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Can someone explain to me....

Discussion in 'Osteopathic' started by skinnyDO, May 21, 2012.

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  1. skinnyDO

    skinnyDO witty phrase here

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    Why is it that when someone gets a neck/back injury, the first thing they think is to go visit a chiropractor? I've noticed that the general consensus on sdn is that OMM >>> chiropractic, yet there's a chiro office on every block in south Florida, and I've never heard anyone say "I messed up my neck, I'm going to see my DO."

    What gives?
  2. Bacchus

    Bacchus PGY-Uh Oh Moderator

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    Because it's cool to hate the physician establishment. You should see the look I get from family/friends/what have you when I suggest going to a DO who does OMM on top of practice traditional medicine. Its as if I have two heads.
  3. DrMediterranean

    DrMediterranean

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    I agree. I am having a very hard time finding a DO who will do HVLA for my neck pain. I refuse visit a chiro.
  4. DrMediterranean

    DrMediterranean

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    I think it has a lot to do with DOs not necessarily doing anything with manipulation most of the time while Chiros ALWAYS do manipulation (that's all they do). You can visit a DO and most likely he/she will not do OMT for you because most (especially the newer minted DOs) practice like MDs. Thus, to the general public, DOs are not perceived to be manual practitioners as much as Chiros are.
  5. SoulinNeed

    SoulinNeed

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    I think the last thing DO's want is to be thought of as the "OMM guys". Plus, there are just not that many DO's, and few even do OMM in their practice.
  6. manubrium

    manubrium

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    unless omm is their specialty (for example if they want to be an omm instructor in do school), most do's don't use omm after graduation so it's probably a use it or lose it thing as well
  7. sonofva

    sonofva

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    i think it also stems from the fact that most people really can't distinguish a DO from an MD. patients don't often know what a DO is. often the most you'll get from a patient is "I got seen by Doctor X for my checkup. He did something funny to my neck."
  8. SpecterGT260

    SpecterGT260 Catdoucheus

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    That and won't OMM cost more than a dc manipulation?
  9. DeDO

    DeDO

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    Probably because they want to be treated conservatively first, and DO's prescribe medicine.
  10. facetguy

    facetguy

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    It's a simple identity issue. DCs are perceived by the public to be neck and back guys/gals, and DOs are not. That, and there are about 8 DOs that do OMM out in real practice, so it's tough to find one if you feel you need one. ;)

    Oh, and also because DCs are awesome. ;);)
  11. Zoopeda

    Zoopeda

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    A chiropractor's primary (only?) modality is adjustment (OMM?). Although certainly there are lousy DCs out there--as there are lousy MDs, DOs, lawyers, administrators, etc--it makes sense that a DC who adjust patients all day long, 5 days a week, for 10 years is going to be better at it than the average DO who has a broad practice where he or she only adjusts a patient every now and then. Although the are some DOs who focus on OMM, they are the minority, so the public image is that DOs aren't as good at manipulation as DCs who are known exclusively for the practice. My two cents...
  12. donkeykong1

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    its b/c there are very few board certified NMM specialists.
  13. MRSAful Fate

    MRSAful Fate

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    I think this is right. DC's have done a great job marketing themselves to the public as the neck/back pain people and DO's don't even have a fraction of that exposure. Plus, as mentioned, there aren't a ton of DO's doing straight OMM practices. I wonder (and hope) that PT's will take a big bite out of the DC market when they win their fight for direct access. Evidence based medicine FTW.

    I see your logic, but you've got to consider that chiropractors start from a really weird place full of metaphysics, vitalism, anti-vaccine and all sorts of woo that would make any science-minded person scratch their head in bewilderment. OMM isn't exacly EBM, but at least there is a rigorous scientific base that DO's start from. I think that makes an important difference.
  14. facetguy

    facetguy

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    Umm...no.
  15. SpecterGT260

    SpecterGT260 Catdoucheus

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    Whether or not you do, facetguy, most DCs are pretty accurately described as above. I have yet to encounter one that doesnt incorporate some sort of metaphysical "treatment". I suspect that such techniques are not uncommon to be found within the schools as well. If we want to hit below the belt here we can talk about the gross numbers of x-rays performed and diagnoses arbitrarily concocted from pathology-free patient films
  16. facetguy

    facetguy

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    MRSA's representation of chiros would have perhaps fit a few decades ago, but most chiros today don't "start from a really weird place full of metaphysics, vitalism, anti-vaccine and all sorts of woo that would make any science-minded person scratch their head in bewilderment." That's an old stereotype that will unfortunately die slowly, at least in part because it continues to get repeated as we've seen here. And your statement that chiros overutilize, you're kidding right? I guess you haven't spent much time in the real world of healthcare, where over-testing and over-treatment reign supreme. Chiros don't even register on the radar screen of overutilization. And diagnosing a "pathology-free" patient, you should know better; mechanical dysfunction doesn't require a tumor or fracture on an xray.
  17. SpecterGT260

    SpecterGT260 Catdoucheus

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    But it DOES require a consensus on what the problem is and what it causes in a repeatable way which chiropractors are not often able to show and also requires a mechanism with sound science behind it. The foundational premise of DC is still false and leaves many searching for pathology in arguably normal structures. And any healthcare provider who provides a treatment to "balance energy" or "pull out extra energy" should be shot on sight. Not saying you all do it, just saying it would greatly thin your ranks.
    Too many of the treatments start off with "I believe" rather than "science has shown".
  18. facetguy

    facetguy

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    What is the false premise you are referring to?

    And as I stated a moment ago, "normal structures" is often meaningless. The structural model is falling by the wayside for maladies such as LBP, and that is according to what you would consider mainstream references.
  19. SpecterGT260

    SpecterGT260 Catdoucheus

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    http://www.palmer.edu/PhilosophyStatement/
    and they do such a good job of keeping it vague up until the end..... The problem with the claim is 1) it has not been shown with any consistency that chiropractic diagnostics can identify (in a manner upon which they agree (and before you complain, agree to a degree as high as other healthcare providers would in their practices)) subluxations 2) it has not been shown that subluxations that are identified are responsible for nerve impairment 3) it has not been shown that nerve impairment can interfere with "the body's innate intelligence to maintain the body in a state of health" and 4)that a "focus on symptoms and disease" is inappropriate for maintaining health and that their focus actually is on "health".

    when you start with the faulty premise that "misalignment forms an obstacle to the body's ability to heal" the above points seem to logically follow. However this is not reality.
  20. skinnyDO

    skinnyDO witty phrase here

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    How can you be so sure?



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  21. SpecterGT260

    SpecterGT260 Catdoucheus

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    because science?
  22. skinnyDO

    skinnyDO witty phrase here

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    Science has proven that misalignment does not affect healing or function?

    I'm not trying to sound rude I'm just curious.


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  23. SpecterGT260

    SpecterGT260 Catdoucheus

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    science has shown no positive correlation to support the broader claim that a misalignment or "subluxation" is going to impair the body's "innate ability to heal" via nervous blockages. I'm using DC language here because I want to avoid technicalities of LBP and crap like that which have obvious mechanisms. The larger claim includes thinking that we can affect outcomes of viral/ bacterial/ fungal infections by "restoring the nerve signals" and implies some sort of feedback mechanism which is regulated by the CNS rather than local responses. Your body's healing mechanisms are locally controlled and the scientific support for this is that we have the same findings in vitro as we do in vivo. There is no CNS in vitro. The cells do not wait to be told, if the mechanism of disalignment was valid, we would expect extreme disalignment to produce extreme results and it does not. Can we prove that the CNS does not communicate at all with damaged tissues in terms of "healing messages"? no. Can we show that it is entirely unnecessary? yes, and we have.

    now to leave the realm of DC and come back to OMT.... lets find evidence supporting the notion that the practitioner becomes "in tune" with the patient by feeling them breathe aura or whatever it is through their cranial sutures :confused:
  24. skinnyDO

    skinnyDO witty phrase here

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    That makes sense... But what about organ function?


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  25. SpecterGT260

    SpecterGT260 Catdoucheus

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    the nervous system is pretty well characterized in terms of the types of signals that get carried. I havent seen any evidence for "healing signals" in any fashion so the very foundation of this belief is simply made up - a sort of "looks good on paper" type of thing.

    While the CNS controls organ function, it doesn't tell the organs whether or not to heal.
    On top of that, since most nerve bundles carry multiple types of signals, it is very unlikly to have a "misalignment" (quotted because identification of such things is often very subjective and open to debate) that impairs the "healing function" without yielding other neural defects like muscle weakness, pain/anesthesia, ect.... This has always been the biggest red flag for the school of thought for me. pinched nerves are usually pretty obvious in their presentation, so it baffles me how some people think we are pinching off nerve signals from probably imaginary nerve tracts that are somehow isolated from the rest of the nerves which we know to be impossible from gross anatomy :idea:
    The other idea is complete section of peripheral nerves having no impact on healing. People with spinal injury need to be careful off their lower extremity because they cannot feel pain so they are more prone to injury (like leaving your leg on something hot and not realizing it) but the tissues heal just fine even though the brain and CNS (aside from maybe some lower spinal reticular formation) is removed from the equation. I have not seen a study that shows de-innervated tissue has difficulty healing or warding off infection - I have only seen things to indicate people with localized anesthesia have issues with hurting themselves more often and are less prone to properly take care of injuries because they lack the pain warning signals that tell you not to drag your bloddy stump through a cesspool :laugh::idea:
  26. skinnyDO

    skinnyDO witty phrase here

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    I see what you mean regarding localized healing, but in terms of organ function, can we not correlate alignment with health?


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  27. SpecterGT260

    SpecterGT260 Catdoucheus

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    you arent going deep enough. It is not sufficient to just throw out a simple explanation like that and call it good.

    You want to say alignment affects organ function? why?
    nerves control organs - ok.... so what sorts of fibers are controlling them?
    autonomics - alright, but dont forget that most of the autonomics do not provide direct control, they provide regulation. Your heart will beat without the CNS, it just wont speed up as a result of hypothalamic chemoreceptor input (it will actually adjust speed due to a variety of non CNS inputs, however). Your gut will still have peristalsis due to local reflex archs within the walls themselves. The CNS input on the gut has more to do with response to outside stimuli, but it does its 'thang all on its own otherwise. The CNS exerts no or nearly no control over the major functions of the liver or spleen. The kidneys have redundant systems, and even the systems that are CNS they are not spinal in any way and would also be associated with a slew of other problems (this regulation occurs in the pituitary, so I'm sure you can imagine....). and furthermore the major regulation of internal organs is via the vagus nerve which exits the skull via the jugular foramen so it is just not likely to be affected by spinal misalignment (or even breaks).

    Misalignment of the spine will effect only
    - your peripheral nerves, so we are talking the major motor/sensory nerves. Misalignment affecting these will be very noticable
    -input to sympathetics in the thorax - this could be problematic, but again we need to actually impede on the nerve in some fashion. Nerves are not "moody" so a slight difference between your back and "the norm" simply doesnt matter. It isnt misaligned, its just different.
    -the spine itself - but this is only a more extensive version of the above two so........
  28. Goro

    Goro

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    My OMM colleagues are NOT into self-promotion, alas.

  29. Zoopeda

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    This is beside the point. The effectiveness of the treatment is dependent upon the skill of the practitioner whether it's a chiro, a d.o., or some medicine man who learned manipulation from a highly skilled dude in the jungle. Obviously a good education will lay the foundation, but the quality of the adjustment is always about the quality of the practitioner and not the degree he posts on his wall. There's a DO in my town who's notorious for messing up peoples' necks--yes, board certified, licensed, US-trained. Likewise, there's a chiro in town who treats people who fly in from all over the country to see him; she's amazing with kids, elderly, chronic, or car crashes. SDN consensus also maintains that MDs make better doctors than DOs. Again, one's degree is far less important than the ultimate ability of the practitioner to communicate effectively with patients and make the right treatment decisions when it counts. A high MCAT score says nothing whatsoever about a practitioner's ability to train their hands in physical manipulation.
  30. IMDoc607

    IMDoc607

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    Wow :mad:
  31. SpecterGT260

    SpecterGT260 Catdoucheus

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    Care to elaborate? As I'm sure you have some awesome mechanism by which spinal subluxations impede total healing? :rolleyes:
  32. IMDoc607

    IMDoc607

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    Lol No I don't but this just proves you must be the most annoying classmate and student in your class. I'm not even paying to much attention to this thread and I'm pretty sure I would actually agree with you. However, here is yet another thread where you are the main poster debating and arguing. God help your residents.
  33. SpecterGT260

    SpecterGT260 Catdoucheus

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    Ill probably be fine assuming my residents aren't foolish enough to think that debating in a discussion forum translates into being obstinate on the wards ;) that is the point of this site and of forums in general :rolleyes:

    If you look closely the posts between skinnyDO and myself were not argumentative. God help your med students if you think a civil discussion is an argument. Holy sensitivity, batman......
  34. IMDoc607

    IMDoc607

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    :laugh:


    I love having medical students to help and teach them. New interns start tomorrow and I'm the night float resident.....god help me lol
  35. GOMERE

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    It's a matter of branding and advertisement. The Chiro world is gigantic, they take tons and tons of students because they don't have to worry about hospital rotations, and residencies. They've done a good job advertising and educating the people through media and such.

    DO board has just eaten up our dues and fees and not done very much for our public image. More needs to be done.
  36. facetguy

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    You're kidding, right? How is the chiro world gigantic? We (chiros) see a tiny slice of the overall population. There are only about 60,000 or so of us, so we're way smaller than allopathic medicine. We have next to zero political influence due to lack of lobbying dollars (as opposed to Big Pharma, which can afford 2 lobbyists for each congressperson...now THAT's gigantic). And there are, what, 14 or 15 chiropractic schools out there? States like California and New York probably have that many medical schools each. And how 'bout them gigantic chiropractic hospitals in all the major metro areas?

    And advertising? What, in the Yellow Pages? Chiropractic is arguably the most poorly understood healthcare profession, so how's that for educating the people. And, once again due to relative lack of funds, chiropractic lacks any type of solid media showing at all. There may be the occasional Jerry Rice print ad and whatnot, but chiros are hardly taking over the media.

    Chiropractors have developed a loyal patient base because what we do works. And we've historically done it despite lack of support from the medical system at-large, and sometimes in the face of concerted efforts of that system to eliminate the entire chiro profession. Things are changing indeed, as more MD/DOs are willing to refer patients to chiros, but it wasn't always this way.
  37. SpecterGT260

    SpecterGT260 Catdoucheus

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    Your patient population is "the healthy"-"the sick".... that's how
  38. facetguy

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    Re-phrase please...didn't get that.
  39. SpecterGT260

    SpecterGT260 Catdoucheus

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    You predominantly treat people that will/ would have been fine on their own.....
  40. SpecterGT260

    SpecterGT260 Catdoucheus

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    Or rather.... nobody ever dials 9-1-chiropractor :shrug:
  41. facetguy

    facetguy

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    Ah, the 'natural history' argument. The natural history of neck and back pain isn't as benign as you think. (You can look it up if interested.)
  42. facetguy

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    So, Counselor, you appear to be saying that because DCs don't usually work in ERs they have no value? Do PTs get called in on 911 situations? How about OTs? Speech pathologists? Endocrinologists? Rheumatologists? Shall we deem them worthless?

    Not that DCs don't see plenty of acute cases, because we do.

    I still don't see your point on this one. Please file another brief to clarify.
  43. SpecterGT260

    SpecterGT260 Catdoucheus

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    What are you defining as an acute case? Anyone who sees a DC is not in any immediate trouble and if they are that DC would be wise to send them to the ER.... the people treated by DCs are predominantly healthy so no wonder you guys boast good outcomes.
  44. facetguy

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    I still don't understand what you're getting at. Are you saying that the only worthwhile healthcare workers are those in emergency medicine? Surely you aware that low back pain alone is a multibillion dollar problem? And how are you defining "healthy"? Believe me, the guy who can't play with his kids because of back pain isn't feeling real healthy.
  45. SpecterGT260

    SpecterGT260 Catdoucheus

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    facetduder, I dont have a problem with chiropractors. I have a problem with chiropractors who think they do anything more than massage. The mechanisms were simply made up by a farmer one day, and the loyal patient population is because you are treating people with questionable need for treatment in the majority of cases with emphasis on "prevention" via these treatments in people who were not likely to incur whatever illness you were trying to prevent in the first place.

    I also have an issue with chiropractors who attempt to undermine valid treatment modalities via propaganda while touting their "therapies" for things that simply do not make sense (asthma? Celiacs? Diabeetus? :scared:) One of your favorite things to attack is NSAIDs (and you have piped in on vaccines too..... but lets leave that for another day) but lets think about this for a minute.......


    NSAID use is HUGE. Everybody is on an NSAID. I would really like to see data normalized to use on complications with NSAIDs vs complications with neck HVLA. You like to downplay it, but for something that has a real harmful outcome and a questionable and possibly placebo benefit (or something that could be reproduced with a weekly massage at half the cost...) id say stroke is still a significant worry factor. And even though stomach issues arise from NSAID use, when compared to the level of use, I would bet money that it is comparable to strokes from cervical manipulation.


    I would agree with this. Misunderstood in the fact that people simply believe the story without looking into it. An ex-co-worker of mine had a frigging chiropractor for her horses... wtf did he do manipulations with? A skid loader?!!? You tell people a fancy story about their spine and use a few buzzwords about "healing" (which for some odd reason people do not interpret as a return to normal, but rather as some form of improvement from the norm) and "dont just treat the symptoms" which is an obvious rhetorical ploy..... and viola! loyal customer base. Homeopaths and naturopaths have this loyal base too..... at least until their kids start dropping dead from the diseases prevented by MMR :shrug:

    You wanna be a back pain guy, fine. Id argue in your favor that you guys do well there. I dont think a one of you knows why it works (or is willing to admit that it just feels good to get your back and hips pounded on every once in awhile) but whatever. But please stop arguing against effective treatments with the assumption that chiropractic is the obvious alternative.
  46. SpecterGT260

    SpecterGT260 Catdoucheus

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    in a proverbial sense, you are the guy who whacks his broken TV with a hammer and it works again. Some people have had success stories. Some have not. Many simply had nothing wrong with them and go in because it is either in style or their friend convinced them that it was a good thing to do. Your treatment modalities do not really vary with the individual condition and the "diagnostics" is almost entirely absent. The chiropractors who limit their practice to LBP I can deal with. But far too many of you guys treat chiropractics as a medical swiss army knife and act like you can treat everything by popping the same joints for 8 hours a day. I would also argue that chiropractic is no more curative for LBP than NSAIDs. It may feel good for a bit, but when this guy goes back home to slouch on his couch all day with his big mac, I wonder how long it takes before the pain returns. PT would be a much better option for this guy, but hell, that involves him actually working and heaven forbid you ask an american pain patient to put any effort into solving their condition :idea:
    Last edited: Jul 14, 2012
  47. facetguy

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    At least we've established that you approve of chiropractors. Whewww! I was nervous there for a second.

    Chiropractic is more than massage. That you don't know that tells me a lot about your knowledge base in this area.

    And DD Palmer was a fish broker. Perhaps he did some farming on the side, I don't know. He "discovered" the chiropractic profession over 100 years ago. We've learned a few things since then.

    If you disagree that there's value in promoting good health practices to patients, that's on you. If you believe health comes solely from Pharma products, shame shame.

    Who does this? If a DC steers a patient away from a "valid treatment" and something happens to that patient, the DC gets sued. It's that simple. That alone would be a deterrent against DCs doing that. Now, regarding something like celiac, why couldn't a DC knowledgeable in nutrition discuss dietary issues with a patient? Of course they could. And for diabetics, especially Type 2 diabetics, should a DC not try to motivate that patient toward better diet and exercise habits? Of course they should. Somehow in your mind that equates to DCs telling diabetics to cease all their meds immediately and rely on Innate Intelligence to take care of the rest; please note that this thought is in your mind, not reality.

    I've never said NSAIDs don't have value, and I certainly have never attacked them. What I have said is that NSAIDS aren't magic and often don't do squat. You're early in your medical education, so you are still of the mindset that everything you prescribe a patient will work like a charm. Give it a few years, especially if you work with MSK patients and you'll quickly learn the limitations of medications. Again, not that they're worthless, because sometimes they can be very helpful; they just aren't the magic pills you think they are right now.

    The topic of NSAIDs has come up from time to time in the context of safety. Typically, someone will say chiros are sooooo dangerous, and I'll remind them that thousands of people die each year from NSAIDs that, despite being properly prescribed, are prescribed with virtually no thought toward safety. That's not an attack on NSAIDs or allopathic medicine; it's keeping things in perspective.




    Where is this coming from? Did I miss something? :confused:

    Off the top of my head, I do recall a similar study from years ago:
    http://www.ncbi.nlm.nih.gov/pubmed?term=dabbs and lauretti

    I would never downplay stroke. You simply fail to grasp several key issues. First, there is currently no established causal relationship between cervical manipulation and stroke. Lots of association/correlation, but no causal. Now, being adults, we should hold out the possibility of causation, however we also need to understand that these events are so rare that the largest study to date looked at 109,000,000 person years and could not find any association at all. That's pretty friggin' rare, which is another issue. Moreover, you misrepresent/misunderstand the literature when you say manipulation is placebo.




    I don't have any experience with horses. In fact, I don't know the first thing about horses. But I do know that many trainers/owners of big time race horses have a chiro "on staff". Beyond that, don't ask me.

    Returning someone to normal, as you say, is always the goal. It's not always possible....under anyone's care....but it's a goal.

    We treat symptoms, but we also look for causes. Once you have more exposure to MSK training, you'll get that.

    As you say, we do well with back pain. As well as anything you will ever refer your future back pain patients for or otherwise treat them with. That's not what I say, that's what the literature says.

    As far as mechanism, you are correct that it's a continually evolving model. But to say that we are at the same place as we were in the days of DD Palmer would of course be ridiculous.

    And your final statement tells me why you are so confused about this. No one is saying that allopathic medicine should be trashed and chiropractic be used to replace it. Dude, that doesn't even make sense! But somewhere along the way, you've come to believe that that's what chiros think. Perhaps I've put your mind at ease today.
  48. SpecterGT260

    SpecterGT260 Catdoucheus

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    I cant tell if you intentionally blew off and twisted many of the points or are simply unable to really understand what I was getting at.....


    also, that paper is crap. No methods are given. You want to talk about me being in a mindset where I think everything will work like a charm (which is inaccurate, btw) and you are going to buy this paper hook line and sinker? Full text, please :rolleyes:

    I do not think promoting good health practices is a bad idea. However I do think that telling someone they need their back cracked once a week for the rest of their life in order to stay off negative consequences is a little sketchy. Sure you look for causes of pain - in a model that has no scientific backing whatsoever in a manner that chiropractors cannot even reliably agree on. You might as well be reading Thetan levels. You like to cite my current level of medical training when these topics come up but you should understand that ad hominem arguments are completely invalid. You still offer really no explanation for anything.

    and if you would like me to go find a series of examples of chiropractors who would divert away from proven therapies I could do so. But I dont think you are actually ignorant enough of the subject to believe I wont find anything.

    furthermore, I did not call manipulation placebo. I was attempting to get you to consider risk/benefit analysis.
    Last edited: Jul 14, 2012
  49. SpecterGT260

    SpecterGT260 Catdoucheus

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  50. SpecterGT260

    SpecterGT260 Catdoucheus

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    This is all beside the point and we do not need to bicker. The major point I was originally making was that "We have a loyal client base therefore what we do works" is an invalid and fallacious argument :thumbup: That's all. There are a LOT of reasons for a loyal client base besides efficacy.

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