dr. robert fulford, DO

[facetguy]

You're right, we cannot dismiss the entire profession because of some people's laziness. However, we can dismiss your profession on the grounds that your 'practice' of medicine is not based on science, but on the delusions of a madman.

This is why SDN discussions so often go nowhere, regardless of whatever evidence is presented. However, you'll some day be in practice and will encounter neck and back pain patients (depending on your chosen field, of course), and you'll come to realize that not everyone will respond to your care or the care of a PT (right now you're thinking you're going to heal everyone because you have all the answers). At the same time, you'll encounter patients who have done well with chiropractic care. Your views will evolve and, although you may never become a cheerleader for chiropractic, you will respect your patients' experiences and will develop your own experiences in practice, and you will change your views, if only a little.

---

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[fahimaz7]

This is why SDN discussions so often go nowhere, regardless of whatever evidence is presented. However, you'll some day be in practice and will encounter neck and back pain patients (depending on your chosen field, of course), and you'll come to realize that not everyone will respond to your care or the care of a PT (right now you're thinking you're going to heal everyone because you have all the answers). At the same time, you'll encounter patients who have done well with chiropractic care. Your views will evolve and, although you may never become a cheerleader for chiropractic, you will respect your patients' experiences and will develop your own experiences in practice, and you will change your views, if only a little.

What evidence are you talking about? DPT's are also trained to do manipulations. What's the difference? They understand their scope of practice and the limitations of their training--something DC's could really benefit from. I guess DC's manage to cram both MD, DPT, and nutritionalist's training into four years.. Good to know. Anything else you guys master?

PS. Most of us don't care if you do spinal manipulations to treat back pain, as long as you stay away from C1, C2, and C3.

 

[facetguy]

What evidence are you talking about? DPT's are also trained to do manipulations. What's the difference? They understand their scope of practice and the limitations of their training--something DC's could really benefit from. I guess DC's manage to cram both MD, DPT, and nutritionalist's training into four years.. Good to know. Anything else you guys master?

PS. Most of us don't care if you do spinal manipulations to treat back pain, as long as you stay away from C1, C2, and C3.

Yes sir.

 

[JaggerPlate]

The D.C.'s that succeed in practice are those that utilize the degree and continue to learn and explore medicine. Those that are quacks and typically don't do well, take the degree and do the basics.

Every doctor is different, some are better than others; this rests on the education of the doctor and their ambition to be better than everyone else and know more than everyone else- in turn they have higher success with patients and their career.

You can not discount every D.C. because of a few jerks that are lazy and didn't do anything after they got their degree except the minimum CCE courses and whatnot and go on to try and just make money off of people.

Have some respect for people.

Let me see if I follow your logic here ...

DCs who are fantastic healers are the one's who refuse to accept any sort of limitation to their degree, push for whatever they 'feel,' may be helpful, explore 'medicine' (without first attending medical school), etc; QUACKS are the DCs who go to school for spinal manipulation, work hard, practice within their scope, and treat within their skill and knowledge base???

Really?

Honestly, this type of attitude is not only EXACTLY what I was trying to convey earlier, but it's also going to bite you in the arse, hard. Why doesn't every dentist start practicing psychiatry? Why don't ODs perform Neurosurgery? I mean, technically, this is 'pushing the limits,' 'exploring,' etc.

Practicing medicine without a medical license, exploring beyond your skill/knowledge base with someone else's wellbeing, asserting yourself as something you are not, etc, is the purest definition of a quack.

 

[jl13]

This thread is awesome!!!!!

 

[vanbamm]

Let me see if I follow your logic here ...

DCs who are fantastic healers are the one's who refuse to accept any sort of limitation to their degree, push for whatever they 'feel,' may be helpful, explore 'medicine' (without first attending medical school), etc; QUACKS are the DCs who go to school for spinal manipulation, work hard, practice within their scope, and treat within their skill and knowledge base???

Really?

Honestly, this type of attitude is not only EXACTLY what I was trying to convey earlier, but it's also going to bite you in the arse, hard. Why doesn't every dentist start practicing psychiatry? Why don't ODs perform Neurosurgery? I mean, technically, this is 'pushing the limits,' 'exploring,' etc.

Practicing medicine without a medical license, exploring beyond your skill/knowledge base with someone else's wellbeing, asserting yourself as something you are not, etc, is the purest definition of a quack.

You've missed the idea by so much I don't even know where to begin to repair the broken logic. This response shows that not only did you decide to hijack the integrity of what was said and interpret it through entirely pessimistic eyes, but it was once again, a scewed attack that was bent into a shape that better fit personal beliefs and read with malicious intent to begin with.

Just because you leave with a degree does not mean you cannot continue your quest for knowledge with fellowships and extended training to enhance what you have to offer the patient- and I honestly don't know how the thought occured that this meant taking bits and pieces of another profession and incorporating them into your own-
ie: dentist- does not learn about nor practice psychiatry but perhaps extends into orthodontics or dental surgery- or simply perhaps they attend lectures, seminars, train in a program to further their technique and stay on top of dental health and current dental research- perhaps they contribute to the research by joining with other doctors to conduct studies-perhaps write and contribute to dentistry type distributions - or perhaps they take the basics of what they learned in dental school and apply only that knowledge and never try to get better, maybe they skip out on ADA gatherings and seminars, do the minimum amount of CCE hours- maybe they don't read journals weekly- maybe they just cash their checks and are done with it.

really, what would have provoked the idea that by trying to learn more meant trying to invade another area and feeling qualified to practice whatever the doctor feels like doing- absurd and ignorant.

By the time you get to clinical and are working with real patients and doctors and see what is on the line, maybe the idea of professionalism with creep its way into your mind. If not, you may want to consider a 3 credit class, and I'd say a 4 credit lab to learn how to interact with peers in the field- or you are in for a rude awakening.

 

[JustPlainBill]

True! We are not on the "team", so to speak. Which explains why there is so much confusion and misinformation among "mainstream medicine" about chiros, much more so than among the general public, who understands very well what chiros do. It's so obvious here on SDN that most pre-meds and med students (and some attendings) simply regurgitate what they've been told along the way about chiropractors without ever taking the time to do their own investigation on the topic; perpetuate the myths. Amazingly, despite being healthcare outsiders, if you will, chiros have survived for over 100 years, and now with ever-increasing research behind what we do, we are gaining ground in terms of inter-professional relations. You are absolutely right when you say we aren't part of the equation, and as such the MD's reflex referral for MSK problems is to a PT, because that is what MDs are trained to do. And not that there's anything wrong with a referral to PTs for MSK problems. But when the amount of research for spinal manipulation and chiro care for neck and back conditions is at least as strong, and often stronger, than that for PT care, you cannot ignore chiro care if you wish to be evidence-based. How's that for spin.

Interesting -- I usually only follow NEJM/AFP and Journal Watch (all I have time for) -- and I don't seem to recall anything about chiropractic in those standard journals. Are we talking peer reviewed research published in NEJM/AFP/Lancet/JAMA/whatevertheheckorthopodspublishin and the like? Or are we talking about the 'research' that comes out of places like Parker College? Or the type of research certain members of my extended family perform -- i.e. Google Search for a topic and read the first 3 hits? How much of this has been repeated by MSK specialists that are NON-chiros? I readily admit to being no expert in research and am only beginning to open that Pandora's box with my scholarly project -- which, by the way, may be OMM for COPD patients in an outpatient setting or something like that -- but I'm kinda skeptical.

I find it interesting that this was the same discourse I ran into 11 years ago when I was looking at chiropractic (was really big into manipulative medicine then) and requested literature from Parker and TCC and took some prereqs with a group of people who eventually wound up at Parker....they were so vociferous in 'proving' they were 'legitimate' healthcare people that it made me a bit suspicious.....glad I wound up D.O. as manipulative medicine bores me and I'm having a great time being a family doc.....

Spin? Hey no sweat -- just make sure you're not drinking any Kool-Aid and realize that not everything taught in med school is financed/dictated by Big Pharma.....

 

[JaggerPlate]

You've missed the idea by so much I don't even know where to begin to repair the broken logic. This response shows that not only did you decide to hijack the integrity of what was said and interpret it through entirely pessimistic eyes, but it was once again, a scewed attack that was bent into a shape that better fit personal beliefs and read with malicious intent to begin with.

One, I didn't miss the point at all ... I simply read between the lines. Call it pessimistic, but your motives are pretty clear - you believe DCs are more than manipulators of the spine and you would like them to have a bigger role in patient care. However, you don't put forward any ideas to actual standardize education, ensure safety, etc.

Just because you leave with a degree does not mean you cannot continue your quest for knowledge with fellowships and extended training to enhance what you have to offer the patient

I agree completely ... CONTINUE your quest for knowledge with fellowships and extended training ... much like a DO/MD completes more specialized fellowships in medicine and surgery after going to medical school and completely a medical or surgical residency.

However, AGAIN, what you're referring to isn't building upon an established knowledge base ... you're talking about assuming you're entitled to something and trying to exert yourself into something without building the base. If your true intentions were to expand your quest for knowledge and hone your skill through further training, you would advocate/seek out better training in spinal DX and TX ... you wouldn't tout yourself as a physician and assert yourself as a primary care provider. Have you forgotten the LONG discussion we had in the DPM boards a while back? Have you forgotten when you put your status as 'medical student' and freely provided advice in the medical student forums, only to change it after it was reported to the mods multiple times? Tough to see through this veil ... truly tough.

ie: dentist- does not learn about nor practice psychiatry but perhaps extends into orthodontics or dental surgery- or simply perhaps they attend lectures, seminars, train in a program to further their technique and stay on top of dental health and current dental research- perhaps they contribute to the research by joining with other doctors to conduct studies-perhaps write and contribute to dentistry type distributions - or perhaps they take the basics of what they learned in dental school and apply only that knowledge and never try to get better, maybe they skip out on ADA gatherings and seminars, do the minimum amount of CCE hours- maybe they don't read journals weekly- maybe they just cash their checks and are done with it.

Exactly! A dentist can venture into the world of orthodontics, cosmetic dentistry, oral surgery, etc, because they have attended dental school, have the proper foundation, and aren't trying to go from step A -> Z without building a proper base or making any suspect claims. Again, this is in the same vein as a chiropractor taking continuing ED classes in extra manipulation, etc, but NOT akin to a DC touting themselves as a physician or thinking for a SECOND that they are able to care for patients at the same level as a residency trained DO/MD. THIS mentality IS akin to a dentist practicing psychiatry, which was my point.

really, what would have provoked the idea that by trying to learn more meant trying to invade another area and feeling qualified to practice whatever the doctor feels like doing- absurd and ignorant.

How about when you stated that DCs were physicians? Does this not sound a bit like ... oh, I dunno - you trying to invade another area and practicing something you feel like doing or feel entitled to???

By the time you get to clinical and are working with real patients and doctors and see what is on the line, maybe the idea of professionalism with creep its way into your mind. If not, you may want to consider a 3 credit class, and I'd say a 4 credit lab to learn how to interact with peers in the field- or you are in for a rude awakening.

Professionalism, huh? It seems to me like you're the one name-calling, becoming overtly defensive, and ignoring any sort of regard for patient safety, clarity, etc. To me ... this is blatantly unprofessional. Your personal attacks only reveal your own ignorance, broad misconceptions, and faulty arguments.

 

[facetguy]

Interesting -- I usually only follow NEJM/AFP and Journal Watch (all I have time for) -- and I don't seem to recall anything about chiropractic in those standard journals. Are we talking peer reviewed research published in NEJM/AFP/Lancet/JAMA/whatevertheheckorthopodspublishin and the like? Or are we talking about the 'research' that comes out of places like Parker College? Or the type of research certain members of my extended family perform -- i.e. Google Search for a topic and read the first 3 hits? How much of this has been repeated by MSK specialists that are NON-chiros? I readily admit to being no expert in research and am only beginning to open that Pandora's box with my scholarly project -- which, by the way, may be OMM for COPD patients in an outpatient setting or something like that -- but I'm kinda skeptical.

I find it interesting that this was the same discourse I ran into 11 years ago when I was looking at chiropractic (was really big into manipulative medicine then) and requested literature from Parker and TCC and took some prereqs with a group of people who eventually wound up at Parker....they were so vociferous in 'proving' they were 'legitimate' healthcare people that it made me a bit suspicious.....glad I wound up D.O. as manipulative medicine bores me and I'm having a great time being a family doc.....

Spin? Hey no sweat -- just make sure you're not drinking any Kool-Aid and realize that not everything taught in med school is financed/dictated by Big Pharma.....

JPBill, I'll keep this brief by simply saying there is indeed a growing base of research for spinal manipulation, published in peer-reviewed journals such as Spine, BMJ, European Spine Journal, Clinical Rehabilitation, Annals of Internal Med, JMPT, etc. And, yes, a good portion of it has been and is being done by non-chiros (a point which some have even used to criticize chiropractic). You mentioned '11 years ago'; while there was some good data back then, there has definitely been much more since then.

Not singling anyone out, but I would ask that at least some effort be expended in searching for manipulation-related literature before making bold statements that such literature doesn't exist. We've seen this time and time again here on SDN. I'm not suggesting everyone here become an expert in the manual therapy literature; you've got other things on your minds. Just please stop repeating the 'same old same old' when in reality the science continues to move forward.

 

[fahimaz7]

JPBill, I'll keep this brief by simply saying there is indeed a growing base of research for spinal manipulation, published in peer-reviewed journals such as Spine, BMJ, European Spine Journal, Clinical Rehabilitation, Annals of Internal Med, JMPT, etc. And, yes, a good portion of it has been and is being done by non-chiros (a point which some have even used to criticize chiropractic). You mentioned '11 years ago'; while there was some good data back then, there has definitely been much more since then.

Not singling anyone out, but I would ask that at least some effort be expended in searching for manipulation-related literature before making bold statements that such literature doesn't exist. We've seen this time and time again here on SDN. I'm not suggesting everyone here become an expert in the manual therapy literature; you've got other things on your minds. Just please stop repeating the 'same old same old' when in reality the science continues to move forward.

Sounds like DC's have a very strong history of practicing evidence based medicine...

 

[vanbamm]

One, I didn't miss the point at all ... I simply read between the lines. Call it pessimistic, but your motives are pretty clear - you believe DCs are more than manipulators of the spine and you would like them to have a bigger role in patient care. However, you don't put forward any ideas to actual standardize education, ensure safety, etc.


D.C.'s CAN do more than manipulate- many are qualified in other areas: D.A.C.B.R.,D.A.C.B.N. etc.- and are held in high regard because they have extensive training, completed residency, and fellowships as well- depending on the state you are in- you are responsible for more than manipulation- this doesn't mean you have to treat- this means identification of pathology and referral-would I like to have them have a bigger role in patient care- that depends- if there are no PCP's around(I.e. shortages in Dakota's, Montana) and they have something that needs to be identified- yes.
Standardized programs;The ACA will be presenting at my school today- I can fill you in.
My school is setting the standard and others will soon follow as we've scored the highest on boards most years since the program was created-indicating that we may have perhaps the most sound format that others may want to replicate.


However, AGAIN, what you're referring to isn't building upon an established knowledge base ... you're talking about assuming you're entitled to something and trying to exert yourself into something without building the base. If your true intentions were to expand your quest for knowledge and hone your skill through further training, you would advocate/seek out better training in spinal DX and TX ... you wouldn't tout yourself as a physician and assert yourself as a primary care provider. Have you forgotten the LONG discussion we had in the DPM boards a while back? Have you forgotten when you put your status as 'medical student' and freely provided advice in the medical student forums, only to change it after it was reported to the mods multiple times? Tough to see through this veil ... truly tough.

No one is entitled to anything- and thank you but I've been taught quite thoroughly on the DX and TX of the spine and would put this knowledge to test against any MD/DO student's.- If I did offer any advice, it was because the knowledge is present- I had no idea I was reported and if you are a medical student I'd think you'd have better things to do. Sad that such things remain in tact in your memory bank.



How about when you stated that DCs were physicians? Does this not sound a bit like ... oh, I dunno - you trying to invade another area and practicing something you feel like doing or feel entitled to???

Physicians yes- that is a title D.C.'s have earned. I think perhaps there is some greater deep rooted animosity in the idea for you that in some way D.C.'s and M.D.'s share something minor in common!



Professionalism, huh? It seems to me like you're the one name-calling, becoming overtly defensive, and ignoring any sort of regard for patient safety, clarity, etc. To me ... this is blatantly unprofessional. Your personal attacks only reveal your own ignorance, broad misconceptions, and faulty arguments.

Totally interpretion.

 

[NYEMMED]

How about when you stated that DCs were physicians? Does this not sound a bit like ... oh, I dunno - you trying to invade another area and practicing something you feel like doing or feel entitled to???

Physicians yes- that is a title D.C.'s have earned. I think perhaps there is some greater deep rooted animosity in the idea for you that in some way D.C.'s and M.D.'s share something minor in common!

Actually in the U.S. only two degrees are allowed to call themselves physicians the MD and the DO... The other degrees can call themselves Drs. but not physicians.
Some states may allow chiropractors to call themselves chiropractic physicians, but not medical physician or just physician.

http://www.bls.gov/oco/ocos074.htm
"There are two types of physicians: M.D. (Medical Doctor) and D.O. (Doctor of Osteopathic Medicine)."

http://www.bls.gov/oco/ocos071.htm
"chiropractors do not prescribe drugs or perform surgery."

http://wapedia.mobi/en/Doctors_of_Osteopathic_Medicine
"In the United States, the DO and the MD are the only two degrees permitting licensure as medical physicians."

In the United States ONLY 2 degrees are allowed to call themselves physicians by law, those that went to medical school, the MD and the DO...

 

[JHInt]

.

"North America
Main article: Medicine
In the United States and Canada, the term physician usually describes all medical practitioners holding the degrees of Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO)."http://en.wikipedia.org/wiki/Physician

"Chiropractic is a health care discipline and profession that emphasizes diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially the spine, under the hypothesis that these disorders affect general health via the nervous system.[1] It is generally categorized as complementary and alternative medicine (CAM)"

"In spite of the general consensus of public health professionals regarding the benefits of vaccination, among chiropractors there are significant disagreements over the subject,[17] which has led to negative impacts on public vaccination and mainstream acceptance of chiropractic"

"Many studies of treatments used by chiropractors have been conducted, with conflicting results. Collectively, systematic reviews of this research have not demonstrated that spinal manipulation is effective, with the possible exception of treatment of back pain.[16] The efficacy and cost-effectiveness of maintenance chiropractic care are unknown.[22]"

"Mainstream health care and governmental organizations such as the World Health Organization consider chiropractic to be complementary and alternative medicine (CAM);"

"Chiropractors are not licensed to write medical prescriptions or perform major surgery in the U.S.,[47]"
http://en.wikipedia.org/wiki/Chiropractors

"Although chiropractors are recognized as "Doctors of Chiropractic" they are not medical doctors. Under current law chiropractors are considered "limited providers" in that there are restrictions on their scope of practice. They can not perform surgery or other invasive procedures nor can they prescribe medications."

"A recent state court decision in Pennsylvania prohibits Chiropractors from calling themselves "Physical Therapists" or "Specialists in Physical Therapy" because Physical Therapy is a separate profession with its own training and licensing requirements."

"Although many states require health insurance companies to reimburse for certain treatments this is a legal standing due to very effective lobbying of both congress and state legislatures by chiropractic organizations. This does not indicate acceptance by Medicare and other insurers that chiropractic treatment is effective nor that chiropractic theory scientifically valid."
http://your-doctor.com/patient_info/alternative_remedies/various_therapy/chiropractic.html

"Avoid chiropractors who "prescribe" dietary supplements, homeopathic products, or herbal products for the treatment of disease or who sell any of these products in their offices. For dietary advice, the best sources are physicians and registered dietitians. "
http://your-doctor.com/patient_info/alternative_remedies/various_therapy/chiropractic.html

Think You’re a Chiropractic “Physician”? Not According to the American Medical Association
Resolution 232 advocates making it a felony to use the title if you are not an MD or DO.
The AMA approved Resolution 232, which advocates the use of state legislation to make it a felony for any non-MD/DO to misrepresent themselves as a “physician.”
http://www.chiroweb.com/archives/26/16/17.html


"Under the Federal Employees’ Compensation Act,
chiropractors were not qualified physicians and their opinions did not constitute medical evidence
except in very limited cases involving specific spine problems."
U.S. Department of Justice


Anyway, long winded, but Chiros are not physicians. Only MDs/DOs are allowed to be considered physicians in the US. CHiros do not attend medical school, and are not licensed as Medical Physicians

 

[vanbamm]

Both of the above- understood.

It may have been a bit technical on my part- the term "physician" alone does imply MD/DO. "chiropractic physician" is, well, a DC. - I didn't intend to create confusion so as to think that they were on the same level in that regard, simply that the term "physician" can be used to describe a DC (with the chiropractic attachment), and I should have been more descriptive- recognized and conceded without a doubt!

 

[fahimaz7]

Both of the above- understood.

It may have been a bit technical on my part- the term "physician" alone does imply MD/DO. "chiropractic physician" is, well, a DC. - I didn't intend to create confusion so as to think that they were on the same level in that regard, simply that the term "physician" can be used to describe a DC (with the chiropractic attachment), and I should have been more descriptive- recognized and conceded without a doubt!

"North America
Main article: Medicine
In the United States and Canada, the term physician usually describes all medical practitioners holding the degrees of Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO)."http://en.wikipedia.org/wiki/Physician

"Chiropractic is a health care discipline and profession that emphasizes diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially the spine, under the hypothesis that these disorders affect general health via the nervous system.[1] It is generally categorized as complementary and alternative medicine (CAM)"

"In spite of the general consensus of public health professionals regarding the benefits of vaccination, among chiropractors there are significant disagreements over the subject,[17] which has led to negative impacts on public vaccination and mainstream acceptance of chiropractic"

"Many studies of treatments used by chiropractors have been conducted, with conflicting results. Collectively, systematic reviews of this research have not demonstrated that spinal manipulation is effective, with the possible exception of treatment of back pain.[16] The efficacy and cost-effectiveness of maintenance chiropractic care are unknown.[22]"

"Mainstream health care and governmental organizations such as the World Health Organization consider chiropractic to be complementary and alternative medicine (CAM);"

"Chiropractors are not licensed to write medical prescriptions or perform major surgery in the U.S.,[47]"
http://en.wikipedia.org/wiki/Chiropractors

"Although chiropractors are recognized as "Doctors of Chiropractic" they are not medical doctors. Under current law chiropractors are considered "limited providers" in that there are restrictions on their scope of practice. They can not perform surgery or other invasive procedures nor can they prescribe medications."

"A recent state court decision in Pennsylvania prohibits Chiropractors from calling themselves "Physical Therapists" or "Specialists in Physical Therapy" because Physical Therapy is a separate profession with its own training and licensing requirements."

"Although many states require health insurance companies to reimburse for certain treatments this is a legal standing due to very effective lobbying of both congress and state legislatures by chiropractic organizations. This does not indicate acceptance by Medicare and other insurers that chiropractic treatment is effective nor that chiropractic theory scientifically valid."
http://your-doctor.com/patient_info/alternative_remedies/various_therapy/chiropractic.html

"Avoid chiropractors who "prescribe" dietary supplements, homeopathic products, or herbal products for the treatment of disease or who sell any of these products in their offices. For dietary advice, the best sources are physicians and registered dietitians. "
http://your-doctor.com/patient_info/alternative_remedies/various_therapy/chiropractic.html

Think You’re a Chiropractic “Physician”? Not According to the American Medical Association
Resolution 232 advocates making it a felony to use the title if you are not an MD or DO.
The AMA approved Resolution 232, which advocates the use of state legislation to make it a felony for any non-MD/DO to misrepresent themselves as a “physician.”
http://www.chiroweb.com/archives/26/16/17.html


"Under the Federal Employees’ Compensation Act,
chiropractors were not qualified physicians and their opinions did not constitute medical evidence
except in very limited cases involving specific spine problems."
U.S. Department of Justice


Anyway, long winded, but Chiros are not physicians. Only MDs/DOs are allowed to be considered physicians in the US. CHiros do not attend medical school, and are not licensed as Medical Physicians

Why do you guys want to be us so bad?

 

[JaggerPlate]

Both of the above- understood.

It may have been a bit technical on my part- the term "physician" alone does imply MD/DO. "chiropractic physician" is, well, a DC. - I didn't intend to create confusion so as to think that they were on the same level in that regard, simply that the term "physician" can be used to describe a DC (with the chiropractic attachment), and I should have been more descriptive- recognized and conceded without a doubt!

OH, so you simply forgot to put the 'Chiropractic' in front of physician the dozens and dozens of times you've referred to DCs as physicians on SDN. Totally an understandable mistake. Man, I must have x-ray specs to see through your game.

This is just getting pointless now ...

-DCs are not physicians, they are chiropractors - even is some states use the awkward term 'chiropractic physician.'
-Practicing outside of your scope (which you clearly intend to do) is textbook quackery and so dangerous for unsuspecting patients
-I'm 99% sure you've just reaffirmed everyone's thoughts/opinions on DCs, and I wouldn't expect your attitude to garner any sort of collaborative sentiments in the future. I know where I stand.

 

[JaggerPlate]

Why do you guys want to be us so bad?

Welcome to America in 2010 ... everyone wants/feels entitled to a piece of the pie, but no one wants to put in the work. Want to be a famous singer but have no musical talent??? Get old men to write your pop songs and autotune the piss out of your annoying voice. Want to be a Hollywood celebrity but don't feel like making connections, honing your skills, putting in 'your time,' etc? Be a skank on some reality show with Brett Michaels.

Want to parade around in a white coat, introduce yourself as a physician, get paid the same money as DO/MDs, but don't want to put in all the time, effort, and sacrifice involved with medical school? Enroll in a DNP, DC, CRNA, etc, program, belittle docs as money grubbing, pharma-******, and mislead patients until you get what you want.

Oh sayyy can you seeeeee .....

 

[fahimaz7]

Welcome to America in 2010 ... everyone wants/feels entitled to a piece of the pie, but no one wants to put in the work. Want to be a famous singer but have no musical talent??? Get old men to write your pop songs and autotune the piss out of your annoying voice. Want to be a Hollywood celebrity but don't feel like making connections, honing your skills, putting in 'your time,' etc? Be a skank on some reality show with Brett Michaels.

Want to parade around in a white coat, introduce yourself as a physician, get paid the same money as DO/MDs, but don't want to put in all the time, effort, and sacrifice involved with medical school? Enroll in a DNP, DC, CRNA, etc, program, belittle docs as money grubbing, pharma-******, and mislead patients until you get what you want.

Oh sayyy can you seeeeee .....

This is my favorite...

http://www.defaulteddocs.dhhs.gov/discipline.asp

Some of the DC's take out 250k in debt, only to discover that they don't really make much money. They end up trying to push diets and supplements, while giving away "free evaluation w/ 4 xrays for all new patients!"

 

[vanbamm]

okay guys- let's simmer- haha. i think we all see what this has amounted to and we know the answers.

MD/DO are physicians
DC is a chiropractor.

There is truly nothing to worry about here- these things will remain the same- I was poking the sleeping dog with a stick- it is interesting to see what the take is on chiropractic and what the reaction is like- there are some things we agree on, some we do not- but the bottom line I think is agreeable- MD/DO are the doctors- and others DC, DDS, etc...are not. I don't think any professional would argue that.

We know all the big differences between MD/DO and everyone else- no one is going to take that away, and no one is going to try- I think it is fair to say that those that have become "doctors" outside of the MD/DO did so because 1. they actually enjoy it and have a calling for it, or 2. they didn't get into MD/DO school and it was the backup plan.

The role of the MD/DO is well understood- they control everything that is- and rightly so- if they were really doing that poor of a job, they would have been overthrown by now- I do enjoy chiropractic, but the profession needs to come together- hopefully soon- worldwide they have- in the US things are lagging because the states vary so much on things it is hard to come to a consensus-

It was a good arguement- valid points from the medical side- and as you can see, and I regret to say, the chiropractic side is lacking in support in some ways- there are so many things I could go into about it (i.e. only 8% of americans use chiropractic and that has remained the same for 50 yrs despite over 200 billion spent in advertising and such)- I do hope for changes, I don't expect them to happen fast here in the US...

The MD/DO are still the nut and bolt of the healthcare system...other practitioners are there for support of the patient depending on the type of care needed.

 

[schrute]

... in the US things are lagging because the states vary so much on things it is hard to come to a consensus.

It is hard to come to a consensus because nearly everyone in the mainstream medical profession sees chiropractic for what it is--Complimentary & Alternative Medicine--while the chiropractic professional organization views itself in entirely different light, as an integral & indespensable component of modern healthcare, and spends its political dollars accordingly.

Because healthcare only gets more expensive, more complicated, and more political, everyone who's not a "physician" is scraping for a bigger slice of an ever shrinking pie, hoping that if they can stake a claim & find a niche, their existence will be affirmed and legitimized by insurance reimbursement & government dollars.

Nobody has beef with a DC, or a massage therapist, or an acupuncturist, or whoever, putting a shingle outside their door and advertising their services as what they are. But the inferiority complex that eats away at countless DCs (and PharmDs, APRNs, etc), turns that shingle into a long white coat, prefacing every name reference with "Dr.", and the insistance that 4 years of post baccalaureate education confers not only the technical title of "doctor" but the respect garnered by physicians, and by "respect" I mean confidence the healthcare field would crumble in the absence of their indispensable contribution. Palmer could melt away tomorrow and I wouldn't blink.

I entirely agree that patients do (and should) seek the type of care they need, and can't disagree that people entering chiro do so because they like it. But liking something that you know people will pay you for doesn't justify the existance of a medical profession...carnival ride operator, yes. But we're talking healthcare, and just because someone will pay you for a service doesn't quality it as bonafide healthcare.

 

[facetguy]

It is hard to come to a consensus because nearly everyone in the mainstream medical profession sees chiropractic for what it is--Complimentary & Alternative Medicine--while the chiropractic professional organization views itself in entirely different light, as an integral & indespensable component of modern healthcare, and spends its political dollars accordingly.

Because healthcare only gets more expensive, more complicated, and more political, everyone who's not a "physician" is scraping for a bigger slice of an ever shrinking pie, hoping that if they can stake a claim & find a niche, there existence will be affirmed and legitimized by insurance reimbursement & government dollars.

Let's remember that the chiropractic profession isn't new and isn't just now trying to stake a claim and find a niche. I understand what you are saying, but I disagree that it applies to chiropractic, which long ago established itself. Also, chiropractic care has been reimbursed by insurance companies for decades now; this is not a new goal for chiros.

I also agree that the healthcare dollar continues to shrink as things get ever more expensive and complicated. As such, we have the push for more "evidence based" care. Fortunately for the chiro profession, there is more evidence in the literature than ever, including effectiveness and cost-effectiveness data. It's true that the line for CAM can be blurry with regard to chiro, but from an evidence standpoint, we fall more on the "mainstream" side of the line.

Nobody has beef with a DC, or a massage therapist, or an acupuncturist, or whoever, putting a shingle outside their door and advertising their services as what they are. But the inferiority complex that eats away at countless DCs (and PharmDs, APRNs, etc), turns that shingle into a long white coat, prefacing every name reference with "Dr.", and the insistance that 4 years of post baccalaureate education confers not only the technical title of "doctor" but the respect garnered by physicians, and by "respect" I mean confidence the healthcare field would crumble in the absence of their indispensable contribution. Palmer could melt away tomorrow and I wouldn't blink.

I entirely agree that patients do (and should) seek the type of care they need, and can't disagree that people entering chiro do so because they like it. But liking something that you know people will pay you for doesn't justify the existance of a medical profession...carnival ride operator, yes. But we're talking healthcare, and just because someone will pay you for a service doesn't quality it as bonafide healthcare.

 

[vanbamm]

It is hard to come to a consensus because nearly everyone in the mainstream medical profession sees chiropractic for what it is--Complimentary & Alternative Medicine--while the chiropractic professional organization views itself in entirely different light, as an integral & indespensable component of modern healthcare, and spends its political dollars accordingly.

And really that is the way it should be- chiropractic deals with pathology of the spine, and sometimes musculoskeletal disorders while screening for other pathologies so the PCP can be informed, or make the proper referral...The ACA and the ICA are erratic in their stances and so it makes it hard,I think, for those coming out of chiropractic school to understand what type of service they are offering. And as I have said previously, OUTSIDE of the US, chiropractic is set up and fit into the healthcare model appropriately...The US isn't sure what to do, and I think that stems from the ACA not being consistent, and so the government has sort of put a hold on the DC (in most states) and what they can do, until they figure that out.

Because healthcare only gets more expensive, more complicated, and more political, everyone who's not a "physician" is scraping for a bigger slice of an ever shrinking pie, hoping that if they can stake a claim & find a niche, there existence will be affirmed and legitimized by insurance reimbursement & government dollars.

In some states chiropractic is a valued service and reimbursement is good (iehio, illinois) and in some states the opposite is true (ie: New York). The healthcare system is getting more political and complicated and while everyone is trying to get a slice of the pie, the slice of pie that does exist is dominated by a handful of practitoners in chiropractic that are trying to take that alotted slice all for themself, leaving others and profession behind.

..and the insistance that 4 years of post baccalaureate education confers not only the technical title of "doctor" but the respect garnered by physicians, and by "respect" I mean confidence the healthcare field would crumble in the absence of their indispensable contribution. Palmer could melt away tomorrow and I wouldn't blink.

I agree there are too many with an inferiority complex that persists, which creates problems for those that don't because in the long run, they end up destroying potential relationships in the healthcare system for future DC's...Without the MD/DO, there would be no center of mass for the rest of the system to rotate around, and it would eventually lose gravity and fall apart...Palmer provided a foundation of sorts, but as we move towards an evidence based system, alot of his techniques and ideas are slowly being swept away and replaced...the ACA is actually taking out the word "subluxation" in the description of what DC's treat because it is too vague and there is no scientific reinforement behind the term- which scares off insurance companies.


I entirely agree that patients do (and should) seek the type of care they need, and can't disagree that people entering chiro do so because they like it. But liking something that you know people will pay you for doesn't justify the existance of a medical profession...carnival ride operator, yes. But we're talking healthcare, and just because someone will pay you for a service doesn't quality it as bonafide healthcare.

At this point chiropractic is taking a step towards validating its existence as a useful service for patients- which studies(that I will find and post) have shown to help acute back pain and help in the management (not sole treatment) of neurologic and musculoskeletal disorders. The scientific evidence is slowly accumulating as more DC's get into conducting research with larger institutions and couple studies in order to describe more definitive outcomes based on type of treatment and its application.
I think what does qualify as a healthcare service is practice that can prevent and/or diminish and/or manage pathology consistenly and efficiently.
[/QUOTE]

 

[facetguy]

In some states chiropractic is a valued service and reimbursement is good (iehio, illinois) and in some states the opposite is true (ie: New York). The healthcare system is getting more political and complicated and while everyone is trying to get a slice of the pie, the slice of pie that does exist is dominated by a handful of practitoners in chiropractic that are trying to take that alotted slice all for themself, leaving others and profession behind.

I'm not sure what you mean here.

At this point chiropractic is taking a step towards validating its existence as a useful service for patients- which studies(that I will find and post) have shown to help acute back pain and help in the management (not sole treatment) of neurologic and musculoskeletal disorders. The scientific evidence is slowly accumulating as more DC's get into conducting research with larger institutions and couple studies in order to describe more definitive outcomes based on type of treatment and its application.
I think what does qualify as a healthcare service is practice that can prevent and/or diminish and/or manage pathology consistenly and efficiently.

Just make sure you include the acute pain AND chronic pain studies, as well as the radicular-pain and disc-related studies (albeit more limited), as well as the low back AND neck pain studies, as well as the recommendations from multidisciplinary 'practice guideline' panels from around the world, as well as the cost-effectiveness studies, as well as the safety studies. It's gonna be a big post, so if your gonna do it, do it right. I've never done it because it will take too much time and will fall on deaf ears around here anyway.

 

[schrute]

...everyone who's not a "physician" is scraping for a bigger slice of an ever shrinking pie, hoping that if they can stake a claim & find a niche, their existence will be affirmed and legitimized by insurance reimbursement & government dollars.

Perfect example of the above per the "American Society of Health System Pharmacists":

http://www.ashp.org/DocLibrary/Advocacy/GAD/Heinrich-Letter.aspx


"Clinical pharmacists bring a unique knowledge of pharmaceutical agents, their mechanism of action, and drug interactions that is separate from the knowledge base of physicians.

This bill takes that important first step in utilizing the health professional with the education and training uniquely directed toward the appropriate use of medications, the pharmacist. Simply put, the time has come to begin addressing the medication use problems that cause adverse drug events and add needless costs to our health care system."

Really? Because understanding pharmacokinetics places pharmacists in a unique position to consequently understand disease processes? It really is quite disconcerting: the push for pharmacists to bill for clinical encounters, basically fulfilling the role of primary care physicians who just manage drugs but have no appreciable understanding of the disease processes those drugs are used to treat.

It's only going to get worse, gang, so buckle up.

 

[jl13]

I still don't know what a pharmacist does!

Why do they go to school? Besides to make sure drug addicts don't have access to all those pain pills.........?

 

[MG2005]

The fact that cranial and the like is still part of our curriculum really makes the profession look bad. Some aspects of OMT have beneficial uses and are effective treatment modalities, other aspects of OMT is utter nonsense.

Simply because YOU are unable to use or understand the techniques properly does not mean that others can't or that the treatment is ineffective.

 

[Black Adder]

Simply because YOU are unable to use or understand the techniques properly does not mean that others can't or that the treatment is ineffective.

Have YOU ever even seen a demonstration of cranial done? Have YOU ever tried doing those techniques yourself?

Practically ever DO aside from the minority of hardcore OMM types will agree that cranial is totally bogus. I guess you must fall into that minority category if you're actually defending that stuff...

 

[JaggerPlate]

Simply because YOU are unable to use or understand the techniques properly does not mean that others can't or that the treatment is ineffective.

This argument, fortunately, doesn't hold up in science/medicine.

 

[vanbamm]

I'm not sure what you mean here.



Just make sure you include the acute pain AND chronic pain studies, as well as the radicular-pain and disc-related studies (albeit more limited), as well as the low back AND neck pain studies, as well as the recommendations from multidisciplinary 'practice guideline' panels from around the world, as well as the cost-effectiveness studies, as well as the safety studies. It's gonna be a big post, so if your gonna do it, do it right. I've never done it because it will take too much time and will fall on deaf ears around here anyway.

What I meant is ethical practice. Some are treating patients- others are doing the same adjustments on everyone, collected the copay, or cash and leaving it at that-

Here is a recent study about the cost effectiveness of chiropractic care:
http://www.jmptonline.org/article/S0161-4754(10)00216-2/abstract
This study was conducted by both an MD and a DC.

And here is the link on the ACA website to the more prominent research that supports chiropractic for acute and chronic pain, comparison to alternative treatment,headaches, cost effectiveness, and patient satisfaction. I don't think the research on chiropractic popularity is really important other than to perhaps change strategies in improving public awareness and knowledge...

http://www.acatoday.org/level2_css.cfm?T1ID=21&T2ID=96

 

[fahimaz7]

What I meant is ethical practice. Some are treating patients- others are doing the same adjustments on everyone, collected the copay, or cash and leaving it at that-

Here is a recent study about the cost effectiveness of chiropractic care:
http://www.jmptonline.org/article/S0161-4754(10)00216-2/abstract
This study was conducted by both an MD and a DC.

And here is the link on the ACA website to the more prominent research that supports chiropractic for acute and chronic pain, comparison to alternative treatment,headaches, cost effectiveness, and patient satisfaction. I don't think the research on chiropractic popularity is really important other than to perhaps change strategies in improving public awareness and knowledge...

http://www.acatoday.org/level2_css.cfm?T1ID=21&T2ID=96

So, when practicing within your scope of practice, you may be "more effective" at treating some causes of back pain, when you look at the financial burden of the insurance companies. Big shocker here. Most MD's will prescribe pain meds/muscle relaxers and then send the patient for physical therapy. They will do standard imaging in the office, and if the patient re-presents in a week or two they will send them for a CT or MRI, both of which will cost BCBS about $1500. If there's some abnormality that needs surgery, then you're looking at 20,000-100,000k for the insurance company to have to put out.

That MD is an advisor to managed health groups and consulting firms (earnst and young), and he is a family practice trained MD. That study carries very little power of clinical significance. Why would you link a journal that publishes an insurance companies agenda?

Out of curiosity, an a DC send a patient for a MRI, CT, or prescribe any medication? If not, I wonder how much money the insurance companies would save by sending their "chronic back pain patients" to a DC instead of a MD. Chronic back pain is one of the most common complaints seen in the ER/primary care setting. Do many people find relieve to their osteoarthritis? I don't think so....

"NEW YORK--(BUSINESS WIRE)--Aug. 21, 2002

Ernst & Young LLP announced today that Richard Liliedahl, MD, a recognized industry leader, has joined the firm as an Advisor in the Health Plan Solutions Group, a division of Ernst & Young's Health Actuarial Services Practice."

 

[facetguy]

So, when practicing within your scope of practice, you may be "more effective" at treating some causes of back pain, when you look at the financial burden of the insurance companies. Big shocker here. Most MD's will prescribe pain meds/muscle relaxers and then send the patient for physical therapy. They will do standard imaging in the office, and if the patient re-presents in a week or two they will send them for a CT or MRI, both of which will cost BCBS about $1500. If there's some abnormality that needs surgery, then you're looking at 20,000-100,000k for the insurance company to have to put out.

That MD is an advisor to managed health groups and consulting firms (earnst and young), and he is a family practice trained MD. That study carries very little power of clinical significance. Why would you link a journal that publishes an insurance companies agenda?

Out of curiosity, an a DC send a patient for a MRI, CT, or prescribe any medication? If not, I wonder how much money the insurance companies would save by sending their "chronic back pain patients" to a DC instead of a MD. Chronic back pain is one of the most common complaints seen in the ER/primary care setting. Do many people find relieve to their osteoarthritis? I don't think so....

"NEW YORK--(BUSINESS WIRE)--Aug. 21, 2002

Ernst & Young LLP announced today that Richard Liliedahl, MD, a recognized industry leader, has joined the firm as an Advisor in the Health Plan Solutions Group, a division of Ernst & Young's Health Actuarial Services Practice."

To clarify, yes, DCs can refer for dx imaging. Prescription meds are not part of our scope.

DCs see lots of chronic spine pain patients, and plenty of studies are available that demonstrate effectiveness with these cases. And if you believe that osteoarthritis is the only factor for chronic back pain, you need to keep studying.

As to the study in question, the insurance records were utilized as a means of studying costs for similar dx codes. The results have nothing to do with an "insurance company agenda". They simply reflect cost-effectiveness of one form of care compared to another. And what difference does it make that one of the authors, assuming you are correct, is an advisor to industry? How does his affiliation benefit chiropractic? If in fact he is an advisor to healthcare-related groups, I would think he would make it his business to do research to determine how to advise these groups. Again, how does that become a negative for chiropractic?

Tell me: had the study instead shown that chiropractic care was 100 times more costly than standard medical care, would your comments had been different? Or are you critical because chiropractic care was found to be more cost-effective in today's economically-sensitive climate?

 

[fahimaz7]

To clarify, yes, DCs can refer for dx imaging. Prescription meds are not part of our scope.

DCs see lots of chronic spine pain patients, and plenty of studies are available that demonstrate effectiveness with these cases. And if you believe that osteoarthritis is the only factor for chronic back pain, you need to keep studying.

As to the study in question, the insurance records were utilized as a means of studying costs for similar dx codes. The results have nothing to do with an "insurance company agenda". They simply reflect cost-effectiveness of one form of care compared to another. And what difference does it make that one of the authors, assuming you are correct, is an advisor to industry? How does his affiliation benefit chiropractic? If in fact he is an advisor to healthcare-related groups, I would think he would make it his business to do research to determine how to advise these groups. Again, how does that become a negative for chiropractic?

Tell me: had the study instead shown that chiropractic care was 100 times more costly than standard medical care, would your comments had been different? Or are you critical because chiropractic care was found to be more cost-effective in today's economically-sensitive climate?

Are you joking, or are you just high when you read my post? What in my post gave you the illusion that the only cause of CBP (that I know of) is OA? Do you really expect a full DDX for this post?

Your condescending posts on here are getting a bit old.

Do me a favor. Read the article that he posted. If for some reason you can't access it, send me a pm and I'll send you my copy. The entire "study" was a retrospective look through BCBS records to see how much money they had to dish out for a chief complaint of...

Intervertebral disk disorders
Other and unspecified disorders of back
Other disorders of soft tissues
Nonallopathic lesions not elsewhere classified
Sprains and strains of sacroiliac region
Sprains and strains of other and unspecified parts of back

They did not look at the overall quality of care, the ability to alleviate/treat the underlying condition, and they didn't look at any "mixed provider" type of care. Another heinous act here is..

"For this analysis, we collapsed providers into 2 categories: MD and DC. All episodes originating with an emergency department visit were assigned to MD providers. Doctors of osteopathic medicine were also assigned to the MD category." -Let me get this right, DC's got assigned ambulatory patients that made scheduled visits, and we get assigned patients that come to the ER? That sounds like a fair thing to do...

"Paid costs also include all pharmaceuticals for these members from the narcotic, analgesic, nonsteroidal, and muscle relaxant group and were also included in the total cost of care for each episode." - Shocker here. They looked at price paid by the insurer for all pharmaceutical interventions that were prescribed. Another thing that only medical doctors can do...

"Finally, this study does not address the mix of services provided, the cost of the individual services, or if chiropractic care is a substitute for conventional care."-- What? No mixed services? No DPT? No record of whether or not the patient is seeing both his medical doctor and a DC at the same time?

And my personal favorite...

FUNDING SOURCES AND POTENTIAL CONFLICTS OF INTEREST
The authors reported no conflicts of interest were reported for this study. This study was funded by the American Chiropractic Association.

 

[facetguy]

Are you joking, or are you just high when you read my post? What in my post gave you the illusion that the only cause of CBP (that I know of) is OA? Do you really expect a full DDX for this post?

Your condescending posts on here are getting a bit old.

Do me a favor. Read the article that he posted. If for some reason you can't access it, send me a pm and I'll send you my copy. The entire "study" was a retrospective look through BCBS records to see how much money they had to dish out for a chief complaint of...

Intervertebral disk disorders
Other and unspecified disorders of back
Other disorders of soft tissues
Nonallopathic lesions not elsewhere classified
Sprains and strains of sacroiliac region
Sprains and strains of other and unspecified parts of back

They did not look at the overall quality of care, the ability to alleviate/treat the underlying condition, and they didn't look at any "mixed provider" type of care. Another heinous act here is..

"For this analysis, we collapsed providers into 2 categories: MD and DC. All episodes originating with an emergency department visit were assigned to MD providers. Doctors of osteopathic medicine were also assigned to the MD category." -Let me get this right, DC's got assigned ambulatory patients that made scheduled visits, and we get assigned patients that come to the ER? That sounds like a fair thing to do...

"Paid costs also include all pharmaceuticals for these members from the narcotic, analgesic, nonsteroidal, and muscle relaxant group and were also included in the total cost of care for each episode." - Shocker here. They looked at price paid by the insurer for all pharmaceutical interventions that were prescribed. Another thing that only medical doctors can do...

"Finally, this study does not address the mix of services provided, the cost of the individual services, or if chiropractic care is a substitute for conventional care."-- What? No mixed services? No DPT? No record of whether or not the patient is seeing both his medical doctor and a DC at the same time?

And my personal favorite...

FUNDING SOURCES AND POTENTIAL CONFLICTS OF INTEREST
The authors reported no conflicts of interest were reported for this study. This study was funded by the American Chiropractic Association.

OK, you got me on the condescension thing. But your remarks had a wiseguy angle to them, so I thought I respond in kind. Truce.

This study isn't some kind of 'end-all' study. It is what it is: an analysis of insurance records to determine cost differences between provider types for similar diagnoses. The analysis included risk adjustment, which would include differences in severity, etc. The pharmaceutical costs are part of medical care; no disagreement there, but are we supposed to ignore those costs? If a patient can find relief w/o the use of meds (and their associated costs), isn't that a good thing? That's kind of the point.

Nobody will read this study and conclude that every patient will get better with chiropractic care alone. Study after study makes it clear that some patients do well with chiro care, others don't. BUT, the same is true for every other treatment and/or intervention as well; that's an important point that sometimes gets overlooked in, say, an SDN forum. No single discipline bats 1.000 with back pain patients. In reality, at least some of these people will likely see multiple providers, who each contribute something to their situation. But, again, in today's healthcare climate, effectiveness studies are important, but cost-effectiveness will count for something as well as the healthcare dollar continues to shrink.

As to the funding of the study, do you usually ignore drug studies funded by the drug's manufacturer, for example?

 

[fahimaz7]

As to the funding of the study, do you usually ignore drug studies funded by the drug's manufacturer, for example?

Our field is very aware of the influence that big pharma may try to have in publishing and supporting certain studies, especially when they are presenting a "new and improved" treatment for a condition. One thing that is important is to learn how to interpret these arguments, and take into consideration the financial means that each patient has when they present with that said complaint. If drug A treats the condition in 5 daily doses and drug B treats the condition in 10 days, but requires 3 doses/day...which one do you think the patient wants? What if drug A costs $275 and drug B costs $6? Is the efficacy equal? If so (and you're not dealing with some life threatening bacterial infection), I plan on sticking with the more affordable option for most of my patients.

In medical school, the first thing they teach you about interpreting primary research is to see who's behind the publication. If it's a double-blinded study or a large meta-analysis, we are much more likely to give it the attention that it deserves. I guess spending 3 years in a PhD program helped sculpt my ability to interpret scientific journals as well.. hmm...

Now if the company wants to pay me $50k/year and fly me to Italy for a 3 week "instructional seminar series".......

 

[facetguy]

Now if the company wants to pay me $50k/year and fly me to Italy for a 3 week "instructional seminar series".......

"...to teach the benefits of co-managing low back pain patients with chiropractors", for which you will obviously need me in attendance as well, on their dime of course.

 

[fahimaz7]

"...to teach the benefits of co-managing low back pain patients with chiropractors", for which you will obviously need me in attendance as well, on their dime of course.

So what do you think about ER visits being included in that study mentioned above? Think it skewed the data a bit

 

[Styria]

To get back to the original post, the newly released third edition of Foundations for Osteopathic Medicine (this one edited by Anthony Chila) has a chapter with a long section on Robert Fulford, his views and background, and his percussion hammer.

 

[VA Hopeful Dr]

Our field is very aware of the influence that big pharma may try to have in publishing and supporting certain studies, especially when they are presenting a "new and improved" treatment for a condition. One thing that is important is to learn how to interpret these arguments, and take into consideration the financial means that each patient has when they present with that said complaint. If drug A treats the condition in 5 daily doses and drug B treats the condition in 10 days, but requires 3 doses/day...which one do you think the patient wants? What if drug A costs $275 and drug B costs $6? Is the efficacy equal? If so (and you're not dealing with some life threatening bacterial infection), I plan on sticking with the more affordable option for most of my patients.

In medical school, the first thing they teach you about interpreting primary research is to see who's behind the publication. If it's a double-blinded study or a large meta-analysis, we are much more likely to give it the attention that it deserves. I guess spending 3 years in a PhD program helped sculpt my ability to interpret scientific journals as well.. hmm...

Now if the company wants to pay me $50k/year and fly me to Italy for a 3 week "instructional seminar series".......

Its cute that you think this. In reality, most physicians either don't have or don't take the time to read too critically into the literature for every new drug out there. The drug companies are experts (and the literature shows this) at manipulating us into using their drugs. In medical school, and even most residencies, we are protected from drug reps. In the real world, this is not true and it shows.

 

[fahimaz7]

Its cute that you think this. In reality, most physicians either don't have or don't take the time to read too critically into the literature for every new drug out there. The drug companies are experts (and the literature shows this) at manipulating us into using their drugs. In medical school, and even most residencies, we are protected from drug reps. In the real world, this is not true and it shows.

It's cute? You write the prescriptions. I would say that some physicians do a much better job than others at examining the financial difficulties of their patient, and prescribing accordingly. I'm not saying that i'll have a practice that is any more ethical than anyone else, but at some point in time we have to take the responsibility on our own, for what we prescribe and when we do it. Most practitioners have a small variety of scripts that they write for any particular pathology, so why would it be difficult to look at the research, or refrain from switching meds when the one that the patient is already on is doing just fine? Although, there's something to be said for a smoking hot brunette in heals, with a BS in psychology, walking into your office to "talk" about how awesome cymbalta (for example) is and how horrible their competitor is.

We have about 10 drug reps in our class (spouses are drug reps) and I spent a year doing phase 1 and phase 2 clinical trials in oncology. Big pharma is a very powerful and manipulative machine. It's well oiled, smooth, and very creative at how they present their research that "supports" the use of the new formula over some older form, or why we should choose their new drug (with NASA like beads with multiple coatings) over their competitors.

After all, when it comes to big pharma it's all about money, and rarely about actually helping someone.

 

[VA Hopeful Dr]

It's cute? You write the prescriptions. I would say that some physicians do a much better job than others at examining the financial difficulties of their patient, and prescribing accordingly. I'm not saying that i'll have a practice that is any more ethical than anyone else, but at some point in time we have to take the responsibility on our own, for what we prescribe and when we do it. Most practitioners have a small variety of scripts that they write for any particular pathology, so why would it be difficult to look at the research, or refrain from switching meds when the one that the patient is already on is doing just fine? Although, there's something to be said for a smoking hot brunette in heals, with a BS in psychology, walking into your office to "talk" about how awesome cymbalta (for example) is and how horrible their competitor is.

We have about 10 drug reps in our class (spouses are drug reps) and I spent a year doing phase 1 and phase 2 clinical trials in oncology. Big pharma is a very powerful and manipulative machine. It's well oiled, smooth, and very creative at how they present their research that "supports" the use of the new formula over some older form, or why we should choose their new drug (with NASA like beads with multiple coatings) over their competitors.

After all, when it comes to big pharma it's all about money, and rarely about actually helping someone.

What you say makes good sense, I'm just telling you how it is outside of large academic centers. Loads of private docs DON'T do the research behind the new products and just trust the drug company reps. It shouldn't be that way, but it is.

I was just making a snide comment about your naivete, that's all.

 

[fahimaz7]

What you say makes good sense, I'm just telling you how it is outside of large academic centers. Loads of private docs DON'T do the research behind the new products and just trust the drug company reps. It shouldn't be that way, but it is.

I was just making a snide comment about your naivete, that's all.

I'm not naive, I'm just hopeful that there are some physicians out there that care more than others. I think that most doctors are too damn busy when they are in practice, and the last thing that they want to do is have homework when they leave the clinic. I can totally understand that. But, in general, we do have the training to see through the BS, if we are willing and motivated to do so.

In a perfect world they would have the time to do the research, as well as to get to know their patients well enough to know what their financial situation is at home. Unfortunately, there aren't many of us that have any extra time, since private practice is all about numbers, and not so much about time.

 

[surag]

how come no one mentions all the times orthopedic pain surgeons get pain patients who received "treatment" from chiropracters only to have some sort of aggravation to their injury or pain? The orthopod ends up having to fix the issue then.

What really irritates me is the medicaid and medicare benefits coverage of chiropracters. Why exactly should they be given reimbursements? Do massage therapists get reimbursements for acute pain patients? Or how about acupuncturists?

 

[facetguy]

how come no one mentions all the times orthopedic pain surgeons get pain patients who received "treatment" from chiropracters only to have some sort of aggravation to their injury or pain? The orthopod ends up having to fix the issue then.

What really irritates me is the medicaid and medicare benefits coverage of chiropracters. Why exactly should they be given reimbursements? Do massage therapists get reimbursements for acute pain patients? Or how about acupuncturists?

You'll want to take a different approach if you wish to bash chiropractors, as chiropractic care is extremely safe. You need to work on that one. And remind me again what an "orthopedic pain surgeon" is?

 

[fahimaz7]

You'll want to take a different approach if you wish to bash chiropractors, as chiropractic care is extremely safe. You need to work on that one. And remind me again what an "orthopedic pain surgeon" is?

Are you trying to go to medical school? Or are you going to continue as a chiropractor? Just curious.

 

[surag]

You'll want to take a different approach if you wish to bash chiropractors, as chiropractic care is extremely safe. You need to work on that one. And remind me again what an "orthopedic pain surgeon" is?

I meant ortho surgeon. Pain was for pain patients-typo

 

[facetguy]

I meant ortho surgeon. Pain was for pain patients-typo

Understood.

 

[surag]

How do uexplain http://en.m.wikipedia.org/wiki/Vertebral_subluxation

I've met many ortho surgeons who informed me the absurdity of this. This was
On top of chiros working on C1 C2 c3. That lead to corrective surgery

 

[facetguy]

How do uexplain http://en.m.wikipedia.org/wiki/Vertebral_subluxation

I've met many ortho surgeons who informed me the absurdity of this. This was
On top of chiros working on C1 C2 c3. That lead to corrective surgery

You seem to be mixing 2 issues here: 1) "vertebral subluxation" and 2) chiropractors supposedly pulverizing patients' upper cervical spines.

Which would you like to go over first? For simplicity, let's take care of #2 real quick: it doesn't happen. As to #1, I don't think your wikipedia article is that bad; although I just skimmed it, it seems to capture the fact that the term "subluxation" in the chiro sense is continually evolving as science evolves. Can you be more specific?

 

[fahimaz7]

You seem to be mixing 2 issues here: 1) "vertebral subluxation" and 2) chiropractors supposedly pulverizing patients' upper cervical spines.

Which would you like to go over first? For simplicity, let's take care of #2 real quick: it doesn't happen. As to #1, I don't think your wikipedia article is that bad; although I just skimmed it, it seems to capture the fact that the term "subluxation" in the chiro sense is continually evolving as science evolves. Can you be more specific?

Perhaps he's referring to the very rare basilar strokes that follow a high cervical manipulation.

So are you ever going to pursue a MD/DO degree, or do you just really enjoy taking over any chiropractic post on this site? I tried to search your history, and the only real theme is that you like to defend DC's with anyone that has an issue with the field.

 

[surag]

You seem to be mixing 2 issues here: 1) "vertebral subluxation" and 2) chiropractors supposedly pulverizing patients' upper cervical spines.

Which would you like to go over first? For simplicity, let's take care of #2 real quick: it doesn't happen. As to #1, I don't think your wikipedia article is that bad; although I just skimmed it, it seems to capture the fact that the term "subluxation" in the chiro sense is continually evolving as science evolves. Can you be more specific?

First off all, you bring in the uncertainity in my comment when it does not exist. The Wiki article clearly states that it is referring to chiro subluxation. It seems you're ubfuscating my argument to create a sheen of doubt. Unnecesseary my friend. Just unnecessary. The article even clearly says that its referencing the second not "vertebral subluxation".

So lets only focus on chiro subluxation. You get the chiro sense it is continually evolving? How about the general consensus there is absolutely no evidence of chiro subs value in any form? How about the inherent unscientific aspect of it? Going back to a previous poster-just because it says there is no proof for its validity does not mean we can continue with it. You cannot prove to me aliens have never abducted you...should I go on saying that you were because of that?

Finally, chiro subluxation is a joke and there is no "evolving" science for it. You imply, disingenuously, that somehow in the future chiro subluxation may be proven to be scientifically valid even though the current science strongly suggests otherwise.

Did you know currently there is no evidence that Cold Fusion does NOT work? Did you also know if we do discover how to harness Cold Fusion effectively all of our energy ills will be all but eliminated? Does this justify continued funding for cold fusion? This is a very dangerous ethical and logical fallacy that, if used for all other controversies in science, will only lead to waste in time, people, and funding. Please stop.