Quacks

[mmmcdowe]

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?

I'd love to hear why most pre-meds don't have real-world experience. After all, working in a cubicle for 20 years gives you so much more life experience than the pre-med who studied in a cubicle for 4, or the pre-med who traveled to save african babies . After all, all pre-meds go to a sheltered college monastary for four years after being sheltered in high school. After all, no pre-med has ever had a real job, just things to put on their application. After all, just because pre-meds have families who are practicioners, those pre-meds don't know what the hell they are talking about. They're just trying to sound smart by repeating what daddy said! You are offended that people here are asserting that chiros are quacks, and yet you yourself are making assumptions about medical students and pre-meds not being able to have valid opinions because "they have no real life experience", which offends me. I'm alive, and I don't think I'm hallucinating you. Who are you to judge what counts as real life experience. Is me working two jobs and going to school full time not count as real life experience just because I'm a student as well as a part time teacher and a research fellow? Also, talking about real life is a bit amusing considering that we are all talking on a message board where anyone could easily change their status to attending, adcom, or whatever they wanted to.

I never said anyone fixed back pain, but at the same time doctors don't say they are going to fix something unless they have clinical data to back up their assertion. Sure, maybe it won't work for that patient, but the data is there. And if the data has been fudged by greedy companies, its still better than not having clinical studies at all. For the record, I believe that our country is addicted to interventional medicine, be it chiro or MD delivered. A healthy life style and excercise "fixes" most back pain by preventing it. I know that ever since I started taking ballet, my back has felt a lot better. Cheaper than medical intervention, and a lot more fun!

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[indo]

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?

Low back pain typically resolves on its own.

 

[indo]

I'd love to hear why most pre-meds don't have real-world experience. After all, working in a cubicle for 20 years gives you so much more life experience than the pre-med who studied in a cubicle for 4, or the pre-med who traveled to save african babies . After all, all pre-meds go to a sheltered college monastary for four years after being sheltered in high school. After all, no pre-med has ever had a real job, just things to put on their application. After all, just because pre-meds have families who are practicioners, those pre-meds don't know what the hell they are talking about. They're just trying to sound smart by repeating what daddy said! You are offended that people here are asserting that chiros are quacks, and yet you yourself are making assumptions about medical students and pre-meds not being able to have valid opinions because "they have no real life experience", which offends me. I'm alive, and I don't think I'm hallucinating you. Who are you to judge what counts as real life experience. Is me working two jobs and going to school full time not count as real life experience just because I'm a student as well as a part time teacher and a research fellow? Also, talking about real life is a bit amusing considering that we are all talking on a message board where anyone could easily change their status to attending, adcom, or whatever they wanted to.

Dude....most pre-meds have never had a real job.

 

[dilated]

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.

This is awesome. If there's something this forum needed, it's clearly someone who writes incoherent posts in a format reminiscent of Nigerian bank scams. To where should I direct the funds necessary to secure the $100bb in gold bullion, good sir?

 

[mmmcdowe]

Dude....most pre-meds have never had a real job.

So jobs = real life experiences? I disagree. College is as real as anything else. It alters who you are. Maybe college life isn't as deep or as meaningful, but it still affects you. To those who would argue that college tends to be an easy phase of our lives where we don't have to worry so much about finances or hardships, does that mean that the average middle class Joe doesn't have any real life experience when compared to farmers in Cambodia? Life and reality are determined by our experiences. They are all real. Med students were shaped from their undergrad experiences, residents are shaped by their experiences as med students. Sure, we tend to change in these transitions, because of new experiences and stuff, but I prefer to consider it adding on layers rather than starting anew.

 

[Excelsius]

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.

I am a premed and said so in one of my posts. I asked about MS1 because I was trying to find out whether it is medical school that instills these prejudices or not.
It is also not the status that counts, but the reasoning. I don't identify with any boxes, whether premed, MD, or CAM. If you can't look beyond those titles, then any debate is pointless. Even though generally the maturity and intelligence seem to increase from pre-med to residency and beyond, as some threads on SDN have proved, it is not always the case since you can have a pre-med that is more mature than a med student and in some cases even residents. This prejudice is the reason why I removed my "pre-med" title (pretty similar to CAM prejudice, isn't it?). And for the record, I am non-trad and one of my jobs invloves research.

 

[Excelsius]

This is awesome. If there's something this forum needed, it's clearly someone who writes incoherent posts in a format reminiscent of Nigerian bank scams. To where should I direct the funds necessary to secure the $100bb in gold bullion, good sir?

Thanks for the useful interjection. My post was full of sarcasm, but more importantly, I was accused of reading comprehension so I threw out something a little more sophisticated for that reader's pleasure. On a subconscious level, and if I were to flaunt my hubris concerning grammar and vocab as much as some guys here make a big deal out of doctors, I'd say that if you can't understand anything at the New Yorker level or beyond, then I don't care if you get what I'm saying.


This thread used to be about CAM vs MD. Then there was a slight hint about MD vs DO. Now it is turning into med student vs pre-med and personal attacks. And exactly how is this different than those threads in the premed forum? Pretty revealing about medical school.

I already made some extra posts I shouldn't have wasted my time on. Maybe I'll get back once this thread gets back on track. Until then, adieux.

 

[mmmcdowe]

Lol, if anything the med forums seem to be more heated than the pre-med ones, I've noticed.

 

[45408]

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.

Isn't that a good thing?

 

[Tired]

x2

 

[facetguy]

I'd love to hear why most pre-meds don't have real-world experience. After all, working in a cubicle for 20 years gives you so much more life experience than the pre-med who studied in a cubicle for 4, or the pre-med who traveled to save african babies . After all, all pre-meds go to a sheltered college monastary for four years after being sheltered in high school. After all, no pre-med has ever had a real job, just things to put on their application. After all, just because pre-meds have families who are practicioners, those pre-meds don't know what the hell they are talking about. They're just trying to sound smart by repeating what daddy said! You are offended that people here are asserting that chiros are quacks, and yet you yourself are making assumptions about medical students and pre-meds not being able to have valid opinions because "they have no real life experience", which offends me. I'm alive, and I don't think I'm hallucinating you. Who are you to judge what counts as real life experience. Is me working two jobs and going to school full time not count as real life experience just because I'm a student as well as a part time teacher and a research fellow? Also, talking about real life is a bit amusing considering that we are all talking on a message board where anyone could easily change their status to attending, adcom, or whatever they wanted to.

I never said anyone fixed back pain, but at the same time doctors don't say they are going to fix something unless they have clinical data to back up their assertion. Sure, maybe it won't work for that patient, but the data is there. And if the data has been fudged by greedy companies, its still better than not having clinical studies at all. For the record, I believe that our country is addicted to interventional medicine, be it chiro or MD delivered. A healthy life style and excercise "fixes" most back pain by preventing it. I know that ever since I started taking ballet, my back has felt a lot better. Cheaper than medical intervention, and a lot more fun!

It's true that assumptions shouldn't be made across the board about all pre-meds. As such, I put in the qualifier "very likely". My statement was not meant to be an insult, but I can see how it may have sounded so. You happen to sound like an ambitious person, and I wish you all the best in your future career. You do have to admit, however, that most pre-meds have little in the way of true clinical experience working with patients. After all, they are pre-meds, and there's nothing wrong with that. Without said experience, one's view limited and should be recognized as such (notice I said "limited" and not "worthless").

Your final point is dead on. Responsible practitioners (chiropractors, for example) try to educate their patients as to these lifestyle changes. It's not all about "cracking backs", as some would lead you to believe.

 

[facetguy]

Low back pain typically resolves on its own.

This is old thinking. Keep studying.

 

[Tired]

This is old thinking. Keep studying.

Not really. Most acute low back strain resolves completely with time. Chronic low back strain, or back pain associated with identifiable structural causes often does not. You have to distinguish etiology prior to offering prognosis. But then, I guess that's why we go to medical school, but you think natural subluxations of vertebrae are pathological.

 

[facetguy]

Not really. Most acute low back strain resolves completely with time. Chronic low back strain, or back pain associated with identifiable structural causes often does not. You have to distinguish etiology prior to offering prognosis. But then, I guess that's why we go to medical school, but you think natural subluxations of vertebrae are pathological.

You are correct regarding the need to distinguish between acute and chronic LBP. I'm not sure our friend is aware of this, however. The 'natural history' argument still gets repeated.

The subluxation thing has certainly added confusion to the chiropractic position, I'll give you that.

 

[grandslam521]

I think everyone who has commented on this forum would benefit greatly from reading this article:

http://www.aafp.org/afp/20070415/1181.html

 

[Perrotfish]

Originally Posted by facetguy
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?

This is sort of a key point. You can't always fix lower back pain, or lots of other medical conditions. Part of being a responsible caregiver is admitting when you can't fix something, or when the only fix is either time. One of the reasons CAM annoys doctors is that it often claims to treat things that either don't need treatment, or where the primary treatment is a lifestyle change (more exercise, less fat and salt solves half the nation's medical problems). When you go to a physician for back pain and they say 'rest and heat and it will get better in a few weeks' that's not very satisfying, even though it's the evidence based answer. So you go to the chiro and he offers to push on your back at $100/session until the pain resolves. And it does... in a few weeks.

BTW, I will say this for chiros, they do seem to limit themselves to either healthy patients or to mild, chronic problems. They will at least generally tell the dying that there's nothing that they can do for pancreatic cancer. I know of very few acupuncturists with the same level of self restraint.

What are you, anyway? Are you a chiro, applicant for medical school, both, or neither?

 

[Excelsius]

Isn't that a good thing?

If you really didn't understand what I said, I'll clarify: Of course that's a good thing. I said that it is possible to show that a vitamin is dangerous, in which case it would be removed from the market. If any of the vitamins on the market were clearly dangerous at their recommended daily values, then they'd be removed.

Listen, as for CAMs, here is what I am saying in basic terms: if some massage therapist claims that he can cure asthma, or if a tarot reader says that she can figure out the condition of your heart and help you by just caressing your palm, or if a tribal man in the bushes of Africa claims that his shaman can cure infertility by massaging his balls in the boiling water (scrotum can take boiling water without pain and in some countries is used as a contraceptive), or if your mother tells you to drink camomile tea for your flu, are you going to take a team of doctors and try to evaluate every stupid claim under the sun? All I am saying is that's not feasible, but at the same time you cannot say that ALL alternative medicine is bull**** without evaluating it. You cannot hold something to an MD standard when that something is barely studied. A case in point: we know more about the surface of the moon than the bottom of the ocean. Before some deep oceanic explorations, everyone claimed that life can't exist without life. All that changed after they took a closer look at the ocean. So don't dismiss anything without testing it first. Pauling already proved the usefulness of vitamins like C. If you are obsessed by chiropractors or bushmen, then by all means, spend your time trying to discredit them. I'd say your time would be better spent trying to prevent AIDS or even trying to find out the usefulness of vitamins in certain diseases. If someone makes a bogus claim that doesn't affect the health of the average patient one way or another, there are better things to do than spend all your time trying to discredit or credit that person. Even James Randi picks and chooses which myths he is going to address. Something tells me that once all of you become wise doctors you are going to spend your time more wisely than trying to discredit some chirporactor in LA. I wish more doctors were involved with some of the more important aspects of CAM, like prevention and vitamin research, but given that so many of you are so prejudiced against all CAM and given that there is barely any money in that research, I don't think that's likely to happen.

 

[eagle34]

I just think it's kind of funny how pre-meds try to argue with medical students who are in their clinical rotations or with residents, thinking that they know more just because they read one research article. I have to adimt, as a pre-med, I thought I knew a lot about medicine until I started med school and got a huge reality check. You'll get that soon as well. Medicine and medical school is all about a hierarchy, and residents can either make your life miserable or amazing during a clinical rotation. So, I hope that when you get to that time, you drop the idea that you know everything and really listen to what the higher-ups tell you.

 

[Perrotfish]

All I am saying is that's not feasible, but at the same time you cannot say that ALL alternative medicine is bull**** without evaluating it. You cannot hold something to an MD standard when that something is barely studied.

Why can't you hold it up to the MD standard? You keep saying that, but you never give a reason. The MD standard is pretty simple: study first, treat second. Everything bull**** until proven innocent, not innocent until proven bull****. As of right now, everything still in FDA trials is bull***, and will remain so it proves otherwise (and even then we reserve the right to challenge it's legitamacy with another study should we feel the need). I fail to see why this is any less feasible for a CAM practicioner than a medical doctor.

And finally, just to show that all forms of stupidity are not created equal: HEALING CRYSTALS FOR ADDISON'S DISEASE!

 

[grandslam521]

If you really didn't understand what I said, I'll clarify: Of course that's a good thing. I said that it is possible to show that a vitamin is dangerous, in which case it would be removed from the market. If any of the vitamins on the market were clearly dangerous at their recommended daily values, then they'd be removed.

Listen, as for CAMs, here is what I am saying in basic terms: if some massage therapist claims that he can cure asthma, or if a tarot reader says that she can figure out the condition of your heart and help you by just caressing your palm, or if a tribal man in the bushes of Africa claims that his shaman can cure infertility by massaging his balls in the boiling water (scrotum can take boiling water without pain and in some countries is used as a contraceptive), or if your mother tells you to drink camomile tea for your flu, are you going to take a team of doctors and try to evaluate every stupid claim under the sun? All I am saying is that's not feasible, but at the same time you cannot say that ALL alternative medicine is bull**** without evaluating it. You cannot hold something to an MD standard when that something is barely studied. A case in point: we know more about the surface of the moon than the bottom of the ocean. Before some deep oceanic explorations, everyone claimed that life can't exist without life. All that changed after they took a closer look at the ocean. So don't dismiss anything without testing it first. Pauling already proved the usefulness of vitamins like C. If you are obsessed by chiropractors or bushmen, then by all means, spend your time trying to discredit them. I'd say your time would be better spent trying to prevent AIDS or even trying to find out the usefulness of vitamins in certain diseases. If someone makes a bogus claim that doesn't affect the health of the average patient one way or another, there are better things to do than spend all your time trying to discredit or credit that person. Even James Randi picks and chooses which myths he is going to address. Something tells me that once all of you become wise doctors you are going to spend your time more wisely than trying to discredit some chirporactor in LA. I wish more doctors were involved with some of the more important aspects of CAM, like prevention and vitamin research, but given that so many of you are so prejudiced against all CAM and given that there is barely any money in that research, I don't think that's likely to happen.

Why don't we throw out the term CAM and grade ALL treatments/interventions by how safe they are (for those that have been studied), by how effective they are, AND by how well they have been studied by quality research. (This is actually the system used for many approaches to disease although my example is a little simplistic in comparison.) If you did this, then you would find that most treatments/interventions currently labeled as CAM would end up as either ineffective or have been poorly studied (either because the studies were poor or no one has researched it yet). You would also find some treatments/interventions currently used by physicians everyday that really have poor evidence to support their use. So why not throw out all of these ineffective treatments as well as hold off from utilizing the ones that haven't been studied well until they are thoroughly researched?

 

[facetguy]

I just think it's kind of funny how pre-meds try to argue with medical students who are in their clinical rotations or with residents, thinking that they know more just because they read one research article. I have to adimt, as a pre-med, I thought I knew a lot about medicine until I started med school and got a huge reality check. You'll get that soon as well. Medicine and medical school is all about a hierarchy, and residents can either make your life miserable or amazing during a clinical rotation. So, I hope that when you get to that time, you drop the idea that you know everything and really listen to what the higher-ups tell you.

Amen, brother. And wait and see how your views change after 10 or 20 years out in the field.

 

[facetguy]

Why don't we throw out the term CAM and grade ALL treatments/interventions by how safe they are (for those that have been studied), by how effective they are, AND by how well they have been studied by quality research. (This is actually the system used for many approaches to disease although my example is a little simplistic in comparison.) If you did this, then you would find that most treatments/interventions currently labeled as CAM would end up as either ineffective or have been poorly studied (either because the studies were poor or no one has researched it yet). You would also find some treatments/interventions currently used by physicians everyday that really have poor evidence to support their use. So why not throw out all of these ineffective treatments as well as hold off from utilizing the ones that haven't been studied well until they are thoroughly researched?

We spoke earlier about problems with funding issues for these proposed studies, and that government involvement to help investigate CAM treatments in already underway. It's not realistic to simply say "Let's just study all of these things right away and keep the good and throw out the bad". As far as holding off from utilizing the ones that haven't been studied, that ain't gonna happen because, in some cases, these treatments/interventions/whatever have been safely in use for 1000s of years, and now because you come along and want them to stop they should? Not reality. It will be a process, not a stop/start.

 

[facetguy]

I think everyone who has commented on this forum would benefit greatly from reading this article:

http://www.aafp.org/afp/20070415/1181.html

I'll admit I only read through the abstract. Regarding spinal manipulation, don't misunderstand what he is saying. At first glance it would appear that spinal manipulation isn't so hot, but what he means is that it isn't any better than anything else. In the many reviews out there, and there are many (which is why I have to laugh at the "there's no research on this stuff blah blah blah" folks), spinal manipulation for low back pain is at least equal to anything else out there, including standard medical care. So, when one says that spinal manipulation is bull, or fake (I still don't know what that means), or anything else, he/she is saying that the current medical care is no better. Now, if we were to discuss spinal manipulation for pancreatic cancer, that would be an entirely different story.

 

[Tired]

So, when one says that spinal manipulation is bull, or fake (I still don't know what that means), or anything else, he/she is saying that the current medical care is no better.

Chiropractics: Four years of school to be just as good as ibuprofen

 

[ZagDoc]

There's starting to be a trickle of decent research into the CAM department. I was willing to give it a chance, but have been disturbed with how the CAM field as a whole has responded to said research. If research has shown that a therapy has no benefit over placebo, there has been a trend to ignore said research and continue practicing said treatments anyways. After all, to do otherwise would be bad for business. And I feel bad for the CAM practitioners that which to verify the legitimacy of their modalities, as they are unable to prevent the true quacks from defecating all over their practices when they themselves may have the greater good of healing in their intentions. I don't buy the "its not fair to hold CAM to the same standards because of funding" crap. If they want to play in the major leagues, they should play by the rules. If they wish to offer therapies as an ALTERNATIVE choice to conventional medicine (not in conjunction with), they should be held to the same strict standards of conventional medicine.

There is a gross amount of lack of oversight on all levels of CAM. From gaining practicioner certification, to production and sales of therapies, to treatment modalities. THAT is was really digs at me. Its like a person who exhibits a behavior that is destructive, figures out that it is destructive, and continues to do it anyways. There is a gross capacity to cause harm even with virtue of intending to do good. And I'm still waiting to see how much harm has to be caused by negligence before people start to wise up.

The sad fact is that there isn't the educational and standardized certification standards necessary to weed out the money making scam artists from the truly well-intentioned individuals from the field. There isn't enough oversight to ensure that supplements contain what they say they do in concentrations they say the do or that said supplements are beneficial.

 

[45408]

are you going to take a team of doctors and try to evaluate every stupid claim under the sun? All I am saying is that's not feasible, but at the same time you cannot say that ALL alternative medicine is bull**** without evaluating it. You cannot hold something to an MD standard when that something is barely studied.

Fine. But I won't prescribe it, and I won't tell my patients that it could work/help, when for all I know, it could cause cancer.

So don't dismiss anything without testing it first.

I also won't use it without testing it first. It's bad medicine to let your patients do something that you don't know to at least be safe. If someone thought that showering twice a day would keep them from getting the flu, I'd tell them to go ahead, but if they thought they should be on warfarin so they didn't get a DVT (with no history or increased risk of them), I would be putting them at a huge risk to say "It couldn't hurt!"

 

[TMP-SMX]

I just wanted to throw this out there. 1/3 of certified acupuncturists in the US are physicians.

 

[facetguy]

There's starting to be a trickle of decent research into the CAM department. I was willing to give it a chance, but have been disturbed with how the CAM field as a whole has responded to said research. If research has shown that a therapy has no benefit over placebo, there has been a trend to ignore said research and continue practicing said treatments anyways. After all, to do otherwise would be bad for business.

You mean like arthroscopy for OA of the knee? Or for the continued prescription of antibiotics for viral infections, despite the risk for serious adverse drug reactions? It isn't just CAM, my friend, and at least CAM treatments are by and large very safe (you can argue effectiveness, but I wouldn't try to argue on the grounds of safety).

And I feel bad for the CAM practitioners that which to verify the legitimacy of their modalities, as they are unable to prevent the true quacks from defecating all over their practices when they themselves may have the greater good of healing in their intentions.

And I'm sure they would agree with you.

I don't buy the "its not fair to hold CAM to the same standards because of funding" crap. If they want to play in the major leagues, they should play by the rules.

I don't think anyone is saying studies shouldn't be done. The reality is that they can't be done, or at least will be difficult to do, because of funding. It will take time.

If they wish to offer therapies as an ALTERNATIVE choice to conventional medicine (not in conjunction with), they should be held to the same strict standards of conventional medicine.

I think this is a key point. It's been my experience that the VAST majority of CAM practitioners, diverse a group as they are, are not trying to sell themselves as an alternative to standard medical care, but rather complementary to it. As such, I prefer the 'C' instead of the 'A' in CAM.

There is a gross capacity to cause harm even with virtue of intending to do good. And I'm still waiting to see how much harm has to be caused by negligence before people start to wise up.

This is an overstatement. Show me the bodies. Again, CAM treatments are on the whole exceptionally safe.

The sad fact is that there isn't the educational and standardized certification standards necessary to weed out the money making scam artists from the truly well-intentioned individuals from the field.

Again, the truly well-intentioned individuals are with you on this.

 

[facetguy]

I just wanted to throw this out there. 1/3 of certified acupuncturists in the US are physicians.

Well, then, each and every one of them must be a charlatan, faker, scam artist, and swindler, right? Just wait until Tired and TheProwler hear of this! They will set these quacks straight! Go get 'em, boys!!

 

[Bleurberry]

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.

Ok, any lay person who has had any family member with experience using steroids long term knows it, not just chiropractors, and that only strengthens the position you're backing me into in this argument you seem to be picking with me. The comments you take objection to in my previous post are factual, not up for debate. I had initially qualified my comment on "manipulation", but I've edited it because it's a linguistic note and not particularly relevant to the conversation anymore. I hadn't meant to imply that chiropractor's aren't aware or skilled in myo-fascial, rolfing, "cranial", and other techniques. Did you watch the 1st international fascial congress rebroadcast that took place at Harvard?? I'm guessing no. Chiropractor's have made soft tissue famous, who's arguing that?

That doesn't change one iota the fact of my grandmother's incident of her vertebral fracture. Her chiropractor is extremely capable and I never brought up the incident other than to relay to him she was having the vertebroplasty done. I hadn't felt it necessary to pursue it further since she's fine now.
If you had read my post, I don't know how you'd get "throwing the profession under the bus" out of it.
Is it STANDARD PRACTICE for a Chiropractor to receive a medical history from a patients primary care specialist? Standard practice is the operative term above. A huge selling point, and challenge all wrapped into one facing chiropractic is that chiropractor's are like snowflakes, there aren't any two alike.
You can rail against me in your frustration over the thread you want, however misplaced I clearly feel it is. I didn't condemn the chiropractic profession as a whole, particularly for reasonably healthy individuals like myself. I still visit my family chiropractor.

If, however, you're going to respond to this post in debating me whether or not chiropractic as a field is equally equipped to handle serious medical conditions, other very vulnerable populations with complex histories, then you'll end up debating with yourself.
If I agreed with such a premise, I'd have saved myself a load of trouble and applied to chiropractic school, side-stepped the OMM training, the physician licensing, the clinical rotations, the internship and 3 year residency. PLEASE.
Check your absolutes; I hadn't included any in my post, why should you retort with a battalion of them?

 

[facetguy]

I was simply disagreeing with some of your assertions. I don't think that is being a know-it-all or combative.

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.

So do chiropractors. That's very straightforward.

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.

This statement I like.

For more fragile and vulnerable populations, going to a DC can be problematic.

This is where you went off-track. This assertion makes the assumption that chiroprators are reckless and don't take into consideration each patient's health issues and potential complicating factors. That's insulting and inaccurate, and I simply responded.

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.

Is this the part when every chiropractor is supposed to chime in with a story or two of how an MD he knows blew a diagnosis or rendered the wrong treatment or otherwise hurt a patient? C'mon. Everyone is trying to do their best for their patients. To tell of a single incident like this is meaningless.

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.

And I hope she is doing well. No sarcasm. I truly do.

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

There's nothing wrong with putting in a plug for your own profession. But don't do it by distorting the truth about chiropractors.

How is that being a know-it-all?

 

[facetguy]

No, I'm not picking a fight. Just trying to clear up some misconceptions.

Is it STANDARD PRACTICE for a Chiropractor to receive a medical history from a patients primary care specialist? Maybe your definition of thorough is different than mine, and standard practice is the operative term above.

What ever happened to getting historical details from the patient? And, yes, there are times when additional records need to be gathered. And are you telling me that every time a patient sees, say, an ortho for LBP, the entire medical file gets forwarded to that ortho first? Hmmmm...sounds a little far fetched.

Chiropractor's are like snowflakes, there aren't any two alike.
You can rail against me in your frustration over the thread you want, however misplaced I clearly feel it is. I didn't condemn the chiropractic profession as a whole, particularly for reasonably healthy individuals like myself. I still visit my family chiropractor.

You may want to whisper that in this forum.

If, however, you're going to respond to this post in debating me whether or not chiropractic as a field is better equipped to handle serious medical conditions, the geriatric population, other very vulnerable populations with complex histories, then you'll end up debating with yourself.

Who ever said that?

 

[Bleurberry]

No, I'm not picking a fight. Just trying to clear up some misconceptions.



What ever happened to getting historical details from the patient? And, yes, there are times when additional records need to be gathered. And are you telling me that every time a patient sees, say, an ortho for LBP, the entire medical file gets forwarded to that ortho first? Hmmmm...sounds a little far fetched.


You may want to whisper that in this forum.

Ok well I appreciate the change in tenor of our discussion. And facetguy, I don't blame you one bit for being overly enthusiastic in protecting the honor of your education and skill. Just don't lump us all in the same light, cause we're all snowflakes, really. lol.
And I'm happy to discuss manual medicine with Tired, as tired as his posts can be regarding some facets of osteopathic medicine, and chiropractic in general. Just kidding, Tired, I spend too much time on SDN already, I don't need to start a banging-my-head-against-a-brick-wall session just this moment. January would be better for me. Can you pencil me in?

 

[grandslam521]

Ok, any lay person who has had any family member with experience using steroids long term knows it, not just chiropractors, and that only strengthens the position you're backing me into in this argument you seem to be picking with me. The comments you take objection to in my previous post are factual, not up for debate. I had initially qualified my comment on "manipulation", but I've edited it because it's a linguistic note and not particularly relevant to the conversation anymore. I hadn't meant to imply that chiropractor's aren't aware or skilled in myo-fascial, rolfing, "cranial", and other techniques. Did you watch the 1st international fascial congress rebroadcast that took place at Harvard?? I'm guessing no. Chiropractor's have made soft tissue famous, who's arguing that?

That doesn't change one iota the fact of my grandmother's incident of her vertebral fracture. Her chiropractor is extremely capable and I never brought up the incident other than to relay to him she was having the vertebroplasty done. I hadn't felt it necessary to pursue it further since she's fine now.
If you had read my post, I don't know how you'd get "throwing the profession under the bus" out of it.
Is it STANDARD PRACTICE for a Chiropractor to receive a medical history from a patients primary care specialist? Standard practice is the operative term above. A huge selling point, and challenge all wrapped into one facing chiropractic is that chiropractor's are like snowflakes, there aren't any two alike.
You can rail against me in your frustration over the thread you want, however misplaced I clearly feel it is. I didn't condemn the chiropractic profession as a whole, particularly for reasonably healthy individuals like myself. I still visit my family chiropractor.

If, however, you're going to respond to this post in debating me whether or not chiropractic as a field is equally equipped to handle serious medical conditions, other very vulnerable populations with complex histories, then you'll end up debating with yourself.
If I agreed with such a premise, I'd have saved myself a load of trouble and applied to chiropractic school, side-stepped the OMM training, the physician licensing, the clinical rotations, the internship and 3 year residency. PLEASE.
Check your absolutes; I hadn't included any in my post, why should you retort with a battalion of them?

Aside from back pain and, perhaps, headache, OMM is just as ineffective as chiropractic treatments for the diseases/conditions that have been studied.

 

[WellWornLad]

Seems like the chicken-egg argument here is that CAM should be held to mainstream medical standards, but that because CAM is not mainstream there's no money to validate it.

Frankly, the idea that you need billions of dollars in pharmaceutical money to perform research is ridiculous. We're not talking about clinical trials here. CAM is already out there in the world. If you are a chiropractor interested in how effective your technique is in resolving low back pain, ask your patients for consent and track outcomes. Call up an orthopedic surgeon or pain management specialist interested in the subject to track and compare alternative therapies.

For example, when I got a couple of wisdom teeth extracted, my dentist could see tetracycline absorbed in my teeth. He was running a study on whether post-extraction infections were less common in people with tetracycline deposits, and all I had to do was return to him if I developed an infection. Net cost to him? Maybe an hour a week of his time.

If a good study involving CAM shows some substantial benefit, you'll see more research dollars and more interest. In fact, I know of a few people who are studying acupuncture with fMRI - not exactly a cheap modality. If you don't see a lot of research, it's more likely due to lack of encouraging results, not lack of money.

 

[Perrotfish]

Originally Posted by TMP-SMX
I just wanted to throw this out there. 1/3 of certified acupuncturists in the US are physicians.
Well, then, each and every one of them must be a charlatan, faker, scam artist, and swindler, right? Just wait until Tired and TheProwler hear of this! They will set these quacks straight! Go get 'em, boys!!

They are, each and every one of them, wrong. Again I am certain that some of them are sincere, but in that case they are sincerely wrong. It's really quite depressing to think that physicians are buying into that.

Acupuncture is, honestly, one of the stupidist medical art forms I have ever heard of. It postulates the existence of magical health energy fields flowing between 7 different energy field centers in your body. One of those energy centers is floating ABOVE YOUR HEAD. These energy fields, though undetectable by any scientific equiptment, can be affected by sharp iron jabbed into your skin. Do you believe that? Magical undetectable energy field affected by needles? Do you think that it's reasonable to 'keep an open mind' about that?

Like I said, I think doctors rant most about chiropractic mainly because understanding why it doesn't work requires a medical degree and a review of scientific literature, so they feel obligated to protect the public from a type of quackery they know can soud quite reasonable, even to intelligent college graduates. Not a lot of people have had the opportunity to see where the spinal nerves exit the vertebral colum, and to realize that the openings are too large to compress the nerve passing through them due to sublexations alone, or to realize that what chiropractors call severe sublexations are present in healthy individuals, or that what the nerves innervate doesn't match up to what chiros say the are treating when they fix various sublexations. Understanding why acuptuncture is BS, though, shouldn't require anything more than an 8th grade education. There is no undetecatable magical spirit energy affecting your health, and if there is I am 100% sure that sticking you with something sharp wouldn't do anything to change it.

While no studies should be necessary to show acuptuncture is BS, several high quality studies have been done. Well designed studies by physicians show no benifit compared to placebo, for anything. Physicians need to push back against the tyranny of open mindedness that has kept stupid beliefs like this from being discrediting for a physician. If your colleages are telling their patients that magic energy fields might be affecting their health that should be cause to suspend their lisence.

 

[facetguy]

Seems like the chicken-egg argument here is that CAM should be held to mainstream medical standards, but that because CAM is not mainstream there's no money to validate it.

Frankly, the idea that you need billions of dollars in pharmaceutical money to perform research is ridiculous. We're not talking about clinical trials here. CAM is already out there in the world. If you are a chiropractor interested in how effective your technique is in resolving low back pain, ask your patients for consent and track outcomes. Call up an orthopedic surgeon or pain management specialist interested in the subject to track and compare alternative therapies.

For example, when I got a couple of wisdom teeth extracted, my dentist could see tetracycline absorbed in my teeth. He was running a study on whether post-extraction infections were less common in people with tetracycline deposits, and all I had to do was return to him if I developed an infection. Net cost to him? Maybe an hour a week of his time.

If a good study involving CAM shows some substantial benefit, you'll see more research dollars and more interest. In fact, I know of a few people who are studying acupuncture with fMRI - not exactly a cheap modality. If you don't see a lot of research, it's more likely due to lack of encouraging results, not lack of money.

More study is always good. Shine the light! As long as the studies are fairly constructed, of course. Now, there will always be those, as we've seen here in this forum, who will insist solely on randomized controlled trials, and that's where the money and other logistics become an issue. Studies like you described, while valuable, will never be enough for some anti-CAM zealots. (I just find the concept of being an anti-CAM zealot a little embarrasing. With all the ills that mankind struggles with everyday, some who are in a position to do so much good would rather go after the low hanging fruit and bash CAM practices. To those people, I saw have some ba!!s and do something important and worthwhile.)

As far as spinal manipulation for low back pain goes, does anyone know how many RCTs have been done to date?

 

[facetguy]

Like I said, I think doctors rant most about chiropractic mainly because understanding why it doesn't work requires a medical degree and a review of scientific literature, so they feel obligated to protect the public from a type of quackery they know can soud quite reasonable, even to intelligent college graduates. Not a lot of people have had the opportunity to see where the spinal nerves exit the vertebral colum, and to realize that the openings are too large to compress the nerve passing through them due to sublexations alone, or to realize that what chiropractors call severe sublexations are present in healthy individuals, or that what the nerves innervate doesn't match up to what chiros say the are treating when they fix various sublexations.

Finally, Perrotfish lets us all know what his theory is on how chiropractic works (or, in his view doesn't work). And as suspected, he is completely wrong. The notion of a bone slipping out of place, compressing a nerve, and leading to some type of health problem went out of style decades ago. If you profess to be an expert in these things, at least get yourself up to speed on the current science, then comment.

Someone once said, and I'll paraphrase, that it's not ignorance that leads to trouble but perceived knowledge. In other words (and WWL will crucify me for being a tautologist here), the problem here is some THINK they know what they are talking about (that's the 'perceived knowledge' part) when they don't (that's the ignorance part). You don't even know what you don't know, yet profess to know all. As a man of science, you need to be more careful.

 

[Perrotfish]

Finally, Perrotfish lets us all know what his theory is on how chiropractic works (or, in his view doesn't work). And as suspected, he is completely wrong. The notion of a bone slipping out of place, compressing a nerve, and leading to some type of health problem went out of style decades ago. If you profess to be an expert in these things, at least get yourself up to speed on the current science, then comment.

Someone once said, and I'll paraphrase, that it's not ignorance that leads to trouble but perceived knowledge. In other words (and WWL will crucify me for being a tautologist here), the problem here is some THINK they know what they are talking about (that's the 'perceived knowledge' part) when they don't (that's the ignorance part). You don't even know what you don't know, yet profess to know all. As a man of science, you need to be more careful.

It's not out of style enough for Palmer's textbook to still be the center of many Chiropractic cirrciulum. And yes, the fact that Chrios generally can't even agree on what the theory of Chiropractic is does make it seem even more BS-ie. Do you think the chiropractos who believe is sublexations are quacks? The way you said that this theory went 'out of style' is pretty telling. Science doesn't have style, it has evidence. Do you admit that there was mountig evidence that Palmer's origional theory didn't make any sense? What's the theory that it was replaced with? Was that theory evidence based? Why are so many Chiros still following Palmer's theories?

In any event, I'll broaden my statement. Not many people have had the opportunity to see that there is no way to fix the musculoskeletal problems of your back by pushing on it, wherever you might choose to push on it. It can't affect your spinal neves, it can't affect your muscles, so what is it affecting? I have yet to hear a coherent theory of why chiropractic medicine works that does not involve the work 'sublexations'.

 

[eagle34]

I see a herniated disk that compresses a spinal nerve all the time in the hospital.

 

[facetguy]

I see a herniated disk that compresses a spinal nerve all the time in the hospital.

Good point. I should have been more clear. As you noted, there are several causes of truly compressed nerves, HNP being one of them. But my comment was directed at the old concept of a bone jumping off-track and choking off a nerve...that is what science over the years has taught us doesn't happen (with any great frequency anyway). Sorry for the confusion.

 

[grandslam521]

Finally, Perrotfish lets us all know what his theory is on how chiropractic works (or, in his view doesn't work). And as suspected, he is completely wrong. The notion of a bone slipping out of place, compressing a nerve, and leading to some type of health problem went out of style decades ago. If you profess to be an expert in these things, at least get yourself up to speed on the current science, then comment.

Someone once said, and I'll paraphrase, that it's not ignorance that leads to trouble but perceived knowledge. In other words (and WWL will crucify me for being a tautologist here), the problem here is some THINK they know what they are talking about (that's the 'perceived knowledge' part) when they don't (that's the ignorance part). You don't even know what you don't know, yet profess to know all. As a man of science, you need to be more careful.

facetguy,

Could you please explain the current theory of how the Diversified technique (a form of HVLA manipulation) can, from a physiological perspective, alleviate lower back pain? Since the Diversified technique is the most commonly used technique by chiropractors, I would be interested to know what is currently believed to be the mechanism behind it. Thanks. (I've searched for it but I can't find anything very comprehensive.)

 

[meister]

I'd refer out to a D.O. colleage rather than a chiropractor. The placebo effect is real, but at least I know if my patient goes to a D.O. he's probably not going to do any damage or take any crazy x-rays without removing metallic objects from the patient first.

As far as 1/3 of acupuncturists being physicians, well you can't really blame a guy for trying to make a buck. It's why my wife's dermotologist sold her a $35 of face cream that you can buy at CVS for $5. As long as it isn't hurting anything, then whatever. People want to waste their money it's fine by me, but you won't see me referring out to chiropractors or acupuncturists.

 

[coldweatherblue]

just if anyone missed the above link from the AAFP, here is the summary regarding spinal manipulation:

Four good-quality systematic reviews of spinal manipulative therapy in acute low back pain are available.51-54 There is some evidence that spinal manipulation results in short-term improvements in pain when compared with sham or ineffective treatments, but not when compared with usual care treatments (i.e., family physician-provided care, analgesics, physical therapy, or back school).51,52,54 There is some evidence that spinal manipulation leads to short-term improvement in function when compared with placebo, but not when compared with usual care.51,53,54 Spinal manipulation does not confer long-term benefits for acute low back pain.51-53

Newer studies that were not included in the reviews have mixed results. A study involving 102 patients with acute low back pain and sciatica found that patients receiving spinal manipulative therapy were significantly less likely to have pain at six months than those receiving sham manipulation.55 A study of 131 patients showed that those meeting prespecified criteria, including short duration of back pain and no radicular symptoms, benefited from spinal manipulation compared with patients who were assigned to exercise or who did not meet the criteria.56 Spinal manipulation was not found to be effective in two large studies involving 2,015 patients with varied durations of back pain; however, there is no way to discern whether it benefited the subset of patients with acute low back pain.57,58 Two trials with a total of 592 patients with acute low back pain found that spinal manipulation was no better than treatment with muscle relaxants, sham treatments, or a brief pain management program.59,60 Manipulative therapy of the lumbar spine is generally safe when provided by an appropriate practitioner, and it is used by many patients.

if you go to the link above you can find references to the studies.

 

[facetguy]

just if anyone missed the above link from the AAFP, here is the summary regarding spinal manipulation:



if you go to the link above you can find references to the studies.

The whole point with all these reviews is that they illustrate that no single discipline is 100% effective for low back pain. Once you get out in the field, you will see this for yourselves.

And to answer my own question posed earlier, at last count there are 39 RCTs on spinal manipulation for LBP (1 or 2 may have slipped by me, but that's a reasonable ballpark).

 

[facetguy]

facetguy,

Could you please explain the current theory of how the Diversified technique (a form of HVLA manipulation) can, from a physiological perspective, alleviate lower back pain? Since the Diversified technique is the most commonly used technique by chiropractors, I would be interested to know what is currently believed to be the mechanism behind it. Thanks. (I've searched for it but I can't find anything very comprehensive.)

Think joint mechanoreceptors. I'll try to expand on this when time allows.

 

[masterofmonkeys]

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 was crippled by a Hep B vaccination (known risk, known etiology/pathophysiology, risk MUCH MUCH higher than stroke due to cervical manipulation), which due to the muscle imbalances led me to being a walking teaching case in just about every degenerative spinal pathology known to man, as well as in complex regional pain syndrome (literally, I have been used as a teaching case in medical school on numerous occasions), and led to my seeing a chiropractor.

Essentially a random event.

I take it you're against the Hep B vaccine too.

 

[Depakote]

I was crippled by a Hep B vaccination (known risk, known etiology/pathophysiology, risk MUCH MUCH higher than stroke due to cervical manipulation), which due to the muscle imbalances led me to being a walking teaching case in just about every degenerative spinal pathology known to man, as well as in complex regional pain syndrome (literally, I have been used as a teaching case in medical school on numerous occasions), and led to my seeing a chiropractor.

Essentially a random event.

I take it you're against the Hep B vaccine too.

I am sorry to hear that but you do mention that the risks of the Hep B vaccine are well documented. Then why do we give such a drug? Well, b/c the benefits obviously outweigh the risks and the net damage of the numerous Hep B cases it has prevented outweighs the side effect you experienced.

If cervical manipulation would care to provide a good solid study documenting the incidence of stroke and maybe some data showing that it provided some therapeutic benefit that made the risk of CVA an acceptable trade off, then I'd consider it an acceptable modality. But as it stands I just have the word of some very enthusiastic people that it works and is safe.

 

[indo]

You are correct regarding the need to distinguish between acute and chronic LBP. I'm not sure our friend is aware of this, however. The 'natural history' argument still gets repeated.

I should've specified new onset back pain, sorry.

 

[Tired]

I take it you're against the Hep B vaccine too.

I would be, if it were fake.