Since the last thread on this subject ended with false/misleading information being posted as "education"....
As opposed to what you are providing here? Expert opinion, especially in this format as opposed to consensus panels, is just about worthless. Especially in the light of the extensive literature on the subject.
I think looking at what respected MD/DO physicians in fields that deal with musculoskeletal issues think of their chiropractic counterparts:
Andrew Cole, MD, a respected educator, physician and recent past president of the American Academy of Physical Medicine and Rehabilitation gave a strong overall endorsement when speaking of chiropractic practice. He said, "Overall, manipulation has the advantage of reducing pain, decreasing medication, rapidly advancing physical therapy and requiring fewer passive modalities."
SD, do you even understand what chiropractic is? It is a system of healthcare solely invented by one man, that eschews all other healthcare systems. All modern physicians, MD or DO, work from the germ theory. In germ theory, alterations to health occur because an outside force acts on the body. Within this theory, healthcare is designed to perform two functions. 1. Remove (or help the patient's body to expel) the outside "force". 2. Repair (or assist the patient's body to repair) or remove tissue affected by this outside force. Everything done in medicine is designed to function in this way. Even preventative care is designed to keep these forces from acting on the body. Now, within this framework, might spinal manipulation have a role? Possibly... I am certainly not enough of an expert to know. So, if Dr. Cole says that "manipulation has the advantage of reducing pain, decreasing medication, rapidly advancing physical therapy and requiring fewer passive modalities"
and if there are data to back that up, o.k.
That, however, does
nothing to validate chiropractic. Chiropractic is a "healthcare" system that asserts that all alterations to health result from spinal misalignment. It is the sole invention of one man. One day chiropractic didn't exist, the next day it did.
From:
http://www.ncahf.org/articles/c-d/chiro.html
"In the Beginning . . .
Chiros (hand) + practos (practice) literally means "done by hand." Chiropractic was invented in 1895 by Daniel D. Palmer, a layperson in Davenport, Iowa [1]. Because he sold goldfish commercially, Palmer is referred to by some historians as a "fish monger." It is more interesting to know that he practiced magnetic healing beginning in the mid-1880s in Burlington, Iowa. Palmer searched for the single cause of all disease. The standard story about chiropractic's "discovery" is that Palmer believed he had found the single cause of disease when he "cured" the deafness of janitor Harvey Lillard by manipulating his spine. (Palmer may have learned spinal manipulation from Andrew Still's osteopathic school in Kirksville, Missouri). Lillard is said to have lost his hearing while working in a cramped, stooped position during which he felt something snap in his back.
Palmer's version of this event has always been disputed by Lillard's daughter, Valdeenia Lillard Simons. She says that her father told her that he was telling jokes to a friend in the hall outside Palmer's office and, Palmer, who had been reading, joined them. When Lillard reached the punch line, Palmer, laughing heartily, slapped Lillard on the back with the hand holding the heavy book he had been reading. A few days later, Lillard told Palmer that his hearing seemed better. Palmer then decided to explore manipulation as an expansion of his magnetic healing practice. Simons said "the compact was that if they can make [something of] it, then they both would share. But, it didn't happen." [2]
Chiropractic's true origin appears to have been of a more mystical nature than the Lillard tale denotes. Palmer was an active spiritualist and apparently believed that the idea of "replacing displaced vertebrae for the relief of human ills" came in a spiritualist séance through communication with the spirit of Dr. Jim Atkinson, a physician who had died 50 years earlier in Davenport [3]. As a young man, Palmer regularly walked the six or seven miles to the estate of his spiritualist mentor, William Drury [4]. It was one of Drury's followers who told him of her vision of a door with a sign on it reading "Dr. Palmer." She said that he one day would lecture in a large hall telling an audience about a new "revolutionary" method of healing the sick [5]. Predisposed to magnetic healing by his belief in spiritualism, Palmer was drawn to the practice by seeing the financial success of illiterate "Dr." Paul Caster of Ottumwa. Palmer's grandson described his technique:
'He would develop a sense of being positive within his own body; sickness being negative. He would draw his hands over the area of the pain and with a sweeping motion stand aside, shaking his hands and fingers vigorously, taking away the pain as if it were drops of water [6].'
Palmer began speculating that the flow of animal magnetism may become blocked by obstructions along the spine [7]. Palmer taught that chiropractic was "an educational, scientific, religious system" that "associates its practice, belief and knowledge with that of religion" and "imparts instruction relating both to this world and the world to come." "Chiropractic," Palmer stated, "sheds enlightenment upon physical life and spiritual existence, the latter being only a continuation of the former." [8] Individual chiropractors sometimes deny that they believe in Palmer's biotheological "Innate Intelligence," but when pressed as to their basis for practice, they must face the physiological facts described in a scientific brief on chiropractic:
If there is partial blockage of impulses in a nerve fibre . . . the impulse is transmitted more slowly in a zone of partial blockage, and resumes all its characteristics as soon as it reaches normal tissue. Thus, it is impossible for a partial blockage of nerve impulses in a particular zone to affect the flow, since the impulses would resume their normal flow [9].
Unsupported by science, chiropractors must either fall back on Palmer's pantheistic views or admit that the "subluxation" theory is erroneous. Without this theory, chiropractors are reduced to spinal manipulators whose primary treatment modality is shared by osteopaths, physiatrists, sports trainers, physical therapists, and others. Without subluxation theory, chiropractic's claim that it is a unique and comprehensive "alternative" to standard medicine is lost. D.D. Palmer had only modest success in promoting chiropractic. It was his son, B.J. Palmer, an eccentric promoter and Iowa radio industry pioneer, who developed chiropractic into a successful business enterprise.' {emphasis added}
So many chiropractors will say "we don't believe in Palmer's theories". Great, good for you. But then what are you? Essentially, these chiropractors are poorly trained physical therapists. Without the framework behind it, chiropractic simply isn't chiropractic. BTW, the certifying body for chiropractic education, the CCE, still does believe in Palmer, and insures that his theory is taught to chiropractors.
From the CCE website at: http://www.cce-usa.org/Frequently%20Asked Questions.pdf
"The application of science in chiropractic concerns itself with the relationship between structure, primarily the spine and function, coordinated by the nervous system of the human body, as this relationship may affect the restoration and preservation of health."
Hmm, I must have missed that chapter in medical school. But let's go on...
(from the same source):
"Further, the application of this science focuses on the inherent ability of the body to heal without the use of drugs or surgery."
Jack Zigler, MD, a nationally known orthopedic spine surgeon states, "There are a lot of myths about chiropractic care. I decided to look into each of these myths, and what I found is that chiropractic education, side-by-side, is more similar to medical education than it is dissimilar. They can do the same work-up and send the patient who has already gone through his conservative treatment and had all his diagnostic work done to the surgeon."
Umm, no. There is extensive research that suggests Zigler is wrong, but research aside, take common sense. How is it that chiropractors, in three and one third calendar years with no inpatient clinical time, obtain a "similar" education to the MD or DO going through four calendar years of medical school followed by at least three years of residency and, quite frequently, additional years of fellowship, all of which involve heavy, in-patient clinical experiences and graduated responsibility. Keeping in mind the chiropractor performs this "time-warp" while starting with students of significantly lower acumen...
But let's look at this assertion in reality. Let's start with a representative chiropractic curriculum. From:
http://www.logan.edu/pages/prostudent_doc.asp
"In practice the Logan College program provides students 4,965 hours in numerous areas relevant to the successful practice of a chiropractic physician. 800 hours are dedicated to hands-on adjusting courses."
Wow. 800 WHOLE HOURS. So the rough equivalent of 10 weeks of clerkship or residency. Yeah, that almost compares. But really, let's look at all of the education differences shall we?
According to the CCE USA's website, as well as those of several state chiropractic associations, chiropractors are required to have 4200 "instructional hours" of training. This includes classroom time as well as clinical time. It is a sizable load for three calendar years. MDs do not have a specific requirement, but according to an article (see:
http://jama.ama-assn.org/cgi/content/full/292/9/1025 ) we spend, on average 1600 so so classroom hours in the first two years. Since that is the only published number - chiropractic students are "better trained".
Except for the pesky problem of the 3rd and 4th year. While there are no nationally published numbers, there are growing complaints that 3rd year medical students should not be exempt from the 80 hour work week rules that govern residents. The implication being that 3rd year clerks work more than 80 hours weekly. But without data, I can't address that, except through personal experience. So let's look at my third year (2002-2003):
48 week program
Family practice - longitudinal across the year, one day per week, 8 hours a day, four weeks off, no call - total time: 352 hours
Surgery - 12 week clerkship, 5 days a week (plus FP), average work day 12 hours, 6 overnight calls, 1 weekend call - total time: 720 hours (plus 96 hours of call)
Internal Medicine - 12 week clerkship, 5 days per week (plus FP), average work day 11 hours, 14 call nights until midnight, 2 weekend call - total time: 660 hours (plus ~ 136 hours of call)
Psychiatry - 8 week clerkship, 4.5 days per week (plus FP), average work day 8 hours, call from home so I won't even count it - total time: 288 hours
Pediatrics - 8 week clerkship, 4 days per week (plus FP), average work day 10 hours, 5 call nights until midnight, 2 17 hour weekend calls - total time: 320 hours (plus 74 hours of call)
OB/GYN - 8 week clerkship, 4.5 days per week (plus FP), average work day 10 hours, 5 overnight calls, 2 weekend calls - total time: 360 hours (plus 118 hours of call)
All told, my third year was roughly 2700 hours plus ~425 hours of call in 48 weeks (or ~65 hrs/wk) and I spent most of that year being in the hospital or clinic 6 (sometimes 7) days per week, between my FP day and the wards. The schedule for fourth years vary by individual student, because of electives. Call volume is far reduced as is ward time. My best guesstimate is roughly 1800 hours plus 200 of call. So, the third and fourth years together (~5125 hours) are more than the hours needed for a DC (at least in my alma mater's cirriculum). This is to say nothing of the ~1600 classroom hours in years one and two. And, of course, leaving out residency entirely.
I will agree with Dr. Zigler however, in that chiropractic college may be roughly equal to years one and two of medical school (but I would still like to see the breakdown of the 4200 hours).
And please remember that does not account for residency at all, nor does it account for the difference in acuity of the patients seen by MD/DO students in the wards and those seen by chiropractic students in their clinics.
A medical director of the Air Force, Lt. Col.(Dr.) Robert Manaker, said, "A similar thing is happening across the Army and the Navy. This is a tri-service program." Manaker said. "Chiropractic helps by essentially realigning joints to their normal alignment", He continued, "A misalignment in your spine can cause the muscles around it to begin to have pain, to spasm or to cramp up. What chiropractors find is that if you realign those vertebrae, that can help decrease your pain."
Yes, the military uses chiropractors. You found a medical doctor and soldier who "toes the party line" - impressive. Now show some hard data that 1. the chiropractic framework is safe and effective and 2. the spinal manipulation actually works in the fashion Col. Manaker suggests.
But hey, I'm just being "false" and "misleading" again by asking you to actually prove your rhetoric, right?
- H
