- Joined
- Mar 18, 2003
- Messages
- 2,271
- Reaction score
- 7
Report on Future of Chiropractic and Related Professions
- Thread starter PublicHealth
- Start date
- Joined
- Jul 13, 2002
- Messages
- 434
- Reaction score
- 2
After briefly going over the report, I have one major contention and that is regards to the statement, "Studies in the U.S. and abroad have concluded that chiropractic education is the equivalent of medical education in all of the basic sciences." Of course, the footnote sites a few papers (even one from 1983!) that hardly have anything to do with an in-depth look into education. So I have my own anecdotal evidence from my experience as a fairly recent chiropractic graduate. It's not equivalent! While the course names are all very similar, the breadth and depth among the basic sciences in medicine and chiropractic can vary greatly. I doubt 2nd year chiro students can explain anything meaningful about lipoid nephrosis or the various forms emphysema. Just as I doubt 2nd year med students could explain anything meaningful about the normal movement pattern of the shoulder or the lower cross syndrome.
- Joined
- Mar 19, 2003
- Messages
- 2,212
- Reaction score
- 30
chirodoc said:
Really, because this document reinforces every concern I have regarding chiropractic. From the executive summary:
"Understanding the different philosophies of chiropractic, how they relate to the professions unity and vision, and what effect they have on chiropractic practice is one of the most difficult tasks for an outsider observing the profession. IAF attempted to understand the different philosophies of the myriad of national and state associations and how they affected chiropractics unity, vision, and relationships. We also attempted to understand the philosophies of the different chiropractic colleges through an informal survey of the presidents, vice-presidents, and deans of the chiropractic colleges. Our assessment was that some parts of the leadership of chiropractic remains bitterly divided over issues of philosophy. This is a serious hindrance to the field. However, there may be more common ground among practicing practitioners."
To summarize, the profession cannot even agree amonst itself what the definition of chiropractic is. Straights, mixers and pseudo-mixers each practicing their own particular "brand" of chiropractic, with no help for the average consumer in choosing between providers."High patient satisfaction remains the chief strength of chiropractic and back pain the professions principle market. Our assessment of chiropractors role in primary care remains similar to 1998. Chiropractors could play a larger role in primary care, but would have to devote considerable effort to expand their scope of practice, improve their clinical skills, and improve their cultural legitimacy."
"Improve their clinical skills" - before they can expand to being true primary care providers, not after! It seems to me most chiropractors want to put the cart before the horse on this one, and have successfully persuaded several state legislatures to this end."Since 1998, the chiropractic community has come a long way in developing institutions for developing research with minimal outside help. The research on spinal manipulation therapy has shown it to be a safe and effective means of natural healing for back and neck pain. Still, many studies show it to be only marginally more effective than other treatments or a placebo. More research is needed to prove that spinal manipulation therapy is efficacious and cost effective for neuromusculoskeletal (NMS) and other conditions."
You have to love research being done with the outcome already presumed. My goodness, what would the outcry be if drug companies used this same logic? "Help wanted - a researcher to prove that our drug, shown to be safe, but only marginally more effective than placebo or other treatments is really LOTS better. Open minds need not apply." And this ignores the very real and demonstrated risks (acknowledged in the above quote in this same report) of patients being treated by chiropractors for NMS or back pain relying on their chiropractors as primary care providers, even though they lack the clinical skills to operate in that capacity.I personally love the report's future outlook scenario #3:
"Manipulation is found to be both efficacious and cost effective for a variety of NMS conditions including back and neck pain, headache and some types of chronic pain. Chiropractors expand their education and training to include more NMS conditions and they push for limited prescription rights. This allows them to fill a broader role as NMS specialists. Clinical experience for chiropractors in integrated settings becomes a standard part of chiropractic education and recertification. This, combined with new authoritative studies showing the benefits of chiropractic for NMS conditions, increases the rates of referrals from medical doctors to chiropractors.
Consumer-directed healthcare grows dramatically. Patients who manage their own care favor those chiropractors who score well on report cards which compare health care providers in their area. By 2015, the few large managed care plans that remain require patients to undergo a course of manipulation for back or neck pain before considering authorization of expensive surgery or medicines. Chiropractors have very sophisticated office information systems which include electronic patient records, the ability to link genomic information, and patient coaching with different chiropractic techniques."
"Push for limited prescription rights"?!? Are you kidding - the Palmers must be spinning in their graves. How would this differentiate the chiropractor from the DO? Or MD for that matter? (Besides the lower standards for entry into and completion of chiropractic education). Lose the basis in the body's "innate ability to heal itself" and you are no longer talking about chiropractic. Consumer-directed healthcare grows dramatically. Patients who manage their own care favor those chiropractors who score well on report cards which compare health care providers in their area. By 2015, the few large managed care plans that remain require patients to undergo a course of manipulation for back or neck pain before considering authorization of expensive surgery or medicines. Chiropractors have very sophisticated office information systems which include electronic patient records, the ability to link genomic information, and patient coaching with different chiropractic techniques."
"Patient satisfaction with chiropractic care is generally high. But it is not clear if this is from spinal manipulation or the broader aspects of chiropractic care as it is delivered, including the personal attention of the chiropractor."
Well, I certainly agree with that."One of the largest growth areas in healthcare will be geriatrics. The retiring Baby Boomers will look for alternative medicine that can help them to remain active and healthy. Developing better evidence for geriatric chiropractic and more in-depth postgraduate programs in geriatric chiropractic will help chiropractic expand. There is much overlap between prevention and wellness approaches for the general population and what elders need."
Yeah, except for those pesky vertebral artery dissections. And, oh yeah, the elderly are poor payors, relying on Medicare for their health coverage. I would personally welcome chiropractic into the land of $0.40 on the dollar payments for service. Come in - the water is nice 
- H
- Joined
- Mar 18, 2003
- Messages
- 2,271
- Reaction score
- 7
FoughtFyr said:Really, because this document reinforces every concern I have regarding chiropractic. From the executive summary:
"Understanding the different philosophies of chiropractic, how they relate to the professions unity and vision, and what effect they have on chiropractic practice is one of the most difficult tasks for an outsider observing the profession. IAF attempted to understand the different philosophies of the myriad of national and state associations and how they affected chiropractics unity, vision, and relationships. We also attempted to understand the philosophies of the different chiropractic colleges through an informal survey of the presidents, vice-presidents, and deans of the chiropractic colleges. Our assessment was that some parts of the leadership of chiropractic remains bitterly divided over issues of philosophy. This is a serious hindrance to the field. However, there may be more common ground among practicing practitioners."To summarize, the profession cannot even agree amonst itself what the definition of chiropractic is. Straights, mixers and pseudo-mixers each practicing their own particular "brand" of chiropractic, with no help for the average consumer in choosing between providers.
"High patient satisfaction remains the chief strength of chiropractic and back pain the professions principle market. Our assessment of chiropractors role in primary care remains similar to 1998. Chiropractors could play a larger role in primary care, but would have to devote considerable effort to expand their scope of practice, improve their clinical skills, and improve their cultural legitimacy.""Improve their clinical skills" - before they can expand to being true primary care providers, not after! It seems to me most chiropractors want to put the cart before the horse on this one, and have successfully persuaded several state legislatures to this end.
"Since 1998, the chiropractic community has come a long way in developing institutions for developing research with minimal outside help. The research on spinal manipulation therapy has shown it to be a safe and effective means of natural healing for back and neck pain. Still, many studies show it to be only marginally more effective than other treatments or a placebo. More research is needed to prove that spinal manipulation therapy is efficacious and cost effective for neuromusculoskeletal (NMS) and other conditions."You have to love research being done with the outcome already presumed. My goodness, what would the outcry be if drug companies used this same logic? "Help wanted - a researcher to prove that our drug, shown to be safe, but only marginally more effective than placebo or other treatments is really LOTS better. Open minds need not apply." And this ignores the very real and demonstrated risks (acknowledged in the above quote in this same report) of patients being treated by chiropractors for NMS or back pain relying on their chiropractors as primary care providers, even though they lack the clinical skills to operate in that capacity.
I personally love the report's future outlook scenario #3:
"Manipulation is found to be both efficacious and cost effective for a variety of NMS conditions including back and neck pain, headache and some types of chronic pain. Chiropractors expand their education and training to include more NMS conditions and they push for limited prescription rights. This allows them to fill a broader role as NMS specialists. Clinical experience for chiropractors in integrated settings becomes a standard part of chiropractic education and recertification. This, combined with new authoritative studies showing the benefits of chiropractic for NMS conditions, increases the rates of referrals from medical doctors to chiropractors."Push for limited prescription rights"?!? Are you kidding - the Palmers must be spinning in their graves. How would this differentiate the chiropractor from the DO? Or MD for that matter? (Besides the lower standards for entry into and completion of chiropractic education). Lose the basis in the body's "innate ability to heal itself" and you are no longer talking about chiropractic.
Consumer-directed healthcare grows dramatically. Patients who manage their own care favor those chiropractors who score well on report cards which compare health care providers in their area. By 2015, the few large managed care plans that remain require patients to undergo a course of manipulation for back or neck pain before considering authorization of expensive surgery or medicines. Chiropractors have very sophisticated office information systems which include electronic patient records, the ability to link genomic information, and patient coaching with different chiropractic techniques."
"Patient satisfaction with chiropractic care is generally high. But it is not clear if this is from spinal manipulation or the broader aspects of chiropractic care as it is delivered, including the personal attention of the chiropractor."Well, I certainly agree with that.
"One of the largest growth areas in healthcare will be geriatrics. The retiring Baby Boomers will look for alternative medicine that can help them to remain active and healthy. Developing better evidence for geriatric chiropractic and more in-depth postgraduate programs in geriatric chiropractic will help chiropractic expand. There is much overlap between prevention and wellness approaches for the general population and what elders need."Yeah, except for those pesky vertebral artery dissections. And, oh yeah, the elderly are poor payors, relying on Medicare for their health coverage. I would personally welcome chiropractic into the land of $0.40 on the dollar payments for service. Come in - the water is nice
- H
Healthcare is in an ever-changing state of flux, bro. PAs are prescribing and performing surgery, nurse practitioners are prescribing, psychologists are prescribing psychotropics (in some states), optometrists are performing eye surgery (in OK), podiatrists prescribe meds and perform surgery, etc. Who knows what will be going on 10 years from now.
That said, why do you think it's so ridiculous to believe that chiropractors may one day be able to prescribe a limited formulary of medications? Philosophy aside, healthcare practitioners have to keep up with the needs of their patients and should evolve professionally over time. Demonstration projects are paving the way for many fields.
- Joined
- May 14, 2004
- Messages
- 1,061
- Reaction score
- 1,765
PublicHealth said:
There are already too many providers with Rx privileges. This just adds to polypharmacy - since there's not good communication amoung providers now. Imagine if we let everyone with only a basic understanding of physiology, or anyone who took a "pharmacology" class prescribe drugs. We'd have a large increase in interactions.
- Joined
- Mar 19, 2003
- Messages
- 2,212
- Reaction score
- 30
PublicHealth said:
Philosophy aside?!? You have to be kidding! Other than the "chiropractic philosophy" what do chiropractors offer? Less education, lower admission standards, less clinical training time, and no residencies, but now we are to make them prescription providers? That aside, here is the rub - they don't want them (prescription rights)! Don't take my word for it, here is an (albiet old) interview witht the presidents of each of the U.S. chiropractic colleges. None of them is for prescription rights for chiropractors.
See: http://www.worldchiropracticalliance.org/tcj/1994/mar/mar1994e.htm
- H
- Joined
- Jun 24, 2004
- Messages
- 461
- Reaction score
- 1
Why don't we just make all drugs available over the counter so that the consumer can make their own decisions about what they need. It would probably be more logical than giving a chiropractor script privalage!
- Joined
- Mar 19, 2003
- Messages
- 2,212
- Reaction score
- 30
PublicHealth said:
Not to beat a dead horse here, but the quote I provided was a bit dated. Here are much more recent quotes from an article in the chiro press on the (now dead) proposal for a Chiropractic College at FSU.
"According to information provided by FSU leaders, the school will compromise the basic tenets of chiropractic and be in direct opposition to the principles of chiropractic agreed upon by all other chiropractic college presidents when they signed and endorsed the ACC (Association of Chiropractic Colleges) Position Paper on chiropractic.
That document, subsequently endorsed by nearly every chiropractic organization, states that:
Chiropractic is a health care discipline which emphasizes the inherent recuperative power of the body to heal itself without the use of drugs or surgery
‑‑ and ‑‑
Chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on the subluxation." {bold added, italics original}
That document, subsequently endorsed by nearly every chiropractic organization, states that:
Chiropractic is a health care discipline which emphasizes the inherent recuperative power of the body to heal itself without the use of drugs or surgery
‑‑ and ‑‑
Chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on the subluxation." {bold added, italics original}
And
"First, we must safeguard our unique identity as non-medical, subluxation-centered wellness providers. We can't merely be one of a slew of practitioners offering spinal manipulation for neuromusculoskeletal disorders. Subluxation correction is the one thing we do that no one else does, and this will be the key to bringing patients into our office and helping them lead healthier lives without drugs and surgery." {italics added, bold type original}
See: http://www.worldchiropracticalliance.org/tcj/2005/feb/rondberg.htm
Why add prescription rights to a profession that doesn't want them and was founded on the principle of health maintainence without drugs or surgery?
It is obvious from my posts that I do not believe there exists an adequate scientific basis for chiropractic in terms of safety or efficacy. That said, I can respect those chiropractors who remain true to the principles of chiropractic. While I personally find them (the principles of chiropractic) to be blatantly unsound on a scientific basis, I can see where the profession itself has a history and methodology which is still taught as fact at Chiropractic Colleges. The idea of morphing those principles into ones which allow for pharmacotherapy and surgery is, to me, absolutely unpalatable. Without a firm basis in chiropractic philosophy there is nothing at all to separate a chiropractor from an allopathic health care provider - except far less training.
- H
- Joined
- Mar 19, 2003
- Messages
- 2,212
- Reaction score
- 30
awdc said:
From: http://www.ncahf.org/pp/chirop.html
"Chiropractors complain that they are cut out from the rest of the health sciences and have even carried this charge to the point of bringing antitrust suits against a number of professional health organizations. In reality, it is chiropractic, with its deviant views on health and disease, that has isolated itself from the health sciences. Chiropractic theory and philosophy contest with basic anatomy, physiology, neurology, microbiology, pharmacology, pathology, immunology, and many other basic sciences. Despite their claims of persecution by organized medicine, chiropractic expends far more effort attacking conventional medical practice than vice versa. Chiropractors often play upon patients' natural fears of surgery and confuse patients by linking responsible therapeutic drug use with drug abuse.
In addition, chiropractors generally oppose public health programs such as fluoridation, immunization, and sometimes pasteurization of milk. Those who engage in nutrition counseling commonly attack modern food technology and promote unscientific ideas. It seems curious that although chiropractic students use many standard medical textbooks, what they learn deviates significantly from others schooled in the health sciences. The source of these problems appears to be faulty schooling where chiropractic philosophy and pseudoscience are mixed with training in manipulative therapy.{emphasis added}
In addition, chiropractors generally oppose public health programs such as fluoridation, immunization, and sometimes pasteurization of milk. Those who engage in nutrition counseling commonly attack modern food technology and promote unscientific ideas. It seems curious that although chiropractic students use many standard medical textbooks, what they learn deviates significantly from others schooled in the health sciences. The source of these problems appears to be faulty schooling where chiropractic philosophy and pseudoscience are mixed with training in manipulative therapy.{emphasis added}
'nuff said
- H
