Need some info on Chiropractor things????

[FoughtFyr]

Thanks for the non-answer.

Translation----"We don't need no stink'in nutrition classes!!"

"I'm a resident and I have nutritional INNATE INTELLIGENCE!!" ha ha ha

It is not a "non-answer" at all. Nutrition is a defined section on each and every step of the USMLE. Given the fact that every allopathic physician must take this exam, it is fairly important (I am certain it is also on the osteopathic exam, but I've never taken or prepared for that). That said, medical schools tend to worry far less about the titles of courses than about the contents. I have seen many chiropractic college cirricula very carefully deliniating course content by title in every class in order to "keep up appearances" that their graduates are actually educated. This concern is not shared by many medical schools. At my medical school (University of Illinois), a class titled "Essentials of Patient Care" contained all of our psychiatry/psychology instruction in the second year. Besides the required core clerkship, my transcript has no psychiatry or psychology listed on it. But I certainly sat in (seemingly endless) classes on the subject(s). As for nutrition, this was also covered in many "other named" classes I took in the first and second year. Additionally, as part of both my internal medicine and surgery clerkships I spent 1 week (60+ hours) each working with and attending lectures by the nutritionists at the hospitals to which I was assigned. Now, as a resident, I have attended probably an additional 10 - 15 lecture hours on the subject and work with dietary orders everyday.

Translation -- We need and recieve instruction on nutrition. We just don't care what the course is titled. BTW - I know of at least one PBL based medical school where, by your standards, no instruction in anything except "medical student year 1" and "medical student year 2" is given. Those are the only two courses listed and the only two grades recieved in the first two years. I guess they don't even learn anatomy there!

- H

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Members don't see this ad.

 

[JohnDO]

FoughtFyr brings up a good point. At my school we don't have individual course names for medical ethics, public health, behavioral medicine, preventitive medicine, and a few other basic courses. It's all under one course titled "The Complete Doctor". There's no way to calculate how many hours a medical student has spent sitting in nutrition lectures, because often they are a part of a larger course.

I had 350 class hours in nutrition. What is the MD/DO class hours?

You must be an expert now.

 

[mx_599]

Having worked with quite a few DOs, the only time I have seen OMM used was to flirt with nurses.
- H

really? Does this work...I can't wait!

 

[FoughtFyr]

really? Does this work...I can't wait!

Yeah, it does! It is funny how often OMM seems to "devolve" into a back rub .

BTW - I do have great respect for DOs and the above comment(s) are not meant in any way to detract from the profession. I have just never worked with one who actually uses OMM therapuetically. Other than the initials on their name tag they have been indistinguishable from allopaths. Some of the DOs have been holistic (as are some of the allopaths) and some not. As far as I have seen, there is no functional difference. I would have no reservation what so ever about joining a practice that included DOs or hiring one into a practice where I might be employed.

- H

BTW - Strong work on the "Rancid" lyrics... {***former 80's punk wiping a tear from his eye***}

 

[mx_599]

Yeah, it does! It is funny how often OMM seems to "devolve" into a back rub .

- H

BTW - Strong work on the "Rancid" lyrics... {***former 80's punk wiping a tear from his eye***}

gosh...I am mentally exhausted after reading this thread. I think I temporarily feel a little dumber.

I didn't get a sense at all that you do not respect DOs. I think I agree with all your posts...I can't even remember now. hahahaha

Out of 4 pages...and flirting with nurses catches my eye. Sorry everyone

I like that song...destination unknown, ruby, ruby....

 

[Docgeorge]

really? Does this work...I can't wait!

To try this as a 3rd or 4th year will lead to the amusement of the staff at your expence even worse your bed empty. As a resident however, I've herd that this is a viable and successfull meathod of picking up nurses and other allied health professionals.

 

[angietron3000]

...and offers to cure my ear/sinus infection.. that can't be possible, right? or ethical? (nevermind what i'm doing in a bar with an ear infection )

 

[awdc]

I had 350 class hours in nutrition. What is the MD/DO class hours?

Can't really calculate it at most schools since it's integrated with other courses. At mine, we had aspects of nutrition covered in courses such as biochemistry, pathology, pharmacology, physiology, histology & development. In my internal medicine rotation so far, the practical application of nutrition is covered under having to consider supplements and tube feedings as needed for various diseases/conditions.

 

[FoughtFyr]

Looks to be a very touchy subject.

Let's get to a REAL touchy subject. The latest OIG report on chiropractic available here: oig.hhs.gov/oei/reports/oei-09-02-00530.pdf and pro-chiro account here: (look, I don't even quote the WCA! ) http://www.chiroweb.com/archives/23/16/11.html

From http://www.ncahf.org/digest05/05-27.html :

"OIG reports chiropractic overpayment. The Office of the Inspector General has concluded that in 2001, the U.S. Government paid chiropractors $285 million for services that should not have been billed to Medicare. The questionable payments amounted to 57% of what Medicare spent on chiropractic services that year. Chiropractors are entitled to payment for spinal manipulation for active therapy for certain conditions, but not for "maintenance care." (Under the Medicare program, active therapy is treatment that provides "reasonable expectation of recovery or improvement of function" and maintenance care is "a treatment plan that seeks to prevent disease, promote health, and prolong and enhance the quality of life; or therapy that is performed to maintain or prevent deterioration of a chronic condition." The improper payments included $186 million for maintenance and $24 million for manipulation of other areas or other treatments such as massage. The OIG report concluded that (a) about 40% of chiropractic services to Medicare patients are for maintenance care; (b) as chiropractic care extends beyond 12 treatments in a year, it becomes increasingly likely that individual services are medically unnecessary; and (c) lack of necessity increases even more significantly after 24 treatments. [Chiropractic Services in the Medicare Program: Patient Vulnerability Analysis. OIG Report #OEI-09-0200530, June 2005] Many chiropractors advise lifetime periodic spinal examinations and adjustments for what they call "preventative maintenance." Because "maintenance care" lacks a plausible rationale and has never been proven beneficial, insurance plans do not knowingly pay for it. The Medicare overpayment rate may improve because as of October 1, 2004, chiropractors must specify on their claims forms whether active or maintenance care was rendered. "​

I love the finding "the strong correlation between the number of services a beneficiary receives and the likelihood a service is not medically necessary". They are close, actually none of the treatments are "medically necessary", but the report is a good start.

To all of the DCs out there, welcome to the wonderful world of government regulation! You all thought that getting chiropractic accepted by medicare / medicaid was such a big step - welcome to the reality. The lawsuits should be starting next year for medicare / medicaid fraud. For this I actually feel for you. If the feds hold true to form they will slam a few bigger chiropractic practices for what will actually amount to innocent paperwork errors. But the fines will be HUGE!

- H

 

[mx_599]

To try this as a 3rd or 4th year will lead to the amusement of the staff at your expence even worse your bed empty. As a resident however, I've herd that this is a viable and successfull meathod of picking up nurses and other allied health professionals.

cool...I made a note of that. "stay single...wait until residency years"
awesome!

 

[PublicHealth]

Here's a recent article on the future of chiropractic education in North America:

http://www.chiroandosteo.com/content/pdf/1746-1340-13-10.pdf

The authors acknowledge that the current chiropractic educational system is in a state of flux, point out a number of problems with existing training models, and devise some recommendations for how to improve the current system. I agree with them on most accounts, but am not sure how their recommendations will be put into practice, if at all.

A related article: http://www.chiroandosteo.com/content/pdf/1746-1340-13-9.pdf

Memorable quote from this article: "Chiropractors are dentists of the back."

 

[BackTalk]

So what's the purpose of having Doctors of Naturopathic Medicine (NDs)? I noticed that some chiropractic programs offer combined DC/ND degrees in chiropractic and naturopathic medicine (e.g., University of Bridgeport). Is there overlap in the curricula or clinical training of DCs and NDs?

I really don’t know much about these programs of the Naturopathic Medicine. Like with many professions I’m sure there is plenty of overlap. I think ND concentrate more on homeopathy and nutrition than does any other profession. Not many states from what I understand have licensing set in place for ND. Of course with time they will gain more and more ground. Some states like Arizona and California has a rather broad scope of practice.

 

[BackTalk]

Let's get to a REAL touchy subject. The latest OIG report on chiropractic available here: oig.hhs.gov/oei/reports/oei-09-02-00530.pdf and pro-chiro account here: (look, I don't even quote the WCA! ) http://www.chiroweb.com/archives/23/16/11.html

From http://www.ncahf.org/digest05/05-27.html :

"OIG reports chiropractic overpayment. The Office of the Inspector General has concluded that in 2001, the U.S. Government paid chiropractors $285 million for services that should not have been billed to Medicare. The questionable payments amounted to 57% of what Medicare spent on chiropractic services that year. Chiropractors are entitled to payment for spinal manipulation for active therapy for certain conditions, but not for "maintenance care." (Under the Medicare program, active therapy is treatment that provides "reasonable expectation of recovery or improvement of function" and maintenance care is "a treatment plan that seeks to prevent disease, promote health, and prolong and enhance the quality of life; or therapy that is performed to maintain or prevent deterioration of a chronic condition." The improper payments included $186 million for maintenance and $24 million for manipulation of other areas or other treatments such as massage. The OIG report concluded that (a) about 40% of chiropractic services to Medicare patients are for maintenance care; (b) as chiropractic care extends beyond 12 treatments in a year, it becomes increasingly likely that individual services are medically unnecessary; and (c) lack of necessity increases even more significantly after 24 treatments. [Chiropractic Services in the Medicare Program: Patient Vulnerability Analysis. OIG Report #OEI-09-0200530, June 2005] Many chiropractors advise lifetime periodic spinal examinations and adjustments for what they call "preventative maintenance." Because "maintenance care" lacks a plausible rationale and has never been proven beneficial, insurance plans do not knowingly pay for it. The Medicare overpayment rate may improve because as of October 1, 2004, chiropractors must specify on their claims forms whether active or maintenance care was rendered. "​

I love the finding "the strong correlation between the number of services a beneficiary receives and the likelihood a service is not medically necessary". They are close, actually none of the treatments are "medically necessary", but the report is a good start.

To all of the DCs out there, welcome to the wonderful world of government regulation! You all thought that getting chiropractic accepted by medicare / medicaid was such a big step - welcome to the reality. The lawsuits should be starting next year for medicare / medicaid fraud. For this I actually feel for you. If the feds hold true to form they will slam a few bigger chiropractic practices for what will actually amount to innocent paperwork errors. But the fines will be HUGE!

- H

I think the term “supportive care” is the key to dealing with this Medicare issue. I am not a believer in routine chiropractic care for the purpose of a “treatment that seeks to prevent disease, promote health, and prolong and enhance the quality of life”. I would lean towards enhance the quality of life for those who suffer from chronic pain secondary to mechanical problems as a result of degenerative arthritis. I mean if Medicare allows a prescription for pain medication once per month then why not allow the patient to see a chiropractor once a month for pain. Under the current guidelines it is considered to be “maintenance care”. A condition that has become chronic is not covered under Medicare and considered maintenance in nature if you see the patient once per month.

 

[FoughtFyr]

I mean if Medicare allows a prescription for pain medication once per month then why not allow the patient to see a chiropractor once a month for pain. Under the current guidelines it is considered to be “maintenance care”. A condition that has become chronic is not covered under Medicare and considered maintenance in nature if you see the patient once per month.

Actually, Medicare doesn't allow that (or any) prescription - the prescription rules are not written that way. BUT Medicare does not allow a new office visit charge for the purpose of dispensing a medication for a chronic condition (with certain exceptions like CHF, diabetes, etc.). Medicare is designed only to treat a specific problem and return the patient to a baseline level of function (so far as possible). That is why the report is so critical of the number of visits required. You have to remember, these are the same rules that MD/DOs are subject to. It is actually worse for us in that if a patient has a given condition, for example community aquired pneumonia, and requires hospitalization, we have only a given number of days (based on the DRG) to successfully treat them. If they respond in that many days (and with only the treatments allowed in the DRG), great. If not, oh well, the government is only going to pay for that much treatment over that many days. The rest is gratis. No kidding. So far Medicare/Medicaid has not made chiropractors responsible to remain within DRG-like guidelines for lengths of or types of therapy. So for the OIG to question more than 12 chiropractic visits for a single condition is no great shakes. That is just the beginning. And remember, if you accept medicare for ANY patients, the billing rules apply to ALL your patients - Medicare or not.

As I said, I think you guys should've been more careful in what you wished for, cause now you have it!

- H

 

[All4MyDaughter]

I have been to two different chiropractors, and the experiences were so vastly different that one might have trouble believing that they are members of the same profession. I think this supports what others have said here about a lack of an overall standard for chiropractic education and practice.


Chiro 1: younger male, under 30. I saw him for shoulder pain during my pregnancy. He checked my ROM, muscle tension, etc. Found some places where my muscles were tight, worked on them a bit and applied heat packs. Did some basic adjustments but did not pop my neck. Showed me how to have my husband rub my shoulder and gave me free samples of an absolutely awesome creme that is both hot and cold at the same time. Had the creme for sale in his office but gave me so many samples I did not need to buy. Said it would take 3-4 visits to get me feeling better, it actually took only 3. He then advised to d/c treatment and gave me some exercises to improve strength and flexibility.



Chiro 2: older male, probably 45-50? Same problem, later in pregnancy. Said he could not make a diagnosis without X-rays but would try to help me anyway. Did same ROM, muscle stuff as Chiro 1. Did adjustments and popped my neck without telling me first. Used a TENS unit on my shoulder muscles with a cold pack, which felt good.

Tried to sell me a treatment plan that was 1000's of dollars for 1 or 2 years of contracted care. Wanted me to come in to see him 3 times per week. I agreed to two. Each time I scheduled my next appointment, his secretary told me that I really needed to be coming every other day.

Had all kind of supplements and herbs for sale in his office, along with other stuff that I can't really describe other than to call them "gadgets." Always wanted to talk about the prescription drugs I take, and had I thought about how they might be affecting my baby? I'd thought about it - and discussed it with my OBGYN and CNM who told me the benefits outweighed the risks and recommended I keep taking them. The chiro advised me to take certain herbs for my pregnancy - can't remember all of them. Told me that he and all of his colleagues "adjust" their children and I should bring in the baby to see him after about 6 weeks.

Most of this junk was annoying, but I ignored it because I hoped he could help my shoulder pain, but then there were more problems:

At every visit, he was visibly annoyed because I couldn't lie on my stomach for treatment and I didn't want to lie flat on my back. Did not seem to know that pregnant women (especially late term) are encouraged not to lie flat on their backs - I had to explain this every time. After 2 weeks, he convinced me to lie on this table that had rollers on it and were supposed to "work" on my back. He said, "just try it". When they turned it on it was excruciating but I was so large and unwieldly in my pregnancy that I couldn't get up - had to shout for help. His assistant helped me up and but didn't apologize, just shrugged and said "most people like it."

I didn't come back after that day. After I cancelled my appointment, his office staff kept calling me, almost daily, to reschedule. My husband finally had to tell them to back off. After the baby was born the DC sent me a letter asking me why I had stopped coming to him for treatment and asking me to call him. I didn't.



Now, I have seen many MD's and there are of course, differences among them. But there are also certain commonalities, certain things that you can expect to experience when you visit the physician's office. If you pay attention you can identify certain steps in assessment, screening, treatment and follow-up that are almost always followed. There are professional standards of care and protocols for handling different situations.

My point is that these two chiropractors, representatives of the same profession, both trained in colleges accredited by some sort of centralized chiropractic education agency, couldn't have been more different in approach, philosophy and practice. I think that's a serious problem if chiropractic wants to be recognized as a legitimate healthcare profession.


I think this thread is really interesting!

 

[skiiboy]

Musculoskeletal Education: MDs Still Fail the Test

--------------------------------------------------------------------------------
In October 1998, the Journal of Bone and Joint Surgery featured a study that confirmed what most doctors of chiropractic have long suspected. The study, which examined the competency levels of nearly 90 recent medical school graduates, revealed that most medical and surgical residents "failed to demonstrate basic competency" in their knowledge of musculoskeletal medicine. The results prompted the authors of the study to conclude that the training provided in musculoskeletal medicine "is inadequate."
Now, more than six years later, a new study, again published in the Journal of Bone and Joint Surgery, shows that today's medical students and young physicians appear to be just as woeful in their understanding of musculoskeletal medicine as their cohorts were several years ago.

In the new study, 334 medical students, residents and staff physicians, specializing in various fields of medicine, were asked to take a basic cognitive examination consisting of 25 short-answer questions - the same type of test administered in the 1998 study. Each question was worth a maximum of one point, with partial credit given for some questions that required multiple answers. Test scores were then multiplied by a factor of four, for a maximum score of 100. A score of 73.1% was determined to be a passing grade.

While the questions used in the 2005 exam were different from the 1998 test, the results were surprisingly similar. In fact, the average score among medical doctors, students and residents who took the exam in 2005 was 2.7 points lower than those who took the exam in 1998.

Just over half of the staff physicians (52%) scored a passing grade or higher on the 2005 exam. Only 21% of the residents registered a passing grade, and only 5% of the medical students passed the exam (see chart above).

As with the 1998 exam, medical doctors and students with training or experience in orthopedics scored higher on the 2005 exam than subjects who lacked such experience. Among the 124 participants who reported taking a required or elective course in orthopedics, the average score was 69%. Among the 210 participants who had not taken an orthopedics course, the average score was 50%. Similarly, the 155 participants who stated they were comfortable with their ability to perform a musculoskeletal examination attained an average score of 66%. Subjects who felt uncomfortable in performing a musculoskeletal exam achieved an average score of just 49%.

Musculoskeletal Education Exam Results, 1998 vs. 2005
Category 1998 Exam 2005 Exam
# of participants 85 residents (7 orthopedic, 61 medical, 17 surgical) 113 medical students, 167 residents, 54 staff physicians
Average score 59.6% (overall)
74.1% (orthopedic residents)
58.4% (medical residents)
58.1% (surgical residents) 56.9% (overall)
48.8% (medical students)
58.1% (residents)
70.4% (staff physicians)
% earning at least a passing grade 17.6% 20.7%

In the original Journal of Bone and Joint Surgery article seven years ago, the authors stated that "all students must be instructed in musculoskeletal medicine," and that medical schools needed to revise their educational standards, either by adding more contact hours in specified training, or by providing additional training in musculoskeletal medicine during one's residency.

Those recommendations appear to have fallen on deaf ears, as the same sentiments continue to be echoed in the new study. As the authors note in their conclusion:

"This study strongly suggests that there is a lack of basic musculoskeletal education in medical school and during nonorthopaedic residency training. Improvements in education in musculoskeletal medicine should be pursued in all medical schools and residency training programs."

Given that musculoskeletal complaints are one of the leading reasons people seek the services of a doctor for care, one wonders why the medical profession is apparently unconcerned when it comes to educating the doctors of the future on the finer points of musculoskeletal medicine. Perhaps the moral to this story is one you already know: Patients would be best served by receiving care from a health care provider with more musculoskeletal training - a doctor of chiropractic.

References

Freedman KB, Bernstein J. The adequacy of medical school education in musculoskeletal medicine. Journal of Bone and Joint Surgery October 1998;80(10):1421-1427.
Matzkin E, Smith EL, Freccero D, Richardson AB. Adequacy of education in musculoskeletal medicine. Journal of Bone and Joint Surgery February 2005;87(2):310-314.

 

[611]

Time To Wake Up Foughtfyre

 

[FoughtFyr]

Given that musculoskeletal complaints are one of the leading reasons people seek the services of a doctor for care, one wonders why the medical profession is apparently unconcerned when it comes to educating the doctors of the future on the finer points of musculoskeletal medicine. Perhaps the moral to this story is one you already know: Patients would be best served by receiving care from a health care provider with more musculoskeletal training - a doctor of chiropractic.

Really, that is what you want to go with? Come on, I would have thought that DO school would have begun to give you a stronger base in scientific debate. Chiropractors were not given the test. We have no idea how badly they would have bombed it. But we do know from this article: J Manipulative Physiol Ther. 2005 Jun;28(5):336-44. Assessment of knowledge of primary care activities in a sample of medical and chiropractic students. Sandefur R, Febbo TA, and Rupert RL. that three groups of chiropractic third year students, when given a test on musculosketal pathology, scored 71.04%, 56.95%, and 54.75% respectively. Kind of the same conclusion that the studies you posted reached abut allopathic physicians - chiropractc students are ill-prepared in musculoskeletal pathology. Before your cry "foul" the test in the chiropractic article was designed by chiropractors, administered by chiropractors, and validated on chiropractors. It was given to both chiropractic students and medical students. The chiros "beat" the medical students in only one area of the test (musculosketal) and that "victory" was not beyond the standard error of measurement. The chiropractic students did "lose" to the medical students in neurology, which, given the basis for chiropractic, is REALLY scary! But so much for the greater musculoskeletal training.

And, your arguement is spurrious on its face. The articles you posted were studies designed specifically to call for additional training for all physicians in musculosketal pathology. There is no question that the current medical school cirriculum is overloaded. The call for extended training in many subjects has been going on for years. Unlike in chiropractic where all of medicine AND all of chiropractic can be learned in three calendar years.

Given the collaborative medical model (remember that unlike chiropractors, MD/DOs do not believe we know everything nor do we believe we can treat everything) a properly treated patient presenting to a primary care physician for treatment of a musculosketal issue will be referred to another physician. So your conclusion was right. Patients would be best served by receiving care from a health care provider with more musculoskeletal training - an orthopedic surgeon or a medical PM&R physician.

BTW - the practicing orthopods ALL passed the test, as usual you left out key facts from the study.

- H

 

[jesse14]

Let me ask you an honest question foughtfryer.

Do you think MD's know more than DC's on such topics as spinal biomechanics, spinal pathology, and pain? I doubt it. MD's are very well trained and i am NOT saying med school is bad because it's far from that. I'm just saying that i don't think you're giving DC's enough credit. They still do 4 years of school ( all be it, no residency). I feel DC's are well equiped to do their job as CHIROPRACTORS because i have both med school and chiro school friends and both are submersed in their studies. They even use the same anatomy, biochemistry, and pathology text books. One of my friends is an M1 at the University of Toronto and the other friend is a first year at the CMCC (Canadain Memorial Chiropractic College) and they study together regularly.
I know that's not scientific evidence or anything like that, but it's just something to think about!
Take care

 

[FoughtFyr]

Let me ask you an honest question foughtfryer.

Do you think MD's know more than DC's on such topics as spinal biomechanics, spinal pathology, and pain? I doubt it. MD's are very well trained and i am NOT saying med school is bad because it's far from that. I'm just saying that i don't think you're giving DC's enough credit. They still do 4 years of school ( all be it, no residency). I feel DC's are well equiped to do their job as CHIROPRACTORS because i have both med school and chiro school friends and both are submersed in their studies. They even use the same anatomy, biochemistry, and pathology text books.

They may use the same texts but if they then "learn" that the books are wrong and that subluxations are the cause of all illness, what book is on the shelf really doesn't matter.

And chiropractic school is three years not four.

And yes, I am saying that "MD's know more than DC's on such topics as spinal biomechanics, spinal pathology, and pain" and so do some chiropractors! (see below)

One of my friends is an M1 at the University of Toronto and the other friend is a first year at the CMCC (Canadain Memorial Chiropractic College) and they study together regularly.
I know that's not scientific evidence or anything like that, but it's just something to think about!
Take care

So lets see the scientific evidence (largely a repost - but it goes to Jesse's question):

J Manipulative Physiol Ther. 2005 Jun;28(5):336-44.

Assessment of knowledge of primary care activities in a sample of medical and chiropractic students.

Sandefur R, Febbo TA, Rupert RL.

Cleveland Chiropractic College, Kansas City, MO 64131, USA. [email protected]

OBJECTIVE: To examine the influence of chiropractic education on knowledge of primary care tasks. Scores received on a test of knowledge of primary care tasks were compared between 3 samples of chiropractic students and 1 small sample of medical students. DATA SOURCES: The taxonomy of primary care tasks that was previously published provided the basis for test items used in this study. A team of test writers prepared an evaluation instrument that was administered to final-term chiropractic students at 3 colleges and to a small sample of medical students as they were entering their residency programs. RESULTS: The chiropractic students scored below the medical students on the primary care examination in every area except musculoskeletal conditions. Chiropractic students scored higher than medical students on the musculoskeletal portion of the examination. CONCLUSIONS: In this sample, chiropractic students performed almost as well as medical students on a test that was designed to measure knowledge of primary care tasks. If the premise is accepted that medical school is the gold standard of primary care instruction, that chiropractic students fared almost as well as medical students is noteworthy.
_______

So, what they did was give a test to on basic primary care to three groups of chiropractic students in their final terms in chiropractic college (groups 1, 2 and 3) and one group of recent medical school graduates who had yet to start residency. The test was created by "2 DCs who also hold bachelor's degrees, 1 DC with a diplomate in radiology, a DC enrolled in the final year of a radiology residency program, and 2 MDs". It was a 100 question test broken into two 50 question sections and some description of attempts to validate the instrument for use on chiropractic students is offered by the authors. So here is what they found...

Group 1: 21 students, raw scores 32.7, % scores 65.4, SD 4.6
Group 2: 22 students, raw scores 28, % scores 56, SD 5
Group 3: 79 students, raw scores 32.1, % scores 64.2, SD 4.4
Groups 1 to 3 (combined): 122 students, raw scores 31.4, % scores 62.8, SD 4.7
Group 4: 20 students, raw scores 36.7, % scores 73.4, SD 3.3

Now, while the medical student sample size is low, the performance of the chiropractic students is abyssmally low. 68% of all of the chiropractic students (who are very soon to enter practice) taking the test, a test designed and validated by DCs, scored between 58.1% and 67.5%?!? This is noteworthy? Yes, it is! It succinctly proves the point that DCs are very ill prepared to serve as primary care physicians. As for the medical students, 68% scored between 70.1% and 76.7%. While I would normally bristle at these data as the sample size is so small, it should be noted that the SD was the narrowest, by a considerable amount, in this group. This leads me to question the need to validate the instrument not only with chiropractic students (as was done) but also with medical students (not done in this study). These results seem to indicate a very tight "clumping" of scores in the medical student group, which may suggest that areas of the test represented material outside their scope of instruction.

Other results:
Percentage scores of all students on 5 major categories of primary care tasks
Primary care activities (% correct)
Information gathering Group 1 - 60.12, 2 - 57.04, 3 - 64.72, 4 - 76.64
Screening and prevention Group 1 - 35.72, 2 - 27.09, 3 - 38.93, 4 - 63.10
Other diagnostic procedures Group 1 - 66.94, 2 - 57.64, 3 - 65.83, 4 - 74.34
Counseling and education Group 1 - 69.05, 2 - 75.00, 3 - 87.74, 4 - 95.24
Management of acute/chronic conditions Group 1 - 65.71, 2 - 57.04, 3 - 64.69, 4 - 73.01

By these data, chiropractic does not perform information gathering or screening and prevention well at all.

I'm not going to post the data on all individual "subcategories of management of acute and chronic conditions". Suffice it to say that group four handily out performed all of the other groups in every area except one:
Musculoskeletal (% correct) Group 1 - 71.04, 2 - 56.95, 3 - 54.75, 4 - 48.02
(but group four did outperform the others in neuro!:
Neurological (% correct) Group 1 - 78.1, 2 - 61.67, 3 - 78.99, 4 - 82.86)

My most significant concern on their methodology is this - the test was given to medical students about to enter residency training and to final term chiropractic students about to enter practice (presumably). Now, the article acknowledges a gap, but that gap should only grow as the medical students have at least three years of training remaining. Also, no attempt was made to identify what area of medicine the MD students were entering. I would argue that given the latitude to self direct fourth year cirricula to a certain degree, students heading into primary care would likely outperform a random sample from all medical students on this examination as they would have more training in this area than the "average" medical student.

Lastly, the conclusions do not match the data. It is not "noteworthy", in a positive sense, that chiropractic students about to enter the workforce score abyssmally low on a test of basic primary care skills. Comparing them to MD graduates with at least three years of training remaining is comparing apples and oranges. And even given the disparity in time remaining in training, the MD students quite significantly outperformed the chiropractors. This paper completely demonstrates what I have been saying since I started coming to this forum. Chiropractors are not equipped to act as primary care physicians.

- H

 

[jesse14]

And chiropractic school is three years not four

http://cmcc.ca/admissions/faq.htm ...ike a very educated and well informed person.

 

[FoughtFyr]

And chiropractic school is three years not four

http://cmcc.ca/admissions/faq.htm

this site states that chiro school is 4 years which includes a 12 month clinical rotation in which much learning does take place.

From that site:
"The programme is four years with summers off in between year I and II and year II and III. Students begin a 12 month clinic internship immediately following the third year of study."

So yes, at that institution (CMCC) chiropractic school is 4 years with summers off. Most U.S. chiropractic colleges, such as Palmer see: http://admissions.palmer.edu/DC/DCProgram.htm, use a three and one quater calendar year program.

"1) How long is the Doctor of Chiropractic program?

Most students attend classes throughout the year and complete their studies in three and one-third years. (If studies are completed during a typical academic calendar year, it would take five academic years to complete the program.) The Palmer College program in Davenport, Iowa, is 10 trimesters. The Palmer West program in San Jose, Calif., and Palmer Florida program in Port Orange, Fla., are 13 quarters."

I think, at first glance, the two programs are similar in course length, they just spread it out differently.

Look, I am not a statisitian or anything like that. Yes, the study does show flaws in the chiropractic education but was this study duplicated? I know for a study to be scientificaly sound it must be duplicated with the same results in order to hold any validity.

Actually the study was internally controlled by having more than one group tested. That said, to be valid a study's results must be duplicatable, not duplicated, to be valid. That means that the methodolgy must be well enough described for another group, in a different time and location, to run the same experiment. This study met that definition. It was a well run and well designed study, as was the orthopedic paper.

This is not to say that the one study done doesn't yeild some disturbing results, it's just not good enough for me. My chiropractor really helped me when i had my car accident like my MD could never do. That's what got me interested in chiropractic.

Contary to popular belief, the plural of "anecdote" is not "fact". The study is disturbing and I think highlights the very serious shortcomings in chiropractic education.

My MD just gave me pills which masked what the real problem was. My vertebra were out of alignment. I know you wouldnt agree with that, but im living proof that chiropractic helps big time. I was in horrible pain and after 3 weeks with my chiropractor, i was MUCH better. Please don't tell me that it would have gotten better on its on or anything like that because I hate that assumption BS.

That "assumption" has been proven in multiple, duplicated studies. What has never been shown, in any study, is that "vertebra out of alignment" is a. the cause of benign LBP or b. that these misalignments are resolved by chiropractic care. Certainly mis-alignment of spinal vertebra occur - usually from high energy trauma and sequlae include paralysis and death. What you had was musculoskeletal back pain. All studies indicate this would resolve on its own. But, true to the findings of several studies, chiropractic patients (including you) express the highest degree of satisfaction with their treatment (even though that treatment does not resolve symptoms any faster and is usually more expensive).

I respect my chiro just as much as i do my MD, i just think they are good at helping patients with different things.

You are entitled to your opinion. It is one that I do not share, nor is it one I believe to be backed by science. That said, neither is religion, yet I still go to church each Sunday.

I do NOT believe DC's can cure cancer or breathing problems, but i do believe they do a great job of musculoskeltal pain and thing's in that ball park.

O.k., now we get closer. I have said repeatedly that I think that sudies have well proven that chiropractic is as effective, but not more so, as conventional medical therapy for idiopathic low back pain. The question is can the chiropractor reliably detremine idiopathic LBP from other, more sinister etiologies.

I wouldn't go to my DC for a blood test or a rash just as how I wouldn't go to my MD for LBP.

Thank's for your time. You seem like a very educated and well informed person.

To be honest, if your MD has ruled out serious pathology as the cause for your LBP, I am all for your seeking chiropractic treatment for it. If not, I would urge you to be examined by an MD, then treated by a DC when no significant pathology is found. But that is just my opinion.

Thank you for keeping an open mind in these discussions and not degenerating them into personal attacks. Have a good night.

- H

 

[skiiboy]

FoughtFyr, where your analysis and conclusions fall flat on their face is your very misguided assumption that most primary care docs always realize that most musculoskeletal complaints fall out of their diagnostic capability and that they always refer out to orthopedists/physiatrists and furthermore your assumption that chiropractors never refer out. Both of these concepts are flat out wrong. Primary care medical doctors, who have never been to shown to have a strong handle on the diagnosis and treatment of musculoskeletal complaints routinely attempt to diagnose and treat these matters. In our HMO world, may pcp's are incentivized not to refer out and add to that doctor's who think they know more than they do.. and you have our current situation. Also, your continual critique of chiropractors who do not conduct differential diagnosis and only look for subluxations of the spine is warranted BUT this is a very small sampling of chiropractors. Chiropractors are absolutely taught medical differential diagnosis and are required by law to render a medical diagnosis on all patients. Chiropractors routinely call for x-rays and write prescrips for mri's and catscans when needed. These are then always read by radiologists and the reports are sent to the chiropractor. The chiropractor than is able to determine if that patient is a candidate for chiropractic treatment or if they also need to be examined/treated by another specialist. This idea that chiropractors can not differentially diagnose musculo-skeletal complaints is completely unfounded. Chiropractors spend just as much time learning about conditions where chiropractic care is contraindicated and a refferal is necessary as they are about conditions that warrant chiropractic care. The picture you paint of the "chiropractor from the countryside" who despite the patients complaint only feels the spine and just keeps adjusting... is far from the actual chiropractic climate at this point in time.

 

[FoughtFyr]

FoughtFyr, where your analysis and conclusions fall flat on their face is your very misguided assumption that most primary care docs always realize that most musculoskeletal complaints fall out of their diagnostic capability and that they always refer out to orthopedists/physiatrists and furthermore your assumption that chiropractors never refer out. Both of these concepts are flat out wrong.

Really? Most chiropractors, in fact outside of workingman's compensation mills like TBI (Texas Back Institute), I would dare all chiropractors, practice without formal arrangements with MD/DOs. Almost none have admission privileges to hospitals. So "referrals" are catch as catch can. If you wish to bemoan HMOs, at least realize that one of the few strengths of an HMO is a relatively seamless referral process.

Now as for your other malarkey. As you are not yet a physician, I think you will owe us all an apology when you yourself get into practice and see how things are done. BTW - did you read the paper I cited above? Let's see, third year chiropractic students, those getting ready to enter practice, scored (as group averages) between (% correct) 71.04 and 54.75% on a chiropractic based exam of musculoskeletal pathology, while medical students with at least three years of training remaining, scored (as a group average) 48.02%. Not a lot of difference between 48.02 and 54.75%. The SEM was not published, but this would likely fall within it. Now let's look at Neurological problems. The third year chiropractic students, remember they getting ready to enter practice, scored (as group averages) between (% correct) 78.99 and 61.67%, while medical students, with at least three years of training remaining, scored (as a group average) 82.86%. Now you want to claim chiropractors are better than the average physician at NMS complaints? Yet, soon-to-be practicing chiropractic students can't even beat medical students who will each have a least three more years of training on a test of NMS pathology! Come on, this test was designed by, validated on, administered by, and reported on by chiropractors.

Primary care medical doctors, who have never been to shown to have a strong handle on the diagnosis and treatment of musculoskeletal complaints routinely attempt to diagnose and treat these matters. In our HMO world, may pcp's are incentivized not to refer out and add to that doctor's who think they know more than they do.. and you have our current situation.

As you are not yet a physician, I would say you have no clue. As others have posted here, the standard of care is referral. Those standards are published and taught. If an untoward outcome should occur from deviation from those standards, the physician will answer for it. But please, if you have a patient outcomes based study to show that primary care medical doctors do not have a "strong handle" on the treatment of musculoskeletal complaints, post it. This study (which you have cited in the past, see: http://www.ncbi.nlm.nih.gov/entrez/...d&dopt=Abstract&list_uids=12779297&query_hl=4) and a Cochrane review: http://www.ncbi.nlm.nih.gov/entrez/...d&dopt=Abstract&list_uids=12779297&query_hl=4 both show that your highly regarded chiropractors are no more effective (in terms of outcome) than those dreaded "primary care medical doctors, who have never been to shown to have a strong handle on the diagnosis and treatment of musculoskeletal complaints".

From: http://www.annals.org/cgi/content/full/138/11/I-33 "What did the researchers find? Spinal manipulation was more effective than sham therapy and therapies already known to be unhelpful. However, it was no more or less effective than general practitioner care, pain killers, physical therapy, exercise, or back school." {emphasis added} Hmm, why hasn't chiropractic been proven to be more effective if they are so great at NMS treatment and primary care medical doctors so poor?

"Very misguided assumption" my left foot! The only misguided assumption that I make is that you, or any of the "D.D. Palmer is God and B.J. is Christ" fanatics will actually be swayed by science as opposed to the quasi-religious hucksterism you push. Face it, even the chiropractic literature bemoans the risks of CVA from high cervical manipulation: http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12466778 and the risks of iatrogenic injury during chiropractic school: http://www.jcca-online.org/client/cca/JCCA.nsf/objects/V49-1-46/$file/jcca-v49-1-046.pdf and the low quality of chiropractic education: http://www.ncbi.nlm.nih.gov/entrez/...&dopt=Abstract&list_uids=15965408&query_hl=10.

Also, your continual critique of chiropractors who do not conduct differential diagnosis and only look for subluxations of the spine is warranted BUT this is a very small sampling of chiropractors. Chiropractors are absolutely taught medical differential diagnosis and are required by law to render a medical diagnosis on all patients.

Actually not. The chiropractor's form for Medicare / Medicaid (the things the chiropractor is "required by law" to do) does not discuss medical diagnosis. Nor should it. Chiropractors are not medical diagnosticians.

Now, what you, and the other "pro-chiro" folks around here have always failed to answer, is how it is that chiropractors can, in three and one quarter calendar years, amass diagnostic skills equal to a physician while also learning all that is the "science" of chiropractic?

Chiropractors routinely call for x-rays and write prescrips for mri's and catscans when needed.

Do not confuse a test being ordered with one being needed.

These are then always read by radiologists and the reports are sent to the chiropractor.

Not always. Some are read in the office by chiropractors (x-rays), and others by chiropractic radiologists (not equal in diagnostic ability to MD/DO diagnostic radiologists, as evidenced by studies you previously posted).

The chiropractor than is able to determine if that patient is a candidate for chiropractic treatment or if they also need to be examined/treated by another specialist. This idea that chiropractors can not differentially diagnose musculo-skeletal complaints is completely unfounded.

Really, here is a great review (among the many out there) that says otherwise.

Archives of Pediatrics & Adolescent Medicine
Volume 151(5) May 1997 pp 527-528
Chiropractic for Children
Turow, Victor D. MD
http://www.ncbi.nlm.nih.gov/entrez/...d&dopt=Abstract&list_uids=9158451&query_hl=11

Chiropractors spend just as much time learning about conditions where chiropractic care is contraindicated and a refferal is necessary as they are about conditions that warrant chiropractic care. The picture you paint of the "chiropractor from the countryside" who despite the patients complaint only feels the spine and just keeps adjusting... is far from the actual chiropractic climate at this point in time.

Really?!? And how exactly is the public supposed to tell the difference between the chiropractor who is "stretching" the limits of their practice and the more "reasonable" one you describe? And why does the profession allow these individuals to practice? Where are the educational standards (the CCE still requires a subluxation based model to be taught see: www.cce-usa.org)? Where is the QI/QA and practice oversight?

(It's o.k., we know, there isn't any, it was a rhetorical question)

- H

 

[DRDCMD]

I am a doctor of chiropractic who will be attending medical school. I have been practicing since 1991. I'll address the initial post by stating that the chiropractic profession is fraught with problems. As a profession, we cannot agree on whether or not chiropractors are NMS specialists or primary care providers. Historically, there have existed schisms on both the state and national level that have negatively impacted public perception and practice scope. Some states have favorable laws, others have laws that are unduly restrictive. DCs have only a handful of CPT codes that can be billed. Public and professional perspectives are often skewed toward the negative. Student loan default is on the rise. Enrollment is dropping. It is becoming increasingly difficult to make it under the rapacious eye of managed care and third party review.

Chiropractic is, however, a great profession and has tremendous potential.

It can be argued that our health care system falls exceedingly short in the "preventative" arena. Chronic disease is increasing rapidly and medicine does not have the answers. This uncharted territory is where, IMO, chiropractic should strive. There is practically no emphasis on treating "functional" disorders, that is, states of physiological dysfunction that precede pathology. Examples of the above include systemic inflammation preceding heart disease, functional hypoadrenia preceding allergies/asthma, liver/gut toxicity preceding IBS/diverticulitis, hypochlorhydria preceding gastric reflux, dysglycemia preceding diabetes, etc. Rather, emphasis is on treating a named disease rather than preventing that disease. With heart disease, cancer, diabetes, obesity, arthridites, auto-immune disease, disc surgery, etc. on the rise, I think we can agree that something in health care is not sound. A system emphasizing preventative care through nutrition, herbals, meridian therapy, homeopathics, cranials, spinal and extraspinal adjusting, stress reduction, etc. is sorely needed. With additional training, chiropractics could fill this niche. It could be perceived as such: one side of the coin is disease/trauma/crisis, that which warrants medicinal intervention. The other side, "dysfunction", where preventative/wellness/functional care - chiropractics - would be applicable. My emphasis is on the aforementioned, however, it is difficult to promote this type of health care as a DC when mass perception is so horribly distorted. I do not blame the public. I fault the profession/colleges for not striving towards teaching a "wellness" care paradigm that allows chiropractors to truly "deliver the goods".

Most DCs take additional post-graduate seminars to learn more in their area of interest. While on site radiology programs have been the most successful in establishing chiropractic radiology as a distinct specialty, I believe on-site residency programs should be further developed in several chiropractic specialties: orthopedics/neurology/internal disorders, etc. These could emphasize conservative non-medicinal, non-surgical treatment while catering to the individual predilections of the practitioner. Although resources are limited, I believe the profession must strive towards specialization and fund more research. While medicine has endless revenue streams for research, chiropractic, sadly, has little to none. The fanaticism that is often "heard" most loudly by critics needs to be quelled in favor of communicating the evidenced benefit of chiropractic, promoting research, and fostering preventative care models.

On a separate issue, in regard to to accusations of the limited diagnostic capability of the DC, chiropractors often find or suspect disease processes that have gone undetected. In my years I have found or ordered tests that have determined the presence of many disease entities including Paget's, bone metastasis, colon cancer, aneurysms, non-Hodgkin's lymphoma, fractures, osteomyelitis, etc. Many of these patients had been given a cursory exam, declared to have a "back sprain", and sent out of the office with a pain prescription before coming to my office. Most DCs know normal from abnormal and that is often enough to get the patient on the right track. If a patient does not respond in a reasonable amount of time, most DCs would follow up with a consult or request additional diagnostics. Since we often have repeated visits with a patient we can sometimes suspect when something is not right. And sure it has gone the other way also.

Today, it is clear that medicine is not without its issues. Starfield's 2000 JAMA article speaking of iatrogenic deaths numbering approximately 250,000 attests to this. Each day approximately 300 people die from "correctly" prescribed meds (106,000 deaths yearly according to the 1998 Lazarou JAMA article). Adverse drug reactions number in the millions. We have seen drugs pulled from the market place and major pharmaceutical industries, along with the FDA, come under deserved scrutiny. A portion of the above can be ascribed to the fact that medicine is dealing with life-and-death issues, however, such does not offer blanket exculpation. Chiropractic remains the safest mode of health care available. Yes it has its faults, and no it certainly does not have all the answers. But neither does medicine. It is my endeavor to find a balance with both systems; however, if both sides learned some toleration, and could find the middleground, it is clear to me, at least, that the benefit to patients, and society as a whole, would be immediate and immeasurable.

 

[JohnDO]

Chiropractic remains the safest mode of health care available.

But the scope of chiropractic health care is severely limited. Trying to make a case for the safety of chiropractic care by citing iatrogenic deaths per year is a weak argument. That's like arguing that dermatology is the safest form of healthcare. It may be true that the number of deaths per year as a result of dermatological intervention is significantly lower than the deaths per year as a result of other fields of medicine, but that is because of the nature of the problems each field deals with, not because there is some sort of inherent safety present in one field that isn't present in the other.

 

[FoughtFyr]

I am a doctor of chiropractic who will be attending medical school. I have been practicing since 1991. I'll address the initial post by stating that the chiropractic profession is fraught with problems. As a profession, we cannot agree on whether or not chiropractors are NMS specialists or primary care providers.

Nor can you agree on a "proper" scope of practice.

Chiropractic is, however, a great profession and has tremendous potential.

See, here is the problem. What is it that you base this conclusion on? The basic "science" behind chiropractic has been debunked. Subluxations are a myth. In the late 1800's, when Palmer was alive and "creating" chiropractic, it sure sounded good. But, as with many things, as our understanding of the human body grows, this theory has simply proven untrue.

It can be argued that our health care system falls exceedingly short in the "preventative" arena. Chronic disease is increasing rapidly and medicine does not have the answers. This uncharted territory is where, IMO, chiropractic should strive.

Actually, you are wrong. Medicine does have the answers and this is hardly "uncharted" territory. Read the IOM report on medicine and public health. Heck, read the latest AMA newsletter bemoaning public health prevention for female patients. The problem is not that we, as physicians, don't know what to do. The problem is that we have neither the time, nor the funding needed to do it. And the public is unwilling or unable to give up those "bad habits" that reduce health. Look at the simple fact that we still have smokers in our society. 'Nuff said!

There is practically no emphasis on treating "functional" disorders, that is, states of physiological dysfunction that precede pathology. Examples of the above include systemic inflammation preceding heart disease, functional hypoadrenia preceding allergies/asthma, liver/gut toxicity preceding IBS/diverticulitis, hypochlorhydria preceding gastric reflux, dysglycemia preceding diabetes, etc. Rather, emphasis is on treating a named disease rather than preventing that disease.

You are so wrong. Let me ask you a simple question - if medicine is not addressing these entities, how do we know about them? Chiropractic research? I am glad that you are going to medical school, altough, in a way I feel sorry for you. I think that the next four years for you are going to feel alot like what a Russian defector to the U.S. in the 1970s might have felt. You are going to realize that a great deal of the propaganda you have come to accept as "fact" (regarding medicine) is simply not true.

With heart disease, cancer, diabetes, obesity, arthridites, auto-immune disease, disc surgery, etc. on the rise, I think we can agree that something in health care is not sound. A system emphasizing preventative care through nutrition, herbals, meridian therapy, homeopathics, cranials, spinal and extraspinal adjusting, stress reduction, etc. is sorely needed. With additional training, chiropractics could fill this niche.

Huh?!? So, on one side, if you are leaning toward the "ill" side of the health disease continuum, you deserve proven care, designed to return you to the prominently healthy side, where you will recieve a bunch of snake oil? I mean homeopathics, crainials, meridian therapy?!? You are about to have a very interesting four years my friend.

It could be perceived as such: one side of the coin is disease/trauma/crisis, that which warrants medicinal intervention. The other side, "dysfunction", where preventative/wellness/functional care - chiropractics - would be applicable. My emphasis is on the aforementioned, however, it is difficult to promote this type of health care as a DC when mass perception is so horribly distorted. I do not blame the public. I fault the profession/colleges for not striving towards teaching a "wellness" care paradigm that allows chiropractors to truly "deliver the goods".

I personally like to compare health to light. We all can certainly agree when we see blazing, bright light, and we can all agree on total darkness. The "in-between" is individually defined, much as health is. What is "very dark" to you might be a bit light to me.

I do agree with you in one point , the problem with chiropractors not being being able to truly "deliver the goods" is their lack of training. However I thnk we would totally disagree on what that training should entail. Can you say PA school anyone?

Most DCs take additional post-graduate seminars to learn more in their area of interest. While on site radiology programs have been the most successful in establishing chiropractic radiology as a distinct specialty, I believe on-site residency programs should be further developed in several chiropractic specialties: orthopedics/neurology/internal disorders, etc. These could emphasize conservative non-medicinal, non-surgical treatment while catering to the individual predilections of the practitioner.

Yeah, the phrase "the blind leading the naked" jumps to mind. One of the problems with chiropractic, in my opinion, is that practices seem to be developed to match the "individual predilections" of the practitioner instead of a well defined standard of care. And, with the exception of radiology, none of the "specialties" listed above have any relation to any proven benefit of chiropractic. There is not a single "internal disorder" that chiropractic is proven to treat!

Although resources are limited, I believe the profession must strive towards specialization and fund more research. While medicine has endless revenue streams for research, chiropractic, sadly, has little to none. The fanaticism that is often "heard" most loudly by critics needs to be quelled in favor of communicating the evidenced benefit of chiropractic, promoting research, and fostering preventative care models.

Ahh, what a wonderful statement. The problem is that to be good research, both the hypothesis and the null hypothesis must be considered. The simple fact is that chiropractic research can't / won't ever advance too far because as the evidence piles up against it's use, you can't create research questions worth postulating. The simple basic science isn't there.

Let me give you a non-chiropractic example. Suppose that I, as an emergency physician, wanted to study if people brought to the ED in red ambulances did better, in terms of outcome, than those brought to the hospital in white ambulances. Even if I found someone to fund the study, few, if any, IRBs would allow it. Why? Because there is no scientifically plausible reason that the color of the ambulance alone would effect outcome. Now,if the local fire department's ambulance was red, and the hospital's ambulance was white, and I thought that a difference in crew training was key to patient outcomes, I could study that, but not the color of the ambulance itself.

So how does that compare to chiropractic research? If you do not have a plausible scientific mechanism and basic science backup to prove that plausibility, a properly designed research study cannot be performed. Take chiropractic treatment of asthma. There is a good body of research out there that chiropractic treatment of asthma is ineffective. Given that, an IRB (if they are doing their job) will refuse to allow futher studies, and subject more asthma sufferers to ineffective treatment, unless some new basic science study gives hope that now it will work.

(to be continued)

 

[FoughtFyr]

On a separate issue, in regard to to accusations of the limited diagnostic capability of the DC, chiropractors often find or suspect disease processes that have gone undetected. In my years I have found or ordered tests that have determined the presence of many disease entities including Paget's, bone metastasis, colon cancer, aneurysms, non-Hodgkin's lymphoma, fractures, osteomyelitis, etc. Many of these patients had been given a cursory exam, declared to have a "back sprain", and sent out of the office with a pain prescription before coming to my office.

Wow. In medical school you will learn that the plural of anecdote is not fact. I am not saying that no chiropractor has ever found disease processes. Nor am I saying that all MD/DOs are flawless diagnosticians. What I am saying is that there is no QI/QA or standard of care for chiropractic. So, if a straight chiropractor choses to treat someone, without medical diagnosis, who later dies, or suffers significant morbidity as the result of their actions, there is no downside. In any case where a patient "had been given a cursory exam, declared to have a "back sprain", and sent out of the office with a pain prescription" and turned up later with, lets say Paget's disease of bone, you had better believe that physician will end up the star of his/her very own M&M. And if called into court, will open their checkbook wide. Why aren't chiropractor's as liable? Ask a lawyer - it has to do with the fact that the experts called "against" them would also have to be chiropractors. Gee, there is no question you "found" the "subluxation" and tried to fix it. He / she was just too far into dis-ease to be saved. He / she should have come to me sooner...

Most DCs know normal from abnormal and that is often enough to get the patient on the right track. If a patient does not respond in a reasonable amount of time, most DCs would follow up with a consult or request additional diagnostics. Since we often have repeated visits with a patient we can sometimes suspect when something is not right. And sure it has gone the other way also.

And the repercussion if the chiropractor errs is...? The oversight mechanisms to insure the error don't occur as a pattern is...? The standard of chiropractic care is...?

Today, it is clear that medicine is not without its issues. Starfield's 2000 JAMA article speaking of iatrogenic deaths numbering approximately 250,000 attests to this. Each day approximately 300 people die from "correctly" prescribed meds (106,000 deaths yearly according to the 1998 Lazarou JAMA article).

Yeah, nice try. The number one cause of death, in both the IOM report and the Lazarou article, is "failure to rescue" i.e., failure to make a timely diagnosis or recognize an impending emergency. This results in far more than 50% of all of the deaths quoted in either source. Would you really want to look at chiropractics numbers in this regard? Oh yeah, we can't, because there is no reporting mechanism for chiropractic errors; but to be fair, without a standard of care there really is no definition for them either.

Adverse drug reactions number in the millions. We have seen drugs pulled from the market place and major pharmaceutical industries, along with the FDA, come under deserved scrutiny. A portion of the above can be ascribed to the fact that medicine is dealing with life-and-death issues, however, such does not offer blanket exculpation. Chiropractic remains the safest mode of health care available.

That assumes two things, one, that you ignore risk versus benefit. Because if you include that, chiropractic is the most deadly and least safe method of "health care" - (a definition in which I do not usually place chiropractic). Any risk measured against no proven benefit equals unnecessary morbidity and mortality. And two, that you ignore the fact that there are no reporting mechanisms for chiropractic iatrogenic injuries. These two articles, from chiropractic research journals seem to suggest that it is far more likely a lack of reporting than a lack of injury:
http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12466778
http://www.jcca-online.org/client/cca/JCCA.nsf/objects/V49-1-46/$file/jcca-v49-1-046.pdf

Yes it has its faults, and no it certainly does not have all the answers. But neither does medicine. It is my endeavor to find a balance with both systems; however, if both sides learned some toleration, and could find the middleground, it is clear to me, at least, that the benefit to patients, and society as a whole, would be immediate and immeasurable.

Well, that assumes that there is benefit to chiropractic, an assumption I am not ready to grant. I don't believe that there is any proven benefit, and I feel that the basic "science" behind chiropractic has been debunked. Do we need more patient centered preventative medicine - absolutely. But within the scientifically proven healing arts. Would I be for the creation of a new PA specialty of preventative medicine - yep. Heck, I would even be for the creation of a bridge program for DCs to be trained into that.

That said, this should be an interesting four years for you. I am sure that we will have to agree to disagree regarding chiropractic, but I sincerely wish you the best of luck in the wild ride you are about to start (you too skiiboy!) It wil be interesting to see if, and how, your views change over time. Hopefully you will keep posting here.

- H

 

[hoselton]

Wow, FYR...what kind of drugs are you on? Take a green chill pill why don't you? I truly feel sorry for the apparent hate filled life that you must live. You can spout studies ad nauseum as nearly an profession can. When it comes down to it though -- it's a personal experience that someone has with chiropractic that appreciates it. From the lowly student wanting to become a Chiropractor or a million dollar heart surgeon. Get off your throne and go "help" someone else.

 

[Jambi]

-- it's a personal experience that someone has with chiropractic that appreciates it.

As has been pointed out before (by FoughtFyr And others) the plural of anecdote is not fact. No one is "hating" on anything. The only thing that has been asked here is to "prove" Chiropractic.

 

[Docgeorge]

Wow, FYR...what kind of drugs are you on? Take a green chill pill why don't you? I truly feel sorry for the apparent hate filled life that you must live. You can spout studies ad nauseum as nearly an profession can. When it comes down to it though -- it's a personal experience that someone has with chiropractic that appreciates it. From the lowly student wanting to become a Chiropractor or a million dollar heart surgeon. Get off your throne and go "help" someone else.

The reason for peer-reviewed scientific papers and Evidence Based Medicine is to make sure that you do "help" someone rather then harm them.

 

[hoselton]

As has been pointed out before (by FoughtFyr And others) the plural of anecdote is not fact. No one is "hating" on anything. The only thing that has been asked here is to "prove" Chiropractic.

There is plenty of evidence to "prove" Chiropractic. But those who, from the outset, have set themselves against it won't ever look at it. So 1000 research papers set in front of that individual won't mean a thing. That goes for almost any topic of debate, not just Chiropractic. If I show you 100 chiropractic papers that "prove" adjustments to be efficacious, another will just show me 10 medical papers proving otherwise. And they'll cling to them like gold. But if the opposite occured, there would be a cry, "but we so many studies compared to your paltry few." I've seen it over and over again for many years. You know as well as I do that any idea against the mainstream will have an uphill battle. Always has and always will.

Interestingly enough though, I've read hundreds of case studies in the medical literature without so much as a whimper from the medical community. And I've seen MD's castigate DC's for what they do........until one of their close relatives have been helped by a DC and their tune suddenly does a 180 turnabout. It wasn't the research that changed their minds (as it won't be for hundreds that do), it's a very personal experience. And once you've had that experience personally, your tune changes. And no amount of "research" to the contrary will change your mind because you've seen it and felt it first hand. You haven't read about it in some journal written by some unknown hundreds of miles away.

I'm not downplaying research. It has it's place. But sometimes research needs to catch up to real life.

From personal experience, I had headaches 3 days a week for years. The only way I could get rid of them was to run. But who feels like running when you have a splitting headache. But once I tried Chiropractic, I had a headache frequency of 3-4 a year. I don't need a research paper for that.

 

[FoughtFyr]

Wow, FYR...what kind of drugs are you on? Take a green chill pill why don't you? I truly feel sorry for the apparent hate filled life that you must live.

Nice to meet you too. I wasn’t aware that scientific discourse and discussion of the scientific basis for a treatment modality indicated hate. But how is it that a DC is recommending I take any pills? Don’t they drum you out of the profession for that kind of thing?

Actually, I don’t lead a hate filled life at all. I am an emergency medicine resident, doing a job I very much love, at one of the (IMHO) best places to practice medicine anywhere. I have a great wife, a baby on the way, and a very cute puppy laying on my feet as I type this. Life is, in a word, SWEET!

You can spout studies ad nauseum as nearly an profession can. When it comes down to it though -- it's a personal experience that someone has with chiropractic that appreciates it.

No, that is religion, not science. Now, I am one of the millions of Catholics in the world. And I am a fairly spiritual person. I wear a scapular because I firmly believe that Mary, the Virgin Mother of God, made a promise to St. Simon Stock at Mount Carmel that those who perish while wearing the scapular shall not suffer eternal fire. That is based on my experience with Catholicism. But I don’t hold it out as science. I don’t ask my government to pay for it. I do not encourage anyone to not get treated for their ailments because by wearing the scapular they will be saved. Heck, I don’t even state that it is “provable” that Christ (or Mary, or St. Simon Stock) ever existed, yet alone hold some reverent place in the Universe. That is my belief. Shared by others to be sure, but not science.

Based on your description of chiropractic “it's a personal experience that someone has”, should we supplement psychics too? I know many people who claim to have had wonderful, deeply moving, personal experiences with psychics.

While we are at it, how about Christian Scientists? Isn’t prayer enough? Isn't dis-ease really just a construct of faulty beliefs?

Get the point? Just because something sounds good doesn't make it so. I wish it were that easy. I wish that every idea about health that someone had, and passed on to others, were true. If they were, we would all lead happier and healthier lives. Fortunately, it is the role of the physician, as a scientist, to separate that which is true, and beneficial when measured against the risks involved, from that which is not.

Chiropractic is not the first, or even the biggest, disproven theory on health. Nor is it the longest-lived. If anything, it is the most organized.

From the lowly student wanting to become a Chiropractor or a million dollar heart surgeon. Get off your throne and go "help" someone else.

Actually, I “help” lots of people every day. In fact, on an average of once a week, I help someone who presents to my emergency room after being seriously hurt by a chiropractor. So, if I promise to go and help someone else, do you promise not to?

There is plenty of evidence to "prove" Chiropractic. But those who, from the outset, have set themselves against it won't ever look at it. So 1000 research papers set in front of that individual won't mean a thing.

O.k., start with one. Post it here. A good, solid defendable paper that proves chiropractic is better than standard medical treatment for any condition. Then, call the National Center for Complementary and Alternative Medicine. Make sure that they spread the word, because as of yet, they have not found such a study.

From http://nccam.nih.gov/health/chiropractic/index.htm#app2

”Spinal manipulation was more effective than sham therapy, but no more or no less effective than other treatments.
Authors found that the specific profession of the manipulators (including chiropractors) did not affect these results.”

And

“Author noted there has been only one systematic review of chiropractic spinal manipulation exclusively (Assendelft et al., 1996, see below), and that, since that study, emerging trial data "have not tended to be encouraging…. The effectiveness of chiropractic spinal manipulation for back pain is thus at best uncertain.””

And

“Authors stated that all studies analyzed had serious flaws in design, execution, and reporting. Studies could not be pooled to reach statistical conclusions because of insufficient data and data quality problems. Authors summarized the available data narratively; concluded they "did not provide convincing evidence for the effectiveness of chiropractic for acute or chronic low back pain"; and noted that better-executed trials are needed in future.”​

That goes for almost any topic of debate, not just Chiropractic. If I show you 100 chiropractic papers that "prove" adjustments to be efficacious, another will just show me 10 medical papers proving otherwise. And they'll cling to them like gold. But if the opposite occured, there would be a cry, "but we so many studies compared to your paltry few." I've seen it over and over again for many years. You know as well as I do that any idea against the mainstream will have an uphill battle. Always has and always will.

I don’t want 100 papers. Just one good one. One that is accepted by the agency whose sole purpose is to bring proof of complementary and alternative methods of healthcare. It is not always an uphill battle. Many physicians, including me, are now routinely referring our patients for acupuncture. Many Emergency Physicians now routinely refer LBP patients to PTs for more definitive treatment than we can provide. Most physicians also now refer patients with idiopathic pain to chronic pain management clinics. It is not new things that we don’t like, it is unproven ones.

Interestingly enough though, I've read hundreds of case studies in the medical literature without so much as a whimper from the medical community.

Post them! Let us look for ourselves! I’ve done literature reviews on this topic and not found them. Heck, I have given two separate M&M presentations on chiropractic errors that have caused mortality! I would love to flesh out those presentations with something, anything, that can scientifically support an “upside” to chiropractic treatment beyond a self taught group’s proclamation of “trust us, it works!”

And I've seen MD's castigate DC's for what they do........until one of their close relatives have been helped by a DC and their tune suddenly does a 180 turnabout.

I’ve seen a few of these myself. Doesn’t mean that it is scientifically the right decision. I’ve seen a physician convert to Evangelical Christianity. Does that make “born-again” the official religion of medicine?

It wasn't the research that changed their minds (as it won't be for hundreds that do), it's a very personal experience. And once you've had that experience personally, your tune changes. And no amount of "research" to the contrary will change your mind because you've seen it and felt it first hand. You haven't read about it in some journal written by some unknown hundreds of miles away.

And what will change their minds back is when those chiropractors they have come to trust hurt their patient and they are dragged into court to answer for making the referral.

Right now, the area where I practice is in the middle of a pertussis outbreak. At least 11 neonates have been exposed (although, thankfully, no significant sequelae yet). Patient zero and several others are believed to be children treated here last year for pertussis. They came from a rural area east of here whose healthcare needs were largely “served” by a two person chiropractic practice. These two idiots had the entire community convinced not to immunize their children. It was, after all, bad for them, and, with regular adjustments the chiropractors could keep dis-ease away. Now I use the past tense because after one ten-year old boy’s death of HiB meningitis (vaccine preventable) and the many cases of pertussis (likewise preventable), they were run out of town. Unfortunately, given the lack of standards of practice within chiropractic, they still have licenses and are still no doubt practicing somewhere. Lawsuits couldn’t be filed because they did not violate the “common practices” of chiropractors. It was felt that it would be impossible to prove in court that they were wrong in the eyes of their professional community, especially given that the state chiropractic board declined to censure them in any way. Can you imagine the outcry if a pediatrician did the same thing?

I'm not downplaying research. It has it's place. But sometimes research needs to catch up to real life.

WOW! Just imagine your attitude if an MD/DO based their practice on this. “Now Mr. Hoselton, I know that there is no science to back this up, but I want you to feed these pills to your kids. They won’t help, and there is a very small chance that they might cause some pain or even a stroke, but hey, it will make us both feel like we are doing something!”

From personal experience, I had headaches 3 days a week for years. The only way I could get rid of them was to run. But who feels like running when you have a splitting headache. But once I tried Chiropractic, I had a headache frequency of 3-4 a year. I don't need a research paper for that.

Nope, you don’t. And odds are, you didn’t need chiropractic to get better. More likely, the natural course of the pathophysiology behind your headaches was going to “settle down” anyway. Good thing you risked arterial dissection to achieve that!

- H

 

[doc_gnosis]

I remember when I was in chiropractic school, by the way I left, there was this guy in my Toggle/Recoil class giving a seminar on Blair Technique telling us that he successfully treated MS patients and Parkinson patients, what was the depth of his arguement...nothing. Also there is a large proportion of straight DCs using anecdotal evidence to supply arguements that chiropractic works. For instance many chiropractors treat children and when their asthma clears up the adjustment is given credit. Unfortunately they all ignore the fact that 35% of children asthma cases spontaneously remit on reaching puberty and early adulthood. If anyone wants me to post references now I will.