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double post
Chiropractic??
- Thread starter doclm
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Fair enough...
Actually I meant to say that most sCAM providers are not educated well enough in biomedicine to give an accurate assessment. This is one of my great fears which motivated me to go back to school. At least with acupuncture, it tends to be provided in the context that the patient has a PCP that will hopefully catch red flags...because unless it is something like a patient gaining 15 pounds in a week and is presenting with pitting edema [happened to me while I was in acupuncture school], it might get missed.
But some providers, like my wife's first boss mentioned above, are trying to be the PCP. That's a problem.
I'll give you some of my wife's business cards...
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**YAWN**
Come on, you know as well as I do this is meaningless. There are three HUGE problems with your assertions that this study indicates a lack of "NMSK" training for GPs (whatever that means - GP is not an accepted specialty).
First, unlike most sCAM providers, medicine is a "team effort". Orthopedic surgeons (those who created and validated the test) are part of that team. So if a patient presents to a primary care physician who needs an orthopedic surgeon, one is consulted.
Second, the authors freely admit this study was created to support mandatory orthopedic surgery rotations for medical students. Any medical specialty could create a similar test and publish a similar study. That is the nature of sub-specialty medicine.
Lastly, you have said in other posts, and infer here, that chiropractors are "better educated" than MD/DOs in terms of "NMSK". Well, chiropractors were NOT given the test from the study above, so it can say nothing about their relative skills. However, there is a study that does, and it was designed and administered by chiropractors. What does it show...
(From: Sandefur R, Febbo TA, Rupert RL. Assessment of knowledge of primary care activities in a sample of medical and chiropractic students. J Manipulative Physiol Ther. 2005 Jun;28(5):336-44.)
OBJECTIVE: To examine the influence of chiropractic education on knowledge of primary care tasks. Scores received on a test of knowledge of primary care tasks were compared between 3 samples of chiropractic students and 1 small sample of medical students. DATA SOURCES: The taxonomy of primary care tasks that was previously published provided the basis for test items used in this study. A team of test writers prepared an evaluation instrument that was administered to final-term chiropractic students at 3 colleges and to a small sample of medical students as they were entering their residency programs. RESULTS: The chiropractic students scored below the medical students on the primary care examination in every area except musculoskeletal conditions. Chiropractic students scored higher than medical students on the musculoskeletal portion of the examination. CONCLUSIONS: In this sample, chiropractic students performed almost as well as medical students on a test that was designed to measure knowledge of primary care tasks. If the premise is accepted that medical school is the gold standard of primary care instruction, that chiropractic students fared almost as well as medical students is noteworthy.
_______So, what they did was give a test to on basic primary care to three groups of chiropractic students in their final terms in chiropractic college (groups 1, 2 and 3) and one group of recent medical school graduates who had yet to start residency. The test was created by "2 DCs who also hold bachelor's degrees, 1 DC with a diplomate in radiology, a DC enrolled in the final year of a radiology residency program, and 2 MDs". It was a 100 question test broken into two 50 question sections and some description of attempts to validate the instrument for use on chiropractic students is offered by the authors. So here is what they found...
Group 1: 21 students, raw scores 32.7, % scores 65.4, SD 4.6
Group 2: 22 students, raw scores 28, % scores 56, SD 5
Group 3: 79 students, raw scores 32.1, % scores 64.2, SD 4.4
Groups 1 to 3 (combined): 122 students, raw scores 31.4, % scores 62.8, SD 4.7
Group 4: 20 students, raw scores 36.7, % scores 73.4, SD 3.3
Now, while the medical student sample size is low, the performance of the chiropractic students is abyssmally low. 68% of all of the chiropractic students (who are very soon to enter practice) taking the test, a test designed and validated by DCs, scored between 58.1% and 67.5%?!? This is noteworthy? Yes, it is! It succinctly proves the point that DCs are very ill prepared to serve as primary care physicians. As for the medical students, 68% scored between 70.1% and 76.7%. While I would normally bristle at these data as the sample size is so small, it should be noted that the SD was the narrowest, by a considerable amount, in this group. This leads me to question the need to validate the instrument not only with chiropractic students (as was done) but also with medical students (not done in this study). These results seem to indicate a very tight "clumping" of scores in the medical student group, which may suggest that areas of the test represented material outside their scope of instruction.
Other results:
Percentage scores of all students on 5 major categories of primary care tasks
Primary care activities (% correct)
Information gathering Group 1 - 60.12, 2 - 57.04, 3 - 64.72, 4 - 76.64
Screening and prevention Group 1 - 35.72, 2 - 27.09, 3 - 38.93, 4 - 63.10
Other diagnostic procedures Group 1 - 66.94, 2 - 57.64, 3 - 65.83, 4 - 74.34
Counseling and education Group 1 - 69.05, 2 - 75.00, 3 - 87.74, 4 - 95.24
Management of acute/chronic conditions Group 1 - 65.71, 2 - 57.04, 3 - 64.69, 4 - 73.01
By these data, chiropractic does not perform information gathering or screening and prevention well at all.
I'm not going to post the data on all individual "subcategories of management of acute and chronic conditions". Suffice it to say that group four handily out performed all of the other groups in every area except one:
Musculoskeletal (% correct) Group 1 - 71.04, 2 - 56.95, 3 - 54.75, 4 - 48.02
(but group four did outperform the others in neuro!:
Neurological (% correct) Group 1 - 78.1, 2 - 61.67, 3 - 78.99, 4 - 82.86)
My most significant concern on their methodology is this - the test was given to medical students about to enter residency training and to final term chiropractic students about to enter practice (presumably). Now, the article acknowledges a gap, but that gap should only grow as the medical students have at least three years of training remaining. Also, no attempt was made to identify what area of medicine the MD students were entering. I would argue that given the latitude to self direct fourth year cirricula to a certain degree, students heading into primary care would likely outperform a random sample from all medical students on this examination as they would have more training in this area than the "average" medical student.
Lastly, the conclusions do not match the data. It is not "noteworthy", in a positive sense, that chiropractic students about to enter the workforce score abyssmally low on a test of basic primary care skills. Comparing them to MD graduates with at least three years of training remaining is comparing apples and oranges. And even given the disparity in time remaining in training, the MD students quite significantly outperformed the chiropractors. This paper completely demonstrates what I have been saying since I started coming to this forum. Chiropractors are not equipped to act as primary care physicians.
So even in NMSK complaints, I'll stick with traditional medicine...
- H
Interestingly.......exactly how were these patients "worse off". Did they complain of more pain or did they suggest "structural damage". I am curious because this is not my experience and my n is near 3000 patients per year. Please enlighten and edify..........
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Let's see, off the top of my head, there was a 25 yo male who had been treated by a DC for almost one year (unsuccessfully) for LBP, finally presented to the ED with hematuria and ESRD secondary to the renal cell CA. There was the elderly man incontinent of urine with dramatic pain on the DC's table. The DC sent him home, then his grandson, a paramedic, insisted he be seen in the ED: cauda equina. Then there was the 33 year old newly minted vascular surgeon who began chiropractic treatment for neck pain he related to mechanical pain from bad OR ergonomics three weeks prior to his death from a vertebral artery dissection (no previous known risk factors). Last, but not least in my experience, the 10 yo boy who died of HiB meningitis. No vaccinated because dad's chiropractor had convinced him it was "too risky". These were each my patients and I am only one resident in one EM program (albeit at a large facility). But hey, the plural of anecdote is not fact, let's look at the literature shall we (after all, you are claiming to be a physician, let's keep up the facade). I'll grant you it is a collection of reposts, but I provide the original links as well as links to the studies where available...
OP: http://forums.studentdoctor.net/showpost.php?p=2687469&postcount=49
"Archives of Pediatrics & Adolescent Medicine
----------------------------------------------
Volume 151(5) May 1997 pp 527-528"
OP: http://forums.studentdoctor.net/showpost.php?p=2687469&postcount=48
"For example, there is a study which I have posted many times that suggested that 17% of chiropractors who identified themselves as treating children would treat a case of neonatal fever without referral to an MD/DO or more appropriately to an ED. (see: http://www.ncbi.nlm.nih.gov/entrez/...d&dopt=Abstract&list_uids=10768681&query_hl=8 ) Neonatal fever is a defacto emergency. No attempt should be made to treat as an outpatient – yet 17% of chiropractors who treat children would try."
OP: http://forums.studentdoctor.net/showpost.php?p=2561300&postcount=1
"Even SCARIER..."
http://www.jcca-online.org/client/cca/JCCA.nsf/objects/V49-1-46/$file/jcca-v49-1-046.pdf" - A chiropractic journal no less!
OP: http://forums.studentdoctor.net/showpost.php?p=2573803&postcount=19
"Now chiropractic and stroke."
from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12743225
from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12692699
from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=15513007
from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12466778 - Your favorite journal; JMPT (that fun lovin' group of chiro-bashers!)
"I thought there were "no side effects" to chiropractic?
Yep it never happens, but the chiropractic journals describe when and how. I guess they are used to reporting on fictional things (like subluxations) anyway..."
from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=14586598
"To be fair, there is an article describing why there is such a different opinion of the level of risk chiropractic manipulation represents."
from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=14589464
OP: http://forums.studentdoctor.net/showpost.php?p=2135577&postcount=95
"Now as an (I assume) educated person, what is your opinion/reaction to these studies?"
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7884327&dopt=Abstract
http://www.cmaj.ca/cgi/content/full/166/12/1531
http://www.cmaj.ca/cgi/content/full/166/12/1544
http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=11340209
"Archives of Pediatrics & Adolescent Medicine
----------------------------------------------
Volume 151(5) May 1997 pp 527-528"
OP: http://forums.studentdoctor.net/showpost.php?p=2687469&postcount=48
"For example, there is a study which I have posted many times that suggested that 17% of chiropractors who identified themselves as treating children would treat a case of neonatal fever without referral to an MD/DO or more appropriately to an ED. (see: http://www.ncbi.nlm.nih.gov/entrez/...d&dopt=Abstract&list_uids=10768681&query_hl=8 ) Neonatal fever is a defacto emergency. No attempt should be made to treat as an outpatient – yet 17% of chiropractors who treat children would try."
OP: http://forums.studentdoctor.net/showpost.php?p=2561300&postcount=1
"Even SCARIER..."
http://www.jcca-online.org/client/cca/JCCA.nsf/objects/V49-1-46/$file/jcca-v49-1-046.pdf" - A chiropractic journal no less!
OP: http://forums.studentdoctor.net/showpost.php?p=2573803&postcount=19
"Now chiropractic and stroke."
from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12743225
from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12692699
from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=15513007
from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12466778 - Your favorite journal; JMPT (that fun lovin' group of chiro-bashers!)
"I thought there were "no side effects" to chiropractic?
Yep it never happens, but the chiropractic journals describe when and how. I guess they are used to reporting on fictional things (like subluxations) anyway..."from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=14586598
"To be fair, there is an article describing why there is such a different opinion of the level of risk chiropractic manipulation represents."
from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=14589464
OP: http://forums.studentdoctor.net/showpost.php?p=2135577&postcount=95
"Now as an (I assume) educated person, what is your opinion/reaction to these studies?"
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7884327&dopt=Abstract
http://www.cmaj.ca/cgi/content/full/166/12/1531
http://www.cmaj.ca/cgi/content/full/166/12/1544
http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=11340209
Now, show me one solid paper that shows chiropractic works...
BTW - your n is 3000 patient per year? You, as an MD/DO pain management specialist, residency trained in anesthesiology, refer 3000 patients a year to chiropractic? Wow, how many patients do you treat yourself? And besides the paper quoted above (http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=14589464) that may explain why you do not perceive a problem, keep in mind that it is the ED and the neurologists, not the pain specialist, that will see the effects of iatrogenic chiropractic injury.
- H
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Earlier in the thread and in other posts he/she claims to be a residency trained anesthesiologist (never states MD or DO) specializing in pain management.
There are other threads where he/she makes similar claims...
- H
Let's see, off the top of my head, there was a 25 yo male you had been treated by a DC for almost one year (unsuccessfully) for LBP, finally presented to the ED with hematuria and ESRD secondary to the renal cell CA. There was the elderly man incontinent of urine with dramatic pain on the DC's table. The DC sent him home, then his grandson, a paramedic, insisted he be seen in the ED: cauda equina. Then there was the 33 year old newly minted vascular surgeon who began chiropractic treatment for neck pain he related to mechanical pain from bad OR ergonomics three weeks prior to his death from a vertebral artery dissection (no previous known risk factors). Last, but not least in my experience, the 10 yo boy who died of HiB meningitis. No vaccinated because dad's chiropractor had convinced him it was "too risky". These were each my patients and I am only one resident in one EM program (albeit at a large facility). But hey, the plural of anecdote is not fact, let's look at the literature shall we (after all, you are claiming to be a physician, let's keep up the facade). I'll grant you it is a collection of reposts, but I provide the original links as well as links to the studies where available...
OP: http://forums.studentdoctor.net/showpost.php?p=2687469&postcount=49
"Archives of Pediatrics & Adolescent Medicine
----------------------------------------------
Volume 151(5) May 1997 pp 527-528"
OP: http://forums.studentdoctor.net/showpost.php?p=2687469&postcount=48
"For example, there is a study which I have posted many times that suggested that 17% of chiropractors who identified themselves as treating children would treat a case of neonatal fever without referral to an MD/DO or more appropriately to an ED. (see: http://www.ncbi.nlm.nih.gov/entrez/...d&dopt=Abstract&list_uids=10768681&query_hl=8 ) Neonatal fever is a defacto emergency. No attempt should be made to treat as an outpatient yet 17% of chiropractors who treat children would try."
OP: http://forums.studentdoctor.net/showpost.php?p=2561300&postcount=1
"Even SCARIER..."
http://www.jcca-online.org/client/cca/JCCA.nsf/objects/V49-1-46/$file/jcca-v49-1-046.pdf" - A chiropractic journal no less!
OP: http://forums.studentdoctor.net/showpost.php?p=2573803&postcount=19
"Now chiropractic and stroke."
from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12743225
from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12692699
from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=15513007
from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12466778 - Your favorite journal; JMPT (that fun lovin' group of chiro-bashers!)
"I thought there were "no side effects" to chiropractic?
from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=14586598
"To be fair, there is an article describing why there is such a different opinion of the level of risk chiropractic manipulation represents."
from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=14589464
OP: http://forums.studentdoctor.net/showpost.php?p=2135577&postcount=95
"Now as an (I assume) educated person, what is your opinion/reaction to these studies?"
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7884327&dopt=Abstract
http://www.cmaj.ca/cgi/content/full/166/12/1531
http://www.cmaj.ca/cgi/content/full/166/12/1544
http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=11340209
Now, show me one solid paper that shows chiropractic works...
BTW - your n is 3000 patient per year? You, as an MD/DO pain management specialist, residency trained in anesthesiology, refer 3000 patients a year to chiropractic? Wow, how many patients do you treat yourself? And besides the paper quoted above (http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=14589464) that may explain why you do not perceive a problem, keep in mind that it is the ED and the neurologists, not the pain specialist, that will see the effects of iatrogenic chiropractic injury.
- H
First, of all it is not nice to personally attack someone just because they do not agree with you. I have not personally attacked you or anyone else on this forum. I must point out, however, that as a resident you have much less CLINICAL EXPERIENCE when compared to someone who has been in practice for several years.
If you wanted to know about my training and my referral patterns, all you had to do was ask instead of making erroneuous assumptions. I am a fellowship trained interventional pain management physician. I obtained an MD at Baylor College of Medicine. I completed a 4 yr anesthesiology residency and a one year fellowship in pain management. I have been in private practice for over three years.
For clarification when I have been discussing chiropractic therapy, I am applying it to musculoskeletal disorders in adults (that may have been unclear). I am opposed to chiropractic therapy for the treatment of neonatal fever, asthma, cancer and other non-musculoskeletal ailments. You may have seen my earlier post in this thread opposing chiropractors performing sports physicals.
As far as my practice goes, I average roughly 100 patients per week and 5000 patients per year. Of these 5000 patients 60% have seen a chiropractor (hence n=3000). Most were referred to the chiropractor by a PCP or had a self referral. I have probably directly refer less than 5 patients per year myself to the chiropractor. Lets face it, by the time they see me, most patients have already seen a chiropractor if they were going to. I have discussed their experiences in detail and very few have had serious side effects. Some felt that it was wonderful and some felt that it was a waste of time. Of the 9000 or so patients in my practice who have seen a chiropractor, one reported a serious adverse effect. He reported worsening cervical radiculopathy and was later found to have serious spinal stenosis. If you polled those same patients and ask about side effects from a medication provided for pain, you would have a far greater number of adverse effects (I did not directly ask this however).
I still believe that chiropractic therapy for musculoskeletal ailments is very safe. I know many of the local chiropractors in my area. They all do very detailed physical exams and will refer patients if the pain is unremitting after their treatments. None of these local practioners would ever think of performing manipulation on patients with severe cervical stenosis or cauda equina syndrome.
I must admit that I did not look at all of the case reports that you quoted. I did notice that a few patients who worsened were later diagnosed with cancer. I would definitely fault the chiropractor for not referring those patients earlier. However, you cannot infer that chiropractic manipulation made their case worse. A few others named very high incidences of adverse effects (one study said that 1 in 2 patients had adverse effects). Upon further reading you will find that the vast majority of these "adverse effects" were local discomfort, fatigue, or headaches that remitted in 24 hours. These are hardly adverse effects. Patients that have a shoulder or knee injection would have similar complaints if you asked them about it. Vertebral dissection is a rare exception and not the rule.
Good luck in your residency.
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Actually you infer. I have many years as a paramedic and have seen many chiropractic disasters there as well.
I am sorry about my inferences. Your practice pattern is an aberrancy in my experience.
Ahh, so your n of 3,000 has been selected out for you. The problem is that you are seeing patients who come to you after going to a chiropractor. The fact that they are seeking outpatient care sort of selects them out for the most severe of side effects. Additionally, when you refer patients to chiropractors, you, as an MD, have assessed their condition. I assume that you would not send a urolithiasis patient to a chiropractor for treatment of the stone...
So this is the retrospectoscope at work...
O.k., so now does it work or doesn't it? 3,000 patients a year seek your services after the chiropractor's.
But aren't they self-selected by that point? The serious stroke, the missed non-NMS pathology, etc. wouldn't continue to present with chronic pain management issues...
One out of 9,000 measured against no scientifically validated benefit. Seems like a skewed risk benefit ratio to me.
But was there scientifically valid evidence that those medications had at least a chance of benefit.
BUt they can cause iatrogenic injury. If you practice in a state with joint and several liability you may be held liable if you make the referral. Are you that sure that chiropractic is the "standard of care" to defend the referral against such a claim?
Again, even if rare, the liability for the disaster and the lack of scientific evidence of efficacy moves chiropractic far enough out of the standard of care to make the liability of referral too high for my taste.
Thanks!
Happy Holidays!
- H
I think that we will have to agree to disagree. I am going to graciously bow out of this discussion because I no longer feel like debating with a resident who is at the very beginning of his career. Come talk with me again after you finish your residency and pass your boards.
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Wow. Well, I'd be happy to call you in 6 months, but it won't change the facts that you don't seem to like.
1. There is no scientific evidence chiropractic works. Neither of two cochrane reviews support it, nor can the The National Center for Complementary and Alternative Medicine (the Federal Government's lead agency for scientific research on complementary and alternative medicine) who state:
"Overall, the evidence was seen as weak and less than convincing for the effectiveness of chiropractic for back pain. Specifically, the 1996 systematic review reported that there were major quality problems in the studies analyzed; for example, statistics could not be effectively combined because of missing and poor-quality data. The review concludes that the data "did not provide convincing evidence for the effectiveness of chiropractic." The 2003 general review states that since the 1996 systematic review, emerging trial data "have not tended to be encouraging…. The effectiveness of chiropractic spinal manipulation for back pain is thus at best uncertain." The 2003 meta-analysis found spinal manipulation to be more effective than sham therapy but no more or no less effective than other treatments." from: http://nccam.nih.gov/health/chiropractic/#9a
2. There are risks, both great and small, from chiropractic therapy. These run the gamut from minor exacerbations of pain to stroke. While catastophic events are rare, there is no method to measure the risks incurred by failure to treat / failure to rescue when a patient is being treated by a chiropractor for the wrong pathology. This type of error comprises the largest majority of medical errors decribed for allopathic medicine in the IOM report, but no measure has been made in chiropractic.
Given the lack of any proven benefit, this level of risk (albeit small) simply isn't worth it. Would you do a beir block on an arm to relieve a patient's migraine, just because they (the patient) thinks that would work? No, of course not. Why? Because the risk of the block without a demonstrable likely benefit is simply bad practice.
3. There exist extremely few, if any, organized QI/QA efforts in chiropractic. With the absence of nursing staff from chiropractic offices, their exclusion from JCAHO, and the lack of prescriptions, even basic inter-profession QI/QA safeguards are not in place.
4. In "joint and several liability" states, a physician can be held liable for the actions of providers to whom they refer. This happens all of the time to ED physicians who are dragged into lawsuits for the actions of physicians in the hospital days after admission. It would be a hard sell that a referral to a chiropractor was the standard of care. There is no way I would ever refer to a chiropractor and accept that liability. If you do, well, that is your choice.
5. Just because a physician has been in practice for a long time, or even three whole years, doesn't mean they are familiar with all other medical specialties. I'm sorry, but each resident in my program has cared for iatrogenic chiropractic disasters. You, as an outpatient physician, have not. Not surprising. I wouldn't expect you would have much experience with many acute processes and their initial presentation after your ED rotation in residency. That's o.k., I couldn't begin to tell you how to perform an interthecal injection...
Happy Holidays!
- H
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A thing about DOs and OMM. OMM is probably the easiest class to skate through doing minimal work. Most student have a tendency to focus on all the sciences and put little work into it. Sounds once they get out of school, they lose it. You get out of omm what you put into it.
About the 5% who use it in practice, 50% of DOs enter md residencies, so would be unlikely to continue practicing it. About 50% specialize, so for many it isn't cost effience or practical to use it daily. OF the people in primary care, psychiatrist cannot really use it, and pediatricians have a limited capacity for it. So only FP and internists realisicaly can use omm full-time. So that 5% proably accounts for a larger % of the people than appears. All statistics are unofficial.
About the 5% who use it in practice, 50% of DOs enter md residencies, so would be unlikely to continue practicing it. About 50% specialize, so for many it isn't cost effience or practical to use it daily. OF the people in primary care, psychiatrist cannot really use it, and pediatricians have a limited capacity for it. So only FP and internists realisicaly can use omm full-time. So that 5% proably accounts for a larger % of the people than appears. All statistics are unofficial.
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yes, Dr. Burly is a cardiologist from Mayo Clinic. He was teaching clinical scirence and doing his chiropractic degree at Northwestern Health Sciences University in 2000.
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I'm not a big fan of chiropractors, but I have to point out that you are actually the one seeing a more skewed patient population as a paramedic and an ER doc. You are seeing the sickest of the sick. Many of them will have seen chiropractors at some point, this doesn't necessarily demonstrate cause and effect.
There are no convincing studies to show causation between chiropractic manipulation and stroke. You link to 3 anecdotal reports and one small retrospective analysis that relied on a questionaire (!) to gather its information. (No flaws with that design...
). Even if this were a reliable method for estimating risk or causation (which, clearly, it isn't) the sample size is embarassingly small and one would expect you to have a similar fervent agenda against the alcohol industry since 76% of those with significant CVA were current consumers of alcohol.I have no real interest in defending chiropractors, but I do have a hard time getting past the intellectual dishonesty of critics who preach from the bible of evidence based medicine but then put forth such flimsy data to bolster their own agendas. Give me a break.
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I'm not a big fan of chiropractors, but I have to point out that you are actually the one seeing a more skewed patient population as a paramedic and an ER doc. You are seeing the sickest of the sick. Many of them will have seen chiropractors at some point, this doesn't necessarily demonstrate cause and effect.
There are no convincing studies to show causation between chiropractic manipulation and stroke. You link to 3 anecdotal reports and one small retrospective analysis that relied on a questionaire (!) to gather its information. (No flaws with that design...
I have no real interest in defending chiropractors, but I do have a hard time getting past the intellectual dishonesty of critics who preach from the bible of evidence based medicine but then put forth such flimsy data to bolster their own agendas. Give me a break.
Yes Mac-
And one of the most vocal here, has been less than honest------he has a familial/personal axe to grind that distorts his objectivity.
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How am I "less than honest"? Do you know me personally? No. You know that I have a brother-in-law (I suppose my "familial/personal axe") who is a straight chiropractor because I have disclosed it here.
How does that make me more biased than the chiropractors (or sons of chiropractors in Jesse's case) who post here? We all bring bias to the table. Mine is actually born more of the iatrogenic injuries and assorted chiropractic misadventures I've seen as an emergency medicine resident than it is from my brother-in-law.
But that still doesn't answer how this makes me more biased than the vocal chiro-apologists here:
wayttk - chiropractor
611 - chiropractor
Jesse14 - chiropractor's son
skiiboy - several first degree chiropractic relatives
backtalk - chiropractor
Do you really think I give my brother-in-law so much thought as to equate the inherant bias of three and a half years of education and assorted professional experience. Dude, I don't dislike ANYBODY that much...
- H
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Here is an article that I referenced above, which does describe the "referral bias" you describe. And I fully acknowledge this exists. My point is not that chiropractic is extremely unsafe. I believe that the overwhelming majority of chiropractic patients are safely manipulated and that VAD after manipulation is very, very rare. But it does occur. That is accepted in both the chiropractic and allopathic literature.
Referral bias:
http://www.ncbi.nlm.nih.gov/entrez/...Retrieve&dopt=abstractplus&list_uids=14589464
Risk of VAD:
Most recent:
http://www.ncbi.nlm.nih.gov/entrez/..._uids=16511634&query_hl=1&itool=pubmed_docsum
A case-controlled study as you didn't like the other studies:
http://www.ncbi.nlm.nih.gov/entrez/..._uids=12743225&query_hl=6&itool=pubmed_docsum
Chiropractic literature that acknowledges some, but minor risk (lit. review):
http://www.ncbi.nlm.nih.gov/entrez/...Retrieve&dopt=abstractplus&list_uids=16226631
Another chiropractic lit. review, probably the best JMPT review article I've read with regard to methodolgy (it looks at CES and heriation, not stroke):
http://www.ncbi.nlm.nih.gov/entrez/...uids=15129202&query_hl=21&itool=pubmed_docsum
Another lit. review assigning an ORadj of 3.8; 95% CI, 1.3 to 11 to manipulation:
http://www.ncbi.nlm.nih.gov/entrez/...Retrieve&dopt=abstractplus&list_uids=15933263
A less strong case series:
http://www.ncbi.nlm.nih.gov/entrez/...Retrieve&dopt=abstractplus&list_uids=10460445
Standardized interview retrospective study:
http://www.ncbi.nlm.nih.gov/entrez/...Retrieve&dopt=abstractplus&list_uids=14586598
And again chiropractic literature trying to identify the risk pattern:
http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12466778
And last but not least, the position of The National Center for Complementary and Alternative Medicine (NCCAM) is (from: http://nccam.nih.gov/health/chiropractic/#6a): "The rate of serious complications from chiropractic has been debated. There have been no organized prospective studies on the number of serious complications. From what is now known, the risk appears to be very low. It appears to be higher for cervical-spine, or neck, manipulation (e.g., cases of stroke have been reported). The rare complication of concern from low-back adjustment is cauda equina syndrome, estimated to occur once per millions of treatments (the number of millions varies; one study placed it at 100 million)."
There is at least one study that suggests other, minor chiropractic side effects:
http://www.jcca-online.org/client/cca/JCCA.nsf/objects/V49-1-46/$file/jcca-v49-1-046.pdf
In my, completely anecdotal, experience, there is also a risk, not explored in the literature, of chiropractic misdiagnosis leading to delays in actual care. I only mention this because many sCAM providers love to quote the IOM study of "medical deaths", which included error catagories such as "Error or delay in diagnosis", "Failure to employ indicated tests", "Use of outmoded tests or therapy", and "Avoidable delay in treatment or in responding to an abnormal test". With no measure to examine if chiropractors and other sCAM providers are making the same errors, there is no way to tell if they are "better". My guess is that they are not.
There are no convincing studies to show causation between chiropractic manipulation and stroke. You link to 3 anecdotal reports and one small retrospective analysis that relied on a questionaire (!) to gather its information. (No flaws with that design...
Actually, there are good studies, including case controlled studies, look above.
You miss my point. I do not believe that the risk of serious injury from chiropractic therapy is large, or even mild. I fully acknowledge that direct iatrogenic chiropractic injury is very rare. But, any measure of risk, balanced against no demonstrable benefit equals the wrong end of a risk:benefit ratio.
I also believe that many chiropractors hold themselves out as primary care physicians and impart a false sense of security to their patients in that these patients believe that their conditions, whatever they may be, have been assessed by and are being treated by, a provider of equal acumen to an MD/DO. But I can not provide any evidence for that opinion.
- H
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Source please. I'm at the clinic, there is no "Dr. Burly" listed. There was an article (here: http://www.chiroweb.com/archives/17/20/01.html) that "Chiroweb" published in 1999 about Dr. Bruley, who may have trained in the first class of the Mayo Medical School, but he is not a clinic employee - nor was he ever.
While the article may be substanatively true, there are some inaccuracies. If Dr. Bruley (who, by the way, does currently hold a medical license in Minnesota) did graduate in the first class from the Mayo Medical School, he did so as an MD, not a "specialist in family practice". Specialities are the result of residency, not medical school. By the article, Dr. Bruley never finished his training, starting a residency but ending as a GP journeyman working in EDs (this was before emergency medicine was a specialty).
A more recent article on Dr. Bruley reveals he may not be the "saving grace" you are attempting to demonstrate: http://www.mmaonline.net/publications/MNMed2006/April/pulse%201.htm
Having a non-residency trained MD teach cardiology at your school is a questionable decision to say the least. In any event, one "cash only" GP does not a trend make. There are very few, if any, licensed MD/DOs returning to do DC training. There are several DCs who go on for MD/DO training.
- H
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If there are no demonstratable benifits to chiropractic C-spine adjustments, then why do so many people continue to seek this trx out for their neck pain or headaches?? I personally know that if i try a pill and over a period of time, if no results are observed, i move on to a new pill or a new trx all together. Obviosly chiropractic has benifts...it wouldn't be the 3rd largest form of health-care after medicine and dentistry if it didn't
I personaly know and speak with many DC's and i'm yet to meet one that assumes the role of a patients GP. DC's are NMSK specalists and are trained as such. Even the OCA (ontario chiro association) mailed out a province-wide statment saying that DC's are NOT to impart their personal beliefs regarding vaccination....it's not in their sciope to do so and i fully agree with that! I will however not say that there are no DC's with delusions of grandur who like to assume primary care over a pt. It's deplorable that it occurs, but it's not as wide spread of an issue as you seem to think it is. 'But I can not provide any evidence for that opinion.'
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I never said that chiropractors weren't good salesmen. And, as described several places in the literature, benign idiopathic LBP is a largely self limited disease. But if you go to a chiropractor who takes credit for that "cure" well...
Think about this: A person sends out 128 envelopes today, 32 each making the "prediction" that one of the remaining NFL teams will win the Superbowl. The prediction asks for nothing in return, just volunteers the information. When the Superbowl is played, the person then sends out predictions for the winner of the world series (when the quarter finals are complete) to each of the 32 people who received the prediction of the winning team. 8 letters each go out containing another "prediction" for one of the four teams. Now you have 8 people for whom you have selflessly and accurately "predicted two major sporting events. Now do it one more time and you will have two people for whom you will have "predicted" three events, accurately and without cost. Don't you think those people would signup for your sports prediction newsletter at just about any cost?
Sales, marketing and the placebo effect.
O.k., look here:
http://www.chiroweb.com/archives/17/25/15.html
or here:
http://www.nysca.com/center_for_excellence7.asp
or here:
http://www.chiropractic.org/index.php?p=chiroinfo/main
or here:
http://www.nechiropractic.org/chiropracticinfo/index.html?id=7
for examples. It is a widespread issue. It is just one that creates too much cognitive dissonance for you to address, so like everything else "wrong" with chiropractic just ignore it and claim it isn't widespread.
- H
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I think we're on the same page as far as our feelings on chiropractors go. I just think you are being a little too vociferous on your anti-chiropractor stance and inadvertantly giving them too much credibility. You actually might be playing right into the hands of some of these clowns who constantly claim that "the medical establishment" is "trying to suppress" them.
I hear alot of CAM critics tout the Neurology study you linked to twice as evidence that chiropractic spinal manipulation is harmful, without acknowledging the blatant flaws and biases that clearly exist in their own right in that very study. I think the design of the study was clearly biased, that the authors had an agenda, and that the quality of that data does not rise above what you would find in some of the questionable chiropractic or CAM journals. In other words, these authors (perhaps inadvertantly) sunk to the level of the alternative medicine quacks they sought to discredit.
My personal feeling is that most chiropractors I have met truly can be described as quacks. I'm not sure if they actually believe the nonsense they spout, but alot of it is reckless and potentially harmful. But in Family Medicine, I've kind of accepted the fact that you can not force people to make smart healthcare decisions. If people want to see a chiropractor, so be it.
What I can't figure out is why CAM and chiropractic care is not a similar hornet's nest of malpractice liability that mainstream medicine has become. I mean, with all the probable harm that is being done, why aren't lawyers cashing in?
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Three reasons:
First, Chiropractic, BJ Palmer in particular, has been very successful at getting legislation passed at the state level to define their practice. Remember, the components of tort are 1. a duty to act, 2. a breech of that duty, 3. an injury occured, and 4. the breech was the proximate cause of the injury. Practicing within the practice act of a state doesn't violate the duty. For example, there was a patient I saw whose parents had relied on a chiropractor as the primary physician for many years around the time of his birth. The patient was subsequently unimmunized on the advice of that chiropractor. The child died of Hib meningitis (vaccine preventable). Several lawyers contacted by the family opined that the chiropractor did not violate the standard of care for chiropractic, thus, he was not liable.
Second, there is a difference between scientific proof, or even strong suspicion, and legal proof of proximate cause. It is hard for the jury to put together an itimal tear cause by CMT and the later stroke.
Third, there is a selection bias in chiropractic patients. These are the "walking well". Chiropractic is an outpatient therapy. By definition, their patients are well enough to get to them. So there is "less on the line". The big med-mal issues tend to be missed MIs, surgical disasters, and missed fractures. These are outside of a chiropractor's purview.
Don't discredit the CMT / stroke link. It is real, there is more than sufficient data to describe it.
And don't worry, the sharks are circling.
http://www.consultwebs.com/clients/chiropractic_malpractice_nc_us.htm
http://www.faact.com/news/1979.html
http://www.kolpan.com/lawyer-attorney-1124593.html and http://www.kolpan.com/lawyer-attorney-1146322.html
http://www.studnickilaw.com/medmal/Chiropractic_Malpractice.htm
http://www.alanbragman.com/bragman1.htm
http://www.salt-lake-city-attorney.com/lawyer-attorney-1129347.html
http://www.personalinjurylawyermd.com/practiceareas.html
http://www.lgglaw.com/pa_medmal.html
- H
I went to Chiropractic College for a few terms. I quit for a million different reasons.
I enjoy and believe in science. Chiropractic College's promote the belief, medical use, and marketing of ideas that have no scientific basis.
The market is going downhill fast. It is overloaded. I have met many chiropractors that have wished they'd gone to D.O. school so they weren't still $100,000 in debt 10 years down the road.
There are many chiropractors that make a lot of money. But, for the most part, they don't practice ethically - they scam their patients. I'd love to make a lot of money, but I could never do this to someone.
*** I don't see what pseudoskepticism has to do with anything. Of course there are people who blindly believe, some who don't believe, and others who would never believe. Skeptics are still skeptics.
I enjoy and believe in science. Chiropractic College's promote the belief, medical use, and marketing of ideas that have no scientific basis.
The market is going downhill fast. It is overloaded. I have met many chiropractors that have wished they'd gone to D.O. school so they weren't still $100,000 in debt 10 years down the road.
There are many chiropractors that make a lot of money. But, for the most part, they don't practice ethically - they scam their patients. I'd love to make a lot of money, but I could never do this to someone.
*** I don't see what pseudoskepticism has to do with anything. Of course there are people who blindly believe, some who don't believe, and others who would never believe. Skeptics are still skeptics.
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647 out of 70,000. Yeah HUGE percentage.
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Actually, the list only accounts for health education assistance loans (HEAL loans). That is only one product available to health professionals. The remarkable part is not the raw number, because, as you point out, the number is small. But 4.5x more chiropractors than allopathic physicians default. Given that there are 7x more allopathic physicians than chiropractors, the default rate is more than 30 times greater in chiropractors. This suggests that far more chiropractors than physicians find themselves in financial trouble.
Again, I'm not "bashing" chiropractic, I'm just pointing out facts.
- H
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I understand that but you, as do I, have a preconcieved notion, which could cloud your judgement. Would you not agree with that?
Now with that being said are not most DCs small business owners? Are they not a greater percentage SBO than DOs and MDs? Is it not true that something like 30% of small businesses fail within the first? I don't remember the exact percentage but the number is staggeringly high.
I am not saying anything as fact but my logic, it may be wrong, would indicate that the additional risk in loan defaulting among DCs may have something to do with their small business or practice failing. Could you not draw the same conclusion?
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Actually, my "notions" are merely the status quo. Once again, show the evidence chiropractic works and I'll listen. The same would be true of a new drug on the market or any new therapy.
Well, if you have data to support these suppositions, please post. And even if you are right, doesn't the chiropractor's role as an SBO possibly bring their motivations into conflict with the needs of the patient?
Actually, I posted in response to your disagreement with the poster who claimed many chiropractors were still in debt long after their training. So now you agree that they are?
- H
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The DCs role as SBO is in no more conflict than the drug manufacture's conflict between drug research and production. Both invest into a particular method and both charge for it, same with any practitioner owned practice. Or for that matter any hospital organization.
No, I don't agree. I find it hard to believe that as posted a person is still $100k in debt for school loans after 10 years since most DC programs are well under $200k, even if you take out full loan amounts. Unless the person is including their student loans from an undergrad insitution or they don't know how to manage their money, which apparently applies to many within our society reguardless of profession.
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If a person has 200K in student loans, their monthly payment would have to be 2301.61 and would have to make at least 184K a year (based on paying 15% of your gross monthly income to repay the loan, but could lead to financial difficulty). They could instead go on an extended plan and pay 1303.85 a month (would need an annual salary of 104K and still might have financial difficulty). That would lead to them still owing 170K of their loans at 10 years (the loan would be paid of in 30 years).
Lets change it to 100K in loans (since you said most programs are well under 200K). To pay it off in ten years they would need to make 92K a year and pay 1150.80. On the extended plan they only need to make 52K and pay 651.93 a month. At ten years they would still owe 85K. Or if they make a little extra and can swing 763.34 a month they will pay it in 20 years, but at ten years they will still owe 66K.
That is how someone with over a hundred thousand in loans can still owe a lot well after graduation, if they don't have a large income (not specific to any profession, I am sure there are plenty of MD graduates who are on an extended repayment plan for their loans.)
This is the site I used to calculate (using the default interest rate)
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No, they just give doctors kickbacks to do it instead...
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Wow, really?!? I've been licensed for two years now. Never got a drug company check yet. But then again, I don't accept their lunches or their pens either. Guess that is why they have moved on to trying to fool the public directly. They've taken a page right out of the chiropractic playbook. Make outrageous claims and promises and take them to the masses!
http://www.annfammed.org/cgi/reprint/5/1/6
But really, is there a way to get some of the "kickback money" you refer to? I could use a new TV for the super bowl. GO BEARS!
- H
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That's funny.. i have 2 anecdotal cases of pharm companies giving kickbacks:
1
) I went into my GP for a physical and while i was there, this dude from Lamisil (nail fungus drug) was offering my GP a free dinner so they could sit down and discuss how the drug works blah blah blah
2) My fathers good friend is an MD who plays squash w/ him weekely. Roughly a month ago he couldn' make the game because he went on a "continuing education" trip to a resort in mexico sponsored by a drug company..basically they recruited doctors for free trips if they agreed to prescribe their drug... that to me doesn't sit right. Now, i don't know if any contracts were signed or if they were verbal agreements but non the less, docs are getting free trips to prescribe drugs AKA a kickback.
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Well here in the U.S. things have changed quite a bit. As usual, Canada is a bit behind, oh well. #2 above would be illegal and in #1 only the physician, not spouses or family could go.
Still doesn't defend the basic point that DCs are caught in an uncomfortable position of needing to sell their snake oil regardless if the patient "needs it" or not.
- H
8
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You need to get out more. And you certainly hold your future collegues in low esteem if you think we are bunch of grasping criminals who will sell our integrity for a coupe of thousand bucks.
Here's how drug companies typically make their pitch: They sponsor a speaker to discuss some topic at a nice restaurant, before which they put in a brief plug for their product. I have been invited to many of these but I have never gone, not because I object but because I have better things to do with my time then listen to a lecture on my off-time.
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Nope. They offer these trips (not as common a practice as it used to be, by the way) in the hopes that the physicians will prescribe their products. There is no agreement, signed contract, understanding, or any obligation of the physician to do anything. All a drug company can do is look at a doctor's prescribing information (which may soon become confidential) and stop giving free pens and lunches to a doctor that doesn't prescribe their drugs.
Big whoop. As if I'm going to need a free lunch on that happy day when I hopefully start making big bucks as an EM attending. I think for 220K per year they can stick their lunches up their ass. Hell, since we eat for free at both of our hospitals I don't even need their free lunches now and have even less of an incentive to go to noon conference than I previously had.
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Chirotalk's host (Proboards) betrayed them and took down their discussion forum site with no notice so they had to move to a new one. The new Chirotalk site is http://chirotalk.hyperboards.com/ .
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Many end up in DO school because MD wasn't an option.
Personally, I wouldn't recommend chiropractic school unless someone wanted to be in sales.
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The problem with selling defective products is that they have a limited lifespan and if you have half a brain and a conscience you feel bad doing it. It would be better to concentrate on a more lucrative, accepted field. 25% to 50% of chiropractors quit the field in 10 years.
Odds of failing as a DC? 25% to 50%
http://chirotalk.hyperboards.com/action/view_board/board_id/55/start/1
I'd rather be a mule taking cocaine over the Mexican border in my rectum than a chiropractor. Better odds.
Odds of failing as a DC? 25% to 50%
http://chirotalk.hyperboards.com/action/view_board/board_id/55/start/1
I'd rather be a mule taking cocaine over the Mexican border in my rectum than a chiropractor. Better odds.
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The typical PA likely earns more than the average DC, with less school.
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Yup. This is why many DCs are becoming NPs through accelerated programs and trying to expand their scope.
NP Chiropractors: Please Don’t Tell Me!
http://clinician1.com/posts/article/np_chiropractors_please_dont_tell_me/
Ironically, the chiropractors themselves are their own worst enemies regarding scope expansion.
According to this Life student in 2013, there is no such thing as prevention in medicine. You are all drug and surgery pushers. Just say no.
http://vitalsourcelife.wordpress.com/2013/09/20/chiropractic-health-care-or-sick-care/
The real source of this problem isn't the chiropractors however, its the banks. By allowing woo like chiropractic, acupuncture, chinese medicine and astrology to be accredited the bankers make loads of money, especially when these quacks fail and they get socked with the default fines. Grads can easily owe $500k on a $100k loan. With debt now up to $200k expect defaults to rise to seven figures. Howeer it is very hard to get true default figures because the ED cohort rate only counts the first two years of repayment. So the current rates probably hide 98% of the defaults. Smart bankers.
NP Chiropractors: Please Don’t Tell Me!
http://clinician1.com/posts/article/np_chiropractors_please_dont_tell_me/
Ironically, the chiropractors themselves are their own worst enemies regarding scope expansion.
New Mexico needs more primary-care medical providers, and select chiropractors moved a step closer Friday to qualifying for those jobs.
The House Judiciary Committee voted 9-6 for a bill that would allow advanced practice chiropractic physicians to prescribe and inject drugs, and to perform diagnostic procedures.
Dr. Grant La Farge, a pediatric cardiologist and medical director of the New Mexico Medical Board, testified that his organization had no opposition to the bill. But numerous chiropractors did, saying a move toward primary care went against the “drugless healing philosophy” of their practice.
Drugless healing philosphy, wow that's got to be the prettiest name I've ever heard for dangerous quackery. Here is some anti-medical rhetoric that would have fit right in back in 1895 when chiropractors were being jailed for practicing medicine without a license, the difference is that it is coming from current chiropractic students who were taught at Life University, the largest chiropractic school in the country. Some may remember this college from its fiasco around 2000 where its accreditor tried to revoke accreditation because it tried to evade standards by not teaching differential diagnosis. Well the college sued and ended up with a settlement where it changed nothing but got a green light from the crooked chiropractic accreditor that it wouldn't be hounded anymore for teaching students to run a premature diagnosis scam to use quacky vertebral subluxation diagnosis to justify treating any condition, because you know the nervous system controls every cell in the body, yeah right, students are actually brainwashed, I mean taught this sth*t and your tax dollars are paying for it when a quarter to half of them default on their loans.The House Judiciary Committee voted 9-6 for a bill that would allow advanced practice chiropractic physicians to prescribe and inject drugs, and to perform diagnostic procedures.
Dr. Grant La Farge, a pediatric cardiologist and medical director of the New Mexico Medical Board, testified that his organization had no opposition to the bill. But numerous chiropractors did, saying a move toward primary care went against the “drugless healing philosophy” of their practice.
According to this Life student in 2013, there is no such thing as prevention in medicine. You are all drug and surgery pushers. Just say no.
http://vitalsourcelife.wordpress.com/2013/09/20/chiropractic-health-care-or-sick-care/
"There are four forms of care for the human body: health care, sick care, emergency care, and symptom care. Obviously, the best of these is health care. Health care is care for a healthy person to optimize their health and bring the person to their full potential. The next best care is sick care. This is care for a sick person to find and remove the cause of the sickness or to bring them from sickness to health. Emergency care is needed, time-critical care. Of the four, the worst is symptom care, where the cause is either unknown or is not sought after and relief of the symptoms is the only goal.
Chiropractic care is not health care because a person with a vertebral subluxation is a sick person. If a chiropractic patient is not sick (no vertebral subluxation) then no care is needed and, therefore, not given. If care is not given unless they are sick, then it is not health care; again, sick care gets the person healthy, but no longer cares for the person once they are healthy. Chiropractic care focuses on and succeeds in restoring a person to health. This doesn’t make it health care, by definition, but it makes chiropractic care better than most care out there. I won’t go into the tragedy of symptom care or the need for emergency care..."
Chiropractic care is not health care because a person with a vertebral subluxation is a sick person. If a chiropractic patient is not sick (no vertebral subluxation) then no care is needed and, therefore, not given. If care is not given unless they are sick, then it is not health care; again, sick care gets the person healthy, but no longer cares for the person once they are healthy. Chiropractic care focuses on and succeeds in restoring a person to health. This doesn’t make it health care, by definition, but it makes chiropractic care better than most care out there. I won’t go into the tragedy of symptom care or the need for emergency care..."
The real source of this problem isn't the chiropractors however, its the banks. By allowing woo like chiropractic, acupuncture, chinese medicine and astrology to be accredited the bankers make loads of money, especially when these quacks fail and they get socked with the default fines. Grads can easily owe $500k on a $100k loan. With debt now up to $200k expect defaults to rise to seven figures. Howeer it is very hard to get true default figures because the ED cohort rate only counts the first two years of repayment. So the current rates probably hide 98% of the defaults. Smart bankers.
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I'm not anti-chiropractic and wouldn't blame someone for changing to a medical career if things weren't working out.
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I know plenty about chiropractic and wouldn't hesitate to visit one for mechanical low back pain or simply because of feeling better after an adjustment. I've had the same chiropractor for years and he hasn't stroked-out me or the kids. It's safe and you really wouldn't want to compare iatrogenic death to those directly attributed to chiropractic manipulation.
I'd trust a good DC far more with my cervical spine than a DO suffering from "OMM blues", LOL! The profession does have a lot of whackos, though.
Chiropractic is more or less sales, 80-85%, and if a patient doesn't get results in a month or so their pain will likely be chronic. The simple fact that everyone can't do sales or run a practice explains the default rate pretty well. I've never been bored enough to research it but have been told Palmer and Life grads make more money because of sales/practice management courses during school.
I do wish chiropractic schools would stop selling gullible students on the idea of any parity between DC/MD school curricula. It's dishonest and there's no legitimate comparison between the knowledge base one needs to practice as a chiropractor versus an MD/DO.
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I had a pinched nerve in my cervical spine as a kid. Zero insurance, crippling pain, and doctors that basically said the only thing they could do is give me drugs and wait. Chanced it on a chiropractor. One flip of my neck later and I was instantly fine. Hell of an improvement over "you might need surgery if it doesn't resolve in its own." 99.99% of the time, however, chiropractors are swindlers that peddle useless treatments to the healthy.
