxations?

DCs do not have to "be insured by law". Yes, we have to carry malpractice insurance like every other doctor, but a chiropractor must voluntarily choose to sign a contract with an insurance company to be paid by that insurance company.

And you donât have issues with reading comprehension? I meant that you have to carry malpractice insurance, hence, be insured, not accept insurance payments.

Actually, there is a movement within the chiropractic profession to split the profession into "chiropractors" and "chiropractic physicians", much like we have "osteopathic physicians" in the U.S. and some in the U.K. and "osteopaths" for the rest of the U.K. and the rest of the world. I would prefer to see the entire profession improve, but in the absence of that, I support the split.

Good. But you have to get rid of all the nutty stuff, not just some of it.

I have clearly stated my views about the distasteful element in my profession, but you continue to ignore that and say whatever you want, so I am probably wasting my time writing it again here.

More than anything, you are stuck denying that those elements exist.

I wait with baited breath for you to turn off "Futurama" and look into the Canadian HIV study. As I said, however, it is ongoing, so you won't find concrete results just yet.

So no full report?

Some studies disprove the autism-vaccine link, and some studies prove it. Rather than doing what you do and choosing to believe just what conforms to the opinions I already hold, I will maintain that it is a hypothesis still in study, and hopefully time will tell. I take no side on the issue, currently, as DEFINITIVE evidence is not yet available.

Headdesk headdesk headdesk

Conflict of interest, by definition, is not unethicalâ¦

Not always, but the ones you find distasteful obviously are.

Where we disagree, however, is in what you consider to be "useless", however. I will continue to work from the available evidence base, and you can do that thing that you are doing.

No better than sham. Useless. A person imitating a chiropractor would be as good. That has to be rough, knowing that those "8" years are worthless.

With regard to the activator, there is research on that, quality research and RCTs, because it is easy to account for the placebo effect there since you can more easily perform a "sham" adjustment with that instrument than in traditional manual adjusting.

So a spring loaded mallet can change the length of your legs? You wonât get into the reality based world with that. A spring loaded mallet is supposed to realign the bones of the spine? This is the most ridiculous thing I have seen in a well, really, since your post yesterday. OK, lets see those RCTs with sham. Pubmed didn't exactly offer me much, but maybe the journals you are talking about aren't listed.

I don't know what the video says (and as a quick question, do you know how old it is?),

The video is from 2002. I said that. Reading comprehension.

----------

Thanks, Dr. Aust. :D

Robster,

Under 45 is not more sensitive to THIS PARTICULAR KIND of stroke. I am not saying it about stroke in general. If you disagree, try presenting research instead of your opinion.

What were the results of the allegations against Cassidy? Hmm, looks like the were dropped as fraudulent. . . or did you not read that far.

Why would you make such a ridiculous comment that I would be "salivating" at the idea of someone hanging themselves? That is just a horrible, horrible thing to say and is a mark of what a terrible person you are. If that is your idea of humor, I think we can see why I don't think it is funny.

Your two references from sciencebasedmedicine are editorials by the same individual. Plus, in the second one she makes the statement that "chiropractic can't fix a ruptured disc", when that claim was not even made by the chiropractor she listed. That doctor had claimed to be able to decompress a disc, not fix a rupture.

Aetna doesn't carry malpractice coverage, so they are clearly not an appropriate example to use in support of the statement, "chiropractors have to be insured and someone has to sell that insurance".

Yes, we agree that you are a moron because you spelled "psychoneuroimmunology" without the "o". I wouldn't have been that harsh, but if you feel that way, I guess I can support you.

If I say that the distasteful elements in my profession make me very angry, how is this a denial of their existence. Have you had some sort of traumatic brain injury that is as of yet undisclosed in this thread?

Nope, no full report from Canada yet. That is what is meant by "ongoing research". It means it isn't done yet.

Funny, I found 44 studies when I looked up "activator" and "chiropract*" in pubmed. Which pubmed were you using? Now, I assume that they are not all applicable, but in the absence of time at the moment, I guess I would assume that the ones titled things like "A randomized clinical trial of manual versus mechanical force manipulation in the treatment of sacroiliac joint syndrome" would be RCTs.

Directing you to the work of Candance Pert is not an appeal to authority. It is providing you with a reference for research on the topic we were discussing. Perhaps you don't recognize it, as you like to provide references to editorials, blogs, commercial websites, and google, rather than research.

You claimed that 686 newtons was the minimum needed to kill someone with the statement "how many Newtons are required to complete a passive hanging (no drop, commonly used in suicides, often causes death due to VBA injury)? 686." If 686 newtons are REQUIRED TO COMPLETE a passive hanging, then more than that would over do it (yep, they would be super dead), and less than that is less than what is required to complete it.

Okay, do you have anything else intelligent to offer to the discussion? Or are you more interested in name calling? If you have something of substance to offer, then I will happily continue this debate. If you are just interested in having a playground quarrel, then I have better things to do with my time.

aCQ,

I'm putting this request up front this time, because I really would appreciate your input. Would you terribly mind reviewing the Scientific American video? I would like clarification on the issues of leg length adjustment, how the activator is used, and if the statements from the chiropractic instructors were accurate.

Also, I would like to know what your reasons for objecting to Erntz and/or Barret are, other than being critical of chiropractors.

------------

OK, one more time. In a population where stroke occurs fairly often, small changes in the incidence of stroke would be hard to detect. In a population where stroke is rare, that change would be easier to detect. Its simple.

Lets imagine we are looking at a shipment of two types of wine bottles. One type of wine bottle has thin glass walls, while the other has thicker ones. A careless worker drops a case of each, breaking a dozen of each type. If 300 of the thin wall bottles break out of 10,000, a dozen would be harder to notice. But for the thick walled bottles, 30 break normally out of 10,000, so the dozen accidentally broken stand out.

Hmm, looks like the were dropped as fraudulent. . . or did you not read that far.

Really? It was settled out of of court.

Searching pubmed for "chiropractic activator sham" gives 5 results. I want to see "real" activator treatment compared with fake activator treatment. I bet it won't do anything compared to sham.

Your two references from sciencebasedmedicine are editorials by the same individual.

Relevence? I was pointing to those to demonstrate why I don't think chiropractic polices itself for fraudulent practices.

Aetna doesn't carry malpractice coverage, so they are clearly not an appropriate example to use in support of the statement, "chiropractors have to be insured and someone has to sell that insurance".

Relevance? You couldn't figure out the meaning of a simple sentence.

If I say that the distasteful elements in my profession make me very angry, how is this a denial of their existence.

And yet you persist in ignoring them or claiming that there just aren't enough of them to be concerned with, while excusing the indoctrination of students in antivaccine beliefs.

Directing you to the work of Candance Pert is not an appeal to authority.

Does she have evidence of a metaphysical energy that flows through nerves and directs the healing process? An energy that that can be reestablished or enhanced by manipulation? No? So not only was it an appeal to authority, it was a misuse of her research.

If 686 newtons are REQUIRED TO COMPLETE a passive hanging, then more than that would over do it (yep, they would be super dead), and less than that is less than what is required to complete it.

Wow, sorry I misstated it. Within the bounds of this discussion, we don't know how many Newtons are required to cause a VBA dissection, but since we do know that chiropractors do on rare occasions cause them, the range is probably much lower than 686 for some patients, but not for most.

Did aCP click on the link on the Creighton curriculum page for third year students? Has he conceded that the third year involves 80 hour per week clinical rotations?

Has he conceded that med school is four year long, not three years long?

Does he realize that a "sub-internship" rotation in the fourth year is not the same thing as the internship year, which happens after med school?

Has he conceded that the first two years of med school are largely didactic while the last two years involve direct patient care?

Is he or she begining to realize that reading comprehension may be a problem?

Robster,

I will do my best to review the Scientific America video when I have free time, but to be honest, I don't have a lot of free time and since I almost never watch TV, making time to watch something inherently non-scientific is not high on my priority list. If you have some quality research for me, I would be much more interested in that.

I object to Edzard Ernst because for the same reason everyone else does. He uses anecdotal evidence (which you are ready to dismiss when it is in support of chiropractic) and even uses it incorrectly, to support his claims. Furthermore, he makes comments that are specifically contrary to the available evidence. Dr. George Waddel (orthopedic surgeon and back pain specialist) perhaps said it well in his letter to the Editor published in the British Medical Journal in 1999 (Br Med J 3:18:263) when he dismissed Ernst's work as "interprofessional confrontation under the guise of scientific objectivity".

Stephen Barret, self-admittedly, was a failure at chiropractic. He was such a bad practitioner that in order to stay open, he would have had to lie, cheat, and steal. He consequently blames the profession and alleges that anyone else who is not such a failure is clearly lying, cheating, and stealing. I am sorry that he wasn't good enough, but maybe I paid attention in class or just went to a better school or chose to practice my skill to better develop the cognitive and sensorimotor skills to physcially perform an adjustment, which means that I am able to succeed in an ethical manner when he couldn't. He is mad because he is a failure. How could you possibly see him as a reliable source? Have you ever heard the phrase "sour grapes"?

Okay, I will accept your analogy of the glass bottles. The only problem is, in this particular, very rare type of stroke, the thinner glassed bottles are the young patients, not the old ones. This particular, VBAI stroke occurs MORE often in younger individuals. This is different than other types of stroke which are more common in the older crowd. There are many different "kinds" of strokes.

"sham" is not a good term to use in PubMed, as "sham" is not a common term to use in these kinds of studies. Try "control" or "placebo".

The relevance is that an editorial need not be based on actual fact, and is no more reliable than a blog. It is this woman's OPINION and her story that these things are true, and there is no way to verify that she isn't lying or crazy or something in between. Editorials are not evidence. Plus, the fact that this woman claims to know what happened inside the board meeting makes me question her truthfulness. These meetings are closed, so she would not know if they decided to fine the doctor or place the doctor on probation or require that the doctor meet certain ethical guidelines.

With regard to the comment on Aetna. . . I said that they had a clear definition of some chiropractic terms, and you said that this was because the law required insurance to cover chiropractic and someone had to sell that insurance. You then tried to change to say you were talking about malpractice insurance, but again, I say that Aetna does not sell malpractice insurance, so no law related to malpractice insurance would have any affect on the policies of Aetna. Do you understand what I am saying here?

I do not ignore the "distasteful element" within the chiropractic profession. As I have said, so many times, I am working to improve the chiropractic profession from within. I do agree that there is a percentage within the profession that should be forced to improve or forceably removed. You claim that this is all chiropractors, however, and I disagree there. It is nowhere near all chiropractors, nor is it even close to half. I would still be concerned if it was even just one bad doctor, and I am actively doing something about it. This is what I have said before, and am saying again, and if you still cannot understand it when I put it in this simple and clear statement, then I don't know what else to do to help you understand.

You, however, despite your claims that it is so many of us who are unethical, have yet to provide even one name.

Candace Pert. You clearly have not read her research. She delves into axonal flow, which is the actual fluid which goes forward and back within the axons of nerves, which carries nutrition, maintains the necessary electronic balance to allow the nerves to fire, carries elements necessary for the healing of damaged nerves, and which can be affected by external pressures, including physical pressures. Axoaxonal and retroaxonal flow are actual, real, verifiable physiological processes. I don't call it "nerve flow" anymore than I refer to the scapula as the "shoulder blade". Some doctors do, however, to help their patients understand. Really, try reading it. I think you'll find it fascinating.

I accept that your misstatement about the 686 number. I am also still interested in where this number comes from because, despite your claim that it is "just physics", I had to take some physics, and we never studied death by hanging. Furthermore, you would still need to find the force needed to actually "break" the barrier, anyway, and that calculation still needs to be based on a measurement somewhere.

I am going to be very careful in making the next statement, not because I am trying to unduly minimize a risk, but because I want to make sure that it is put into proper perspective. It is true that, in very rare situations, the movements associated with a chiropractic cervical adjustments performed on individuals with pre-existing factors, which may or may not be detectable in the absence of dopplar angiogram, can lead to or exacerbate an impending stroke. It is also true, however, that as many of the "delicate" (for lack of a better word) category of patients have this same, very rare stroke, due to exacerbations or causation of gentle neck movements performed by hairwashers at the salon, physical therapy modalities, or any doctor performing cervical range of motion as a component of an examination, as well as gentle neck movements performed by the patient themselves including, but not limited to, looking over their shoulder to back out of a parking space, brushing their hair, or having a sports "collision". As I think, if nothing else, a chiropractic adjustment has significantly more health benefit than a wash-and-cut or driving, I disagree with the idea that this is an unreasonable risk.

Dr. Benway,
I chose not to respond to you because there is nothing more to say. We are looking at the same website, and despite the fact that I have copied and pasted the quote directly from the site in support of my statement, you will persist in insisting that it means something else. I have no interest in discussing it further, as it is not possible to discuss something logically with someone who is fundamentally illogical. I suggest thay anyone interested in deciding for themselves can go to see the website. If they cannot read, they can call the admissions department. Acceptable?

Robster, I stand in awe ...

Dr. Benway, I feel your pain. Check this out "... As a greenhorn DC, I clearly recollect the first patient who told me, straight out, that he needed a âgood cracking.â {snip} Since I was just out of school and without any meaningful experience, this seemed perfectly reasonable." http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=53681&MERCU…

Imagine graduating from a four-year program "without any meaningful experience" and being licensed to play doctor. And why didn't he have meaningful experience? Because they spend their "clinical" time practicing on each other; and on healthy, young friends (and relatives) that pose as walk-in customers!

Finally, I was floored when I read in aCQ's post that he thinks Dr. Barrett is a failed chiro. WTF! Stephen Barrett received his M.D. from Columbia.

Stephen Barret, self-admittedly, was a failure at chiropractic. He was such a bad practitioner that in order to stay open, he would have had to lie, cheat, and steal. He consequently blames the profession and alleges that anyone else who is not such a failure is clearly lying, cheating, and stealing. I am sorry that he wasn't good enough, but maybe I paid attention in class or just went to a better school or chose to practice my skill to better develop the cognitive and sensorimotor skills to physcially perform an adjustment, which means that I am able to succeed in an ethical manner when he couldn't. He is mad because he is a failure. How could you possibly see him as a reliable source? Have you ever heard the phrase "sour grapes"?

HUH???

Are we talking about the Quackwatch guy?

That Steve Barrett is a retired psychiatrist. He never worked or trained in the chiropractic field.

I chose not to respond to you because there is nothing more to say. We are looking at the same website, and despite the fact that I have copied and pasted the quote directly from the site in support of my statement, you will persist in insisting that it means something else. I have no interest in discussing it further, as it is not possible to discuss something logically with someone who is fundamentally illogical. I suggest thay anyone interested in deciding for themselves can go to see the website. If they cannot read, they can call the admissions department. Acceptable?

In other words, you don't know ANYTHING about how medical schools in the US operate. It's a standard 4 year program: 2 years of pre-clinical education followed by 2-years of clinical education. It doesn't matter what a website says. If Creighton didn't follow that standard, they would not be accredited in the US.

"Stephen Barret [sic] ... would have had to lie, cheat, and steal [to make a living as a chiro]."

That is because Dr. Barrett is too well-educated to fall for chiro nonsense. T be fair, it is difficult to distinguish chiros who actually do lie, cheat and steal from those who are dumb-enough to believe their quackery.

aCQ,

I will do my best to review the Scientific America video when I have free time

Thanks. That I am asking you for verification of these procedures and viewpoints should demonstrate my skeptical nature. I want to make certain that the words of the chiropractic instructors are not being taken out of context.

I object to Edzard Ernst because for the same reason everyone else does...

I found said comment and the reply by Ernst and Assendelft, and link to it so that it can be read and examined by all. It seems that your "everybody" is the chiropractic community, and their biggest problem is that Erntz has constantly been critical of chiropractic. But since it has trouble beating sham treatment, its hard not to.

Stephen Barret, self-admittedly, was a failure at chiropractic...

Its pretty clear you don't know who Barret is. Perhaps before you dismiss him outright as some greater evil, you should figure out who he is. I was actually expecting you to repeat the lie that he had had his license revoked. Mind you, that never happened, he retired after a successful career in real healthcare, and became an anti healthcare fraud advocate.

Okay, I will accept your analogy of the glass bottles. The only problem is, in this particular, very rare type of stroke, the thinner glassed bottles are the young patients, not the old ones. This particular, VBAI stroke occurs MORE often in younger individuals. This is different than other types of stroke which are more common in the older crowd. There are many different "kinds" of strokes.

You were so close... Detecting strokes of any kind caused by a specific activity is easier in the younger group.

"sham" is not a good term to use in PubMed, as "sham" is not a common term to use in these kinds of studies. Try "control" or "placebo".

Odd. Acupuncture and sham gave me 544, and chiropractic sham gave me 56, but chiropractic activator placebo gave me one. Sham is a pretty descriptive term for a specific form of negative control in medical science.

Plus, the fact that this woman claims to know what happened inside the board meeting makes me question her truthfulness. These meetings are closed, so she would not know if they decided to fine the doctor or place the doctor on probation or require that the doctor meet certain ethical guidelines.

Again, really? Dr. Douglas Schnell Grove, Oklahoma was found guilty March 28, 2006 for the following: Violation of Title 59 Section 161.12(B)(1) by pleading nolo contendere to two counts of Aggravated Assault and Battery, as set forth in the First allegation of the complaint. (On file at the Board office). Respondent was in violation of Title 59 Section 161.12(B)(9) by obtaining a renewal license in a fraudulent manner. Found guilty by the Board of Examiners, fined in the amount of $750.00 for each violation, placed on probation by the Board to run concurrently with the probation imposed by the District Court of Delaware County in Case No. CF-2002-234, and ordered to complete (8) hours of Ethics before the termination of his probation. I think this depends on the state laws, and as to specific details, perhaps somebody told her. I'm pretty sure that such decisions have to be made public as a matter of public safety.

With regard to the comment on Aetna. . .

Whatever. Point is, you didn't understand what I meant. Maybe I wasn't clear enough for you. That seems to be a theme with you. So Aetna doesn't sell chiropractic insurance, but they do pay for treatment of patients. Right? So why not use the chiropractic term? My point stands, either way.

I do not ignore the "distasteful element" within the chiropractic profession. As I have said, so many times, I am working to improve the chiropractic profession from within.

Color me unconvinced. You don't have a problem with half of the students at a chiropractic school holding antivaccination views, with the percentage consistently increasing over their time as students (and are profoundly misinformed on the autism / vaccine connection, yourself). You find certain practices distasteful, but thats as far as you go. What is it that you are doing, other than protecting a procedure that several studies have determined to increase the risk of stroke in a young population.

I do agree that there is a percentage within the profession that should be forced to improve or forceably removed.

Good! Get to work! Start investigating! I'm an outsider, and not a patient, but you want me to do your legwork.

You claim that this is all chiropractors, however, and I disagree there. It is nowhere near all chiropractors, nor is it even close to half.

Back to the reading comprehension thing again. I didn't say that, but dCs that use subluxation as their operating theory are doing something that does not match up with reality. dCs that claim to be able to adjust the length of a patient's legs are committing fraud. dCs that are performing the kind of manipulation that can cause VBA dissection, when other procedures within the chiropractic field have the same effect, with greatly reduced risk, are needlessly putting their patients at risk. If that means all of you, so be it, but from my limited examination of the field, there are many that don't do this.

I would still be concerned if it was even just one bad doctor, and I am actively doing something about it. This is what I have said before, and am saying again, and if you still cannot understand it when I put it in this simple and clear statement, then I don't know what else to do to help you understand.

Great! So, why don't you tell us what you are doing instead of just claiming it. In your own words, "there is no way to verify that [you aren't] lying or crazy or something in between."

You, however, despite your claims that it is so many of us who are unethical, have yet to provide even one name.

Since you subscribe to the concept of subluxation, I'd say you are skirting on the edge of bad ethics, or at least bad reasoning. Why have I not "named names?" I don't want to fall into a libel/slander trap, thank you very much. I did, however, explain how a person could perform their own search for people that are more ducktor than doctor.

Candace Pert. You clearly have not read her research.

Actually, we studied the concepts of axonal flow in a neurotox class in depth, especially how drugs like taxol affect it. This isn't innate energy or analogous to the flow of chi, and it isn't being reestablished by popping joints, nor is it being impeded by mythical subluxations. You are misappropriating real research to prop up your claims. But maybe you interpret it that way, with your reading comprehension issues, and all. As a side not, a search for Pert chiropractic turns up nothing.

I am also still interested in where this number comes from because, despite your claim that it is "just physics", I had to take some physics, and we never studied death by hanging.

I'll write this slowly for you.

A 70 kg person exerts a force of 686 Newtons, suspended or not. In the following equation I will use 9.8 in place of the universal gravitational constant, mass of the earth, and distance from the earth's center at sea level. 70 kg x 9.8 = 686 Newtons. Thats pretty basic stuff.

It is true that, in very rare situations, the movements associated with a chiropractic cervical adjustments performed on individuals with pre-existing factors, which may or may not be detectable in the absence of dopplar angiogram, can lead to or exacerbate an impending stroke.

HOORAY! FINALLY! And since you cannot predict who these individuals are, and lower risk procedures exist than said form of manipulation, why perform those manipulations? Lets say drug A has a lower risk ratio than drug B, and identical benefits and the same cost. Who, in their right mind, would use drug B?

As I think, if nothing else, a chiropractic adjustment has significantly more health benefit than a wash-and-cut or driving, I disagree with the idea that this is an unreasonable risk.

Thats your opinion. But since sham treatment is shown to be just as effective in many RCTs, I have to disagree with you. But even if you could beat sham therapy, when there is an acknowledged risk of stroke with treatment A, which is as effective as treatment B with no risk of stroke, a comparison between the two shows a disparity in risk vs benefit that is approaching infinity in scope.

Attacking hairdressers, whom I would suggest perform a more valuable service than any sCAM artist, which includes many (but not all) chiropractors, is a tu quoque fallacy. Hairdressers should develop lower risk procedures as well, but blaming them is not an excuse for malpractice.

As to your discussion with Dr. Benway, I checked the link he provided, and you are wrong. I feel sorry for you that it is this hard for you to admit that you could possibly be wrong in a functionally anonymous forum. What a sad person you are.

Finally, as to a lack of self policing, California found that it's state auditing board was simply ineffective and was endangering patients. Thats just one (very big) state out of 50, but it does give you a bad reputation.

My comment on Ernst came from BMJ, as should have been clear from the reference I provided. Dr. Waddell is a surgeon at Glasgow Nuffield Hospital, so I am not sure how you consider him "part of the chiropractic community". Nor is BMJ a pro-chiropractic publication by any stretch of the imagination.

In October 2005 in a thread on the chiro base website, a poster by the name Dr. Stephen J. Barret claimed to have intimate knowledge of the weakeness in the chiropractic education because he had attended Life University in Georgia and knew that the only way he would have been able to practice was to lie, cheat, and steal. I know this, because the comment was a response to my posting on the thread. The thread is not still available now, however, unfortunately, I went back and tried to check. I do have the website saved as a file because he made such clearly fraudulent and slanderous statements. No, I do not find information on this elsewhere, and as such, you can choose not to believe me. The options are then, however, that he was lying then, he is lying now, or someone else was posting under his name on his own site. In the absence of additional support, however, I will assume that I am incorrect and that I took someone at their word when I should not have. I apologize for this.

You are close, but not quite. Detecting stroke of any kind is easier in the population in which it is less common. . . which would be the over 45 population with regard to this particular rare stroke.

Yes, if there is action taken against a doctor of chiropractic's license, that is a matter of public record, just like it is with any other practitioner. If someone is warned, fined, or put on probation, it is not; or at least it is not in all states.

Clearly you cannot understand what I am trying to say here. In the context of the reference you used, any comment about malpractice insurance is irrlevant. The reverse could also be true, and in any comment about malpractice insurance, the Aetna source is irrelevant. The two are entirely unrelated. I understand things perfectly. You, however, need to work on your ability to write.

You have no idea what I do in my attempts to clean up the profession, but sitting on my state licensing board and teaching ethics continuing education classes are some of the basics. I don't need you to do any legwork, nor am I asking you to. I simply asked that if you wanted to make accusations, you take the responsibility to make sure that your accusations were not as completely unfounded as they have appeared to be at times. I find it amusing that you hide behind "wanting to avoid a slander/libel trap", when the definition of slander or libel is saying something that is UNTRUE. If you are making a just, accurate accusation, you cannot be found guilty of slander. You basically just said that the reason you will not accuse a doctor of chiropractic of wrongdoing by name is because you would be lying.

Candace Pert is not a chiropractor, nor does she do specifically chiropractic research, so no, I wouldn't expect anything to turn up under a search like that. Chiropractic is a part of basic science, however, including components of physics, biochemistry, neurology, physiology, etc. so research in those areas can also explain what we do. I have never said anything about Chi, as that is an Eastern energy healing term with which I am not terribly familiar and it has nothing to do with chiropractic practice. It is pretty clear, however, that flow within the axons of nerve cells is, in simple terms, nerve flow. The Pert research and others do discuss that this flow can be interrupted by pressure, and this pressure can come from a number of things including osseous structures. Since subluxations are alterations in positions or motions of the bones in a joint, and this concept is accepted by the medical community, even if they choose to use a different word for it, it does apply. Can you really not understand this or are you intentionally playing dumb?

Show me the research on the techniques that are lower risk. I haven't seen you provide any research on this yet. And if we should discontinue chiropractic cervical adjustments due to the risk, shouldn't we also discontinue all practices which have equivalent or even higher risk?

You say: "Hairdressers should develop lower risk procedures as well, but blaming them is not an excuse for malpractice.". I am not blaming them to excuse malpractice (which, by the way, unpredictable accidents are not considered malpractice in any profession) but I am pointing out that you will excuse the unnecessary salon activity of leaning backwards over a sink when that causes a stroke, or the PT who causes it when they try to "strengthen" the neck muscles of someone with neck pain, but you want to crucify the chiropractor when they are responsible only as often, and sometimes less often, than these other individuals. You have a ridiculous double standard. I am not saying the standard should be lowered for the chiropractor, but I wonder why you would not want it raised for all individuals? You can wash hair without leaning a head backwards and treat neck pain without PT. . . so why not call the hairdressers and PTs quacks and spend hours on blogs denouncing them as just short of evil?

If neither you nor Dr. Benway can read, that is a shame. I suggest that you try to call them (or any other medical school) and ask. I would suggest, however, that in the interest of this conversation you are not exactly an unbiased or uninvolved person capable of handing down a trustworthy judgement.

Uh oh. California was the wrong state to pick. California is the only state out of 50 that is not licensed by an independent board of chiropractic examiners. It is the only state in the US where chiropractors are licensed directly under the office of the governor. You can see this if you look up the composition of the Board. . . there is no requirement that the California board be made of chiropractors! Gov. Arnold's "two friends" certainly aren't. Maybe that is why the other states, where the boards are made of more chiropractors than random appointees, do a better job of policing ourselves.

Sorry, forgot to include the quotes from your California article which say that "This represents a stark contrast to other state licensing boards, which make an effort to get the details of malpractice claims to see if discipline is warranted," and "virtually all boards take only a matter of weeks" to investigate complaints, said Assemblyman Mike Eng, D-Monterey Park. "This particular board takes a matter of months and that is completely and wholly unacceptable."

Looks like even your newpaper article author managed to check out the other boards to see that CA compares poorly. You would have seen this if you had read the whole article, rather than just the title, before posting it.

aCQ

In October 2005 in a thread on the chiro base website, a poster by the name Dr. Stephen J. Barret claimed to have intimate knowledge of the weakeness in the chiropractic education because he had attended Life University in Georgia and knew that the only way he would have been able to practice was to lie, cheat, and steal.

Perhaps he had started chiropractic school and seen how clearly it contradicted the biological sciences back in the 50s. Sounds right to me. Or, just as likely, you are misinterpreting someone's writings again.

You have no idea what I do in my attempts to clean up the profession...

But we do now, and we can see that since there is no report of a crusading chiropractor cleaning house of quackery, so readily and easily available for all to see on chiropractic practitioner's websites, that you are ineffective. All someone needs, from what you have written, to continue a fraudulent practice (treating bedwetting or asthma) is a case study to demonstrate a remote chance that something would work. I am concerned that teaching ethics may not be a good place for you, especially in light of your view of conflict of interest matters, detailed above.

How about finding out which dCs practice homeopathy alongside chiropractic. That is clearly an ethical breach. And speaking of breaches, how about acting to end the use of the Webster technique to adjust the position of a fetus? Even to you, this must stink of quackery.

You basically just said that the reason you will not accuse a doctor of chiropractic of wrongdoing by name is because you would be lying.

No. I don't think you understand the judicial system, either. You don't have to be guilty to be sued, and I would rather not find out how litigious a person is by experiment.

Candace Pert is not a chiropractor, nor does she do specifically chiropractic research, so no, I wouldn't expect anything to turn up under a search like that.

So you don't have a reason to point her out other than to attempt to appropriate her authority. Thanks.

Chiropractic is a part of basic science, however, including components of physics, biochemistry, neurology, physiology, etc. so research in those areas can also explain what we do.

Actually, they do a good job of explaining why you can't beat sham treatments, and why chiropractic subluxations aren't a real phenomenon.

I have never said anything about Chi, as that is an Eastern energy healing term with which I am not terribly familiar and it has nothing to do with chiropractic practice.

It is remarkably similar to innate intelligence and nerve energy, espoused by straights, especially in the detail that they don't exist.

It is pretty clear, however, that flow within the axons of nerve cells is, in simple terms, nerve flow. The Pert research and others do discuss that this flow can be interrupted by pressure, and this pressure can come from a number of things including osseous structures.

But a mystical healing energy doesn't flow through them.

Since subluxations are alterations in positions or motions of the bones in a joint, and this concept is accepted by the medical community, even if they choose to use a different word for it, it does apply. Can you really not understand this or are you intentionally playing dumb?

The real medical community does not accept chiropractic subluxations. They are just part of the chiropractic sCAM, and good chiropractors are leaving this concept behind. I completely understand that you are attempting to connect real science to fake science in order to find some way to explain how chiropractic works (but not better than sham). You might as well be trying to cite quantum mechanics.

Show me the research on the techniques that are lower risk. I haven't seen you provide any research on this yet. And if we should discontinue chiropractic cervical adjustments due to the risk, shouldn't we also discontinue all practices which have equivalent or even higher risk?

In the medical community, if a procedure does not provide demonstrable benefit that cannot consistently be separated from placebo or beat sham, then yes. Stop.

What is of lower risk? Well, for one, sham. It does just as well in many cases. For self limiting issues, try doing nothing. How about more gentle mobilizations? None of these provide the violent motion that could cause a VBA dissection. At the very least, mandate informed consent.

I am not blaming them to excuse malpractice (which, by the way, unpredictable accidents are not considered malpractice in any profession) but I am pointing out that you will excuse the unnecessary salon activity of leaning backwards over a sink when that causes a stroke, or the PT who causes it when they try to "strengthen" the neck muscles of someone with neck pain, but you want to crucify the chiropractor when they are responsible only as often, and sometimes less often, than these other individuals. You have a ridiculous double standard.

We aren't talking about hairdressers and their risk factors. All hairdressers have to do is change how they wash hair. Chiropractors would actually have to stop highest cervical manipulations, one of their historical reasons for existing. But the point remains. You are deflecting the issue. Also PTs actually do something that works better than placebo and sham. I don't want to crucify chiropractors, just have them reform themselves and free themselves of quackery and overly risky procedures.

But hairdressers provide a useful service, something that RCTs with sham demonstrate that chiropractors have a difficult time doing. (Watch aCQ take this seriously, heh)

California is the only state out of 50 that is not licensed by an independent board of chiropractic examiners. It is the only state in the US where chiropractors are licensed directly under the office of the governor. You can see this if you look up the composition of the Board. . . there is no requirement that the California board be made of chiropractors!

OK, learned something. However, I would say that these boards should perhaps include an outside advocate who can point out that certain practices are not evidence based, since as a member of such a board, you don't seem to be able to confront this concept yourself. Not including outside advocates is a failure of any such board in any medical or pseudomedical field.

... unpredictable accidents are not considered malpractice in any profession

How about performing a needless and risky procedure?

You fail at math, physics, statistics, reading comprehension, etc etc. Trying a rubber/glue move on saying that it is Dr. Benway and I that can't read doesn't look good for you, especially when anybody can follow Dr. Benway's link and see that the most likely explanation is that you misunderstood what your friend said.

I really pity you, though. Your reading comprehension and basic maturity in not being able to admit mistakes is really sad. If you are what is protecting patients from bad chiropractors, it makes the situation even worse.

If we're having trouble understanding the Creighton web site, we can look at another source.

From Wikipedia, about halfway down the page under "Curriculum":

"Once admitted to medical school, it takes four years to complete a Doctor of Medicine (M.D.), or Doctor of Osteopathic Medicine (D.O.) degree program. The course of study is divided into two roughly equal components: pre-clinical and clinical.

"Preclinical study generally comprises the first two years and consists of classroom and laboratory instruction in core subjects such as anatomy, biochemistry, physiology, pharmacology, histology, embryology, microbiology, pathology, pathophysiology, and neurosciences. Once students successfully complete preclinical training, they generally take step one of the medical licensing boards, the USMLE, or the COMLEX.

"The clinical component usually occupies the final two years of medical school and takes place almost exclusively on the wards of a teaching hospital or, occasionally, with community-based physicians."

Robster,
To begin with, both the question of whether or not you could read and the mention of the "rubber and glue" mentality was something I said so long ago that I am surprised you remember. However, in light of this, how can you comment that I would be "trying to turn this back on you" when I made the comment and you have been trying to turn is back on me ever since?

If you cannot find information on chiropractors who are doing good things for the profession, you aren't looking very hard. You make accusations, and provide no evidence with which to back them up. When I show something positive, you dismiss it as "poor quality". Tell me what you would find acceptable, and then I'll know what to get for you. You will not accept RCTs, comparative trials, metadata, or case studies. You will accept newspaper articles, personal blogs, and TV shows that are against chiropractic, but you will not accept those that make positive claims. Does your bias really blind you so much that you can't see that what you are doing here is ridiculous?

Oh, and the Webster technique, although designed by a chiropractor, is now being used more commonly in hospitals in place of the more aggressive, dangerous, and uncomfortable External Cephalic Version technique. Look it up. I don't use the Webster technique myself, however, having only an academic understanding of the procedure.

I understand the judicial system, which is why I said that you would not be GUILTY of slander/libel if what you said was true. If you have record of unethical conduct and a doctor tried to sue you for publicizing that, the case would be thrown out and fast. If it is your interpretation or misinterpretation of information, then yes, you could be successfully sued.

You will not accept research done by chiropractors, nor will you accept research done by MDs and PhDs on chiropractic topics, and in rejecting Candace Pert because she is not a chiropractor OR researching specifically chiropractic topics, you make it clear that you will not accept PhDs doing research on non-chiropractic topics if it can remotely be used in support of chiropractic despite the fact that it was not the researcher's original intention. So I ask again, what evidence will meet your criteria? Does it have to be negative before you will acknowledge it?

Candace Pert is not a chiropractor. She does not do chiropractic research. She happens, however, to do research in an area that, among other disciplines including physiology, etc. that I have mentioned before, happens to be a part of modern chiropractic practice. On what grounds do you reject her research?

I have given you a definition of innate intelligence. That is straight from the mouth of a chiropractor, me. You acknowledged that the processes I outlined are legitimate, medically accepted processes. You denied, however, that the word "innate intelligence" can be used to describe these processes. On what do you base this? Have you provided a different definition of innate from a chiropractor which conflicts with this? How do you define the word "innate intelligence" and on what authority? I have heard you compare nerve flow with chi energy, but that is not anything I have heard in my profession. My profession doesn't even use the concept of chi, and I really don't know anything about it.

No, mystical healing energy doesn't flow through nerves. What does is fluid containing various substances required for nutrition, maintenance, and repair of the nerve cells. You may consider this mystical, but to the average doctor, this is just physiology. Can you provide a link to any site in which a doctor of chiropractic uses the words "mystical healing energy"?

The medical community does accept the idea that there can be alterations in position or motion of bones at a site of articulation. It doesn't matter what you call it, all doctors (MD, DO, DC) accept that this is a condition exists. It is even an international concept. Call up your local doctor of choice and ask if you can read through their ICD-9. If you like some other word better, by all means, use your vast authority and write your own dictionary.

You accuse me of trying to connect real science to fake, but I ask you, what fake science have I presented here? All of my statements related to the science of chiropractic have been backed up by evidence. Which one of them was fake?

Yes, if there is no demonstrable benefit, a practice should be eliminated. Arthroscopic knee surgery in osteoarthritis and knee pain may be a candidate, here, as recent studies have shown improved function and pain scores in individuals who receive sham surgery as compared to the legitimate procedure (Mosely 2002 - NEJM 374(2)L81-87). The unsupported leap you make here, however, is when you say that chiropractic cervical adjustments have no demonstrable benefit. I have provided you with evidence showing benefit, and even you, with your skeptical pride, have acknowledged that the task force report on neck pain and associated conditions did show some benefit, although you did qualify that this may only be in certain conditions. We have established there is benefit.

If you want to use insurance company data, that is fine, we can do so. Insurance companies are, as you say, all about the numbers. If they have to pay more, they will charge more, so that they still make money. If chiropractors were guilty of malpractice, they would be getting sued. If they were getting sued, they would have huge malpractice premiums. Why, then, is chiropractic malpractice insurance so much lower than other primary care, portal of entry physicians? Why does our insurance cost so much less than the PTs, if they are less likely to hurt someone? In January 2003, in a national survey it was reported that internists were paying up to $10,000 per year, general surgeons were $36,000, and OB/GYNs were $55,000 per year. I found this in a report on a government report just by googling " average cost of malpractice insurance for different providers". It was the second hit. You know what I paid for my malpractice insurance last year? $860. HPSO will charge a PT who works the same hours in the same situation with the same length of time since graduation $1884, and that is with the discount they offer for being a member of the APTA, and they are secondarily covered by the physician who referred the patient to them, as they should have correctly diagnosed and referred. There is a direct comparison. Why does the same company charge me less than half of someone who is a therapist, not a doctor, and somewhere less than 9-2% of what they charge the other doctors? I certainly average as many patient visits as any single one of those doctors.

Okay, so research says that there is at least SOME benefit to chiropractic cervical adjustments in SOME conditions, and malpractice insurance rates show that chiropractors are not being sued by patients on claims of injury. So what exactly are you basing your accusations on?

Try reading what I wrote about California again. I said the other boards which are made more of chiropractors may do a better job, not only of chiropractors. For example, my state board is composed of 12 members. We have 7 chiropractors, 2 medical doctors, 1 doctor of osteopathy, a woman who works at a retirement community, and a teacher. Don't worry, though, I am sure you can find a way to dismiss them all as "chiropractic supporters". All health care regulatory boards in all states have a required number of "public members", as in, those who are not members of the profession which is being regulated. Do you ever read ANYTHING before you make stupid comments online?

You accuse me of not being able to admit mistakes. What did I say about my comments about Stephen Barrett? That looked like I admitted a mistake right there, and pretty quickly too. Save your pity, it looks like you need it more than I do.

another Chiropractic quack | March 12, 2009 12:04 PM wrote "Okay, so research says that there is at least SOME benefit to chiropractic cervical adjustments in SOME conditions ..."

The real concern is whether your neck-snap is significantly better than safer procedures to justify the risk. Do you have any information on this?

Dim dim dim.

aCQ,

We pointed out that you had issues with reading comprehension. You tried to claim that, nu-uh, it was us. You didn't coin the rubber glue phrase, so I think I can use it.

You have offered some papers supporting chiropractic manipulation, and on reading past the abstract, it was clear that the case was weak. I offered papers in return that were more critical. There are a mix of positives and negative studies, which most people will interpret as meaning that an area needs more study, but probably will turn out to be low to no effect beyond placebo.

I pointed out why certain papers were of low quality, and what they needed in order to become a higher quality paper. I pointed out that the best designed studies showed that chiropractic does not beat sham studies, a phrase that apparently is new to you.

I don't accept single papers positive or negative, but examine the totality of the data and how it was gathered. When a dC produces a good paper, thats great. No problem. But when someone claims to have demonstrated that a technique does not cause stroke using billing records, that is bad methodology. Since it shows what you want it to, you won't admit this, but reality does not need your consent. It is this that keeps so much of chiropractic separate from real medicine.

Your response to learning that Barrett was not a failed chiropractor was to call him a liar. That isn't admitting that you are wrong, but following an ad hom with an ad hom, then gave a limp apology. How nice...

On the Webster technique, perhaps you could explain how one can adjust the fused bones of the sacrum and how this would affect the position of the fetus? Can someone seriously believe that they can correct subluxations in a fetus, when they only exist to chiropractors (yes, yes, you claim that they do, under a different name, but so subtly that nobody else can find them)? How does poking at a patient without actually attempting to reposition the fetus do anything that wouldnât happen normally? Directly put, how many of these breeches would have resolved themselves normally? One survey paper on this technique showed that many procedures were performed without even ultrasound verification of breech. If this is not endangering a patient, then nothing is. Furthermore, without ultrasound monitoring, the risk of being entangled in the umbilical cord exists, a serious complication for which no chiropractor without a real medical degree is prepared to deal with.

The medical community does accept the idea that there can be alterations in position or motion of bones at a site of articulation.

Of course the real medical community does, but chiropractic has had a very difficult time proving that the extremely minor alterations that it calls subluxation really exist or can even be altered by manipulation. Iâm not proposing a new definition, only conformation to reality and evidence.

On innate intelligence, I am attempting to explain to you, a chiropractor, what many other chiropractors believe.

Perhaps you can provide research demonstrating that chiropractic adjustment can renew or improve axonal flow. Otherwise, you are using real science to attempt to explain how chiropractic works (when it actually does have an effect above placebo). To claim that adjustments have an effect at all, we need to have evidence that they are real and do have a measurable negative effect on health. The evidence based community, as a group is not yet convinced of this based on the evidence presented.

Pointing out differences in medical malpractice fees is a non starter. Since most of your treatments do nothing and have low risk, even considering neck manipulation (which should be replaced with lower risk mobilization), a low malpractice rate (combined with underreporting of injuries and lower awards) doesnât impress.

Again, pointing to other disciplines (knees) is tu quoque.

As to your outside members, great. Do they challenge the use of such things as the Webster technique, or adjustments for bedwetting? If not, then they are enabling fraudulent practices.

Being a member of such a board does not make you a reformer, and based on your statements here, only the most egregious patient abuse would even catch your notice.

Sorry, this, To claim that adjustments have an effect at all, we need to have evidence that they are real and do have a measurable negative effect on health. should read To claim that your "subluxations" and adjustments have an effect at all, we need to have evidence that they are real and do have a measurable, non placebo, negative or positive effect (respectively) on health.

Robster,

You have yet to offer a single scientific paper showing that chiropractic manipulation has no benefit or is unreasonably unsafe. Editorials are not science. You have offered papers on other topics, of varying quality, but not actually anything on this topic.

The Webster Technique doesn't adjust the fused bones of the sacrum. It has an effect on the juxtaposition of the sacrum on the innominates and, subsequently, to the ligaments that are attached to these bones which attach to, support, and suspend the uterus. This also includes nothing about any subluxations of the fetus. I am begging you, please, please try knowing ANYTHING about what you are trying to discuss on this forum.

Medical doctors can find alterations in position and motion in the bones of a joint. So can chiropractors. Why about this concept is tough to understand? I am trying to use small words for you here! There is evidence that these things exist. Even you admit it! Where is the missing step for you? In terms of the evidence you are looking for that alterations in bone position can have an effect on axonal flow, and at the risk of repeating myself yet again, I direct you to the research of Candace Pert!

On innate intelligence, you still haven't actually said what it is that you think the other chiropractors believe this is? I asked that if you say that "innate intelligence" is described by a chiropractor as "mystical healing energy", you provide a source verifying this claim, because it is not anything I have ever heard in my profession.

Your claim of underreporting of injuries and lower award amounts is crap, and either you know it or you are just stupid. Award amounts are based on the severity of injury and the amount of subsequent medical care that will be needed to address or correct the iatrogenic injury. Stroke is a big deal, death leads to a big award, and those who survive a stroke will need lots and lots of care. Injuiries in chiropractic are no more likely to be underreported than injuries in allopathic practices.

I use a variety of disciplines as examples in the hope that perhaps if I use your words you will understand. Alas, it seems that you just can't understand anything at all.

aCQ,

You have yet to offer a single scientific paper showing that chiropractic manipulation has no benefit or is unreasonably unsafe. Editorials are not science. You have offered papers on other topics, of varying quality, but not actually anything on this topic.

Anybody can scroll up and see that this is incorrect. You must have hallucinated your way past them. It is interesting though, that you consider yourself a judge of the quality of a paper, but donât recognize the problems with the Cassidy study.

The Webster Technique doesn't adjust the fused bones of the sacrum. It has an effect on the juxtaposition of the sacrum on the innominates and, subsequently, to the ligaments that are attached to these bones which attach to, support, and suspend the uterus. This also includes nothing about any subluxations of the fetus. I am begging you, please, please try knowing ANYTHING about what you are trying to discuss on this forum.

Oh, so it doesn't do anything at all. I don't know about your skeleton, but my sacrum doesn't exactly move that much in comparison to the pelvic bones... Do you have any evidence that the Webster technique actually works better than time? Breach presentation goes from 25% at 32 weeks to about 3% at full term. I would suggest that what you claim is an effective procedure is a pointless scam, playing on the fears of the mother. The improvement you see is nothing more than the baby moving normally. Perhaps if you could offer a paper demonstrating that the Webster technique does better than placebo or sham technique, your claim that âit worksâ would be more than the pragmatic fallacy.

Medical doctors can find alterations in position and motion in the bones of a joint. So can chiropractors. Why about this concept is tough to understand?

Nothing hard to understand here. You are wrong. Real medical doctors find real alterations, but only chiropractic quacks claim to be able to find chiropractic subluxations.

I am trying to use small words for you here! There is evidence that these things exist. Even you admit it! Where is the missing step for you?

On x-rays, chiropractors canât reliably find the same chiropractic subluxation, and they canât tell the difference between before and after treatment. That isnât evidence that chiropractic subluxations exist, but rather that they donât. What is truly humorous is that chiropractors use such ridiculous tools, like the nervometer, to find their subluxations.

In terms of the evidence you are looking for that alterations in bone position can have an effect on axonal flow, and at the risk of repeating myself yet again, I direct you to the research of Candace Pert!

Back to abusing real science again, are you? Searches of pubmed for chiropractic or subluxation and terms such as axonal flow or axoplasmic turn up nothing of use. You have a hypothesis as to why chiropractic might work, if your chiropractic subluxations were real. Thatâs it. Thatâs all you have, but you keep on pointing to Pertâs research as though it were proof of concept. You need evidence and data to demonstrate that your hypthesis is correct, not just dogged insistence.

On innate intelligence, you still haven't actually said what it is that you think the other chiropractors believe this is? I asked that if you say that "innate intelligence" is described by a chiropractor as "mystical healing energy", you provide a source verifying this claim, because it is not anything I have ever heard in my profession.

Really? I thought I was quite clear. And do you have no concept of the history of your profession? Where it came from or what the formative beliefs were? I canât imagine being so completely separated from my curiosity as you are.

OK, again. Innate intelligence, is described by a straight chiropractor on this page using cultish, vitalistic terms and the words of the Palmers. Here is an article about the history of chiropractic, in a chiropractic journal, about innate intelligence. I am stunned that you claim ignorance of the history of your own practice.

I use a variety of disciplines as examples in the hope that perhaps if I use your words you will understand. Alas, it seems that you just can't understand anything at all.

Go right ahead and try to prop up your failed sCAM. It isnât working.

Hmph. Links didn't come through. first one. second one.

Robster,
I scrolled up, and didn't find what I was looking for. Perhaps you could post the links again? Thank you.

Your sacrum doesn't move in juxtaposition to your innominates? I am so sorry. I had no idea that you couldn't walk. That is a ridiculous statement and no, the sacrum is not fused to the pelvic bones. If you don't believe me, call your local PT. If you can't find one with a DPT, even an MPT will be able to tell you that this is a normal motion associated with walking.

If you are looking for research about the Webster technique, try The Webster Technique: A Chiropractic Technique with Obstetric Implications. J Manipulative Physiol Ther. 2002 Jul-Aug;25(6): E1-9, Application of the Webster in-utero constraint technique: a case series. Kunau, PL. J of Clinical Chiropractic Pediatrics Vol 3 No. 1, 1998., or Chiropractic management of third trimester in-utero constraint. Forrester J. Can Chiropractor 1997; 2(3):8-13 (Special Section). I am sure that none of these will meet your standards, even the case study, but it might be of interest. Oh, and these are all indexed in PubMed, so I'm not sure how you could claim that you couldn't find them. Plus, your stats are not very representative. Most breech babies will turn by 34 weeks, but very few of those who do not turn afterward without assistance, whether that be Webster Technique or ECV.

So real doctors find alternations in the position and motion of bones, but chiropractors find the exact same thing and they are fake? What is the difference? What do you think is the actual exact difference between what an MD finds and what a DC finds?

What the hell is a nervometer? That is something I have never heard of, nor can I google it. Google wants to change "nervometer" to "servometer". The hits for "nervometer" include an anti-chiropractic website, and several sites about the new "nervometer" application for the I-Phone.

With regard to your rant about my hypothesis, I will have to accept that you are going to actually refuse to read the research and see how it applies. No, the research doesn't talk about subluxation. The research talks about the amount of pressure needed to disrupt axonal flow. Other research talks about the amount of pressure created by osseoous malposition. Take them together and voila! If, in the future, you feel like using your brain, I suggest you follow these steps. First, read the research. Second, use logic to analyze the research. Third, understand what I am saying! This process will save you frustration and me the frustration of having to repeat myself.

I know the history of chiropractic, but as it is history not science, it has little to do with how I practice. This is similar to allopathic medicine, where the history which embraced concepts of religion, witchcraft, etc. is not longer applied in practice. (Now you're mad at me that I'm not doing what you accuse my profession of?!? I don't believe that something said 100 years ago still holds true so you're upset and want to call me a quack? Make up your mind, either chiropractors believe all that old history stuff or they don't. . . you can't be mad at us for both!)

In your first site, the chiropractor talks about innate intelligence being the "force" which makes a sperm fertalize an egg, causes cells to divide, and heals you when you are injured (like skin cells regenerating to close a cut). You might not like the picture at the top or his subsequent rant against allopathic medicine (which I agree, is unnecessary but no worse than your rant against chiropractic) but how is what he talking about "mystical"? Do you deny that sperm finds eggs and skin cells divide in the absence of outside assistance? Do you believe that there is some allopathic treatment option which makes it happen? Your second article is an article about history. It even talks about the issues in the history and how it is no longer applicable. It even goes on to say that the term should be abandoned, as it has historically negative connotations. How do either of these support your allegation of "mystical healing energy"?

Sorry that today is a little short, there just wasn't much worth addressing.

aCQ,

Your sacrum doesn't move in juxtaposition to your innominates? I am so sorry. I had no idea that you couldn't walk. That is a ridiculous statement and no, the sacrum is not fused to the pelvic bones. If you don't believe me, call your local PT. If you can't find one with a DPT, even an MPT will be able to tell you that this is a normal motion associated with walking.

Fused was the wrong word, but it isn't that mobile of a joint, and you have yet to prove that it can be chiropractically subluxated. Beyond that, how on earth does it have an effect after the patient gets up and walks to their car? Answer, it doesn't. Your fellows are charging patients to be poked at, and then rely on the baby to move, claiming that they did something when it was nature that did it. And you are fine with that. If you had to admit that the Webster technique does nothing, you might have o start admitting that some of the other quackopathic techniques didn't do anything either. You go along to get along.

If you are looking for research about the Webster technique...

I'll look at them (all in chiropractic journals, I wonder what they will say), but unless it works better than doing nothing, then no, I won't be impressed. I want proof that it works better than placebo. We need proof that poking a pregnant woman has an effect if you are going to charge. If it doesn't then you need to investigate the chiropractors that are performing it for fraud.

So real doctors find alternations in the position and motion of bones, but chiropractors find the exact same thing and they are fake? What is the difference? What do you think is the actual exact difference between what an MD finds and what a DC finds?

The difference is that everybody can agree that the real doctors have found something. Only chiropractors claim to be able to find subluxations, but they can't even find the same one, or tell the difference between before and after manipulation. The difference is real vs fake.

If you were honest enough to admit this, you would be forced to clean house of all the fraudulent quack chiropractors in your state. I completely understand why you won't admit that chiropractic subluxations and real subluxations aren't the same thing.

What the hell is a nervometer?

Also called a nervoscope. In the Scientific American video, an instructor at a chiropractic college claims that by measuring the temperature on both sides of the spine, he can find a subluxation. Its complete BS, of course, but hey, it makes money, so it must be good for something.

With regard to your rant about my hypothesis, I will have to accept that you are going to actually refuse to read the research and see how it applies. No, the research doesn't talk about subluxation. The research talks about the amount of pressure needed to disrupt axonal flow.

But not pressure from chiropractic subluxations, something that you can't even prove exist. You don't have any evidence that axonal flow applies.

Other research talks about the amount of pressure created by osseoous malposition.

Yes. Real malpositions, not fake chiropractic ones.

Take them together and voila!

No. Not voila. You have to prove that chiropractic subluxations are real and have real effects and can be positively affected by manipulations. Until you do that, you are appropriating real research to prop up baloney.

If, in the future, you feel like using your brain, I suggest you follow these steps. First, read the research. Second, use logic to analyze the research. Third, understand what I am saying! This process will save you frustration and me the frustration of having to repeat myself.

Thats just it, aCQ. I applied logic. You can't prove that chiropractic subluxations exist, so your claim remains a hypothesis involving something that doesn't exist. I applied Occam's razor, and your hypothesis ended up as ribbons on the floor.

I understand what you are saying, but I don't have to accept it, no matter how many times you repeat it. If you had evidence, it would be a different story.

I know the history of chiropractic, but as it is history not science, it has little to do with how I practice. This is similar to allopathic medicine, where the history which embraced concepts of religion, witchcraft, etc. is not longer applied in practice.

If a real doctor used concepts of witchcraft to make a diagnosis or develop a treatment, then they would be a qauck. Straights do apply this mystical baloney to their practice. While you act as though you have left behind the innate energy concept, you still hold onto chiropractic subluxations like a worn out and soiled blankie.

(Now you're mad at me that I'm not doing what you accuse my profession of?!? I don't believe that something said 100 years ago still holds true so you're upset and want to call me a quack? Make up your mind, either chiropractors believe all that old history stuff or they don't. . . you can't be mad at us for both!)

Dim dim dim. Straight chiropractors believe this, not all of them, but the straights. You don't use innate energy, but do use subluxations, so you haven't left behind all of those 100 year old coprolites that the Palmers sold.

You might not like the picture at the top or his subsequent rant against allopathic medicine (which I agree, is unnecessary but no worse than your rant against chiropractic) but how is what he talking about "mystical"? Do you deny that sperm finds eggs and skin cells divide in the absence of outside assistance?

In absence of outside assistance, yes. But no vitalistic force is needed either. Its just biochemistry. Making an appeal to some kind of force is not necessary. "Force" is a word with a scientific definition, one that is not met by either your definition or your hand waving understanding of the particulars of mitosis. The definition that you and the other chiropractic quack are using is a vitalistic, and therefore mystical, concept.

Do you believe that there is some allopathic treatment option which makes it happen?

What? I do think, sir, that you are insane. No "allopathic" treatment is needed, unless reality is an allopathic treatment option. Oh wait, now I get it. Yes. Reality, the basis of "allopathy" is the "guiding" "force." Sperm cells find eggs and cells divide without any help from anyone or anything, including an unmeasureable force, to which you apparently do ascribe to, despite your protestations.

Your second article is an article about history. It even talks about the issues in the history and how it is no longer applicable. It even goes on to say that the term should be abandoned, as it has historically negative connotations. How do either of these support your allegation of "mystical healing energy"?

First, pick up a thesaurus and go back and do a reread. Second, straights still practice the old version. I know that it is important to you to act like they don't exist, but they do, and if you were a fraction of the reformer that you (sometimes) claim to be, you would be cleaning house. You aren't, so you are not only a quack, but you aid and abet quackery.

Robster,

Okay, first, before you start saying that "chiropractic subluxations" and "allopathic subluxations" are different, can you please tell me what the actual difference is? You cannot say "one is real and the other is fake (paraphrase)" unless you can show a difference. You ask me to admit that one is real and the other is fake, but you have yet to tell us what you are basing this on (other than the statement that real doctors find real ones and chiropractors find fake ones. . . logic so faulty that I can't believe you were paying attention to what you wrote).

I am not aware of anything that is a "chiropractic subluxation". I use the "subluxation complex" definition that is found in the International Classification of Disease, 10th revision. This does not specificy WHAT practitioner is diagnosing it, just what the diagnosis actually is. The ICD-10 was not written by any chiropractors, nor were there any on the review board. I am unaware of any chiropractors who do not use this definition. If you find any, specifically who are using old terminology, (instead of the generic term "straights", which doesn't actually mean anything anymore) then you can justifiably accuse them of being out of date.

All available research shows that the Webster technique does have a beneficial effect. I cannot comment on it personally, but that is what the reseach shows. There are a lot of treatment options, allopathic and chiropractic, which are not backed by placebo studies. Fortunately, the Webster technique is not one of them. See if you can find the study done in 2004 by Blue Cross Blue Shield of Illinois. I can't find a link at the moment, but they took 5000 women, 2500 of whom were the "placebo control" group. It had some pretty significant results.

Never heard of a "nervoscope" either. Temperature can indicate areas of increased blood flow or muscle output, but not, as far as I have ever been aware, detect a subluxation.

The research is available to quantify the amount of pressure applied by a displaced bone on the nerve which disrupts axonal flow. Try Pathology of lumbar nerve root compression. Part 2: morphological and immunohistochemical changes of dorsal root ganglion. Kobayashi S, Yoshizawa H, Yamada S. Department of Orthopaedics, Fujita Health University, School of Medicine, 1-98, Dengakugakubo, Kutukake-cho, Toyoake, Aichi 470-1192, Japan [corrected] kshigeru@f8.dion.ne.jp and Pressure-induced interruption of axonal transport, Invest Ophthalmol Vis Sci. 1981 Jan;20(1):136-7 for that. Okay, so we have shown that pressure on a nerve has a negative effect on axonal flow. Next, to show that subluxation can cause this pressure, check out Axonal Lesions and Waltzing Syndrome after IDPN administration in Rats With a Conccpt-"Axostasis" By StII-MING CtIOU** and HENRIK A. HAItTMANN and the subsequent work by J.G. Greenfield. You will have to read the whole article, however, to get to the quote where they say,

"The instability of axoplasmic matter to various physical and chemical agents, of either endogenous or exogenous origin, was well illustrated in both human and eperimental neuropathology: (1) traumatic injuries; e.g. in dissection of the neurites n "damming" of nerve fibers, and in subluxation of spine; (2) vascular lesions; e.g. in encephalomalacia after hemorrhage and in nitrogen
embolism or "decompression sickness" (3) tumor compression; e.g. in the periphery of brain tumors . . ." etc.

Okay, so we have research that shows that subluxations change axoplasmic flow. Next question?

I used "force" in quotes, as I don't believe that it is exactly the right term to use. However, you are not correct when you say it is "biochemistry" which causes an egg and sperm to unite or skin cells to divide and multiply. At minimum, these are physiological processes, which include biochemistry, but are much larger definitions. I ask you, then, what causes these physiological processes to proceed? They don't "just happen". There is a reason. I do not claim to know what this reason is, as I am not well-versed in the field of quantum theory, but what would you call it? I understand that you have little to no science background (despite your earlier claims) but no one in research is willing to accept that a physiological process (i.e. mitosis) "just happens". It is not luck that sperm fertalizes an egg or blue eyed parents have a blue eyed baby. These are processes that occur according to specific processes, and some people might say that these processes are a force. I don't, but it is a relatively simple concept to grasp.

aCQ,

The difference between real subluxation and chiropractic subluxation is that real ones can be detected reliably with static imaging, while chiropractic ones cannot. Its that simple. Real = everybody agrees that they exist. Chiropractic = only chiropractors claim they exist, and not even they can find them reliably. You are the one with an unsupported claim, so you need to provide evidence that chiropractic subluxations are real and can be detected reliably by dCs.

You are willing to (sort of) leave innate intelligence behind, but not the evidence free chiropractic subluxation.

I find it interesting that you are using a changed definition when you accused those mean old "allopaths" of changing the definition. Why use a subluxation complex or syndrome unless you know that the original term was unprovable, necessitating the addition of weasel words to support chiropractic "medical" care? If you want to take up the question of the existence of straights, try doing so with your fellows, whom you claim don't exist, despite having their writings pointed out to you. Hear no evil, see no evil, speak no evil against other chiropractors.

I look forward to seeing that BCBS study. Odd that it doesn't seem to have been published if it provided positive and significant results. Of the papers you suggested that I look at on the Webster technique, only the first came up on pubmed (and it doesn't look impressive... a mail survey?). Could you offer the pubmed ID number of the others?

Never heard of the "nervoscope" either? Wow. You really don't know what other chiropractors do? And you are supposed to be on a board that protects the public from bad practice? If I ever needed a convincing reason to avoid chiropractors, you are it. The Scientific American program clearly shows an instructor using one and describing its use. Now this may be because you went to a mixer school and this was filmed at a straight school, but is this really new to you?

On anxonal flow, again, you are grasping at straws. First you need to demonstrate that chiropractic subluxations are real, and not just say that other things can impinge on axonal flow, so your hypothesis must be accepted without the benefit of evidence.

Regarding the Pathology of lumbar nerve root compression paper, this was not about chiropractic subluxation, so it doesn't apply to the discussion.

Pressure-induced interruption of axonal transport was a fracking letter to the editor of a journal. Bwuhahahaha! And it was about methods in an animal study, not chiropractic subluxations! But feel free to suggest that I don't read what I post again. Are you for real? Dr. Aust? Dr. Benway, is this a prank? Do I need to call Poe's law?

Also, we need to know that you are not, like a creationist, quote mining for the words intelligent and design in a paper, just looking for subluxation and spine in the paper (from 1964) Axonal Lesions and Waltzing Syndrome.... Is the subluxation in question a real, visible by imaging subluxation, or a chiropractic one that may or may not be there?

All links of the chain must be solid, not just one. Until you can prove that chiropractic subluxations are real, there is no point in moving further. I found the 1964 paper, and can't say that it is clear what kind of subluxation is being referred to, but it is clear that this is not the topic of the paper, and one should not lift a single sentence from a single article from a single journal (that I don't think is peer reviewed) to claim legitimacy for a point of view, let alone an entire field of practice.

And on the "subsequent work by J.G. Greenfield." Admit it, you didn't look those up. Did you even look at the works cited section to see that 3 works of Greenfield's cited from 1936 to 1960 were titled âObservation on the histopathology of the cerebral lesions in disseminated sclerosis.â - âPost-encephalitic parkinsonism with amyotrophyâ and âDemyelinating diseasesâ? Do those apply to this discussion, or are you trying a Gish Gallop? Do you really think this will pass with someone who has to grade undergrad research papers? I've seen better BS from a student, and they still didn't get a passing grade until they provided a working draft without so many holes.

However, you are not correct when you say it is "biochemistry" which causes an egg and sperm to unite or skin cells to divide and multiply.

I'm not? Do you have some insight that will overthrow the scientific world's understanding of how enzymes and metabolic pathways work?

At minimum, these are physiological processes, which include biochemistry, but are much larger definitions. I ask you, then, what causes these physiological processes to proceed? They don't "just happen". There is a reason.

Are you really trying to start an argument from ignorance on some fairly well characterized processes? Biology is applied biochemisty on a larger scale, which is applied organic chemistry, which is applied chemistry, which is finally applied physics. Physics, not metaphysics.

No reason, just biochemical processes that drive a sperm cell to follow a chemical trail, up a concentration gradient, to an egg cell, where enzymes are released from the cap of the sperm cell, which degrade the egg's protective covering. Once the egg cell detects that a sperm cell has penetrated it, the cell's membrane changes, again, based on well characterized biochemical events, to prevent a second fertilization event. No "reason" played into this process. Neither Jesus nor Baron Samedi is overseeing fertilization.

I do not claim to know what this reason is, as I am not well-versed in the field of quantum theory, but what would you call it? I understand that you have little to no science background (despite your earlier claims) but no one in research is willing to accept that a physiological process (i.e. mitosis) "just happens".

I do hope you are attempting to make a joke with the quantum theory line. You aren't very good at making jokes (being a joke, yes, but not making jokes) so perhaps you should point them out with [joke][/joke] tabs. Thanks.

The driving process behind mitosis is also not in need of a metaphysical reason. We have cyclins and cyclin dependent kinases, cell cycle and mitotic checkpoints, growth factors, receptors, etc etc to describe how it "just happens" with no "reason" needed to explain it.

It is not luck that sperm fertalizes an egg or blue eyed parents have a blue eyed baby.

Well, it is by chance that a specific sperm cell fertilizes a specific egg cell, which is what we mean by random fertilization in genetics. I wouldn't call the exact mechanisms chance, but something selected for by hundreds of millions of years of evolution. And if two blue eyed parents have a blue eyed kid, that isn't chance. The parents have to be homozygous recessive for blue eyes on several genes, and if they have a kid with brown eyes, then either a mutation occurred, a switch-up happened at the hospital, or there was some hanky panky going on. Why blue eyes? A pigment chemical is acted on by a pathway of enzymes, and if you have all recessive genes, you get blue.

My dad has blue eyes, my mom, brown, but carries the recessive genes, as evidenced by one of my siblings having blue eyes. My wife has blue eyes, and I have brown, and it will be interesting to see what color our children's eyes will be, because I have at the very least one set of recessive alleles. Its a flip of the coin as to what our kids receive, but that is as far as it goes. No guiding "force." No "reason."

These are processes that occur according to specific processes, and some people might say that these processes are a force.

And they aren't doing science.

I don't, but it is a relatively simple concept to grasp.

Yeah. Right. Whatever. That makes complete sense after your protestation for a required reason.

It isn't scientific, no matter what you believe. Science is based on methodological, rational, materialistic investigation, which makes such philosophical need for "reason" to be something better suited to the worlds of philosophy and theology.

Until such investigation can demonstrate that chiropractic subluxations are real, only the chiropractors that have dropped both of Palmer's rotten eggs, innate intelligence and undetectable subluxations (complexes, whatever), deserve to be part of the evidence based community. That some few manipulations have a moderate effect beyond placebo or sham is not enough to prove that they are real.

Oh, and since you have such issues with reading comprehension, in that last sentence, by "they" I specifically mean chiropractic subluxations.

Here is a free article on chiro subluxations by chiro proponents:
http://www.chiroandosteo.com/content/13/1/17

In short, the chiro subluxation is only a notion. Potentially, it can be experimentally verified; but, as of 2005, it has not been. Instead, it is promoted (incorrectly) as a fact.

The authors even point-out the weasel words and vagueness in the definition of subluxation from the Association of Chiropractic Colleges. It's 114 years and holding- when are you going to give us the straight story on what your subluxation is and how you (demonstrably) fix it, using clinical evidence.

Wow, that was a lot of crap to sift through.

You still haven't actually given a difference between the term "subluxation" used by different practitioners. To say that one profession can find them and the other can't and therefore they don't exist is illogical. Perhaps we can look at this another way. What part of a allopathic subluxation (the diagnosis itself, not the method used for detection) is missing from the subluxation referred to as a chiropractor? Yes, they might use different techniques of detection, but what is the actual physiological component of the allopathic diagnosis that is missing from the chiropractic?

I am not using a changed definition. It is "a lesion or dysfunction in a joint or motion segment in which alignment, movement integrity, and / or physiological function are altered, although contact between joint surfaces remains intact. It is essentially a functional entity, which may influence biomechnical and neural integrity". The terms "subluxation" and "subluxation complex" are used pretty much interchangeably. You can also find it under fixation, lesion, biomechnical dysfunction, etc.

Maybe the term "nervoscope" was used to dumb down the procedure for a TV audience. I don't know. The lack of rigor in TV is one of the reasons I don't watch it. There is no recognized tool called a "nervoscope" in my state.

Yes, the Pathology of lumbar nerve root compression paper was not about chiropractic subluxations, nor did I say that it was. I said that it was evidence that a displaced osseous structure can disrupt axonal flow. I used OTHER information to show that a subluxation is an example of the displaced osseous structure. Try to read what I am saying. Since in reliable medical sources, like the ICD, there is no designation between "subluxation" and "chiropractic subluxation", I guess I will stick with the experts and use the term "subluxation" as it is used in the research. I was not referring to the works of Greenfield that were listed in the references of that particular paper. I was referring to the other work that Greenfield did with relation to what are referred to as "spinal subluxations". Also, since I have already accused you of searching for words and not really reading the articles, doesn't it seem a little "rubber and glue"-like for you to recycle the comment now?

Animal physiology is shockingly similar to human physiology in many ways. This is what allows us to use bovine insulin or do drug testing in rats. Saying that a study showing effects in an animal population cannot be extrapolated to humans is. . . there are not words. Perhaps just this, "be careful, your ignorance is showing".

Let's see if I can bring this down to your level. Mitosis is a process through which (for example) skin cells can divide to heal a wound. The process is driven by a number of factors, including (as you say) many chemical signals. I ask you, however, to explain how your body can detect sensory input, process it, and release the right chemicals at the right times and respond appropriately to them? You also say that "Once the egg cell detects that a sperm cell has penetrated it, the cell's membrane changes", but may I ask you how this cell "detects" the penetration by the sperm?

I should clarify that I don't really care if you answer or not. Also, this is not something that I discuss with patients. . . any more than the surgeon who cuts open someone on the table explains mitosis to the patient. I am simply attempting to break down why someone, when dealing with patients, might simplify the processes and say that "your body is intelligent enough to be able to heal itself when injured, unless the injury is too severe in which case you will need an intervention, like stitches." This is the concept that I refer to as "relatively easy to grasp".

Next point, I said physiological, not physical. Physiology and Physics, although they sound similar, are different branches of science.

Okay, here are some references to check out:
The effects of compression upon conduction in myelinated axons of the isolated frog sciatic nerve, Fern and Harrison. PMCID: PMC1181320 Yes, it is in frogs, but the nerves function similarly enough to be usable.

Degenerative changes following spinal fixation in a small animal model.Cramer GD, Fournier JT, Henderson CN, Wolcott CC. PMID: 15129196 Again, this is also in animals, but see the above statements. Also, this refers to "spinal fixations" not subluxations, but see my earlier comments. Spinal fixation is a term that is used interchangeably, as consistent with the definition of alteration in position or MOTION of bones in an articulation.

Wow, that was a lot of crap to sift through.

You still haven't actually given a difference between the term "subluxation" used by different practitioners. To say that one profession can find them and the other can't and therefore they don't exist is illogical. Perhaps we can look at this another way. What part of a allopathic subluxation (the diagnosis itself, not the method used for detection) is missing from the subluxation referred to as a chiropractor? Yes, they might use different techniques of detection, but what is the actual physiological component of the allopathic diagnosis that is missing from the chiropractic?

I am not using a changed definition. It is "a lesion or dysfunction in a joint or motion segment in which alignment, movement integrity, and / or physiological function are altered, although contact between joint surfaces remains intact. It is essentially a functional entity, which may influence biomechnical and neural integrity". The terms "subluxation" and "subluxation complex" are used pretty much interchangeably. You can also find it under fixation, lesion, biomechnical dysfunction, etc.

Maybe the term "nervoscope" was used to dumb down the procedure for a TV audience. I don't know. The lack of rigor in TV is one of the reasons I don't watch it. There is no recognized tool called a "nervoscope" in my state.

Yes, the Pathology of lumbar nerve root compression paper was not about chiropractic subluxations, nor did I say that it was. I said that it was evidence that a displaced osseous structure can disrupt axonal flow. I used OTHER information to show that a subluxation is an example of the displaced osseous structure. Try to read what I am saying. Since in reliable medical sources, like the ICD, there is no designation between "subluxation" and "chiropractic subluxation", I guess I will stick with the experts and use the term "subluxation" as it is used in the research. I was not referring to the works of Greenfield that were listed in the references of that particular paper. I was referring to the other work that Greenfield did with relation to what are referred to as "spinal subluxations". Also, since I have already accused you of searching for words and not really reading the articles, doesn't it seem a little "rubber and glue"-like for you to recycle the comment now?

Animal physiology is shockingly similar to human physiology in many ways. This is what allows us to use bovine insulin or do drug testing in rats. Saying that a study showing effects in an animal population cannot be extrapolated to humans is. . . there are not words. Perhaps just this, "be careful, your ignorance is showing".

Let's see if I can bring this down to your level. Mitosis is a process through which (for example) skin cells can divide to heal a wound. The process is driven by a number of factors, including (as you say) many chemical signals. I ask you, however, to explain how your body can detect sensory input, process it, and release the right chemicals at the right times and respond appropriately to them? You also say that "Once the egg cell detects that a sperm cell has penetrated it, the cell's membrane changes", but may I ask you how this cell "detects" the penetration by the sperm?

I should clarify that I don't really care if you answer or not. Also, this is not something that I discuss with patients. . . any more than the surgeon who cuts open someone on the table explains mitosis to the patient. I am simply attempting to break down why someone, when dealing with patients, might simplify the processes and say that "your body is intelligent enough to be able to heal itself when injured, unless the injury is too severe in which case you will need an intervention, like stitches." This is the concept that I refer to as "relatively easy to grasp".

Next point, I said physiological, not physical. Physiology and Physics, although they sound similar, are different branches of science.

Okay, here are some references to check out:
The effects of compression upon conduction in myelinated axons of the isolated frog sciatic nerve, Fern and Harrison. PMCID: PMC1181320 Yes, it is in frogs, but the nerves function similarly enough to be usable.

Degenerative changes following spinal fixation in a small animal model.Cramer GD, Fournier JT, Henderson CN, Wolcott CC. PMID: 15129196 Again, this is also in animals, but see the above statements. Also, this refers to "spinal fixations" not subluxations, but see my earlier comments. Spinal fixation is a term that is used interchangeably, as consistent with the definition of alteration in position or MOTION of bones in an articulation.

Wow, that was a lot of crap to sift through.

You still haven't actually given a difference between the term "subluxation" used by different practitioners. To say that one profession can find them and the other can't and therefore they don't exist is illogical. Perhaps we can look at this another way. What part of a allopathic subluxation (the diagnosis itself, not the method used for detection) is missing from the subluxation referred to as a chiropractor? Yes, they might use different techniques of detection, but what is the actual physiological component of the allopathic diagnosis that is missing from the chiropractic?

I am not using a changed definition. It is "a lesion or dysfunction in a joint or motion segment in which alignment, movement integrity, and / or physiological function are altered, although contact between joint surfaces remains intact. It is essentially a functional entity, which may influence biomechnical and neural integrity". The terms "subluxation" and "subluxation complex" are used pretty much interchangeably. You can also find it under fixation, lesion, biomechnical dysfunction, etc.

Maybe the term "nervoscope" was used to dumb down the procedure for a TV audience. I don't know. The lack of rigor in TV is one of the reasons I don't watch it. There is no recognized tool called a "nervoscope" in my state.

Yes, the Pathology of lumbar nerve root compression paper was not about chiropractic subluxations, nor did I say that it was. I said that it was evidence that a displaced osseous structure can disrupt axonal flow. I used OTHER information to show that a subluxation is an example of the displaced osseous structure. Try to read what I am saying. Since in reliable medical sources, like the ICD, there is no designation between "subluxation" and "chiropractic subluxation", I guess I will stick with the experts and use the term "subluxation" as it is used in the research. I was not referring to the works of Greenfield that were listed in the references of that particular paper. I was referring to the other work that Greenfield did with relation to what are referred to as "spinal subluxations". Also, since I have already accused you of searching for words and not really reading the articles, doesn't it seem a little "rubber and glue"-like for you to recycle the comment now?

Animal physiology is shockingly similar to human physiology in many ways. This is what allows us to use bovine insulin or do drug testing in rats. Saying that a study showing effects in an animal population cannot be extrapolated to humans is. . . there are not words. Perhaps just this, "be careful, your ignorance is showing".

Let's see if I can bring this down to your level. Mitosis is a process through which (for example) skin cells can divide to heal a wound. The process is driven by a number of factors, including (as you say) many chemical signals. I ask you, however, to explain how your body can detect sensory input, process it, and release the right chemicals at the right times and respond appropriately to them? You also say that "Once the egg cell detects that a sperm cell has penetrated it, the cell's membrane changes", but may I ask you how this cell "detects" the penetration by the sperm?

I should clarify that I don't really care if you answer or not. Also, this is not something that I discuss with patients. . . any more than the surgeon who cuts open someone on the table explains mitosis to the patient. I am simply attempting to break down why someone, when dealing with patients, might simplify the processes and say that "your body is intelligent enough to be able to heal itself when injured, unless the injury is too severe in which case you will need an intervention, like stitches." This is the concept that I refer to as "relatively easy to grasp".

Next point, I said physiological, not physical. Physiology and Physics, although they sound similar, are different branches of science.

Okay, here are some references to check out:
The effects of compression upon conduction in myelinated axons of the isolated frog sciatic nerve, Fern and Harrison. PMCID: PMC1181320 Yes, it is in frogs, but the nerves function similarly enough to be usable.

Degenerative changes following spinal fixation in a small animal model.Cramer GD, Fournier JT, Henderson CN, Wolcott CC. PMID: 15129196 Again, this is also in animals, but see the above statements. Also, this refers to "spinal fixations" not subluxations, but see my earlier comments. Spinal fixation is a term that is used interchangeably, as consistent with the definition of alteration in position or MOTION of bones in an articulation.

Just as a side note, I was trying to track down more information on Stephen Barret, and I found his article, "Subluxation: Chiropractic's Elusive Buzzword". I thought you might find it interesting that I agree completely with much of what he says, including:
- some chiropractic practitioners cling to Palmer for dear life and that this is ridiculous and detrimental to the advancement of the quest for science behind the practice
- that since (at least) 1972, the chiropractic profession defined ""subluxations" to include common findings that others could see" (although I disagree that this was "just so they could get paid").
- that Rondberg and Koren are just about the most unethical and dispicable individuals in any profession and that it is unfortunate that they happen to be chiropractors. I agree with Dr Barretts agreement with Dr Triano that the focus should be on research to verify the effects of chiropractic care. I am grateful for the research that has come out since this article (in 2000) and hope that the trend will continue.

aCQ

I guess we'll just have to agree to disagree. My position is that something that cannot be reliably or repeatedly detected by chiropractors by any means is not real, while you protest that it is. You seem to fine with this being a basis for bilking the patient, and as someone who stands between bad practice and the patient community, your opinion does trump mine. Too bad for the patients.

Maybe the term "nervoscope" was used to dumb down the procedure for a TV audience. I don't know. The lack of rigor in TV is one of the reasons I don't watch it. There is no recognized tool called a "nervoscope" in my state.

So the instructor was using a tool that is not approved in all states? You just keep digging the hole for your profession deeper and deeper Just google nervoscope and see if you recognize what comes up. It may be known to you as a "neurocalometer."

Yes, the Pathology of lumbar nerve root compression paper was not about chiropractic subluxations, nor did I say that it was. I said that it was evidence that a displaced osseous structure can disrupt axonal flow. I used OTHER information to show that a subluxation is an example of the displaced osseous structure.

Ah, no. You see you didn't do that. First you have to prove that chiropractic subluxations are real, something that no chiropractor has managed to do. You did manage to quote mine a paper for the word subluxation, though. Congrats. You managed to do just as well as a creationist on his first day out.

Try to read what I am saying. Since in reliable medical sources, like the ICD, there is no designation between "subluxation" and "chiropractic subluxation", I guess I will stick with the experts and use the term "subluxation" as it is used in the research.

Argument from dictionary. And said research has yet to demonstrate that subluxations are real.

Animal physiology is shockingly similar to human physiology in many ways. This is what allows us to use bovine insulin or do drug testing in rats. Saying that a study showing effects in an animal population cannot be extrapolated to humans is. . . there are not words. Perhaps just this, "be careful, your ignorance is showing".

Never said it wasn't. I pointed out that citing a letter to the editor on methodology isn't good enough. How you got it in your head that I reject animal research is completely beyond any sane person. You halucinated that one, too.

You not only are cherry picking lines from papers, but you are deliberately lying about what I am writing. OK, that probably isn't true. I really don't think your reading comprehension is high enough for you to read what other people write, let alone misconstrue it. You really need to back off of self manipulation.

On to your next Olympian feat of reading comprehension failure.

Next point, I said physiological, not physical. Physiology and Physics, although they sound similar, are different branches of science.

I never said anything of the like. Your writing clearly (well, as clearly as you can manage) calls for a "reason."

What you wrote...

I used "force" in quotes, as I don't believe that it is exactly the right term to use. However, you are not correct when you say it is "biochemistry" which causes an egg and sperm to unite or skin cells to divide and multiply. At minimum, these are physiological processes, which include biochemistry, but are much larger definitions. I ask you, then, what causes these physiological processes to proceed? They don't "just happen". There is a reason. I do not claim to know what this reason is, as I am not well-versed in the field of quantum theory, but what would you call it? I understand that you have little to no science background (despite your earlier claims) but no one in research is willing to accept that a physiological process (i.e. mitosis) "just happens". It is not luck that sperm fertalizes an egg or blue eyed parents have a blue eyed baby. These are processes that occur according to specific processes, and some people might say that these processes are a force. I don't, but it is a relatively simple concept to grasp.

You specifically asked for a reason behind "physiological processes," as though science has no understanding of what drives them, refusing the concept that they occur without outside influence. You want, based on the examples of mitosis and blue eyes as an heritable trait, a reason. There are materialistic reasons that can be quantified and are scientific, and vitalistic reasons that are no better than fable. Chiropractic is based on the vitalistic fable of subluxation, as told by the Palmers, where all bodily functions are controlled by the nervous system, something that is plainly and demonstrably false.

Let's see if I can bring this down to your level.

You mean up to my level. I have a real doctoral degree.

Mitosis is a process through which (for example) skin cells can divide to heal a wound. The process is driven by a number of factors, including (as you say) many chemical signals. I ask you, however, to explain how your body can detect sensory input, process it, and release the right chemicals at the right times and respond appropriately to them?

So let's go with mitosis. A cell receives a growth signal, based on protein based receptors either integrated into the cell membrane or present in the cytosol. This receptor protein undergoes a conformational change, binds the next protein member of the signal transduction pathway, and the signal gets passed down the line. If the signal is of a sufficient amplitude, several transcription factors and adapter proteins are recruited and transcription of a specific set of genes occurs. This set is based on sequences of DNA found in the vicinity of the target genes.

From this point, depending on the message strength (determined by the secondary structure present in the 5' UTR of the mRNA), and length of the poly A tail, a specific amount of protein is produced for a specific amount of time, respectively. This protein is broken down on a specific schedule to prevent a message from being expressed longer than appropriate.

You also say that "Once the egg cell detects that a sperm cell has penetrated it, the cell's membrane changes", but may I ask you how this cell "detects" the penetration by the sperm?

Look up zona reaction. Is this your first exposure to these concepts?

I should clarify that I don't really care if you answer or not.

Of course not. You won't comprehend it anyway.

Also, this is not something that I discuss with patients. . .

How could you even attempt it? That isn't an attack on your patients, but on your mental capacity. I don't think you could understand it. I don't say this out of malice, but because I am astounded that you could be so incredibly ignorant that no reason for these processes is needed beyond the evolutionary drive to survive long enough to successfully reproduce.

any more than the surgeon who cuts open someone on the table explains mitosis to the patient. I am simply attempting to break down why someone, when dealing with patients, might simplify the processes and say that "your body is intelligent enough to be able to heal itself when injured, unless the injury is too severe in which case you will need an intervention, like stitches." This is the concept that I refer to as "relatively easy to grasp".

But it isn't intelligence that is driving this healing process. The body can heal itself, and yes, real medical intervention may be needed in some cases, but there is no reason to suggest a vitalistic process unless your patients like fairy tales.

What I want from you is not more and more papers that are not about chiropractic subluxations, but you claim are analagous, but proof that chiropractic subluxations are real and can be detected reliably enough to serve as a useful diagnostic tool.

If you want to continue offering up papers, try finding an animal model of chiropractic subluxation, not something like it, and demonstration that axonal flow is inhibited.

--------------

Now, back to the antivzx tendencies of chiropractors.

At the ICA's December 2008 "Super Conference on Pediatrics and the International Symposium on the Science, Art and Philosophy of Chiropractic," Andrew Wakefield was the keynote speaker. Wakefield is a known academic fraud, who produced profoundly flawed work, claiming that the MMR vaccine caused autism. He faked his background research, faked his results, hid his conflicts of interest that he was working for lawyers to produce the paper, and had a competing vaccine patent. Wakefield has done as much as anyone to ensure that measles, mumps and rubella come back and sicken children, while scamming parents of autistic children looking for anything that could help make their children "normal" out of money that could go towards real therapy. This is the guy that the ICA's pediatric group decided to celebrate and honor in the Bahamas.

Next, the ACA and the WCA are both closely alligned with Barbara Loe Fisher and the NVIC (a major antivax group), with both inviting her to speak at conferences and to be interviewed in their publications.

The two biggest chiropractic associations are proudly linked to antivax groups and fight against mandatory vaccination, the only thing that keeps community immunity high enough to prevent widespread outbreaks, while providing cover to those who either deny the efficacy of vaccines or prefer to leech off of society, thinking that they are avoiding risks for their children.

Deny all you want, but chiropractic has a cancer, and no amount of manipulation or adjustment will fix it. You have to cut it out.

I'd like to adjust that last statement (heh). The ACA and ICA are the two big associations, not the WCA. But the ACA and ICA do support, honor and spread the word of the heroes of the antivax movement.

Robster,

Ahh, I think we finally have a basis for miscommunication. You say that I "specifically asked for a reason behind "physiological processes," as though science has no understanding of what drives them, refusing the concept that they occur without outside influence". This is not actually anything like what I am saying. The concept of an intelligent design of the human body (i.e. innate intelligence") is, by definition NOT outside influence. It is the scientific processes ("force") through which the body sends out the right cytokines needed for mitosis or allows a B-cell to divide such that one of the new cells will retain immunological memory. Evolution is, of course, a factor ("force"?) in this process, but evolution happens over millions of years and if evolution were responsible for why an egg is fertalized none of us would be here because who would survive long enough to pass on their genetics for the next generation to improve upon to make the process effective and efficient? If Person A has eggs that DON'T get fertalized, there there is no offspring to benefit from selection.

A neurocalometer is a piece of medical equipment that was invented and used 100 years ago. It is not something in use now. Perhaps that part of the show was about chiropractic history? Also, shockingly, as each state has the right to regulate practice within itself, there are scope differences in all health care professions when you travel between states. This is the case for chiropractors, medical doctors, doctors of osteopathy, even veterinarians, dentists, and massage therapists.

The ICD is not a dictionary. How do you not fall down more? The ICD requires rigorous scientific evidence to validate the diagnostic categories and conditions. Check this out with either the ICD internation page, or directly with the American Medical Association, which publishes the US version. This thing is not a bunch of guys sitting in a room making up words. I wouldn't expect you to know this, as it is something people learn in the course of education it is clear you never got. Try at least using Goggle, however, as that might help you out.

Okay, let's look at mitosis again. You start off by saying "A cell receives a growth signal, based on protein based receptors either integrated into the cell membrane or present in the cytosol". Great. What is the cause of the growth signal release? What are the processes which allow the appropriate amount of signal to be released to diffuse in significant enough quantity to cause the effect?

I am going to say once again that I do not care if you answer this in terms of the science behind the process. I already understand the processes and I don't need you to copy and paste explanations from your encyclopedia. I appreciate that you are so incredibly insecure that you need to try to insult me so that you feel better about yourself, but it is really pointless. I can't imagine that it gives you joy, and since I am not offended (despite your allegations that my pointing out that you are being unnecessarily and unsupportedly rude is evidence of my having taken great offense) It is really just a waste of space on this blog.

I am trying to make the point that nothing in the body happens in a vaccuum. All of these processes are interconnected and it is not a truly comprehensive explanation if it fails to acknowledge that the start of the explanation is not exactly the start of the process. There are processes ("forces"?) at work within the body, which are the explanation of how things happen.

Let's try an example. I called my friend, the Creighton grad, and asked what she would tell someone if they asked her how cuts heal. She said that she would tell them that their skin cells will divide and multiply and fill in the cut so they close over. I asked her how she would respond to the question of why cells would multiply faster when there is a cut involved or why they wouldn't just be multiplying like crazy all of the time resulting in way too many skin cells. Her response was "because those skin cells are pretty smart. They know when they need to divide faster." This is something or something like that which you know doctors say to patients. (as a note, I asked her what she would say if a doctor asked her this questions, and she laughed and said that she would say they should already know). In any case, referring to those cells as "smart" is not so different from saying that the body is intelligent enough to heal itself or that we have an innate (inside of us) intelligence.

Spinal fixation is ONE of the kinds of subluxation. Therefore, an animal model showing the diagnostic features and deleterious effects of a spinal fixation is exactly what you just asked for. I have already provided this to you.

Can you please provide a reference for why you claim that the ACA is "closely aligned" with Barbara Loe Fischer? I can't find any relationship, either on her website or on the ACA site. The closest I can find is an article on her and her work that was published in the JACA, which was actually written by a PhD, not a DC.

The ICA is 2000 chiropractors and chiropractic students from across the US, making them less than 3% of the chiropractic practitioner population. Not exactly a representative population, nor do they have any easily discoverable "alignment" to Fisher, a non-chiropractor.

We have already established the situation of the WCA. It is a group of less than 250 individuals, not all of whom are chiropractors, from around the world, some of whom are the backwards joke that you accuse us all of being. I would personally like to see them eliminated, as they are the ones you try to use an example when you accuse me of wrongdoing. They are a miniscule section of the profession and in no way can be used as representative of all chiropractors.

Trying to look a little more, I found an article by Fisher in the WCA publication titled "The PR arm of the vaccine machine works overtime". In it, she makes the statement that, "Appearing to enjoy the support of the entire chiropractic profession, one CDC handout proclaims, 'The American Chiropractic Association advises the public that vaccination has been shown to be a cost effective and clinically practical public health preventive procedure for certain viral and microbial diseases.'"

That sounds like she is not a huge fan or in partnership with the ACA, and it also sounds like the ACA is not advocating a "stealth anti-vaccination" stance to me.

Seems strange to me that several of the bloggers seem to think that chiropractic physicians are not real doctors. Let's see, Chiropractors graduate with 3950hours from their doctorate. We have Neurology, Biochem, Biology, etc. Every hour that we study except for 12 Pharm/Tox hours are spent on learning about how the human body functions. Medical doctors graduate with 3560 hours of study with over half of those hours being on medication alone. I graduated from chiropractic college myself and I have a cousin who just graduated from med school. I have been out for a year. We compared our courses of study and this is what presented. Now, let's see. You want to call someone who can prescribe man made medications that have severe reactions in the human body and kill over 450,000 people per year a real doctor. But you want to call a chiropractor, where all of their study is on nothing but the human body and is only associated with one death every 3 years a quack. I was almost killed by one of the NATIONS LEADING CARDIOLOGIST because he wasn't listening to my symptoms after putting me on a certain medication that has since been pulled from the market because only 2 of us that took the drug are still alive. Yet he can call himself a real doctor? I have gotten several people well and out of pain that medical doctors and their "potions" haven't been able to cure. My cousin stated that in one of her first days of class the lead professor came in and stated" By going into this profession you will kill people. Accept the fact and get over it." I don't know about you, but why in the world would you want to go into a profession that feels that way and that the afore said is a proven fact. Where as in the chiropractic profession, yes we are taught a couple of manipulation techniques that could harm the VBA. With that being said, we are also taught that those are techniques in which you never use. I am not sure what the total number of chiropractic colleges in the US is right off the top of my head. But I do know this number. Parker Chiropractic College has been in practice for 26 years. In that time period, there have been millions of adjustments performed. THERE HAS NEVER BEEN A SINGLE CASE OF VAD OR STROKE RELATED TO ANY OF THE ADJUSTMENTS GIVEN. With that being said, every one of those adjustments were given by STUDENTS WHO WERE LEARNING THE TECHNIQUES! You would think that with that, if chiropractic was so harmful, there would have at least been ONE incident.

This blog entry reminded me of a teacher who I think is fantastic and to whom I would attribute my success as a computer scientist. BTW, any failures as a computer scientist would not be his fault.

If you called him at home, you didn't dare ask for Doctor Ford. If you did, you usually were answered with the phrase "Which One?"

This was during the early 80s, but I still think it is a problem of sexism and I agree with some of the comments that if Doctor Biden was male then this would not be an issue.

This blog entry reminded me of a teacher who I think is fantastic and to whom I would attribute my success as a computer scientist. BTW, any failures as a computer scientist would not be his fault.

If you called him at home, you didn't dare ask for Doctor Ford. If you did, you usually were answered with the phrase "Which One?"

This was during the early 80s, but I still think it is a problem of sexism and I agree with some of the comments that if Doctor Biden was male then this would not be an issue.

Robster
You are an idiot.
I know many Doctors. They come in the form of Chiropractors, GPs, naturopaths etc etc and they prefer being referred to on a first name basis. There is no need to offend people who have put a lot of hard work and determination into achieving an education which enabled them to be referred to as DR. Sounds like you are a tad bitter of others being referred to by Doctor. At the end of the day who gives a flying shit...Dr numbnuts

Robster
You are an idiot.
I know many Doctors. They come in the form of Chiropractors, GPs, naturopaths etc etc and they prefer being referred to on a first name basis. There is no need to offend people who have put a lot of hard work and determination into achieving an education which enabled them to be referred to as DR. Sounds like you are a tad bitter of others being referred to by Doctor. At the end of the day who gives a flying shit...Dr numbnuts

I posted on this when it was all about academic titles and missed the subsequent slugging match between the Robster and the backcrackquack.

In Post 121 Robster metions a quack article on how vaccination and antibiotics cause autism (http://www.todayschiropractic.com/issues/archives/may_jun_05/feat_004.h…)

Am I the only person who looked at the references used in this article and found """"Wakefield AJ. Enterocolitis, autism and measles virus. Mod Psych 2002;7(Suppl 2):S44â6.
""""

It would appear that fraudulent backcrackquackery is based on the criminally fraudulent charlatanry of "Dear Andy" WackFraud. Not really surprising is it - most like animals crap at the same waterhole.

I can't resist:

Below is the text of an email the British Chiropractic Association or BCA) (the guys suing Simon Singh) have recently sent out to their 1000-odd UK based members.

Note ESPECIALLY number 8.

NB Special exercise for skeptic textual analysis:
Compare what this tells you the law says about use of titles (and other stuff) with the attitude of the chiropractors posting higher up the thread.

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STATEMENT

The BCA would remind members of their obligations under the Advertising Standards Authority (ASA) section 50 (relating to Health & Beauty Products and Therapies

Members are strongly encouraged to review their current marketing materials (whether they are paper- or web-based to ensure that they are compliant with both ASA and GCC (General Chiropractic Council, the statutory UK regulator of chiropractors) requirements. Note that the ASA has no jurisdiction over editorial materials placed on members own websites.

When reviewing your materials it may be helpful to consider the following:

1. Are there any claims made that cannot be justified by reference to evidence? Remember, the GCC requires chiropractors to practice evidence based care, which is defined as "clinical practice that incorporates the best available evidence from research, the preferences of the patient and the expertise of practitioners (which includes the individual chiropractor himself).

2. Be mindful of making promises that you cannot be sure of delivering on;

3. Be wary of listing conditions that are controversial and away from mainstream chiropractic care e.g. dyslexia/dyspraxia unless you have research to back this up. If you have made references to prolonged crying, sleep and feeding problems, breathing difficulties and frequent infections, as these are symptoms rather than condition specific, we suggest you remove these references.

4. Do not refer to yourself as a specialist in any particular form of chiropractic;

5. Do not use unfamiliar words for common conditions;

6. Do not unjustly criticise other healthcare professionals;

7. If you refer to subluxations, provide information to explain what they are.

8. Take care in the use of the Doctor title. Ensure that there is no way there can be any doubt that you are a chiropractor, and not a registered medical practitioner. Do not use the doctor title in paper advertising without explicitly stating that you are a chiropractor.

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For much more on this, Google "Chiropocalypse"