Quacks

[facetguy]

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.

These are all good reasons to refer to a chiropractor that you trust. One that focuses primarily on musculoskeletal issues and practices a quality standard of care. And as far as a chiropractor recommending surgery for a psedoarthrosis at L5-S1, I think your patient may have been a bit confused there.

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[WellWornLad]

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.

EVERYONE knows there are bad things you shouldn't eat. "Our colleague" made a point about enemas as a therapy, not about the existence of "bad things."

Again, to say "toxic substances that are harmful" is an example of tautology. Cut it out.

 

[facetguy]

EVERYONE knows there are bad things you shouldn't eat. "Our colleague" made a point about enemas as a therapy, not about the existence of "bad things."

Again, to say "toxic substances that are harmful" is an example of tautology. Cut it out.

From Dictionary.com:tau·tol·o·gy (tô-tŏl'ə-j&#275 Pronunciation Key
n. pl. tau·tol·o·gies

1. 1. Needless repetition of the same sense in different words; redundancy.
   2. An instance of such repetition.

Very nice. I think I know someone who got one of those 'word-a-day' calendars for the holidays last year (hint: initials WWL)!

And who said anything about eating these harmful toxins (I just had to do it once more, for old times sake)? They enter our systems in many ways, my friend. Don't limit your thinking.

 

[grandslam521]

From Dictionary.com:tau·tol·o·gy (tô-tŏl'ə-j&#275 Pronunciation Key
n. pl. tau·tol·o·gies

1. 1. Needless repetition of the same sense in different words; redundancy.
   2. An instance of such repetition.

Very nice. I think I know someone who got one of those 'word-a-day' calendars for the holidays last year (hint: initials WWL)!

And who said anything about eating these harmful toxins (I just had to do it once more, for old times sake)? They enter our systems in many ways, my friend. Don't limit your thinking.

wow...way to make yourself look like a fool...how long did you spend looking up the definition of tautology?

 

[mmmcdowe]

wow...way to make yourself look like a fool...how long did you spend looking up the definition of tautology?

I don't know about that person, but it took me about 11 seconds to do it. 11 seconds well spent in my opinion

 

[facetguy]

wow...way to make yourself look like a fool...how long did you spend looking up the definition of tautology?

About 3 seconds. Welcome to the internet.

 

[WellWornLad]

Very nice. I think I know someone who got one of those 'word-a-day' calendars for the holidays last year (hint: initials WWL)!

You learn all sorts of crazy things when you take a course in logic. It'd be nice if everyone on the Internet at least read up on the fallacies of relevance and weak induction, as arguments would be a lot more productive.

 

[facetguy]

You learn all sorts of crazy things when you take a course in logic. It'd be nice if everyone on the Internet at least read up on the fallacies of relevance and weak induction, as arguments would be a lot more productive.

At least Spock appreciates your logic,
even if nobody else does.

 

[coldweatherblue]

facetguy, you're not in medical school, are you? just curious...

 

[facetguy]

facetguy, you're not in medical school, are you? just curious...

Not yet. Can you put in a good word for me?

 

[LikesScience]

From Dictionary.com:tau·tol·o·gy (tô-tŏl'ə-j&#275 Pronunciation Key
n. pl. tau·tol·o·gies

1. 1. Needless repetition of the same sense in different words; redundancy.
   2. An instance of such repetition.

Very nice. I think I know someone who got one of those 'word-a-day' calendars for the holidays last year (hint: initials WWL)!

And who said anything about eating these harmful toxins (I just had to do it once more, for old times sake)? They enter our systems in many ways, my friend. Don't limit your thinking.

You looked up tautology and you still don't know what it means, LOL.

 

[indo]

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.

Originally, I sarcastically asked what toxins were removed by enemas. Then you asked if I really had never heard of any toxins that cause diseases. The answer is no, I know about some disease causing toxins but I don't know which ones are removed by enemas.

I asked about enemas and then you got all blowhardy and made the assumption that I don't know anything about toxins. That is when I called you a ******. I stand by that observation.

Also, which toxins are removed by putting that weird tape on the bottom of your feet?

Can anyone define what a "toxin" is? I'm trying to avoid ALL toxins but I heard that a lady died of water toxicity...do I need to avoid water too?

 

[facetguy]

Originally, I sarcastically asked what toxins were removed by enemas. Then you asked if I really had never heard of any toxins that cause diseases. The answer is no, I know about some disease causing toxins but I don't know which ones are removed by enemas.

I asked about enemas and then you got all blowhardy and made the assumption that I don't know anything about toxins. That is when I called you a ******. I stand by that observation.

Also, which toxins are removed by putting that weird tape on the bottom of your feet?

Can anyone define what a "toxin" is? I'm trying to avoid ALL toxins but I heard that a lady died of water toxicity...do I need to avoid water too?

Indo, if I came off 'blowhardy', my apologies. Don't put tape on your feet...save your money for beer. And please keep drinking water (you may want to filter it, however.) And, finally, I believe a person about to enter medicine should not use the term '******' the way you currently use it...it's unprofessional.

 

[facetguy]

You looked up tautology and you still don't know what it means, LOL.

I don't know what you mean.

 

[indo]

Apology accepted.

 

[indo]

I don't know what you mean.

 

[45408]

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...)

Oh, I guess that's why one of my patients has to have his wife suction his secretions because of a vertebral artery dissection after a spinal manipulation. Essentially a random event.

 

[45408]

I was merely stunned that our colleague was unaware that there are toxic substances that end up inside of us and are harmful.

It's your naivete that is stunning.

But also amusing.

 

[facetguy]

Oh, I guess that's why one of my patients has to have his wife suction his secretions because of a vertebral artery dissection after a spinal manipulation. Essentially a random event.

I never said these events have never happened but that they are extremely rare. No treatment is without risk.

 

[facetguy]

It's your naivete that is stunning.

But also amusing.

Naive? Explain please.

 

[WellWornLad]

At least Spock appreciates your logic, even if nobody else does.

That's OK, didn't mean to burst your little bubble of subjectivism. Please, proceed to wax authoritative through the misrepresentation of others' comments.

Here, I even made your day easier:

http://en.wikipedia.org/wiki/Subjectivism
http://www.thefreedictionary.com/wax
http://www.thefreedictionary.com/authoritative

 

[Perrotfish]

I never said these events have never happened but that they are extremely rare. No treatment is without risk.

Thank you for summing up why physicians need to oppose alternative medicine. No treatment, however useless, is without risk. That basic premise is why no physician is, ethically or legally, allowed to perform a procedure or perscribe a drug unless he can prove, from double blind trials, that there is a benifit. Because the risk is assumed. It is unethical to refer your patients to a provider that you don't think, or don't have good reason to believe, performs a benificial service.

Tired, the military really reimburesed for Chiros? I thought the Navy was above this sort of thing.

 

[Mister J]

Facetguy, I have some pads I'd like to sell you:

[youtube]http://www.youtube.com/watch?v=exmEGrNqgcA[/youtube]

 

[indo]

the active ingredient in Lipozene is fiber.

 

[Excelsius]

...holding others to the same standard that we are held to. ... 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. ...

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. ...

You are being very unreasonable. You want to hold CAM and MD to the same standards? Or submit CAMs to FDA trials? I am sorry, but that's total BS. There is a reason why MDs spend so many years studying. Saying that you hold a CAM to the same standard is ludicrous. As for FDA, are vitamins evaluated by FDA? NO! So are we supposed to remove them from the market then? Absolutely not. But if a given vitamin was as dangerous as Vioxx, then your trials would show its harms and the vitamin would not be available OTC anymore.

 

[Excelsius]

... 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?).
...
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.

You contradict yourself pretty well in here. You admit that there is evidence for moderate recuperation, you admit that you have to refer patients to chiropractors every week because you yourself can't help them, yet you think they are "complete bunk." Amazing. Let me ask you this: if someone refers his patients to a "quack," what does that make that someone to be? I'd say he's worse than a quack.

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.

That's very simplistic. You are trying to apply the philosophical principle of the impossibility to prove a negative to this case, but that's a fallacy as it doesn't apply. Your claim could be easily disproven by anyone trying to replicate your results, just like AMA could gather a group a chiropractors to prove that they provide no benefit. But just like several pre-doctors in this thread alone, I am sure that AMA doens't think chiros have no use.

 

[Excelsius]

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.
...
Finally, if you want to use anecdotes as the best evidence, then please again consider the idea of risk vs. benefit...

I agree with your first paragraph. Personally, I am not aware of any chiropractors who claim to cure asthma. That's ridiculous. But instead of attacking all of them because of those claims, I'd suggest that doctors advocate (and prove too) that chiropractors are only good for the back and create a regulation that says they can't claim to cure anything else besides the back. I myself have better things to do than to care what some chiropractors claim. If it becomes a health hazard, then it might be worth taking on the cause, but otherwise, it's just not worth it. But let's try to avoid the term "idiot" when addressing any large group of practitioners.

As I clearly stated in my post, my anecdote cannot be considered as evidence.

It is also a little hard for me to understand as to why you guys are so pissed with chiros. Do they directly affect your lives? Maybe you are stressed as students/residents and are taking out your anger on something irrelevant. If you truly care about this topic, it would be great if you could create a controlled study and prove what chiropractors can and can't do. These anonymous rants in this forum are futile. Though admittedly they must help you vent, nothing more.

One final note: it seems all of you dodged the bone manipulation of DOs - such as the cranial. DOs are true doctors and it must hit too close to home that one of your own is advocating bone manipulation, so you don't want to touch that. I disagree - if you are going to judge chiros, who are severely undereducated compared to regular doctors, you should definitely hold DOs to a much higher standard. Can't you see what nonsense all these accusations are? Just let them be (or use the scientific method).

 

[thechad]

One final note: it seems all of you dodged the bone manipulation of DOs - such as the cranial. DOs are true doctors and it must hit too close to home that one of your own is advocating bone manipulation, so you don't want to touch that. I disagree - if you are going to judge chiros, who are severely undereducated compared to regular doctors, you should definitely hold DOs to a much higher standard. Can't you see what nonsense all these accusations are? Just let them be (or use the scientific method).

I have had multiple DOs treat me over the years, and not one of them has ever used manipulative medicine...they used real medicine.

 

[Perrotfish]

You are being very unreasonable. You want to hold CAM and MD to the same standards? Or submit CAMs to FDA trials? I am sorry, but that's total BS. There is a reason why MDs spend so many years studying. Saying that you hold a CAM to the same standard is ludicrous. As for FDA, are vitamins evaluated by FDA? NO! So are we supposed to remove them from the market then? Absolutely not. But if a given vitamin was as dangerous as Vioxx, then your trials would show its harms and the vitamin would not be available OTC anymore.

Some vitamins, like the ones you will recomend to your senior patients, only make health benifit claims supported by peer reviewed studies (which is why the bottles are mostly blank. The myriad of vitamins that have more... creative ... claimsof health benifits (like everything in GNC) should be either submitted to FDA trials or taken off the market, yes. Really, the fact that none of this health junk is evaluated by the FDA is part of the CAM problem I would like to see the government fix.

Medicine isn't just taken off the market if it's found to be harmful. There's a reason you can't perscribe intert products to your patients (however much you would like to get rid of them with a placebo). Two of the three phases of FDA drug testing are 100% about whether or not the product WORKS. If we don't take things off the market until they're proven harmful, then we should be able to perscribe anything that's only passed phase one of the trials (or, if we hold it to CAMs standards, anything that hasn't killed anyone yet).

There is a reason why MDs spend so many years studying.

the reason MDs spend so many years studying is so that they are able to practice medicine. By inference, anyone who hasn't studied quite as hard shouldn't be allowed to practice medicine unless they're under the supervision and licence of an MD (i.e. Nurses, PAs, etc.).

It is also a little hard for me to understand as to why you guys are so pissed with chiros.

Because people hate bull****, with all their hearts. It's a trait we evolved to make society workable, and it's a good thing. Those with a little medical education, who know CAM is BS, hate Chiropractors the same way your average SDN premed hates anyone with a 2.4 who says they're going straight to medical school because their Dad knows a guy. It's not that it affects you, it's that you feel a deep in your bones obligation to keep people from saying and doing stupid things. The hippocratic obligation to keep these charlatans from first fleecing and then hurting your patients is just gravy.

Also, not just chiros, CAM. All CAM. This conversation has been strangely Chrio-centric. Does that mean were all in agreement about acupuncture, enemas, and Reiki? It's not really strange, I guess. I think in general Chiros take the brunt of it mainly because they're the most believable. They don't have any mystical energy fields flowing through/around your body (how to you argue with someone who is trying to treat a chakra floating above their head, anyway). Instead Chiros work with real body parts, and at least a premedical knowledge of bio to understand why what they do doesn't make sense.

One final note: it seems all of you dodged the bone manipulation of DOs - such as the cranial. DOs are true doctors and it must hit too close to home that one of your own is advocating bone manipulation, so you don't want to touch that.

It's an unsuported throwback for the sake of their chrio-ish history and they should get rid of it the same way allopathic got rid of homeopathy and leeching. But that doesn't mean that they, in general, aren't real doctors that are both taught and use real medicine (and I've never met one that actually uses the bone cracking crap). They go through the same rigerous exams, use the same evidence based medicine, and are liable in the same way if they fail to do so.

 

[thechad]

One final note: it seems all of you dodged the bone manipulation of DOs - such as the cranial.

DOs can manipulate the bones of the skull? Awesome!

DOs are true doctors and it must hit too close to home that one of your own is advocating bone manipulation, so you don't want to touch that.

See my previous post.

I disagree - if you are going to judge chiros, who are severely undereducated compared to regular doctors, you should definitely hold DOs to a much higher standard.

Well, we do. They have to pass their licensing exams (USMLE or COMLEX) which proves they are competent. Also, see my previous post.

Can't you see what nonsense all these accusations are?

Can't you see what nonsense their claims are?

Just let them be (or use the scientific method).

I'm at a loss, please show me how the scientific method can be used for chiropractic, especially considering their ONLY treatment for the various ailments they claim they can rectify is cracking your back. My brother can do that, and he doesn't even charge.

 

[facetguy]

Also, not just chiros, CAM. All CAM. This conversation has been strangely Chrio-centric. Does that mean were all in agreement about acupuncture, enemas, and Reiki? It's not really strange, I guess. I think in general Chiros take the brunt of it mainly because they're the most believable. They don't have any mystical energy fields flowing through/around your body (how to you argue with someone who is trying to treat a chakra floating above their head, anyway). Instead Chiros work with real body parts, and at least a premedical knowledge of bio to understand why what they do doesn't make sense.

Perrotfish, in your mind, what exactly is it that chiropractors do? What part of chiropractic treatment "doesn't make sense" from a "premedical knowledge of bio"? I'm not too sure you even know what chiropractors do, let alone have any type of expertise in this area. Enlighten us, please.

 

[facetguy]

Thank you for summing up why physicians need to oppose alternative medicine. No treatment, however useless, is without risk. That basic premise is why no physician is, ethically or legally, allowed to perform a procedure or perscribe a drug unless he can prove, from double blind trials, that there is a benifit. Because the risk is assumed. It is unethical to refer your patients to a provider that you don't think, or don't have good reason to believe, performs a benificial service.

You are delusional if you believe that everything ever done in medicine or surgery has been based on double blind trials. Economics and old habits are a big part of everyday practice. And let's not forget the trials that turn out to be less-than-truthful...yeah, there's that economics thing again.

Take, for example, an early Celebrex trial, in which the authors found no significant risk factors after 6 months of use...unfortunately, the study ran for 12 months, and the life-threatening side effects began to show up after the initial 6 months. So, what to do? Just bury the second 6 months of data and publish only the data for the initial 6 months. The well-meaning docs in clinical practice read this study and conclude that Celebrex is completely safe...it's not their fault that the story they were given was a lie. The practice of prescribing Celebrex for months on end was based on a double blind trial, right? Why would a drug manufacturer do this? I can give you billions of reasons. And where are Vioxx and Bextra today? Oh, that's right, it turned out that they were killing people, despite having undergone double blind trials.

There are skeletons in that closet, my friend. Let's not pretend there aren't.

 

[Perrotfish]

Take, for example, an early Celebrex trial, in which the authors found no significant risk factors after 6 months of use...unfortunately, the study ran for 12 months, and the life-threatening side effects began to show up after the initial 6 months. So, what to do? Just bury the second 6 months of data and publish only the data for the initial 6 months. The well-meaning docs in clinical practice read this study and conclude that Celebrex is completely safe...it's not their fault that the story they were given was a lie. The practice of prescribing Celebrex for months on end was based on a double blind trial, right? Why would a drug manufacturer do this? I can give you billions of reasons. And where are Vioxx and Bextra today? Oh, that's right, it turned out that they were killing people, despite having undergone double blind trials.

Yes, see, the Celebrex thing doesn't exactly disprove my point. When people involved with allopathic medicine tries to skirt the scientific process, people get hurt. Doctors both admit and teach that. Same goes for CAM. The difference is that when allopathic medicine goes outside the scientific process it's a rarity, a crime, and the people responsible are hugely liable for it. Which is good, ignoring or avoiding scientific evidence is a bad thing and people get hurt when you do it. CAM, on the other hand, doesn't even attempt to be evidence based. So every single CAM practicioner is on a level with the scumbags who burried those 6 months of results (I know nothing about the case, I'm trusting your word here). So, my solution is that CAM should be subjected to the same kind of rigerous scientific testing that allopathic medicine is. There will always be people who break the rules, that's not a good reason to exempt other people from those same rules, it's a good reason to create harsher penalties for the rule breakers.

To be fair, I guess I am sounding a little harsh on the average CAM practicioners' motivations. The Celebrex people were probably motivated by greed and knew perfectly well what they were doing, whereas I believe most CAM people think what they are doing makes sense. I know two CAM practicioners personally, and both are incredibly sincere in their efforts to help and their beliefs that they are doing so. Unfortunately, you can be sincerely wrong.

 

[Tired]

You contradict yourself pretty well in here. You admit that there is evidence for moderate recuperation, you admit that you have to refer patients to chiropractors every week because you yourself can't help them, yet you think they are "complete bunk." Amazing. Let me ask you this: if someone refers his patients to a "quack," what does that make that someone to be? I'd say he's worse than a quack.

Guess they don't teach reading in chiropractic school, eh "Doctor"?

Chiropractic manipulation has been shown to have mild-to-moderate benefit in acute low back strain. Likely this benefit has more to do with therapeutic touch than the specific modality. Unfortunately our insurance covers chiro but not massage. So I refer to the quacks.

See, that wasn't so hard, was it?

 

[silas2642]

You are delusional if you believe that everything ever done in medicine or surgery has been based on double blind trials. Economics and old habits are a big part of everyday practice. And let's not forget the trials that turn out to be less-than-truthful...yeah, there's that economics thing again.

Take, for example, an early Celebrex trial, in which the authors found no significant risk factors after 6 months of use...unfortunately, the study ran for 12 months, and the life-threatening side effects began to show up after the initial 6 months. So, what to do? Just bury the second 6 months of data and publish only the data for the initial 6 months. The well-meaning docs in clinical practice read this study and conclude that Celebrex is completely safe...it's not their fault that the story they were given was a lie. The practice of prescribing Celebrex for months on end was based on a double blind trial, right? Why would a drug manufacturer do this? I can give you billions of reasons. And where are Vioxx and Bextra today? Oh, that's right, it turned out that they were killing people, despite having undergone double blind trials.

There are skeletons in that closet, my friend. Let's not pretend there aren't.

No one is denying that there are skeletons in the closet of modern medicine, particularly regarding the pharmaceutical industry, which is why we have the FDA and strict guidelines to help prevent mass disaster. What would have happened if those guidelines were not in place? How many people would have died then? The drug company covered up, people got hurt, and now they're paying for it.

I think one of the things that physicians moan and groan at when it comes to with alternative medicine, particularly these "nutritional supplements" is that when there are very few restrictions on them (they have to be proven UNSAFE), is that we have no idea how they are going to interact with other medications, what kind of longterm effects they are going to have in our patients, or even what the hell is in the pill that they are taking in what concentrations. There just aren't sufficient studies.

Plus these supplements contain tons of different ingredients, so you're not even sure what is doing what. At least with prescription medications there are only a few ingredients, so you have a pretty good idea of what is doing what.

And don't tell me that nutritional supplements/alternative medicine doesn't have skeletons either-- ma huang?

 

[facetguy]

Yes, see, the Celebrex thing doesn't exactly disprove my point. When people involved with allopathic medicine tries to skirt the scientific process, people get hurt. Doctors both admit and teach that. Same goes for CAM. The difference is that when allopathic medicine goes outside the scientific process it's a rarity, a crime, and the people responsible are hugely liable for it. Which is good, ignoring or avoiding scientific evidence is a bad thing and people get hurt when you do it. CAM, on the other hand, doesn't even attempt to be evidence based. So every single CAM practicioner is on a level with the scumbags who burried those 6 months of results (I know nothing about the case, I'm trusting your word here). So, my solution is that CAM should be subjected to the same kind of rigerous scientific testing that allopathic medicine is. There will always be people who break the rules, that's not a good reason to exempt other people from those same rules, it's a good reason to create harsher penalties for the rule breakers.

To be fair, I guess I am sounding a little harsh on the average CAM practicioners' motivations. The Celebrex people were probably motivated by greed and knew perfectly well what they were doing, whereas I believe most CAM people think what they are doing makes sense. I know two CAM practicioners personally, and both are incredibly sincere in their efforts to help and their beliefs that they are doing so. Unfortunately, you can be sincerely wrong.

Yes, medicine does try its best to clean up its messes, which as you say is a good thing. As far as subjecting CAM to rigorous research, remember that these studies are hugely expensive to perform, and without pharmaceutical dollars behind them, it's a little tough to get such studies done. The gov't, in the form of the National Center for CAM, is trying to do this, but it's slow going by nature. For chiropractic's research history, I'd say it would be difficult to find any intervention for low back pain that has been more heavily researched than spinal manipulation. And most of it is positive (at least as effective as whatever it was compared to). Medicine evolved slowly too(it wasn't that long ago that some bizarre activities were considered standard of care!); give CAM a chance.

And I'm still not sure how you can be so certain that "CAM people" are not doing good for those they see. Are you saying that the millions of visits to CAM practitioners per year, for which people pay their hard earned cash, are somehow done out of some type of trickery or something? Why would people continue to see these practitioners if they weren't helping? I don't understand your basis for that statement.

You still haven't demonstrated that you have a good grasp on what exactly the biomechanical/neurophysiologic effects of spinal manipulation are. One would expect a certain level of expertise here if criticism is to be taken seriously.

In a broader sense, I know you entered medicine to make a difference, and I'm sure you are a sincere person. It just seems like a waste of time and energy for you to get so worked up about CAM practices when there are such bigger issues in your own 'house' to focus upon. Go after obesity, or cancer, or the ever-increasing incidence of autoimmune diseases. Or figure out why more kids than ever suffer with asthma. There is so much other important stuff that you can directly impact. With the safety record of CAM practices, there doesn't seem to be much to gain by denigrating them. You have the opportunity to do much good; don't get bogged down with trivialities. Good luck.

 

[facetguy]

Guess they don't teach reading in chiropractic school, eh "Doctor"?

Chiropractic manipulation has been shown to have mild-to-moderate benefit in acute low back strain. Likely this benefit has more to do with therapeutic touch than the specific modality. Unfortunately our insurance covers chiro but not massage. So I refer to the quacks.

See, that wasn't so hard, was it?

I'm glad Tired has it all figured out. He's so smart.

 

[facetguy]

No one is denying that there are skeletons in the closet of modern medicine, particularly regarding the pharmaceutical industry, which is why we have the FDA and strict guidelines to help prevent mass disaster. What would have happened if those guidelines were not in place? How many people would have died then? The drug company covered up, people got hurt, and now they're paying for it.

I think one of the things that physicians moan and groan at when it comes to with alternative medicine, particularly these "nutritional supplements" is that when there are very few restrictions on them (they have to be proven UNSAFE), is that we have no idea how they are going to interact with other medications, what kind of longterm effects they are going to have in our patients, or even what the hell is in the pill that they are taking in what concentrations. There just aren't sufficient studies.

Plus these supplements contain tons of different ingredients, so you're not even sure what is doing what. At least with prescription medications there are only a few ingredients, so you have a pretty good idea of what is doing what.

And don't tell me that nutritional supplements/alternative medicine doesn't have skeletons either-- ma huang?

Ah, good ol' ma huang. My heart skips a beat (and races a little uncontrollably, and maybe my blood pressure goes up a bit) just thinking about it. Yes, there are skeletons everywhere. And I, too, would like to see stricter control over supplements. I just don't think medical physicians are in any position to make those determinations (*cough*lackoftraining*cough*). There are some very good supplement companies out there that use only the best ingredients, perform quality control, etc., but it's true that it isn't always clear to the average citizen which companies they are. And these higher quality supplements are understandably a little more costly, while consumers are usually looking for the best deal (i.e., cheapest stuff).

As far as the FDA goes, they've still got some work to do to clean up their reputation. They've dropped the ball a few too many times, and the 'revolving door' between industry and the FDA remains concerning.

To bring this full circle with the "toxins" thing (or as WWL prefers, "harmful toxins"), the chemical industry introduces 100s of new chemicals every year. And guess what? They do not have to prove safety for any of them! Instead, you would have to be prove them unsafe. Now, where would your efforts pay off more: criticizing CAM, which is ridiculously safe, or criticizing the number of unknown chemicals that enter our environment day after day, year after year. If you wish to pretend to own all things health-related, you can't ignore this. For the moment, you all get a pass because you are busy studying other stuff. But think about returning to this issue someday.

 

[EMmedic]

It just seems like a waste of time and energy for you to get so worked up about CAM practices when there are such bigger issues in your own 'house' to focus upon. Go after obesity, or cancer, or the ever-increasing incidence of autoimmune diseases. Or figure out why more kids than ever suffer with asthma. There is so much other important stuff that you can directly impact. With the safety record of CAM practices, there doesn't seem to be much to gain by denigrating them. You have the opportunity to do much good; don't get bogged down with trivialities. Good luck.

Hey, I've been reading this for a while and I'll chime in...I for one, do think its ok to give CAM a chance. I'm specifically talking about the vitamins and supplements (I really don't know enough about the chiropractor issue). Many of our current allopathic medications came from herbs (atropine, pseudoephedrine, colchicine, salicylin etc). Some of the herbal supplements out there probably do work to a degree because these are pharmalogically active compounds. This is why they can be so dangerous, however.

It is the business of physicians to worry about what CAM practitioners are doing. The Dietary and Supplement Health and Education Act (1994) states that companies are not required to prove efficacy or safety of dietary supplements (herbs, vitamins, minerals, metabolites, extracts) before marketing them to the public. This leaves the burden of proof on the FDA as an "after-the-fact" measure...aka...remove it if lots of people have terrible side effects. Take the example of Ephedra. Did it work for weight loss? Yes, it actually did show more weight loss than the placebo. Unfortunately, people also had a 3x increase of palpitations, psychiatric symptoms and GI symptoms. Thus, the FDA ended up taking it off the market far after many people were very sick. This is the business of phsyicians -- these are our patients being affected by untested and potentially harmful substances.

All I'm saying is that pharmalogically active compounds given to people or bought over the counter should have to undergo rigorous testing to make sure that they are SAFE. Its not an issue of whether they work or not, the more important thing is that physicians don't have to react after the fact and get a drug removed because they are seeing patients who are very sick from it. Did you know that 47% of Americans either think supplements are regulated by the government or they aren't sure if this is true or not? 81% favor pre-market testing of products for safety by the FDA. (Blendon 2001, Arch Internal Med).

 

[Bleurberry]

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.

Manipulation in the USA means usually HVLA (High Velocity Low Amplitude), but DO's use gentler techniques when HVLA and other "bone cracking" techniques are contraindicated; soft tissue and fascia manipulation that can achieve the same goals. For a relatively healthy invidual, you're not going to run into many problems at the chiropractor, and a skilled chiropractor can be really a healthy force in an individual's life.

For more fragile and vulnerable populations, going to a DC can be problematic. In fact, I suspect my grandmother had a fractured vertebrae after the DC attempted to expand her ribcage with some thrusting technique, and he's quite a capable guy (someone I've entrusted with various musculoskeletal issues I've had, and who has come through in a positive way for me and others in my family.) The problem was she's been taking steroidal inhalers for COPD for many years, and she's got mild osteoporosis. Did the DC figure on this in his analysis before "cracking" her? I'm telling you the chances are very slim. He doesn't have a list of her medications, it doesn't come up much in her infrequent visits, he has no concrete MEDICAL history to draw from, so the physiology aspect of her care is obscure. She did experience a short term benefit in her breathing from the DC's technique, but a few weeks after that visit (which was the first in months, maybe over a year), she had vertebroplasty done to mitigate the pain, and the procedure was successful.

Refer your patient concerns to a capable osteopathic medical doctor if they believe OMM may be beneficial.

 

[facetguy]

Manipulation in the USA means usually HVLA (High Velocity Low Amplitude), but DO's use gentler techniques when HVLA and other "bone cracking" techniques are contraindicated; soft tissue and fascia manipulation that can achieve the same goals. For a relatively healthy invidual, you're not going to run into many problems at the chiropractor, and a skilled chiropractor can be really a healthy force in an individual's life.

For more fragile and vulnerable populations, going to a DC can be problematic. In fact, I suspect my grandmother had a fractured vertebrae after the DC attempted to expand her ribcage with some thrusting technique, and he's quite a capable guy (someone I've entrusted with various musculoskeletal issues I've had, and who has come through in a positive way for me and others in my family.) The problem was she's been taking steroidal inhalers for COPD for many years, and she's got mild osteoporosis. Did the DC figure on this in his analysis before "cracking" her? I'm telling you the chances are very slim. He doesn't have a list of her medications, it doesn't come up much in her infrequent visits, he has no concrete MEDICAL history to draw from, so the physiology aspect of her care is obscure. She did experience a short term benefit in her breathing from the DC's technique, but a few weeks after that visit (which was the first in months, maybe over a year), she had vertebroplasty done to mitigate the pain, and the procedure was successful.

Refer your patient concerns to a capable osteopathic medical doctor if they believe OMM may be beneficial.

First, I'm telling you that any competent DC will take a good history and knows, as in your example, that prolonged steroid use weakens bone. Second, why do you assume that chiropractors only perform HVLA? Do you think chiros aren't trained in the low-force and myofascial treatments you mentioned? C'mon, at least know what you are talking about before you throw an entire profession under the bus. You speak as though chiropractors are these automatons who walk into a treatment room, lay a patient down, and start banging on their spines. Please.

 

[Tired]

I'm glad Tired has it all figured out. He's so smart.

You mean that what you guys learn and do is totally fake? Yeah, I figured that out. But don't worry, so has everyone else in the medical community. There is no science behind your "techniques". Your presense is tolerated, but certainly not appreciated, in the medical world.

I'm amused that you would have the audacity to suggest in a later post that chiropractors know how to take a history. You clearly think of yourselves as doctors. You're not.

 

[mmmcdowe]

Yes, medicine does try its best to clean up its messes, which as you say is a good thing. As far as subjecting CAM to rigorous research, remember that these studies are hugely expensive to perform, and without pharmaceutical dollars behind them, it's a little tough to get such studies done. The gov't, in the form of the National Center for CAM, is trying to do this, but it's slow going by nature. For chiropractic's research history, I'd say it would be difficult to find any intervention for low back pain that has been more heavily researched than spinal manipulation. And most of it is positive (at least as effective as whatever it was compared to). Medicine evolved slowly too(it wasn't that long ago that some bizarre activities were considered standard of care!); give CAM a chance.

And I'm still not sure how you can be so certain that "CAM people" are not doing good for those they see. Are you saying that the millions of visits to CAM practitioners per year, for which people pay their hard earned cash, are somehow done out of some type of trickery or something? Why would people continue to see these practitioners if they weren't helping? I don't understand your basis for that statement.

You still haven't demonstrated that you have a good grasp on what exactly the biomechanical/neurophysiologic effects of spinal manipulation are. One would expect a certain level of expertise here if criticism is to be taken seriously.

In a broader sense, I know you entered medicine to make a difference, and I'm sure you are a sincere person. It just seems like a waste of time and energy for you to get so worked up about CAM practices when there are such bigger issues in your own 'house' to focus upon. Go after obesity, or cancer, or the ever-increasing incidence of autoimmune diseases. Or figure out why more kids than ever suffer with asthma. There is so much other important stuff that you can directly impact. With the safety record of CAM practices, there doesn't seem to be much to gain by denigrating them. You have the opportunity to do much good; don't get bogged down with trivialities. Good luck.

Not trickery at all. It seems to me that most chiropractic treatments are not a "fix", rather a temporary removal of a problem. From what friends of mine who have visited chiros have said, it seems that their pain goes away for a while, and then comes back. So in that sense, chiros work as short term alleviation of a problem, which is why people come back. They see "results", just like how a good massage can relieve muscle pain for a while.

 

[Excelsius]

...The myriad of vitamins that have more... creative ... claimsof health benifits (like everything in GNC) should be either submitted to FDA trials or taken off the market, yes. Really, the fact that none of this health junk is evaluated by the FDA is part of the CAM problem I would like to see the government fix.

...If we don't take things off the market until they're proven harmful, then we should be able to perscribe anything that's only passed phase one of the trials (or, if we hold it to CAMs standards, anything that hasn't killed anyone yet).

...By inference, anyone who hasn't studied quite as hard shouldn't be allowed to practice medicine unless they're under the supervision and licence of an MD (i.e. Nurses, PAs, etc.).


...Those with a little medical education, who know CAM is BS, hate Chiropractors the same way your average SDN premed hates anyone with a 2.4 who says they're going straight to medical school because their Dad knows a guy. It's not that it affects you, it's that you feel a deep in your bones obligation to keep people from saying and doing stupid things. The hippocratic obligation to keep these charlatans from first fleecing and then hurting your patients is just gravy.

Also, not just chiros, CAM. All CAM. ... Chiros work with real body parts, and at least a premedical knowledge of bio to understand why what they do doesn't make sense.
...

Are you a first year med student? You are saying some incredible things. Somehow you think that every drug that passes its "phases" of tests and gets approved by FDA is not only useful, but is safe. Well, welcome to the real world where the lobbying power, incomplete data disclosure, and simple incompetence put dangerous drugs out there. FDA can't even protect us from BPA and drug contamination from China. Yet in almost every post you bring up the three letter word "FDA." I have a five letter word for you "Vioxx." Ruminate that for a while.

I couldn't disagree with you more when you put all CAM into one box. You don't even know what CAM represents, yet you are attacking. That's a good trait of a future doctor - attacking something you don't know. Did you know that there are drugs that have been developed as a result of knowledge gathered from tribal people? There are just so many holes in your argument that they just can't be addressed without writing a book. Go ahead, call dietitians quacks too. In my opinion it's the doctors who are illiterate about nutrition and that the study thereof should be made mandatory (those two hours in your medschool don't count).

A pronounced exhibition of the God complex when one is not even a God yet is disturbing. Let's get off the pedestal and admit that doctors are not the most well-rounded bunch and have no bearing in CAM unless they personally get involved in that research. That's is very unlikely to happen. Do you know why? Because there is no money in vitamin research.

Your example of hating the people with low GPAs who make it into med school is very interesting psychologically. Besides certain callowness, it also demonstrates insecurities. You think that those people got into medschool because of their daddy, but that's hardly the case except in rare circumstances. Those people get into med school because they're really got something that those with perfect scores don't. Compare that to the myriad of "perfect number" applicants who get in and bring disgrace to the medical community. Keep in mind that one student out of a thousand who did get into medschool due to money, his daddy paid so much money to the school that you as a student will be able to go to that school for a cheaper price or be able to do high tech research. How can we be so culturally and scientifically intolerant is beyond me. If we could screen these people for med school, the profession would get much better.

 

[Excelsius]

Guess they don't teach reading in chiropractic school, eh "Doctor"?

Chiropractic manipulation has been shown to have mild-to-moderate benefit in acute low back strain. Likely this benefit has more to do with therapeutic touch than the specific modality. Unfortunately our insurance covers chiro but not massage. So I refer to the quacks.

See, that wasn't so hard, was it?

Nice one, Mr. Resident!

I know better, but I can't resist to unsubstantiate a resident as a premed, especially since you questioned my reading comprehension skills. Enjoy:

1. I am NOT going to chiro school, my resident friend. If you used your astute reading comprehension, you'd easily see that I protecting CAM as a matter of simple scientific tolerance based on the scientific method and not because I am one. And guess what, I even said that I don't care about chiropractors one way or another. Miss out on the memo you did.
2. From 1 above it follows that the probability is high that you use the same style of punctilious reasoning to evaluate chiros.
3. Even if 2 were not true, your post clearly shows that a doctor (without quotation marks) like you has a lot of hubris and if for now other reason, looks at others as inferior just because of that One. That's a good reason to discount anyone who's not in your league, though as a future doctor, I'd rather have the quotation marks than be in the same league. There are MDs, then there are "MDs."
4. Sidenote from 1-3: Your book says that anyone who protects humane treatment of dogs IS a dog. Pulchritudinously handsome and theoretically fastidious!
5. Leap of faith: "Likely this benefit has more to do with therapeutic touch than the specific modality." One question, are you a religious man? I sure hope so!
6. Insurance only covers chiros? Now god damn it, ain't that a shame. That problem completely explains what you're trying to say! One tiny caveat here - if insurances only covered masseuses, I bet an insecure professional resident like your kind self would jump up and down and bemoan (=b!tch and moan) how insurance companies dare to claim that masseuses belong in the health professions. Reiteration fomenting re-remonstration.

In the end, thank you from the abyss of my heart for construing your position. That was a fun read. At least we have an example why the level of the education has nothing to do with the thought processes. Closure. Expostulate with me! Nah, nevertheless closure.

I'm glad Tired has it all figured out. He's so smart.

A genius for climbing the pedestal, but not climbing the pedestal because of being a genius.

 

[Excelsius]

Hey, I've been reading this for a while and I'll chime in...I for one, do think its ok to give CAM a chance. I'm specifically talking about the vitamins and supplements (I really don't know enough about the chiropractor issue). Many of our current allopathic medications came from herbs (atropine, pseudoephedrine, colchicine, salicylin etc). Some of the herbal supplements out there probably do work to a degree because these are pharmalogically active compounds. This is why they can be so dangerous, however.

It is the business of physicians to worry about what CAM practitioners are doing. The Dietary and Supplement Health and Education Act (1994) states that companies are not required to prove efficacy or safety of dietary supplements (herbs, vitamins, minerals, metabolites, extracts) before marketing them to the public. This leaves the burden of proof on the FDA as an "after-the-fact" measure...aka...remove it if lots of people have terrible side effects. Take the example of Ephedra. Did it work for weight loss? Yes, it actually did show more weight loss than the placebo. Unfortunately, people also had a 3x increase of palpitations, psychiatric symptoms and GI symptoms. Thus, the FDA ended up taking it off the market far after many people were very sick. This is the business of phsyicians -- these are our patients being affected by untested and potentially harmful substances.

All I'm saying is that pharmalogically active compounds given to people or bought over the counter should have to undergo rigorous testing to make sure that they are SAFE. Its not an issue of whether they work or not, the more important thing is that physicians don't have to react after the fact and get a drug removed because they are seeing patients who are very sick from it. Did you know that 47% of Americans either think supplements are regulated by the government or they aren't sure if this is true or not? 81% favor pre-market testing of products for safety by the FDA. (Blendon 2001, Arch Internal Med).

It is relieving to see reason at least in some med students. I agree with everything you say. I wish these pre-doctors would put their money where their mouth is and do something useful - evaluate at least some of the CAMs. We sure need it. There isn't enough money available to do this kind of research and it seems they just don't understand that its the main problem with CAM. That also explains why we are such a cure oriented industry. We cure instead of preventing.

 

[facetguy]

Not trickery at all. It seems to me that most chiropractic treatments are not a "fix", rather a temporary removal of a problem. From what friends of mine who have visited chiros have said, it seems that their pain goes away for a while, and then comes back. So in that sense, chiros work as short term alleviation of a problem, which is why people come back. They see "results", just like how a good massage can relieve muscle pain for a while.

I understand that as a pre-med you very likely lack real-world experience, and that's OK. Just don't delude yourself into thinking that everything you will someday be doing as an MD will "fix" everything you intend it to "fix". By the way, who does "fix" low back pain anyway?

 

[Tired]

One tiny caveat here - if insurances only covered masseuses, I bet an insecure professional resident like your kind self would jump up and down and bemoan (=b!tch and moan) how insurance companies dare to claim that masseuses belong in the health professions.

Pretty incomprehensible post, but this part actually made a fair bit of sense, so I'll be happy to respond:

If insurance covered massage, I would send every low back pain patient to them and not chiro. I consider them medically equivalent, and masseurs less annoying.

 

[smq123]

You are being very unreasonable. You want to hold CAM and MD to the same standards? Or submit CAMs to FDA trials? I am sorry, but that's total BS. There is a reason why MDs spend so many years studying. Saying that you hold a CAM to the same standard is ludicrous. As for FDA, are vitamins evaluated by FDA? NO! So are we supposed to remove them from the market then? Absolutely not. But if a given vitamin was as dangerous as Vioxx, then your trials would show its harms and the vitamin would not be available OTC anymore.

So you DON'T want to hold CAM therapies to the same standards as traditional medical therapies? WHY THE F*** NOT?!

If you use a CAM therapy to treat a condition, you're using a chemical, putting it in your body, ostensibly to improve your health.

a) How is that different from a traditional medication?!?

b) I don't know about you, but I'm not willing to put things in my body that have not been proven to be helpful, or (at the very least) haven't been proven to be non-toxic.

And, actually, a lot of CAM advocates WANT FDA trials. They know that they'll never earn validation in the medical community without evidence that these therapies are beneficial, and that lay people may not use these therapies if they may be toxic.

And yes, if they prove that a vitamin is as harmful as Vioxx, God forbid that they stop selling it over the counter! That might actually help the public interest! The HORROR!!

 

[78222]

Are you a first year med student?

A look at your post history would suggest you are still a premed. I wouldn't go around calling people out on being a first year, when you are still in the application process.