Quacks

[facetguy]

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

It's all good.

 

[facetguy]

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.

Ummm...did you look for any? Admittedly, there isn't the volume of study for neck pain as there is for low back pain. But you at least have to look before you proclaim there aren't any studies. You may just find something.🙂

 

[facetguy]

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'.

Let's imagine, just hypothetically, that a patient has a musculoskeletal problem in, say, the lumbar region of the spine. If you were to "push on it", or better yet, skillfully apply a high-velocity manipulation to a particular motion segment of the lumbar spine, what then happens on a neurophysiologic level? Nothing, as Perrotfish believes? What happens to the joints? The muscles?

Perrotfish and others are so hung up on this "pinched spinal nerves" model that they totally overlook reflex/neurologic effects of manipulation (I would have said they never even thought to consider these effects, but I don't know this for sure...although I suspect it!) 😉

 

[mmmcdowe]

I just looked up and all the SDN ads happened to be chiropractic. Lol

 

[DrZeke]

Too lazy to read everything, but I do agree that most of these people are definitely quacks. As an aside.. I've also met some really bad doctors in Florida and I'm sometimes alarmed at how FM dispenses antibiotics with limited evidence. It's to the point where I sometimes wonder whether or not these people actually went to medical school. This whole giving people a shot in the ass for their strep throat is overrated...

Anyways, that's neither here nor there. What I really wanted to say is that sometimes the way we talk to our patients drives them away. I hate to see people go to certain CAM places that don't work, but I feel like some of us are partially responsible. We hardly know how to talk to our patients and they feel misunderstood at times and then look for people who give them magical solutions. This isn't an exact example, but it's about how doctors are often unaware of what their patient is getting out of the visit.

I was in a clinic today trying to explain a study to a patient and I was very aware to use terms like "build-up" instead of "infiltration", or "blocks it" instead of "obstruction" and to use my hands to talk and to get some type of affirmation from the patient. Even though some of my physician colleagues would repeatedly use terminology like "blockage", obstruction, coronary arteries, vessels, "have you had a cath???" (are you ****ing kidding me???). You would be amazed at how many people in the american population, english as their first language or other, do not understand many of the terms we as physicians take for granted. But, I look at my colleagues and I think..."REALLY??? do you really think this guy who speaks english poorly and has this blank look on his face when you talk to him really understood you??". Obviously, some patients just don't get it, but plenty get it when you take it down a notch.

Anyways, I'm just bringing this up, because though I think chiropractors are insane and useless, I think it's lack of connection with our patients that we are unaware of or not acknowledging their needs or questions that drives them away anyways. If we're speaking a foreign language and are basically unapproachable because of that, then we're part of the problem.

 

[indo]

Too lazy to read everything, but I do agree that most of these people are definitely quacks. As an aside.. I've also met some really bad doctors in Florida and I'm sometimes alarmed at how FM dispenses antibiotics with limited evidence. It's to the point where I sometimes wonder whether or not these people actually went to medical school. This whole giving people a shot in the ass for their strep throat is overrated...

Anyways, that's neither here nor there. What I really wanted to say is that sometimes the way we talk to our patients drives them away. I hate to see people go to certain CAM places that don't work, but I feel like some of us are partially responsible. We hardly know how to talk to our patients and they feel misunderstood at times and then look for people who give them magical solutions. This isn't an exact example, but it's about how doctors are often unaware of what their patient is getting out of the visit.

I was in a clinic today trying to explain a study to a patient and I was very aware to use terms like "build-up" instead of "infiltration", or "blocks it" instead of "obstruction" and to use my hands to talk and to get some type of affirmation from the patient. Even though some of my physician colleagues would repeatedly use terminology like "blockage", obstruction, coronary arteries, vessels, "have you had a cath???" (are you ****ing kidding me???). You would be amazed at how many people in the american population, english as their first language or other, do not understand many of the terms we as physicians take for granted. But, I look at my colleagues and I think..."REALLY??? do you really think this guy who speaks english poorly and has this blank look on his face when you talk to him really understood you??". Obviously, some patients just don't get it, but plenty get it when you take it down a notch.

Anyways, I'm just bringing this up, because though I think chiropractors are insane and useless, I think it's lack of connection with our patients that we are unaware of or not acknowledging their needs or questions that drives them away anyways. If we're speaking a foreign language and are basically unapproachable because of that, then we're part of the problem.

Ha, your first sentence says "too lazy to read everything" but then you type 1000 words. haha.

 

[Perrotfish]

Too lazy to read everything, but I do agree that most of these people are definitely quacks. As an aside.. I've also met some really bad doctors in Florida and I'm sometimes alarmed at how FM dispenses antibiotics with limited evidence. It's to the point where I sometimes wonder whether or not these people actually went to medical school. This whole giving people a shot in the ass for their strep throat is overrated...

This is the case of the doctor doing something that 'treats the physician', meaning it saves him a headache by making it apear that he did something to make the patient better. Sick people don't like hearing 'rest and wait' afting sitting in a waiting room, so an exhausted physician often just perscribes something to get them out of his office. It's unethical, no question, but the doctor knows it's harmless and they want to go home so they take the easy way out. Refering to CAM, I think, I pretty much the same thing as the useless medication. It's that same attitude of 'fine, I'll send you to the acupuncturist, just go away' that is legitimizing pseudomedicines.

 

[TMP-SMX]

People like to feel like they have control over illness and be proactive. Stagnation is a problem and people will seek help elsewhere for chronic conditions.

 

[masterofmonkeys]

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.

Actually the Hep B vaccine DIDN'T make public health sense. It made dollars and cents. Literally. It was approved not based on health risks and prevention but on the fact that it would save the government money by reducing taxpayer expenses on people with Hep B.

 

[facetguy]

Too lazy to read everything, but I do agree that most of these people are definitely quacks. As an aside.. I've also met some really bad doctors in Florida and I'm sometimes alarmed at how FM dispenses antibiotics with limited evidence. It's to the point where I sometimes wonder whether or not these people actually went to medical school. This whole giving people a shot in the ass for their strep throat is overrated...

Anyways, that's neither here nor there. What I really wanted to say is that sometimes the way we talk to our patients drives them away. I hate to see people go to certain CAM places that don't work, but I feel like some of us are partially responsible. We hardly know how to talk to our patients and they feel misunderstood at times and then look for people who give them magical solutions. This isn't an exact example, but it's about how doctors are often unaware of what their patient is getting out of the visit.

I was in a clinic today trying to explain a study to a patient and I was very aware to use terms like "build-up" instead of "infiltration", or "blocks it" instead of "obstruction" and to use my hands to talk and to get some type of affirmation from the patient. Even though some of my physician colleagues would repeatedly use terminology like "blockage", obstruction, coronary arteries, vessels, "have you had a cath???" (are you ****ing kidding me???). You would be amazed at how many people in the american population, english as their first language or other, do not understand many of the terms we as physicians take for granted. But, I look at my colleagues and I think..."REALLY??? do you really think this guy who speaks english poorly and has this blank look on his face when you talk to him really understood you??". Obviously, some patients just don't get it, but plenty get it when you take it down a notch.

Anyways, I'm just bringing this up, because though I think chiropractors are insane and useless, I think it's lack of connection with our patients that we are unaware of or not acknowledging their needs or questions that drives them away anyways. If we're speaking a foreign language and are basically unapproachable because of that, then we're part of the problem.

Recognizing the importance of good communication with patients is an important step. Very good. Keep it up.

And with all of your expertise on the subject, your opinion of chiropractors doesn't carry much weight. Sorry.

 

[DrZeke]

Recognizing the importance of good communication with patients is an important step. Very good. Keep it up.

And with all of your expertise on the subject, your opinion of chiropractors doesn't carry much weight. Sorry.

Hey, I didn't mean to offend about the chiropractor thing. I was actually referring to the chiropractors that some of the people on this thread were referring to - making stuff up to their patients. I do think chiropractors help some lower back pain and whatnot, but I've also found great relief from my sciatica, tendonitis, muscle tension headaches and whatever from pilates and physical therapy from a great physical therapist and from an osteopath in Canada (NOT a DO - just a physical therapist trained in manipulations). LOL, I lived in Canada, I didn't travel there to see an osteopath 🙂

I actually do believe in CAM, because I think some of it does work - acupuncture, certain creams, electro(pulse?magnetic?) therapy... and remember that Naturopaths are part of the CAM movement as well. We had a huge CAM symposium at my school, and we were required to go and some of my classmates were really ticked off. But I think many people overestimate our (the doctor's) word. The reality is that if your patient has a chronic issue and you dismiss it, because you weren't THAT well trained in pain management - a sensitive issue, then many patients will try to look for alternatives. With lots of bogus advertising out there and quacks, people fall into some stupid stuff. That's not to say that all of it is stupid, because it isn't. It's just to say that instead of constantly ridiculing CAM, we as the physicians need to educate ourselves, using EBM and some of the limited research that is out there and decide what are opinions are, find out who might be credible in our areas and attempt to understand and maybe even refer our patients out to this individuals that we are ok with. If we ignore them, you have patient's buying into all kinds of things. For example, my dad has a college degree, is a business man and my mom has a graduate degree, yet my dad bought those weird bracelets with the two points on the end (ion aligning thing???) because my grandfather swore by it and stopped taking his COX-2 inhibitor for a while. After a while he went back on it, so I do think it was a psychosomatic placebo type of effect, but the statistics show that often it's the educated and those that can afford it that will buy into a lot of CAM. So if you brush it off like it's dumb you lose a lot from your patient. That was my whole point...and I'm not inexperienced in the world of CAM, but unfortunately I do think there are some idiots out there.

 

[facetguy]

This is the case of the doctor doing something that 'treats the physician', meaning it saves him a headache by making it apear that he did something to make the patient better. Sick people don't like hearing 'rest and wait' afting sitting in a waiting room, so an exhausted physician often just perscribes something to get them out of his office. It's unethical, no question, but the doctor knows it's harmless and they want to go home so they take the easy way out. Refering to CAM, I think, I pretty much the same thing as the useless medication. It's that same attitude of 'fine, I'll send you to the acupuncturist, just go away' that is legitimizing pseudomedicines.

Perrotfish, this is kind of interesting. Awhile back, you mentioned the teachings of Palmer and how chiropractors can't seem to agree on theory, etc. I think one of the reasons some of the old theory continues to be professed today is simply one of convenience. Here's what I mean. Let's say it's a busy day in the chiro office, the chiro is running behind schedule, and he is in the room with a patient. After all the usual history and examination, the patient says something like, "So, Doc, I think I've got this bone out of place. Can you put it back in for me?". At which point the busy chiro can either 1) dive into a long, complicated diatribe about muscle spindles, mechanoreceptors, descending inhibitory pathways, etc OR 2) simply say "Yes, Mr. Jones, you're right. Let's fix that thing". Is it right to take the easier road? No. Is it right the MD prescribes the antibiotic even though he knows it's not necessary but the patient expects/demands it? No. The MD should take the time to explain why the antibiotic isn't necessary, etc etc, but sometimes that's not practical at the moment. Again, not right but happens everyday.

So, what's the effect of chiros not fully explaining (communicating, as DrZeke mentioned)? A perpetuation of old, overly simplistic information. That perpetuation even made it into your brain, leading to an incorrect assumption about what spinal manipulation does.

Regardless of whether the patient understands the real mechanism or just understands the bone-out-of-place model, the spinal manipulation (if appropriate for that patient) is rendered and the effect is the same. The same can be said for, say, radiation oncologists. The patient doesn't have to understand all the details of how radiation works. They just have to understand that their tumor is getting zapped and that hopefully will help them.

The same cannot be said for the antibiotic example, as overprescription of antibiotics has lead to the creation of superbugs, has caused countless allergic reactions (some life threatening), etc. [Note: please don't twist my words and claim that I said antibiotics were worthless. Thanks.]

Enough for now. I'm getting carpal tunnel.

 

[Perrotfish]

We had a huge CAM symposium at my school, and we were required to go and some of my classmates were really ticked off.

Where do you go to medical school?

 

[facetguy]

Hey, I didn't mean to offend about the chiropractor thing. I was actually referring to the chiropractors that some of the people on this thread were referring to - making stuff up to their patients. I do think chiropractors help some lower back pain and whatnot, but I've also found great relief from my sciatica, tendonitis, muscle tension headaches and whatever from pilates and physical therapy from a great physical therapist and from an osteopath in Canada (NOT a DO - just a physical therapist trained in manipulations). LOL, I lived in Canada, I didn't travel there to see an osteopath 🙂

I actually do believe in CAM, because I think some of it does work - acupuncture, certain creams, electro(pulse?magnetic?) therapy... and remember that Naturopaths are part of the CAM movement as well. We had a huge CAM symposium at my school, and we were required to go and some of my classmates were really ticked off. But I think many people overestimate our (the doctor's) word. The reality is that if your patient has a chronic issue and you dismiss it, because you weren't THAT well trained in pain management - a sensitive issue, then many patients will try to look for alternatives. With lots of bogus advertising out there and quacks, people fall into some stupid stuff. That's not to say that all of it is stupid, because it isn't. It's just to say that instead of constantly ridiculing CAM, we as the physicians need to educate ourselves, using EBM and some of the limited research that is out there and decide what are opinions are, find out who might be credible in our areas and attempt to understand and maybe even refer our patients out to this individuals that we are ok with. If we ignore them, you have patient's buying into all kinds of things. For example, my dad has a college degree, is a business man and my mom has a graduate degree, yet my dad bought those weird bracelets with the two points on the end (ion aligning thing???) because my grandfather swore by it and stopped taking his COX-2 inhibitor for a while. After a while he went back on it, so I do think it was a psychosomatic placebo type of effect, but the statistics show that often it's the educated and those that can afford it that will buy into a lot of CAM. So if you brush it off like it's dumb you lose a lot from your patient. That was my whole point...and I'm not inexperienced in the world of CAM, but unfortunately I do think there are some idiots out there.

Well, you did refer to chiropractors as "insane and useless", but let's bury the hatchet. Most MDs, especially family practice docs, would do themselves a favor by taking your advice (highlighted above). Let's face it: musculoskeletal cases, especially chronics, are a hassle to family docs. Why not have someone in your area that you have some trust in (as you suggested) to dish these patients off to? As has been said many times on this thread: no single discipline has a 100% track record when it comes to things like back and neck pain. And we know by now that lifelong usage of NSAIDs for chronic musculoskeletal pain is not a good strategy, if not a downright dangerous one. So why not punt to other practitioners, one of which should be a chiropractor.

Believe it or not, most chiropractors do not see themselves as standing alone in the fight against pain and functional impairment (of course, there are always exceptions, and those are the ones that get the attention and make it more difficult for the rest). They see themselves as part of the greater medical community who can contribute in the team concept of doing whatever is best for the patient. It's not an "either/or" situation. If the neck and back pain research has taught us anything, it should be humility: you can't fix 'em all by yourself. Many of you right now, because you haven't been around all that long, probably still believe that you WILL fix 'em all (that's not a knock, by the way, it's just part of the training process...you gotta start somewhere). But you will quickly learn once you are out in the field for a bit that, despite your best efforts, a fair percentage of patients will fail to improve under your care.

 

[Depakote]

Ummm...did you look for any? Admittedly, there isn't the volume of study for neck pain as there is for low back pain. But you at least have to look before you proclaim there aren't any studies. You may just find something.🙂

You're right... I guess it is the duty of the skeptic to prove himself wrong.

Still, I took you up on your challenge. I don't think I can repost the whole article, but here's the info so you can look it up on your own.

Kawchuk et al, The relation between the spatial distribution of vertebral artery compromise and exposure to cervical manipulation. Journal of Neurology, Volume 255, issue 3 (March 2008), p. 371 - 377 ISSN: 0340-5354, DOI: 10.1007/s00415-008-0667-3 Steinkopff-Verlag, Darmstadt

I think it's safe to repost the abstract.

■ Abstract Background and purpose The vertebral artery is made up of four segments, one of which (V3) is connected to highly mobile cervical vertebrae. This connection underlies the common assumption
that persons with pre-event histories of mechanical neck movements,
such as cervical spine manipulation (cSMT), should experience increased V3 dissection. Methods Two of the largest case series of vertebral artery dissection describing subjects with and without a specific history of cSMT were reassessed to determine which segment(s) of the vertebral artery was most commonly compromised. Results The V3 segment was the most commonly involved vertebral artery segment in both the +cSMT group (e.g., V3 vs.V1 prevalence ratio (PR)=8.46) and the –cSMT group (V3 vs.V1 PR=4.00).However,V3 vulnerability was augmented by the effect of cSMT. The joint effect of V3 location and exposure to cSMT was greater than if each effect were simply combined. In addition,multiple site lesions were significantly more common than single sites in both the +cSMT group (PR=2.67, p=0.008) and the –cSMT group (PR=2.44, p=0.0008). Conclusions In prior studies which identified vertebral artery compromise, those with a history of cSMT were more likely to have involvement of the V3 segment. Although this study does not identify a mechanism which relates vertebral artery dissection and exposure to cSMT, these data are compatible with a greater than additive relation between compromise of an arterial segment thought to be mechanically vulnerable and history of a mechanical event.

I'll admit that this was the first study I looked at, but it did have some interesting data. It's on pubmed if you want to check it out.

Actually the Hep B vaccine DIDN'T make public health sense. It made dollars and cents. Literally. It was approved not based on health risks and prevention but on the fact that it would save the government money by reducing taxpayer expenses on people with Hep B.

care to back that up?

 

[meister]

Actually the Hep B vaccine DIDN'T make public health sense. It made dollars and cents. Literally. It was approved not based on health risks and prevention but on the fact that it would save the government money by reducing taxpayer expenses on people with Hep B.

I don't know man, I'm pretty happy to be vaccinated against hepB. Do you have any proof of what you're claiming?

 

[facetguy]

You're right... I guess it is the duty of the skeptic to prove himself wrong.

No, it's up to the skeptic to have evaluated all the available information, then form an opinion. No free passes for dogmatic thinkers who simply repeat unfounded statements.

Still, I took you up on your challenge. I don't think I can repost the whole article, but here's the info so you can look it up on your own.

Kawchuk et al, The relation between the spatial distribution of vertebral artery compromise and exposure to cervical manipulation. Journal of Neurology, Volume 255, issue 3 (March 2008), p. 371 - 377 ISSN: 0340-5354, DOI: 10.1007/s00415-008-0667-3 Steinkopff-Verlag, Darmstadt

I think it's safe to repost the abstract.



I'll admit that this was the first study I looked at, but it did have some interesting data. It's on pubmed if you want to check it out.

Saw it when it came out, but thanks. By the way, the lead author (Kawchuk) and at least 2 of the co-authors are chiropractors (What?? Can't be!). One of the co-authors is a guy named Scott Haldeman, who has a fairly unique training background of being a chiropractor, an MD (neurologist) and a PhD. He has written extensively on a variety of spine-related issues, including vertebral artery dissection/stroke, and all chiropractors are familiar with his work. Haldeman, along with a host of others (including chiropractors!), have just compiled a huge amount of data for the Task Force on Neck Pain and Associated Disorders as part of the Bone and Joint Decade 2000-2010, the results of which were recently published in Spine, the most respected spine-related medical journal in the world.

Look, no one is saying that vertebral artery dissection from spinal manipulation is impossible. It has happened. But you have to look at the overall level of risk: it is incredibly small. I'm not sure it would be easy to come up with an example of anything in medicine/surgery where the risk is about 1 in a million or so.

Here's an interesting take on perhaps why there are differences in perception of stroke risk between chiros and MDs (particularly neurologists, who would be the ones to see these unfortunate cases)(again, the lead author is Haldeman): http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

At least give the chiropractic profession some credit for studying the issue and trying to better understand it (Poor chiropractors: they get bashed for supposedly NOT having research and they get bashed for DOING research...they can't win!!).

 

[Depakote]

No, it's up to the skeptic to have evaluated all the available information, then form an opinion. No free passes for dogmatic thinkers who simply repeat unfounded statements.



Saw it when it came out, but thanks. By the way, the lead author (Kawchuk) and at least 2 of the co-authors are chiropractors (What?? Can't be!). One of the co-authors is a guy named Scott Haldeman, who has a fairly unique training background of being a chiropractor, an MD (neurologist) and a PhD. He has written extensively on a variety of spine-related issues, including vertebral artery dissection/stroke, and all chiropractors are familiar with his work. Haldeman, along with a host of others (including chiropractors!), have just compiled a huge amount of data for the Task Force on Neck Pain and Associated Disorders as part of the Bone and Joint Decade 2000-2010, the results of which were recently published in Spine, the most respected spine-related medical journal in the world.

Look, no one is saying that vertebral artery dissection from spinal manipulation is impossible. It has happened. But you have to look at the overall level of risk: it is incredibly small. I'm not sure it would be easy to come up with an example of anything in medicine/surgery where the risk is about 1 in a million or so.

Here's an interesting take on perhaps why there are differences in perception of stroke risk between chiros and MDs (particularly neurologists, who would be the ones to see these unfortunate cases)(again, the lead author is Haldeman): http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

At least give the chiropractic profession some credit for studying the issue and trying to better understand it (Poor chiropractors: they get bashed for supposedly NOT having research and they get bashed for DOING research...they can't win!!).

Ok. So we've established that there's a documented risk (albeit apparently low in frequency, high in morbidity) to the manipulations...

Now is there a documented benefit that makes it worth the risk?

 

[Depakote]

To elaborate on the point I'm making...

Say I've got a pill.

It works for headaches, muscle aches, etc. A lot of people like it, most people do pretty well on it.

But 1 in 50,000 people have a stroke that can be linked to that pill. Well, I'd probably find another way to treat those headaches, headaches, etc.

 

[Depakote]

To elaborate on the point I'm making...

Say I've got a pill.

It works for headaches, muscle aches, etc. A lot of people like it, most people do pretty well on it.

But 1 in 50,000 people have a stroke that can be linked to that pill. Well, I'd probably find another way to treat those headaches, headaches, etc.

now if that pill treated cancer, a 1/50,000 risk of stroke might be an acceptable risk.

 

[meister]

now if that pill treated cancer, a 1/50,000 risk of stroke might be an acceptable risk.

What if it treated ED? I'd still give it a go. Is there a better way to die?

 

[facetguy]

Ok. So we've established that there's a documented risk (albeit apparently low in frequency, high in morbidity) to the manipulations...

Now is there a documented benefit that makes it worth the risk?

Why do I get the sense that I am doing your homework for you? But, anyway, to answer your question, yes. There's quite a bit, more than I can list here (as I mentioned earlier, there are at least 39 RCTs for spinal manipulation for LBP and I believe there are over a dozen RCTs for neck pain. This in addition to lots of other types of studies.)

But here are a few examples:
http://www.ncbi.nlm.nih.gov/pubmed/...nkpos=1&log$=relatedarticles&logdbfrom=pubmed

http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

http://www.ncbi.nlm.nih.gov/pubmed/...inkpos=3&log$=relatedreviews&logdbfrom=pubmed

Also, there's an important distinction to be made regarding chiropractic care. There is usually an erroneous tendency to equate chiropractic care with just spinal manipulation. Remember, chiropractors perform spinal manipulation when appropriate, but also perform various forms of spinal mobilization, prescribe exercises, perform a variety of soft tissue/myofascial therapies, utilize physiotherapeutic modalities, render advice on posture and ergonomics, provide dietary and nutritional advice, etc. Not to mention the important task of referring out to other specialties when appropriate. Research study design by its nature is very specific and restricted to the conclusions that can be reached. It would be difficult, if not impossible, to assess the effectiveness of all the possible therapeutic combinations chiropractors use everyday in their practices. So, when you see a study that says "spinal manipulation is no better than anything else", don't take that to mean "chiropractic care is therefore useless". An important thing to bear in mind.

 

[facetguy]

To elaborate on the point I'm making...

Say I've got a pill.

It works for headaches, muscle aches, etc. A lot of people like it, most people do pretty well on it.

But 1 in 50,000 people have a stroke that can be linked to that pill. Well, I'd probably find another way to treat those headaches, headaches, etc.

You already have those pills. They're called NSAIDs. And conservative estimates are that at least 8000 people die every year from them, and over 100,000 are hospitalized with NSAID-induced toxicity. And now with the COX-2 inhibitors, you can add 1000s more harmed or killed by cardiovascular complications. Yet they are prescribed every day like candy. Do they help people? Sure. Are they without risk? No way. If you get the time, look up the estimates for death from Vioxx alone (and, although Vioxx was pulled from the market along with Bextra, Celebrex is still out there!)

 

[masterofmonkeys]

I do think chiropractors help some lower back pain and whatnot, but I've also found great relief from my sciatica, tendonitis, muscle tension headaches and whatever from pilates and physical therapy from a great physical therapist and from an osteopath in Canada (NOT a DO - just a physical therapist trained in manipulations). LOL, I lived in Canada, I didn't travel there to see an osteopath

The best chiros are cross-trained in long-lever soft tissue work like physical therapy, as well as osteopathy. One of the most intriguing and evidence-based practices is a soft-tissue based manipulation called Active Release Technique which focuses on myofascial and connective tissue dysfunction.

The origins of chiro are kinda nasty and ugly. But there is a LOT of good stuff coming out of it today. Admixed with a whole lot of crap. On the other hand, pretty much everything that allopathic medicine offers is crap.

The reality is that if your patient has a chronic issue and you dismiss it, because you weren't THAT well trained in pain management - a sensitive issue, then many patients will try to look for alternatives.

I don't mean to bash you here because your interest in CAM is refreshing, but I'm going to use you to illustrate a point anyway.

The bolded words are exactly why so many patients turn away from allopathic medicine. And why we need to take a serious look our profession's glaring inadequacy in the understanding and treatment of musculoskeletal dysfunction.

I have facet syndrome from my lower t-spine to my mid C-spine. I have multilevel symptomatic disc disease that affects both arms and compresses my spinal cord. Needless to say my ROM and functionality are compromised. 90%+ of physicians will see that and think "Pain management." As I am fond of saying, I am not a chronic pain patient. No one is. Pain is not something to treat in and of itself (except in cases of direct nerve trauma). Pain is a symptom of underlying dysfunction. That is the point of pain. To tell you that SOMETHING SOMEWHERE is wrong.

I have seen neurologists, physiatrists, sports docs, and even a neurosurgeon. And almost every visit was wasted. Everyone offered pain management solutions. The physiatrists and sports docs at least were able to make SOME headway in improving my functional status with traction and physical therapy. But no one was able to really tackle my problems head on. Few even began to approach my very meager knowledge of functional anatomy and none were really able to help me brainstorm about how my damaged muscles and consequent asymmetries might have contributed to the spinal pathology or how to address them to prevent continued deterioration. The textbooks are likewise silent on the underling pathologic processes that lead to back pain. Occasionally you get some good case reports from intelligent and innovative allopathic physicians who apply basic principles of kinesiology and exercise science to improve the health of their patients, but this is the exception and not the rule.

Turn around and look at the exercise science and PT literature and you see that lots of OTHER people seem to understand the importance of muscular balance in joint and spine pathology, the role of exercise in prevention and rehabilitation, the assessment of the body for functional asymmetries and misalignments, and other important aspects of musculoskeletal health. But, we're superior to them, since we can recite the purine degradation pathway from memory right?

I go to my chiro (who's also a PT) because in 11 years, he was the FIRST to demonstrate to me that he actually understood the basic science of the back's structure and function.

 

[masterofmonkeys]

You already have those pills. They're called NSAIDs. And conservative estimates are that at least 8000 people die every year from them, and over 100,000 are hospitalized with NSAID-induced toxicity. And now with the COX-2 inhibitors, you can add 1000s more harmed or killed by cardiovascular complications. Yet they are prescribed every day like candy. Do they help people? Sure. Are they without risk? No way. If you get the time, look up the estimates for death from Vioxx alone (and, although Vioxx was pulled from the market along with Bextra, Celebrex is still out there!)

Recently I've read that some nephrologists have been making noise about the role of NSAIDs in the incidence of CRI in non-hypertensive non-diabetics, as well as accelerating decline of kidney function in HTN and DM2

 

[meister]

Recently I've read that some nephrologists have been making noise about the role of NSAIDs in the incidence of CRI in non-hypertensive non-diabetics, as well as accelerating decline of kidney function in HTN and DM2

Hey that's nice, how about you tell us how the hepB vaccine is a sham.

 

[Depakote]

Why do I get the sense that I am doing your homework for you?

I'm not sure why you get that impression. When it comes to evidence based medicine, typically the burden of proof lies with the one claiming that said modality is not bunk.

But, anyway, to answer your question, yes. There's quite a bit, more than I can list here (as I mentioned earlier, there are at least 39 RCTs for spinal manipulation for LBP and I believe there are over a dozen RCTs for neck pain. This in addition to lots of other types of studies.)
But here are a few examples:
http://www.ncbi.nlm.nih.gov/pubmed/...nkpos=1&log$=relatedarticles&logdbfrom=pubmed

http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

http://www.ncbi.nlm.nih.gov/pubmed/...inkpos=3&log$=relatedreviews&logdbfrom=pubmed

Also, there's an important distinction to be made regarding chiropractic care. There is usually an erroneous tendency to equate chiropractic care with just spinal manipulation. Remember, chiropractors perform spinal manipulation when appropriate, but also perform various forms of spinal mobilization, prescribe exercises, perform a variety of soft tissue/myofascial therapies, utilize physiotherapeutic modalities, render advice on posture and ergonomics, provide dietary and nutritional advice, etc. Not to mention the important task of referring out to other specialties when appropriate. Research study design by its nature is very specific and restricted to the conclusions that can be reached. It would be difficult, if not impossible, to assess the effectiveness of all the possible therapeutic combinations chiropractors use everyday in their practices. So, when you see a study that says "spinal manipulation is no better than anything else", don't take that to mean "chiropractic care is therefore useless". An important thing to bear in mind.

I'll take a look at those studies and the methods over Thanksgiving... I'm not familiar with the journals. (I do recognize McMaster in the one article, though.)

I do realize that Chiropractic care has been applied to more than just neck pain and consists of more than just cervical manipulation. That was just my case in point as it seems like a disproportionate risk/reward ratio.

 

[facetguy]

I'll take a look at those studies and the methods over Thanksgiving...

Speaking of which and while I'm thinking about it, everyone enjoy your upcoming Thanksgiving holiday and cherish the time spent with family and friends, and be thankful for the opportunity you have to make a difference in the world.

 

[meister]

I'll second that. I have an anatomy practical in 2 hours and a written exam tomorrow, then Thursday I am going to fill myself with so much wine and turkey that I'll probably gain 10 pounds in a day.

 

[masterofmonkeys]

Hey that's nice, how about you tell us how the hepB vaccine is a sham.

How about you learn to read, son. The HepB vaccine is a vaccine, and it does provide immunity to HepB. Granted, in the pediatric age population, the biggest source of new Hep B infection is vertical transmission at birth, which isn't prevented by vaccination so much as by HBIG. Which somewhat obfuscates the attempt to figure out just how instrumental the vaccine has been in reducing HepB infection rates. What is the risk of HepB infection in a person whose mother was HepB negative, is not or never will be an IVDU, and doesn't engage in other high risk behaviors anyway? Probably about the risk of getting a stroke from a chiropractic manipulation.

The question is whether the benefits outweigh the costs, whether mandating what is to a greater or lesser degree a 'lifestyle vaccine' is ethical, and whether or not we do a proper job of safety surveillance with vaccines. Given that according to the CDCs own self-admittedly optimistic estimation, VAERS only catches 1-10% of adverse reactions, and that followup in clinical trials is measured in days, not the weeks, months, or even years that would be necessary to properly monitor for immune cross-reaction, I think it's a valid concern.

Since we're being all 'evidence-based' now, we should probably recognize that one of the most basic principles of doing science is that the evidence is only as good as the study design. And the study decine when it comes to vaccine trials is piss-poor. To the point where the companies are allowed to use substances that are by their nature reactive as placebos. A reactive placebo, kind of an oxymoron, right?

 

[meister]

How about you learn to read, son. The HepB vaccine is a vaccine, and it does provide immunity to HepB. Granted, in the pediatric age population, the biggest source of new Hep B infection is vertical transmission at birth, which isn't prevented by vaccination so much as by HBIG. Which somewhat obfuscates the attempt to figure out just how instrumental the vaccine has been in reducing HepB infection rates. What is the risk of HepB infection in a person whose mother was HepB negative, is not or never will be an IVDU, and doesn't engage in other high risk behaviors anyway? Probably about the risk of getting a stroke from a chiropractic manipulation.

Uh, that's the entire point of the vaccine. What if that child someday does try drugs or does engage in high risk behaviors? He or she should get infected with hepB virus as some sort of cosmic punishment? Not to mention that hepatits B virus is endemic in many parts of the world. Are you suggesting we all just stay within our nice western hemisphere, never try drugs, never have unprotected sex, never have mothers with hepB viral infection and hold hands all day? That's nice, but that's not how public health programs work.

The question is whether the benefits outweigh the costs, whether mandating what is to a greater or lesser degree a 'lifestyle vaccine' is ethical, and whether or not we do a proper job of safety surveillance with vaccines. Given that according to the CDCs own self-admittedly optimistic estimation, VAERS only catches 1-10% of adverse reactions, and that followup in clinical trials is measured in days, not the weeks, months, or even years that would be necessary to properly monitor for immune cross-reaction, I think it's a valid concern.

Since we're being all 'evidence-based' now, we should probably recognize that one of the most basic principles of doing science is that the evidence is only as good as the study design. And the study decine when it comes to vaccine trials is piss-poor. To the point where the companies are allowed to use substances that are by their nature reactive as placebos. A reactive placebo, kind of an oxymoron, right?

Care to provide any evidence at all regarding these supposed nasty substances that are worse than potentially contracting hepB virus?

 

[masterofmonkeys]

Uh, that's the entire point of the vaccine. What if that child someday does try drugs or does engage in high risk behaviors? He or she should get infected with hepB virus as some sort of cosmic punishment?

Not to mention that hepatits B virus is endemic in many parts of the world. Are you suggesting we all just stay within our nice western hemisphere, never try drugs, never have unprotected sex, never have mothers with hepB viral infection and hold hands all day? That's nice, but that's not how public health programs work.

Ohh ratcheting up the rhetoric! I'm quaking in my boots. I'm glad you could illustrate how public health works to me. Clearly I'm an idiot.

The question is how big of a risk are we dealing with? How big is the risk of the vaccine itself? The answer to the former question is not very much. Many of the chronically HBV infected were due to poor blood product screening. The answer to the latter is that it does exist, peripheral neuropathy is a known side effect, and many vaccines are under suspicion for the rise in pediatric auto-immune disorders, but quantifying is impossible due to poor study design in safety trials and even worse post-marketing surveillance. Either way we're dealing with a small fraction of those vaccinated receiving benefit. And a small fraction of people being harmed. while a vaccine like this might have a good RELATIVE risk reduction, its absolute risk reduction (especially if someone actually took into account the role of HBIG in the prevention of vertical transmission) isn't exactly mind-numbing.

And yes, you're right. Africa and asia have a totally different epidemiology and thus must take a totally different approach.

Care to provide any evidence at all regarding these supposed nasty substances that are worse than potentially contracting hepB virus?

And once again your lack of reading comprehension shows itself. All I said was that many vaccines are tested against a REACTIVE placebo. Which by the basic definition of placebo doesn't make any sense. How can we know how safe a vaccine is if we don't actually compare it to an inert substance? How can we know how safe it is when we don't actually monitor for adverse events even in clinical trials long enough to see what happens over the ABSOLUTE MINIMUM of 3-6 weeks you should EXPECT to see any sort of subacute or chronic immune-related sequelae?

The ONLY argument I make re: vaccines is that we need to do a better job of determining safety and have a better dialogue of costs and benefits of vaccination. Just because the autism crazies are out in force does not mean that ANYONE who raises vaccine safety concerns is nuts.

 

[meister]

The ONLY argument I make re: vaccines is that we need to do a better job of determining safety and have a better dialogue of costs and benefits of vaccination. Just because the autism crazies are out in force does not mean that ANYONE who raises vaccine safety concerns is nuts.

Of course you're right about this. It just seems obvious to me that vaccinating the population against HBV infection is a good thing, and that while there are side effects to the vaccine it doesn't warrant dropping the entire program. For many, myriad reasons. My original problem was with your statement:

Actually the Hep B vaccine DIDN'T make public health sense. It made dollars and cents. Literally. It was approved not based on health risks and prevention but on the fact that it would save the government money by reducing taxpayer expenses on people with Hep B.

I'm just curious if you have any evidence of these claims. So, do you? If not, ok, but you're not going to be changing many minds without it. And while I really feel for your situation, I find that when people start throwing around "It made economic sense!" we're a step away from "You don't know the history of psychiatry, I do!" I don't doubt the vaccine has made many people very rich, but I just want to see what you're looking at to draw all your conclusions.

 

[masterofmonkeys]

Of course you're right about this. It just seems obvious to me that vaccinating the population against HBV infection is a good thing, and that while there are side effects to the vaccine it doesn't warrant dropping the entire program. For many, myriad reasons. My original problem was with your statement:

I'm just curious if you have any evidence of these claims. So, do you? If not, ok, but you're not going to be changing many minds without it. And while I really feel for your situation, I find that when people start throwing around "It made economic sense!" we're a step away from "You don't know the history of psychiatry, I do!" I don't doubt the vaccine has made many people very rich, but I just want to see what you're looking at to draw all your conclusions.

It's in the ACIP proceedings. As is a lot of hilarity with regard to lack of scientific principles. Sorry, no link now, have to go back to work pretty soon, but I will look for one tonight.

Some facts that I do have on hand that are straight from CDC data.

1990-1998 - 24,000 adverse events recorded in VAERS (which I cannot highlight enough only catches 1-10% of adverse events). Roughly 8000 of those were for autoimmune phenomena ranging from peripheral nervous dysfunction to full blown JRA. 70% or so had an onset within 4 days of vaccination. The association of HepB vaccination with autoimmune vaccination has been backed up in several published peer-review articles in leading rheumatology journals.

In 1996 in children under 14, there were 872 serious adverse events requiring ER visits, hospitalization or leading to disability. There were 48 deaths resulting from these adverse events. This includes only adverse events reported within 5 days. And again, uncorrected for the poor catchment of VAERS. By contrast there were 279 Hepatitis B infections. The large majority of these patients would not go on to develop chronic infection.

The mechanism by which Hepatitis B can stimulate auto-immune reactions is known and has also been peer-reviewed journal published. Same for its association with peripheral nerve damage.

Certainly enough to take notice of, in my opinion. And the FDA has taken drugs off the market for more insignificant findings. Yet the ACIP routinely dismisses VAERS findings without any further study.

I have read the studies that purport no link between hepatitis B and MS, but although that link garnered a lot of attention, things like seizures, hypotonia, arthralgic syndromes, and peripheral nerve damage are far more commonly reported. There haven't been very many studies regarding those. All of these studies that have actually been done are very methodologically limited by authors' own admission.

 

[DrZeke]

The best chiros are cross-trained in long-lever soft tissue work like physical therapy, as well as osteopathy. One of the most intriguing and evidence-based practices is a soft-tissue based manipulation called Active Release Technique which focuses on myofascial and connective tissue dysfunction.

The origins of chiro are kinda nasty and ugly. But there is a LOT of good stuff coming out of it today. Admixed with a whole lot of crap. On the other hand, pretty much everything that allopathic medicine offers is crap.



I don't mean to bash you here because your interest in CAM is refreshing, but I'm going to use you to illustrate a point anyway.

The bolded words are exactly why so many patients turn away from allopathic medicine. And why we need to take a serious look our profession's glaring inadequacy in the understanding and treatment of musculoskeletal dysfunction.

I have facet syndrome from my lower t-spine to my mid C-spine. I have multilevel symptomatic disc disease that affects both arms and compresses my spinal cord. Needless to say my ROM and functionality are compromised. 90%+ of physicians will see that and think "Pain management." As I am fond of saying, I am not a chronic pain patient. No one is. Pain is not something to treat in and of itself (except in cases of direct nerve trauma). Pain is a symptom of underlying dysfunction. That is the point of pain. To tell you that SOMETHING SOMEWHERE is wrong.

I have seen neurologists, physiatrists, sports docs, and even a neurosurgeon. And almost every visit was wasted. Everyone offered pain management solutions. The physiatrists and sports docs at least were able to make SOME headway in improving my functional status with traction and physical therapy. But no one was able to really tackle my problems head on. Few even began to approach my very meager knowledge of functional anatomy and none were really able to help me brainstorm about how my damaged muscles and consequent asymmetries might have contributed to the spinal pathology or how to address them to prevent continued deterioration. The textbooks are likewise silent on the underling pathologic processes that lead to back pain. Occasionally you get some good case reports from intelligent and innovative allopathic physicians who apply basic principles of kinesiology and exercise science to improve the health of their patients, but this is the exception and not the rule.

Turn around and look at the exercise science and PT literature and you see that lots of OTHER people seem to understand the importance of muscular balance in joint and spine pathology, the role of exercise in prevention and rehabilitation, the assessment of the body for functional asymmetries and misalignments, and other important aspects of musculoskeletal health. But, we're superior to them, since we can recite the purine degradation pathway from memory right?

I go to my chiro (who's also a PT) because in 11 years, he was the FIRST to demonstrate to me that he actually understood the basic science of the back's structure and function.

I believe that your chiro probably does understand and help you. I was basing my statement about chiros previous on the reports by people in this forum about SPECIFIC chiros. I didn't realize that it came off sounding like a generalization (I probably forgot a preposition - I'm kinda dumb like that).

 

[masterofmonkeys]

I believe that your chiro probably does understand and help you. I was basing my statement about chiros previous on the reports by people in this forum about SPECIFIC chiros. I didn't realize that it came off sounding like a generalization (I probably forgot a preposition - I'm kinda dumb like that).

As I said, the rant was not directed at you, in any way shape or form. It was just a convenient jumping point.

 

[Excelsius]

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

Another good one. Do you think your patient is better off increasing his risk of heart attack, stroke, or general life-threatening circulation problems just to temporarily alleviate his LBP? Maybe you don't get it: they call it alternative medicine not because it supplants or supersedes MDs, but rather because it is an alternative form of treatment that can achieve about the same result without having to use overly invasive techniques. Since you're a resident, I blame medical schools for the education that does not address prevention or alternatives to prescription at all. It really angers me that my aging mother will one day be prescribed a bull**** drug that would make her sicker, without being necessary.

It is disappointing to see that the only guy defending chiropractors here seems to be one himself. Are there really no medical students that are open minded at all? Some of you guys are MS1 and your biology knowledge is probably less than mine (and I'm not even talking about the rest of the subjects). So I don't understand whether this bias comes from the entitlement one feels by attending med school - just look at the other thread where med students go to bars flaunting their stethoscopes - or the educational system of the school.

Whatever it is, I know that our healthcare system sucks. Some blame it on the fact that we spend too much money on the people who are going to die anyway and we should let them die. Well, instead of concentrating on the money, why don't we see if the healthcare system sucks in general. If there are so many sick people in this country, there is some blame to go around doctors. It seems that most docs these days just take an X-ray and give you a pill. Why not? It's certainly faster. I mean why should a doctor try to find out what food you're eating or how you exercise if he can just shove Crestor down your throat and have you outta his office in less than five minutes? When even AMA admits that we suck at prevention you have to admit we're in deep ****.

Nothing is going to fix the system if we don't fix the med students themselves. Doctor's job these days is to come on you with drugs and be skeptical of any alternative solutions. Just like my friend who couldn't hear with one of his ears. His doc prescribed him antibiotics and scheduled to see an ENT in about a month (no early appt available). After I talked to him and found out that he had no pain, I suggested that perhaps it is simple wax buildup. He was skeptical, but tried the drops I told him. After two weeks of being def in one ear, he could hear again in less than a day. Sure enough he was pissed at his doc - and it was a well-paid private doctor. Anecdotal evidence is not conclusive, but it illustrates how dumb many doctors are. Or maybe they just don't give a damn. Prescribe a pill and take an X-ray. If that doesn't work, opps, prescribe something else. After some years you need another prescription to undo what the first prescription did. There are some patients walking around with BAGS of prescriptions. Makes me sick just looking at the sight. Drug companies are the same to doctors as lobbyists are to congress. I know several docs who get gifts from drug companies. Even though that's illegal in CA, I wish the regulations were tighter. If I were an employee, I'd report every single one of them and I am already doing something politically about this. That's nothing compared to the clout that's possible after you get your MD degree. I can't wait to oust the real quacks who make the real negative impact on healthcare. Meanwhile, carry on with your pitiful, futile, and meaningless quest to attack that which does not matter. Too many bums that don't deserve the MD title. How did these guys get into medschool, I don't know. Need to change the requirements. The picture is upside-down.

 

[Perrotfish]

The origins of chiro are kinda nasty and ugly. But there is a LOT of good stuff coming out of it today. Admixed with a whole lot of crap. On the other hand, pretty much everything that allopathic medicine offers is crap.

I find this quote amazing

It is disappointing to see that the only guy defending chiropractors here seems to be one himself. Are there really no medical students that are open minded at all? Some of you guys are MS1 and your biology knowledge is probably less than mine (and I'm not even talking about the rest of the subjects). So I don't understand whether this bias comes from the entitlement one feels by attending med school - just look at the other thread where med students go to bars flaunting their stethoscopes - or the educational system of the school

No, we are not open minded. Not towards CAM, and not towards our own therapies either. We are incredibly closed minded about every possible medical treatment. When a drug company proposes a new drug, or your friendly neighborhood ortho wants to try a new surgical technique, we ask, demand actually, that they first do so in a carefully controlled test where the patients are compeltely aware they are taking part in an unproven and experimental procedure. And even then it's malpractice if there was good reason to belive that their was no reasonable chance of success. And even if it passes the test we reserve the right to retest it and feed you to the lawyers if we have reason to believe it either is harmful or doesn't actually work.

I say this to make it clear that we are not being unfair to CAM. We are not asking to hold them to a higher standard than our own. We are simply asking that they hold themselves to our standards, and if they fail to do so that they face the same threats of both civil and criminal legal penalties that doctors do. If you think it's reasonable to be open minded towards everything, meaning anyone should both be allowed to practice medicine and should be allowed to perscribe absolutely anything that someone else hasn't proven definitively harmful, that's a reasonable opinion. I strongly disagree, and I think you would kill a lot of people that way, but it's at least internally consistent. Saying, however, that allopathic medicine needs to hold itself to strict evidence based while everyone who practices 'traditional' or 'holistic' medicine can do whatever they want regardless of how poorly documented the benifit and the risks are, well that's just you trying to protect people who label themselves a certain way from the consequences of their actions.

BTW, it's not a medical student thing, it's a scientist thing. You'll find the same skepticism amoung nurses, PAs, biologists, chemists, engineers, and any other profession that prides itself on being skeptical of anything that lacks scientific evidence. This is group of people who are very proud of looking at a healing crystal and saying: Bull****, there are no magic anti-disease rocks.

Open minded is often just another way of saying gullible

 

[Excelsius]

...
No, we are not open minded. Not towards CAM, and not towards our own therapies either. We are incredibly closed minded about every possible medical treatment. When a drug company proposes a new drug, or your friendly neighborhood ortho wants to try a new surgical technique, we ask, demand actually, that they first do so in a carefully controlled test where the patients are compeltely aware they are taking part in an unproven and experimental procedure. And even then it's malpractice if there was good reason to belive that their was no reasonable chance of success. And even if it passes the test we reserve the right to retest it and feed you to the lawyers if we have reason to believe it either is harmful or doesn't actually work.

I say this to make it clear that we are not being unfair to CAM. We are not asking to hold them to a higher standard than our own. We are simply asking that they hold themselves to our standards, and if they fail to do so that they face the same threats of both civil and criminal legal penalties that doctors do. If you think it's reasonable to be open minded towards everything, meaning anyone should both be allowed to practice medicine and should be allowed to perscribe absolutely anything that someone else hasn't proven definitively harmful, that's a reasonable opinion. I strongly disagree, and I think you would kill a lot of people that way, but it's at least internally consistent. Saying, however, that allopathic medicine needs to hold itself to strict evidence based while everyone who practices 'traditional' or 'holistic' medicine can do whatever they want regardless of how poorly documented the benifit and the risks are, well that's just you trying to protect people who label themselves a certain way from the consequences of their actions.

BTW, it's not a medical student thing, it's a scientist thing. You'll find the same skepticism amoung nurses, PAs, biologists, chemists, engineers, and any other profession that prides itself on being skeptical of anything that lacks scientific evidence. This is group of people who are very proud of looking at a healing crystal and saying: Bull****, there are no magic anti-disease rocks.

Open minded is often just another way of saying gullible

Maybe you need a definition as to what open-minded means: receptive to arguments or ideas. Open-minded means that you find out all the arguments for and against and then make a judgment. I don't care what the claim is; it could be the most ridiculous claim. That is completely irrelevant. That's what open-minded is and it is ALWAYS good. The premise of any successful and intelligent scientist is TO BE open-minded. Sometimes that means not dismissing the most absurd claim and other times it means challenging even the most patent establishment - for the example, the claim that aspirin is not harmful or that it's good for the heart. I have been working in the science field for few years now. The only guys who are closed-minded are those old fart scientists who are set in their ways and don't want to hear anything new. These are not the people who make cutting-edge discoveries. These are not the people you want in the room when you're brainstorming new ideas.

You talk about some controlled tests. I am not against any tests. The more, the better. What I am saying is that you don't have a good idea what a particular CAM does, yet you attack it. I am also saying that docs are so closed-minded that they do not want to invest the time and money to do thorough research on CAMs. It is very likely that this is because there isn't enough money in CAM research.

And what makes you think that DCs would not be fed to the lawyers if they screwed up? Or maybe you think that if one patient dies, then all chiropractors should be pulled out? That's a shotgun approach. It's like saying that since most drugs have side-effects, we should not use any of them.

Do you realize the absurdity of your comment? Let's take vitamins. Who the hell do you expect to hold vitamins to MD standards? It has to be the MDs themselves!!! Or maybe you're expecting the vitamin producing companies to do it? Sure, that's possible. Why don't you go work for them then? The bottom line is this: if you want something to be held to MD standards, then DO IT!

Again, WHAT are you taking about? Who told you that DCs or CAMs can prescribe anything at all? In fact, they CANNOT. This just shows what I mean when I say that you attack something without having the faintest idea what it is. And please, for Mary's sake, show me all the CAM bodies. I did some cursory reading and DCs started in 1890. Screw doctors. Do you think people are so dumb as to continue seeing DCs if there was a body count over the last 120 years? The implication here is that the public in general is pretty dumb. Or maybe you were talking about all those VITAMIN DEATHS! A brief memo here just FYI: most vitamins are water soluble. Water soluble vitamins are almost impossible to overdose on. In fact, some researchers let the subjects ingest 10,000% or more of the daily value of the given vitamin or mineral. Or maybe you're talking about those people who died drinking chamomile tea? That's tragic indeed. Should I start nailing docs who prescribe drugs for personal gain? There is a lot more in that closet. How ludicrous that instead of taking out one's own radioactive waste from one's closet, one decides to attack his neighbors organic yard waste instead.

And no, IT IS a medical student thing. Most scientists I work for (engineering) would consider your comment an insult. Go to a physicist and try to "identify" with him as a closed-minded student. See what he says. Skeptical does not equal closed-minded. I don't want to go through more definitions. But you may be right. This may be a pre-medical issue rather than a medical one. It is possible that the cocoon was weaved as a pre-med and the metamorphosis must have accured during the same time. Then once in med school, you get eclosion. We need to move the metamorphosis to med school.

By the way, please, let's drop this back-and-forth saying that DCs are not only futile, but are harmful. Besides several other med students, the Tired resident himself said that DCs do provide moderate LBP relief. You can't find anyone with more experience here. And he is an emeritus DC critic too. Just heed his advice. His only beef is that a masseuse or an ibuprofen might do just as well as a DC, much like gastric bypass can be just as effective as exercise and healthy diet.

"Open minded is often just another way of saying gullible"

I already couldn't resist here. Here is a definition for gullible: easily duped or cheated.

Your theory says:
Receptive to arguments or ideas = easily duped or cheated.

A logic of steel.

I wonder how representative of the overall med school you guys are. I am somewhat worried about what my med school class might be like and how it will affect the experience overall. And I thought Loma Linda was bad.

 

[coldweatherblue]

dude for real, where do these people come from?

 

[Perrotfish]

You talk about some controlled tests. I am not against any tests. The more, the better. What I am saying is that you don't have a good idea what a particular CAM does, yet you attack it. I am also saying that docs are so closed-minded that they do not want to invest the time and money to do thorough research on CAMs. It is very likely that this is because there isn't enough money in CAM research.

And what makes you think that DCs would not be fed to the lawyers if they screwed up? Or maybe you think that if one patient dies, then all chiropractors should be pulled out? That's a shotgun approach. It's like saying that since most drugs have side-effects, we should not use any of them.

Do you realize the absurdity of your comment? Let's take vitamins. Who the hell do you expect to hold vitamins to MD standards? It has to be the MDs themselves!!! Or maybe you're expecting the vitamin producing companies to do it? Sure, that's possible. Why don't you go work for them then? The bottom line is this: if you want something to be held to MD standards, then DO IT!

Again, WHAT are you taking about? Who told you that DCs or CAMs can prescribe anything at all? In fact, they CANNOT. This just shows what I mean when I say that you attack something without having the faintest idea what it is. And please, for Mary's sake, show me all the CAM bodies. I did some cursory reading and DCs started in 1890. Screw doctors. Do you think people are so dumb as to continue seeing DCs if there was a body count over the last 120 years? The implication here is that the public in general is pretty dumb. Or maybe you were talking about all those VITAMIN DEATHS! A brief memo here just FYI: most vitamins are water soluble. Water soluble vitamins are almost impossible to overdose on. In fact, some researchers let the subjects ingest 10,000% or more of the daily value of the given vitamin or mineral. Or maybe you're talking about those people who died drinking chamomile tea? That's tragic indeed. Should I start nailing docs who prescribe drugs for personal gain? There is a lot more in that closet. How ludicrous that instead of taking out one's own radioactive waste from one's closet, one decides to attack his neighbors organic yard waste instead

.

There's a lot of vitrol here, but to bottom line it: I said CAM was useless, you argue that it's not harmful.

CAM generally isn't harmful. There are a few things that DCs and acupuncturists do that are harmful, and a few healing herbs you can make yourself quite sick with, but generally CAM is harmless. I haven't been ranting about all the people that CAM killed. The objection here is not that CAM is harmless, but that CAM IS USELESS. Healing crystals are, for me, the epitome of CAM. A magic rock. It can't hurt you, for the exact same reason it can't help you: it's a rock. Acuptuncure can't help you because you don't actually have chakras. DC doesn't do anything because sublexations (or is it non-existant vertebral mechanoreceptors now?) don't affect your nevous system. Homeopathy doesn't work because your illness are not due to toxins that can be flushed out by an enema. Reiki doesn't work because you don't shoot beams of healing energy out of your fingertips, however hard you concentrate. Voodoo doesn't work because there is no pantheon of lesser dieties that you can invoke to cure/curse someone. Holding CAM to medical standards means it's not just malpractice to do a therapy that's harmful, but also to do (and charge for) a therapy that's useless.

Chiropractic is, in terms of results, the very best CAM has to offer: it doesn't use any magical spirit energy and 4 out of 6 studies shows that their extremely expensive treatments might match the healing powers of Tylenol or massage, for lower back pain only. It is also the most potentially harmful: the cervical manipulation in particlar carries significant risks. For me, even if you ignore the 2/6 studies that says Chriopractic does nothing at all, 'almost as good as Tylenol for lower back pain' doesn't warrent the risk, the expense, or the profession. I wouldn't refer to it at all, actually: you mentioned earlier that physicians should always try and perscribe the cheapest and safest therapy and I agree. And that's not Chiro.

Most importantly, though, I don't want my patient to be exposed to their terrible theories that Chriopractors spout about joint misalignment (or whatever it is now) being responsible for all their troubles when chances are I'm trying to tell them they need a lifestyle change. The root cause of most problems chiropractors see are: fat people need more exercise, overtraining athletes need less, trauma victims need long recovery times, and old people need to accept that their pain might not get better. There's no way around that (other than maybe some major surgical options for elderly joint pain), and it's not good to give your patients excuses and false hope. I think the main reason people keep going back to CAM other than to real physicians is to avoid the two things that patients least want to hear: "this is going to take a lot of hard work" and "there's nothing we can do".

Who the hell do you expect to hold vitamins to MD standards? It has to be the MDs themselves!!! Or maybe you're expecting the vitamin producing companies to do it? Sure, that's possible. Why don't you go work for them then?

Just to be clear on this point, yes, I would expect the vitamin producing companies to do it. Specifically I would want the companies to do the research and submit it to an independent government agency for the right to sell their product. If the research doesn't show that the product is either harmful or just useless, they don't get to sell it. Same with DCs and acupuncturists and all the other BS out there. This is the way it currently works for doctors and drug companies, and there is no reason it can't work the same way for CAM. Same profit motive applies.

Anyway, I think this conversation is basically on loop right now, so I'm signing off of it. Y'all can have the last word.

 

[facetguy]

Anyway, I think this conversation is basically on loop right now, so I'm signing off of it. Y'all can have the last word.

Perrotfish, wait...it was just about to get fun. You never answered my question of the other day. What happens when a skilled practitioner manipulates a spinal motion segment? What do the spinal joints do? How about the spinal musculature? I'm trying to throw you a rope here, because you are sinking fast with comments like this one:

.DC doesn't do anything because sublexations (or is it non-existant vertebral mechanoreceptors now?) don't affect your nevous system.

I'm trying to tell them they need a lifestyle change.

And chiropractors don't tell their patients this? I think there is a very strong argument that it is chiropractors and other CAM practitioners that are telling patients about lifestyle changes, while you are not (or are at least doing a poor job of it).

So, come on out and play. After all, I know you'll have some free time over Thanksgiving.

 

[grandslam521]

Maybe you need a definition as to what open-minded means: receptive to arguments or ideas. Open-minded means that you find out all the arguments for and against and then make a judgment. I don't care what the claim is; it could be the most ridiculous claim. That is completely irrelevant. That's what open-minded is and it is ALWAYS good. The premise of any successful and intelligent scientist is TO BE open-minded. Sometimes that means not dismissing the most absurd claim and other times it means challenging even the most patent establishment - for the example, the claim that aspirin is not harmful or that it's good for the heart. I have been working in the science field for few years now. The only guys who are closed-minded are those old fart scientists who are set in their ways and don't want to hear anything new. These are not the people who make cutting-edge discoveries. These are not the people you want in the room when you're brainstorming new ideas.

You talk about some controlled tests. I am not against any tests. The more, the better. What I am saying is that you don't have a good idea what a particular CAM does, yet you attack it. I am also saying that docs are so closed-minded that they do not want to invest the time and money to do thorough research on CAMs. It is very likely that this is because there isn't enough money in CAM research.

And what makes you think that DCs would not be fed to the lawyers if they screwed up? Or maybe you think that if one patient dies, then all chiropractors should be pulled out? That's a shotgun approach. It's like saying that since most drugs have side-effects, we should not use any of them.

Do you realize the absurdity of your comment? Let's take vitamins. Who the hell do you expect to hold vitamins to MD standards? It has to be the MDs themselves!!! Or maybe you're expecting the vitamin producing companies to do it? Sure, that's possible. Why don't you go work for them then? The bottom line is this: if you want something to be held to MD standards, then DO IT!

Again, WHAT are you taking about? Who told you that DCs or CAMs can prescribe anything at all? In fact, they CANNOT. This just shows what I mean when I say that you attack something without having the faintest idea what it is. And please, for Mary's sake, show me all the CAM bodies. I did some cursory reading and DCs started in 1890. Screw doctors. Do you think people are so dumb as to continue seeing DCs if there was a body count over the last 120 years? The implication here is that the public in general is pretty dumb. Or maybe you were talking about all those VITAMIN DEATHS! A brief memo here just FYI: most vitamins are water soluble. Water soluble vitamins are almost impossible to overdose on. In fact, some researchers let the subjects ingest 10,000% or more of the daily value of the given vitamin or mineral. Or maybe you're talking about those people who died drinking chamomile tea? That's tragic indeed. Should I start nailing docs who prescribe drugs for personal gain? There is a lot more in that closet. How ludicrous that instead of taking out one's own radioactive waste from one's closet, one decides to attack his neighbors organic yard waste instead.

And no, IT IS a medical student thing. Most scientists I work for (engineering) would consider your comment an insult. Go to a physicist and try to "identify" with him as a closed-minded student. See what he says. Skeptical does not equal closed-minded. I don't want to go through more definitions. But you may be right. This may be a pre-medical issue rather than a medical one. It is possible that the cocoon was weaved as a pre-med and the metamorphosis must have accured during the same time. Then once in med school, you get eclosion. We need to move the metamorphosis to med school.

By the way, please, let's drop this back-and-forth saying that DCs are not only futile, but are harmful. Besides several other med students, the Tired resident himself said that DCs do provide moderate LBP relief. You can't find anyone with more experience here. And he is an emeritus DC critic too. Just heed his advice. His only beef is that a masseuse or an ibuprofen might do just as well as a DC, much like gastric bypass can be just as effective as exercise and healthy diet.

"Open minded is often just another way of saying gullible"

I already couldn't resist here. Here is a definition for gullible: easily duped or cheated.

Your theory says:
Receptive to arguments or ideas = easily duped or cheated.

A logic of steel.

I wonder how representative of the overall med school you guys are. I am somewhat worried about what my med school class might be like and how it will affect the experience overall. And I thought Loma Linda was bad.

It isn't just MD standards (whatever that means...) - it is the standards of science! Science is a methodology; not a group of individuals or single profession.

 

[facetguy]

it is the standards of science! Science is a methodology; not a group of individuals or single profession.

Grandslam, please explain to Perrotfish that mechanoreceptors (since he mentioned them) are a thing of science, not of chiropractic. Thanks (he could use the help right now).

 

[Excelsius]

.
There's a lot of vitrol here, but to bottom line it: I said CAM was useless, you argue that it's not harmful.

CAM generally isn't harmful. ... Healting crystals are, for me, the epitome of CAM. ... DC doesn't do anything because sublexations (or is it non-existant vertebral mechanoreceptors now?) don't affect your nevous system. ...

Chiropractic is, in terms of results, the very best CAM has to offer: it doesn't use any magical spirit energy and 4 out of 6 studies shows that their extremely expensive treatments might match the healing powers of Tylenol or massage,...Tylenol for lower back pain' doesn't warrent the risk, the expense, or the profession. ...

...
I would expect the vitamin producing companies to do it. Specifically I would want the companies to do the research and submit it to an independent government agency for the right to sell their product. ...
Anyway, I think this conversation is basically on loop right now, so I'm signing off of it. Y'all can have the last word.

Apparently one of the threads you started was about whether you can become DO and DC certified at the same time. Besides your motives for starting that thread, you apparently are unable to grasp the arguments presented to you. Not only that thread had many positive comments on DCs, but also it said that DCs are NOT based on subluxations. Facetguy said it here too. Yet you just couldn't understand that even after numerous recitations and still make the same claim to fame.

You are also unable to understand what I am saying. You are also claiming that a company that puts together pieces of ascorbic acid or fish oil is qualified to do MD experiments! What an amazing claim! I guess we should go to every single concrete manufacturing company and require them to prove that concrete is better than bricks or asphalt. Guess what? It is up to the scientists to prove or disprove scientific aspects, not some backyard vitamin maker that simply makes pills to FDA standards and daily values. Drug companies have money, doctors, and other scientists working for them, so you can't compare them. Nice try!!!

Look at the bolded misspelled words above. No, they're not typos (of which you have many). Also look below:

Wierd (another misspelling, along with surgury - I can' believe it either)

You're either not a med student or you just started this year (SMP). Given that you can't grasp concepts that well and that you make such egregious spelling and grammar errors, I think that your claim of 34T is not true. Maybe I could somehow live with 34 (but not really), but a T, the highest grade possible on the writing section with your orthography? I am sorry if this is not true, but the probability of trolling is pretty high. You really don't represent mainstream med school, especially with threads like "med students for life." I am somewhat relieved.

Yeah, it is time to end this argument as things are getting pretty unraveled.

 

[meister]

Some facts that I do have on hand that are straight from CDC data.

Interesting. I'm still wholly unconvinced that we can summarily assume HBV vaccine was foisted on the populace solely because of some nebulous government conspiracy, but it seems there should definitely be some peer-reviewed well-modeled studies done on the subject. And while there are certainly some risks involved with the vaccine, your statement "It was approved not based on health risks and prevention but on the fact that it would save the government money by reducing taxpayer expenses on people with Hep B." is pretty unfounded from the looks of it. I've seen absolutely nothing to conclude that, at all.

So perhaps next time instead of frothing at the mouth on a subject like it's so clear-cut and simple, you should provide actual evidence when asked after making pretty outrageous claims.

 

[Depakote]

Interesting. I'm still wholly unconvinced that we can summarily assume HBV vaccine was foisted on the populace solely because of some nebulous government conspiracy, but it seems there should definitely be some peer-reviewed well-modeled studies done on the subject. And while there are certainly some risks involved with the vaccine, your statement "It was approved not based on health risks and prevention but on the fact that it would save the government money by reducing taxpayer expenses on people with Hep B." is pretty unfounded from the looks of it. I've seen absolutely nothing to conclude that, at all.

So perhaps next time instead of frothing at the mouth on a subject like it's so clear-cut and simple, you should provide actual evidence when asked after making pretty outrageous claims.

lil bit o' info on HBV vaccination programs:
Kids:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5730a3.htm?s_cid=mm5730a3_e
Adults:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5516a1.htm?s_cid=rr5516a1_e

a note from the adverse events reporting in the second article:

Adverse Events

CDC and FDA continually assess the safety of hepatitis B vaccine and other vaccines through ongoing monitoring of data from the Vaccine Safety Datalink (VSD) project, the Vaccine Adverse Events Reporting System (VAERS), and other surveillance systems. A causal association has been established between receipt of hepatitis B vaccine and anaphylaxis (178). On the basis of VSD data, the estimated incidence of anaphylaxis among children and adolescents who received hepatitis B vaccine is one case per 1.1 million vaccine doses distributed (95% confidence interval = 0.1--3.9) (180).

Early postlicensure surveillance of adverse events suggested a possible association between Guillain-Barré syndrome (GBS) and receipt of the first dose of plasma-derived hepatitis B vaccine among U.S. adults (181). However, in a subsequent analysis of GBS cases reported to CDC, FDA, and vaccine manufacturers, among an estimated 2.5 million adults who received >1 dose of recombinant hepatitis B vaccine during 1986--1990, the rate of GBS that occurred after hepatitis B vaccination did not exceed the background rate among unvaccinated persons (CDC, unpublished data, 1992). An Institute of Medicine review concluded that evidence was insufficient to reject or accept a causal association between GBS and hepatitis B vaccination (178,182,183).

One retrospective case-control study (184,185) reported an association between hepatitis B vaccine and multiple sclerosis (MS) among adults. However, multiple studies (186--189) have demonstrated no such association. Reviews by scientific panels have favored rejection of a causal association between hepatitis B vaccination and MS (190,191).

In rare instances, chronic illnesses have been reported after hepatitis B vaccination, including chronic fatigue syndrome (192), neurologic disorders (e.g., leukoencephalitis, optic neuritis, and transverse myelitis) (193--195), rheumatoid arthritis (196,197), type 1 diabetes (198), and autoimmune disease (199). However, no evidence of a causal association between these conditions or other chronic illnesses and hepatitis B vaccine has been demonstrated (183,190,200--203).

Reported episodes of alopecia (hair loss) after rechallenge with hepatitis B vaccine suggest that vaccination might, in rare cases, trigger episodes of alopecia (204). However, a population-based study determined no statistically significant association between alopecia and hepatitis B vaccine (205).

The studies are cited in the article if you want to review them.

This would be an excellent example of evidence based medicine. Numerous studies currently demonstrate that the vaccine is safe. This gives us good reason to prescribe it. If new data gives us cause to question the above findings we will absolutely revisit our current prescribing practices and it would be negligent of us not to.

 

[masterofmonkeys]

lil bit o' info on HBV vaccination programs:
Kids:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5730a3.htm?s_cid=mm5730a3_e
Adults:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5516a1.htm?s_cid=rr5516a1_e

a note from the adverse events reporting in the second article:


The studies are cited in the article if you want to review them.

This would be an excellent example of evidence based medicine. Numerous studies currently demonstrate that the vaccine is safe. This gives us good reason to prescribe it. If new data gives us cause to question the above findings we will absolutely revisit our current prescribing practices and it would be negligent of us not to.

Every one of those studies fails to acknowledge the 10% capture rate of adverse events by VAERS. In fact I mentioned the MS study myself earlier. But what about seizure, rheumatic disease, and peripheral neuropathy, which as I've already mentioned far outnumber the reported cases of MS post Hep B vaccination?

http://www.neurology.org/cgi/content/abstract/63/5/838

Dissenting study showing an OR of 3.1 for developing MS in those who are vaccinated versus those who aren't.

 

[Tired]

Every one of those studies fails to acknowledge the 10% capture rate of adverse events by VAERS. In fact I mentioned the MS study myself earlier. But what about seizure, rheumatic disease, and peripheral neuropathy, which as I've already mentioned far outnumber the reported cases of MS post Hep B vaccination?

Straw man.

Adverse event rates always include the common reactions of injection site pain, congestion, fever, etc. You make it sound like the 10% is primarily serious reactions, but actually these are a negligible portion (and as pointed out by the CDC, usually occurs at a rate approximately equivalent to the background population).

 

[masterofmonkeys]

Straw man.

Adverse event rates always include the common reactions of injection site pain, congestion, fever, etc. You make it sound like the 10% is primarily serious reactions, but actually these are a negligible portion (and as pointed out by the CDC, usually occurs at a rate approximately equivalent to the background population).

Far less than 10% of HepB vaccinations are accompanied by an adverse event. I was referring to how many adverse events actually get picked up by VAERS. The risk of adverse events post Hep B vaccination is admittedly relatively low. The issue is that the risk of first contracting and then becoming a chronic carrier of Hep B or developing fulminant hepatitis is also relatively low.

No, i mean that it is highly unscientific to say on one hand that VAERS only catches about 10% of the adverse events that happen after vaccination, and then on the other hand report that these uncorrected figures are the same as the background population. Let me put this in concrete terms. Lets say that 10 people end up in the ED for anaphylaxis after HepB vaccination, one of them on average would be reported to VAERS as such. The CDC admits that this tends to be the case. Then it turns around and reports that there was ony one case of anaphylaxis after Hep B vaccination.

BTW, 35% of reported HepB reactions were placed in the 'serious' category.