Current Views of Chiropractic; What Do You See?

SpecterGT260 · Dec 12, 2012

Thanks, I appreciate that

facetguy · Dec 12, 2012

SpecterGT260 said:
You're off your game pops. If you are trying to "school' me on the basis that nerves all connect up well but just because they feed into the CNS doesnt mean that your treatment is affecting the CNS in any way. You are really only showing me that chiro training is worse than I thought if you have difficulty discerning between the peripheral and central nervous systems simply because they hook to each other. Since you like the analogies so much: Is the road in front of your house an interstate simply because it connects up to one? The papers you are citing are making the claim that because there is a change in the CNS (reported as significant, but god knows how they came up with that with their n value....) that the treatments must be eliciting their responses in the CNS. Fun fact, the CNS changes constantly under all manner of situations. On the PET scan paper, at the numbers they were using (and the severe lack of controls), it would only have taken 1 guy to be holding in a fart to throw the results completely off. They do not establish causation. The DOs at least teach this. I still find the therapies to be inefficacious, but hey, at least they track it down to a reasonable mechanism rather than pretend they are changing brain chemistry with a back rub . Your manipulations are registered in the CNS but that is about it. You could make a case that we are dealing with reflex arcs which would also be reasonable AND be concerned with the CNS, but I wouldn't if I were you.... because spinal reflex arcs don't have anything to do with the brain and going down this road would only show further that your researchers have no idea what they are doing.

I should hope you'd be sharper than me when it comes to basic neuroscience since you're knee deep into it as a current medical student and I've been out of school for years now. That aside, if you can't concede that spinal manipulation stimulates mechanoreceptors and sends a barrage of afferent information into the CNS, then we can't go much further on this topic. Exactly what happens once that afferentation gets there is arguably up for debate, but there are plenty of ideas out there.

Regarding the couple of papers I linked to earlier (the PET scan one and the other 2), you are clearly misrepresenting my intention in mentioning them. You are acting as though I'm trying to claim that the existence of those papers is the final, ultimate proof-positive when it comes to spinal manipulation and central effects. I've said this repeatedly now: I posted them to demonstrate that there are indeed efforts to understand the mechanisms behind spinal manipulation, particularly those effects that go beyond patients simply saying "yes, I do feel better after you adjusted my back". This is very new territory that will continue to be explored and more fully understood. But you have to start somewhere, so yes these studies are rudimentary. But at least there are efforts underway to explore this area.

Let's set our calendars to remind us to return to this thread in 20 years and we'll see if any progress has been made. (This assumes the Mayans were wrong. If it turns out they were right, nevermind.

)

And when you say that manipulation is registered in the CNS and that's it, with all due respect you don't know that at all. The people who study this full-time, or at least devote time to the topic professionally, don't even understand this completely; yet you do? C'mon, have a little humility.

cdmguy · Dec 12, 2012

Humility to you? :laugh:

Let me give you a hint, you lost the debate-badly.

There's no need for another red herring.

Now put the microphone in your bag of snake oil and slither back to your hole.

facetguy · Dec 12, 2012

SpecterGT260 said:
Their reported values couldn't possibly be significant given the overlap in the error.

Pain reduction on the subjective scale was reported as ~1 +/- 1.1 in nearly every category. If you ran stats on these results you would get a p value easily over .5 (that is a guess, but feels pretty safe with how close they are and the fact that the variance is nearly as large as the magnitude of change). Mathematically this means that there is very low probability that the findings in any category are in any way distinct from each other. They called it a finding, but the math says they reported 3 groups with identical results.

If you notice, the only p values they report are for unrelated findings - # back school patient followup visits or alternative therapies, crap like that. They fit in a significant p value hoping the skimmer won't catch it but the actual results are lacking in reported statistics. If these were odd ratios or hazard ratios things may be a little different, but these are first order reductions in subjective reporting making everything about the study just worthless. Being indexed by pubmed doesn't mean anything either. Nearly everything shows up on pubmed. They are a gnats ass away from indexing bloggers. The value in pubmed comes after knowing how to discriminate the papers.

SpecterGT260 said:
They didnt report significance values, only raw values. I am pretty certain they are also insignificant. The variance in all of those overlap quite a bit. While you can't just look at it like that and assume that means the difference is insignificant, it is a pretty good indicator. The omission of stats also makes me question the validity of any of it at all.... At this point who is to say their pain survey wasnt biased in its writing? I have seen similar things in other papers where surveys will include things things specific to one group but not another. One DO paper was trying to prove a more holistic approach by DO doctors, and their survey included several questions phrased like "the physician verbally described the core osteopathic tenets during the encounter", and when lo and behold the DOs scored higher on said survey the AOA published a paper saying they were more holistic . I could write a survey phrased such that only the wording will impact the results. It is actually pretty easy.

So, let me get this straight. You're guessing that the authors of this paper, who aren't even chiros by the way, massaged their numbers to make manipulation look better than it is (which we don't even know for sure they did), therefore that invalidates any and all science and/or studies relating to chiropractic.

Sounds legit.

Now, when a drug company fudges numbers in a drug trial, it's obviou$$$ why they would do that. Why would the authors of the paper in question do it?

facetguy · Dec 12, 2012

evilbooyaa said:
Specter, let me just say that I've read the past page and a half (from when it was re-brought up yesterday), and let me just say that based on this thread and others I have read from you (even ones that we've disagreed on) I think you are going to make one hell of a doctor.

Your ability and willingness to show shoddy research for what it is trying to represent against someone who is clearly not reading them to the same extent you are, is awesome.

Just wanted to drop in and say I agree with you, and cdmguy (although I will admit I think he has a larger bias on the topic than you), while disagreeing with facetguy about chiropractors doing anything that affects the brain in a significant manner. They treat muscle pain. If I had chronic lower back pain that couldn't be explained by X-ray/MRI, then sure, maybe I'd go see a chiro for it. If I had neck pain, no chiro is touching me, period.

I'm going to go out on a limb here and assume that you have no idea what chiropractors do. "They treat muscle pain"? At least Specter brings it; you're gonna have to step it up.

facetguy · Dec 12, 2012

cdmguy said:
Humility to you?

Let me give you a hint, you lost the debate-badly.

There's no need for another red herring.

Now put the microphone in your bag of snake oil and slither back to your hole.

When you start contributing something meaningful to the debate, as you say, I'll respond. However ,given that you've contributed next to nothing meaningful in these threads over the years, I'm not holding my breath.

DocVapor · Dec 12, 2012

I actually just went to my wife's first appointment with a DC. She went last week for her initial consult, which I didn't go to. She has some scoliosis and chronic plantar fasciitis/fasciosis. She told him last week that I'm a DO student and apparently he gets really excited about DO's and really wanted me to be there today, and wants me to keep coming back with her. I'm not sure why.

My first concern was that last week they took some films of my wife's T- and L-spine. She said they were "the most casual X-rays I've ever had." At least they asked her if she was pregnant or could be first, but other than that they were taken in her plain clothes. Would have preferred they put her in a gown and seemed a little more professional about irradiating her abdomen (regardless of how little radiation there was).

Then today we get in consult room and the first thing they do is show us this video, probably from the mid-90's, explaining some of the diagnosis and theory of how chiropractics works. I must say I chuckled a couple times, but it was all so basic that I didn't see anything real worrying.

Once that was over he came in and talked to us, actually showed us the X-rays. His analysis looked fine to me. He started talking about what he wanted to do; it all sounded reasonable.

We then went over to another room so she could get some electrotherapy on her lumbar region, along with some ultrasound of one (why just one?) foot. While in there, I was looking at all the posters they had showing acupuncture techniques, and red flags went up fast. I mean... it seemed there was a spot on the ear that had some sort of effect on the sciatic nerve. Really? The one that really freaked my wife out was the ear with the inverted fetus situated inside the pinna. At least he didn't try to push any of that on her (yet).

Finally we get into the treatment room, which consisted of a few seconds with the vibratory machine on her back, and then lots of HVLA of her thoracic and lumbar spine. Lots of foot HVLA, and then some brief plantar fascia release. Now I know HVLA is dramatic to begin with but this all seemed out of proportion. I would have liked to have seen him actually really palpate before and recheck after, and try some more conservative treatments first, i.e. muscle energy, so it didn't freak my wife out so much. But the place was run like an assembly line, and pops and cracks make people think something has happened, good or bad.

Now on to the future - she's going back tomorrow, the day after, and the day after, then 3 times next week. At that point she'll be evaluated to determine whether or not it can go down to twice/week for 2 weeks or if she has to go another 3 times/week for 2 more weeks before she is evaluated again.

$$$

I don't know what kind of effect my presence had on his treatment. Was it more dramatic? Less dramatic? Was he trying to impress me? Was he holding back on some less proven techniques because I was there? He said he'd like to see me there but he isn't "going to teach me the techniques." I would never expect him to. Especially since I'm going to be learning them anyway.

In conclusion, so far the guy seems mostly reputable. I'm not fully versed in manipulation yet since I'm only an M1 just finishing MSK block next week. But you can bet I'll be keeping a close eye on things. I feel like he has a good start to her treatment. If she sees some improvement and she continues going to see him, we'll see if he starts talking about discharging her from his care or if he's going to want x# treatments/month. I do feel that some treatments have their place and chiropractors are definitely able to perform them competently. But, like anyone (be it mid-level, DC, OD, or even MD/DO) to keep their respect they need to know the limits of the practice and their own limits, and thus when to refer out.

SpecterGT260 · Dec 12, 2012

facetguy said:
I should hope you'd be sharper than me when it comes to basic neuroscience since you're knee deep into it as a current medical student and I've been out of school for years now. That aside, if you can't concede that spinal manipulation stimulates mechanoreceptors and sends a barrage of afferent information into the CNS, then we can't go much further on this topic. Exactly what happens once that afferentation gets there is arguably up for debate, but there are plenty of ideas out there.

Well, let's address that - you were the one originally getting condescending over inaccuracies in academic minutia. All I did was call out a similar inaccuracy. I said that chiropractic manipulation has nothing to do with the CNS (implying its mechanism) and you countered by talking about mechanoreceptors.

I dont have to concede the point, however, as I never suggested anything to the contrary. The fact that the CNS interprets this information is a non-point. Furthermore, you have to ignore the context of the PET scanning paper you posted to understand just how far you are missing the mark in focusing on mechanoreceptors. I would say mechanoreceptor reflex arcs do play a minor role in the therapy. This is not altering the CNS as is implied in the papers you posted, and mere travelling through it doesn't change any of that. I don't call post-streptococcal glomerulonephritis an aortic disorder just because the molecules of interest passed through

Regarding the couple of papers I linked to earlier (the PET scan one and the other 2), you are clearly misrepresenting my intention in mentioning them. You are acting as though I'm trying to claim that the existence of those papers is the final, ultimate proof-positive when it comes to spinal manipulation and central effects. I've said this repeatedly now: I posted them to demonstrate that there are indeed efforts to understand the mechanisms behind spinal manipulation, particularly those effects that go beyond patients simply saying "yes, I do feel better after you adjusted my back". This is very new territory that will continue to be explored and more fully understood. But you have to start somewhere, so yes these studies are rudimentary. But at least there are efforts underway to explore this area.

You are mistaken. They make NO effort to look into the mechanism. They take a series of measurements which have poorly understood meaning to begin with and assign meaning to their findings. The fact that they close their discussion with talk of eliciting brain plasticity or whatever it was shows they have no interest in a critical assessment. I would agree that they are trying to combat the idea that chiropractic adjustment is just a feel-good therapy like massage, but that doesnt imply that they are investigating a real mechanism. Crystal therapists also tout underlying mechanisms to their craft

The problem is that they are starting with poorly controlled clinical trials and trying to reverse-engineer their answer towards their desired goal. We need non-subjective testing to illuminate a mechanism and nobody is even approaching that yet. There are horse chiropractors... start up an animal lab

Let's set our calendars to remind us to return to this thread in 20 years and we'll see if any progress has been made. (This assumes the Mayans were wrong. If it turns out they were right, nevermind. )

And when you say that manipulation is registered in the CNS and that's it, with all due respect you don't know that at all. The people who study this full-time, or at least devote time to the topic professionally, don't even understand this completely; yet you do? C'mon, have a little humility.

The problem here is that they are basing conclusions on an assumption that is already contradictory to the basic science it attempts to add to. If it was simply uncertain I would be less adamant. We started with a blatant falsehood - that "healing signals" are required to maintain the body and are obstructed by structural misalignment. This has been downplayed by a subset of chiropractors as they attempt to dress it up as something more sciency... but in the process fail to be accurate in the background information required to carry out meaningful work.

facetguy said:
So, let me get this straight. You're guessing that the authors of this paper, who aren't even chiros by the way, massaged their numbers to make manipulation look better than it is (which we don't even know for sure they did), therefore that invalidates any and all science and/or studies relating to chiropractic.

Sounds legit.

Now, when a drug company fudges numbers in a drug trial, it's obviou$$$ why they would do that. Why would the authors of the paper in question do it?

Which paper? you posted 2 from the NZ college of chiropractic.
The last paper... do you know they arent? They are italians publishing a work straight to a library rather than a journal (remember how good all of those straight to VHS movies are compared to the boxoffice ones?). Whether or not chiropractors themselves, their interest is in alternative therapy..... Yes, that is an assumption, but please don't act like they are just well-meaning scientists who for no reason at all set up a manipulative medicine experiment.

Did they massage their numbers? (p.s. I appreciate the pun there) No idea. Probably not. They are definitely pulling our leg, however, with the reporting of the numbers

meanie

. Their primary metrics are not significant and yet they report them as "increased" or "decreased", whichever best fit. They are aware of significance because they report it for secondary metrics. Here is the thing about secondary analysis criteria, however.... The statistical power needed goes up exponentially the more things you look at. It isn't a commonly understood phenomenon, but a p=0.05 means that statistically 1 in 20 measurements of this experiment will result in indistinguishable results between the test groups. What does this translate into? It means if you set up 20 criteria for your analysis, one of them is statistically bound to end up significant (<0.05). If you do 40 there will be 2 "significant" findings. So on and so forth. I read enough papers, good and bad, to know when someone is trying to pass data off as useful when it is in fact a negative finding. The key is not in what is written but in what is omitted.

cdmguy · Dec 12, 2012

This is my favorite stooge chiropractic researcher, Anthony Rosner PhD.

http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=9080

http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=15130

http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=46350

http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=15480

facetguy · Dec 13, 2012

SpecterGT260 said:
Well, let's address that - you were the one originally getting condescending over inaccuracies in academic minutia. All I did was call out a similar inaccuracy. I said that chiropractic manipulation has nothing to do with the CNS (implying its mechanism) and you countered by talking about mechanoreceptors.

You and I have our spirited discussions. But I wasn't being condescending. If my comments came across that way, it was not my intent. My point was to open the thought process beyond the old model of a bone out of place pressing on a nerve. That's why I mentioned mechanoreceptors. Folks, particularly around here, continue to want to chain chiropractic to 1895. Chiropractic-related science has advanced just like every other area of science. Are there some in chiropractic who continue to espouse some outdated notions? Sure, and I wish it weren't that way. But that's not the entire profession, and I'd say these days it's the minority. Yes, we can all find websites and various examples of chiros claiming various things, but let's not over-extrapolate.

Regarding the idea that afferent info, in this case a sudden barrage of mechanoreceptor firing, just passes through the CNS without having any effects is ludicrous. It reminds of the old days when it was thought that our blood vessels were simply a passive system of pipes and plumbing. I know you don't believe this, so I struggle to figure out why you say it.

I dont have to concede the point, however, as I never suggested anything to the contrary.

What's this, an escape hatch? A hedge? Perhaps there's hope afterall.

The fact that the CNS interprets this information is a non-point. Furthermore, you have to ignore the context of the PET scanning paper you posted to understand just how far you are missing the mark in focusing on mechanoreceptors. I would say mechanoreceptor reflex arcs do play a minor role in the therapy. This is not altering the CNS as is implied in the papers you posted, and mere travelling through it doesn't change any of that. I don't call post-streptococcal glomerulonephritis an aortic disorder just because the molecules of interest passed through

When you say reflex arcs, yes I agree that there are reflex effects. But why do you then assume that that's where it ends? Since when does somatosensory information not ascend the CNS? I willingly concede that it is currently unclear exactly what higher center effects occur, but why do you denigrate those who are trying to do the early legwork investigation into this? Remember, this is a brand new avenue of inquiry.

You are mistaken. They make NO effort to look into the mechanism. They take a series of measurements which have poorly understood meaning to begin with and assign meaning to their findings. The fact that they close their discussion with talk of eliciting brain plasticity or whatever it was shows they have no interest in a critical assessment. I would agree that they are trying to combat the idea that chiropractic adjustment is just a feel-good therapy like massage, but that doesnt imply that they are investigating a real mechanism. Crystal therapists also tout underlying mechanisms to their craft

The problem is that they are starting with poorly controlled clinical trials and trying to reverse-engineer their answer towards their desired goal. We need non-subjective testing to illuminate a mechanism and nobody is even approaching that yet. There are horse chiropractors... start up an animal lab

The problem here is that they are basing conclusions on an assumption that is already contradictory to the basic science it attempts to add to. If it was simply uncertain I would be less adamant. We started with a blatant falsehood - that "healing signals" are required to maintain the body and are obstructed by structural misalignment. This has been downplayed by a subset of chiropractors as they attempt to dress it up as something more sciency... but in the process fail to be accurate in the background information required to carry out meaningful work.

Ah, we might be on to something here (bold/underlined). When you say "healing signals obstructed by structual misalignments", you are referring to older 'vitalistic' notions that were years ago held by some (and probably still held by some today, in and out of chiro). Current chiros, at least most of us, don't think in those terms. Contemporary models of how spinal manipulation works (and, again, this isn't chiro-exclusive) involve both mechanical factors and neurophysiologic factors associated with manipulation. If that's what you mean by "sciency", so be it. That's what science tells us is happening. As I've said before, it's as though folks like you would like it if chiros continued to spout outdated notions instead of moving forward in a scientific fashion to better understand mechanisms involved; it's easier to criticize the chiropractic profession if it stays in the past science-wise.

Which paper? you posted 2 from the NZ college of chiropractic.
The last paper... do you know they arent? They are italians publishing a work straight to a library rather than a journal (remember how good all of those straight to VHS movies are compared to the boxoffice ones?). Whether or not chiropractors themselves, their interest is in alternative therapy..... Yes, that is an assumption, but please don't act like they are just well-meaning scientists who for no reason at all set up a manipulative medicine experiment.

Did they massage their numbers? (p.s. I appreciate the pun there) No idea. Probably not. They are definitely pulling our leg, however, with the reporting of the numbers meanie. Their primary metrics are not significant and yet they report them as "increased" or "decreased", whichever best fit. They are aware of significance because they report it for secondary metrics. Here is the thing about secondary analysis criteria, however.... The statistical power needed goes up exponentially the more things you look at. It isn't a commonly understood phenomenon, but a p=0.05 means that statistically 1 in 20 measurements of this experiment will result in indistinguishable results between the test groups. What does this translate into? It means if you set up 20 criteria for your analysis, one of them is statistically bound to end up significant (<0.05). If you do 40 there will be 2 "significant" findings. So on and so forth. I read enough papers, good and bad, to know when someone is trying to pass data off as useful when it is in fact a negative finding. The key is not in what is written but in what is omitted.

cdmguy · Dec 13, 2012

facetguy said:
You and I have our spirited discussions. But I wasn't being condescending. If my comments came across that way, it was not my intent. My point was to open the thought process beyond the old model of a bone out of place pressing on a nerve.

As spec said, the sum of chiropractic research has been to prove that procedures are correct-regardless of the mechanism. Bone out of place is just one of many theories that DCs use to do this. It's irrelevant to chiropractic practice.

That's why I mentioned mechanoreceptors. Folks, particularly around here, continue to want to chain chiropractic to 1895. Chiropractic-related science has advanced just like every other area of science.

Yet the educational institutions still test on outdated manipulation techniques based on false biomechanical listing systems? Just stop. Lying shouldn't be this difficult.

Ah, we might be on to something here (bold/underlined). When you say "healing signals obstructed by structual misalignments", you are referring to older 'vitalistic' notions that were years ago held by some (and probably still held by some today, in and out of chiro). Current chiros, at least most of us, don't think in those terms.

Toggle technique aka "Hole in One" was taught by BJ Palmer in the 1950s. BJP was the son of the founder DD Palmer. At BJP's time the mechanism was explained vitalism, today it is taught by Palmer, Life University, Sherman and other schools and explained using mechanoreceptor theory. The method is exactly the same and it is still based on false biomechanics and the debunked idea that someone can torque a bone by twisting skin. Mouse over Occiput to verify (http://www.sherman.edu/academics/technique.asp).

SpecterGT260 · Dec 13, 2012

facetguy said:
You and I have our spirited discussions. But I wasn't being condescending. If my comments came across that way, it was not my intent. My point was to open the thought process beyond the old model of a bone out of place pressing on a nerve. That's why I mentioned mechanoreceptors. Folks, particularly around here, continue to want to chain chiropractic to 1895. Chiropractic-related science has advanced just like every other area of science. Are there some in chiropractic who continue to espouse some outdated notions? Sure, and I wish it weren't that way. But that's not the entire profession, and I'd say these days it's the minority. Yes, we can all find websites and various examples of chiros claiming various things, but let's not over-extrapolate.

Regarding the idea that afferent info, in this case a sudden barrage of mechanoreceptor firing, just passes through the CNS without having any effects is ludicrous. It reminds of the old days when it was thought that our blood vessels were simply a passive system of pipes and plumbing. I know you don't believe this, so I struggle to figure out why you say it.

What's this, an escape hatch? A hedge? Perhaps there's hope afterall.

When you say reflex arcs, yes I agree that there are reflex effects. But why do you then assume that that's where it ends? Since when does somatosensory information not ascend the CNS? I willingly concede that it is currently unclear exactly what higher center effects occur, but why do you denigrate those who are trying to do the early legwork investigation into this? Remember, this is a brand new avenue of inquiry.

Ah, we might be on to something here (bold/underlined). When you say "healing signals obstructed by structual misalignments", you are referring to older 'vitalistic' notions that were years ago held by some (and probably still held by some today, in and out of chiro). Current chiros, at least most of us, don't think in those terms. Contemporary models of how spinal manipulation works (and, again, this isn't chiro-exclusive) involve both mechanical factors and neurophysiologic factors associated with manipulation. If that's what you mean by "sciency", so be it. That's what science tells us is happening. As I've said before, it's as though folks like you would like it if chiros continued to spout outdated notions instead of moving forward in a scientific fashion to better understand mechanisms involved; it's easier to criticize the chiropractic profession if it stays in the past science-wise.

I seriously have to study so I cant go through this thoroughly, but I just wanted to make a quick note:
Information ascending the CNS does not directly imply any tangible effect as a result of that ascension such that downstream processes are affected. Nobody is arguing that mechanoreceptor info doesn't ascend. I could draw out the pathways for you if you'd like. It is common knowledge. What is not established in any way is that these impulses cause the brain to do anything other than register and record. Those papers imply that the brain changes and sends either new information down or changes the behavior of things in the periphery as a result. That's crazy talk.

cdmguy · Dec 13, 2012

Spec,

I'd recommend not wasting too much time. You have an alt med field that still praises vitalism, defines its scope around it and blatantly allows schools to teach techniques based on it.

http://www.life.edu/enrollment/admissions/chiropractic-admissions
Watch the video. Pause at 17 seconds. This is a current video interview from a practicing 2008 Life University graduate. They are still using the same Merrick nerve-organ chart that was used decades ago. Also notice the Tytron surface skin temperature measurement device, that's to measure autonomic function (usually done without proper aclimation period) and is done to "prove" that whole body function is disturbed from subluxations. And finally, notice the severe forward head posture-belying any claim that effective posture correction is taught to chiropractors.

Further, every reformist association (NACM, orthopractic) that tried to just pare down the claims to musculoskeletal while still leaving a quack focus on preventing osteoarthritis with ineffective biomechanical subluxation treatment gathered an insignificant number of members and was rejected by mainstream associations, failed and went defunct.

The National Association of Chiropractic Medicine (NACM) apparently no longer exists. Responding to an inquiry regarding the organization's status from another chiropractor, a March 6, 2010 e-mail sent by NACM's national executive director, Ronald Slaughter, DC, said it all: "All good things come to an end. We tried. We failed. Chiropractic is a 'failed' profession." -http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=54548

When you think of it why in the world would a field that in many states has a wide "primary care" scope voluntarily limit it with no direct benefit and the massive PR loss that would occur from having to admit "yes by golly we did practice quackery-sorry!"?

A more outspoken group, the National Association for Chiropractic Medicine (NACM), is composed of chiropractors who use only SMT and treat only functional back disorders that are not disease-related. NACM believes that chiropractic pseudomedicine and cultism are too well entrenched, and that the moral responsibility for public well-being is too serious to merely hope and patiently wait for self-reform. NACM members publicly renounce the subluxation theory and other forms of chiropractic pseudomedicine. They do not present chiropractic as an alternative to regular medicine, but offer their skills as SMT specialists in cooperation with mainstream medicine.

Reformers have a difficult time because they find themselves ostracized by the chiropractic guild for breaking ranks and openly criticizing chiropractic, but they may have difficulty being accepted by regular medical practitioners. These reformers, particularly NACM's leaders, exhibit rare, selfless courage. The first outspoken reformer, Samuel Homola, D.C., published his observations in 1963 in Bonesetting, Chiropractic, and Cultism, which is posted on this Web site.]

The dilemma reformers face is that chiropractors do not perform any service or deal with any condition not covered by some other health profession. State laws that enable them to practice either specifically mention the subluxation theory or describe it as the basis for chiropractic as an entity. Renouncing chiropractic's theoretical basis would eliminate its justification for existing as a separate profession. -http://www.chirobase.org/01General/controversy.html

That versus an anonymous chiro's unsupported assertion that it just isn't so. Do some schools have a naturopathic-esque scope (called "mixer") and more physical therapy methods? Sure. But those are the ones that also push other types of woo like acupuncture, ayurveda and homeopathy. Woo is endemic-whether you call it subluxation vitalism, chi or prana. It all accomplishes the same purpose-to allow treatment of a wide range of diseases that may walk in the door using unproven and debunked treatments and rationales.

SCUHS (Mixer school)
http://www.scuhs.edu/
Acupuncture program
Ayurveda program

Facet, back to your hole. Your misinformation isn't working here.

facetguy · Dec 13, 2012

cdmguy said:
As spec said, the sum of chiropractic research has been to prove that procedures are correct-regardless of the mechanism.

Wrong-O. Modern times required clinical effectiveness/outcomes trials, and they were therefore done and continue to be done. But your assertion that this is where the research ends is just silly. You've got the time, do a little reading.

Bone out of place is just one of many theories that DCs use to do this. It's irrelevant to chiropractic practice.

How many times do I have to remind you that BOOP is an old model, which I know you know. You also know the people reading this thread are casual observers who you believe you can sway with misinformation, and it's shameful.

SpecterGT260 · Dec 13, 2012

I still see many "BOOP" based theories being discussed by DCs in practice. (I like that term

)

I also have used the word "cult" to describe the DC/pt relationship on many occasions.

cdmguy · Dec 13, 2012

I'd go beyond that spec. The schools are educational cults and the students then use the methods on patients.

Here's a 1996 Life University grad talking about the environment.

My program at Life program seemed like that of any other school and I had no major problems until about halfway into the curriculum. During the eighth quarter of the 14-quarter system, the program became much more adversarial as we entered the outpatient clinic. This was our internship, where we were supposed to gain our clinical experience by treating the public. In earlier quarters, the school had taken extra effort to make us feel welcome. We were treated to free lunches, guided tours of the campus by friendly enthusiastic students, and free lodging when touring the campus. The clinic atmosphere was different. The instructors made it very clear that unless a long list of rules was followed, we would face suspension from the clinic and possible failure of that quarter's clinical internship. Infractions were outlined in a student handbook. Violations would result in either a warning or a suspension—known as a "pink slip." This system was unbelievably harsh. Students could find themselves suspended from clinic for such minor mistakes as forgetting to empty a cup of urine, not filling out a form completely, missing an appointment because of a miscommunication with a patient about the appointment date, or even wearing casual slacks rather than dress slacks.

In addition to this harsh system of rules, students were kept constantly busy by the demands of the clinic, academic classes, and national boards. My typical day would be to arise at 6 am, arrive early in the clinic in order to secure a place on a walk-in list for new patients. After doing this I would sit on a stool at one of four telephone stations where I and up to three other students would take turns answering the clinic's one telephone with the hope of finding new patients to treat.

Students who were not recruiting enough patients to pass the course became desperate. A large wooden sign hung in the hallway with carved letters that read "Whatever It Takes." Instructors advised us to use direct solicitation. They encouraged us to visit drugstores and to target people in pain. This approach was often difficult, because many local residents had been solicited so often that Life students were regarded as desperate and fanatical. Successful students targeted faculty and families with young children who could receive care at discounted rates. Many students paid their patients' clinic fees out of desperation.

In retrospect, this system of strict rules and harsh punishments resembles descriptions of how cults operate. Since students were kept busy, they had little time to question the teachings of the group; and the Draconian punishments encouraged conformity. Up to 30% of students failed this class and had to pay to retake it.

http://www.chirobase.org/03Edu/botnick.html

Imagine getting suspended from class for a week because you forgot to empty a cup of urine or wore the wrong pants. Imagine having to go recruit your own stent patients from asymptomatic people off the street. This should give you an idea of how chiropractic minds are created and why they are so hard to deprogram.

facetguy · Dec 13, 2012

cdmguy said:
Spec,

I'd recommend not wasting too much time.

Something I'm reminding myself of right now.

You have an alt med field that still praises vitalism, defines its scope around it and blatantly allows schools to teach techniques based on it. Further, every reformist association (NACM, orthopractic) that tried to just pare down the claims to musculoskeletal while still leaving a quack focus on preventing osteoarthritis with ineffective biomechanical subluxation treatment gathered an insignificant number of members and was rejected by mainstream associations, failed and went defunct.

Just because a small group...apparently a very, very small group... of chiropractors got together, proclaimed they should be the new leaders of the profession, and failed to gain that leadership doesn't mean anything. As if the entire profession was supposed to say "Gee look, Joe Schmoe feels he should be the new voice of chiropractic around the world. Well I guess we should just gather around him, pay him dues money, accept everything he says, and all will be right with the world...". How juvenile and naive are you? That's not how things work.

And the 'orthopractic' thing, as we've discussed before, was more of a business venture by an entrepreneurial MD...in Canada was it?...who also wanted to be the leader of an organization, except this time it was to be a new profession called Orthopractic, which he would lead, make all the rules, collect all the money, in turn for providing those gullible chiropractors with the promise of 'medical legitimacy'. Being an insecure chiropractor, you would have fallen for that, and perhaps did, I don't know. Please stop citing this as some example of how the chiropractic profession is somehow a bad profession.

When you think of it why in the world would a field that in many states has a wide "primary care" scope voluntarily limit it with no direct benefit and the massive PR loss that would occur from having to admit "yes by golly we did practice quackery-sorry!"?

That versus an anonymous chiro's unsupported assertion that it just isn't so. Do some schools have a naturopathic-esque scope (called "mixer") and more physical therapy methods? Sure. But those are the ones that also push other types of woo like acupuncture, ayurveda and homeopathy. Woo is endemic-whether you call it subluxation vitalism, chi or prana. It all accomplishes the same purpose-to allow treatment of a wide range of diseases that may walk in the door using unproven and debunked treatments and rationales.

SCUHS (Mixer school)
http://www.scuhs.edu/
Acupuncture program
Ayurveda program

Facet, back to your hole. Your misinformation isn't working here.

You keep saying this, yet you never bring anything meaningful to the conversation. You simply rehash the same goofy accusations over and over.

facetguy · Dec 13, 2012

SpecterGT260 said:
I still see many "BOOP" based theories being discussed by DCs in practice. (I like that term )

I also have used the word "cult" to describe the DC/pt relationship on many occasions.

The cult thing I disagree with, obviously.

The BOOP thing I think continues to exist, at least in large part, because it makes for an easy visual on the part of the patient. It's an easy way to explain things. That doesn't make it right, but I can understand why that's the case. It's sort of like a pediatrician being confronted by the anxious parent of a child with an ear infection, demanding an antibiotic. Does the pediatrician take the time to explain a bunch of literature that says the antibiotic may not be the best idea, or does he default to the quicker, simpler option of just writing the darn prescription and moving on to the next patient. (There are obvious differences in my comparison, not the least of which is the over-prescription of antibiotics which is proving to be a real problem.

)

facetguy · Dec 13, 2012

cdmguy said:
I'd go beyond that spec. The schools are educational cults and the students then use the methods on patients.

Here's a 1996 Life University grad talking about the environment.

Imagine getting suspended from class for a week because you forgot to empty a cup of urine or wore the wrong pants. Imagine having to go recruit your own stent patients from asymptomatic people off the street. This should give you an idea of how chiropractic minds are created and why they are so hard to deprogram.

I love how you cite yourself and expect us to take it as gospel.

And didn't Life lose it's accreditation for awhile for various shortfalls and problems with their educational standards? Yes, they did. Your story is pre-accreditation loss and therefore is meaningless today. I'm not saying Life is the greatest institution in the world, but it's cleaned up its act since you were there.

cdmguy · Dec 13, 2012

Hey I agree we have a communication problem F, but the failure is with the receiver not the sender or the message.

You intentionally or unintentionally misinterpret and minimize the significance of the message.

There is nothing I can do to help that and frankly I don't think you want help.

SpecterGT260 · Dec 13, 2012

Right... all those non-bacterial AOM cases....
I don't think pediatricians are prescribing antibiotics for most cases of OME.... some of your good gm- drugs are ototoxic to begin with.

pharyngitis would probably be a better one to go after.

cdmguy · Dec 13, 2012

facetguy said:
I love how you cite yourself and expect us to take it as gospel.

Not necessary, there is a link to the archived clinic handbook. Try reading the article next time.

Oh and I love this double standard where you do exactly the same thing then criticize others for it (ie. ridiculous assertion that somatovisceral treatment isn't relevant and practiced by many DCs and schools).

And didn't Life lose it's accreditation for awhile for various shortfalls and problems with their educational standards? Yes, they did. Your story is pre-accreditation loss and therefore is meaningless today. I'm not saying Life is the greatest institution in the world, but it's cleaned up its act since you were there.

Actually Life regained accreditation after suing the accreditor in 2001 and this weakens your assertion that the problems were addressed. If they hadn't sued they would have been permanently shut down for teaching false subluxation boilerplate diagnosis in place of the required differential diagnosis. They claimed the other schools were poaching patients (when Life lost accreditation some schools offered discounts to Life students to transfer and they left in droves). The judge Moye http://chirotalk.proboards.com/index.cgi?board=LifeU&action=display&thread=1908 was politically connected to Life's president and came out of retirement just to hear the case. He ignored the accreditor's safety arguments that Life's diagnosis system was endangering patients through premature diagnosis, unnecessary radiation from inappropriate xrays and there are many cases of students and faculty who died as a result of the problems.http://chirotalk.proboards.com/index.cgi?board=LifeU&action=print&thread=5067 The end result was a preliminary injuction restoring Life's accreditation and a settlement where just a few token hours of diagnosis were added to the curriculum and their continuing to teach premature diagnosis. Students attending the program are forced to make premature primary care diagnoses because they aren't allowed to order testing to rule out and confirm complaints.

http://chirotalk.proboards.com/index.cgi?board=badboards&action=display&thread=3571

I asked the US Dept of Education to produce evidence verifying the problems were corrected and they couldn't do it. US accreditation is a joke. It can't be anything other than sham because it allows any subject no matter how goofy (chiropractic, astrology, oriental medicine, acupuncture, naturopathy, etc).

F all you do is make assumptions and mislead people here. You are an untrustworthy source of information.

tiedyeddog · Dec 13, 2012

You guys going to give up here soon so we can let this thread die for awhile only to revive it in a few months?

SpecterGT260 · Dec 13, 2012

there has been a lot of revivals happening lately, hasnt there?

cdmguy · Dec 13, 2012

I'm cool with that. This gets old.

Ost3oclast · Dec 13, 2012

DCMBAMD · Dec 13, 2012

I am going to try to be as objective as I can be on here.. something many of you need to try. There seems to be a lot of misunderstanding and ignorance of other professions.

Background: Chiropractor for 12 years, MD for 4, MBA 6 years.

I practiced as a chiropractor for a few years and loved most of it. I opened 3 separate clinics and employed other chiros, MD's, DO's, PT's, and massage therapists. However, I realized that I wanted to know more and do more, so I sold everything and went back to med school (joint MBA program). Now I am in neurology (MSK and some pain).

Chiropractors are considered primary care physicians under Medicare standards, and do have a doctorate level degree. Do they have the training MDs have, NO. Do they have MSK training far beyond non-MSK related medical specialists, YES. However, the chiropractic profession is its own worst enemy. There is in-fighting and no consistent practice model. This is why many people are confused as to what chiropractic is and does.

Chiropractors do carry malpractice insurance (and for the ignorant here, many states do not require MDs to carry it, and many in those states do not). Most chiropractors carry more malpractice coverage, on average, than MDs, mostly because it is cheaper. Example.. My state's chiropractic coverage for 1mil/3mil is $730/year, same coverage for family medicine is $10,300 a year (after your first two years of introductory reduced pricing). The reason in the difference, chiropractors get sued far less often.

As to people who say they've seen these carotid dissections, I'd like to see that. I do neuro... my wife is a plaintiff's attorney.. if these cases were out there as you exclaim, I would have seen a lot and my wife would be suing these people. I've adjusted around 100 people a week on average for give or take a decade..Even in med school and residency. So, let's say 5,000 cervical manipulations a year, or 50,000. I have NEVER.. not once, EVER had one complaint, ailment, stroke-like symptom, dissection, etc.. EVER. I can also account for at least 4-5 of my closest friends, with similar states, who also have NEVER had one incident. Can any medical professional say they have never had a severe side effect from a medication or complication for a procedure?

I've never seen non-pathological disc herniation from a spinal manipulation, this is almost anatomically impossible due to ligamentous and musclular structure of the spine, as well as the zygapophysial joints which prevent the extreme rotation required to mechanically cause a herniation. I would agree a previous herniation would exacerbate, but how would one know without MRI, which would be the same case as a PT treating.

For people who are searching for some abstract on the success or failure of chiropractic, please look up the same data on surgery and medicine. Look at medical malpractice being one of the leading causes of death in the US. I guess you overlook those studies and say they are faulty. If you have really been to med school and passed the steps, you know how to analyze the data from biostats and epidemiology classes.

Most studies show chiropractic is as effective, if not more, for LBP than conventional medical treatment.. but FM and IM docs keep scripting NSAIDs that cause GI bleeds, liver and kidney damage, etc.

So.. here is the TRUTH.. do many chiros have wacky ideas.. absolutely. Do many of them use cheesy sales tactics, you bet. Do some claim to cure things that just don't seem legit.. oh yea.. Is there a lot that they do that doesn't have sound empirical, evidence based data behind it, Yep! (so does the application of most off-label scripts..but who's counting, right?). Do MDs get way more in depth education on many subjects and a heap more training.. God yes... Does it make me realize why MDs don't like chiros calling themselves "doctor"?..I do now.

There were many things that I didn't like about the profession of chiropractic. However... I can tell you, as a medically trained professional, that a "good" chiropractor will help patients with LBP, headaches, and 3-4 other common problems. Should they be seen X number of visits, with care plans for months, etc.. HECK NO! I have had patients with odd conditions, chronic ones... that were never "cured" until I adjusted them. Did I tell them I did that or that the adjustment cured it.. NOT ONCE. But, do I understand nerve pressure causes dysfunction and relieving that pressure could help restore it, Yes.. I think we all do. If you believe that a small change in the diameter of an arteriole makes a huge difference, then why not believe that moving a boney structure that could be impinging a nerve through a narrow foramen could restore that nerve's normal function?

Do more research before you bash someone. From the deceased Rodney King.. can't we all just get along?..

PS. Sorry for any typos, I am in the passenger side of my car heading on vacation..

SpecterGT260 · Dec 13, 2012

I suspect that you spent less time reading and more time assigning points to each time based on the connotation of the perceived position....

cdmguy · Dec 13, 2012

I once calculated the odds of an individual DC seriously stroking someone out. It came out to be a 50% probability of causing one stroke case in a 20 year career. Now since chiropractic manipulations are delivered irrespective of medical necessity and there are 60,000 DCs in the USA with that 50% risk it reveals that chiropractors cause 1500 strokes per year. Let's say that 30% are a result of subluxation analysis and delivering unwarranted care. This means that 500 people would die per year across the USA and you wouldn't even know it. This is why personal observation means nothing.

Futher, all the malpractice data is screened through chiropractically owned malpractice insurance companies so the true reporting numbers are much higher.

JGimpel · Dec 13, 2012

I've taken the time to read through this entire thread and I wanted to add another dynamic here that I'm surprised hasn't come up. As a DO, if anything related to OMM is brought up by either the patient or myself, the patient usually says something to the effect that I'm kind of like a Chiropractor, often implying that this is the sum total of my education and skills. I try to be polite and tell them that we do offer all of the things that an MD can, such as management of disease with medicine and surgery, but we are, IN ADDITION, trained on elements of physical therapy and manipulation of the spine, but the emphasis is on less High Velocity techniques than on a combination of effective and less invasive ones. I'm not ready to throw a right-cross until they follow up with comparing me to a massage therapist with a prescription pad and a scalpel.

The unfortunate truth is that the leaders of our profession keep us hidden under some veil of mystery like some kids at Hogwart's. There is no education of the public as to what we can do and what the uniqueness of our TRAINING, not our actual practice in the real world (we're not allowed to do the more risky treatments like HVLA at any hospital anyways), so we're left having to explain why we're not a chiropractor and why we're able to do the same things as an MD can. The points about the vertebral arteries are well taken and form the basis of many rules made by risk management specific to DOs. I kick back pain's a** every day and am proud of it, but I do it with the safest methods as most of ours have far less evidence to base it on than most standard of care.

The DC's, on the other hand, have one hell of a PR team and everyone knows what a DC can do, and probably buys into some of the "peripheral" treatments they're barely able to sell under the guidelines of their "medical" license. We share the space on www.quackwatch.com with them and probably always will, and that's the perspective I wanted to offer. I spent enough time in a chiropractor's office to see the exact same choreographed treatment performed on every patient that came in, no matter what the ailment or even if there was none at all, in which case it was and "adjustment" likened to changing the oil in a car every couple thousand miles. You have to work on the muscle attached to the painful bone so it doesn't get pulled back to the site of dysfunction, and DCs don't focus on that; plain and simple.

Any DC, DO or MD that prevents a child from getting vaccinated will loose his/her license eventually as a kid dies because of it; that problem solves itself in enough time. Yes, there may be a touch of mercury in some of them, what Dr. Still started this side of medicine for, but if you're truly scared of this preservative, you can ask for a thiomercury-free version that may take a week to order and get in, but that's the extent of the issue and that metal is about as rare in vaccines as it is in your Cheerios wolfed down between rounds.

Now, when a fellow resident or attending asks me to come work my voodoo on them, I laugh and graciously perform small miracles and make little gremlins fly from their bones, but I will rarely do HVLA on them and never anything close to cranial manipulation as the former is contraindicated in most of the aged population we take care of (many of our attendings are pretty old too) and the latter will get you barred from any chief positions for sure. The DO profession is still a closed union shop that extorts thousands of dollars from us over the life of our professional careers, but please remember, your employment contracts are renewed on an annual basis and at will where most of you will end up working. And that time on a PET scanner to prove any of the above DC or DO treatments is better spent staging cancer patients or finding tumors, so I doubt much empirical evidence will be paid for by NIH, the state of Texas or anyone else for some time, if at all. The going rate for FDG is in the thousands, per patient, per exam; try justifying it's use in a large double-blinded cohort to your IRB and see what happens.

SpecterGT260 · Dec 13, 2012

I don't believe there is any mercury still in any of them........

I'm sorry but this thread is attracting a series of unverified noobs (means in all due respect)..... but anyone can claim to be anyone on the internet.

facetguy · Dec 13, 2012

cdmguy said:
I once calculated the odds of an individual DC seriously stroking someone out. It came out to be a 50% probability of causing one stroke case in a 20 year career. Now since chiropractic manipulations are delivered irrespective of medical necessity and there are 60,000 DCs in the USA with that 50% risk it reveals that chiropractors cause 1500 strokes per year. Let's say that 30% are a result of subluxation analysis and delivering unwarranted care. This means that 500 people would die per year across the USA and you wouldn't even know it. This is why personal observation means nothing.

I'm trying to be nicer to you. But you make it difficult.

You forgot to include "When I was drunk, I once calculated..."

When you get desperate, you always go back to the stroke issue for its sensationalism and fear-mongering. Similar to DCMBAMD's experience, I know a lot of chiropractors who have been in practice a long time, and I don't know ONE who has "seriously stroked someone out", as you would say. Now you come along with your nonsense calculations and expect everyone here to believe that each chiro has a 50% probability? How do you continue to delude yourself for all these years??

cdmguy · Dec 13, 2012

I agree with Harriet Hall's articles about chiropractically induced strokes posted on the ScienceBasedMedicine blog. All interested parties should check them out.

In an earlier study, patients under 45 who suffered a vertebrobasilar stroke were 5 times more likely than controls to have had neck manipulations in the previous week. The actual magnitude of the risk is impossible to quantify, and perceptions differ. There is reason to believe that many cases are not recognized or reported. Typically, a single chiropractor was aware of each case of manipulation-related dissection while 3-4 neurologists were involved in the patient's treatment. 1 out of every 48 chiropractors and 1 of 2 neurologists were aware of a case over their lifetime.
Despite some loud protestations, chiropractors do acknowledge the risk. Provocative testing before cervical manipulation is widely recommended in the chiropractic literature. The validity of such testing is questionable, and at any rate the HVLA maneuver is not part of the provocative test and it is the likely culprit. Regardless of the magnitude of risk, the existence of a risk is undeniable and patients should know there is a risk before they agree to treatment. The Association of Chiropractic Colleges suggests informed consent but does not mandate it. Even knowing about the risk won't protect patients entirely. I know of one case where a patient fully intended to avoid neck manipulation, yet the chiropractor manipulated her neck without any warning and she suffered an immediate stroke on the table. And there wasn't even any indication for neck manipulation: she was being treated for shoulder pain, not neck pain.
It's been said before, but I'll say it again: any degree of risk is unacceptable when there is no benefit. A Cochrane systematic review has shown that HVLA manipulations are no more effective for neck pain than gentle mobilization and that neither is effective unless used in conjunction with an exercise program. And there is even less evidence for benefit in non-neck-related conditions. NUCCA practitioners and other chiropractors who manipulate necks for almost any complaint are clearly out of line.
http://www.sciencebasedmedicine.org/index.php/chiropractic-strokes-again-an-update/

Here is the formula I used to come up with that stroke risk:
http://chirotalk.proboards.com/index.cgi?board=victims&action=display&n=1&thread=3085

Note that the actual number I came up with was 355 not 1500. I stand by that older figure (355) rather than the later quick estimate (1,500).

JGimple, thanks for discussing how DOs safeguard patient safety by limiting neck HVLAs as much as possible. It makes a good contrast to DC practice.

facetguy · Dec 13, 2012

JGimpel said:
I've taken the time to read through this entire thread and I wanted to add another dynamic here that I'm surprised hasn't come up. As a DO, if anything related to OMM is brought up by either the patient or myself, the patient usually says something to the effect that I'm kind of like a Chiropractor, often implying that this is the sum total of my education and skills. I try to be polite and tell them that we do offer all of the things that an MD can, such as management of disease with medicine and surgery, but we are, IN ADDITION, trained on elements of physical therapy and manipulation of the spine, but the emphasis is on less High Velocity techniques than on a combination of effective and less invasive ones. I'm not ready to throw a right-cross until they follow up with comparing me to a massage therapist with a prescription pad and a scalpel.

I can't tell if you are implying that the non-HVLA techniques are more effective than HVLA techniques?

And I'm not so sure that DO education doesn't emphasize HVLA. Whenever a patient mentions to me that they have been manipulated by a DO (it's not often, by the way), it's always HVLA.

In addition, when I was being given a tour of a DO school on interview day a few years ago, the 2 DO students giving the tour took us into the OMT room, one lay down supine and the other, for purposes of demonstration of OMM, performed HVLA on his classmate. He could have chosen any number of techniques, but he chose to impress us all with cervical HVLA. And, for the record, the demonstration was not impressive (at least not to someone who knew better).

I'll also mention a recent case. It was an older woman with neck pain who was referred by her DO PCP, and the script he wrote said "HVLA cervical spine". Now, I certainly appreciate the referral and the DO's recognition of the beneficial role that DCs play. But this was a patient that I would NEVER perform HVLA upon, yet that's exactly what he recommended. I recognized the practice name but not the DO's name, and when I asked the patient about him, she said he was "just out of school".

The unfortunate truth is that the leaders of our profession keep us hidden under some veil of mystery like some kids at Hogwart's. There is no education of the public as to what we can do and what the uniqueness of our TRAINING, not our actual practice in the real world (we're not allowed to do the more risky treatments like HVLA at any hospital anyways), so we're left having to explain why we're not a chiropractor and why we're able to do the same things as an MD can. The points about the vertebral arteries are well taken and form the basis of many rules made by risk management specific to DOs. I kick back pain's a** every day and am proud of it, but I do it with the safest methods as most of ours have far less evidence to base it on than most standard of care.

The unfortunate truth is that most of your DO classmates and colleagues don't give a darn about OMM, and they are probably openly criticizing it. Anyone who has spent 10 minutes on the DO subforums can tell you this. With so few DOs being pro-OMM, it's no wonder the public doesn't understand your training. I could be even more critical and say that DO schools are full of students who wanted to be MDs but didn't get in and therefore have zero interest in OMM, but I won't go that far because I know it's not true in every case.

The DC's, on the other hand, have one hell of a PR team and everyone knows what a DC can do, and probably buys into some of the "peripheral" treatments they're barely able to sell under the guidelines of their "medical" license. We share the space on www.quackwatch.com with them and probably always will, and that's the perspective I wanted to offer. I spent enough time in a chiropractor's office to see the exact same choreographed treatment performed on every patient that came in, no matter what the ailment or even if there was none at all, in which case it was and "adjustment" likened to changing the oil in a car every couple thousand miles. You have to work on the muscle attached to the painful bone so it doesn't get pulled back to the site of dysfunction, and DCs don't focus on that; plain and simple.

I'll never understand it when I hear someone say that DCs have a great PR team and/or great lobbying strength. As a DC, I wish that were true. We are a relatively small profession that lacks any form of large donors or financial supporters (think Pharma). We speak with a non-unified voice since we have 2 national organizations and each state often has multiple state organizations. And, in my view, the public doesn't have that crystal clear understanding of what we do that you might think they have. We barely have any PR effort and even less lobbying.

Now, about the issue of needing to work on the muscle etc. The implication here is that chiros have one speed: HVLA. Truth is, most DCs are well aware of the importance of the soft tissues and do lots of that treatment; I know I do a ton of it everyday. Perhaps the chiro office you mentioned spending time in didn't do much soft tissue work, but I would remind you to not paint with such a broad brush.

Any DC, DO or MD that prevents a child from getting vaccinated will loose his/her license eventually as a kid dies because of it; that problem solves itself in enough time. Yes, there may be a touch of mercury in some of them, what Dr. Still started this side of medicine for, but if you're truly scared of this preservative, you can ask for a thiomercury-free version that may take a week to order and get in, but that's the extent of the issue and that metal is about as rare in vaccines as it is in your Cheerios wolfed down between rounds.

Now, when a fellow resident or attending asks me to come work my voodoo on them, I laugh and graciously perform small miracles and make little gremlins fly from their bones, but I will rarely do HVLA on them and never anything close to cranial manipulation as the former is contraindicated in most of the aged population we take care of (many of our attendings are pretty old too) and the latter will get you barred from any chief positions for sure. The DO profession is still a closed union shop that extorts thousands of dollars from us over the life of our professional careers, but please remember, your employment contracts are renewed on an annual basis and at will where most of you will end up working. And that time on a PET scanner to prove any of the above DC or DO treatments is better spent staging cancer patients or finding tumors, so I doubt much empirical evidence will be paid for by NIH, the state of Texas or anyone else for some time, if at all. The going rate for FDG is in the thousands, per patient, per exam; try justifying it's use in a large double-blinded cohort to your IRB and see what happens.

JGimpel · Dec 13, 2012

I agree that HVLA is more about showmanship and less about treating the patient, because it looks cool in a demo to family or prospective students, whether a DC or DO is doing it. A DO or DC that makes HVLA a large part of his practice to people with contraindications to it is inviting a great deal of litigation, not unlike an OB/GYN does, and I choose to only do it on others if I've gone through it with another DO recently and if there is no other technique to get the patient fully adjusted. HVLA on anyone in their 60's and beyond just for the sake of doing it is irresponsible.

With regard to DOs using OMM, I will agree with you on this point as well.
The way it works is that students go to DO school for one reason or another. By the end of the first year, they're still pumped about being a DO, but do notice some of the chatter from the upperclassmen about "stuff."

By the time they finish their second year, they've heard enough stories of their leaders doing crazy things while drunk or high or whatever and they get the idea that they can do the same thing...and start failing things. Trust me, a lot more shenanigans happen on an almost monthly basis that is thoroughly embarrassing to our profession but is quickly hidden so nobody can find more things wrong with us. Run a public records search on the leadership at each new school in the old state they used to be in and you'll find lots of interesting things.

The COMLEX is a huge wake-up call where they realize that their education has failed to prepare them for this very strange test and many retake it multiple times. At this point, the NBOME becomes their nemesis and the AOA seems too aloof to care about problems the students are going through.

They are allowed to start their clinical rotations and find out that it wasn't just them that "winged it" in OMM, that every DO hospital they go to seems to have just become a DO hospital for the money, or because no other doctors would work in such an underserved area. By now, they don't care about OMM, the AOA and hate the NBOME with a vengeance.

It only gets better in residency when you find out that you're evaluated on efficiency and doing OMM on a significant number of your patients just gets you dinged by your PD in the end, so you definitely cut down on it.

At this point, I don't have much respect for the AOA, the NBOME and the practice of OMM at all and neither do the people in the field I interact with on a regular basis. I thought it would be interesting to show you the progression as well as my agreement with you on that topic.

There is a huge difference in training between a DC and a DO and I ask that the DCs remember this when treating their patients or professing their expertise on a subject. Both camps get enough ribbing about the whole "rack 'em and crack 'em" style of medicine that can be used, but I went to DO school so could use as many tools as possible, even if a lot of it isn't evidence based. Getting into DO school is easier now than it's ever been due to the new schools exploding out there and I guarantee that you and a large amount of your fellow classmates could have gone to DO school if they wanted to, but chose not to and must stay with that decision now.

ophthope · Dec 14, 2012

I would just like to be the voice of reason here and point out that everyone arguing with the Chiropractor is, at the end of the day, trying to win an argument with someone who basically sells placebo therapy all day long and actually believes that it is working. When presented with evidence to the contrary they either 1. say the study didn't look at the real issues and there is still 'so much we don't know' or something to that effect or 2. point to their own ridiculous, contrived studies that in no way prove efficacy. They are all very polite and have that schmoozy college guy feel to them because it's what sells, and at the end of the day when their head hits the pillow I don't think they even care that they are taking people's money for doing basically nothing for them.

This is not someone whose opinion you will change with a debate.

If you want to win the argument then sell allopathic medicine to patients better because we have much better evidence that our treatments work! And at the end of the day this guy's patients are probably walking out of his clinic after being sold what is basically snake oil and paying in cash and leaving happy. This is what we need to be able to replicate.

cdmguy · Dec 14, 2012

50% of them aren't happy when their necks are sore and they feel worse because the manipulations are a biomechanical crapshoot. The outcomes aren't as great as you think. But overall, yeah.

SpecterGT260 · Dec 14, 2012

ophthope said:
I would just like to be the voice of reason here and point out that everyone arguing with the Chiropractor is, at the end of the day, trying to win an argument with someone who basically sells placebo therapy all day long and actually believes that it is working. When presented with evidence to the contrary they either 1. say the study didn't look at the real issues and there is still 'so much we don't know' or something to that effect or 2. point to their own ridiculous, contrived studies that in no way prove efficacy. They are all very polite and have that schmoozy college guy feel to them because it's what sells, and at the end of the day when their head hits the pillow I don't think they even care that they are taking people's money for doing basically nothing for them.

This is not someone whose opinion you will change with a debate.

If you want to win the argument then sell allopathic medicine to patients better because we have much better evidence that our treatments work! And at the end of the day this guy's patients are probably walking out of his clinic after being sold what is basically snake oil and paying in cash and leaving happy. This is what we need to be able to replicate.

SpecterGT260 said:
I don't have any hopes of convincing facetguy of anything. On occasion he and I see eye to eye, more often than not we dont. Its been the name of the game for several threads like this. But with any luck those who are lurking will learn something, gain some ammo for their own discussions, or gain a new perspective. It isn't necessarily about making Facetguy see things my way.

We covered that

It isn't always about making the person you disagree with see your side.

Sent from my DROID RAZR using SDN Mobile

facetguy · Dec 14, 2012

cdmguy said:
50% of them aren't happy when their necks are sore and they feel worse because the manipulations are a biomechanical crapshoot. The outcomes aren't as great as you think. But overall, yeah.

Will you ever stop making **** up out of thin air?? "50% of them aren't happy..."?? Dude, attacking chiropractic from a patient satisfaction standpoint is arguably the absolute worst approach you can take because multiple studies/surveys consistently show patient satisfaction ratings to be OFF THE CHARTS when it comes to chiropractic. Look them up for a change. More likely, you knew this already but hoped you'd get by due to the fact that nobody reading along knows it. That ain't gonna work.

SpecterGT260 · Dec 14, 2012

facetguy said:
Will you ever stop making **** up out of thin air?? "50% of them aren't happy..."?? Dude, attacking chiropractic from a patient satisfaction standpoint is arguably the absolute worst approach you can take because multiple studies/surveys consistently show patient satisfaction ratings to be OFF THE CHARTS when it comes to chiropractic. Look them up for a change. More likely, you knew this already but hoped you'd get by due to the fact that nobody reading along knows it. That ain't gonna work.

This I would agree w. Hence the description of "cult" earlier. The patients are almost ready to go to war for chiro

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facetguy · Dec 14, 2012

ophthope said:
I would just like to be the voice of reason here and point out that everyone arguing with the Chiropractor is, at the end of the day, trying to win an argument with someone who basically sells placebo therapy all day long and actually believes that it is working. When presented with evidence to the contrary they either 1. say the study didn't look at the real issues and there is still 'so much we don't know' or something to that effect or 2. point to their own ridiculous, contrived studies that in no way prove efficacy. They are all very polite and have that schmoozy college guy feel to them because it's what sells, and at the end of the day when their head hits the pillow I don't think they even care that they are taking people's money for doing basically nothing for them.

This is not someone whose opinion you will change with a debate.

If you want to win the argument then sell allopathic medicine to patients better because we have much better evidence that our treatments work! And at the end of the day this guy's patients are probably walking out of his clinic after being sold what is basically snake oil and paying in cash and leaving happy. This is what we need to be able to replicate.

Good sir, may I suggest you begin to do some of your own reading/inquiry/research instead of parroting what you've been told by others?

Understand that when you say that chiropractic is all placebo, that is an automatic red flag that you haven't done your due diligence. Yes, you'll sound cool among people who are like-minded. But you'll sound woefully ill-informed among those who are informed on the subject.

There's a reason why spinal manipulation is recommended for both acute and chronic LBP by the North American Spine Society, the American Pain Society, the American College of Physicians, and Clinical Practice Guidelines from literally around the world. Look them up. This isn't a coincidence. This isn't an oversight. And notice that these aren't chiropractic groups publishing this stuff.

Realize that when you say chiropractic doesn't work, you are at the same time saying nothing else works either. Would you ever say PT doesn't work for these patients? Would you ever say various spinal injections don't work for these patients? Would you ever say the usual medications (e.g., muscle relaxers) don't work for these patients? Well guess what? The data on these treatments ain't all that great either; look it up for yourself (or look around these threads because these citations are scattered around somewhere). And also realize that NOTHING has been shown to be more effective than spinal manipulation for these cases. Manipulation may not always be head and shoulders above the rest of the usual treatments, but it's rarely if ever worse and often better. These studies are out there, and they haven't all been done by chiros either.

So if you're going to step into the arena, do your homework.

facetguy · Dec 14, 2012

SpecterGT260 said:
This I would agree w. Hence the description of "cult" earlier. The patients are almost ready to go to war for chiro

Sent from my DROID RAZR using SDN Mobile

Or maybe...just maybe...they are satisfied with their experience?? Could it be? And these studies usually tie satisfaction with outcome, so something is working for these people. Yes, I know, it's all placebo, or it's the spell we cast upon all of our patients, or something. (Don't tell anybody, but the trick is to mix the Cool-Aid just strong enough to control their minds but not kill them.

)

DCMBAMD · Dec 14, 2012

I love these stats people come up with. How about calculate this.. How people die within one week of either 1) visiting their physician 2) visiting the dentist, or 3) taking an OTC or rx medication. I'm sure the numbers would be off the chart.

If one is smart enough you can either make any stat favor your cause or call BS on a stat when you see it. I know one stat.. 100% of people who go to a doctor die.. So by your poor logical argument, physicians kill all their patients. Look, we found a causal link, by the stats, correct?

Here is an idea.. Some of the chiro haters should learn a little more before they keep bashing..

cdmguy · Dec 14, 2012

Thin air? This is from a 2005 study in Spine. They found 30-50% AE rates.

Chiropractic Therapy for Neck Pain May Have High Rate of Adverse Reactions
News Author: Laurie Barclay, MD
Laurie Barclay, MD
is a freelance writer for Medscape.

July 8, 2005 — Chiropractic therapy for neck pain has a high rate of adverse reactions, according to the results of a randomized study published in the July 1 issue of Spine. The investigators suggest that if chiropractic treatment is needed, mobilization is better than manipulation.

"Chiropractic care is frequently sought by patients for relief from neck pain; however, adverse reactions related to its primary modes of treatment have not been well examined," write Eric L. Hurwitz, DC, PhD, from the UCLA School of Public Health in Los Angeles, California, and colleagues. "Recent observational studies have shown that within hours after treatment, nearly a third to a half of chiropractic patients have transient unpleasant reactions such as discomfort, increased pain or stiffness, radiating symptoms, headache, and tiredness, and minor adverse reactions have been noted in recent clinical trials assessing the effectiveness of manual therapies and methods commonly used by chiropractors."

At four southern California health care clinics, 336 patients with neck pain were randomized in a balanced 2×2×2 factorial design to manipulation with or without heat, and with or without electrical muscle stimulation (EMS); and mobilization with or without heat and with or without EMS. Two weeks after the randomization and baseline visit, patients assessed their own discomfort or unpleasant reactions from chiropractic care.

Of 280 participants (83%) who responded, 85 (30.4%) reported 212 adverse symptoms after chiropractic care. The most common symptom was increased neck pain or stiffness, reported by 25% of the participants; headache and radiating pain were less common.

Compared with patients randomized to mobilization, those randomized to manipulation were more likely to report an adverse symptom occurring within 24 hours of treatment (adjusted odds ratio [OR], 1.44, 95% confidence interval [CI], 0.83 - 2.49).

Although heat (OR, 0.94; 95% CI, 0.54 - 1.62, and EMS (OR, 1.09; 95% CI, 0.63 - 1.89) were only weakly associated with adverse symptoms, moderate-to-severe neck disability at baseline was strongly associated with adverse neurologic symptoms (OR, 5.70; 95% CI, 1.49 - 21.80).

Study limitations include potential outcome misclassification, confounding, lack of generalizability, and the imprecision of estimates.

"Our results suggest that adverse reactions to chiropractic care for neck pain are common and that despite somewhat imprecise estimation, adverse reactions appear more likely to follow cervical spine manipulation than mobilization," the authors write.

"Given the possible higher risk of adverse reactions and lack of demonstrated effectiveness of manipulation over mobilization, chiropractors should consider a conservative approach for applying manipulation to their patients, especially those with severe neck pain."

The Health Resources and Services Administration and the National Chiropractic Mutual Insurance Company supported this study (NCMIC), and Dr. Hurwitz was supported by a grant from the National Center for Complementary and Alternative Medicine. No benefits in any form have been or will be received from a commercial party related directly or indirectly to this study.
Spine. 2005;30:1477-1484

Read more: http://chirotalk.proboards.com/index.cgi?board=resource&action=display&thread=1885#ixzz2F2IN6jEP

facetguy · Dec 14, 2012

cdmguy said:
Thin air? This is from a 2005 study in Spine. And it was 30% not 50% (damn memory).

First, you're mixing adverse reactions with patient satisfaction. But anyway...

Here's a news flash: "Nealry 100% of people exercising at a health club experience adverse reactions because they get sore after working out!". That settles it, no one should ever exercise again by your logic.

Realize what these "adverse reactions" are: transient soreness, usually lasting not longer than 24 hours. Gee, that sounds horrible. And, yes, if you crank on someone's neck when they are experiencing acute neck pain, yes it's going to hurt. So you work around that, do other things, modify your approach. Oh, wait, chiros are incapable of doing that because we only have one speed: HVLA as hard as you can.

What else ya got?

JGimpel · Dec 14, 2012

Patients come in for a treatment, they get "popped" with HVLA, then are told to take Aleve and drink plenty of fluids and they usually feel better the same day. Not a very scientific process to follow with lots of confounders but that's a lot of what occurs at DC and DO practices. I wouldn't hang my hat on this phenomenon no matter which area I'm a part of.

If you can't tell already, I'm strongly DO and proud, but there are many things wrong with our profession that is nailing the coffin down on it pretty quickly and I wish more people would do something about it but don't. The least I can do is do a reality check for people once in a while. We're still recovering from the ACGME taking over our residency accreditation process, thank goodness, and another DD (Dean DUI) and that was just in the last few months.

I am trained in medicine and surgery and support either one of those with a full knowledge of pharmacology and physiology, that is why I'm called a doctor and it will have taken a decade of my life to earn that right by the time I'm doing true patient care.

A DC, NP, CRNA or PA that calls himself a doctor with not even half the training or experience will have no place in my practice or sit at the hospital governance committees where I work. DCs are already barred from most hospitals, I've never seen one note from one on the hundreds if not a couple of thousand charts I've put any of my ink in. NPs don't have a role in most hospitals that I've been through, CRNAs kill people and anesthesiologists are already tired of putting down their Sudoku and saving a patient that has decompensated because the dial on the can on the right wasn't adjusted when the blood pressure got too low. Argue with me once about keeping the BP appropriate while I've got a tourniquet on the patient and see what happens. PAs can manage blood pressure and diabetes meds but know exactly what place they play in the health care world and if they overstep or don't consult us with a case beyond their training, they're gone and one of the other thousand classmates that have graduated from their respective diploma mills will gladly take their place.

The salary for any of these jobs will soon cap out at 65K in most rural areas and 80K in most cities, so the gravy train will stop and some will stop trying to do these jobs and actually make the leap in going to medical school. Be an FP with full autonomy and a salary commensurate with your training and education that is qualified to do ALL of the above. You picked your boat to float in, stop trying to paddle upstream.

DCMBAMD · Dec 14, 2012

I wonder what the adverse reaction rates to people getting their blood taken is? I'd guess over 95%. I am ashamed by the bad logic some on here are using.. Put down the micro book and learn some logical reasoning. This is one reason attorneys beat closed minded, and narrowly educated physicians.. You can recite mechanisms of action, but can't THINK for yourself.

Don't make yourself look ignorant.. I can argue for and against chiropractic and medicine.. Because I am intimately familiar with both and I can actually objectively analyze data.

I hope the people arguing are medical students.. This would make me feel better to know that naive, young kids who have never had a job and still trying to figure out what their favorite color is.

DCMBAMD · Dec 14, 2012

This is funny.. I just had 5 family docs and one boarded ER send me resumes from a $90/hr job.. A year ago I couldn't get a plumber that cheap.

ophthope · Dec 14, 2012

facetguy said:
Good sir, may I suggest you begin to do some of your own reading/inquiry/research instead of parroting what you've been told by others?

Understand that when you say that chiropractic is all placebo, that is an automatic red flag that you haven't done your due diligence. Yes, you'll sound cool among people who are like-minded. But you'll sound woefully ill-informed among those who are informed on the subject.

There's a reason why spinal manipulation is recommended for both acute and chronic LBP by the North American Spine Society, the American Pain Society, the American College of Physicians, and Clinical Practice Guidelines from literally around the world. Look them up. This isn't a coincidence. This isn't an oversight. And notice that these aren't chiropractic groups publishing this stuff.

Realize that when you say chiropractic doesn't work, you are at the same time saying nothing else works either. Would you ever say PT doesn't work for these patients? Would you ever say various spinal injections don't work for these patients? Would you ever say the usual medications (e.g., muscle relaxers) don't work for these patients? Well guess what? The data on these treatments ain't all that great either; look it up for yourself (or look around these threads because these citations are scattered around somewhere). And also realize that NOTHING has been shown to be more effective than spinal manipulation for these cases. Manipulation may not always be head and shoulders above the rest of the usual treatments, but it's rarely if ever worse and often better. These studies are out there, and they haven't all been done by chiros either.

So if you're going to step into the arena, do your homework.

I am aware that the one indication for a Chiropractor's services is low back pain. Of the chiropractors I am familiar with, low back pain patients are a minority in their clinics. Instead they are manipulating children for Otitis Media and telling people not to vaccinate their children and to take more and more unstudied supplements. I said mostly placebo and I stick by that - MOST of the time a Chiro does an adjustment it is not for lower back pain or even for other issues that could be treated by physical therapy and as such might be treated well by chiropractic services too.

Do you have any data that shows that most chiropractors stick to treating lower back pain?

I thought the vitriol for Chiropractors by MDs was harsh until I met some Chiropractors and heard how they talk about real, proven allopathic medicine. MOST of you chiropractors don't even stick to adjustments and manipulation - of the ten or so Chiros in my area only ONE OF THEM doesn't have anti-vaccination propaganda posters or some other such nonsense visible on their clinic walls. In the 30 minutes I was in a Chiropractor's office this week I heard that chiro lambast real, proven, modern medical treatments for 2 different patients' illnesses to the patient. She seriously recommended therapy with magnets because it makes the tissue "heal itself." So I, quite honestly, think the pushback from MDs and DOs is good, because you guys are behind the scenes trying to convince people that alternative medicine is as good as conventional medicine for treating illness and someone HAS to be the voice of reason in a society where people are so easily swayed.

Do you have any data about how many chiropractors are anti-vaccination? Or how many also think that completely disproven therapies are efficacious?

And I've seen your posts - but you are going to have a hard time convincing us that "most Chiropractors" don't do this stuff. If I was forced to estimate it I'd say from my experience 9/10 Chiros are BAD for patients. It would be great if that was wrong, but as long as the chiropractor is selling magnet therapy and 'light pulse' therapy and telling people not to get vaccinated they are harming patients and wasting health care dollars.

DCMBAMD · Dec 14, 2012

What med school are you at? You sure seem to have a lot of time to visit chiro offices.

But, I agree with you on the over zealous nature of anti-vaccination talk, far out therapies and medical bashing. Most of this comes from the same place you are coming from... Ignorance. Chiros are not taught the medical model and its theories, etc. therefore when the authority figures in chiro say something wacky, there sheep go along with it. No unlike the "only medicine is the answer" montra of physicians. You preach what you know, which at your level isn't much. It is soooo funny to see so many medical practices trying to be more alternative and natural, yet so many alternative health clinics trying to be more medical.

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