Fringe treatment chiropractic association

[djarvis]

Hello all,

As the title suggests, this post concerns the seeming association between chiropractic care and fringe medical practice. I would like to hear some opinions on why chiropractic is the source of so many 'alternative' forms of treatment (i.e. KST, Active Release, Applied Kinesiology, Contact Therapy, Craniosacral Therapy, Iridology, Toftness Radioation, etc., etc...). There are so many. I am not yet deep enough into the medical profession to grasp this issue. Why does chiropractic produce so much fringe treatment? Some have evidence support, some have been exposed as fraud. So what is it?

- Dan

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[facetguy]

Hello all,

As the title suggests, this post concerns the seeming association between chiropractic care and fringe medical practice. I would like to hear some opinions on why chiropractic is the source of so many 'alternative' forms of treatment (i.e. KST, Active Release, Applied Kinesiology, Contact Therapy, Craniosacral Therapy, Iridology, Toftness Radioation, etc., etc...). There are so many. I am not yet deep enough into the medical profession to grasp this issue. Why does chiropractic produce so much fringe treatment? Some have evidence support, some have been exposed as fraud. So what is it?

- Dan

This will surely be an informative and productive thread. Can't wait.

 

[djarvis]

No responses, eh? Anyone?

 

[facetguy]

No responses, eh? Anyone?

Nice try, but everyone sees through your bull.

 

[cdmguy]

>Why does chiropractic produce so much fringe treatment? Some have evidence support, some have been exposed as fraud. So what is it?

I can think of many reasons. First, chiropractic itself isn't evidence based. It is an alternative form of treatment which subscribes to the false idea that manipulation cures fundamental underlying biomechanical lesions, termed subluxations, that are held to cause a multitude of diseases and result in progressive osteoarthritis. Chiropractors may use research from physical therapy to pretend to give rational care but if you scratch the surface you find phony diagnosis systems that don't diagnose conditions and the absence of PT clinical prediction rules that are mandatory for EB care.

Quackery, whether overutilization of hokey manipulation systems or otherwise, is profitable. It makes the chiropractor feel like they are providing a special service not provided by legitimate healthcare. Chiropractors like to brag that these methods give better results and make them ahead of their time. Overutilization lets them make a lot more money by keeping patients for life when the same patients would have been discharged in PT offices after they had reached maximum medical improvement. Chiropractic education contains a heavy propaganda component where medical problems are emphasized and research techniques are de-emphasized and scorned. So unless they have done further study, most chiropractors don't have the skills to evaluate claims and research, making them easy marks. Chiropractic schools often host conventions where quackery is touted at vendor booths. The presence of the quackery with the school's consent transfers the presumed legitimacy of the school (also false but studetns don't know this) onto the vendor. Some chiropractic methods run premature research then use it to sell the technique, omitting the fact that outcomes research hasn't been done. A good example of this is the Impulse IQ mechanical manipulation instrument by Chris Colloca DC, a graduate of Life University-a program that had its accreditation revoked due to teaching false diagnosis. Despite having this questionable degree, Colloca is a postgraduate instructor in his technique where he is able to sell equipment. Here's his website http://www.neuromechanical.com/ .

 

[djarvis]

facetguy, not helpful.

cdmguy, thanks for the response.

cdmguy: Your description of the 'quackery' component is exactly what I am curious about. I am fully aware of the presence of pseudo-science in the chiropractic 'sub-disciplines', but what I am really curious about is why so many 'alternative' medical methodologies sprout up under the field of chiropractic. The field of Physical Therapy is certainly not immune to this phenomenon (e.g., ultrasound therapy), but the majority of these alternative methods seem to gravitate to chiropractic. Is this because it is a field that has already set a precedent for accepting questionable methods, or are newly graduated chiropractors simply naive to the peer-reviewed process, therefore attracted to such methods by their apparent flair and profit potential? (e.g. do they come from chiropractic, and if so, why?)

 

[facetguy]

facetguy, not helpful.

So Dan, let me get this straight. You are a "medical student" who joined SDN in April, and your very first question ever, amongst the hundreds of useful and informative threads, was the one with which you created this thread. In other words, you appear to have joined SDN to start this thread. Then your second post ever was a follow-up to that first one when nobody responded. Then your third and final post to date was a couple of months later, again here in this thread that you started.

In 3 months of your SDN membership, you haven't had any other interesting comments or questions to post in any other thread. As a medical student, you could be asking questions about med school classes, USMLEs, or a rare infectious disease. You could be commenting about future residencies, healthcare reform, or even the Trayvon Martin case. But no. Your entire SDN existence over the course of 3 months includes this thread.

Sounds legit.

Forgive me if I'm "not helpful".

 

[cdmguy]

facetguy, not helpful.

cdmguy, thanks for the response.

cdmguy: Your description of the 'quackery' component is exactly what I am curious about. I am fully aware of the presence of pseudo-science in the chiropractic 'sub-disciplines', but what I am really curious about is why so many 'alternative' medical methodologies sprout up under the field of chiropractic. The field of Physical Therapy is certainly not immune to this phenomenon (e.g., ultrasound therapy), but the majority of these alternative methods seem to gravitate to chiropractic. Is this because it is a field that has already set a precedent for accepting questionable methods, or are newly graduated chiropractors simply naive to the peer-reviewed process, therefore attracted to such methods by their apparent flair and profit potential? (e.g. do they come from chiropractic, and if so, why?)

It's a valid question. First you need to understand what alternative medicine licensing entails. It means that a state legislature grants a license to unproven methods that have not met a burden of proof for efficacy but are low enough risk not to draw much attention when things go wrong. Review some chiropractic licensing laws and you'll see many quack methods and false biomechanics supported-this is because the laws were written before the false biomechanics was known and because chiropractors wrote and maintain the laws:

http://www.chiropractic.org/?p=legislation/state_statutes

Chiropractors even recently credited quack diagnosis for saving practice in Texas:
http://www.dynamicchiropractic.ca/mpacms/dc/article.php?id=55886

Chiroweb/Dyanic chiropractic is the largest chiropractic newspaper.

PT on the other hand has to meet the burden of proof at least for outcomes if not a mechanism as well. So chiropractic doesn't have a burden of proof, teaches false biomechanics as sound, and gives inadequate research analysis coursework and emphasis. So yes there is a precedent for accepting fringe methods especially if an official entity endorses it, either a leader, school or other group. Schools aren't hard to get involved as long as you give them a cut of the profits and it doesn't overly cannibalize their own offerings. Are DCs naive to peer review? Well as I said peer review doesn't really exist. Instead everything is pure politics and a concensus of quacks. Are DCs attracted by flair and profit potential? Absolutely. New methods are usually invented by DCs as advancements and promoted with inadequate research. But then again, when the standard of care is quackery and false biomechanics why would anyone want to piss of the existing base of chiropractors by telling them that what they are doing is ineffective? Nobody wants to risk that because all of the methods continue to be taught. Instead a technique may emphasize that it is more effective or more evidence based (usually puffery) and use skanty research to back the claim. Something else to consider is that chiros need things that allow them to do high volume and add profit so anything that allows them to justify more treatment and can be done without taking up the DC's time is likely to have a good chance of success. Most of the items you see are like this, cold lasers, dry hydro massage, standing on computerized foot scanners for orthotics (Foot Levelers) and muscle testing of vitamin supplements (Standard Process). Just go to http://www.dynamicchiropractic.com/deals_events/ and look at the vendors listed, most of those are selling quackery (also http://www.dynamicchiropractic.com/webcasts/archives2012.php). Chiropractic Economics also has many http://www.chiroeco.com/products/products_cats.php .

You must understand that this isn't just harmless overutilization. DCs claim to manipulate better than PTs but they don't use the PT prediction rules so they get 10% worse outcomes and have more strokes. DCs are leery of medicine and vaccination so they sometimes delay referrals and result in missed treatment windows.

DCs are always reluctant to talk about these things because they are their "skeletons in the closet." They would prefer to bury their mistakes and mislead people into thinking that they are equivalent to evidence based PTs but it just isn't so. The thing that really irks me is how the US Dept of Education allows their schools to mislead naive students. Read this link about it: http://tinyurl.com/7z3zqt9. Here's an important petition mobilizing to stop them. http://tinyurl.com/6ssql5s

Tell everyone you know to sign it.

Moreover, most MDs don't know enough about biomechanics and physical medicine to evaluate the data and really understand the problems. Hopefully this clears up your questions.

 

[facetguy]

Links to magazine ads and your personal blog are some strong references with which to make your case.

 

[cdmguy]

From wikipedia:

Chiropractic: Controversy and criticism

Chiropractic authors have stated that fraud, abuse and quackery are more prevalent in chiropractic than in other health care professions.[38] Unsubstantiated claims about the efficacy of chiropractic have continued to be made by individual chiropractors and chiropractic associations. The core concept of traditional chiropractic, vertebral subluxation, is not based on sound science. The biomechanical listing systems taught in chiropractic college technique offerings have been criticized as inaccurate, inadequate and invalid.[194] A critical evaluation found that research has not demonstrated that spinal manipulation, the main treatment method employed by chiropractors, is effective for any medical condition, with the possible exception of treatment for back pain.,[7] whereas, another review found manual therapies in general to be effective for back pain, neck pain, some forms of headaches and some extremity joint conditions.[22] Although rare,[1] spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death; these can occur in adults[33] and children.[174]

http://en.wikipedia.org/wiki/Chiropractic#Controversy_and_criticism

 

[facetguy]

From wikipedia:

Chiropractic: Controversy and criticism

Chiropractic authors have stated that fraud, abuse and quackery are more prevalent in chiropractic than in other health care professions.[38] Unsubstantiated claims about the efficacy of chiropractic have continued to be made by individual chiropractors and chiropractic associations. The core concept of traditional chiropractic, vertebral subluxation, is not based on sound science. The biomechanical listing systems taught in chiropractic college technique offerings have been criticized as inaccurate, inadequate and invalid.[194] A critical evaluation found that research has not demonstrated that spinal manipulation, the main treatment method employed by chiropractors, is effective for any medical condition, with the possible exception of treatment for back pain.,[7] whereas, another review found manual therapies in general to be effective for back pain, neck pain, some forms of headaches and some extremity joint conditions.[22] Although rare,[1] spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death; these can occur in adults[33] and children.[174]

http://en.wikipedia.org/wiki/Chiropractic#Controversy_and_criticism

Gee, if I didn't know better, I'd say you wrote most of that. Wait, what?? You DID write most of that! You've been a busy little Wiki-editor, haven't you.

I'm outta here.

 

[cdmguy]

Actually I only contributed one sentence to that paragraph but don't let that get in the way of your Napoleonic complex.

 

[djarvis]

facetguy:

Thanks for taking the time to respond. This is indeed an emotional topic for some. I joined this forum because as a medical student I have many questions and concerns about debates and misconceptions among the public about medical science. I chose to begin with this topic. I appreciate your input and would be glad to hear some of your arguments on the subject.

cdmguy:

Thanks for the information. I have also read these types of criticisms about chiropractic. You seem to have come to similar conclusions as others I have spoken with. Though your answer does not completely answer my questions. Do you think DCs that practice more fringe methods came to chiropractic because they were already interested in fringe methods, or do you think they tend to receive their interests after entering the field? It seems there is a pretty big variance in age of those who practice such methods. Does this mean it's a little of both?

On a related note, within the field of Integrative Medicine, many methods similar to chiropractic are used - that is, similar in that they are often placebo-effective, and are supported by major medical institutions. Therefore, are we being obtuse to reject the entire field of chiropractic? To be sure, I do not know of any other alternative medicine that carries the risk of vertebral artery dissection, but should all methods be summarily dismissed? Maybe this is the real problem. Chiropractic spinal manipulation itself carries the stigma of physical danger, therefore all methods associated with chiropractic necessarily get lumped into this risk category, when some may be quite similar to methods already employed in integrative medicine. Of course the efficacy of integrative medicine is its own debate, but that is not the main topic here - though I suppose it is a premise to this question.

 

[cdmguy]

djarvis:

Do you think DCs that practice more fringe methods came to chiropractic because they were already interested in fringe methods, or do you think they tend to receive their interests after entering the field? It seems there is a pretty big variance in age of those who practice such methods. Does this mean it's a little of both?

I would say that students come in with an above average use of woo. They are probably well acquainted with health food stores, have seen a chiropractor, buy vitamins, may have used homeopathy and probably have had bad experiences and are leery of medical doctors. However very few students have certifications in other fringe disciplines coming in and are adding chiropractic to their tool chest but many chiropractors go on to add other woo certifications (acupuncture, homeopathy, quack pediatrics) after they are DCs because they see it as adding something to their practice. So I would say that chiropractic education trains students to be anti-science fringe practitioners due to its indoctrination.

On a related note, within the field of Integrative Medicine, many methods similar to chiropractic are used - that is, similar in that they are often placebo-effective, and are supported by major medical institutions. Therefore, are we being obtuse to reject the entire field of chiropractic?

Treatment acceptance is completely political. It is akin to the wild west. The only time we see science based guidelines is when a group mandates them, and what may appear to be evidence based guidelines may actually be consensus and biased research. Further, this kind of bias is actively promoted by insurance companies who have an interest in denying care and insurance claims by denying illnesses. We saw this in the CDCs denial of chronic fatigue syndrome as organic, its promotion of it as a mental illness and denial of research funding for clinical research on the disease. I suspect that the IDSA's rejection of chronic Lyme disease and similar stealth infections (bartonella, bartonella like organism, babesia) versus labeling the patients having somaticization disorders is another example of this. http://gonzagalawreview.org/2011/01...ase-treatment-guidelines-development-process/

It's important to remember that manipulation effects are more than placebo because they provide neurological stimulation to understimulated joints so don't make the mistake of calling it that. Chiropractic is very easy to reject today. It is an inferior duplicated provider of manipulation services that are better served from DPTs who use clinical prediction rules, give adequate informed consent and are critical thinkers. I expect that in states where PTs are providers of manipulation there will be heavy resistance to the use of chiropractors. The only advantage of chiropractic will be in states where PTs are not allows to manipulate and there they would be the providers of last resort due to the increased stroke risk. So no we are not being obtuse for rejecting chiropractic. The overall analysis is that it is a contamination of manipulation providers and is a net negative. Until it ever straightens that out and starts being ethical they should be avoided as much as possible.

The acceptance of other quack practices in integrative medicine is a big problem. It shows a lack of discrimination and critical analysis that concerns me. We can't expect a dyslexic provider to perform critical analysis while suspending judgment to practice woo. The only way to pull it off is to do what the chiropractors did is to mislead students in their schools by contaminating curriculums and actively lying to them. On the other hand it is important to not be overly dismissive of untested theories either. For illnesses where good treatments aren't available and patients can be actively monitored I don't have a problem with using untested treatments with viable mechanisms of action experimentally with informed consent and writing them up as case studies. To me a physician who doesn't do so is acting as a mindless technician who is turning his practice into a capitation mill for greedy insurance companies. Being a doctor should be more than that. There are important treatments that started with self-experimentation by courageous doctors who wanted to advance patient care. If we stop thinking we slow the progress of medical advancement. Even worse, we set a precedent that all experimentation and deviation from imperfect consensus guidelines is malpractice and end up seeing witch hunts against practitioners who have done nothing wrong other than to disagree.

 

[facetguy]

Further, this kind of bias is actively promoted by insurance companies who have an interest in denying care and insurance claims by denying illnesses. We saw this in the CDCs denial of chronic fatigue syndrome as organic, its promotion of it as a mental illness and denial of research funding for clinical research on the disease. I suspect that the IDSA’s rejection of chronic Lyme disease and similar stealth infections (bartonella, bartonella like organism, babesia) versus labeling the patients having somaticization disorders is another example of this.

On the other hand it is important to not be overly dismissive of untested theories either. For illnesses where good treatments aren’t available and patients can be actively monitored I don’t have a problem with using untested treatments with viable mechanisms of action experimentally with informed consent and writing them up as case studies.

In other words, as long as it directly benefits YOU it's ok, otherwise it's woo. Nice.

 

[cdmguy]

You really missed your calling. You'd make a great comedian f, all bark and no substance. Chiropractic is about as tested as you can get. The biomechanical claims are absurd for most of the techniques taught and used. The mechanism of action is questionable. Results are on par with PT manipulation without the PT clinical prediction rules, 10% worse for the DC if comparing a PT using the rule to a chiro. No proven advantage of manipulation over mobilization but might be worth a try if mobs fail.

At this point chiropractic is more religion than health profession. Maybe they should renamed it Chiro-tology. Then DCs can get all the vaccine waivers they want.

 

[facetguy]

You really missed your calling. You'd make a great comedian f, all bark and no substance. Chiropractic is about as tested as you can get. The biomechanical claims are absurd for most of the techniques taught and used. The mechanism of action is questionable. Results are on par with PT manipulation without the PT clinical prediction rules, 10% worse for the DC if comparing a PT using the rule to a chiro. No proven advantage of manipulation over mobilization but might be worth a try if mobs fail.

Are you saying that chiropractors never mobilize joints? Where did you come up with that? I mobilize joints all day.

And, following your reasoning, if mobilization = manipulation and mobilization fails a patient, why would you ever consider manipulation? You and your nonsense.

 

[facetguy]

You really missed your calling. You'd make a great comedian f, all bark and no substance. Chiropractic is about as tested as you can get. The biomechanical claims are absurd for most of the techniques taught and used. The mechanism of action is questionable. Results are on par with PT manipulation without the PT clinical prediction rules, 10% worse for the DC if comparing a PT using the rule to a chiro. No proven advantage of manipulation over mobilization but might be worth a try if mobs fail.

At this point chiropractic is more religion than health profession. Maybe they should renamed it Chiro-tology.

Oops. Forgot to wait for your requisite edit.

Someday, when I'm bored, I'm going to go back and look at all your posts to see what percentage of them contain an edit. I'd be willing to bet it's at least 75%, probably higher. Why is that? Can we psychoanalyze that? It's as though you lack confidence in what you say, and that you are remorseful about your words just as you are remorseful about your professional failure.

I'd have way more respect for you and your efforts if you could simply own up and say that you just didn't do well in chiropractic and therefore left the profession. But instead you've created this whole narrative in your mind and now have to endlessly rationalize, blaming everyone from college presidents to student loan officers to God knows who. MOVE ON with your life; all this must be killing you.

 

[cdmguy]

Are you saying that chiropractors never mobilize joints? Where did you come up with that? I mobilize joints all day.

And, following your reasoning, if mobilization = manipulation and mobilization fails a patient, why would you ever consider manipulation? You and your nonsense.

I presume whether a DC learns mobilization depends on which school they attended. Life Univ does not teach mobs and they are not covered by the accreditation standards. Overall efficacy is the same for mob vs. manip but individual response might differ, they do have different effects. I'm not sure why MDs wuold prefer to refer to a DC for a procedure that isn't standardized across the schools and tested on. Chiropractic schools aren't trustworthy. It's much safer to go with a PT.

You really can't say that manip and mobs are the same at this time. Better to start with mob (safer) then try manip if mobs fail. That's called a cost to benefit analysis.

Cervical manipulation and mobilisation produced similar changes. Either may provide immediate- or short-term change; no long-term data are available. Thoracic manipulation may improve pain and function. Optimal techniques and dose are unresolved. Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. (Gross, A. Manipulation or mobilisation for neck pain. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD004249).
.

Try searching medline before you shoot your mouth off.

 

[PetMySausage]

Someday, when I'm bored, I'm going to go back and look at all your posts to see what percentage of them contain an edit. I'd be willing to bet it's at least 75%, probably higher

What difference does that make? There's an edit function for a reason. This seems like a poor attempt at argumentum ad hominem.

 

[facetguy]

What difference does that make? There's an edit function for a reason. This seems like a poor attempt at argumentum ad hominem.

CDM and I go way back.

 

[facetguy]

I presume whether a DC learns mobilization depends on which school they attended. Life Univ does not teach mobs and they are not covered by the accreditation standards. Overall efficacy is the same for mob vs. manip but individual response might differ, they do have different effects. I'm not sure why MDs wuold prefer to refer to a DC for a procedure that isn't standardized across the schools and tested on. Chiropractic schools aren't trustworthy. It's much safer to go with a PT.

You really can't say that manip and mobs are the same at this time. Better to start with mob (safer) then try manip if mobs fail. That's called a cost to benefit analysis.



Try searching medline before you shoot your mouth off.

In the cervical spine, the literature suggests not much difference between mobilization and manipulation, although there are individual papers demonstrating better effectiveness with manipulation. In other regions of the spine, this is not the case and manipulation usually produces better results. (Did you really think I didn't know this already??)

 

[cdmguy]

Since that's the case please explain why the chiropractic profession hasn't mandated clinical prediction rules for the neck and in fact prefers using manipulation with higher stroke risk over mobilization and not disclosing stroke risks in informed consent documents.

 

[facetguy]

Since that's the case please explain why the chiropractic profession hasn't mandated clinical prediction rules for the neck and in fact prefers using manipulation with higher stroke risk over mobilization and not disclosing stroke risks in informed consent documents.

It's difficult for you to understand because you are so blinded by anti-chiro bias, so please bear that in mind. As I've said elsewhere, I think clinical prediction rules can be a step in the right direction. However, particularly with regard to the cervical spine, they aren't ready for primetime yet. There are too many cases that don't fit neatly into little categories, and if you were as objective as you should be, you would know that even PTs have written about this. Each patient still needs to be evaluated as an individual and skilled clinical judgement still needs to be utilized. So let's not pretend that clinical prediction rules are the end-all.

Regarding cervical mobilization vs. manipulation, again I understand why it's difficult for you to understand since you see everything in an overly simplified fashion so as to fit your contrived personal narrative. Suffice it to say that both are useful but that there is a place for each of them. And don't forget, the studies that find mobilization and manipulation have equal effectiveness also find equal rates of adverse effects; i.e., manipulation is no more likely to cause adverse effects than mobilization. And I recall a study a few years ago that compared the two and found mobilization had higher incidence of adverse effects!!

 

[cdmguy]

It's difficult for you to understand because you are so blinded by anti-chiro bias, so please bear that in mind. As I've said elsewhere, I think clinical prediction rules can be a step in the right direction. However, particularly with regard to the cervical spine, they aren't ready for primetime yet. There are too many cases that don't fit neatly into little categories, and if you were as objective as you should be, you would know that even PTs have written about this. Each patient still needs to be evaluated as an individual and skilled clinical judgement still needs to be utilized. So let's not pretend that clinical prediction rules are the end-all.

So instead of saying we will use the rule where the following don't apply chiroprators use that as a convenient excuse to throw it out and just stroke everyone out. Moreover, you dodged my request as to why chiros don't give informed consent. I'll tell you why, because it would scare patients away and cost them money.

Regarding cervical mobilization vs. manipulation, again I understand why it's difficult for you to understand since you see everything in an overly simplified fashion so as to fit your contrived personal narrative. Suffice it to say that both are useful but that there is a place for each of them. And don't forget, the studies that find mobilization and manipulation have equal effectiveness also find equal rates of adverse effects; i.e., manipulation is no more likely to cause adverse effects than mobilization. And I recall a study a few years ago that compared the two and found mobilization had higher incidence of adverse effects!!

Actually above we just discussed and found that this isn't true in the cervical spine; that research says it would be premature to say that. So rather than do the responsible thing and order the safer treatment you jump to the one that pays the most and skip informed consent. Your explanation is complete misdirection and you never cite good meta analysis studies to support your bullcr@p opinions. This is why research shows many cases of patients getting strokes that could have been avoided. I calculated that an individual chiro practicing 20 years would have a 50% chance of stroking out a patient. So if there are 60,000 chiropractors that means we see about 300 unnecessary strokes per year which is similar to what research by neurologists report. Thank you for showing us by your discussion why chiropractic, even mixer style with full diagnosis, is dangerous quackery. Let's face it, chiropractors are incapable of doing anything that decreases their earnings even if it compromises patient safety and especially if it goes against their 1890s vertebral subluxation quack beliefs. I remind readers that these teachings, which you see strongly espoused at that vitalsource student newspaper above, are falsely taught as being supported by science (which the video mentions early on) not as history to be replaced by sound biomechanics as would a real healthcare field. That's why you see Palmer's Hole in one/toggle technique, Gonstead, Diversified and the rest of the techniques being taught in today's accredited chiropractic programs even though they are known to use false diagnosis. Even worse, students are false told they use legitimate diagnosis. Any field that has to lie in its colleges to promote illegitimate curricula as true is a horrible one. I see you are totally silent on this as well; as well you should be since there is no good way to spin it. Chiropractic is bad medicine.

Yes we have been debating a long time and you never cease the ad hominem attacks and poor arguments. Readers should take this into account when reading your responses. My concern is that moderators need to be especially careful in making sure you don't mislead readers with propaganda that you were taught at your chiropractic school as fact. It's a good exercise in fact checking, however I'm not sure SDN should be allowing you on the forum without a warning attached to every one of your posts that you are not a credible source of information. If they were kind they would stick you in a special area labelled quackery and list the warning in your signature. But I think that's overly generous. Because your responses are so misleading and because they really don't ever change I would just ban you from the forum and not bother. That's what is done at chirotalk.proboards.com.

Again, I encourage everyone to sign the petition to ban pseudoscience from federal student financial aid at http://tinyurl.com/6ssql5s. They only need 44 more signatures and it gets listed live on the site. Encourage your friends to do it. We need this legislation. It is much better to pre-empt quacks than waste time debating them on discussion forums.

 

[facetguy]

So instead of saying we will use the rule where the following don't apply chiroprators use that as a convenient excuse to throw it out and just stroke everyone out. Moreover, you dodged my request as to why chiros don't give informed consent. I'll tell you why, because it would scare patients away and cost them money.

"Just stroke everyone out". Do you wonder why nobody takes you seriously?

Re: informed consent, this has certainly been a topic of discussion within the profession, with the most well publicized case being in Connecticut a few years ago. At the end of the day in CT, science and facts won out over unscientific fear tactics (see CDM's posts). This was the final ruling in that case:

"On June 11, 2010, the Connecticut State Board of Chiropractic Examiners issued their declaratory ruling on the issue of a mandated informed consent policy requiring a specific stroke Warning. In a well-reasoned, carefully worded statement, the Board concluded:
“The Board heard the testimony of persons who have suffered a stroke and who allege that joint mobilization, manipulation, or adjustment of the cervical spine was the cause of such stroke, experts, and lawmakers, and carefully reviewed the statistical and analytical data that was admitted into evidence at the hearing. After a careful and thorough review of all of the testimony and documentary evidence admitted at the hearing, the Board concludes that there is sufficient evidence to establish that a stroke or a cervical arterial dissection is not a risk or side effect of a joint mobilization, manipulation or adjustment of the cervical spine. Therefore, the Board finds that in securing informed consent from a patient a chiropractor is not required to address with each patient the risk and/or possibility of the occurrence of a stroke or cervical artery dissection as a side effect of a joint mobilization, manipulation or adjustment of the cervical spine.” "

You and I have gone back and forth many times now. Each time, I present facts, science, literature. You present hyperbole, fear-based emotional tactics, classified ads from magazines that you extrapolate as your "evidence" of what the chiropractic profession is doing, and other nonsense. You may want to re-evaluate your anti-chiro tactics because your current strategy isn't working.

Actually above we just discussed and found that this isn't true in the cervical spine; that research says it would be premature to say that. So rather than do the responsible thing and order the safer treatment you jump to the one that pays the most and skip informed consent.

So your basis for all this is that chiros do HVLA instead of mobilization because HVLA pays more? Why do I waste my time with you.

Your explanation is complete misdirection and you never cite good meta analysis studies to support your bullcr@p opinions. This is why research shows many cases of patients getting strokes that could have been avoided. I calculated that an individual chiro practicing 20 years would have a 50% chance of stroking out a patient. So if there are 60,000 chiropractors that means we see about 300 unnecessary strokes per year which is similar to what research by neurologists report.

Unfortunately for you and those like you, your sophomoric calculations don't mean jack. Again, you don't seem to grasp the difference between nonsense and real research. This "research by neurologists" is in the form of case reports, surveys, a show of hands at a conference, etc. The best research on the topic, on the other hand, is published in peer-reviewed journals (including Spine) and unfortunately for you paints a very different picture. I know you understand this, but yet you continue to spew ridiculous nonsense because you are driven by motives other than the truth.

Thank you for showing us by your discussion why chiropractic, even mixer style with full diagnosis, is dangerous quackery. Let's face it, chiropractors are incapable of doing anything that decreases their earnings even if it compromises patient safety and especially if it goes against their 1890s vertebral subluxation quack beliefs.

To attempt to state with a straight face that chiropractic education and chiropractic-related research hasn't improved by light years in recent decades is simply beyond delusional. Will the profession continue to improve? Of course, because scientific knowledge marches on. But to deny huge improvements haven't already happened is, as we see over and over with you, pure nonsense.

I remind readers that these teachings, which you see strongly espoused at that vitalsource student newspaper above, are falsely taught as being supported by science (which the video mentions early on) not as history to be replaced by sound biomechanics as would a real healthcare field.

Thank you for once again demonstrating the nature of your "evidence" against chiropractic. An online student newspaper? A video made by a group no one has ever even heard of? Real solid, champ.

That's why you see Palmer's Hole in one/toggle technique, Gonstead, Diversified and the rest of the techniques being taught in today's accredited chiropractic programs even though they are known to use false diagnosis. Even worse, students are false told they use legitimate diagnosis. Any field that has to lie in its colleges to promote illegitimate curricula as true is a horrible one. I see you are totally silent on this as well; as well you should be since there is no good way to spin it. Chiropractic is bad medicine.

Translation: chiropractic didn't work out for you as a career choice, and now you're bitter and need someone to blame, and this pursuit of blame has become your whole persona.

Yes we have been debating a long time and you never cease the ad hominem attacks and poor arguments.

You have right from the start called me a "quack", "dangerous" and all the rest. Don't even go there about the ad hominem crap.

Readers should take this into account when reading your responses. My concern is that moderators need to be especially careful in making sure you don't mislead readers with propaganda that you were taught at your chiropractic school as fact.

This again demonstrates your delusional nature. You are the king of propaganda. You never bring real data. You repeated spew nonsense. Perhaps you don't see that but, rest assured, everyone else does. The only reason I respond to your silliness is to point out that yours is nothing other than propaganda from a very bitter man.

It's a good exercise in fact checking, however I'm not sure SDN should be allowing you on the forum without a warning attached to every one of your posts that you are not a credible source of information. If they were kind they would stick you in a special area labelled quackery and list the warning in your signature. But I think that's overly generous. Because your responses are so misleading and because they really don't ever change I would just ban you from the forum and not bother. That's what is done at chirotalk.proboards.com.

Ha! So you guys at chirotalk whatever simply ban those who dispute your nonsense with real facts? Ah, that's a great strategy that enables you to prolong your bias unchecked. Well, that's not gonna happen here.

 

[cdmguy]

Exactly. A bunch of quack chiropractors on the CT state board does a biased literature review, puts it up as fact using their authority and pretends it holds up. Chiropractic associations have been doing this ever since the issue was raised and the studies they rely on have been found to be flawed.

The Science based medicine blog already covered it in 2008:

http://www.sciencebasedmedicine.org/index.php/chiropractic-and-stroke-evaluation-of-one-paper/

Unfortunately the chiros continued the deception in 2010:

http://www.skeptical-science.com/science/chiropractic-manipulation-spine-strokes-death/

 

[facetguy]

Exactly. A bunch of quack chiropractors on the CT state board does a biased literature review, puts it up as fact using their authority and pretends it holds up. Chiropractic associations have been doing this ever since the issue was raised and the studies they rely on have been found to be flawed.

It was 4 days of public hearings, with testimony from all sides of the issue, cross-examinations, and all the rest. It wasn't a literature review at all.

 

[cdmguy]

CT DECLARATORY RULING PROCESS A SHAM
CHIRO BOARD REJECTS TELLING PATIENTS OF STROKE RISK

Westville, CT | March 16, 2010 – Victims of Chiropractic Abuse, Inc. (VOCA) is outraged that in less than three hours of "fact finding" the Connecticut Board of Chiropractic Examiners today rejected powerful evidence from four days of hearings that neck manipulation can cause stroke.

"We are supremely disappointed, but not surprised," said Janet Levy, President of VOCA. "From the start of this Declaratory Ruling process it was evident that the chiropractors on the board had no intention of protecting patients' rights."

The board, which is missing two of the three public members required by law, voted 4-1 to reject a Declaratory Ruling that would have mandated chiropractors in Connecticut to warn patients of the stroke risk. The only dissenting vote came from the only member of the board representing the public, Jean Rexford, who is also the Executive Director of the Connecticut Center for Patient Safety.

"This is a ruling by chiropractors for chiropractors and against the public interest," Levy said. "In fact, the American Chiropractic Association stated in one of its own news articles just this week that specifically informing patients about a relationship between neck adjustments and stroke would ‘set a dangerous precedent' so this decision merely confirms the obvious – chiropractors would rather protect their business interests than protect their patients."

According to the Model Code of Ethics of the Federation of Chiropractic Licensing Boards, members must respect patient autonomy and ask themselves, "Would I be exploiting others, treating them paternalistically, or otherwise affecting them without their free and informed consent?"

VOCA strongly believes the Connecticut Chiropractic Board is violating this basic ethical tenant of their professional with today's decision.

The Connecticut State Board of Chiropractic Examiners now has 90-days to issue its formal written ruling, but in the meantime VOCA plans to continue to seek remedies.


About Victims of Chiropractic Abuse, Inc:
Victims of Chiropractic Abuse, Inc. (VOCA) was incorporated in May of 2005 to promote awareness of chiropractic risks through advocacy and legislation. VOCA seeks to require chiropractors to obtain informed consent from patients prior to treatment and believes malpractice claims against chiropractic physicians should be made public, just as they are for medical physicians.
-http://vocact.com/news_releases/index.php

The ruling wouldn't hold up if the board was objective. The board relied on biased literature reviews by industry affiliated experts. Imagine if medicine did this, ignored all the non-industry affiliated research-it is often the cause of patient deaths and recalls.

But yes f guy, keep arguing that a profession that teaches quackery and false biomechanics really gives a hoot about the patients other than damage control. Medical students actually learn to review literature, unlike chiros. You are wasting your time.

 

[facetguy]

CT DECLARATORY RULING PROCESS A SHAM
CHIRO BOARD REJECTS TELLING PATIENTS OF STROKE RISK



The ruling wouldn't hold up if the board was objective. The board relied on biased literature reviews by industry affiliated experts. Imagine if medicine did this, ignored all the non-industry affiliated research-it is often the cause of patient deaths and recalls.

But yes f guy, keep arguing that a profession that teaches quackery and false biomechanics really gives a hoot about the patients other than damage control.

Dude, the group you quoted presented their case as well, except they had no science to rely on, just emotion and sesationalism (to which you are no stranger). This is a serious matter, and the best available evidence, not emotion and bias, should prevail. But fear not, because your anti-chiro groups will continue to press on, I'm sure.

 

[cdmguy]

Funny that's not what one CT board member said. She said:

"They see no risk of stroke from cervical manipulation,'' said Jean Rexford, the lone yes vote and the executive director of the Connecticut Center for Patient Safety. "They relied on one study. It's time to really take a close look at how all these boards are being run. We have way too many foxes watching the henhouse.-http://vocact.com/news_stories/031710.php"

A MD testified that there was compelling evidence for stroke due to chiropractic manipulation:

Douglas Fellows, a physician testifying on behalf of the state Board of Medical Examiners during hearings this winter, said that the "compelling circumstantial evidence" of stroke risk cannot be ignored. Quoting Thoreau, he likened it to "a trout in the milk. -http://vocact.com/news_stories/031710.php"

CONCLUSIONS:
Chiropractic manipulation of the cervical spine can produce dissections involving the cervical and cranial segments of the vertebral and carotid arteries. These injuries can be severe, requiring endovascular stenting and cranial surgery. In this patient series, a significant percentage (31%, 4/13) of patients were left permanently disabled or died as a result of their arterial injuries.-J Neurosurg. 2011 Dec;115(6):1197-205. Epub 2011 Sep 16.

 

[facetguy]

Hey CDM, I'll look for your new thread about orthopedists being quacks and dangerous charlatans:
http://annals.org/article.aspx?articleid=1181877

 

[cdmguy]

Red herring fallacy.

http://www.fallacyfiles.org/twowrong.html

 

[facetguy]

Red herring fallacy.

http://www.fallacyfiles.org/twowrong.html

My comment was about you, not orthopedists. By your reasoning, orthopedists who do these visco shots must all be scammers who put profits over patient safety, right?

 

[cdmguy]

You are so adorable, arguing that it is an ad hominem fallacy instead of a red herring. Your talent is wasted as a chiro, you would make a great village idiot. Thanks for providing an example of medieval style entertainment.

 

[facetguy]

You are so adorable, arguing that it is an ad hominem fallacy instead of a red herring. Your talent is wasted as a chiro, you would make a great village idiot. Thanks for providing an example of medieval style entertainment.

Nice photo. Was that with your cellphone or your webcam?

Anyway, I'm curious to hear your opinion on this visco issue. You are a guy who says chiros are dangerous quacks because their treatment is based on "false" research and therefore they put their patients at undue risk and do it in the name of profit. How do you square that with the visco study I linked to, which shows that viscosupplementation research finds little if any benefit yet potential for "serious adverse risks", and obviously there's financial gain in performing these injections, which are very commonly performed. Where's your consistency? C'mon man, put your cape on and save some lives here.

 

[facetguy]

Since that's the case please explain why the chiropractic profession hasn't mandated clinical prediction rules for the neck...

As I told you before, clinical prediction rules aren't ready for primetime yet. I just read this and thought you'd be interested (well, I know you're not interested in anything that runs counter to your bias, but you know what I mean). Oh, and it's written by PTs...sorry bro.

http://chiromt.com/content/pdf/2045-709X-20-19.pdf

"In its current state, the diagnosis-based clinical decision guide is a theoretical approach for

classifying patients with neck or back pain. The authors have identified the potential

classification criteria based upon narrative literature reviews.[19,20] While some of the

individual studies identified in these reviews represent a high level of evidence, other studies

underpinning the guide represent low level evidence. Furthermore, some aspects of the

classification approach are hypothetical. The next logical step in the development of the

diagnosis-based classification approach could be to undertake formal CDR derivation studies

examining the multivariate relationships between potential predictor variables and treatment

outcomes. Subsequently, the potential CDRs should be validated through the rigors of

randomized trials. If broad validation of the CDRs were supported by experimental results,

analyses of impact could then be undertaken. While it may be appropriate for CDR derivation

study results to influence clinical decision making (
e.g., when very little evidence is available

in a particular area or on a localized level where the impact on patient care can be monitored),

widespread implementation of a CDR requires validation. Consequently, given the

hypothetical nature of the diagnosis-based clinical decision rule (now termed clinical decision

guide), its widespread implementation by clinicians is premature.

Although in its current state the diagnosis-based clinical decision guide represents a

preliminary and untested approach, new and innovative developments in neck and back pain

classification such as this should be welcomed and their development encouraged. However,

it is also important to understand the appropriate context for interpreting this classification

approach and recognize its limitations. Despite its potential to inform future efforts of

subgrouping patients with neck or back pain who may preferentially respond to one or more
forms of therapy, the diagnosis-based classification approach is not ready for clinical

implementation. Nevertheless, we are hopeful that future advancements in and additional

knowledge of patient classification hold promise for improving the quality of healthcare

provided to patients with spinal pain and the diagnosis-based clinical decision approach is no

exception."

 

[cdmguy]

I don't think that's a reputable journal. Got anything from PTs?

 

[djarvis]

Well, this has been a lively discussion. It sounds like some feel fringe methods are associated with chiropractic both because the profession itself supports an indoctrination of alternative styles and because some practitioners enter the field with existing interests in such methods, while others feel asking questions about fringe methods is problematic.

Thanks for your input guys.

I'd be glad to hear more on this subject if the information is available.

 

[facetguy]

Well, this has been a lively discussion. It sounds like some feel fringe methods are associated with chiropractic both because the profession itself supports an indoctrination of alternative styles and because some practitioners enter the field with existing interests in such methods, while others feel asking questions about fringe methods is problematic.

Thanks for your input guys.

I'd be glad to hear more on this subject if the information is available.

OK, "Dan". SDN has lots of other interesting threads for you to enjoy, so I look forward to your posts there.

 

[djarvis]

Have I offended you in some way, facetguy? I apologize if so.

 

[djarvis]

I suppose that's the last quip. Thanks again for your participation.