Quacks

[78222]

My G-d. I can't believe how some non-physician "Doctors" are allowed to practice without being sued for serious malpractice. I'm on FM right now and I keep seeing the same thing, patients coming in, much much later than they should have for a medical problem because their Chiropractor either told them specifically not to come to a doctor or told them some nonsense about how their BP of 200/100 was do to misalignment of the spine. They also generally come in with a box full of overexposed xrays (many of them multiples of the same image) which the chiropractor took.

Why is it that a physician can get sued for the slightest of oversight, when a Chiropractor or Homeopathic "Doctor" can get away with selling patients patent bull****?

 

[thechad]

Chiropracters: filling people's minds with crap since the 1890s!

Actually, what's worse is the people who go to them. I have had friends who have said things like, "Man, I'm so congested, I need to get to the chiropracter," or, "This headache is killing me, I can't wait to see the doctor (chiropracter) so he can get rid of it."

Ridiculous, right?

 

[Tired]

Amen, brothers.

Amen.

 

[TMP-SMX]

Easy: Patients love their chiropractors. Think about it (all cash and the patients choose to go there). Clin Med 101: If you communicate with your patients and have good rapport and trust with them they will most likely not sue you if you screw up.

 

[GreenShirt]

LOL, I have to laugh at the x-ray thing. My mom went to a chiropractor last week for some lower back pain and had a bad experience. The x-ray tech at the chiropractor's office forgot to ask my mom to remove her jeans and belt buckle for the x-ray so the film came back with a giant illumination of her belt buckle and zipper exactly in the lumbar region in question. They wanted to schedule another appointment for a redo. My mom was majorly ticked off about this (and other reasons) and was wondering how on earth an office like this was allowed to be in business. She had seen a different chiropractor years ago for a ruptured disc and was happy with her experience there but this guy was clearly bad.

I guess there are good and bad chiropractors out there just and there are good and bad doctors. If people are willing to pay for their services rather than seeing a physician, it's a risk they take.

 

[Perrotfish]

Seriously, the AMA could do a lot here, if they got it through their head that there's nothing wrong with pushing back against this crap. Lobby the government to make these idiots jump through the same evidence based hoops that the drug companies need to, and at the same time run ads in all 50 states that make Chriopractors look like the scam artists they are (whether they know they are or not). If Apple can make the PC guys look like a bunch of idiots even though they're bothing selling working products, why in the world can we band together and make people think that the various psuedomedical types out there are full of sh!t?

I guess there are good and bad chiropractors out there just and there are good and bad doctors. If people are willing to pay for their services rather than seeing a physician, it's a risk they take.

No, see this is the problem right here. There are good and bad doctors. There are no good chiropractors because what they do, no matter how well they do it, doesn't work. No matter whether or not that tech had nailed the X-ray, the chriopractor cannot fix a ruptured disc. You can't push on someone's back hard enough that the disc is going to unrupture. There are good mechanics and bad mechanics. If your brakes are shot and you choose a garage out of the phone book you're going to risk getting a bad mechanic that either doesn't fix them right, overcharges, or or is just an all around dick. However if there is an alternative psuedo-mechanic that trys to fix your brakes by massaging the the rearview mirror, he can't be good at that. No matter how well he does it, nothing useful is going to friggin happen.

 

[Tiger26]

saw a 40ish guy a few months ago with no previous risk factors and a very healthy who had his chiropractor neighbor manipulate his neck and then have a major stroke the next day--completely unrelated i'm sure . . .

 

[SomeDoc]

Patients will pay to see someone who makes them feel better, whether or not they necessarily get better. This is the scary news- and it applies to healthcare providers of all forms- be they physicians or otherwise.

Thus, there's a lot to be said here about responsibility on the physician to provide competent care with good bedside manner, for the overall benefit of the patient's well-being and finances, given the options available to them in the current healthcare industry.

Medical students should also be exposed to the economics of the delivery of healthcare, which is severely lacking in medical curriculums across the nation.

 

[Sol Rosenberg]

Seriously, the AMA could do a lot here, if they got it through their head that there's nothing wrong with pushing back against this crap. Lobby the government to make these idiots jump through the same evidence based hoops that the drug companies need to, and at the same time run ads in all 50 states that make Chriopractors look like the scam artists they are (whether they know they are or not). If Apple can make the PC guys look like a bunch of idiots even though they're bothing selling working products, why in the world can we band together and make people think that the various psuedomedical types out there are full of sh!t?

Unfortunately the AMA is unlikely to say anything bad about chiropractors as a result of the Wilk lawsuit:

http://en.wikipedia.org/wiki/Wilk_v._American_Medical_Association

 

[badasshairday]

Patients like/believe in chiropractors because they feel like the chiros are actually doing something for them. It is hands on, so it feels to them that they are getting more care for their $. At least that is how I see it. But yeah, I think it is totally bogus.

 

[Perrotfish]

Unfortunately the AMA is unlikely to say anything bad about chiropractors as a result of the Wilk lawsuit:

http://en.wikipedia.org/wiki/Wilk_v....al_Association

The judges ruling (inane as it is) seems to focus on the evidence that chiropractors might actually have a working technique (they don't, but nevermind). So focus on the other quacks that are more obviously full of it. Start with acupuncture and Reiki and work your way up the food chain.

 

[SomeDoc]

So focus on the other quacks that are more obviously full of it. Start with acupuncture and Reiki and work your way up the food chain.

I would like to stress the importance of keeping an open mind regarding CAM, as EBM does show some potential regarding validity.

 

[Instatewaiter]

Whether or not you believe in all the other stuff chiropractors do or promote, EBM has shown chiropractics to be effective for low back pain.

 

[cpants]

I would like to stress the importance of keeping an open mind regarding CAM, as EBM does show some potential regarding validity.

It is a bad idea to keep an open mind about any alternative therapy which has not been proven effective and safe. For example, acupuncture has been shown to have some success in treating chronic pain. It is right to share this with appropriate patients and even to encourage acupuncture, as it's a side effect free treatment. That doesn't mean we should encourage or accept acupuncture as a treatment for say, diabetes. Once alternative medicine is proven effective it should become standard medicine.

It is wrong that alternative practitioners claim they can lower cholesterol, cure the common cold and cancer, and whatever other quackery they are trying to sell with absolutely no proof. We should not keep an open mind about therapies which are expensive, ineffective, sometimes dangerous, and can delay proven treatments. Even for lower back pain, it could be risky to have a chiropractor be your only consult. Back pain could be a sign of cancer metastases, a visceral infection, or dozens of other conditions which chiropractors are unqualified to diagnose or treat.

Chiropractic for low back pain after consulting a real doctor, fine. Chiropractic for high blood pressure, not fine. If chiropractic actually worked for this wide range of diagnoses, they would be able to prove it in two seconds (as they have for back pain). It doesn't work. Period.

 

[Droopy Snoopy]

It is a bad idea to keep an open mind about any alternative therapy which has not been proven effective and safe. For example, acupuncture has been shown to have some success in treating chronic pain. It is right to share this with appropriate patients and even to encourage acupuncture, as it's a side effect free treatment. That doesn't mean we should encourage or accept acupuncture as a treatment for say, diabetes. Once alternative medicine is proven effective it should become standard medicine.

It is wrong that alternative practitioners claim they can lower cholesterol, cure the common cold and cancer, and whatever other quackery they are trying to sell with absolutely no proof. We should not keep an open mind about therapies which are expensive, ineffective, sometimes dangerous, and can delay proven treatments. Even for lower back pain, it could be risky to have a chiropractor be your only consult. Back pain could be a sign of cancer metastases, a visceral infection, or dozens of other conditions which chiropractors are unqualified to diagnose or treat.

Chiropractic for low back pain after consulting a real doctor, fine. Chiropractic for high blood pressure, not fine. If chiropractic actually worked for this wide range of diagnoses, they would be able to prove it in two seconds (as they have for back pain). It doesn't work. Period.

Chiropracty (sp?) is like the 'gateway drug' of alternative medicine. Get hooked and before you know it you're broke and out on your a**, jonesin' for your next visit to magnet therapist. I like Penn & Teller's take on it (caution: intro is NSFW, skip to 1:40):

 

[Roy Basch]

There are good and bad doctors. There are no good chiropractors because what they do, no matter how well they do it, doesn't work. No matter whether or not that tech had nailed the X-ray, the chriopractor cannot fix a ruptured disc. You can't push on someone's back hard enough that the disc is going to unrupture. There are good mechanics and bad mechanics. If your brakes are shot and you choose a garage out of the phone book you're going to risk getting a bad mechanic that either doesn't fix them right, overcharges, or or is just an all around dick. However if there is an alternative psuedo-mechanic that trys to fix your brakes by massaging the the rearview mirror, he can't be good at that. No matter how well he does it, nothing useful is going to friggin happen.

LOVE the analogy.

 

[rachmoninov3]

Because CAM practitioners are not as overworked as us popular allopathics, they get to spend more time with the patient, and maybe even convince them to change all the stuff that we are bad at changing:
Diet, Exercise, Stopping smoking, Stopping consuming a 6 pack of beer every night.
Hey, if someone is going to be able to tell a patient they need they chakras (sp?) realigned and the only way to do this is to stop eating fast food, and the patient actually does it...more power to CAM.

Many of the "Good" alternative medicine peoples will know when to send someone to an allopathic doctor. The few people you see who get F8cked over by CAM are not a representation of all people who use the therapies.

I think you all already know this, but the thread wouldn't be quite so much fun. death to all things not backed by EBM!

 

[SomeDoc]

It is a bad idea to keep an open mind about any alternative therapy which has not been proven effective and safe. For example, acupuncture has been shown to have some success in treating chronic pain. It is right to share this with appropriate patients and even to encourage acupuncture, as it's a side effect free treatment. That doesn't mean we should encourage or accept acupuncture as a treatment for say, diabetes. Once alternative medicine is proven effective it should become standard medicine.

I'm not sure if you mean:
Not been proven to be effective or safe, or
Proven to not be effective or safe?

If you mean the latter, then I absolutely agree with you. If you mean the former, how would one know if something is effective or safe, if it hasn't been studied to begin with?

The caveat is that it takes an open mind to initially consider investigation into a given potentially useful CAM (potential usefulness based on supporting EBM in the basic sciences) that is otherwise unproven, as opposed to dismissing it completely, with no formal scientific basis for doing so.

The irony is that such practice is the equivalent of pseudoscience in itself.

 

[WellWornLad]

...how would one know if something is effective or safe, if it hasn't been studied to begin with?

That's the point. If you're going to recommend a therapy, it should have some objective measure of efficacy and safety. It doesn't mean you don't have an "open mind," it means you're not prescribing a black box for your patient.

New therapies are (or should be) tested in a very rigorous experimental protocol with special protections for the safety of the patient, as well as a thorough briefing of the patient to make sure they know what they're getting into.

I can't speak to specific CAMs - maybe some have experimental evidence, I dunno - but it's not good enough to say "I've heard of that, I don't know how safe or effective it is, but I'll recommend it to my patient."

 

[indo]

word...and can anyone explain to me what f'ing "toxins" are being washed out by homeopathic enemas?

 

[facetguy]

word...and can anyone explain to me what f'ing "toxins" are being washed out by homeopathic enemas?

I don't know anything about homeopathic enemas, but are you seriously saying that you are unaware of any toxins that begin in our environment and end up in us, and that some of these substances are harmful?

 

[mmmcdowe]

I believe it is the 20 pounds of toxins found in your large intestine, according to a radio ad. Lose weight and be toxin free!

 

[Mr hawkings]

I don't know anything about homeopathic enemas, but are you seriously saying that you are unaware of any toxins that begin in our environment and end up in us, and that some of these substances are harmful?

If what you are referring to as toxins (which they are not) do end up in your body, it is at the physiological level and cannot be simple "flushed away" by an enema or anything else.

 

[Mr hawkings]

I believe it is the 20 pounds of toxins found in your large intestine, according to a radio ad. Lose weight and be toxin free!

yeah, its called poo. And its will all be back in your large intestine within 48hrs

 

[coldweatherblue]

Chiropractors should be able to practice the techniques of spine manipulation that are proven beneficial.

However there is a trend for chiropractor schools to teach that manipulation can manage hypertension, diabetes, and other issues in primary care. I have heard chiropractors claim that the holistic care they provide is at the same level as a primary care physician. If chiropractors are claiming to be able to manage pathology, they should be held to the same standards as physicians. If their treatment methods are proven beneficial by a double-blinded RCT, let it continue. If not, they should be charged with practicing medicine without a license.

 

[facetguy]

If what you are referring to as toxins (which they are not) do end up in your body, it is at the physiological level and cannot be simple "flushed away" by an enema or anything else.

You mean pesticides, dioxin, flame ******ants, and any of 1000s of other untested industrial chemicals are not toxic or at least potentially toxic? And who has determined what is physiologic and what is toxic/harmful? Bisphenol-A is but one recent example of disagreement on what should be considered safe levels.

The enema thing is not my statement.

 

[facetguy]

Chiropractors should be able to practice the techniques of spine manipulation that are proven beneficial.

However there is a trend for chiropractor schools to teach that manipulation can manage hypertension, diabetes, and other issues in primary care. I have heard chiropractors claim that the holistic care they provide is at the same level as a primary care physician. If chiropractors are claiming to be able to manage pathology, they should be held to the same standards as physicians. If their treatment methods are proven beneficial by a double-blinded RCT, let it continue. If not, they should be charged with practicing medicine without a license.

Manipulation to manage diabetes? I'm not sure you've got that right. Perhaps 'non-pharmacologic approaches' is what you meant. As far as practicing medicine without a license goes, that's what state-regulated scopes of practice are for.

 

[Excelsius]

My G-d. I can't believe how some non-physician "Doctors" are allowed to practice without being sued for serious malpractice. I'm on FM right now and I keep seeing the same thing, patients coming in, much much later than they should have for a medical problem because their Chiropractor either told them specifically not to come to a doctor or told them some nonsense about how their BP of 200/100 was do to misalignment of the spine. They also generally come in with a box full of overexposed xrays (many of them multiples of the same image) which the chiropractor took.

Why is it that a physician can get sued for the slightest of oversight, when a Chiropractor or Homeopathic "Doctor" can get away with selling patients patent bull****?

Hearsay. I'd like someone in this forum to point to a scientific study (article, letter, research) that proves chiropractors are completely futile or are harmful. Is there evidence? I don't care either way, besides for my self-edification purposes. I remember reading that chiropractors supposedly have more respect in the medical community with time. What you say contradicts that.

 

[mmmcdowe]

Would you believe that Chiropractors SUED the AMA and WON? They gained legitimacy by arguing to courts that the reason the AMA was attacking chiropractors was not because they had an actual concern for the health of people. Oh no no no... AMA was doing it to protect their "monopoly" on medicine! AMA got crunched by an anti-trust law, and that's why we have legal chiropractors.

 

[SomeDoc]

Would you believe that Chiropractors SUED the AMA and WON? They gained legitimacy by arguing to courts that the reason the AMA was attacking chiropractors was not because they had an actual concern for the health of people. Oh no no no... AMA was doing it to protect their "monopoly" on medicine! AMA got crunched by an anti-trust law, and that's why we have legal chiropractors.

Actually, the AMA's history is by no means spotless. It's ironic the word "monopoly" was quoted and that the post had a intent of sarcasm, as that's precisely the way things were in the mid to early 20th century.

 

[indo]

I don't know anything about homeopathic enemas, but are you seriously saying that you are unaware of any toxins that begin in our environment and end up in us, and that some of these substances are harmful?

******ed. are you part of the pro-enema set?

 

[cpants]

I'm not sure if you mean:
Not been proven to be effective or safe, or
Proven to not be effective or safe?

If you mean the latter, then I absolutely agree with you. If you mean the former, how would one know if something is effective or safe, if it hasn't been studied to begin with?

The caveat is that it takes an open mind to initially consider investigation into a given potentially useful CAM (potential usefulness based on supporting EBM in the basic sciences) that is otherwise unproven, as opposed to dismissing it completely, with no formal scientific basis for doing so.

The irony is that such practice is the equivalent of pseudoscience in itself.

I should have been clearer. Of course I have an open mind when it comes to legitimate studies of CAM. In fact, I stated in my above post that I would endorse acupuncture for treatment of chronic pain. I can make this endorsement because properly controlled studies have shown it to be effective and safe.

What I do not have an open mind about is baseless claims by CAM practitioners. In EBM, we FIRST prove something effective and safe, and then start using it. We don't start using a treatment and then wait for it to be proven unsafe or ineffective. We don't use anecdotal reports or dubious studies to make claims of possible efficacy or as a basis for treating wide populations of patients. Something like chiropractic for hypertension, for example, is a waste of my patients' time, money, and possibly health until proven otherwise.

 

[thechad]

Hearsay. I'd like someone in this forum to point to a scientific study (article, letter, research) that proves chiropractors are completely futile or are harmful. Is there evidence? I don't care either way, besides for my self-edification purposes. I remember reading that chiropractors supposedly have more respect in the medical community with time. What you say contradicts that.

From The American Academy of Neurolgy


"From our case report, we have reached two conclusions:
(1) patients with unidentifiable arterial
wall diseases are at risk to develop arterial dissection,
and (2) cervical spine manipulation can cause
carotid artery dissection in patients at risk."

Full text: http://www.neurology.org/cgi/reprint/45/12/2284?ijkey=onHjFPZk0NAEA

Found a bunch of articles about spinal manipulation and blood vessel damage.

EDIT: Can't say they are completely futile, but they can be harmful.

 

[78222]

Manipulation to manage diabetes? I'm not sure you've got that right. Perhaps 'non-pharmacologic approaches' is what you meant. As far as practicing medicine without a license goes, that's what state-regulated scopes of practice are for.

I had a patient come in with a "spinal reading" the other day. It had colored bars next to each spinal segment which signified "good/bad". The patient told me her chiropractor had determined that she was under stress and probably depressed because of a spinal reading. She said "I didn't even know I was depressed until I got the reading!" She also told me that the chiropractor told her that since the nerves to "everything" exit from the spine, he could tell if there was organ dysfunction by reading her spine...
What a bunch of bolone.

Hearsay. I'd like someone in this forum to point to a scientific study (article, letter, research) that proves chiropractors are completely futile or are harmful. Is there evidence? I don't care either way, besides for my self-edification purposes. I remember reading that chiropractors supposedly have more respect in the medical community with time. What you say contradicts that.

I never said they were completely futile. I am sure they help lower back pain as has been stated. I think thats about the extent of it though and I doubt you would find a significant difference between chiros and massage therapists in successful treatment of LBP.

" I remember reading that chiropractors supposedly have more respect in the medical community with time."

I don't know what this is supposed to mean. I've met a significant number of quacks in medicine (especially FM), so it doesn't surprise me that they would respect chiropractors or other homeopathic fruitcakes. I mean, during our M1 year we had an MD come talk to us about accupuncture and other forms of quackery.

 

[facetguy]

******ed. are you part of the pro-enema set?

By any chance, are you a 3rd grader?

 

[facetguy]

From The American Academy of Neurolgy


"From our case report, we have reached two conclusions:
(1) patients with unidentifiable arterial
wall diseases are at risk to develop arterial dissection,
and (2) cervical spine manipulation can cause
carotid artery dissection in patients at risk."

Full text: http://www.neurology.org/cgi/reprint/45/12/2284?ijkey=onHjFPZk0NAEA

Found a bunch of articles about spinal manipulation and blood vessel damage.

EDIT: Can't say they are completely futile, but they can be harmful.

The incidence of vascular injury from spinal manipulation is EXCEEDINGLY rare, to the point where it has been difficult to even measure in the available research. A recent study (Cassidy JD et al, Spine. 2008 Feb 15;33(4 Suppl):S176-83) found that these episodes were so rare they are essentially random events, with no difference in incidence from patients seeing a family physician. The current thought is that the vascular event creates the symptoms (neck pain, etc.) for which the patient THEN presents to the chiropractor or family physician, for example, and that when you examine the numbers, there is no difference between those who had a vascular injury who saw their chiropractor vs. those who saw their family physician instead. There's a lot of bias out there, so bear that in mind (perhaps I should have said there's a lot of bias in here...)

 

[Perrotfish]

Originally Posted by Excelsius
Hearsay. I'd like someone in this forum to point to a scientific study (article, letter, research) that proves chiropractors are completely futile or are harmful. Is there evidence? I don't care either way, besides for my self-edification purposes. I remember reading that chiropractors supposedly have more respect in the medical community with time. What you say contradicts that.

No, see, it doesn't work this way. The burden of proof is on the practicioner, it's not our responsiblity to run around trying to prove every idiotics branch of CAM is unsafe. If you perscribe a patient an untested/ not FDA approved drug you get sued for malpractice. They don't need to prove that the drug is harmful/useless to sue you, just that you perscribe a drug that's not approved. Even if the drug has already been through several phases of FDA trials, and the patient is fully aware it's experiemental, you can't perscribe it unless the patients meets the guidelines for being in a study of the drug. These rules were (reasonably) put into place to keep the chronically ill and the dying from losing their savings and harming what was left of their health with therapies that didn't actually do anything.

CAM practicioners need to be held to the same standard as the medical community. They need to be sued/lose their right to practice/go to jail when they do something that isn't proven in an FDA style, 3 phase, double blind study. It shouldn't be our job, or the general public's job, to try and sort through their BS to figure out if there's some small part of what they do that actually works. We don't have the time and the public doesn't have the education. If the CAM practicioner is claiming that their technique works, it's the CAM practicioners job to show that his/her technique works.

 

[Excelsius]

From The American Academy of Neurolgy


"From our case report, we have reached two conclusions:
(1) patients with unidentifiable arterial
wall diseases are at risk to develop arterial dissection,
and (2) cervical spine manipulation can cause
carotid artery dissection in patients at risk."

Full text: http://www.neurology.org/cgi/reprint/45/12/2284?ijkey=onHjFPZk0NAEA

Found a bunch of articles about spinal manipulation and blood vessel damage.

EDIT: Can't say they are completely futile, but they can be harmful.

OK, but that simply talks about the risks of the professions. It's like listing the risks of cardiac surgery - possible uncontrolled aortic bleeding...

... I am sure they help lower back pain as has been stated. I think thats about the extent of it though and I doubt you would find a significant difference between chiros and massage therapists in successful treatment of LBP.
...

Well then, that means that they are NOT quacks. Everyone knows that chiropractors are for the back. We don't claim that they help the heart. So I don't know what is your point if you agree they help "the lower back." As for chiropractors and message therapists being the same, you don't know that. Neither do I. I would presume that the massage would concentrate on the muscles, chiropractor on the bones. And let's now forget those DOs, with their "cranial osteopathy." If we follow the train of thought, then we'd say DOs are 10% quack...

 

[Excelsius]

No, see, it doesn't work this way. The burden of proof is on the practicioner, it's not our responsiblity to run around trying to prove every idiotics branch of CAM is unsafe. If you perscribe a patient an untested/ not FDA approved drug you get sued for malpractice. They don't need to prove that the drug is harmful/useless to sue you, just that you perscribe a drug that's not approved. Even if the drug has already been through several phases of FDA trials, and the patient is fully aware it's experiemental, you can't perscribe it unless the patients meets the guidelines for being in a study of the drug. These rules were (reasonably) put into place to keep the chronically ill and the dying from losing their savings and harming what was left of their health with therapies that didn't actually do anything.

CAM practicioners need to be held to the same standard as the medical community. They need to be sued/lose their right to practice/go to jail when they do something that isn't proven in an FDA style, 3 phase, double blind study. It shouldn't be our job, or the general public's job, to try and sort through their BS to figure out if there's some small part of what they do that actually works. We don't have the time and the public doesn't have the education. If the CAM practicioner is claiming that their technique works, it's the CAM practicioners job to show that his/her technique works.

We are not in court to discuss burden of proof. This is a service, and even a business. As a knowledgeable doctor, you should either take the high road and demonstrate the futility of chiropractors (which your colleagues disagree with) or be quiet about something you don't know. In astronomy we say "absence of evidence is not evidence of absence." Just because you don't know something because someone has failed to prove it to you, it doesn't mean you can make a claim of contradiction proof.

None of us here know much about chiropractors. All I am saying is that before spilling bile, get some data to back your quack claims. My evidence is only anecdotal, but I have two friends who claim they have benefited from chiropractors. One had a back problem, the other one had a jaw alignment problem and pain. The latter's only mainstream option was surgery. After several months of chiropractic visits, her jaw is fine now. Is this a definite proof? Of course not. I don't know whether it was the chiropractor who helped her or she just grew out of that stage. What I do know is that it sure would be easier to call the CAM a quack had she not improved.

 

[Perrotfish]

We are not in court to discuss burden of proof. This is a service, and even a business. As a knowledgeable doctor, you should either take the high road and demonstrate the futility of chiropractors (which your colleagues disagree with) or be quiet about something you don't know. In astronomy we say "absence of evidence is not evidence of absence." Just because you don't know something because someone has failed to prove it to you, it doesn't mean you can make a claim of contradiction proof.

No, we're not a court, we're a profession trying to defend our patients by holding others to the same standard that we are held to. We are not allowed to make sh!t up and wait for other people to prove us wrong before we stop, we are repsonsible for proving our therapies work before we start implementing them. I am suggesting that anyone else who wants to be considered a health care practicioner be held to the same standard. Either hold us to their lowered standard or, (this is the better solution) hold the CAM idiots to our standards. However we've accepted a status quo where we're guilty until proven innocent, and they're innocent until proven guilty. And, of course, no ammount of proof will be enough to convince them that they're taking part in an elaborate placebo effect.

They're not quacks because I have diffinitive evidience that what they do doesn't work. They're quacks because they don't have proof to offer. Until they submit to the same kind of FDA trials that drug companies go through for their therapies, the medical profession should warn people away from them the same way they are responsible for warning them away from untested drugs. Just because I don't have a study that shoving hershy's kisses up your ass isn't a cure for colon cancer, it doesn't mean I need to accept it or 'keep an open mind' about it. 'Keeping an open mind' is another way of saying that we give up on evidence based medicine as long as the person distribuiting the medicine isn't an MD.

 

[Tired]

For the students here, a little note about the practical outcomes of chiropractic referrals:

I find myself in a position nowadays where I refer to chiro at least 1-2x a week. Anyone who's read my posts knows that I consider them to be complete bunk, but there is some evidence that in acute low back strain they are marginally more effective than placebo (how's that for a ringing endorsement?).

So on occassions where this is the case, I do refer to chiro.

The problem is that when you refer to another "provider" (and I use that term very very loosely) you cannot limit their scope of practice. In an ideal world, I would have a consult that read, "Please do your fake manipulation thing and try to tell my patients lots of crazy stuff." Unfortunately I can't do that.

So let me tell you what ends up happening. Or at least what's happened to me in the last month.

- patient comes back to me, says that chiropractor took an xray and he has horrible spinal disease and congenital malformations. He thinks he needs surgery. Why? Pseudoarthrosis of L5-S1.

- patient comes back, says all his problems are due to a "tilted pelvis". How did the chiropractor know the pelvis was tilted? Because it wasn't level on the xray. I politely point out that it doesn't really work that way, and that perhaps his back pain is more the result of the car accident he was in the previous week.

- patient is told he has a leg-length discrepancy, and that's why his back hurts. I point out he went on a 10mi hike with a 80lbs pack. I also point out that you have to actually do a specific xray (scanogram) to determine limb length discrepancies. I also suggest that perhaps, even if he has one, that he doesn't need to see a podiatrist just to be a lift.

- Chiropractor refuses to see patient because he also sees Sports Medicine. "No point seeing two doctors for the same problem." Um, what? Didn't know the board certified, fellowship-trained Sports Medicine physician provided equivalent services to the "Doctor" of Chiropractics.


Remember, once you send them there, you can't control what they will do or say. So yes, there is mild-to-moderate benefit from chiropractic manipulation in acute low back pain. But that doesn't mean that's all they'll do to your patients.

 

[thechad]

We are not in court to discuss burden of proof. This is a service, and even a business. As a knowledgeable doctor, you should either take the high road and demonstrate the futility of chiropractors (which your colleagues disagree with) or be quiet about something you don't know. In astronomy we say "absence of evidence is not evidence of absence." Just because you don't know something because someone has failed to prove it to you, it doesn't mean you can make a claim of contradiction proof.

None of us here know much about chiropractors. All I am saying is that before spilling bile, get some data to back your quack claims. My evidence is only anecdotal, but I have two friends who claim they have benefited from chiropractors. One had a back problem, the other one had a jaw alignment problem and pain. The latter's only mainstream option was surgery. After several months of chiropractic visits, her jaw is fine now. Is this a definite proof? Of course not. I don't know whether it was the chiropractor who helped her or she just grew out of that stage. What I do know is that it sure would be easier to call the CAM a quack had she not improved.

If I punch someone square in the teeth (and I'm the only one who can do this), I can cure AIDS. Show me an article. Prove me wrong.

 

[SomeDoc]

Perhaps I need to clarify something that was unclear (my fault). Failing to acknowledge EBM supporting specific CAM definitely warrants "open mindedness".

 

[indo]

By any chance, are you a 3rd grader?

No. That was a horrible attempt at an insult. Are you Brittish or just a super fan of enemas?

 

[grandslam521]

We are not in court to discuss burden of proof. This is a service, and even a business. As a knowledgeable doctor, you should either take the high road and demonstrate the futility of chiropractors (which your colleagues disagree with) or be quiet about something you don't know. In astronomy we say "absence of evidence is not evidence of absence." Just because you don't know something because someone has failed to prove it to you, it doesn't mean you can make a claim of contradiction proof.

None of us here know much about chiropractors. All I am saying is that before spilling bile, get some data to back your quack claims. My evidence is only anecdotal, but I have two friends who claim they have benefited from chiropractors. One had a back problem, the other one had a jaw alignment problem and pain. The latter's only mainstream option was surgery. After several months of chiropractic visits, her jaw is fine now. Is this a definite proof? Of course not. I don't know whether it was the chiropractor who helped her or she just grew out of that stage. What I do know is that it sure would be easier to call the CAM a quack had she not improved.

While I am not familiar with any research that indicates manipulation is harmful, there are studies that show that manipulation fails to improve conditions such as asthma, hypertension, and other, neurological conditions. Therefore, evidence exists that should guide chiropractors not to treat these conditions with manipulation.

Furthermore, in medicine, it is important to weigh risk and benefit when using treatment methods. Clearly, no benefit exists from manipulation for many medical conditions, yet the risks are unknown! Doesn't it seem reasonable then to either perform trails that illustrate the safety of manipulation or quit using the technique all-together?

Finally, if you want to use anecdotes as the best evidence, then please again consider the idea of risk vs. benefit. There are anecdotes that you cite that describe beneficial outcomes for jaw misalignment However, there are also anecdotes that describe how manipulation lead to stroke, paralysis and death. While it is up to the individual in these cases to take each anecdote with a grain of salt, if I had to weigh the risk and benefit of manipulation based on these anecdotes, then I would never set foot in the office of any chiropractor. I am not that naive; however, the fact that current evidence suggests manipulation has no effect except for back pain makes me think twice before going to a chiropractor.

 

[mmmcdowe]

Actually, the AMA's history is by no means spotless. It's ironic the word "monopoly" was quoted and that the post had a intent of sarcasm, as that's precisely the way things were in the mid to early 20th century.

Of course its not, no organizations name is. BUT, it was still a bogus lawsuit. Fighting chiropractors might have had financial reasons attached, but the whole point of AMA, the whole point of the founding of Johns Hopkins, the whole point of the MD degree, was and is an attempt to ensure a certain level of quality in the medical practice, and to keep quacks out of the medical business. Chiropractors are quacks. Herbalists are quacks. It offends me that they call themselves doctors of anything. The only reason that they exist is because they fill a niche which physicians are not successfully doing. We can't cure everything, so cancer patients resort to herbs and vitamins, because they give hope. Also, we are sometimes not as understanding in the medical practice as we could be, nor do we spend as much time with human interaction as is ideal. Alternative practitioners give patients control, they give patients someone to talk to and have person to person contact with, and they also give hope and some form of relief.

Basically, these quacks are all practicing the Art of medicine, without legitimate scientific backing. They exist in part because science hasn't solved all our problems, and in part because some physicians are too much scientist and not enough artist. Is it their fault? Probably not totally, we make do with what we can, but acknowledging are faults is better than ignoring them, even if we can't fix anything.

And for the record, I think one organization which oversees all legitimate medical practice is a good thing, just like having only one set of phone lines. It's a monopoly, but it makes things run a lot smoother than having 100 phone lines. I know we don't have this, but at the same time I think that the current divide among physicians is so small that it doesn't cause a lot of headaches.

 

[mmmcdowe]

A good website. I wish more was done to fight quackery in the mainstream.

http://www.quackwatch.org/

 

[WellWornLad]

Everyone knows that chiropractors are for the back.

I think you'd be surprised by what people don't know.

 

[WellWornLad]

I don't know anything about homeopathic enemas, but are you seriously saying that you are unaware of any toxins that begin in our environment and end up in us

As long as we're being "serious," maybe you could explain how an enema would prevent "toxins" from ending up in us, whether we should receive daily enemas to deal with ingested "toxins," or at least how such would be preferable from not ingesting "toxins" in the first place.

...and that some of these substances are harmful?

That's funny, I thought "toxin" was kinda synonymous with "harmful." Of course, if people didn't use vague/abstract terms like "toxin," maybe we could have a discussion predicated on fact rather than symbolism.

 

[facetguy]

As long as we're being "serious," maybe you could explain how an enema would prevent "toxins" from ending up in us, whether we should receive daily enemas to deal with ingested "toxins," or at least how such would be preferable from not ingesting "toxins" in the first place.

That's funny, I thought "toxin" was kinda synonymous with "harmful." Of course, if people didn't use vague/abstract terms like "toxin," maybe we could have a discussion predicated on fact rather than symbolism.

In case you weren't paying attention, I said I don't know anything about the homeopathic enemas that someone else mentioned. I was merely stunned that our colleague was unaware that there are toxic substances that end up inside of us and are harmful.

Very good! Toxins are harmful! And to avoid using vague terms, I listed a few well-known toxins that are everywhere in our environment and are gaining more attention from concerned scientists.

Of course, we are all busy and don't always have time to educate ourselves on everything going on in the world of health. But don't kid yourself: Just because you don't know something exists doesn't mean it doesn't exist. It does, however, make for a little comedy when I hear a few of our colleagues speak of things they clearly know very little, if anything, about.