cdmguy

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Correct me if I'm wrong but right now it seems that osteopathic manipulation is based on an outdated functional rehabilitation model. Chiropractic has started a new type of rehabilitation called structural rehabilitation where neutral position is assessed and tight ligaments are restored to normal length using multi-fulcrum traction devices (i.e. cervical extension traction). However, chiropractors can't address ligament laxity because their scope of practice prohibits prolotherapy injections. Osteopathy, on the other hand, performs these injections routinely and could easily take over and improve this niche if it moved from a manipulation model to using multi-segmental fulcrums that allowed the spine to be supported in a normal extension endpoint.

Does anyone have an interest in effective spinal restoration for either themselves or their patients?
 

skatertudoroga

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Correct me if I'm wrong but right now it seems that osteopathic manipulation is based on an outdated functional rehabilitation model. Chiropractic has started a new type of rehabilitation called structural rehabilitation where neutral position is assessed and tight ligaments are restored to normal length using multi-fulcrum traction devices (i.e. cervical extension traction). However, chiropractors can't address ligament laxity because their scope of practice prohibits prolotherapy injections. Osteopathy, on the other hand, performs these injections routinely and could easily take over and improve this niche if it moved from a manipulation model to using multi-segmental fulcrums that allowed the spine to be supported in a normal extension endpoint.

Does anyone have an interest in effective spinal restoration for either themselves or their patients?
I think what you are referring to is very much in the scope of PMR residents, whether allopathic or osteopathic(most do allopathic residency anyway). They also get accupuncture training and all that. But they finish med school and residency so they could make the correct diagnosis most of all.
 
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cdmguy

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I agree with you that diagnosis is critical and this is a weak subject in chiropractic programs due to lack of patient exposure and regional bans on ordering diagnostic testing-giving DOs the edge.

I think what needs to be done is just to test and implement some method and equipment updates.
 

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I'd like Osteopathic Physicians reclaim their roots in many of these areas. Why on earth would we want Chiropractors to take this over? Physical Therapists are hoping by 2020 to be the sole providers in this arena.. Inexcusable IMHO. Yes, many students shed their OMM training after they get into Allopathic residencies, and I personally see this as a travesty. That said, it'd be very difficult for DO students who didn't have the palpation skills or simply chose not to develop them because they didn't buy into OMM to take this role. Perhaps the improvement comes in learning and realizing that some of their DO peers are quite good at this and that instead of referring folks out to PT, they might instead refer them to their peers whom they know enjoy doing OMM and find it extremely useful.

I'm interested in family practice and have found OMM (especially BLT on the thoracic vertebrae to be amazing, holy crap my back hasn't felt this good in years since one of our instructors used me as his guinea pig, I did volunteer) to be quite useful. If I'm able spend some time talking to a patient of mine for an extended time because I can do the OMM on them and help them, I see that as an asset. I'd love for my DO peers to refer their patients to me for OMM instead of seeing people hit the chiropractor when they're out. I went to a chiropractor, (a good one at that) who was able to provide minimal relief for what was out. He was unable to achieve what I experienced from an OMM specialist in 15 seconds of BLT. Food for thought.

Don't get me wrong, I'm not an OMM lunatic and know you can't perform a "Counterpunch on the Ear to relieve chest pain" for those who saw the youtube video. I just know it to be a really valuable tool to help relieve some suffering out there.
 

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Physical Medicine and Rehabilitation (AKA Physiatry) is a medical specialty that studies how disease or injuries affect the way people move with a goal of maximizing function and quality of life. We are experts in various muscle, bone, and nerve disorders. Musculoskeletal injuries (acute and chronic) are certainly in our curriculum, specifically spine care. Manipulative techniques are not formally taught in PM&R residency but the philosophy is something that we are familiar with. There are many practitioners that use acupuncture in their practice but this is not taught in residency. I believe that most of them have sought out this training on their own.
 

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I think the standard of care should be the NMM/OMM residency, but there are only 8 of those. There are a good number of NMS+1 fellowships, though. As well, there are a lot of FP/OMT specialists that are very good, but there are many, many that are mediocre ("let me pop that for you"). What chiropractic and PT have going for them is those are their main modalities so it serves them best to excel, whereas a FP has numerous different resources that it's easy to let OMM fall aside. I think it really takes a lot of skill and experience to diagnose the correct, underlying issue with regard to OMM. I don't think half-assing this in an FP/OMM residency would ever get close to hitting the real issues and (in my own opinion) believe that it's really best served through dedicating residency to NMS/OMM. It's unfortunate that osteopathic physicians aren't the first thought on someone's mind when they think of MSK problems, but there really isn't enough interest in mastery, much less OMM, to really change this. If chiropractic were to actually step it up like podiatry and implement higher standards, some legitimate medical rotations in chiropractic school under physicians and not chiropractors, followed by a residency where they would have to train in all relevant areas of practice (ER, orthopedic surgery, FP, PM&R, sports med, etc.) in a rigorous setting, then I think this would be a suitable alternative. Obviously it'd be ideal if there were more DOs out there qualified and willing to provide legitimate OMM care, but if chiropractic were able to strengthen itself, integrate itself into legitimate medical care and dropped all the BS, then it would be pretty beneficial for patient populations. Neither one has much hope in the foreseeable future, however.
 

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To the OP: can you tell me a little more about "structural rehabilitation?"

I actually think that there is a lot of interest in the medical community to master musculoskeletal medicine. The problem is that most medical schools (with the exception of osteopathic schools) do not provide adequate musculoskeletal education.

In my opinion, I think the problem with most practitioners who specialize in spine care are trained very well in one area (i.e. injections, spinal manipulation, soft tissue mobilization, physical therapy.) We fail to appreciate the fact that spine care (along with other things) requires a comprehensive approach to be successful. We all are trained (in some respect) to believe that "if I just fix this, everything will correct itself." For example:

-DOs and Chiropractors: Joint articulation will restore balance and decrease myofascial dysfunction/pain

-Interventional Spine: Finding the "pain generator" and injecting the area with steroid will decrease inflammation/pain and allow the patient to participate in therapies

-Physical Therapy: Improving range of motion and core stabilization through therapeutic exercise will restore function

-Massage Therapy: Soft tissue massage will remove restriction and increase blood flow within muscle and fascia

There is no such thing as a magic bullet. However, we all believe that we have it. All of these areas need to be addressed to be successful.
 
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cdmguy

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Encouraging responses everyone.

Fozzy,To answer your question I’ll say a few words about structural rehab. If you’re familiar with modern biomechanics you may have run across M. Panjabi’s neutral zone dysfunction theory of joint damage. The basic idea is a wonderful elaboration of the different stages of osteoarthritis. First joints have a normal window of motion. As they undergo micro and macro traumas, supporting ligaments get deformed and this window enlarges, usually anterior and we start to see postural changes, i.e. forward head posture translation, flattening of the thoracic kyphosis, anterior rib translation and reversal of the cervical lordosis. Disk nucleus pulposes lock at end ranges and start to protrude, eventually prolapsing when they reach critical tolerances at stress point (usually apices of curves). Next, ligaments remodel to the new positions and lock them in with contracture.

As I said previously, one chiropractic technique, Chiropractic Biomechanics of Posture, has created a multi-segmental rehabilitation approach which they call structural rehabilitation designed to correct posture. It consists of traction to undo the contractures (commonly cervical three point fulcrums used three or four times per week in office), high repetition mirror image postural exercises (home and office), mirror image postural “adjustments” using a dropping table (office only). The treatment takes a ridiculously long time, typically 6-9 months costing $3,000-$6,000 due to the high number of office visits required to traction.

I have many problems with it. My criticisms include:
  • It is uncomfortable and because chiropractors don’t have access to analgesics there is nothing they care to do about it.
  • The traction is only done at three points per area. For example, when tractioning the neck (seven vertebra + skull) they can only manage three contact points (skull, mid fulcrum, shoulders). This means excessive traction at one apex and is too slow. You have to keep applying traction for 20 minutes per application per segment-a much smarter system would be a multi-segmental fulcrum to support all the involved joints and do this in 1/7 the time. However chiropractors like it this way because then they can run up a lot of office visits. I think this can easily be improved to a home system where an orthoses is prescribed that is similar to the dental appliance for orthodontics, Invisalign, where all the vertebra would be supported through a computer determined changing multisegmental fulcrum brace and traction system. This would be sent home with them and they would do home mirror image exercises. Prolotherapy added on top of this should fix the ligament laxity provided the disks aren’t too wonked out.
  • The frequent drop table adjustments really only pad the bill and are unnecessary.

Here are three links about the chiropractic CBP structural rehab method:

Haas, J. Evidence-based protocol for structural rehabilitation of the spine and posture: review of clinical biomechanics of posture (CBP®) publications. December 2005. 49:(4).

Cooperstein, R. Editorial: Flawed trials, flawed analysis: why CBP should avoid rating itself. June 2006. 50(2).

CBP website

I used the above Invisalign-type approach to treat my own chest and was able to stabilize my own chest and stop chronic exercise-induced asthma wheezing (along with omega 3 supplementation). This absolutely was the “magic bullet” for the asthmatic reflex and shuts it off like a switch. I can literally feel the costosternal joint at the rib head protrude anterior when it subluxates. It also develops a chronic tenderness (also present in the interspinous space at the same level) that immediately resolves when realigned. The only caveat is that the joint isn’t stable without the prolotherapy (as predicted) so I have to monitor and retreat it every few weeks. I want to bring the home system I used to market under osteopathy but don’t have the capital right now to do it yet and got sidetracked with a really bad bartinella spp. infection that has me debilitated with chronic fatigue for the immediate future but if anyone can help get that moving forward please message me. I would love to see osteopathy reclaim this niche.

As you all are probably familiar, prolotherapy doesn't try to restore a healthy neutral zone but instead just freezes joints in positions of pathology. This is probably the reason why it gets mixed results. Prolotherapy hasn't advanced to yet integrate structural rehab concepts in its approach-but it needs to.

Fozzy, research on functional rehabilitation shows that position and joint integrity are the primary factors determining prognosis so it just doesn’t work. Eventually people tire and the active muscular system can’t make up for passive ligament defects-it just isn’t designed to handle it. That’s why PT and DC models of functional rehab are limited.

It's unfortunate that osteopathic physicians aren't the first thought on someone's mind when they think of MSK problems, but there really isn't enough interest in mastery, much less OMM, to really change this. If chiropractic were to actually step it up like podiatry and implement higher standards, some legitimate medical rotations in chiropractic school under physicians and not chiropractors, followed by a residency where they would have to train in all relevant areas of practice (ER, orthopedic surgery, FP, PM&R, sports med, etc.) in a rigorous setting, then I think this would be a suitable alternative. Obviously it'd be ideal if there were more DOs out there qualified and willing to provide legitimate OMM care, but if chiropractic were able to strengthen itself, integrate itself into legitimate medical care and dropped all the BS, then it would be pretty beneficial for patient populations. Neither one has much hope in the foreseeable future, however.
ST, I’ve heard the lack of interest before and frankly, given the failure to effect a good biomechanical fix can understand why osteopathy would tire of functional rehab and general manipulation and move on to other areas. Chiropractic is too steeped in alternative pseudoscience and economically dependent on overutilization for office visits to expand scope and develop fixes for the ligament laxity. That’s why osteopathy has to step up and do it. We’ll all be a lot healthier when we can get this done.

A passive home treatment (aka Invisalign) approach to the spine could be a very lucrative new business approach for osteopathy and provide ample incentive to get away from intensive office visit models.
 
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TeamZissou

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Physical Medicine and Rehabilitation (AKA Physiatry) is a medical specialty that studies how disease or injuries affect the way people move with a goal of maximizing function and quality of life. We are experts in various muscle, bone, and nerve disorders. Musculoskeletal injuries (acute and chronic) are certainly in our curriculum, specifically spine care. Manipulative techniques are not formally taught in PM&R residency but the philosophy is something that we are familiar with. There are many practitioners that use acupuncture in their practice but this is not taught in residency. I believe that most of them have sought out this training on their own.
Diggin the info on PM&R from the resident perspective. Keep it comin:thumbup:
 

vanbamm

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There is not enough interest in the DO realm where other avenues are plentiful...PT focus is on rehab- they should be the specialists- DC focus is mainly spinal care, where rehab is one aspect of total maintenance..difference: PT move already mobile joints back into place- DC manipulates fixations and restrictions that are not hypermobile....with more training maybe PT could learn that, but the approaches are not one in the same, common misconception.
 

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I do not necessarily agree that there is not enough interest in the DO world. In fact, I think from a medicine perspective we (DOs) probably understand spine care, biomechanics, and kinesiology better than our allopathic counterparts. Symptom management and rehabilitation of the spine are very complicated processes as we all know. We (physicians and allied health) all have models and theories of how and why back pain occurs, recurs, treatment, and prevention. The truth is the literature does not definitively support any of our positions because of poor study design, hetergenous patient selection, small patient population, and/or confounding variables. Believe me, I'm not saying that what we all do doesn't work its just that its very hard to design a study that proves that one modality is better than another.

I think that the actually problem is that we all think we hold the "magic key" when there are truly multiple locks.

Back to the OPs proposition, do I think that "spinal rehabilitation" is an area that DOs should reclaim? In a simple answer, no. Do I think that DOs are in a position to contribute to the solution? Absolutely! I think it's foolish for any of us to "reclaim" this area and/or "proclaim" that we are the experts.
 

vanbamm

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Well put- there are a variety of modalities and approaches that can be utilized, and while the result of the treatments remain to be effectively compared- perhaps important factors to consider are individual patient response, patient mentality, and practitioner akill.
 

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DO's can make plenty of money doing whatever field they finish a residency in. Why would they want to become glorified DC's, and make way less money while scrounging around for business? I suppose DO's would have a much more valid practice of selling vitamins and diet plans though.... hmm...
 
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cdmguy

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DO's can make plenty of money doing whatever field they finish a residency in. Why would they want to become glorified DC's, and make way less money while scrounging around for business? I suppose DO's would have a much more valid practice of selling vitamins and diet plans though.... hmm...
I didn't evision them doing that but reinventing spinal care to get away from practioner provided manual therapy into more of a home treatment model.
 

fahimaz7

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I didn't evision them doing that but reinventing spinal care to get away from practioner provided manual therapy into more of a home treatment model.
How many patients/day can you see in a "home treatment" model? What would the reimbursement be like?

DC's will be around forever. Lets just hope that they don't get a full prescriptive authority anytime soon.
 

fozzy40

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DO's can make plenty of money doing whatever field they finish a residency in. Why would they want to become glorified DC's, and make way less money while scrounging around for business? I suppose DO's would have a much more valid practice of selling vitamins and diet plans though.... hmm...
Well, some of us "glorified DCs" do enjoy manipulative and musculoskeletal medicine more than just making money. No matter what you go into, if you are good referrals will come. I'm excellent at what I do and I'm not worried about scrounging for business.
 

vanbamm

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Making money and making progress are not necessarily one in the same- it is an indicator of the proficiency,utilization and value of a skill..I suppose a DO could go that route if they had any idea about nutrition,diet and how to employ that per the indivudal rather than the superficial knowledge that everyone is given as it relates to pathology
 

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DO's can make plenty of money doing whatever field they finish a residency in. Why would they want to become glorified DC's, and make way less money while scrounging around for business? I suppose DO's would have a much more valid practice of selling vitamins and diet plans though.... hmm...
I personally know of some OMT gurus who charge upwards of 200-300 bucks an hour, cash for OMT. Practices started out a bit slow at first, but now have constant volume all day. Take 300ish an hour (cash) with essentially no overhead, and very low malpractice, and it's not impossible to imagine why someone would do strict OMM. Granted, I only know of a few people who do this, and I do agree with you that when presented with the option of doing a residency in a high paying field vs trying to crack out on your own as an OMM specialist ... most people would recommend the first option.

DC's will be around forever. Lets just hope that they don't get a full prescriptive authority anytime soon
Won't ever happen.
 

JaggerPlate

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Making money and making progress are not necessarily one in the same- it is an indicator of the proficiency,utilization and value of a skill..I suppose a DO could go that route if they had any idea about nutrition,diet and how to employ that per the indivudal rather than the superficial knowledge that everyone is given as it relates to pathology
You really want to take the angle here that a trained physician who has been through medical school does not have the capacity to comprehend and recommend diet and nutrition or that they would be 'blinded' from the truth by a knowledge of pathology? Only DCs, huh?
 

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Well, some of us "glorified DCs" do enjoy manipulative and musculoskeletal medicine more than just making money. No matter what you go into, if you are good referrals will come. I'm excellent at what I do and I'm not worried about scrounging for business.
When you quit practicing a full-scope PM&R practice, and solely rely on manipulations to support your business, then you'll be a glorified DC.

PM&R is a very good field of medicine, and they are defiantly not limited to just manipulations. I'm not sure why you imply that it's the only thing that you do as a resident in PM&R. You're a good blend of a physician and a DPT, with full prescriptive authority, imaging, and the ability to manage complex patients with a whole plethora of c/c's.
 

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I think that the actually problem is that we all think we hold the "magic key" when there are truly multiple locks.
:thumbup:

Brilliant and captures the issue/problem completely. This has been perhaps my whole point re: spinal manipulation. There is no magic, 100% solution for these patients. Some do well with Tx A, some with Tx B, some with A + B, etc. Spinal manipulation HAS to be included in the list of potentially effective treatments since the literature tells us it's at least as effective as anything else. Now, if you think it should be DOs, or PTs, or Santa Claus doing the manipulation, well that's a different discussion.

In the real world, it becomes quite clear that no single treatment or specialty has all the answers for these patients. Realizing this is good for patients. And I don't want to single out any group, but let's just say that experience makes this more clear, and inexperience (for example, students) doesn't always allow for this clarity.
 

vanbamm

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You really want to take the angle here that a trained physician who has been through medical school does not have the capacity to comprehend and recommend diet and nutrition or that they would be 'blinded' from the truth by a knowledge of pathology? Only DCs, huh?
What are you talking about?- yes, I am saying after 4 years of medical school that one couldn't create an accurate and in depth nutritional regime for the patient- then again why would they when you have a dietitian on the next floor to do that- didn't say DC were only one- but they have more hours in school on the subject- ... Blinded by pathology? no, but more versed on how nutrition plays a role on pathology...also, doc should probably practice what they preach- if you're going to tell someone to lose weight, eat right, exercise and quit smoking- be an example.
 

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What are you talking about?- yes, I am saying after 4 years of medical school that one couldn't create an accurate and in depth nutritional regime for the patient
LOL ... for sure. Neurosurgery ... no problem; setting up a diet plan, pfff whaaaa???? Is this theoretical physics? I wish someone with an AA in nutrition was here to help me input this diet data into an excel chart for my patient

then again why would they when you have a dietitian on the next floor to do that-
Because everyone wants a piece of the pie, so somebody started making masters in nutrition programs, or someone got a BA in 'nutrition' out of college and wanted to be a nutritionist and not go to medical school. Saying the existence of nutritionists is proof that DOs don't know how to set up nutritional plans for patients is one of the most asinine things you've said yet today. I don't want to say it WILL be the most asinine, inane, laughable, clueless thing you say today though ... because the night is young.

didn't say DC were only one- but they have more hours in school on the subject
No, you didn't say DCs were the only ones, but you did say that a DO wasn't equipped to manage a chiro patient because although they may have the manipulative skills, they don't have the knowledge to properly manage nutrition. Wow, it even sounds absurd while paraphrasing.

... Blinded by pathology? no, but more versed on how nutrition plays a role on pathology...also, doc should probably practice what they preach- if you're going to tell someone to lose weight, eat right, exercise and quit smoking- be an example.
So all DOs are chain smoking, fast food eating, sloths, and DCs are shining beacons of light for their patients to emulate? Jesus Christ. Ironically enough, I used to work next door to the DC I saw for a while and I don't think I've ever seen someone chain smoke so much in my life. Easy 15-25 lbs overweight too.

Long story short ... quit making these inane comments, it makes you look insecure and like you have some sort of inferiority complex. I'm 100000% sure that if a DO wanted to, they could provide a great nutritional regiment for their patients. I hate to break it to you, but I don't think the nutritional classes taught at your chiropractic college give you the +1 in this situation. If you want to say you're better at spinal manipulation ... fine. If you want to say that DOs are too caught up in pathology/don't possess the skill set to understand nutrition ... you're even more delusional that previously assumed.
 

TeamZissou

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LOL ... for sure. Neurosurgery ... no problem; setting up a diet plan, pfff whaaaa???? Is this theoretical physics? I wish someone with an AA in nutrition was here to help me input this diet data into an excel chart for my patient



Because everyone wants a piece of the pie, so somebody started making masters in nutrition programs, or someone got a BA in 'nutrition' out of college and wanted to be a nutritionist and not go to medical school. Saying the existence of nutritionists is proof that DOs don't know how to set up nutritional plans for patients is one of the most asinine things you've said yet today. I don't want to say it WILL be the most asinine, inane, laughable, clueless thing you say today though ... because the night is young.



No, you didn't say DCs were the only ones, but you did say that a DO wasn't equipped to manage a chiro patient because although they may have the manipulative skills, they don't have the knowledge to properly manage nutrition. Wow, it even sounds absurd while paraphrasing.



So all DOs are chain smoking, fast food eating, sloths, and DCs are shining beacons of light for their patients to emulate? Jesus Christ. Ironically enough, I used to work next door to the DC I saw for a while and I don't think I've ever seen someone chain smoke so much in my life. Easy 15-25 lbs overweight too.

Long story short ... quit making these inane comments, it makes you look insecure and like you have some sort of inferiority complex. I'm 100000% sure that if a DO wanted to, they could provide a great nutritional regiment for their patients. I hate to break it to you, but I don't think the nutritional classes taught at your chiropractic college give you the +1 in this situation. If you want to say you're better at spinal manipulation ... fine. If you want to say that DOs are too caught up in pathology/don't possess the skill set to understand nutrition ... you're even more delusional that previously assumed.
Dear god I didn't even read the whole convo but I gotta say JP your post actually made me laugh. Love the humor in it.

To the other person in the convo, nothing against you just saying the post was humorous.
 

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LOL ... for sure. Neurosurgery ... no problem; setting up a diet plan, pfff whaaaa???? Is this theoretical physics? I wish someone with an AA in nutrition was here to help me input this diet data into an excel chart for my patient



Because everyone wants a piece of the pie, so somebody started making masters in nutrition programs, or someone got a BA in 'nutrition' out of college and wanted to be a nutritionist and not go to medical school. Saying the existence of nutritionists is proof that DOs don't know how to set up nutritional plans for patients is one of the most asinine things you've said yet today. I don't want to say it WILL be the most asinine, inane, laughable, clueless thing you say today though ... because the night is young.



No, you didn't say DCs were the only ones, but you did say that a DO wasn't equipped to manage a chiro patient because although they may have the manipulative skills, they don't have the knowledge to properly manage nutrition. Wow, it even sounds absurd while paraphrasing.



So all DOs are chain smoking, fast food eating, sloths, and DCs are shining beacons of light for their patients to emulate? Jesus Christ. Ironically enough, I used to work next door to the DC I saw for a while and I don't think I've ever seen someone chain smoke so much in my life. Easy 15-25 lbs overweight too.

Long story short ... quit making these inane comments, it makes you look insecure and like you have some sort of inferiority complex. I'm 100000% sure that if a DO wanted to, they could provide a great nutritional regiment for their patients. I hate to break it to you, but I don't think the nutritional classes taught at your chiropractic college give you the +1 in this situation. If you want to say you're better at spinal manipulation ... fine. If you want to say that DOs are too caught up in pathology/don't possess the skill set to understand nutrition ... you're even more delusional that previously assumed.
Why bother to understand the pathology of a systemic disease, when you can simple adjust the lumbar and thoracic vertebrae and put someone on your uberdooper vitamin supplement plan. After all, those two together will virtually eradicate diabetes, hypertension, depression, thyroid/PTH abnormalities, pituitary dysfunction, adrenal dysfunction, aldosterone dysfunction, androgen dysfunction/infertility, and even impotence.

Just one of these guys. He'll hook you up with a healthy dose of Vitamin D and CoQ

http://www.chiropractor-and-nutrition-with-vitamins-and-supplements.com/
http://www.chiropractormaitland.com/chiropractic-services/
http://anatomypower.com/custom_content/c_67979_vitamin_therapy.html
http://hatmakerchiro.com/wellness_topics/c_50_the_wellness_approach.html
 

vanbamm

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So I guess I can assume you know everything inside and out- meal placement: based on goal outcome, agonist/synergist/antagonist nutrition, creating diets for special populations,nutrition Across the lifespan, nutrition for athletes, ages of food introduction, food-drug interactions, supplementing through a natural diet (your comments about pushing pill supplementation is ignorant), nutrition for the cancer patient, nutritional therapy...I could really go on all day.- it appears simple to you because you don't understand it- done with this thread, read up.
 

fozzy40

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When you quit practicing a full-scope PM&R practice, and solely rely on manipulations to support your business, then you'll be a glorified DC.

PM&R is a very good field of medicine, and they are defiantly not limited to just manipulations. I'm not sure why you imply that it's the only thing that you do as a resident in PM&R. You're a good blend of a physician and a DPT, with full prescriptive authority, imaging, and the ability to manage complex patients with a whole plethora of c/c's.
When I said that musculoskeletal and manipulative medicine is what I like to do I was speaking personally not as a field (PM&R). Part of physiatric training is musculoskeletal medicine but not manipulative medicine.

Fashima7, I did look up your previous posts but are you a DC that went back to medical school? If not, it's pretty judgmental for you to call someone a glorified "anything" if you haven't received said training. However, that's the beauty of the Internet and I acknowledge your opinion!

I do agree with you in that PM&R is an awesome field! However, I do want to clarify one point. There is a lot of misconception about the difference between physical therapy and PM&R. Physical therapists are trained kinesiology, biomechanics, motor learning, and anatomy with the goal of maximizing function through therapeutic exercise. Physiatrist do have a similar goal in maximizing function through managing acute and chronic medical issues (i.e. pain, spasticity, neurogenic bowel/bladder, etc.) that occur during the rehabilitative phase of patient recovery. So, I would not say that my field is a blend of DPT and Medicine.

I digress from the OPs original post...
 

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So I guess I can assume you know everything inside and out- meal placement: based on goal outcome, agonist/synergist/antagonist nutrition, creating diets for special populations,nutrition Across the lifespan, nutrition for athletes, ages of food introduction, food-drug interactions, supplementing through a natural diet (your comments about pushing pill supplementation is ignorant), nutrition for the cancer patient, nutritional therapy...I could really go on all day.- it appears simple to you because you don't understand it- done with this thread, read up.
I really do get a good laugh when a DC tries to claim that they are not pushing supplements to supplement their income.

lol. There's nothing that 4000IU of Vitamin D can't cure, right? Especially if you couple it with a proper spinal alignment.
 

facetguy

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I really do get a good laugh when a DC tries to claim that they are not pushing supplements to supplement their income.

lol. There's nothing that 4000IU of Vitamin D can't cure, right? Especially if you couple it with a proper spinal alignment.
Cost of 1 year supply of vitamin D: about $25. DCs around the world are surely retiring on that.
 

TeamZissou

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So I guess I can assume you know everything inside and out- meal placement: based on goal outcome, agonist/synergist/antagonist nutrition, creating diets for special populations,nutrition Across the lifespan, nutrition for athletes, ages of food introduction, food-drug interactions, supplementing through a natural diet (your comments about pushing pill supplementation is ignorant), nutrition for the cancer patient, nutritional therapy...I could really go on all day.- it appears simple to you because you don't understand it- done with this thread, read up.
Lol interesting....

I think I speak for most DO students. No I don't know any of that stuff off the top of my head. Wtf would I? Can I design a meal plan or something of that nature to manage the patient and tailor it specifically to the patient? Of course I can and I have the ability to use any resource or literature I want to back my decisions. This is what Osteopathic (aka medical school) education is. Not memorizing a bunch of stupid facts. What you learn in classes along with residency only furthers your individual ability to care for patients.
 

fahimaz7

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When I said that musculoskeletal and manipulative medicine is what I like to do I was speaking personally not as a field (PM&R). Part of physiatric training is musculoskeletal medicine but not manipulative medicine.

Fashima7, I did look up your previous posts but are you a DC that went back to medical school? If not, it's pretty judgmental for you to call someone a glorified "anything" if you haven't received said training. However, that's the beauty of the Internet and I acknowledge your opinion!

I do agree with you in that PM&R is an awesome field! However, I do want to clarify one point. There is a lot of misconception about the difference between physical therapy and PM&R. Physical therapists are trained kinesiology, biomechanics, motor learning, and anatomy with the goal of maximizing function through therapeutic exercise. Physiatrist do have a similar goal in maximizing function through managing acute and chronic medical issues (i.e. pain, spasticity, neurogenic bowel/bladder, etc.) that occur during the rehabilitative phase of patient recovery. So, I would not say that my field is a blend of DPT and Medicine.

I digress from the OPs original post...
I'm not a DC, nor would I ever consider going to chiropractic school. I'm in medical school (MD), and I have a ton of respect for DO's and I view them as equally trained physicians that get trained in OMM (which can be of good use as well).

My comment about a "glorified DC" was in regards to a DO giving up the practice of clinical medicine, in order to pursue a pure OMM/nutrition type of a practice (ie DCoid phenotype). There's no disrespect meant for anyone in the DO field, I was merely pointing out the fact that you would be underutilizing your clinical training, if any DO was to purely practice OMM and nutrition (ie become a DC).

And yes, I would prefer a DO to manipulate anything on my body over a DC, so Im not saying that OMM=DC training. You guys have a much greater understanding of disease pathology, and I would trust your interpretation of my clinical symptoms and imaging studies over a DC.
 

JaggerPlate

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Why bother to understand the pathology of a systemic disease, when you can simple adjust the lumbar and thoracic vertebrae and put someone on your uberdooper vitamin supplement plan. After all, those two together will virtually eradicate diabetes, hypertension, depression, thyroid/PTH abnormalities, pituitary dysfunction, adrenal dysfunction, aldosterone dysfunction, androgen dysfunction/infertility, and even impotence.

Just one of these guys. He'll hook you up with a healthy dose of Vitamin D and CoQ

http://www.chiropractor-and-nutrition-with-vitamins-and-supplements.com/
http://www.chiropractormaitland.com/chiropractic-services/
http://anatomypower.com/custom_content/c_67979_vitamin_therapy.html
http://hatmakerchiro.com/wellness_topics/c_50_the_wellness_approach.html
Ugh, I've just been wasting so many hours in biochemstry!

So I guess I can assume you know everything inside and out- meal placement: based on goal outcome, agonist/synergist/antagonist nutrition, creating diets for special populations,nutrition Across the lifespan, nutrition for athletes, ages of food introduction, food-drug interactions, supplementing through a natural diet (your comments about pushing pill supplementation is ignorant), nutrition for the cancer patient, nutritional therapy...I could really go on all day.- it appears simple to you because you don't understand it- done with this thread, read up.
Why the hell would you think that a DC is capable of putting something like this together but a physician isn't? Of course I don't know everything about putting a meal together for a cancer patient ... neither do you, and the fact that you think a nutrition class taught at a chiro college makes you an expert in something like that is laughable.

However, to say that a physician with 4 years of medical education (2 of those in hard sciences), and X years of residency isn't capable of putting this sort of thing together is blatantly laughable. I'm unsure if you've just been brainwashed into thinking all docs would rather shove a dangerous pill down a patient's throat or undergo an invasive procedure opposed to preventive measures, but there simply is no logic in what you're saying.
 

facetguy

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However, to say that a physician with 4 years of medical education (2 of those in hard sciences), and X years of residency isn't capable of putting this sort of thing together is blatantly laughable. I'm unsure if you've just been brainwashed into thinking all docs would rather shove a dangerous pill down a patient's throat or undergo an invasive procedure opposed to preventive measures, but there simply is no logic in what you're saying.
Perhaps not brainwashed, but financially-driven, yes. In your defense, at least some of this is system-induced.
 

JaggerPlate

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Perhaps not brainwashed, but financially-driven, yes. In your defense, at least some of this is system-induced.
So MD/DOs are part of the big-pharma machine huh? You guys are killing me. I don't understand how you can slap future physicians in the face with one hand, and then state that your drive for more 'evidence based medicine' (which I hate to break it to you, is going to involve some of these evil drugs and surgical procedures) and parity will bring us into a better inter-disciplinary team mentality in the future.

You know first hand that I've been fair to DCs on this board in the past (despite overwhelming personal experience that should lead me to believe otherwise), but this is just getting absurd. I'm so sick of groups demonizing physicians in an attempt to gain some sort of greater foothold in the health service sector. We're evil, money grubbing, big-pharma whores, who hate patients, always push for invasive procedures, and this is why chiropractic, nurse practitioners, NDs, etc, etc, etc are so much better ... yet, when you're loved one falls over with horrendous chest pain, they somehow end up on the emergency room - lair of the evil, arrogant, bastards - and not in a CAM medicine practice taking plantar's wart for acute MI.

If you want to label physicians as something negative ... that's fine, but don't grasp toward MD/DO models when you want respect/patients from certain individuals and then backhand these same practitioners in the face.
 

facetguy

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So MD/DOs are part of the big-pharma machine huh? You guys are killing me. I don't understand how you can slap future physicians in the face with one hand, and then state that your drive for more 'evidence based medicine' (which I hate to break it to you, is going to involve some of these evil drugs and surgical procedures) and parity will bring us into a better inter-disciplinary team mentality in the future.

You know first hand that I've been fair to DCs on this board in the past (despite overwhelming personal experience that should lead me to believe otherwise), but this is just getting absurd. I'm so sick of groups demonizing physicians in an attempt to gain some sort of greater foothold in the health service sector. We're evil, money grubbing, big-pharma whores, who hate patients, always push for invasive procedures, and this is why chiropractic, nurse practitioners, NDs, etc, etc, etc are so much better ... yet, when you're loved one falls over with horrendous chest pain, they somehow end up on the emergency room - lair of the evil, arrogant, bastards - and not in a CAM medicine practice taking plantar's wart for acute MI.

If you want to label physicians as something negative ... that's fine, but don't grasp toward MD/DO models when you want respect/patients from certain individuals and then backhand these same practitioners in the face.
You are getting carried away, which is uncharacteristic for you. I'm not saying MDs are money-hungry bastards etc. I'm saying that, the way the system is set up, it's more profitable for an MD to be in a procedure-heavy specialty (why does everyone want to be a dermatologist and not a family physician?), or prescribe a med and dash off to the next patient. Time constraints are a real problem, which also goes with the 'system-induced' notion, and taking time to get into lifestyle changes with patients is often just too time consuming. So we get "eat better and exercise more".

Tell me our healthcare system doesn't chase diseases with drugs AFTER the diseases occur. This despite the fact we know that most of our chronic diseases are driven by lifestyle factors and are therefore preventable. Acute problems--different story. We have a reactionary healthcare system. Perhaps it's more along the lines of fantasy, but I'd much rather we had a proactive healthcare system that actually promoted health. That's where a greater emphasis on things like diet and nutrition come into play. Not that MDs couldn't do it (although you'd be far from well-practiced at it), but you simply don't do it, and usually for the systemic reasons cited above.

And, while individual physicians may not be part of your 'big pharma machine', there is indeed a 'big pharma machine', and that 'machine' exerts lots of influence on how our healthcare system functions. It would be naive to believe otherwise. Don't be overly defensive about that; it's not a slap in the face of individual MDs to say that Big Pharma throws its weight around.
 
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cdmguy

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Jag, don't take it personally. Chiropractic school indoctrination is that medicine is evil. Black vs. white thinking is a cult training hallmark. It's good to have enemies...helps keep the recruitment rate up.

How many patients/day can you see in a "home treatment" model? What would the reimbursement be like?
Fah, probably many if you see patients once a month after the acute care just loan and sell them equipment.

What are you talking about?- yes, I am saying after 4 years of medical school that one couldn't create an accurate and in depth nutritional regime for the patient- then again why would they when you have a dietitian on the next floor to do that- didn't say DC were only one- but they have more hours in school on the subject- ... Blinded by pathology? no, but more versed on how nutrition plays a role on pathology...also, doc should probably practice what they preach- if you're going to tell someone to lose weight, eat right, exercise and quit smoking- be an example.
Van, DCs are only required to get six hours of nutrition courses and it can be diluted down with fad content like fasting and vegetarianism so don't take it that seriously.
 

newbie04

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Tell me our healthcare system doesn't chase diseases with drugs AFTER the diseases occur. This despite the fact we know that most of our chronic diseases are driven by lifestyle factors and are therefore preventable. Acute problems--different story. We have a reactionary healthcare system. Perhaps it's more along the lines of fantasy, but I'd much rather we had a proactive healthcare system that actually promoted health. That's where a greater emphasis on things like diet and nutrition come into play. Not that MDs couldn't do it (although you'd be far from well-practiced at it), but you simply don't do it, and usually for the systemic reasons cited above.
You've seen Americans lately, right? Many are fat slobs that eat & drink whatever the hell they want, smoke and just sit around. You can shove "lifestyle changes" down a patient's throat all day, but if they aren't willing to do anything, it's not the physicians fault--we can only twist their arms so much. Whatever happened to self-responsibility? :shrug:
 
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cdmguy

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You've seen Americans lately, right? Many are fat slobs that eat & drink whatever the hell they want, smoke and just sit around. You can shove "lifestyle changes" down a patient's throat all day, but if they aren't willing to do anything, it's not the physicians fault--we can only twist their arms so much. Whatever happened to self-responsibility? :shrug:
This thread has gotten ridiculously off topic.

Newbie, it's way more complicated than that. There was a study that just came out that showed that wild rats are getting fatter. The obesity epidemic isn't just a lack of willpower or the standard diet and exercise recommendations would work for more than 10% of the patients.
 

JaggerPlate

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You are getting carried away, which is uncharacteristic for you.
Well, I suppose that has a tendency to occur when within the same thread, my profession is slated as incapable of defining and implementing a nutritional plan and also accused of happily shoving pills down patient's throats to pad my own and big-pharma's bottom line.


I'm not saying MDs are money-hungry bastards etc. I'm saying that, the way the system is set up,
You may not be directly saying physicians are money-grubbing bastards, but your quip about it essentially being ingrained within us during medical training asserts the same thing. Different origin, same result (which is what matters).

it's more profitable for an MD to be in a procedure-heavy specialty (why does everyone want to be a dermatologist and not a family physician?), or prescribe a med and dash off to the next patient. Time constraints are a real problem, which also goes with the 'system-induced' notion, and taking time to get into lifestyle changes with patients is often just too time consuming. So we get "eat better and exercise more".
I'm not going to try and deny that reimbursement isn't tied to this model, however, to turn this around on physicians and somehow imply that we made it such isn't fair. What you're asserting is that we LIKE it this way, and see some sort of preventive measures as something that would simply eat away too much of our time and decrease our bottom line. Again, from what I'm noticing, this seems to be something that's ingrained in the minds of other health professionals, but I assure you it isn't pressed in our training model.

Additionally, I can tell you a large majority of the reason why people aren't entering primary care - encroachment from non-physician providers. My generation is up in arms about it. Everywhere we turn, NPs, DNPs, etc are trying to use the fact that physicians are forced to practice within this hectic model are some sort of leverage into making unsuspecting patients believe that we do this because we care about big pharm and Italian sports cars. Frankly, many of the comments coming from Van fall into this same mentality of thinking - physicians only think of the pathology, they don't connect to the patients, they don't care about preventive medicine ... you know who does, chiropractors. Hence, we should be the primary care providers. When in reality, this far less to do with the humanistic approach, and far more to do with seeing 40 patients a day, paying high malpractice premiums, and utilizing the most modern, effective modalities.

Again, if this is you're point that yes, it is the model, not physician who think that way ... making a quip about us bending over for big pharm wasn't the best way to go about it, and does make me think you may have some preconceived notions yourself.

FURTHERMORE, have you truthfully ever worked within the preventive model with regard to anything outside chiropractic? Try telling the 300 lbs type II DM patient that he can either quit his 30 pack year habit and start jogging, or take a shot in the ass once a day and continue watching wheel of fortune while the government disability monies roll in. Frankly, I highly doubt this is the type of patient who would bother coming to a DC practice, where from what I understand you believe a good deal of this nutrition, wellness type care/model would come from, but low and behold, he shows up in our ERs while there are 25 patients left to be seen within this hour.

Not that MDs couldn't do it (although you'd be far from well-practiced at it), but you simply don't do it, and usually for the systemic reasons cited above.
I'll ignore the fact that I see this as another quip, and just focus on the idea that yes, MD/DOs can do this, and if the circumstances were right, they probably would, but it's not hard to see how I'd get offended/think it's absurd when people like Van somehow assert that DCs have knowledge about this area of wellness that a physician wouldn't possess.

Again, to me, this is the type of talking point that plays off the predicament of physicians to leverage patients into their own type of care, which as I discussed before is comparing apples to oranges.

And, while individual physicians may not be part of your 'big pharma machine', there is indeed a 'big pharma machine', and that 'machine' exerts lots of influence on how our healthcare system functions. It would be naive to believe otherwise. Don't be overly defensive about that; it's not a slap in the face of individual MDs to say that Big Pharma throws its weight around.
Not that I'm denying that big-pharm plays a role in the way our health care system functions, but have you ever really worked within this realm, or is your experience simply based off opinions and things you pick up along the way? Have you ever balanced the books or done charting at a MD/DO practice? Have you ever taking hospital admin classes or really even worked within a hospital system? To me, the practice model of chiropractic seems to removed from this world, that you continually shouting big-pharma this and big-pharma that is beginning to sound like people who fall back on government conspiracy theories when their POV doesn't play out. Not that the government is innocent, but these people have no inside knowledge of the situation.
 

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This thread has gotten ridiculously off topic.

Newbie, it's way more complicated than that. There was a study that just came out that showed that wild rats are getting fatter. The obesity epidemic isn't just a lack of willpower or the standard diet and exercise recommendations would work for more than 10% of the patients.
What's your theory here?
 

newbie04

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This thread has gotten ridiculously off topic.

Newbie, it's way more complicated than that. There was a study that just came out that showed that wild rats are getting fatter. The obesity epidemic isn't just a lack of willpower or the standard diet and exercise recommendations would work for more than 10% of the patients.
I was responding to "Tell me our healthcare system doesn't chase diseases with drugs AFTER the diseases occur" and not the obesity epidemic, which you brought up. :confused:

Treating people after diseases occur falls on the shoulders of the American public---people need to eat well, exercise and actually take time to give a damn about their own health (not smoke, etc.). Let me repeat...it's not the physicians fault.
 

facetguy

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Well, I suppose that has a tendency to occur when within the same thread, my profession is slated as incapable of defining and implementing a nutritional plan and also accused of happily shoving pills down patient's throats to pad my own and big-pharma's bottom line.




You may not be directly saying physicians are money-grubbing bastards, but your quip about it essentially being ingrained within us during medical training asserts the same thing. Different origin, same result (which is what matters).
I simply said what you say below: whether MD/DOs like it or not, medical practices are businesses, and to function in a business-savvy way means you've got to either do lots of procedures or move quickly so you can see a lot of patients. I'm not sure that equates to anything being ingrained; it's just reality.



I'm not going to try and deny that reimbursement isn't tied to this model, however, to turn this around on physicians and somehow imply that we made it such isn't fair. What you're asserting is that we LIKE it this way, and see some sort of preventive measures as something that would simply eat away too much of our time and decrease our bottom line. Again, from what I'm noticing, this seems to be something that's ingrained in the minds of other health professionals, but I assure you it isn't pressed in our training model.
Additionally, I can tell you a large majority of the reason why people aren't entering primary care - encroachment from non-physician providers. My generation is up in arms about it. Everywhere we turn, NPs, DNPs, etc are trying to use the fact that physicians are forced to practice within this hectic model are some sort of leverage into making unsuspecting patients believe that we do this because we care about big pharm and Italian sports cars. Frankly, many of the comments coming from Van fall into this same mentality of thinking - physicians only think of the pathology, they don't connect to the patients, they don't care about preventive medicine ... you know who does, chiropractors. Hence, we should be the primary care providers. When in reality, this far less to do with the humanistic approach, and far more to do with seeing 40 patients a day, paying high malpractice premiums, and utilizing the most modern, effective modalities.
You likely, and rightfully so, think about this more than I do, so I'm inclined to believe you. But I'm not sure I agree completely. Isn't it plausible that as family medicine becomes less and less profitable, it becomes less and less popular among med students, which leaves a void that is getting filled by other provider groups, particularly DNPs? As I said, I haven't thought a lot about this, so I'd be interested to hear your thoughts as to WHY primary care is being encroached upon.

Again, if this is you're point that yes, it is the model, not physician who think that way ... making a quip about us bending over for big pharm wasn't the best way to go about it, and does make me think you may have some preconceived notions yourself.
I don't have any reason to believe that the MD/DOs I know 'bend over' for big pharma. What I'm saying is big pharma exerts it's influence further up the chain, at the policy-making level. Big Pharma also exerts its influence over what research gets funded and which doesn't; more research, more published findings, more on-the-minds of MD/DOs. By the same token, no research, no credibility, no wide acceptance among MD/DOs.

FURTHERMORE, have you truthfully ever worked within the preventive model with regard to anything outside chiropractic? Try telling the 300 lbs type II DM patient that he can either quit his 30 pack year habit and start jogging, or take a shot in the ass once a day and continue watching wheel of fortune while the government disability monies roll in. Frankly, I highly doubt this is the type of patient who would bother coming to a DC practice, where from what I understand you believe a good deal of this nutrition, wellness type care/model would come from, but low and behold, he shows up in our ERs while there are 25 patients left to be seen within this hour.
Your example patient is what I'm talking about. I'd much rather see our healthcare system keep that guy from becoming the 300 lb diabetic in the first place. It's a complex issue, obviously, and doesn't solely fall on the shoulders of any individual physician. There are many factors, such as socioeconomics, the food industry, etc.



I'll ignore the fact that I see this as another quip, and just focus on the idea that yes, MD/DOs can do this, and if the circumstances were right, they probably would,
But by-and-large they don't, and as you said a moment ago, same result, and that's what matters. Whether they could doesn't appear to be all that relevant.

but it's not hard to see how I'd get offended/think it's absurd when people like Van somehow assert that DCs have knowledge about this area of wellness that a physician wouldn't possess.

Again, to me, this is the type of talking point that plays off the predicament of physicians to leverage patients into their own type of care, which as I discussed before is comparing apples to oranges.



Not that I'm denying that big-pharm plays a role in the way our health care system functions, but have you ever really worked within this realm, or is your experience simply based off opinions and things you pick up along the way? Have you ever balanced the books or done charting at a MD/DO practice? Have you ever taking hospital admin classes or really even worked within a hospital system? To me, the practice model of chiropractic seems to removed from this world, that you continually shouting big-pharma this and big-pharma that is beginning to sound like people who fall back on government conspiracy theories when their POV doesn't play out. Not that the government is innocent, but these people have no inside knowledge of the situation.
These are things I've picked up along the way over 2 decades in healthcare and as a thinking human being. I have no hospital experience, to answer your question. And it's funny to see you bring up 'conspiracy theories' because I had written something about that in my last post but deleted it; the 'conspiracy' thing usually comes up eventually in these discussions.

(Level-headed discussions like this are always more productive in my view.)
 

facetguy

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For the rats I think it's due to the increasing CO2's premature induction of the hyperventilatory vasoconstrictive reflex decreasing their exercise tolerance and raising their appetite.
There are those that would say that exercise isn't all that great for weight loss (there are references for this, including the Amer College of Sports Med; not my original opinion). There are also those who would contend that we move less because we weigh more, not vice versa. This is based at least partially on insulin's effects (meaning insulin resistance and resultant hyperinsulinemia) of storing away a portion of calories as fat right off the bat, leaving less calories for energy production. The result: we get fatter and at the same time have less available energy for movement.

Along a different track, there are those who theorize that various environmental chemicals are screwing up our metabolic machinery. These researchers use the term "obesogens" to describe these various chemicals; search PubMed for "obesogens" and you'll find some interesting stuff.
 

JaggerPlate

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I simply said what you say below: whether MD/DOs like it or not, medical practices are businesses, and to function in a business-savvy way means you've got to either do lots of procedures or move quickly so you can see a lot of patients. I'm not sure that equates to anything being ingrained; it's just reality.
Which is fine, and the reality we work in, but what I don't think is fair whatsoever is when certain people blame DO/MDs for this, or assert that they like it this way. Furthermore, I find it even worse when certain groups, like the DNPs, use it as a platform to nudge their way into independent practice, which just ends up generating more physician referrals (because these individuals don't handle anything above routine), most cost on the system, more of the same, and less patient safety.



You likely, and rightfully so, think about this more than I do, so I'm inclined to believe you. But I'm not sure I agree completely. Isn't it plausible that as family medicine becomes less and less profitable, it becomes less and less popular among med students, which leaves a void that is getting filled by other provider groups, particularly DNPs? As I said, I haven't thought a lot about this, so I'd be interested to hear your thoughts as to WHY primary care is being encroached upon.
Like I said before, a decline in the popularity of PC fields is 3 fold (in my novice opinion):

1. Payment issues (discussed)

2. Midlevel encroachment (the old dogs in the field can deny this all they want, my generation of peers is aware and concerned about it. Look at Anesthesiology and the CRNA issue if you need any reassurance).

3. A perceived lack of respect in the field - like it or not, it's viewed as uncompetitive, and many, many med students are in this game for the 'respect' associated with the turf.

As far as why midlevels are STARTING in primary care:

It's the easy way to get their foot in the door - med students aren't going into primary care for the reasons listed above (long hours, bad reimbursement compared to other options, undesirable practice models, etc), so NPs/DNPs see this as a way to utilize the talking point 'filling a crucial void in primary care.' People know there is a primary care issue, NPs fund and conduct their own studies proving they are equal to physicians (you want to see some bias and laughable models, check out these sometime), go on a very well greased/militant PR and lobbying campaign, and boom ... they are in. They also know that they can handle a lot of the primary care cases (though the problem is that they'll do fine with the horseys but likely miss the zebras) and the malpractice is reasonable.

However, like I said before, they are only starting here. They are already moving into areas that are more desirable, more profitable, but also carry a similar private practice model where they (believe) they can handle a lot of cases. Dermatology is a prime example. Recently a 'nursing dermatology' residency opened at the university of south florida. Of course it's a joke, but because it's open to DNPs, you now have nurses who introduce themselves as doctors and claim to be certified in dermatology pumping botox in south florida. Definitely filling that crucial gap.

It will also be interesting to see how/if this affects the competitiveness of derm among med students.

Now, a cynic would say that certain DCs who are pushing for more of a primary care role and make statements like 'physicians can't properly counsel patients on nutrition regiments because they don't have our special training' are doing a similar thing. However, it's well established that I'm not a cynic.



I don't have any reason to believe that the MD/DOs I know 'bend over' for big pharma. What I'm saying is big pharma exerts it's influence further up the chain, at the policy-making level. Big Pharma also exerts its influence over what research gets funded and which doesn't; more research, more published findings, more on-the-minds of MD/DOs. By the same token, no research, no credibility, no wide acceptance among MD/DOs.
If it's any consolation, we took a big class my first quarter of medical school called 'evidence based medicine' that essentially taught us how to properly view, review, and utilize studies. One big section of the course was identifying and interpreting bias in the study. From what I've seen, many of the publications in reputable journals either don't suffer from this fate as much (though I suppose you could argue that the chain goes up further than any of us can comprehend), or admit the bias outright. Since this was taught in the first quarter of school, I can only assume I'll receive more training in this as time goes on and learn to spot and interpret this bias and make sure it isn't affecting the way I treat patients.



Your example patient is what I'm talking about. I'd much rather see our healthcare system keep that guy from becoming the 300 lb diabetic in the first place. It's a complex issue, obviously, and doesn't solely fall on the shoulders of any individual physician. There are many factors, such as socioeconomics, the food industry, etc.
Not to play devil's advocate too much, but my point was that it's going to essentially take an entire cultural shift to make this occur. Frankly, this kid was probably given coca-cola and feed hamburgers 3 nights a week as a kid while his dad smoked unfiltered ciggies in front of the TV. Docs can hark about it all they want, but this guy naturally grew into what he was, and I think this type of intervention may be outside the realm of the health service industry.

Granted, I really, really do believe in preventive measures, but I don't even know how possible it will be for our health service industry to switch from reactionary to preventive without our society as a whole (within the realm of generations) switching to wellness. Furthermore, this is probably outside of any physician, DC, nurse's control.


These are things I've picked up along the way over 2 decades in healthcare and as a thinking human being. I have no hospital experience, to answer your question. And it's funny to see you bring up 'conspiracy theories' because I had written something about that in my last post but deleted it; the 'conspiracy' thing usually comes up eventually in these discussions.

(Level-headed discussions like this are always more productive in my view.)
I was more curious than anything else. Many times I just hear the same incorrect statements regarding hospitals, studies, bias, etc repeated on this site, and I wanted to see where you were getting your info. I didn't mean any disrespect by it, just wanted to make sure you weren't reading articles in homeopathic monthly about the evil MD playing 18 holes of gold in the Caribbean with the hot pharm rep, because from my very limited experience, this just isn't the case (note: exaggerated to make myself clear).
 
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cdmguy

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There are those that would say that exercise isn't all that great for weight loss (there are references for this, including the Amer College of Sports Med; not my original opinion). There are also those who would contend that we move less because we weigh more, not vice versa.
I disagree with that argument because it doesn't fit the science. Oxygen utilization capacity always determines exercise ability, not vice versa. This is why different body types are better for different sports, i.e. ectomorph for running vs. endomorph for powerlifting. But first I need to point out the flaw that you changed subject groups from wild rats to overweight humans-they aren't equivalent but they do both suffer from the CO2 effects. Going back to the rats, an additional factor that needs to be considered is that the shorter winter provides more time to gather food (especially fruit) and put on fat-tipping the balance towards weight gain.

This is based at least partially on insulin's effects (meaning insulin resistance and resultant hyperinsulinemia) of storing away a portion of calories as fat right off the bat, leaving less calories for energy production. The result: we get fatter and at the same time have less available energy for movement.
Although I think hormone resistance is an important obesogenic factor (particularly leptin), you can't specifically blame insulin resistance on obesity because many overweight people aren't diabetics. Rather, I think the mechanism behind the insulin resistance is the key and being able to apply it to other hormones. The key to curing a disease is to understand its pathogenesis.

Along a different track, there are those who theorize that various environmental chemicals are screwing up our metabolic machinery. These researchers use the term "obesogens" to describe these various chemicals; search PubMed for "obesogens" and you'll find some interesting stuff.
I'm familiar with xenoestrogens in BPA plastics, unfermented soy products and residual medications from the water supply. Mainly they are a factor with women because men's testosterone buffers them. But going back to the rat study, obesity is affecting both male and female rats so obesogens can't be the primary factor.
 

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If it's any consolation, we took a big class my first quarter of medical school called 'evidence based medicine' that essentially taught us how to properly view, review, and utilize studies. One big section of the course was identifying and interpreting bias in the study. From what I've seen, many of the publications in reputable journals either don't suffer from this fate as much (though I suppose you could argue that the chain goes up further than any of us can comprehend), or admit the bias outright. Since this was taught in the first quarter of school, I can only assume I'll receive more training in this as time goes on and learn to spot and interpret this bias and make sure it isn't affecting the way I treat patients.
I had posted these in another forum but they fit here:
http://www.the-scientist.com/2010/12/1/32/1/ Former BMJ editor on EBM; says "Finally, even some of the strongest proponents of evidence-based medicine have become uneasy, as we have increasing evidence that drug companies have managed to manipulate data. In the heartland of evidence-based medicine—drug trials—the “evidence” may be unreliable and misleading."

http://www.theatlantic.com/magazine/...-science/8269/ Worth the read if you haven't seen it yet.

Both of these articles remind us that, try as we may, the "evidence" published in the journals isn't always 100% automatically reliable. This makes it tough for the busy physician who doesn't always have time to fine-tooth-comb these studies but believes he is getting the best info available.

Not to play devil's advocate too much, but my point was that it's going to essentially take an entire cultural shift to make this occur. Frankly, this kid was probably given coca-cola and feed hamburgers 3 nights a week as a kid while his dad smoked unfiltered ciggies in front of the TV. Docs can hark about it all they want, but this guy naturally grew into what he was, and I think this type of intervention may be outside the realm of the health service industry.

Granted, I really, really do believe in preventive measures, but I don't even know how possible it will be for our health service industry to switch from reactionary to preventive without our society as a whole (within the realm of generations) switching to wellness. Furthermore, this is probably outside of any physician, DC, nurse's control..
This shift will be difficult, will take many years, and will require changes on many fronts, I agree. Clinically, though, it's one patient at a time, and I think chiros are in as good a position as anyone to guide patients through these lifestyle changes. Bear in mind that chiros aren't usually going to be the ones initially diagnosing many of these disorders/diseases, so you guys will still get to keep an eye on these patients.
 
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Jeez facet is the crusade really necessary? Given the lawsuits (ie. Bayer) isn't it naive to believe that medical students aren't on guard about studies and information provided by pharma companies? I would think that the research analysis class would warn students about this.
 

facetguy

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Jeez facet is the crusade really necessary? Given the lawsuits (ie. Bayer) isn't it naive to believe that medical students aren't on guard about studies and information provided by pharma companies? I would think that the research analysis class would warn students about this.
Posting 2 links that are pertinent to a discussion I was having with Jaggs is a crusade now? And who said medical students aren't aware of this situation? These are simply two articles, one published the other day and the second published a few months ago, that discuss the problem of unreliable research being published. Perhaps those following this thread would like to see what the former editor of the British Medical Journal has to say about this problem, as opposed to what you have to say about it.
 

fahimaz7

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Posting 2 links that are pertinent to a discussion I was having with Jaggs is a crusade now? And who said medical students aren't aware of this situation? These are simply two articles, one published the other day and the second published a few months ago, that discuss the problem of unreliable research being published. Perhaps those following this thread would like to see what the former editor of the British Medical Journal has to say about this problem, as opposed to what you have to say about it.
So a few bad seeds are out there and that makes all of our "evidence-based" practice irrelevant and flawed?

I'll take our rich history of evidence-based medicine over the not-so-supported practice of chiropractic manipulations.

Just out of curiosity, do you have any idea how many drugs a pharm company must design before one gets into the clinic? Any idea how much money it takes to get a drug to market? Any idea how many phase 1 clinical trials never make it to phase 2? And how many phase 2 trials never become phase 3? Give me a break! Oh no, drug companies are manipulating the data to get every single drug to market! It's an entire scam! I also hear that vaccines are causing obesity these days and that the HIV virus was the rich man's way of taking over the world!

PS. Who do you think provides greater care the the general public? Chiro or MD/DO? Who do you think saves the most lives in a year? What do you think has made the largest impact on modern day medicine? Antibiotics? Vaccinations? Spinal manipulations? Nutritional supplements in a bottle? Proper spinal alignment and energy flux balances?