Chiropractic

Anecdotally, I have heard that chiropractors and physical therapists are at odds. Much of this tension is supposedly due to the overlap in services that these practitioners provide and the level of autonomy within each profession. I have also heard that the Doctor of Physical Therapy degree is a political effort to "level the playing field" between chiropractors and physical therapists. Have any of you heard similarly? Also, have any of you encountered a situation in which chiropractors and physical therapists worked collaboratively, perhaps alongside a PM&R physician, massage therapist, or other professionals?

Not all services overlap. Some chiropractors are chiropractic radiologists; some have diplomats in nutrition, internal medicine and forensics to name a few. I don't think there are any specialties within physical therapy that are similar to these. Its the vision of the APTA to level the playing field but I think chiropractic has a big time head start and do not see the PT profession catching up.

Most people, when they think of chiropractic, think about the back or the spine and also manipulation. "Got a bad back? See a chiropractor". Nothing will ever change that. If people are interested in being treated with manipulation they will seek the services of a chiropractor. I think chiropractors and physical therapists shouldn't worry as much about each other and should be worrying more about massage therapists.

There are many groups out there that are multidiscipline. I we all work well together. I would love to be the one adjusting patients all day. Let the therapist do their thing so I don't have to. I really do not see this type of practice hanging around for a long time because of the way insurance reimbursement is and is headed. Those facilities have huge overhead and require big reimbursement to stay afloat. This requires doing most of the billing through the MD, which is starting to be very closely monitored by the insurance companies.

HAHAHAHAHA!!!

A chiropractor with a "diplomate" (which means nothing) in internal medicine?? From where, disney world? Who told you this?

PLEASE DO NOT CONFUSE A DC "DIPLOMATE" vs RESIDENCY TRAINED MD OR DO! BIG HELLAVA DIFFERENCE.

Freeeedom! said:

HAHAHAHAHA!!!

A chiropractor with a "diplomate" (which means nothing) in internal medicine?? From where, disney world? Who told you this?

PLEASE DO NOT CONFUSE A DC "DIPLOMATE" vs RESIDENCY TRAINED MD OR DO! BIG HELLAVA DIFFERENCE.

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I don't think that he's confusing DC diplomates with board certified/ eligible MD/DO's. He's just pointing out that there are differences in the scope of practice regulations for DPT's and DC's.

PublicHealth said:

Oh, and the Canadiens kick ass!

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They have a bright future with Bob Gainey as GM.

Freeeedom! said:

HAHAHAHAHA!!!

A chiropractor with a "diplomate" (which means nothing) in internal medicine?? From where, disney world? Who told you this?

PLEASE DO NOT CONFUSE A DC "DIPLOMATE" vs RESIDENCY TRAINED MD OR DO! BIG HELLAVA DIFFERENCE.

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Looks to me like you are the only one confused. I never said a chiropractic internist was the same or better than a medical trained internist. Same goes for all the chiropractic diplomat programs. A chiropractic orthopedist is not a medical orthopedist and Russell will tell you that a chiropractic radiologist is in no way the same as a medical radiologist. They are specialties within the chiropractic profession not the medical profession.

What do you mean by your "which means nothing" comment?

http://www.rollanet.org/~internis/dabci/

There is definitely a big push within the APTA to level the playing field and one of the major reasons is direct access. Anyone off the street can walk into a chiropractic clinic without a referral from their physician. This is not so for the PT profession. Although different states have varying levels of direct access to PT services, to my knowledge one cannot walk into a PT clinic and ask for PT services without a referral. Regardless of the scope of practice of PT and chiropractic, this does not make a whole lot of sense to me. People can see massage therapists and chiropractors but need a referral to see a PT???

The APTA feels that by raising the title of the degree to a clinical doctorate, it will help in the push to gaining direct access for PT services, which in some ways will help "level the playing field" between chiropractors and PT's. Granted, some people would go to PT's for problems that are outside their scope of practice, but PT education these days includes differential diagnosis and all the one's I've met and worked with know enough to refer a patient to a physician if it's outside their scope. I imagine this is what chiropractors do as well.

There are specialties in physical therapy, by the way. The APTA recognizes and confers several, OCS (orthopedic clinical specialist), NCS (neurologic clinical specialist), PCS (pediatric clinical specialist), SCS (sports clinical specialist), GCS (geriatric clinical specialist), etc. There are more that I am probably leaving out. In addition, PT's can receive additional training in mobilization/manipulation leading to some type of manual therapy certification.
I imagine this is what much of the controversy between PT's and chiropractors is about.

I think PT's are fully capable of performing spinal manipulations, if they receive additional post-grad education. We are certainly not taught enough about it in school to be competent. With that said, I don't think there are enough "qualified" PT's performing manipulations out there to be that much of a threat to the chiropractic profession.

The DC did NOT graduate from a medical residency (not even eligible), but did graduate from a DC fellowhip in Integrative Medicine (a new DC fellowship position, likely open to PT's also).
Get it right publichealth.

Mellow out public health...you were the one who said it was a "medical residency" (prior to editing).

You need a c2 manipulation my friend, I think you are subluxed.

Freeeedom! said:

HAHAHAHAHA!!!

A chiropractor with a "diplomate" (which means nothing) in internal medicine?? From where, disney world? Who told you this?

PLEASE DO NOT CONFUSE A DC "DIPLOMATE" vs RESIDENCY TRAINED MD OR DO! BIG HELLAVA DIFFERENCE.

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My brother-in-law, a DC, recently started advertising as a "pediatric chiropractor". This after "earning" an "honorary PhD" in pediatric chiropractic care from Palmer, his alma mater. The "degree" was issued after his paying a fee and submitting a 20 page paper (not original research or defended). No coursework or examination necessary. Yep, chiropractic should be right up there with medicine. As a matter of fact, I think I'll go notify my program director (I'm a resident) that as soon as my paper is done, I'm ready to practice emergency medicine!

- H

PublicHealth said:

This is odd. I've heard of Certification and Diplomate programs in Chiropractic Pediatrics (http://www.icpa4kids.com/chiropractic_pediatrics_diplomate.htm). These programs typically take three years to complete and require candidates to write case reports for potential submission to peer-reviewed journals. According to the aforementioned website, being a diplomate in chiropractic pediatrics allows you to use the title "pediatric chiropractor." This "honorary PhD" thing is suspect. Would you mind passing along your brother-in-law's e-mail address so that I could contact him directly to inquire about his "honorary PhD?" Perhaps he was trying to impress people by saying that he received such a degree, even though he really only completed a diplomate in chiropractic pediatrics.

No one ever argued that "chiropractic should be right up there with medicine." Your bringing it up suggests that you need to defend medicine or your life pursuits for some reason. Chiropractic and medicine are two DIFFERENT professions, each with their own licensing and diplomate systems.

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No, I won't pass on his e-mail addy. There are enough "discussions" around the family dinner table as it is. However, what I can ascertain from family and the Palmer website he may have oversimplified the title and I the training.

Per the Palmer website the degree is "L.C.P. (Legion of Chiropractic Philosophers) Honorary Award". According to other family his coursework was on "all of chiropractic" but his "thesis" was on pediatrics.

Again according to Palmer's website the program is:
"- Scheduled to begin every year in October.
- Attend five live 12-hour weekend sessions.
- Complete correlative online study between sessions.
- Write and submit a final thesis paper in the spring for possible publication.
- Participate in Grand Rounds at Palmer Lyceum in August.
- This program serves as the first 100 hours of the Diplomate in Philosophical Chiropractic Standards (D.Ph.C.S.) program credentialed by the ICA.
- This program may qualify for relicensure credit in select states that recognize chiropractic philosophy."

Still seems shady to me to claim to be a "pediatric" anything after this amount of study. It is this disjoined nature of certifications, the extreme variance between DC cirricula at various schools, and the perception (my bias I'll grant you) that chiropractors can change their scope of practice at will that leads me to question the veracity of the profession as a whole.

And no I do not need to defend my life pursuits or medicine, I am quite happy where I am.

Unfortunately, my patients aren't. In the two months I have been in my residency I have seen six different patients whose chiropractic treatments (by different chiropractors) had delayed necessary medical treatment or worsened their condition. Two of these cases were extremely severe. In one case a chiropractor was treating a patient complaining of malaise and thorasic spine pain with manual adjustments and massage. Unfortunately, the patient had breast cancer that had metastisized to her spine. When, after 3 months of adjustments, she fell and fractured her hip, the actual cause of her symptoms was discovered. At that point there were no therapuetic options left. The second case was a 30ish male with lateralized low back pain would presented to the ED after 6 months of chiropractic therapy which did not relieve his pain. Which was understandable given the significant cystic renal disease and hydronephrosis he had. Granted, these are anecdotal experiences, but I am only one EM resident working at one hospital...

I am, above all else, a patient advocate. When I read studies that demonstrate 17% of "pediatric chiropractors" would treat a two week old neonate who presents with fever without sending them for a referral, I fear for my pediatric patients who see chiropractors. (see: http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=10768681&dopt=Abstract )
When I hear of chiropractors encouraging their patients not to immunize their children, I cringe.
(see: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7884327&dopt=Abstract and http://www.cmaj.ca/cgi/content/full/166/12/1531 )
When I see chiropractors authorized to perform school physicals in Texas (see: http://www.chiroweb.com/archives/18/23/18.html ) and fighting for that right in other states (see: www.matznerclinic.com/newsletter/April2003.pdf ), I worry about what will be missed.

I don't want to defend medicine - I want to defend my patients!

BTW - how can you, as "public health" leap to the defense of a profession that actively advocates non-immunization?

- H

PublicHealth said:

I don't see "honorary PhD" or "pediatric" in any of this. Did your brother-in-law make that up? Moreover, I don't think this program allows you to call yourself a "pediatric chiropractor." The only way to get that title is to complete Diplomate training in chiropractic pediatrics.

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No, I don't think he did. I think it was his way to equate the "honorary award" to something lay people could understand. The pediatric is, in my opinion, the "shady" part of this. The topic of a single paper in a course of subject does not an expert make. I think we agree on that point.

PublicHealth said:

Good point. To my knowledge, chiropractic is a field that has swirled in controversy and allopathic opposition for decades. It's no surprise that people call into question the quality of chiropractic educational programs. Last I heard was that chiropractic colleges accept EVERYONE who applies and that they're constantly competing for students. Perhaps these honorary/fellowship/diplomate programs are a way for them to fool potential students into thinking that chiropractic is like medicine?

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It is not the acceptance that bothers me, it is the wide diversity between programs. An MD/DO, DPT, RN, clinical psycologist, or podiatrist carries the same meaning and training regardless of the site of training. Obviously there are some variations, but the gestalt is the same. There is a HUGE difference between a Logan graduate and a Palmer graduate. One school in the Southwest is apparently gearing up to teach pharmacology, which would be an anathema to any other program. There is no standardization - and that is a problem...

PublicHealth said:

This is unfortunate, but I'm sure we can discuss countless examples of how MDs, DOs, and practically any other healthcare professional has missed diagnoses, treated inappropriately, or left scissors inside a patient.

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True, but the difference is that an MD/DO could "solve" the illness for which treatment is sought. Not all cab drivers have excellent driving records, but we can all agree that a cabbie without a driver's license is a bad idea.

The chiropractor, while well trained in whichever chiropractic theory they have studied, is ill-equipped to handle significant medical problems. The physician who "bungles" a case had, at least at one time, demonstrated basic proficency in treating that condition they later mistreated. There is an old saying "the eyes can not see what the mind does not know..."

PublicHealth said:

The individual cases you described should have known better than to see a chiropractor as a front-line approach (again, the "primary care provider" designation may be the problem). Perhaps the public is unaware of the fact that chiropractors are not MEDICAL doctors? This may indeed be the case, given that most people don't know the difference between all the doctoral-level practitioners -- MD, DO, DDS, DMD, DPT, DC, OD, PhD, DPT, etc, and that chiropractors like to use the title "Dr. John Doe" instead of "John Doe, D.C." In fact, the majority of the people I informally surveyed told me that chiropractors were medical doctors who specialized in treating back pain.

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How should the public "know better" if the chiropractors hold themselves out as primary care providers? You yourself admit that many people equate chiropractors with medical doctors. That needs to stop. A PT (DPT or not) does not hold themselves out as a primary care physician. Chiropractors are trained to do just that...

From Palmer College of Chiropractic's website (at: http://admissions.palmer.edu/info/PCC.htm ) -
"Palmer College teaches chiropractic as a complete health care system. When you attend Palmer College, you not only draw from The Fountainhead of chiropractic?s heritage, but you also place yourself in a professional leadership environment. Not only will you associate with leaders in the profession, but, in time, you can become one of them."

A "complete health care system"... given the classes chiropractors attend during their training on marketing and business, how is the public to know?

PublicHealth said:

To my knowledge, most good chiropractors would not evaluate a patient until they have been medically cleared or referred from medical specialists. But then there are the quacks who want money and who could care less about what happens to their patients -- I, like you, worry about these people. It's unfortunate but they're out there -- probably more so in chiropractic than in other healthcare professions. Is managed care to blame?

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I absolutely disagree. Having close ties to graduates of both Palmer and Logan I have been often assured that while they gladly accept medical referrals (and in fact try to generate them), they feel confident in their abilities to evaluate and treat any patient who presents to them. They also assure me that the primary care provider role is taught at both institutions, and they believe the can serve in that capacity far better than an MD (because they take a "more holistic approach").

PublicHealth said:

Great point. Perhaps chiropractic is seeking to expand beyond its scope of practice? Has the "primary care provider" designation gotten to chiropractors' heads? In terms of non-immunization, not all chiropractors support this view (e.g., http://www.vacareers.com/chiropractor.html). Chiropractic philosophy tends to embrace a naturalistic view of health and disease. Some DCs are against immunization, some are not. You have to keep in mind that "natural healing" does not mesh well with "medical healing." This is why chiropractic and medicine have been at odds for so long.

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I agree that some chiropractors do believe in immunization. The studies I cited clearly demonstrate that as well. Non-immunization is however taught at every chiropractic school in this country. It is the offical position of both of the major professional associations in chiropractic (ICA and WCA). While some practitioners "see the light" after their training, non-immunization is part and parcel of the profession. And these are "primary care providers" who treat children and argue for the ability to perform school physicals!

PublicHealth said:

I don't "leap to the defense of a profession." I tend to prefer balanced discussion regarding contentious topics. It's all too often that medical doctors and students in these forums jump all over non-medical professions such as chiropractic, clinical psychology, and optometry.

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Which is why I have provided citable sources for my arguments. I am not 'jumping all over" chiropractic because it is "not medical", I am doing so because it is dangerous.

For that matter, it is dangerous for the very reason that I fully respect PTs, clinical psychologists, optometrists and the like. Those professionals are plugged into a system that is designed to get the needs of the patient met safely and with continuous re-evaluation by providers of various disciplines (I'll grant that it doesn't always work). As an MD I have no idea how to perform physical therapy, or fit eyeglasses, or provide psychotherapy and long term counseling. But I can identify patients who need these services. I can arrange for patients to recieve them. I can check back with those providing these services to ensure no new medical problems have arisen. And I can work with those providers and the patient to maximize the therapy and meet realistic goals. Chiropractic, as taught,is a system onto itself. While many have sought integration, the ideas that form the bulk of chiropractic are simply not compatible with medicine. "I don't know, it just works" is not a scientific explantion from which other disciplines can build. "Just do something to make them feel better" is not an order I would write. Give me a consistent approach, with real and demonstrable treatments that produce physiologic effects coupled with clinical improvement (or lack thereof) and I can work you. Chiropractic simply can't do that. It was created to explain, in one theory, all alterations to health.

From: http://www.chirobase.org/01General/controversy.html

"Obsessed with uncovering "the primary cause of disease," Palmer theorized that "95 percent of all disease" was caused by spinal "subluxations" (partial dislocations) and the rest by "luxated bones elsewhere in the body." Palmer speculated that subluxations impinged upon spinal nerves, impeding their function, and that this led to disease. He taught that medical diagnosis was unnecessary, that one need only correct the subluxations to liberate the body's own natural healing forces. He disdained physicians for treating only symptoms, alleging that, in contrast, his system corrected the cause of disease.

Palmer did not employ the term subluxation in its medical sense, but with a metaphysical, pantheistic meaning. He believed that the subluxations interfered with the body's expression, of the "Universal Intelligence" (God), which Palmer dubbed the "Innate Intelligence." (soul, spirit, or spark of life). Palmer's notion of having discovered a way to manipulate metaphysical life force is sometimes referred to as his "biotheology."

- H

"I need a biotheology consult - STAT!"

PublicHealth said:

If you read the article by Lee et al. (2000), you'd learn that the International Chiropractors Association, which is composed of 5% to 10% of all DCs in the United States is opposed to mandatory immunizations. For a public health view of immunizations, check out Gostin (2001) - Public Health Law: Power, Duty, Restraint (http://www.amazon.com/exec/obidos/t...gy_img_2/002-1584653-0084826?v=glance&s=books) and Gostin (2002) - Public Health Law and Ethics: A Reader (http://www.amazon.com/exec/obidos/t...002-1584653-0084826?v=glance&s=books&n=507846) It's an issue of individual vs. public rights.

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You edited while I was replying. Gostin's Reader is a fantastic text. I throughly enjoy it and have taught from it. As long as we are listing the primers lets not forget Beauchamp and Steinbock for public health ethics or Conrad for the sociology of public health. (BTW - I earned my MPH before I started medical school and served as an MPH TA during med school).

It is an issue of individual vs. public rights - at base. However, it is also an issue of autonomy of the child (would the child make the same choices if they understood the risks and benefits?) and an issue of informed consent (many of the chiropractic materials on the issue are simply false, especially in regard to the risks of vaccination. If chiropractors were required to provide materials supporting immunizations as well, would the choices remain the same?)

Ethics are always in "shades of gray", but as has been upheld time and time again, vaccinations work. They are a demonstrable public health victory and have saved countless lives. Why should we accept a blantantly erroneous challenge to them?

- H

FoughtFyr said:

I agree that some chiropractors do believe in immunization. The studies I cited clearly demonstrate that as well. Non-immunization is however taught at every chiropractic school in this country. It is the offical position of both of the major professional associations in chiropractic (ICA and WCA). While some practitioners "see the light" after their training, non-immunization is part and parcel of the profession. And these are "primary care providers" who treat children and argue for the ability to perform school physicals!

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FoughtFyr,
I respect with much you have to share regarding your concerns about chiropractic but I'd like to clarify a few things. I seriously doubt that non-immunization is taught at most, if not all, chiropractic schools. It definitely wasn't taught at the school I went to. But for some reason, certain students seem to be overly drawn to the philosophical basis of chiropractic (including non-immunization). And unfortunately, at a few schools, students get conflicting ideas about immunizations from the more philisophically based clinical professors/instructors. Also, the major professional organizations are not the ICA nor the WCA. The ACA is by far the largest chiropractic organization, I don't have the numbers on me but if I had to dig deep in my memory, it's probably five times larger than both the ICA and WCA (if not more)... but I wouldn't quote me on that. And I definitely don't think it's the official position of the ACA to endorse non-immunizations.

As someone who put in the time to take doctoral coursework, conduct research, bring new knowledge into the world, and defend --- I find it offensive that anyone would over-inflate the value of their diplomate as an "honorary PhD."

While I respect that a chiropractor may do a post-doctoral fellowship in pediatrics, it sounds more like the post-graduate clinical fellowship that I did after physical therapy school. While it DID provide a means for my advisor to wave a PhD course or two, it was BY NO MEANS anything close to an "honorary PhD" and neither is a diplomate. To describe it as such, even to a lay person, stinks of the delusion of superiority, importance, and skill that far to many DC's ascribe to themselves.

Chiropractic IS a noble profession, but it is not medicine, it is not a PhD.

Chiropractic IS a noble profession, but to many individual DC's are not.

Drew

awdc said:

And I definitely don't think it's the official position of the ACA to endorse non-immunizations.

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From the ACA website:

"Resolved, that the American Chiropractic Association (ACA) recognize and advise the public that:

Since the scientific community acknowledges that the use of vaccines is not without risk, the American Chiropractic Association supports each individual's right to freedom of choice in his/her own health care based on an informed awareness of the benefits and possible adverse effects of vaccination."

Sounds like it to me...

- H

PublicHealth said:

"Freedom of choice" granted to each patient is not endorsement or non-endorsement. Who taught you public health law? Also, the next time you cite from a document, you should make an effort to include ALL of the relevant text, not just the part that supports your viewpoint. Oh, and please provide references.

Those who read the full disclosure of the ACA's position regarding vaccination should know that FoughtFyr neglected to include this paragraph, which followed the one s/he referenced above:

"The ACA is supportive of a conscience clause or waiver in compulsory vaccination laws thereby maintaining an individuals' right to freedom of choice in health care matters and providing an alternative elective course of action regarding vaccination. (Ratified by the House of Delegates, July 1993, Revised and Ratified June 1998)."

Source: http://www.acatoday.com/pdf/2002_aca_policies.pdf

In the article by Lee et al. (2000; Archives of Pediatric and Adolescent Medicine) that you cited above, you'll read that "Thirty percent of respondents reported actively recommending childhood immunizations; 7% reported recommending against immunization. The remainder (63%) reported that they did not make any recommendations or that they educated parents to allow them to make informed decisions" (p. 404).

Seven percent is hardly the majority of DCs. I am willing to bet that an equal amount of MDs and DOs also actively recommend against immunization.

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I drew my quote from:
http://www.amerchiro.org/about/policies.shtml#96

I won't grant that 7% of MD/DOs recommend against immunization. MD/DOs are held to practice standards. If there were an untoward outcome, either from immunization or non-immunization, and there was 7% dissent within the medical community, there would exist no "standard of practice" and the MD/DO would be increasingly liable. That is simply not the case. There is a near absolute accepted standard of practice in favor of immunization (much to chiropractic's chagrin) that has been demonstrated in court time and time again.

The problem in the article above is in the 63% who "educated patients to allow them to make informed decisions". The ACA quote, "Since the scientific community acknowledges that the use of vaccines is not without risk" is a pretty light statement of what is actually going on. To be entirely fair, the scientific community acknowledges that band-aids are not without risk. The risk versus benefit is the issue and chiropractors seem to have a "unique" viewpoint when it comes to them.

Since you want citations, o.k. Pediatric Chiropractic, a major chiropractic pediatric textbook, states that "rather than advising the parent(s) to vaccinate or not to vaccinate, the chiropractic doctor should focus on educating the parent(s) on the subject and allow the parent(s) to make the decision they feel is most appropriate for their child." [1] The book's 27-page chapter on these "issues" is devoted mainly to adverse reactions, contraindications, and "failures." Nothing in the chapter suggests that immunization is a good idea [2]. Hard to discuss risk benefit without discussing benefit...
1. Buerger MA. History and physical assessment. In Anrig CA, Plaugher G, editors. Pediatric Chiropractic. Baltimore: Williams & Wilkins, 1998, p 181.
2. Lafranchi R, Alcantra J, Plaugher G. Vaccination issues. In Anrig CA, Plaugher G, editors. Pediatric Chiropractic. Baltimore: Williams & Wilkins, 1998, pp 24-50.

You are right, there are chiropractors who do believe in immunization. Read this article, by such a DC (full disclosure, he is also an MD), and tell me it is not a widespread practice.
http://www.jcca-online.org/client/cca/JCCA.nsf/objects/Issue+46_3/$file/Pages167-172.pdf

I quote (only the first sentence):"The discussion of vaccines is one that, more often than not, evokes some rather spirited disagreements within the chiropractic community. Nearly every issue of every chiropractic journal or newspaper, has something ? a letter, an article, an advertisement ? discussing vaccines, and almost never in a positive manner."

The question is who taught you public health law? Does the "tradegdy of the commons" ring a bell? Well here is a primer. From: Malone KM, Hinman AR. Vaccination Mandates: The Public Health Imperative and Individual Rights. In: Goodman RA, Rothstein MA, Hoffman RE, et al., eds. Law in Public Health Practice. New York: Oxford University Press, 2003: 262-84.

"Analogously, a community free of an infectious disease because of a high vaccination rate can be viewed as a common. As in Hardin?s common, the very existence of this common leads to tension between the best interests of the individual and those of the community. Increased immunization rates result in significantly decreased risk for disease. Although no remaining unimmunized individual can be said to be free of risk from the infectious disease, the herd effect generated from high immunization rates significantly reduces the risk for disease for those individuals. Additional benefit is conferred on the unimmunized person because avoidance of the vaccine avoids the risk for any adverse reactions associated with the vaccine. As disease rates drop, the risks associated with the vaccine come even more to the fore, providing further incentive to avoid immunization. Thus, when an individual in this common chooses to go unimmunized, it only minimally increases the risk of illness for that individual, while conferring on that person the benefit of avoiding the risk of vaccine induced side effects. At the same time, however, this action weakens the herd effect protection for the entire community. As more and more individuals choose to do what is in their 'best' individual interest, the common eventually fails as herd immunity disappears and disease outbreaks occur. To avoid this 'tragedy of the commons,' legal requirements have been imposed by communities (in recent times, by states) to mandate particular vaccinations."

So I suppose the question is "do they work"? The evidence as you well know is an overhelming "yes".
http://www.cdc.gov/mmwr/preview/mmwrhtml/00056803.htm

I leave you with an article from the BMJ which so accurately, IMHO, describes how the chiropractic community argues against vaccinations in the face of overwhelming evidence to the contary.
http://bmj.bmjjournals.com/cgi/content/full/327/7429/1424

PublicHealth, I have enjoyed this discussion with you. Please refrain from public attacks. I did not put the whole quote in because I chose not to. In my opinion the second paragraph was rhetoric, designed to make the recomendation "palatable". I certainly cited my source as their website, which is true. From now on I will include all links, but let's not let this digress please.

- H

FoughtFyr
Since you seem to have a good understanding of chiropractic, what are your thoughts on the new legislation in some states put forth by chiropractors banning PTs from performing manipulations?
We're having some huge discussions around school on this topic...as an MD do you really care? Or is this something you'd like to see stay in the scope of PT practice?
Thanks

dpt06eas said:

FoughtFyr
Since you seem to have a good understanding of chiropractic, what are your thoughts on the new legislation in some states put forth by chiropractors banning PTs from performing manipulations?
We're having some huge discussions around school on this topic...as an MD do you really care? Or is this something you'd like to see stay in the scope of PT practice?
Thanks

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I care only in that I am a staunch advocate of PT. I write my PT orders as "Please evaluate and treat as needed" and then give the patient's next scheduled follow-up date (so hopefully the PT can discuss plans and goals with the patient by then and the MD/DO can support). Given this view, I am against PTs losing ANY tool they see as necessary to their practice.

Further, it would seem to me that if chiropractors insist that their practice is derived from the system created by Palmer and not part of the greater medical community, then they should have no room to question PTs' practices. PT is derived from medicine, a completely separate science.

That is just my opinion, no citations or anything.

- H

PublicHealth said:

There is a group of chiropractors known as the National Association for Chiropractic Medicine (http://www.chiromed.org) who renounce the chiropractic philosophy and subluxation-based approach. In fact, "The first and foremost requirement for membership in the NACM is that a Doctor of Chiropractic Medicine renounce the chiropractic hypothesis and/or philosophy; that is, the tenets upon which their scope of practice is based." Their practice is defined as follows:

"NACM members confine their scope of practice to the treatment of joint dysfunctional disorders, which include the biomechanics of the human frame, posture, weight bearing and gait, and the pain or discomfort concomitant with this dysfunction which may result in excessive "wear" of these joint structures. NACM members do not consider themselves to be an "alternative" to scientific medical care and attempt to work closely with medical/osteopathic professionals.".

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First of all, I noticed you failed to respond to the vaccination post. O.k., you are letting that one go. Now your arguement is - Hey, here is a group of people who realize that they were trained inncorrectly ("The first and foremost requirement for membership in the NACM is that a Doctor of Chiropractic Medicine renounce the chiropractic hypothesis and/or philosophy; that is, the tenets upon which their scope of practice is based."). These folks argee that the model on which the cirriculum they were taught is just "wrong". O.k. I agree with them. Now, if they want to go to school and obtain their DPT or RN or MD/DO or OD or... I will be happy to refer patients to them.

"NACM members confine their scope of practice to the treatment of joint dysfunctional disorders, which include the biomechanics of the human frame, posture, weight bearing and gait, and the pain or discomfort concomitant with this dysfunction which may result in excessive "wear" of these joint structures. NACM members do not consider themselves to be an "alternative" to scientific medical care and attempt to work closely with medical/osteopathic professionals."

That sounds an awful lot like PT. If you want to go to PT school go to PT school! But don't become a chiropractor, admit the basis of your training is false and then suggest "well, it is good enough to practice PT." It isn't. If I wanted out of medicine, my MD isn't even close to sufficent training to make me a PT. The DC degree certainly is not!

I guess this is why, as you alluded to in previous posts there is a problem with the admissions policies at Chiropractic schools. Apparently, those without the academic standing to enter medical school or PT school (which I think might be more difficult than medical school admissions these days) are attempting to "back door" through DC.

- H

PublicHealth said:

Of course, the fact that an organization such as NACM even exists underscores the lack of philosophical and educational standardization within the chiropractic profession. This is probably why most people have such a negative perception of the field, as they think that because a small faction of DCs believe that immunization is wrong and that vertebral subluxations underlie structural dysfunction and impede health, then all DCs must hold the same view.

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Read their textbooks, go to the websites of their colleges, talk to large numbers of chiropractors, the vast majority believe immunization is wrong. The vast majority believe to some degree in "innate health" or "subluxation theory".

BTW - if they do not believe in "subluxations" and are billing Medicare, they are committing fraud. Plain and simple! From the OIG (available online at: http://oig.hhs.gov/oei/reports/oei-04-97-00490.pdf)

"In 1965, title XVIII of the Social Security Act created Medicare to provide health insurance for people 65 and over, people who are disabled, and persons with permanent kidney failure. Medicare has two parts: Hospital Insurance (Part A) and Medical Insurance (Part B). In 1972, Section 273 of the Social Security Amendment (P.L. 92-603) expanded the definition of physician under Part B of Medicare to include chiropractors. This made chiropractors eligible to participate in the Medicare program. However, the only Medicare reimbursable chiropractic treatment is manual manipulation of the spine to correct a subluxation demonstrated by X-ray.{emphasis added}"

BTW - according to the OIG site (at: http://exclusions.oig.hhs.gov/bygclass.html) 1,805 chiropractic practices are excluded from doing business with Medicare. To be fair, 4,115 medical practices are, but per capita, that gives chiropractors a horrible rate.

PublicHealth said:

Philosophy aside, I support chiropractors who practice according the NACM tenets, and who work collaboratively with MDs and DOs in getting patients healthy. There has to be a reason why billions of dollars are spent each year for alternative and complementary care.

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Billions are spent each year because there are limits to what medicine can do, and our culture doesn't accept limits. If a MD/DO/PT/NP/PA says to a patient "we've done everything we can do", there is always a chiropractor or other AM provider around to take the last of their money, and a shyster lawyer to sue the MD to get the patient more!

- H

PublicHealth said:

DCs as Primary Care Providers: New Managed Care Study Finds Improved Patient Outcomes and Significant Cost Savings With DC Gatekeepers

http://www.chiroweb.com/archives/22/18/12.html

Link to the actual article at the end.

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With a screen name like PublicHealth, one would gather that you have a background in just that. As such, I'd like to know what you think of this article and whether or not it's results are generalisable and/or clinically important. Anyone can post an article without commenting.

Do you think that the comparison groups are appropriate and that the different types of patient profiles affect the outcome? Are there systematic differences in the patients who choose the CAM providers compared to conventional providers? Are you surprrised by the apparent cost savings? What happens to patients who fail conservative measures for conditions such as HTN, DM, hyperlipidemia, etc, and who will require more expensive conventional management and are at higher risk for linger hospitalisations and need for specialty care (hint: they might just exit the CAM group and enter the conventional PCP group, hence keeping CAM costs down while increasing conventional costs) ? Do you think that this merited publication in a major public health journal as opposed to a Chiropractic journal? Do you think that folks who have at least 3 years less training than conventional PCP's offer a preferrable alternative?

In a nutshell, do you think that this article is at all meaningful?

It's been a while since I took those clinical epidemiology and biostats courses, so I'll hope that someone with greater expertise than me in this area chimes in.

I'm not asking these questions as a means to criticize Chiropractors. I'm quite well aware of the benefits of Chiropractic care within its scope. But I think that your approach is really misleading.

PublicHealth said:

DCs as Primary Care Providers: New Managed Care Study Finds Improved Patient Outcomes and Significant Cost Savings With DC Gatekeepers

http://www.chiroweb.com/archives/22/18/12.html

Link to the actual article at the end.

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Nice spin. Instead of repeating the quack chiropractic mantra, why dont you actually read the study? If you did, you would find that not only does this study NOT show what chiroweb claims that it does, it also shows the following:

1) This is not an randomized controlled trial.

2) Its a historical review of incurred cost/hospital data from a pilot program compared to traditional HMOs.

3) The comparison groups were NOT randomized

4) The chiros used as PCPs were NOT representative of chiros at large.

5) The patients selected to the pilot program were NOT randomized.

6) The patients selected to the pilot program were NOT representative of patient groups at large that MDs treat. MDs treat a MUCH higher proportion of acutely ill patients with non musculoskeletal complaints than this pilot program.

7) The whole stated premise of the pilot program which gathered the data is that drugs/surgery are supposedly suboptimal for medical treatments. Inherent observer bias comes into play. Since the stated goal of this "alternative" HMO organization from its inception was to prove that drugs and surgery are "bad", the data they supplied to the authors CAN NOT be trusted.

8) The ONLY indices of health quality were number of hospital days, drug cost, and length of hospital stay. Thats ENTIRELY INADEQUATE to reach the general conclusion of "improved health" or "improved patient outcomes"

9) Most importantly, the DATA REPORTS ONLY AGGREGATE NUMBERS WITH NO P VALUES OR CONFIDENCE INTERVALS. Any knowledge of elementary statistics will tell you that its bull**** unless you have data on standard deviation and confidence levels.

10) Finally, JMPT is a poor reference. Its the point of destination for DC quacks who cant get their stuff published in reputable scientific journals. Its better than the quacks at JVSR, but only marginally so. JMPT is a journal created for a purpose of advocacy, not scientific inquiry. Its a propaganda magazine masquering as a scientific journal. Its sole purpose is to advance chiropractic. The editors at JMPT and the authors who "publish" in JMPT have a disease called "conclusion in search of evidence."

PublicHealth said:

For MacGyver...Here's a recent RCT from JMPT Yeah, I know...it's that JMPT journal again. Maybe you should post your reply in caps, bold, AND italics this time!

J Manipulative Physiol Ther. 2004 Jul-Aug;27(6):388-98.

A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain.

Hoiriis KT, Pfleger B, McDuffie FC, Cotsonis G, Elsangak O, Hinson R, Verzosa GT.

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Actually, this is why the JMPT is not worthwhile. Let's see a study that compares chiropractic care to medical care (as opposed to only one component of medical care). Oh, wait, you posted that very study earlier from the NIH. It showed NO DIFFERENCE between the two... So we are back to increased risk (from chiropractic misinformation) for no benefit.

The study referenced above: Hurwitz EL, Morgenstern H, Harber P, et al. A randomized trial of medical care with and without physical therapy and chiropractic care with and without physical modalities for patients with low back pain: 6-month follow-up outcomes from the UCLA low back pain study. Spine. 2002;27(20):2193-2204.

(this link is from your post: http://nccam.nih.gov/health/chiropractic/index.htm#app1)

PublicHealth said:

I think the following article summarizes what most medically trained people (and medical wannabes such as MacGyver) involved in this discussion fear:

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Nope, I fear the poor outcomes, poor advice, and generally poor public health that results from chiropractic care.

PublicHealth said:

But then again...

Am Fam Physician. 2004 Jun 1;69(11):2544.

Chiropractors are not a usual source of primary health care.

McCann J, Phillips RL, Green LA, Fryer GE.

Robert Graham Center: Policy Studies in Family Medicine and Primary Care, 1350 Connecticut Ave., NW, Suite 201, Washington, DC 20036, USA.

Chiropractors are the largest source of office-based care in the United States that does not involve a physician, but people do not view chiropractors as primary providers of health care or advice. Unlike the care given by primary care providers, the majority of care provided by chiropractors is limited to musculoskeletal problems.

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This is an opinion and observation, not a study. Obviously people can be fooled; case in point - I assume that you are trained in public health and you seem to support chiropractic...

- H

FoughtFyr said:

Actually, this is why the JMPT is not worthwhile. Let's see a study that compares chiropractic care to medical care (as opposed to only one component of medical care). Oh, wait, you posted that very study earlier from the NIH. It showed NO DIFFERENCE between the two... So we are back to increased risk (from chiropractic misinformation) for no benefit.

The study referenced above: Hurwitz EL, Morgenstern H, Harber P, et al. A randomized trial of medical care with and without physical therapy and chiropractic care with and without physical modalities for patients with low back pain: 6-month follow-up outcomes from the UCLA low back pain study. Spine. 2002;27(20):2193-2204.

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I don't think your reply is referencing the same article PublicHealth just mentioned about chiropractic adjustments vs. muscle relaxants for subacute low back pain. Or, maybe you were referencing the study in Spine that you just described, which clearly isn't JMPT. Please clarify.

Also, you stated that there is an increased risk from chiropractic misinformation. I assume this is your opinion/observation or do you have evidence for this?

awdc said:

I don't think your reply is referencing the same article PublicHealth just mentioned about chiropractic adjustments vs. muscle relaxants for subacute low back pain. Or, maybe you were referencing the study in Spine that you just described, which clearly isn't JMPT. Please clarify.

Also, you stated that there is an increased risk from chiropractic misinformation. I assume this is your opinion/observation or do you have evidence for this?

Click to expand...

What I was saying was that the JMPT article was invalid as it was not comparing full medical treatment (including PT) to chiropractic therapy. If you want to compare two treatment modalities then you must allow for full use of both. The Spine study did just that (as PublicHealth correctly pointed out in a prior post). That study however, showed that chiropractic care was only "as good as" not "better than" conventional medical therapy.

The increased risk from chiropractic misinformation is a topic I have discussed, and posted links, cited sources, etc. on this thread as well as the thread on the hiring of a chiropractor by HMS. Between the misinformation regarding immunizations to the claims made regarding chiropractors as primary care providers, I feel I have aptly demonstrated the downside to chiropractic and the increased risks faced by the poor decisions they guide their patients to. If not, please see www.chirobase.org for a more complete discussion.

- H

An interesting article (from: http://www.chirobase.org/04Ads/brochures.html)

"Educators Blast Mainstream Chiropractic Brochures
by Stephen Barrett, M.D.

Chiropractic is based on the belief that spinal problems ("subluxations") are the cause * or underlying cause * of health problems and that spinal manipulations ("adjustments") can restore and maintain health. These ideas clash with what is known about health, disease, and the human body, but the vast majority of chiropractors still subscribe to them in one way or another [1].

During the past 25 years, I have never seen a major chiropractic organization acknowledge that there is anything fundamentally wrong with chiropractic beliefs or practices. When misleading chiropractic claims are criticized by an outsider, they say that the critic is biased. When embarrassed by quotes from within their own profession, they claim that whatever is said does not represent the chiropractic "mainstream." [2]

A few months ago, the leading chiropractic journal published criticisms that could not be defended with these tactics. After examining various patient-education materials, three chiropractic college professors reported:

The largest professional associations in the United States and Canada distribute patient brochures that make claims for the clinical art of chiropractic that are not currently justified by available scientific evidence or that are intrinsically untestable. These assertions are self-defeating because they reinforce an image of the chiropractic profession as functioning outside the boundaries of scientific behavior [3].

In addition, the trio wrote, "the distribution of patient brochures involving unsubstantiated claims . . . meets several of the formal criteria for quackery."

The critics were Jaroslaw P. Grod, DC, a professor at Canadian Memorial Chiropractic College, in Toronto, and two other professors at Los Angeles College of Chiropractic. Together they objected to 26 claims in 20 brochures distributed by the American Chiropractic Association, the Canadian Chiropractic Association, the Foundation for Chiropractic Education and Research, the British Columbia Chiropractic Association, the Ontario Chiropractic Association, the California Chiropractic Association , the New York State Chiropractic Association, or the Texas Chiropractic Association.

In considering the brochures, the professors considered three types of statements to be improper:

- Claims that spinal manipulation could treat diseases unrelated to musculoskeletal problems were considered unsubstantiated.
- Vague statements that "chiropractic care" is beneficial were considered untestable and therefore misleading.
- Assertions that chiropractors treat "subluxations" were considered unsubstantiated because no such entity has been experimentally established.

Here are examples of their analyses:

Unjustified Claim
"The doctor of Chiropractic adheres to the philosophy that the body is capable of maintaining and restoring health with a balanced diet, rest, and a properly functioning nervous system. Manipulation of the spine and other areas is the key to recovery." (Canadian Chiropractic Association)

Objection
"This panacea assertion suggests that manipulation produces a nonspecific and beneficial effect on the nervous system; no experimental data are available to substantiate this assertion."

Unjustified Claim
Chiropractic differs from traditional medicine because "chiropractic treats the patient, not just the symptoms . . . the doctor of chiropractic not only addresses the problem, but the cause as well." (American Chiropractic Association)

Objection
Chiropractors have yet to demonstrate any unique cause for any condition.

Unjustified Claim
"When compared to other therapies, chiropractic is safer and more effective . . . chiropractic care is safe and effective with less risk than many medications or medical interventions." (Canadian Chiropractic Association)

Objection
"Claims for . . . relative safety and effectiveness . . . should be judged with respect to the particular health problem for which care is provided. There are very few trials that compare chiropractic (manipulative) and medical (pharmacological) intervention methods."

Unjustified Claim
"The spine . . . should get the same regular checkups as your teeth, not just when you've got pain." (Canadian Chiropractic Association)

Objection
The preventive value, if any, of chiropractic care is unproven and largely unstudied. The value of "regular check-ups" by chiropractors is unknown.

Unjustified Claim
"A chiropractor could prevent many of these problems [arthritis] from developing in the first place by reducing their subluxations and other spinal problems." (Ontario Chiropractic Association)

Objection
"Chiropractic care" and "subluxation correction" have no proven value

Unjustified Claim
"Chiropractic care is one of the safest types of treatments available today, and is an effective alternative to drugs and surgery for many conditions." (American Chiropractic Association)

Objection
The claim for effectiveness of unspecified chiropractic methods is untestable because the "many conditions" are not defined. Experimental comparisons of medical, surgical, and chiropractic interventions are extremely rare.

It will be interesting to see whether the organizations mentioned in this report will stop making any of the claims that were criticized. My guess is that they will not. In fact, the only reaction I have seen from a chiropractic leader came from Matthew McCoy, D.C., editor of the Journal of Vertebral Subluxation Research, who said (in part):

"Want to know what really makes me mad as hell? We have probably less than 100 full time researchers in the chiropractic profession and we can't even afford to pay them a livable wage. The least we should be able to do is rely on our research journals, foundations and institutions to make sure idiots like this do not work in our profession. Their obvious skewing of data, mining of the literature and political agendas are obvious to anyone with a head just a tad sharper than a bowling ball. . . .

Will YOU call your alma mater and ask why these people are still on the payroll? Will YOU write to the Editor of these journals and ask how these people get past peer review? [4]"

In 2003, the professors who did the above study have reported that in July 2001, the majority of chiropractic college Web sites contained similarly unsubstaniated claims [5].

References
1. Chiropractic's elusive "subluxation." Chirobase, updated Dec 25, 2001.
2. Barrett S. The spine salesmen. In Barrett S. Knight G. The Health Robbers: How to Protect Your Money and Your Life. Philadelphia: George F. Stickley Co., 1976
3. Grod JP, Sikorski D, Keating J. Unsubstantiated claims in patient brochures from the largest state, provincial, and national chiropractic associations and research agencies. JMPT 24:514-519, 2001.
4. McCoy M. Stroke, chiropractic and subluxation: Sorting fact from fiction. JVSR Research Update, March 4, 2002.
5. Barrett S. Improper claims on chiropractic college Web sites. Chirobase, March 6, 2004."

- H

FoughtFyr said:

First of all, I noticed you failed to respond to the vaccination post. O.k., you are letting that one go. Now your arguement is - Hey, here is a group of people who realize that they were trained inncorrectly ("The first and foremost requirement for membership in the NACM is that a Doctor of Chiropractic Medicine renounce the chiropractic hypothesis and/or philosophy; that is, the tenets upon which their scope of practice is based."). These folks argee that the model on which the cirriculum they were taught is just "wrong". O.k. I agree with them. Now, if they want to go to school and obtain their DPT or RN or MD/DO or OD or... I will be happy to refer patients to them.

"NACM members confine their scope of practice to the treatment of joint dysfunctional disorders, which include the biomechanics of the human frame, posture, weight bearing and gait, and the pain or discomfort concomitant with this dysfunction which may result in excessive "wear" of these joint structures. NACM members do not consider themselves to be an "alternative" to scientific medical care and attempt to work closely with medical/osteopathic professionals."

That sounds an awful lot like PT. If you want to go to PT school go to PT school! But don't become a chiropractor, admit the basis of your training is false and then suggest "well, it is good enough to practice PT." It isn't. If I wanted out of medicine, my MD isn't even close to sufficent training to make me a PT. The DC degree certainly is not!

I guess this is why, as you alluded to in previous posts there is a problem with the admissions policies at Chiropractic schools. Apparently, those without the academic standing to enter medical school or PT school (which I think might be more difficult than medical school admissions these days) are attempting to "back door" through DC.

- H

Click to expand...

AGREED, there is a study published in the Journal of Manipulative and Physiological Therapeutics Volume 20, pages 86-91, 1997 by Doxey and Phillips that compairs average undergraduate GPA of enrollees in various professional programs. PT is not included but is around 3.7-3.8/4.0.
MD 3.56
OD 3.3
DO 3.26
DDS 3.13
DPM 3.06
DC 2.9

That means entrants into a chiropractic school gets more "C"s than "A"s.
I realize that GPA is not a perfect indicator of intelligence and critical thinking ability, but do you want someone to determine whether your back pain is because of NMS dysfunction vs something more sinister, who got those kinds of grades??

Some DCs are very intelligent and practice responsibly, but it does seem to make some people doctors who do not deserve and have not earned the respect that the title demands in our society.

As a PT, I find it laughable that my state (MN) allows for DCs to write prescriptions for PT when often, they are not as intelligent and their doctorate required less education than my master's degree did.

The worst thing in the world is to "compare GPA's"...I think we all understand that an A from Michigan is not the same as an A from Miami Grove Community College...part of the REAL comparisons between professions come from previous academic endeavors, previous schools attended, types of classes taken etc. While I am not defending a particular group of people, I can tell you those quotes are extremely VARIED from school to school. DO and MD GPA's prior to matriculation are far closer today than 5 years ago, and PT and DC GPA's are nothing of what they were 10 years ago as the market and low wages has driven down the matriculants in both specialties.

As a former practicing PT, I can guarantee that generally the PT degree is a more academic degree than the DC...but yet they are far similar than any other two (besides DO and MD) than any other on that list. I personally think that PT's are closer to DC's than at any other time in their history. There was a time when PT's were outwardly against manipulation, now they lobby for its use. Very strange how the two are so similar today...yet they dislike each other like never before.

I think most people will take "street smarts" over "book smarts". Look at the show "The Apprentice". They have Self-Made Entrepreneurs with no college education. They must be pretty talented to go up against Ivy League graduates.

I would agree that chiropractic colleges have poor entrance requirements. Chiropractic colleges are private and tuition dependant. This is the reason entrance requirements are low. They need to fill as many seats as possible to stay afloat. Even with that said Chiropractic College still has a weed out process. Many substandard students may get in, but they won't last long.

truthseeker, I detect an arrogant tone. I think chiropractors have earned the right to be addressed as doctor just like other clinical doctoring professions. You're in Minnesota right? Northwestern Chiropractic College is a very good chiropractic college and represents the profession well. I would assume most practicing chiropractors in Minnesota went to Northwestern. If your "masters" is equivalent to a doctorate, then why is it called a masters degree? Take it for what its worth.

As a former practicing PT, I can guarantee that generally the PT degree is a more academic degree than the DC.

You're offering a pretty big "guarantee" for someone who hasn't experienced Chiropractic College.

I personally think that PT's are closer to DC's than at any other time in their history.

I would agree in the sense that our treatments overlap.

There was a time when PT's were outwardly against manipulation, now they lobby for its use.

Funny how everyone looked at chiropractors as quacks and now they fight for a piece of the pie.

Very strange how the two are so similar today...yet they dislike each other like never before.

Plain and simple, it's a turf war and will always be.

BackTalk said:

If your "masters" is equivalent to a doctorate, then why is it called a masters degree? Take it for what its worth.

As a former practicing PT, I can guarantee that generally the PT degree is a more academic degree than the DC.

You're offering a pretty big "guarantee" for someone who hasn't experienced Chiropractic College.

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O.k., but if you actually look at where the DC is "accepted" as an academic doctoral level degree outside of chiropractic colleges, the answer is pretty much nowhere. What do I mean? A DPT (or a Masters trained PT), an MD, MPH, MS, Ph.D., Sc.D., JD, and others are generally accepted by institutions of higher education as prerequiste degrees for academic posts. A DPT would be an acceptable degree, on its own, to be appointed into most University's departments of physiology. A DC would not. Granted, as discussed in another post, a DC who obtains additional credentials might be hired, but a DC alone will not. Nor, in formal academia, is a DC permitted to wear the academic dress of a doctor. I know this is a bit of arcane and esoteric trivia when it comes to "real life" (i.e., who care about three stripes on a graduation gown), but it speaks volumes as to how academia views the DC.

- H

Freeeedom! said:

As a former practicing PT, I can guarantee that generally the PT degree is a more academic degree than the DC...but yet they are far similar than any other two (besides DO and MD) than any other on that list. I personally think that PT's are closer to DC's than at any other time in their history. There was a time when PT's were outwardly against manipulation, now they lobby for its use. Very strange how the two are so similar today...yet they dislike each other like never before.

Click to expand...

Yes, but the basic difference is still the same, and is to me the most important part. A chiropractor, in theory, is taught that interruptions in the nervous system are the source for all disease and the maintainence of those connections is the path to health. A PT realizes that manipulations may work well for neuromuscular problems, but have little role in other areas of medicine.

And before BackTalk or any other chiropractic apologists jump on this thread and suggest that "not all chiropractors believe that" or "I don't practice that way" I say GREAT! But it doesn't change the fact that this theory forms the basis for your education. If you choose now to disavow the basis of chiropractic, then go get an education in the theory you believe in. There is an old saying "the eyes can not see what the mind does not know", and in my experience chiropractors are the living embodiment of this. I do not debate that in some limited circumstances, chiropractic care can be as effective as traditional medicine. The problem is chiropractors are not able to recognize those circumstances, and refuse to limit their practices to them when they are recognized by others. This is the problem with chiropractic.

A great example, if you look at "The Council on Chiropractic Education" standards for the DCP degree, they include the study of gynecology and obstetrics. Now, to the best of my knowledge, and please correct me if I am wrong, DCP students do not routinely attend births. They are not trained, nor are they legally allowed, to intervene beyond first aid in the event a birth results in a life threat to the infant or mother. So why train in it? What obstetric care is a chiropractor providing? What gynecologic care? Can a chiropractor deal with a gynecologic cancer or infection? Dysfunctional bleeding? Dysparenuria?

I am sure that, as usual, this post will be answered with one of the following (from http://www.chirobase.org/11Responses/response.html):
"I never heard of this procedure.", "This certainly is not mainstream practice.", "Nobody I know does this.", "It was not taught in my school.", "This is not taught in chiropractic colleges.", "Every barrel has a few rotten apples. So does every profession." When it is, I urge you to go to the website www.cce-usa.org and look for yourself as to what the standards are.

On the other hand, they might adress this with their second favorite tactic - attack the medical profession: "What about unnecessary surgery?", "What about overprescription of drugs?", "Medical errors are a serious and common problem.", "How come our malpractice rates are lower?" In which case, I would only ask that you recognize a straw man when you see one...

- H

BackTalk said:

I think most people will take "street smarts" over "book smarts". Look at the show "The Apprentice". They have Self-Made Entrepreneurs with no college education. They must be pretty talented to go up against Ivy League graduates.

Click to expand...

Dpends on the scenario, BT. If I'm picking someone to oversee business operations, then 'street smarts' might trump 'book smarts'. But if I'm picking a Nephrologist, I will value book smarts over street smarts. As it applies to this discussion, I think that improving the academic requirements for Chiropractic Colleges would go a long way towards developing a well defined niche for Chiropractic within conventional health care for various reasons including, a) you would have students who are less likely to buy into some of the dubious aspects of Chiropractic Philosophy, b) you would have students who are more likely to pursue careers in research, thus improving the scientific basis of the profession.

And before BackTalk or any other chiropractic apologists jump on this thread and suggest that "not all chiropractors believe that" or "I don't practice that way" I say GREAT! But it doesn't change the fact that this theory forms the basis for your education. If you choose now to disavow the basis of chiropractic, then go get an education in the theory you believe in. There is an old saying "the eyes can not see what the mind does not know", and in my experience chiropractors are the living embodiment of this. I do not debate that is some limited circumstances, chiropractic care can be as effective as traditional medicine. The problem is chiropractors are not able to recognize those circumstances, and refuse to limit their practices to them when they are recognized.

To be fair, I don't think that BT is an apologist. I have talked with him more than enough to have a good understanding of his viewpoint, and I think that his view of his profession is realistic and rational. In fact, if I were a PCP, I would be happy to refer my back/neck pain patients to him, because I know that I could trust him. I think that he's been very willing to acknowledge both the strengths and weaknesses of Chiropractic and practices within its strengths. I think it's also very valuable to have his viewpoint expressed on a website which caters to those of us within the conventional health care system.

O.k., but if you actually look at where the DC is "accepted" as an academic doctoral level degree outside of chiropractic colleges, the answer is pretty much nowhere.

I agree. Courses that are earned in a chiropractic college usually do not transfer to a university system. Chiropractic schools and universities have their own system and are not accredited through the same agency that accredits most major colleges and universities in American.
This doesn't mean that the chiropractic courses are not equivalent. Once FSU opens the chiropractic college, it won't be a problem for those students who choose to attend there.

A DPT would be an acceptable degree, on its own, to be appointed into most University's departments of physiology. A DC would not. Granted, as discussed in another post, a DC who obtains additional credentials might be hired, but a DC alone will not.

Can you explain why Dr. Terry Yochum (a chiropractor) teaches skeletal radiology at the University Of Colorado School Of Medicine? He holds a BS, a DC and a "DACBR" (Diplomate of the American Board of Radiology). All obtained through chiropractic colleges. For some strange reason the University Of Colorado School Of Medicine thinks a Doctor of Chiropractic degree is acceptable. Maybe you better call....

Nor, in formal academia, is a DC permitted to wear the academic dress of a doctor. I know this is a bit of arcane and esoteric trivia when it comes to "real life" (i.e., who care about three stripes on a graduation gown), but it speaks volumes as to how academia views the DC.

What the hell are you talking about?

BackTalk said:

Can you explain why Dr. Terry Yochum (a chiropractor) teaches skeletal radiology at the University Of Colorado School Of Medicine? He holds a BS, a DC and a "DACBR" (Diplomate of the American Board of Radiology). All obtained through chiropractic colleges. For some strange reason the University Of Colorado School Of Medicine thinks a Doctor of Chiropractic degree is acceptable. Maybe you better call....

Click to expand...

Well instead of calling, I looked on the web. Now, a google search reveals lots of references to Dr. Yochum in "chiropractic" literature (chiroweb etc.). But he is not listed among the faculty on the University of Colorado School of Medicine Radiology Department homepages, nor is he listed as faculty in the University phonebook. I don't know what to make of that...

BackTalk said:

Nor, in formal academia, is a DC permitted to wear the academic dress of a doctor. I know this is a bit of arcane and esoteric trivia when it comes to "real life" (i.e., who care about three stripes on a graduation gown), but it speaks volumes as to how academia views the DC.

What the hell are you talking about?

Click to expand...

Formal academic dress, worn for honorary ceremonies including graduations. There is are formal guidelines for this which call for specific dress based on degree obtained. Esoteric, I agree, but part of academia.

- H

Yes, but the basic difference is still the same, and is to me the most important part. A chiropractor, in theory, is taught that interruptions in the nervous system are the source for all disease and the maintainence of those connections is the path to health. A PT realizes that manipulations may work well for neuromuscular problems, but have little role in other areas of medicine.

I'll agree with most of your statement. What you're describing is "straight chiropractic". There are only a few schools left that teach chiropractic that way.

And before BackTalk or any other chiropractic apologists jump on this thread and suggest that "not all chiropractors believe that" or "I don't practice that way" I say GREAT! But it doesn't change the fact that this theory forms the basis for your education. If you choose now to disavow the basis of chiropractic, then go get an education in the theory you believe in. There is an old saying "the eyes can not see what the mind does not know", and in my experience chiropractors are the living embodiment of this.

It's not a suggestion, it's the truth. Chiropractic care is based upon theory and that is true. In fact, many professions have started with a theory. The thing is, when they found that the theory didn't work they changed. Our problem is we haven't changed. I have, or least I think I have, but the profession as a whole hasn't. I feel that with time chiropractic theories will cease to exist and schools will change the way they teach chiropractic. I don't think much of the philosophical hoopla will fly at FSU.

A great example, if you look at "The Council on Chiropractic Education" standards for the DCP degree, they include the study of gynecology and obstetrics. Now, to the best of my knowledge, and please correct me if I am wrong, DCP students do not routinely attend births. They are not trained, nor are they legally allowed, to intervene beyond first aid in the event a birth results in a life threat to the infant or mother. So why train in it? What obstetric care is a chiropractor providing? What gynecologic care? Can a chiropractor deal with a gynecologic cancer or infection? Dysfunctional bleeding? Dysparenuria?

DCP (Doctor of Chiropractic Programs) says the curriculum required for the DCP must include gynecology and obstetrics. That is true. In fact; our courses in OBGYN were in depth but not to the extent that we learned how to deliver babies, at least not as a career. So yes, it is true we do not attend births. The reason we train in OBGYN is because we have patients who will present with female problems. We don't learn in order to treat but rather to recognize and refer. You should know that many female conditions can produce back pain that in itself is enough for a DC to learn OBGYN. Did you learn any thing about teeth in medical school? What the hell for? You're no Dentist! But if someone comes to your office with nasty tooth disease at least you have the training to recognize it and enough common sense to refer the patient to a specialist (aka Dentist). So you see the point?


I am sure that, as usual, this post will be answered with one of the following (from http://www.chirobase.org/11Responses/response.html) "I never heard of this procedure.", "This certainly is not mainstream practice.", "Nobody I know does this.", "It was not taught in my school.", "This is not taught in chiropractic colleges.", "Every barrel has a few rotten apples. So does every profession." When it is, I urge you to go to the website www.cce-usa.org and look for yourself as to what the standards are.

I see you memorize Barrett's routine list of answers given by chiropractors . Maybe chiropractors use those phrases because most, if not all of the time, they're true.

"I never heard of this procedure" Well most of the information in the chirobase is outdated so this would qualify as a good response.

"This certainly is not mainstream practice." I can think of many idiotic chiropractic procedures and techniques that would demand this response.

"Nobody I know does this" Well if it's not mainstream then it is very unlikely I know someone who does it.

"This is not taught in chiropractic colleges" which is basically the same as "It was not taught in my school" Most of the quackery that chiropractors practice, demand this response because most of the time it's true. Example: They do not teach us to cure cancer in chiropractic school yet many people claim chiropractors say they can cure cancer. The quack schools aren't even crazy enough to teach that.

"Every barrel has a few rotten apples. So does every profession." This statement is true no matter who says it.

"On the other hand, they might adress this with their second favorite tactic - attack the medical profession:" Well, we usually attack those who are attacking us. 95% of all attacks are from the medical profession so logically we attack them back.

"What about unnecessary surgery?" "What about overprescription of drugs?", "Medical errors are a serious and common problem.", "How come our malpractice rates are lower?" Basically, I guess chiropractors are saying "clean up your own yard before you **** in ours!"

Well instead of calling, I looked on the web. Now, a google search reveals lots of references to Dr. Yochum in "chiropractic" literature (chiroweb etc.). But he is not listed among the faculty on the University of Colorado School of Medicine Radiology Department homepages, nor is he listed as faculty in the University phonebook. I don't know what to make of that...

I don't think the website gives a full list of faculty members. I knew you would look so I looked first. I didn't even find a faculty list. If you did then it's possible he is no longer teaching which doesn't matter.


https://www.spinephysicians.org/dr3memnews.cfm

"Terry Yochum, D.C. During June of 2003, Dr. Terry Yochum, chiropractic radiologist and member of the AASP Academy Council was awarded Radiology Teacher of the Year by residents of the University of Colorado, School of Medicine, Department of Radiology. Each year graduating residents have the opportunity to honor the instructor who has provided the highest level of academic and clinical instruction. This is the seventh time Dr. Yochum has received this distinquished recognition. No other radiologist has achieved this acclamation more than twice."


http://www.chiroweb.com/archives/22/17/16.html

"Recognized as an outstanding teacher, Dr. Yochum was invited to lecture at the University of Colorado's School of Medicine, Department of Radiology. Dr. Michael Manco-Johnson put his reputation on the line and lobbied for Dr. Yochum to be appointed to a position on the staff at the medical school, teaching medical radiology residents skeletal radiology. The Yochum edge cut through the medical prejudices, and in his 13 years of teaching, the students have elected him "Outstanding Teacher of the Year" eight times."

Look, there are plenty of schools other than chiropractic that accept DC degrees and allow them to teach. I'm not going to list all of them. Dr. Yochum is teaching in medical school, thats why I choose him as an example.

Formal academic dress, worn for honorary ceremonies including graduations. There is are formal guidelines for this which call for specific dress based on degree obtained. Esoteric, I agree, but part of academia.

OK

Nor, in formal academia, is a DC permitted to wear the academic dress of a doctor

Alright then, where did you read that? My gown had three chevrons on the sleeve (not that I really care). My point is we are permitted to wear the academic dress of a doctor and do. Do a search on Google on chiropractic graduation "images" and you'll see what I mean.