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A cure for chiropractic

Almost 10 years ago, a thoughtful article, entitled “Chiropractic as spine care: a model for the profession”, appeared in the journal Chiropractic & Osteopathy. The authors were a group of both academic and practicing chiropractors, as well as representatives from a health insurer specializing in coverage of CAM provider services. Another article, under different authorship, appeared the same year deploring some aspects of chiropractic education. In 2008, a third article came out with a similar theme, “How can chiropractic become a respected mainstream profession? The example of podiatry.” All three are open access and worth reading. The authors are to be commended for taking on an extremely contentious subject in their own profession.

The first article is a refreshingly honest look at the current state of chiropractic. The authors note the inability of chiropractors to consistently define who they are and what they do, which results in public confusion (including among those in the healthcare industry) about just what role chiropractors should play in the healthcare system. The authors deplore the continued existence of the “subluxation” in chiropractic and it’s accommodation by no less than the Association of Chiropractic Colleges. And they thoroughly deconstruct any notion that such a thing exists. The idea that chiropractors are capable of acting as primary care physicians is given equally short shrift and debunked as well.

The article points out that, whatever the confusion among chiropractors about who they are and what they do, the public has decided on its own: the public perception of chiropractors is that of back pain specialists. Back-related problems account for over 90% of the reason patients see chiropractors. They also argue that chiropractic must embrace evidence-based healthcare and stop relying on their clinical experience, noting the many reasons (e.g., regression to the mean) that a chiropractor’s observations may be explained by something other than treatment effectiveness. They admit that the chiropractor’s stock-in-trade, spinal manipulation, might not hold up under an evidence-based standard. (A possibility that is becoming a reality.) They even quote Marcia Angel’s observation on “alternative” medicine:

There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work.

The article on chiropractic education is downright disturbing considering claims by chiropractors that they are qualified to serve as primary care physicians. Especially appalling is the lack of clinical training:

Our cumulative observations suggest that the obvious contrast in numbers of patient encounters in a chiropractic externship, when compared to a medical/osteopathic internship, are sadly disconcerting from the perspective of the volume and variety of patient exposures.

And this alarming observation:

Instruction in evidence based medicine (EBM) in American chiropractic schools also appears to be lacking.

In addition to improvements in chiropractic education, they propose stiffening chiropractic school admission requirements, which they note are the least stringent among all professional degree healthcare disciplines.

The third article holds up podiatry as a template for necessary change to chiropractic: university-based education and training, a commitment to improving podiatry education via honest analysis of its weaknesses (including a Flexner Report-type analysis), collaboration with (not rejection of) medical doctors, commitment to public health (including proven public health measures like vaccination and fluoridation), and acceptance of a niche patient population (people with foot problems).

So why has nothing happened?

Summarizing all three articles, their solution is a professional model of chiropractic as portal-of-entry provider of “spine care,” improvements in chiropractic education, ridding chiropractic of the “subluxation,” acceptance and promotion of evidence-based healthcare, a conservative clinical approach, chiropractic as an integrated part of the healthcare system, and implementation of accepted standards of professional ethics.

As far as I can tell, their suggestions have been ignored by the chiropractic profession. This is due, at least in part, to a fatal flaw in their plan:

[T]he Spine Care model is completely consistent with current state licensing.

I’m afraid not.

As pointed out in an informative article by a physical therapist (also well worth reading) writing about the chiropractors’ incessant attempts to claim (falsely) that chiropractors alone have education and training to perform spinal manipulation:

In effect, the subluxation construct was and remains to this day central to the legal definition of chiropractic, its scope of practice, and reimbursement for chiropractic services, no matter how many factions within the profession decry defining the profession based on this outdated 19th century construct.

My own review of the 50 chiropractic state practice acts agrees with this conclusion.

The physical therapist notes that chiropractors have expanded the subluxation definition (while keeping it equally nonsensical) over the years, thereby automatically expanding the chiropractic scope of practice, as well as opportunity for insurance reimbursement, without ever having to amend the chiropractic practice acts. The subluxation is, quite conveniently, whatever they say it is.

(I’ve even wondered whether the chiropractic practice acts could be challenged in court on the basis that they exceed the state’s police power, that is, the power to regulate for protection of the public health, safety and welfare, reserved to the states via the Tenth Amendment to the U.S. Constitution. Certainly, allowing baseless diagnoses and treatments hardly meets this protective purpose. But we’ll leave that for another day and more research.)

Despite the widespread recognition that chiropractic desperately needs reform, after a search of both PubMed (which indexes a number of chiropractic journals) and the legal literature, I could find only one article discussing the need to amend the chiropractic practice acts to address this pressing problem. (In this journal, although the article, “Note: Adjusting the Role of Chiropractors in the United States: Why Narrowing Chiropractor Scope of Practice Statutes Will Protect Patients,” by Peter Morrison, is not available on online without a subscription service.) To his credit, the author recognized the need to rid chiropractic of the subluxation via reform of the chiropractic practice acts, although he did not make specific suggestions for statutory language.

If there is a movement afoot among chiropractors to limit their practice to the sort of model suggested in the three chiropractic journal articles, it is not evident in their current legislative efforts. Right now, for example, there is a bill pending in Hawaii that would simply default to the faulty chiropractic educational system to determine chiropractic scope of practice. And, as expected, chiropractors in New Mexico are again attempting to expand their scope of practice to include prescribing even more drugs, including dangerous drugs. (You can find out more about these bills and other unfortunate legislative efforts to expand the reach of CAM providers on the Society for Science-Based Medicine website, updated weekly. See how many pro-CAM bills are pending? Discouraging, isn’t it?)

I am not of the opinion that we necessarily need chiropractors at all. (As best I can tell, physical therapists can do everything evidence-based that chiropractors do, and more.) But I am concerned about the continued fleecing of the public with outlandish claims that the detection and correction of subluxations is not only beneficial, but necessary for good health (and so forth), forcing health insurance consumers and taxpayers to pay for unnecessary and, in some cases, frankly quack diagnoses and treatments. And yes, in anticipation of the irrelevant comments that will almost certainly appear, medicine needs reform too but for entirely different reasons. And medicine is paying attention to its problems and offering solutions, not ignoring them. Chiropractors are largely ignoring their problems. In fact, they are actively perpetuating them.

While it is all well and good to make frank assessments of the many deficiencies in chiropractic education, training and practice, the authors are not advocating for the one action that can have the most impact. In fact, they deny the need for a legislative solution. Reformers (some of whom have commented on SBM) must draft a new model chiropractic practice act and lobby for it. (Physical therapists already have a model act; see page 25.) Pick a state and start. I guarantee you will get a legislator’s attention if you, a group of chiropractors, tell him or her that the state’s chiropractic practice act is promoting quackery, not giving patients and third-party payers value for their healthcare dollar, and permitting unsafe practices. And I imagine this is one piece of chiropractic legislation that will find support in other businesses and professions, such as health and worker’s compensation insurers, employers, medical doctors, and doctors of osteopathy.

And we’re going to help you.

Here are my suggestions for the Model Chiropractic Practice Reform Act. (I’ve ventured into this territory before.) They would need to be drafted as a bill, in statutory language, a detail that can be left for later and with the help of experts in bill drafting. Reasons for the provisions follow in parentheses.

  1. Limit chiropractic scope of practice to diagnosis, treatment and prevention of musculoskeletal conditions related to the spine. (That is what they are educated and trained for, if imperfectly, and that is what their patients see them for.)
  2. Prohibit the administration, prescription or recommendation of drugs. (They are not sufficiently educated and trained to do this. And when given the privilege, they have employed it irresponsibly.)
  3. Forbid diagnosis and treatment based on the existence or clinical significance of the subluxation or any putative condition derived from the original subluxation “hypothesis.” (For obvious reasons.)
  4. Require that chiropractors practice evidence-based healthcare. (Should they be singled out among healthcare professions? Yes, because of their long history of what might be called “abuse of science.”)
  5. Require chiropractors to make clear to patients the limitations of their scope of practice and to refer all conditions outside their scope of practice to a medical doctor or doctor of osteopathy. Require a referral from an M.D. or D.O. for treatment of pediatric patients. (There is evidence that the public isn’t aware they are not medical doctors. As to pediatric patients, again, the issue is education and training, and the lack of reliable safety and effectiveness evidence.)
  6. Prohibit the sale of dietary supplements, vitamins, homeopathic products and other remedies by chiropractors to patients. (A terrible conflict of interest.)
  7. Starting in four years, require that all chiropractors applying for a license to practice have a baccalaureate degree prior to entering chiropractic college and a one-year post-graduation internship. (For the reasons stated in the journal articles.)
  8. Form a commission consisting of academic and practicing chiropractors, medical doctors, osteopathic physicians, and university-based academics who specialize in spinal anatomy, physiology and neuroscience. Chiropractors should choose their members and M.D.s and D.O.s should choose the rest of the group. This group should meet and in two years have recommendations ready for further amendments, if necessary, to the chiropractic practice act to ensure the health, safety and welfare of the public. This should include the administration of additional testing and post-graduation internship requirements prior to being licensed by the state. There should also be some mechanism for continued monitoring of how the new law is working.
  9. Require the state chiropractic board to issue regulations in accordance with the chiropractic practice act, as amended, within a specified period of time. (No foot-dragging allowed.)

There is certainly room for improvement in these suggestions. But someone has to start somewhere. Chiropractors who don’t like being lumped in with the subluxation or “DC as PCP” set need to step up to the plate and be proactive about reform. And without legislation chiropractors simply won’t make the sort of dramatic changes needed to bring them into the 21st century.

Posted in: Chiropractic, Legal, Politics and Regulation

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348 thoughts on “A cure for chiropractic

  1. Dave Ruddell says:

    Here is an excerpt from the Chiropractic Act, 1991 (Ontario) dealing with scope of practice:

    Scope of practice

    3. The practice of chiropractic is the assessment of conditions related to the spine, nervous system and joints and the diagnosis, prevention and treatment, primarily by adjustment, of,

    (a) dysfunctions or disorders arising from the structures or functions of the spine and the effects of those dysfunctions or disorders on the nervous system; and

    (b) dysfunctions or disorders arising from the structures or functions of the joints. 1991, c. 21, s. 3.

    Authorized acts

    4. In the course of engaging in the practice of chiropractic, a member is authorized, subject to the terms, conditions and limitations imposed on his or her certificate of registration, to perform the following:

    1. Communicating a diagnosis identifying, as the cause of a person’s symptoms,

    i. a disorder arising from the structures or functions of the spine and their effects on the nervous system, or

    ii. a disorder arising from the structures or functions of the joints of the extremities.

    2. Moving the joints of the spine beyond a person’s usual physiological range of motion using a fast, low amplitude thrust.

    3. Putting a finger beyond the anal verge for the purpose of manipulating the tailbone. 1991, c. 21, s. 4.

    It’s that last one that really gets me, for some reason.

    1. Thor says:

      I hear you, but keep in mind that the anterior sacrum provides attachment points for the piriformis, levator ani, and coccygeus muscles. In order for these to be palpated and treated manually if necessary, they must be accessed by finger insertion through the anus. Chiropractic, osteopathy, PT, and some advanced forms of massage therapy utilize this method.

      1. agitato says:

        3. Putting a finger beyond the anal verge for the purpose of manipulating the tailbone. 1991, c. 21, s. 4.

        “Chiropractic, osteopathy, PT and some advanced forms of massage therapy utilize this method.”

        Seriously? Massage via the anus?! Any citations on the frequency and efficacy of this particular therapeutic modality?

        1. Thor says:

          I practiced massage therapy as a career for 25 years. After basic massage training and licensure (Florida, as no license required in CA), I became certified in neuromuscular therapy. I personally was taught this technique and practiced it in training workshops. I never used it, though, as it is illegal in CA to go into body orifices. Not that I would even want to.

          Due to overuse of my hands, I became disabled about six years ago.
          I never subscribed to the abundance of woo-claims so prevalent in the field.
          I was a nuts and bolts, anatomy-based practitioner, and am 100% in line with Paul Ingraham (SBM editor). His site is: http://saveyourself.ca. (Disclaimer: I’m not affiliated with him in any way.)

          No citations, just some references quickly found at UG:

          http://www.coccyx.org/treatmen/manual.htm

          http://en.wikipedia.org/wiki/Neuromuscular_therapy

          1. Ingraham science is incomplete because myofascial pain and dysfunction can be treated with hands-on and leverage plus with needles. Acupuncture needles are simple and safe.

            1. WilliamLawrenceUtridge says:

              Steve, the reason why I respect Paul’s work and belittle yours (despite having numerous overlaps in several areas), is because Paul consistently refers to the scientific literature, uses it to challenge his personal experience and reconciles or discards his approaches to ongoing developments in the field. He acknowledges the tentative nature of his conclusions, and clearly illustrates where they are speculative. And for speculative health interventions, he gives a clear risk-to-benefit analysis. His opinions and writings change as new evidence becomes available.

              You selectively cite only the (old) literature that supports what you already believe, and ignore anything that inconveniently contradicts your current practice. You have fossilized at the mid-80s state of the art. You give every appearance of being lazy, self-serving and borderline exploitative of your patients.

              Acupuncture needles are simple and safe.

              Kim Ribble-Orr, Roh Tae-woo, not to mention all the people given cancer, collapsed lungs or outright killed that several meta-analyses of acupuncture have located. Acupuncture is relatively low risk, that is not the same as absolutely safe (particularly given your propensity to practice it without sterile technique, driving skin bacteria through the protective dead layers and into the living subcutaneous).

    2. Jann Bellamy says:

      Interesting — the Ontario practice act is much like some of the U.S. state practice acts. They don’t mention the subluxation specifically but are written in “code.”
      The language “a disorder arising from the structures or functions of the spine and their effects on the nervous system” is another way of describing the subluxation. It could describe a legitimate condition (I don’t know, you’d have to ask someone who understands spinal anatomy and neurology) but it definitely covers a diagnosis of subluxation. “Adjustment” is the chiropractic term for spinal manipulation directed to the (non-existent) subluxation.

    3. Robert says:

      The correct term for an osteopathic physician is a Doctor of Osteopathic Medicine. It is not Doctor of Osteopathy. This should be corrected. Happy to provide proof of this distinction if necessary.

  2. Jairo says:

    Why in point five is this recommendation?

    “Require chiropractors to make clear to patients the limitations of their scope of practice and to refer all conditions outside their scope of practice to a medical doctor or doctor of osteopathy.”

    Specifically I’m referring to the point where is recommended to refer to an osteopath and not to a orthopedic. Why is there a recommendation to an osteopath when that is considered alternative treatment.

    1. WilliamLawrenceUtridge says:

      Jairo, depending on where you are from, osteopaths are either quacks or indistinguishable from real physicians. In the United States, DOs underwent a change in practice, training and scope similar to what Jann is calling for here, in order to become essentially modern medical practitioners with a small difference in training (they are taught, and most abandon, osteopathic manipulation) and a substantial difference in history. SBM is mostly written by US authors, and hence has a US focus.

      If you’re from Canada, or the UK, or Australia, osteopaths are nutjobs and “alternative” in the worst sense of the word.

      1. Thor says:

        Even though that is the case in the US, DOs here still have the option of being quacks or real physicians. In my neck of the woods (Sonoma County, CA), there is an abundance of DO uber-quacks.

        1. irenegoodnight says:

          There are lots of MD uber-quacks as well, but I have noticed a number of DO’s offering ultra-quackish modalities in their ads that run in the publication the co-op puts out–along with chiros, acupuncturists, and many others. MD’s are in there as well, and a survey might be in order to determine which branch has the highest percentage of graduates who are able to mostly ignore their education.

          And this is in dull and (supposedly) the “common sense” midwest.

          1. Thor says:

            Absolutely! Just being an MD doesn’t get you off the hook. There is a fairly large group of “holistic, alternative” MDs here as well, using live blood cell analysis, chelation therapy, orthomolecular medicine, saliva testing, hair analysis, herbs, etc. An “integrative” neurologist even performs acupuncture and has a complete nutraceutical pharmacy right next to his office. Would make for an interesting survey.

            1. Stephen S. Rodrigues, MD says:

              Acupuncture is a viable theory but not for what you guys may think there are a lot of us MDs who use it in everyday practice. http://www.medicalacupuncture.org/Home.aspx

              Define Acupuncture and them you can study it, otherwise using the word without an idea is just plain asinine.

              If you guy stop twisting your personal opinions, biases and idea into the science methods we all could make progress.

              I’ve read @Hall’s accounts of the noble discipline and they are nonsense.

              The discipline of adjustment is valid but it gets twisted into the business of medicine which is as corrupted.

              1. windriven says:

                Rodrigues is an intellectual fraud and coward. He uses these pages to peddle his infantile delusions but refuses to confront the fact that modern medicine has changed the human condition in revolutionary ways while the quackery that he advocates only seems to ‘work’ where actual outcomes can’t be objectively measured.

                We do not have “alternative chemistry” or “alternative aeronautics” or “alternative physics” because these delusions have nothing to offer while their non-alternative counterparts have delivered everything from smart phones to supersonic flight. So too the difference between medicine and the quackery that masquerades as “alternative medicine”. I’ve offered Rodrigues untold opportunities to prove me wrong, to humiliate me with the power and majesty of his quackery.

                So far, only the sounds of silence.

            2. cloudskimmer says:

              Impressive. Speak of the MD nut jobs and in less than three hours, one shows up!

              1. Stephen S. Rodrigues, MD says:

                Thank you … I have to make sure you kids get off on the correct path. Dang too late for that — so you all have work to do re configuring your logic.

                It will be difficult but if you keep an open mind and think freely you will be enlightened.

              2. windriven says:

                Rodrigues is an intellectual fraud and coward. He uses these pages to peddle his infantile delusions but refuses to confront the fact that modern medicine has changed the human condition in revolutionary ways while the quackery that he advocates only seems to ‘work’ where actual outcomes can’t be objectively measured.

                We do not have “alternative chemistry” or “alternative aeronautics” or “alternative physics” because these delusions have nothing to offer while their non-alternative counterparts have delivered everything from smart phones to supersonic flight. So too the difference between medicine and the quackery that masquerades as “alternative medicine”. I’ve offered Rodrigues untold opportunities to prove me wrong, to humiliate me with the power and majesty of his quackery.

                So far, only the sounds of silence.

              3. WilliamLawrenceUtridge says:

                I’m still “curious” how Steve reconciles his love of acupuncture with the consistent failure to find any efficacy for anything but pain and nausea, and the fact that even for those symptoms the results are so unimpressive, it’s difficult to distinguish them from placebo.

                And by “curious”, I mean “completely unsurprised”. Steve obviously doesn’t engage with any scientific research that contradicts his personal experience, and consistently fails to appreciate just how deceptive personal experience can be.

              4. Stephen S. Rodrigues, MD says:

                “failure to find any efficacy for anything but pain and nausea,”

                Funny you should say this because this therapy is the treatment of choice for these pain syndromes:
                Acute Neck and Back Pain with or without arm or leg pain
                Chronic Neck and Back Pain with or without arm or leg pain
                Chronic pain in the neck or back might result from the same sources as noted in acute neck or
                back pain. However, many times the pain may originate from injury to the nerve tissues from
                chronic degeneration of the spine, or may continue after surgery.
                Post Herpetic Neuralgia
                Neuropathic Pain Syndromes
                Myofascial Pain Syndrome (MFPS)
                Headache — Tension Type
                Headache — Migraine
                Headache — Cluster
                Headache — Cervicogenic
                Failed Back Surgery Syndrome
                Chronic Pelvic Pain
                Facial Pain
                Spasticity
                Persistent Post Surgical Pain
                neuropathic pain
                Occipital Neuralgia
                Interstitial Cystitis
                Trigeminal Neuralgia
                Fibromyalgia

              5. windriven says:

                “Funny you should say this because this therapy is the treatment of choice for these pain syndromes:”

                Treatment of whose choice? Geese? Quacking, honking, ducks, geese and foul fowl masquerading as physicians?

                When are you going to man up and meet my challenge, punk boy?

              6. MadisonMD says:

                “failure to find any efficacy for anything but pain and nausea,”

                Funny you should say this because this therapy is the treatment of choice for these pain syndromes:

                **facepalm**

                Guys, you are discoursing with this.

              7. WilliamLawrenceUtridge says:

                Yeah, Steve, I acknowledge that there is (questionable) evidence of efficacy for pain and nausea (two symptoms, which are not etiologies, for which placebo effects are unusually strong). My whole point is – except for these symptoms acupuncture is useless, and even for these symptoms it is questionable whether the treatment is effective or whether it is the compassionate care and attention by a physician. You still aren’t curing anything, you are temporarily reducing a symptom and your customers are required to come back regularly when these symptoms return.

                So quit bragging, how ’bout? You’re a one-trick pony whose one trick will gradually be replaced by something better once these conditions are better understood.

        2. irenegoodnight says:

          What’s the point of worrying about chiropractors when we have Dr Oz? It gets nearly impossible to have a sensible discussion with a wooie when his or her first line of argument is, “well, I’ll have you know that Dr. Oz is a respected and practicing cardiologist”–(therefore there HAS to be something to it is the implied conclusion).

          I had yet another RN gushing her adoration of the Great Oz last week–she gets $55/hr for putting pills in my elderly neighbor’s med-minder pill box. She was also wearing a number of “crystals” (in the form of jewelry) that she equally glowingly gushed about giving her all the right “energy”.

          I’m (only a little) sorry to tell you that I snapped and told her off (to which she replied that I was entitled to my “opinions”). I also double-checked the pills after she left.

          1. Harriet Hall says:

            “What’s the point of worrying about chiropractors when we have Dr Oz?”

            1. We have no hope of changing anything about Dr. Oz; there is hope for reforming chiropractic if the advice of its own experts (in the 3 papers Jann cites) is followed.
            2. We should worry about everything that interferes with providing the best quality science-based medicine to patients for their individual welfare and for public health.

            1. irenegoodnight says:

              You are right, of course and my lame defense is that it wasn’t a real question–more of a frustration.

          2. RobRN says:

            RNs way into woo & alt make me sometimes ashamed to be an RN! So many who have strayed down that path (fallen over that cliff) are MSNs too. I’ve encountered RNs who see themselves and “Healers”, not members of a health care team. Many are quite into “Therapeutic Touch” & “Healing Touch” – there’s a difference, just ask them. They use terms like “other ways of knowing” and regularly vacation at Sedona where they buy crystals and meditate at spiritual vortex sites. A few obscure journals publish their “research” – the most laughable nursing study I once saw was “The effect of carbonated beverages on chakras.”

            When my wife and I cared for my mother-in-law during her last days with multiple myeloma, we observed a hospice nurse doing a therapeutic touch ritual & mantra chant over my M-I-L. After the nurse left, she said “If I’d wanted a Priest, I would have asked for one!”

            1. Stephen S. Rodrigues, MD says:

              “RNs way into woo & alt make me sometimes ashamed to be an RN!”
              Joint in the embarrassment too, being a physician who uses alternative I’m ashamed that other MDs deceive patients by not giving them full informed consent of all viable options. The AMA and RUC has a lot to do with this and most of the folks here who are narrow minded and biases.

              My definition of woo-medical procedures has changed and expanded over the past decade to include back surgery, neck, hip and carpal tunnel surgeries. (a lot more too like RA, GI and bladder meds and bladder surgery)

              Yes woo have invade traditional medicine blessed by the AMA!

              1. windriven says:

                Rodrigues is an intellectual fraud and coward. He uses these pages to peddle his infantile delusions but refuses to confront the fact that modern medicine has changed the human condition in revolutionary ways while the quackery that he advocates only seems to ‘work’ where actual outcomes can’t be objectively measured.

                We do not have “alternative chemistry” or “alternative aeronautics” or “alternative physics” because these delusions have nothing to offer while their non-alternative counterparts have delivered everything from smart phones to supersonic flight. So too the difference between medicine and the quackery that masquerades as “alternative medicine”. I’ve offered Rodrigues untold opportunities to prove me wrong, to humiliate me with the power and majesty of his quackery.

                So far, only the sounds of silence.

              2. WilliamLawrenceUtridge says:

                The amusing thing is – RobRN is ashamed because his (her?) fellow professionals ignore the empirical research and believe in nonsense.

                Steve is ashamed of his fellow professionals because they pay attention to the empirical research and don’t believe in nonsense.

                Way to miss the point Steve. One is not “narrow minded” if one asks for good evidence of efficacy before putting resources into a treatment modality. It’s called “being a responsible grown-up”. It’s called “accountability”. It’s called “integrity”. And mostly it’s called “knowing just how easy it is for personal experience to deceive”.

              3. WilliamLawrenceUtridge I can not hold your hand and spoon feed you what you should do for yourself.

                The data is not there … we need fresh updated data!!

              4. WilliamLawrenceUtridge says:

                Allow me to translate:

                “I can’t refute your point, I can’t substantiate my own, so I’m going to pretend that the problem is you are lazy.”

                If the data is not there, I’m not sure how you can justify your clinical practice.

            2. irenegoodnight says:

              Funny you should mention hospice, Rob. The nurse in my anecdote also does hospice care–where she uses the crystals and “other modalities”. I used to think hospice was a great idea, but now I think I’ll look for something else or make damn sure I have a written directive as to what is allowed.

          3. Stephen S. Rodrigues, MD says:

            Gee we agree Oz has been puppetized and mesmerized by fame and fortune and has lost sight for the good of healthcare in America.

            1. windriven says:

              Rodrigues is an intellectual fraud and coward. He uses these pages to peddle his infantile delusions but refuses to confront the fact that modern medicine has changed the human condition in revolutionary ways while the quackery that he advocates only seems to ‘work’ where actual outcomes can’t be objectively measured.

              We do not have “alternative chemistry” or “alternative aeronautics” or “alternative physics” because these delusions have nothing to offer while their non-alternative counterparts have delivered everything from smart phones to supersonic flight. So too the difference between medicine and the quackery that masquerades as “alternative medicine”. I’ve offered Rodrigues untold opportunities to prove me wrong, to humiliate me with the power and majesty of his quackery.

              So far, only the sounds of silence.

            2. WilliamLawrenceUtridge says:

              It sure would be nice if we could agree that medical interventions should arise from a sound evidence base, rather than your consistent approach of ignoring inconvenient evidence in favour of your own personal experience.

              And again an amusing hypocrisy. Oz is criticized here because he prefers sensationalism over good quality science. This causes you to condemn him. But without irony, you’re willing to charge patients money, despite good quality science suggesting your efforts accomplish essentially nothing a nice cup of tea with a friend would accomplish.

              Talk about a double-standard.

        3. Jann Bellamy says:

          I agree that pseudo-science is a big problem among M.D.s and D.O.s, and something should be done to curb what seems to be a growing phenomenon. However, while one might get ripped off, harmed even, being treated by such a practitioner, you might have a better chance dealing with someone who has had sufficient education and training in diagnosis to know when you are really in trouble and do something about it. Small comfort, I know.

          1. KillCurve says:

            I unfortunately know many scientists that, despite being very good at what they know best, exhibit profound myopia when it comes to general scientific literacy. Hence, we get these troubling chimeras of academic and scientific excellence saddled with superstition and pseudoscience (Linus Pauling as the shining example). I know a full professor of physics at a major university that believes in the miracle of Noah’s ark. I’ve worked with a number of scientists from both home and abroad that believe in astrology and other types of woo. Dr. Oz’s and Chupra’s are everywhere I’m afraid. But when it comes to human healthcare, the moral impetus to reign the woo in becomes much more urgent.

      2. James K. says:

        back when the drug trusts were helping monopoly medicine figure out how to get the over-abundance of physicians under control, the Osteopathic profession had to make compromises to avoid extermination.

        Modern Osteopaths are better than MDs i

        1. James K. says:

          … Modern Osteopaths are better than MDs in certain aspects of medical practice.

          1. Harriet Hall says:

            “Modern Osteopaths are better than MDs in certain aspects of medical practice.”
            I don’t know that that is supported by any evidence, but from my personal observations, I would tend to agree. The majority of the ones I worked with in the Air Force were very good at practical aspects and bedside manner as opposed to book learning and scientific theory.

            1. irenegoodnight says:

              Why do you think this is so? Difference in training? Difference in basic personalities? I’ve only seen one DO, and he was very nice, but that’s hardly evidence.

              1. Harriet Hall says:

                I’m not sure that it IS so. I was only reporting my personal impressions. Without knowing for certain that it is so, there’s no point in trying to explain why it is so.

        2. Stephen S. Rodrigues, MD says:

          In this respect because the DO concept was rooted in truth-medicine and hands-on patient care you can not vending machine this care and thus somewhat immune to the push-button disease.

          All we have to do is expose the already known musculoskeletal system connections to pain, illness and dysfunction than the paradigm will shift!

          1. windriven says:

            Rodrigues is an intellectual fraud and coward. He uses these pages to peddle his infantile delusions but refuses to confront the fact that modern medicine has changed the human condition in revolutionary ways while the quackery that he advocates only seems to ‘work’ where actual outcomes can’t be objectively measured.

            We do not have “alternative chemistry” or “alternative aeronautics” or “alternative physics” because these delusions have nothing to offer while their non-alternative counterparts have delivered everything from smart phones to supersonic flight. So too the difference between medicine and the quackery that masquerades as “alternative medicine”. I’ve offered Rodrigues untold opportunities to prove me wrong, to humiliate me with the power and majesty of his quackery.

            So far, only the sounds of silence.

            1. Manfred says:

              windriven is as windriven does.

          2. WilliamLawrenceUtridge says:

            If all it took to heal people, relieve illness, alleviate suffering and improve lives was simple hands-on care, human life expectancies wouldn’t have jumped several decades with the advent of modern medicine. Humans have been able to touch suffering friends and families since before we were human. This did nothing to prevent or cure smallpox, to rehydrate infants with diarrhea, to remove inflamed appendicies.

            Stephen, merely because you might be able to help with acute mechanical or referred low back pain doesn’t mean you can magically cure real disease. Meanwhile, a veding machine could indeed prevent smallpox, polio, pertussis, meningitis, cancers and more if one could purchase the correct drugs (which is dependent on a medical doctor’s understanding of the body, immune system and the nature of infectious diseases). Pretending that the musculoskeletal system is everything is simply wrong, it is hubris, and it’s just plain stupid. Like, chiropractic-stupid.

            Also, you’re pretending that real doctors don’t practice hands-on care, that they can’t refer to physios or massage therapists, that they don’t listen to their patients and know their limitations. Your entire argument is premised on error or lies.

  3. Ali says:

    “[T]he public has decided on its own: the public perception of chiropractors is that of back pain specialists”
    I was curious about it not too long ago. I was coming out of my anti-science/natural is best phase. I found an episode of Penn & Teller’s Bulls**t on alternative medicine and that cured me of that interest. Of course it wouldn’t work on someone that had already made up their mind.

    1. George says:

      Penn and Teller’s Bulls**t is a really kind of bullshit and I personally wouldn’t use it for the basis of my judgements. I’ve noticed a lot of the time they aren’t actually providing any evidence against what the other side says, or even for their own side, but are instead just using ad hominems to attack the people with a different opinion, and anecdotes to prove their point. (for example in the fast food episode they use a skinny family to prove that fast food doesn’t cause obesity, whilst never mentioning the mountains of evidence linking fast food to obesity. Same episode, the healthy side of the argument chick is listing the health risks associated with obesity and they say something like “woah we get it, she hates fat people”)
      but yeah, they don’t believe second hand smoke is dangerous or fast food is linked to obesity, to name a couple. it’s just poor research I guess.

      then again when it comes to something like chiropractors it’s pretty hard to think they’re not bullshit with any amount of research… well unless you were weighting the questions (like googling “why chiropractors work” or something)

      1. Andrey Pavlov says:

        Yeah, they are definitely much more entertainment than science and they do get a few things wrong – most notably the second hand smoke episode, which they actually admitted to finally after much prodding. Our very own Dr. Gorski has written about them and that in particular. As has Orac.

        I agree that anecdotes are not particularly strong, but they resonate with people. Quite frankly I’d rather have people start questioning their own wrong ideas through P&T’s BS than not at all. Overall they do a reasonable job.

        In regard to the fast food episode, I believe they were trying to debunk the idea that fast food in and of itself and intrinsically make you fat. That it is somehow “worse” for you than fine dining. There is a link between fast food and obesity – but it is not directly causal. It is much more complicated than that, but the real point for me (which I agree with) is that it is better to have a balanced diet in context and not just assume that “fast food = bad” and “more expensive fine dining = good.”

        I mean, come on, it is an entertainment show by entertainers who are not scientists, swear a lot, and have gratuitous nudity just for the sake of gratuitous nudity. It should be taken with a grain of salt.

        1. WilliamLawrenceUtridge says:

          Pen & Teller is kinda the opposite side of the Dr. Oz coin – you can’t trust Oz because you can’t tell (without an MD or a fair bit of background) the good information from the bad. Same with P&T – you can’t tell the good skepticism from the knee-jerk iconoclasm that they so dearly love. They definitely get some things right, but they get other things wrong.

          Skeptics are just as vulnerable to insular, reactionary protectionism (elevatorgate, Penn’s defence of climate change denialism) and claims made by skeptics require just as much proof as claims made by anyone else. We have to acknowledge that we get it wrong, and when we get it wrong.

          That’s a lot of sweet, sweet gratuitous nudity though. I’m not saying it’s my only reason to watch P&T, but it definitely helps :)

          1. Harriet Hall says:

            P&T got the second-hand smoke thing wrong because their research team misled them. They admitted they were wrong and issued a retraction. At TAM, when Penn was asked about climate change, he simply said “I don’t know.” A not unreasonable attitude for anyone who is not an expert in the area. I have friends who won’t watch his show because of the profanity, but on the other hand the language, nudity, and coarse humor attract the college frat boys who wouldn’t be exposed to skeptical ideas otherwise. There is a place for different approaches in communicating critical thinking and science facts, but there is no excuse for Dr. Oz.

  4. KillCurve says:

    An excellent article, I agree 100%.

  5. Harriet Hall says:

    Stephen Perle was a co-author on all 3 papers. He teaches in the College of Chiropractic at the University of Bridgeport. He used to be a constant presence on the Quackwatch Healthfraud list, trying to convince us that chiropractic was in the process of reforming itself. He failed to convince us then, especially since he seemed to think the “activator” instrument was evidence-based. And, as you point out, there has been no action on the reforms recommended years ago in the papers you cite.

    Chiropractors claim to be better trained and more experienced in spinal manipulation than DOs and PTs. That may well be true. Like any hands-on skill, we can assume that it takes practice. I wonder if a better solution might be to develop a PT/spinal-manipulation program that would teach the same skills under the auspices of a more reputable profession. Something like a Back Therapy sub-specialty within PT. That would have the advantage that PTs have many tools, wouldn’t feel obligated to offer manipulation to every patient, and might eventually be able to figure out if there is a subset of patients who get better results with manipulation than with other treatments (I think there may be; I have seen a patient hobble in with agonizing pain and straighten up and walk out apparently pain-free after a spinal manipulation.) After all these years, chiropractors still have no way of predicting which patients will benefit; they can only try manipulating everyone. Sam Homola used to tell patients that he didn’t know if it would work, that he would give it a try, and if they hadn’t improved after 3 treatments, he would quit.

    1. Adam Rufa says:

      Dr. Hall,

      There are already several specialization tracts in the PT profession. Manual therapy is probably the area that has the most ways to get extra training and credentials. I think the better question is, how trained does one have to be in order to be effective (assuming manual therapy is effective)? I have seen no convincing evidence that “highly trained” manual practitioners have better outcomes than a practitioner who has less training but the same degree of confidence. There is obviously a ceiling effect where more training in MT does not = improved outcomes. I think that point is much lower than many believe.

      1. Harriet Hall says:

        “There is obviously a ceiling effect where more training in MT does not = improved outcomes.”

        I was trying to acknowledge the claims of chiropractors, not necessarily to endorse them. How could proficiency in spinal manipulation even be measured? I don’t think we have a way to know whether chiropractors are better than others at providing SMT. However, it does seem likely that (1) experience and practice improve skills in general and also (2) some individuals are naturally more adept and learn skills more easily than others.

        1. Adam Rufa says:

          I do realize that you were not endorsing those arguments. I think you are correct that it is very difficult to define spinal manipulation proficiency.

      2. Stephen S. Rodrigues, MD says:

        Training would be better if the mechanics of pain were exposed which is in the muscles.

        Also outcomes have a lot to do with time, effort, the health of the patients, what meds the patient are taking, family, work and social issues.

        Difficult to measure apples to apples as in the present science methods. So lets dump them and use a mix salade approach of all inclusive options personalized to each case. You can not examine the benefits of alternatives like a pill or ablation surgery.

        1. windriven says:

          Rodrigues is an intellectual fraud and coward. He uses these pages to peddle his infantile delusions but refuses to confront the fact that modern medicine has changed the human condition in revolutionary ways while the quackery that he advocates only seems to ‘work’ where actual outcomes can’t be objectively measured.

          We do not have “alternative chemistry” or “alternative aeronautics” or “alternative physics” because these delusions have nothing to offer while their non-alternative counterparts have delivered everything from smart phones to supersonic flight. So too the difference between medicine and the quackery that masquerades as “alternative medicine”. I’ve offered Rodrigues untold opportunities to prove me wrong, to humiliate me with the power and majesty of his quackery.

          So far, only the sounds of silence.

        2. WilliamLawrenceUtridge says:

          Training would be better if the causes of muscle and back pain were better understood, which is in turn based upon improved research. The thing is, Steve, even if you were onto something (which is questionable since you seem to think every single problem is due to muscle knots, despite there being myriad causes of pain, dysfunction and suffering) everything you do is based purely on personal experience. You might be right, but personal experience is so deceptive, you’ll never know. And all that carefully-built-up personal experience? As soon as it is tested, you can isolate the individual components, control for them, and produce a series of interventions that are more effective, cheaper, faster and generally better to anything you offer.

          It’s just that real doctors have been concerned with real diseases, thus underserving muscles, joints and bones to a certain extent. Which is a shame, but it’s not like it would take a miracle to fix. Just a bit of time and a good idea.

          1. Stephen S. Rodrigues, MD says:

            I noticed in you comment that you are not interested in my references.
            Not my protocols just my time and effort.

            1. windriven says:

              Rodrigues is an intellectual fraud and coward. He uses these pages to peddle his infantile delusions but refuses to confront the fact that modern medicine has changed the human condition in revolutionary ways while the quackery that he advocates only seems to ‘work’ where actual outcomes can’t be objectively measured.

              We do not have “alternative chemistry” or “alternative aeronautics” or
              “alternative physics” because these delusions have nothing to offer while their non-alternative counterparts have delivered everything from smart

              phones to supersonic flight. So too the difference between medicine and the quackery that masquerades as “alternative medicine”. I’ve offered Rodrigues untold opportunities to prove me wrong, to humiliate me with the power and majesty of his quackery.

              So far, only the sounds of ducks quacking in the marsh grass.

            2. WilliamLawrenceUtridge says:

              What references? You didn’t provide any in this comment, and the references you provided in previous comments were horribly, horribly flawed. You provided a small-n study from 1980 for fuck’s sake, as if it were the definitive word on whatever nonsense you were peddling. Plus, you’re only interested in the scientific research and references when they support your pre-existing conclusion. Whenever a reference shows up that refutes your beliefs, your reply is invariably “well, it works for me and my patients”. Meanwhile, someone gave a link to your patient ratings a while back, and even this is apparently self-deception, since your popularity only reflects repeat patients. Another website rates you as below national average. If half your patients love you, but the other half leaves in disgust, then all you’re going to see are patients willing to blow sunshine up your ass and proclaim you a deity. Your personal experience misses out completely on everybody who doesn’t come back for a second appointment because they think you are an idiot.

              I mean, do you not see how something can appear to “work” for your patients when all the ones it doesn’t “work” for never come back?

              And that’s why we think your personal experience is deceptive.

  6. Dr. Stephen M. Perle says:

    Dr. Hall

    I never said that the Activator was evidence based. Just that as a biomechanist I know it generates forces that are comparable to those produced when someone (DC, PT, MD, DO) provides a manipulative thrust. AND at the time the studies that compared mechanically produced manipulation thrusts had comparable outcome to those using manually produced manipulation thrusts. I make nor made any other assertions related to the Activator instrument. To me 200 Newtons is 200 Newtons until other mechanical parameters of the thrust are determined to be important. Which is an area of active research.

    Dr. Perle

    1. Harriet Hall says:

      I stand corrected. I apologize for mis-remembering the details of our discussion years ago. I don’t doubt that the instrument can produce a comparable force, but I understand the force is adjustable and can be much smaller, equivalent to a light finger tap. Do you have any evidence as to how often the full 200 Newton force is used in typical practice among chiropractors in the community? Activators are used by about half of chiropractors; do you think they are effective? Safer than manipulation? If the outcomes are comparable, why is anyone still manipulating?

      And while we’ve got your attention, what can you tell us about the response of the chiropractic community to the reforms you recommend? Do you think any progress has been made since you wrote those articles?

      1. Dr. Stephen M. Perle says:

        Dr. Hall,

        At its lowest level the current version of the Activator produce more force than a finger tap.

        I am not aware of any research that has investigated the parameters of how Activators are used in practice. Investigating how any healthcare provider actually uses the therapeutic interventions at their disposal is a methodologically challenging. The prevalence of actual clinical usage of Activators is unknown, what is known is that a majority of the profession owns these devices. Personally I have used them primarily for manipulation of the hand or foot.

        Social media has dramatically increased the exposure of the vocal minority in the chiropractic profession and allowed critics the luxury of being able to find with great ease targets worthy of derision. This month McGregor et al (1) published one of the most rigorous studies of the profession and found (consistent with previous research around the world) that the unorthodox represents ~19% of the profession. Despite the fact that the Internet makes it appear as if this minority is expanding exponentially it is in fact statistically unchanging over the last decade.

        Is the profession changing yes – and that makes the minority only louder.

        1. McGregor M, Puhl AA, Reinhart C, Injeyan HS, Soave D. Differentiating intraprofessional attitudes toward paradigms in health care delivery among chiropractic factions: results from a randomly sampled survey. BMC Complement Altern Med. 2014 Feb 10;14(1):51. http://bit.ly/1hBtAax

        1. Blue Wode says:

          @ Dr Stephen M. Perle

          Re the McGregor et al study, this is very telling:

          QUOTE
          “As with any investigation, this study has limitations. First, although the response rate was good at 68%, it remains unclear what practice perspectives and behaviours are associated with non-participants. Also, although the sample was randomly selected and stratified according to the number of licensed practitioners in each province, the sample represented only approximately 12 percent of practitioners from each province. As always, there is the possibility that despite the randomization scheme, a unique sample was selected, and generalizability is a possible concern.”

          Certainly, the results do seem somewhat inconsistent with the other available data:
          http://tinyurl.com/pts2ns5

          Also, the 1st 3rd 4th 5th and 6th subgroup descriptions don’t seem to exclude the unethical chiropractic element. IOW, 5 of the 6 subgroups could easily indulge in chiroquackery – (1) “Wellness”, (3) “general probs”, (4) “organic-visceral”, and (5/6) “subluxations”.

          1. Dr. Stephen M. Perle says:

            What I find is “telling” is that you believe a scientist honestly and appropriately describing the limitations of their research is “telling.”

            Further what is telling is that you read McGregor et al in enough detail to find their exposition of their limitations but not their discussion which showed that previous research has found a consistent proportion of the profession to be “unorthodox” INCLUDING McDonald’s study.

            Also telling is your irrational belief that description of subgroups within the profession should somehow account for unethical behavior. Think of the analogous situation, because some orthopedic surgeons are in the subgroup that does spine surgery don’t seem to exclude the unethical surgical element who do spine surgery on those for whom it is not indicated. There are unethical people in all professional subgroups that doesn’t invalidate or call into question the whole subgroup.

            1. Blue Wode says:

              Dr Stephen M. Perle wrote: “What I find is “telling” is that you believe a scientist honestly and appropriately describing the limitations of their research is “telling.””

              I quoted the limitations of the research because chiropractors are well known to gloss over them, just like many of them did with the Cassidy et al study – i.e. chiropractors seemed to delight in citing it as sound evidence for the safety of chiropractic, but none of them appeared to mention that the study’s authors said that the results had to be interpreted cautiously because they could not rule out neck manipulation as a potential cause of some vertebrobasilar artery stroke.

              Dr Stephen M. Perle wrote: “Further what is telling is that you read McGregor et al in enough detail to find their exposition of their limitations but not their discussion which showed that previous research has found a consistent proportion of the profession to be “unorthodox” INCLUDING McDonald’s study.

              Here’s what McGregor et al said : “The data in this investigation suggest that only 18.8% of chiropractors in Canada today define themselves in accordance with Langworthy’s original premise. This figure is consistent with McDonald’s data in the United States from 2003 [22], whereby a survey of 647 chiropractors suggested that 19.3% of practitioners could be identified in this way relative to their scope of practice.”

              If you check the McDonald survey you’ll see that it showed that 89.8% of respondents felt that spinal manipulation should not be limited to musculoskeletal conditions. Why wouldn’t that fall into the ‘unorthodox’ category?

              Dr Stephen M. Perle wrote: “Also telling is your irrational belief that description of subgroups within the profession should somehow account for unethical behavior.”

              I don’t see it as being irrational at all, especially as the integrity of chiropractors continues to be repeatedly – and justifiably – questioned. Indeed, more often than not chiropractic research is demolished swiftly by the scientific community for being flawed and/or biased and/or remarkably inconsistent with other recent data.

        2. Jann Bellamy says:

          The survey was of Canadian chiropractors, most of whom graduated from Canadian Memorial Chiropractic College, which appears to have a more orthodox orientation than, for example, Life or Palmer. I agree with Blue Wode’s comment that the groups not included in the unorthodox category doesn’t mean the others are necessarily free of unorthodox views.

          While the survey is interesting, I thought it disingenuous for the authors to compare the stratification in chiropractic to that of medicine. That we are talking about vastly different phenomena is illustrated by the two examples they offer from medicine: the original rejection of Jenner’s paper on smallpox, which occurred in 1797, and Duesberg’s claim that HIV is not a cause of AIDS, which has been widely and publicly decried by scientists, and not just in their own journals.

          Finally, even 18.8% is too much. That’s almost one in five and 100% too many. I imagine few would take comfort in a statement like “only 18.8% of medical doctors reject the germ theory of disease.”

        3. Harriet Hall says:

          ” Personally I have used them primarily for manipulation of the hand or foot.”

          I confess I know nothing about hand and foot manipulations. I’d appreciate it if you would explain what conditions indicate a need for manipulation of hand or foot, how the manipulations are done, what they accomplish, and why you choose the Activator for those cases. And how that relates to your proposed spine care model of chiropractic.

          1. Dr. Stephen M. Perle says:

            Dr. Hall,

            Manipulation has been found to be an effective intervention for various pain syndromes of the extremities. (1, 2)

            The fact that I have written about spine care as the predominate practice model doctors of chiropractic does not mean that it should or does exclude other parts of the musculoskeletal system. My sports medicine practice in NYC mostly revolved around treating lower extremity conditions. But that was a speciality. One wouldn’t call functioning as a flight surgeon as a model for what family medicine should be, would they?

            1. Brantingham JW, Cassa TK, Bonnefin D, Pribicevic M, Robb A, Pollard H, et al. Manipulative and multimodal therapy for upper extremity and temporomandibular disorders: a systematic review. J Manipulative Physiol Ther. 2013;36(3):143–201.
            2. Brantingham JW, Bonnefin D, Perle SM, Cassa TK, Globe G, Pribicevic M, et al. Manipulative therapy for lower extremity conditions: update of a literature review. J Manipulative Physiol Ther. 2012;35(2):127–66.

            1. Harriet Hall says:

              I asked you nicely to explain some things and you haven’t answered my questions. Instead, you attempt a diversion that is not even apropos.
              As a matter of fact, my practice as a flight surgeon was indeed a model for family practice. I took care of the entire families of those on flying status, I delivered babies, did well-baby care, took care of them when they were in the hospital, including the newborn nursery, did minor surgery, all kinds of preventive medicine, community health and disaster response, air evac, search and rescue, occupational medicine, environmental medicine, food facility inspections, did some teaching, and directly observed the work environment of my active duty patients by spending 4 hours a month in the air with them. I was far more of an all-round “family physician” than the FPs in the FP Clinic.

  7. Thor says:

    Thanks for your hard work on this topic. Consoling to know we have someone like you demanding a science/reality-based approach to this. And demanding change. As a career massage therapist, I have an insider’s view, and personally witnessed terribly shabby work on an ongoing basis, not to mention downright harm (malpractice) being inflicted on trusting yet hapless clients, er, I mean patients. It was not uncommon for clients of mine to present with, not only acute harm (pain, ROM limitations) from thrust manipulations, but also permanent, chronic problems, especially neck injury. Older people seemed to be more prone to undesirable outcomes. I was in the room with the patient and DC when an “adjustment” was made on her rib, breaking it in the process (why would any educated medical professional perform this action on such a delicate structure). In Florida, DCs used to be able to inject substances. A chiro colleague injected testosterone and other hormones, for example. One basic tenet is to have the person come back as much as possible, often 2-3 times per week. Homola (Dr. Hall’s reference) was admirable and the exception. Plus, most offices are loaded with items for sale, including the most off the wall stuff, sometimes from MLM schemes. I also had the privilege of working closely with PTs—a world of difference. Not much woo going on there, and generally substantially more effective treatment protocols. Most MDs are happy to refer patients to them; definitely not so to DCs. Go figure.

    1. Jann Bellamy says:

      Interesting. Your observations are in accordance with what I have heard from MDs. Why risk the woo and injury when there are other professionals who will provide safe and effective care and without the anti-MD attitude.

  8. KillCurve says:

    I have a good insider’s perspective on the field of chiropractic, and unfortunately, at least from my current vantage point, there is major backsliding towards the pseudoscientific/vitalistic foundation of chiropractic. That is why I will be leaving and publicly reporting my observations posthaste. The conservative chiro base is too influential, and I don’t see how chiropractic curricula, culture, or “scholarship” can possibly disentangle itself from the woo in the foreseeable future.

    If evidence-based chiropractors truly want to differentiate themselves from straight and mixed chirporactors, I think they will need to march under a new flag altogether. Call it chiro “plus” or something. As it stands, the profession of “chiropractic” carries just too much baggage.

  9. Thinking_Chiro says:

    Thankyou for the article. I agree with all you have said. Your 9 suggestions are valid and merit further discussion, especially in light of our Australian experiences:

    1.” Limit Scope of practice to Musculoskeletal treatmenrt and prevention.”
    The subluxationists would have us believe that this is all about a turf war to limit chiropractic. This is a load of rubbish. Chiropractors see 5-10% of the population depending on your country. Who sees 100%? A focused message on what chiropractors do would cut through the confusion and be good for the profession. It would lead to growth.

    2.”Prohibit administration, prescribing or recommending drugs”.
    This is already here in Australia. I’am not even allowed to recommend to patients that they go to the supermarket and get some panadol/tylenol etc. I actually discuss this with my patients and recommend that they see their doctor if they require them and I state “I am not allowed to recommend”. This is very important because if they are on multiple medications then any drug interactions and adverse reactions should be managed by an expert. It is also a great opportunity to communicate with the patients doctor. When I tell a doctor that it is beyond my scope of practice it does not make me look ignorant, it generates respect from the doctor.

    3.”Forbid Dx and Tx of subluxation”.
    If the research is done and it is proven then I would take it onboard. The subluxationists talk about the science, art and philosophy of chiropractic and they place a huge emphasis on philosophy. But what does philosophy mean? Coulter in this article http://www.drjnhoffman.com/coulter.pdf‎ says it all. Philosophy means critical thinking and that is what chiroractic needs, more critical self examination leading to change and progress. Medicine may have its issues, but it has an excellent culture of critical assessment and reevaluation leading to change. Thats PROGRESS!

    4. “Require evidence based practice”.
    That has already happened here with the journal Chiropractic and Manual Therapies http://www.chiromt.com/ and the association COCA http://www.coca.com.au/ and the university courses at Macquarie, Murdock and RMIT. Subluxation is not taught at these institutions except in its historical context only. Being evidence based in my practice has lead to 80% of all my new patients coming from medical referrals. Developing the trust of my local doctors took years but it was worth it. Last year we had a lot of bad press about the anti-vaccination chiropractors and their membership of the Australian Vaccination Network (AVN). Those 120 (out of 4700) chiro’s have been diciplined by the board. You need to do the same in the USA. Just look at CalJam 2014 conference and the lineup of speakers. http://californiajam.org/speakers/ The first three speakers says it all.

    5. “Inform patients of Limit of scope of practice”.
    We have had compulsory informed consent here in Australia for ALL health care providers since 2000. It MUST include diagnosis, prognosis, proposed treatment and care plan, alternative treatments available, option of doing nothing, RISKS and benefits, followed by “do you understand and sign here”. The patients are so used to it now that often I get “Yeah, yeah where do I sign” without reading it, so I explain everything! The registration board requires it and it is checked on registration every year. My professional Indemnity insurer also demands it and also checks every year.

    6. “Prohibit sale of Supplements, homeopathic remedies etc”.
    If you are fully trained in those and registered for those then fine, but it should be separate to chiropractic. Still an isue here. Although it should equally apply to doctors, physio’s etc as well.

    7. “Require Buccalaureate degree proir to chiro college and 1 year internship”.
    This is already standard here. Chiropractic is an end on masters degree following a bachelor of science (Med). The physio’s have also adopted this at several universities. Macquarie University was the first in the world to do so. The internship is also standard here for chiro’s and physio’s although it is part of the final year for both. Not post grad.

    8. “Board with Chiro’s MD’s, academics and patient advocates”.
    This is also already here. There use to be state boards for all professions but this was combined into a single national board several years ago. Australian Health Pratitiioner Regulation Board http://www.ahpra.gov.au/ Does this mean that all is rosey. Not by a long shot, but it is moving in the right direction.

    9. “Boards regulating Chiropractic Practice”.
    Again AHPRA is working on it. Their recent statement on social media, patient testamonials, code of conduct etc was most welcome. The $10,000 fine for breaches from next month was also fantastic. Hope they start enforcing the rules. Will wait and see!

    Having said all that, the subluxationists have not been gagged and institutions like the Australian Spinal Research Foundation (ASRF) and The University of Central Queensland still promote it. This recent blog covers all the issues we have with the ASRF. http://theroguechiropractor.wordpress.com/

    I have spent decades gaining the trust of doctors and I now work closely with doctors in a medical centre. Health is the ultimate team sport and the sooner the subluxationists realise this the better. Chiropractic is not a “one stop fix all shop”.
    The Danish model is the way to go. All chiropractors contributing to a research fund and working with doctors. They are now taken seriously and are producing some good research.

    1. Andrey Pavlov says:

      I am copy-pasting this comment purely because I see no reason to re-write it and I wanted to say the exact same thing to you as well:

      As a physician and someone who has written a lot about how chiros are quacks and inadequately trained (for the most part, with exceptions) I just want to thank you for being the exception. I have no problem with the idea of referring my patient to anyone who I think may help my patient. I’ve recommended spa days, massages, picnics, etc to my patients because I think it would help them in many ways. The problem with chiropractic is that at base, I can’t trust them to be a chiropractor like you and I can’t expect my patient to understand the difference between you as a DC and the subluxationist as a DC. So when they leave my care for whatever reason and go to a different area, they are likely to get a different chiro who has a significant chance of being an utter quack.

      Keep working on reform from within and get things to the point where I can comfortably refer my future patients and I will. And you will get support from the likes of us.

    2. Thor says:

      I second the acknowledgement and appreciation expressed in Andrey’s comment. I didn’t mean to give the impression above that every chiropractor I’ve ever come across is absolutely woo-stricken, inadequately trained, out of their scope of practice, or causes harm. Sadly, many are and do, but not all. And most are certainly well-intentioned. It is refreshing to know that reform is taking place and that DCs, like yourself are stepping up to the plate.

    3. Stephen S. Rodrigues, MD says:

      My favorite text on manipulations is Burke it reminds me of a time when all you had was you hands, leverage and wit. Burke noted back in the 50s that the terms used to describe pathology were use to conveyed to insurance companies a name for which they could be paid and should be eliminated. They are incomplete descriptions and need to be deleted.

      I have found that this disciple has been infiltrated by profits, business, high technology and quick fix mentality. Thank goodness it was already grounded in the truth for which it will remain.

      1. windriven says:

        Rodrigues is an intellectual fraud and coward. He uses these pages to peddle his infantile delusions but refuses to confront the fact that modern medicine has changed the human condition in revolutionary ways while the quackery that he advocates only seems to ‘work’ where actual outcomes can’t be objectively measured.

        We do not have “alternative chemistry” or “alternative aeronautics” or “alternative physics” because these delusions have nothing to offer while their non-alternative counterparts have delivered everything from smart phones to supersonic flight. So too the difference between medicine and the quackery that masquerades as “alternative medicine”. I’ve offered Rodrigues untold opportunities to prove me wrong, to humiliate me with the power and majesty of his quackery.

        So far, only the sounds of silence.

      2. WilliamLawrenceUtridge says:

        it reminds me of a time when all you had was you hands, leverage and wit

        Jebus, what kind of a doctor are you? They’ve had smallpox vaccinations for over a century now, opiates for several centuries more, and you’ve been practicing with just your hands?

        Wow, you are a terrible doctor. No wonder you think everything goes back to muscles and bones, you’ve probably killed or driven off any patient with a problem that medical rather than mechanical!

    4. kschang777 says:

      The part about selling supplements should apply to EVERY type of medical professionals except nutritionists (as it’s their job) and dieticians.

      Amway’s Metagenic’s division sells ONLY to medical professionals, but apparently, NOT to nutritionists. And there are various articles on Chiro boards on “how to supplement your income with nutritional supplements”. This needs to be nipped in the bud ASAP.

      1. irenegoodnight says:

        There is NO reason for a “nutritionist” (a nebulous term) or a Registered Dietician to sell supplements. It is NOT their job. Their job is to help people develop a healthy diet appropriate to their medical condition; i.e., diabetes.

    5. kschang777 says:

      It seems Australia is dealing with the med-deniers swiftly and fairly on all fronts. Gagging AVN was a great job. If they reformed chiro it’d be a job well done indeed and a model for rest of the world.

  10. Thinking_Chiro says:

    In response to KillCurve:
    I agree 100%. Institutions following EBP and guidelines should call their degrees “Spinal Rehabilitation Chiropractic”. Help patients and doctors to sort out the ethical from the Woo and dogma!

  11. Thinking_Chiro says:

    R.E. the “Coulter Philosophy article” link. If you copy and paste it into google it comes up and works. Sorry for the inconvenience.

  12. Point 1 – agree with this whole-heartedly.

    Point 2 – absolutely agree. Definitely not trained well enough in the administration or prescription of drugs. 12×1 hr lectures (like one chiropractic school) does not train one well enough for the intricacies of pharmacodynamics or pharmacokintetics, or drug interactions.

    Point 3 – of course. You can’t diagnose a mythical entity, not recommend treatment for it.

    Point 4 – I agree in part. Should chiropractors be singled out among healthcare professions? No. Regardless of the history of chiropractic, it should be encumbent on ALL health professions that their treatments be evidence based.

    Point 5 – I don’t see anything wrong with most of it. The need for a referral from an MD (not DO in my jurisdiction) could be unnecessary if the practitioner is practicing evidence based healthcare. This would require an acknowledgement that treatment of many paediatric conditions will be similar or even identical to what a MD or PT will give for MSK conditions and not unique to chiropractic. But yes, chiros need to acknowledge their limitations. And simply saying “I’m removing nerve interference” is NOT acknowledgement of one’s limitations.

    Point 6 – I have no interest in selling these products anyway, however, many do. There is a potential conflict of interest there in prescribing a supplement (which may be unnecessary anyway) and then offering it to them as you walk them out the door. But it’s in sales101…

    Point 7 – I’m unfamiliar with US educational requirements. However, I like your idea that chiropractors must hold a one year post graduate internship. Would this internship be a paid internship, like becoming an intern at a hospital? This lack of internship could be a reason why many who attend chiropractic colleges that claim to teach an evidence based program could fall prey to unscrupulous practice owners offering “mentorship” to vulnerable new grads who are eager to earn an income and simultaneously keep their principle happy.

    Point 8 – This point may not be applicable to my jurisdiction. Sounds alright though.

    1. Andrey Pavlov says:

      As a physician and someone who has written a lot about how chiros are quacks and inadequately trained (for the most part, with exceptions) I just want to thank you for being the exception. I have no problem with the idea of referring my patient to anyone who I think may help my patient. I’ve recommended spa days, massages, picnics, etc to my patients because I think it would help them in many ways. The problem with chiropractic is that at base, I can’t trust them to be a chiropractor like you and I can’t expect my patient to understand the difference between you as a DC and the subluxationist as a DC. So when they leave my care for whatever reason and go to a different area, they are likely to get a different chiro who has a significant chance of being an utter quack.

      Keep working on reform from within and get things to the point where I can comfortably refer my future patients and I will. And you will get support from the likes of us.

      1. Andrey,
        Thanks for your comments. I appreciate that you can’t at base trust a lot of DCs where you are. It takes time to earn doctors’ trust and respect. One must maintain communication with them and work within and alongside the medical system to have any hope of ever being accepted by mainstream healthcare. This includes speaking medical language, not chiropractic jargon.
        Unfortunately, soooooo many wish to make that gap even wider than it already is.
        RC

        1. Andrey Pavlov says:

          Agreed. Hopefully there will be a day when the whole of your field leaves quackery behind and we can all work together.

    2. Thor says:

      Kudos to you as well! The “rogue” in your name says it all.

  13. Marc says:

    DCs are distinct medical speciality whose primary clinical treatment method is spinal manipulative and/or manual therapy. PTs can’t and won’t be chiropractors, although they are trying to be osteopractors. (http://www.spinalmanipulation.org/). The reform that is sought in the US has been in place in Canada for over a decade now and the fruits are blooming.

    As a Canadian DC, I do think it’s time we begin to differentiate the 2 different paths the profession is headed in North America. The Canadians are seeking and have made inroads to securing the primary conservative spine expert model. I disagree that DCs should only limit the diagnosis set to the spine, the extremities influences the spine and vice-versa. I agree that the focus should be NMSK. However, for DDx purposes the profession needs the ability to order labs and imaging. I need to know is that is LBP and fatigue or is it MM?

    We should call a spade a spade. There are problems in chiropractic and we know what it is and where it is. This paper sets the wheels in motion. There are heretical ways of practice that aren’t orthodox (mainstream). 81% of DCs despite their diversity, practice within NMSK medicine + general health. The Danish, Swiss and Canadian models are the future of chiropractic, whether the US likes it or not. University affiliations are a realty in Canada for both schools. There’s 16 active DC/PhDs doing research in universities in every Canadian province, with 19 in the pipeline. There is unity and a vision to be an integral part of every Canadian’s health care team by 2023. The tipping point is among us.

    http://www.ncbi.nlm.nih.gov/pubmed/24512507

    http://www.ncbi.nlm.nih.gov/pubmed/24512507

    1. Great comment Marc (Bronson I presume??). Thanks for pointing out. Why do you think the Canadian model is functioning so effectively? Where has the breakthrough come from?

      How would you rate the Canadian experience to say, that of Australia, where one university based program, that at Macquarie, is being shopped around to potential bidders (and if no bidder can be found, discontinued) while another course at CQU has commenced, which appears to be teaching vertebral subluxation complex as an actual entity?

  14. Thinking_Chiro says:

    In Reply to Marc:
    The next step is to get Danish, Australian, UK, US, Swiss and Canadian chiro’s and PhD’s to collaborate more. Pity you stole Simon French from us! LOL

  15. JC Smith says:

    Why is Jann Bellamy so concerned about chiropractors when the inefficiency and dangers in the medical world far exceed anything DCs pose? Methinks she continues to fish for red herrings to gain attention for herself since the state licensing boards are empower to protect the public, not her.
    Nor is the medical profession as scientific as she insinuates. Indeed, if medicine is so wonderful, why are Americans so sick and broke? Upon review, evidence now shows that much of “scientific medicine” is an oxymoron.
    New research reported in the British Medical Journal shows her stance is, in effect, a red herring argument considering 2,000 of 3,000 common medical treatments have been shown to be “ineffective, unproven, or not worth the risk.” The Washington Post revealed this startling study an article in 2013: “Surprise! We don’t know if half our medical treatments work.”
    This shocking revelation is no surprise in medical spine care treatments either as Mark Schoene, editor of an international spine research journal, admits, “Spinal medicine in the US is a poster child for inefficient spine care.”[2] In fact, Mr. Schoene was being nice because he easily could have said medical spine care (opioid painkillers, epidural steroid injections, and spine surgery) is also expensive, dangerous, disabling, addictive, and sometimes deadly as Dr. Gupta noted in his exposé, Deadly Dose.
    Allowing this medical curmudgeon to vilify CAM providers is a dubious policy considering the popularity of CAM revealed in a landmark study by Dr. David Eisenberg from Harvard’s Osher Institute that found Americans made more visits to CAM providers than MDs.[3]
    According to surveys by Dr. David Eisenberg from Harvard, Baby Boomers made 427 million office visits to CAM providers in 1990 compared to 388 million visits to MDs; the follow-up survey in 1997 revealed that the numbers to CAM providers rose to 629 million while the numbers to MDs went down to 386 million.[4]
    Dr. Eisenberg acknowledged the huge popularity of CAM when he said, “Maybe ‘alternative’ isn’t so alternative anymore.”[5]
    In this era of diversity, equality, and inclusion, the medical bigots like Jann Bellamy and Harriet Hall continue to show the intolerance in medicine that has led to the present healthcare crisis. It’s time for intelligent MDs to be concerned about cleaning up their own house, stop throwing stones at other practitioners, and let the state licensing boards do their jobs to protect the public from bad medicine.

    1. Andrey Pavlov says:

      Why is Jann Bellamy so concerned about chiropractors when the inefficiency and dangers in the medical world far exceed anything DCs pose?

      Tu quoque much?

      We do recognize our own issues and work on them. We are concerned because DC’s like yourself refuse to do the same and instead make ridiculous snipes at actual scientific medicine as if that demonstrates the validity and safety of chiropractic.

      I suggest you read your colleagues’ comments above.

      1. Blue Wode says:

        @ JC Smith

        I see you operate the website ‘Chiropractors for Fair Journalism’
        http://chiropractorsforfairjournalism.com/ (readers should keep scrolling down the link)

        Am I right in saying that you are also the JC Smith who wrote a book called ‘The Medical War Against Chiropractors: The Untold Story from Persecution to Vindication’ ? If so, Professor Edzard Ernst recently reviewed it:

        QUOTE
        “This book is focused on the unfortunate legal battle between the American Medical Association (AMA) and the US chiropractic profession. It could be an interesting historical exposé but, unfortunately, JC Smith spoils it thoroughly by his entirely one-sided, biased view and inflammatory language. Smith goes not one but several steps too far and thus loses all credibility. For instance, he repeatedly compares the ‘medical lynch mob’ to Nazis and extreme racists: ‘Just as the Nazis used the Big Lie to undermine the image of Jews, so did the AMA use its own version of the Big Lie to defame the chiropractors’ (p. 132). Elsewhere, Smith states that the actions of some medical professionals in Florida were ‘clearly reminiscent of the days of racial desegregation in the South’ (p. 179). This is a great shame, not least because the tensions between the two professions would deserve a scholarly evaluation. I suspect that a sober analysis would have put the clinical evidence in the centre; an aspect that Smith avoids almost entirely. The tensions, I fear, are not between two groups fighting over the same patients, but between one group believing in science and evidence and the other having very little more than aggressive promotion. As it turns out, this book is not an analysis of a 130-year-old conflict but provides a wealth of misguided concepts; it is also a rich source for rampantly paranoid ideas that sadly still exist in the chiropractic profession.”
        Ref: http://tinyurl.com/p3yy9bq

        And there’s another review here, this time by a former chiropractor:
        http://tinyurl.com/cke838s

        It’s plain to see what your modus operandi is.

        1. Harriet Hall says:

          I reviewed JC Smith’s book on the SBM blog over a year ago: http://www.sciencebasedmedicine.org/the-war-against-chiropractors/ I agree with Ernst: I thought the book was despicable.

    2. KillCurve says:

      “Why is Jann Bellamy so concerned about chiropractors when the inefficiency and dangers in the medical world far exceed anything DCs pose? ”

      In other words, “why bother to fight this battle when there are plenty of other battles, which, according to me, are so much more serious?” All activists get this meaningless line from apologists. If battles weren’t fought on multiple simultaneous fronts then society wouldn’t progress much. Personally I’m glad there are folks that are so interested and well studied on a variety of issues that they are willing to invest their time and experience to drive societal change in areas that might not be of immediate importance or interest to every individual in society. I am glad that doctors, lawyers, scientists, and other concerned activists pursue social agendas that they are most well equipped and motivated enough to deal with. I have engaged in activism in non-healthcare related topics and I get the same argument used here, except it might be something like: “why don’t you instead spend your time worrying about the problems of economy or something ”. This is nothing more than a purely defensive maneuver which tries to distract from point of the issue.

      The title of this blog is “Science Based Medicine”. The subtitle is “Exploring Issues and Controversies in Science and Medicine”. Ms. Bellamy’s post fits squarely within the scope of this blog.

      “Indeed, if medicine is so wonderful, why are Americans so sick and broke?”

      I can think of two major contributors offhand, both of which have to do with American lifestyles, and neither of which have to do with medical inefficiencies. Those are: terrible diets, and increasingly sedentary lifestyles. I’m sure there are many more covariates that I can’t immediately think of.

      “New research reported in the British Medical Journal shows her stance is, in effect, a red herring argument considering 2,000 of 3,000 common medical treatments have been shown to be “ineffective, unproven, or not worth the risk.”

      There are multiple reasons why citing this statement in the context you are using it for is unreasonable. 2,000-3,000 treatments that are ineffective OR unproven OR not worth the risk is a very broad statement that needs to be understood in the appropriate context. Some unproven treatments, for example, might persist because they are backed by good plausibility, are well tolerated, and have minimal side effects. At some point studies should be funded to more closely scrutinize these studies, but there may be other, more urgent uses for that money at the present time. You might be tempted to make the same argument for chiropractic as a treatment for, say–asthma, except with one important caveat: there is no good plausibility (but there ARE negative data).

      Other subjects commonly taught in chiropractic curricula, such as AK, are so absurd that they fail a basic quality control test. Basically, if your treatment/diagostic tool defies any known mechanism in physics, chemistry, or biology, it has zero plausibility, and it should be thrown out. This doesn’t take a study to show it doesn’t work, we can reason that it doesn’t work in a brief moment of reflection. And any institutions that teach this kind of fantasy should not be accredited by the profession’s accrediting body (I don’t think chiro schools in the US should be regionally accredited by the DOE either). But, it does get taught, and all chiropractic curricula under the purview of these accrediting bodies are contaminated with it.

      Again, you are basically arguing that chiropractic shouldn’t be scrutinized for
      lacking fundamental quality control simply because, well, there are other unresolved problems in the world. This is silly. The fact is, the vitalistic core of chiropractic, being detached from reality, is a public health hazard, and all the information needed to make this assessment is already out there.

    3. Sawyer says:

      Just imagine for a moment how silly this argument would look if it was used by someone in the pharmaceutical camp:

      “Why is Harriet Hall so concerned about acetaminophen when the inefficiency and dangers of opiates far exceeds any dangers Tylenol poses. Methinks she continues to fish for red herrings to gain attention for herself since the state licensing boards are empower to protect the public, not her. New research reported in the British Medical Journal shows tens of thousands patients suffering from opiate addiction.

      Allowing this medical curmudgeon to vilify Tylenol providers is a dubious policy considering the popularity of Tylenol revealed in a landmark study by Dr. John Smith from Harvard’s Osher Institute that found Americans use Tylenol for headache treatments than any other medication.

      Bigots like Jann and Harriet continue to show their intolerance for acetaminophen that has lead to the current healthcare crisis.

      Sincerely,
      a McNeil Consumer Health drug rep”‘

      This is what your post looks like to the rest of us.

    4. WilliamLawrenceUtridge says:

      Is the chiropractic profession somehow prevented from improving its own practice until medicine is perfect? How curious! I’ve never heard of such an issue being relevant in any other profession. It’s like saying “car manufacturers don’t have to make any improvements in passenger safety until airplanes pose no risks whatsoever”.

      Why, it’s almost like chiropractors are looking for some sort of excuse to avoid having to change their practice, or some sort of distraction from the flaws present in their own practices…

  16. Stephen S. Rodrigues, MD says:

    This discussion begs the question as to why we need Chiropractors, massage and PT.
    The key issue is broken muscle/neuromuscular units which causes the muscles to contract, spasm, function erratically compressing nerves and vessels leading to pain and dysfunctions.
    The treatment for this issue is myofascial release therapy which comes in 2 classes; 1. hands-on and with leverage. 2. with needle therapy as Travell/Simons and acupuncture.

    This singular issue if accepted and understood will link all of these disciplines into a therapeutic spectrum that is safe, practical and requires no technology. Also once adapted you will be able to view the body as a mass of muscles supported by a skeleton. The muscles are the active unit which generates the pain signals whereas the bones and joints are the static part and do not generate chronic pain.

    The gross discussion about the anus is valid but unnecessary because it is possible to access those muscles from out side. Again the coccyx is a static structure supported by muscles where pain lives.

    1. Thor says:

      You serve an important function as a commentator on this blog—displaying for all to vividly see what it is that the science-based medicine community is railing against. You embody that entity. I’m not quite sure why you always demonstrate how wrong and misguided you are about, well, almost everything you have written. Doesn’t embarrassment ever come up? I’m not keen on responding to you, per se,
      so this comment is for others, ones without unshakable certainty about their magical healing powers.

      Travell’s book used to be the ‘bible’ for manual therapists, acting as scientific verification for all things related to soft-tissue therapy. It is certainly one of the best illustrated anatomical books available. But, the very concept of trigger points is not settled, by any sense of the word, and their very existence is under scrutiny. For reference, see Paul Ingraham’s article on Save Yourself: http://saveyourself.ca/articles/trigger-point-doubts.php.

      Finally, what’s so “gross” about the anatomy of the human body (it seems more gross to stick needles all over it, claiming special healing powers in the process)?
      You are confusing anatomical locations, getting the term anterior confused with posterior. One can easily access the soft-tissue structures on the posterior aspect of the sacrum and coccyx. But, logic alone dictates that the only way to palpate the anterior aspect is to go through the anal opening. There is no other way to access structures which line and attach to the inner (anterior) surface of the sacrum and coccyx. I’m definitely not keen on this method, but it does have it’s place as a means for therapy when absolutely necessary, say for an injured, knotted coccygeus muscle. It is similar to massaging a hurt deltoid or trapezius—not a magic cure-all, but they generally just feel better after being massaged.

      1. Stephen S. Rodrigues, MD says:

        “Paul Ingraham’s article on Save Yourself: http://saveyourself.ca/articles/trigger-point-doubts.php.” is working on incomplete information as I have discussed in a prior post. TrPs or muscle/neuromuscular units are at the root of most chronic pain and dysfunction.

        It behoves all of you need you to complete your study. by reading Gunn, Hackett, Edwards, reread Travell/Simons, then spend a decades practicing the protocols in the real world to understand how important they are to patients in pain and dis-ease. YOU expect me to ignore the decades of work those pioneers have done for an opinion of a newbie??!!

        Most of the internal organ or deep pelvic muscle triggers can be accessed on surface points. Rarely do you need to actually touch the tail-bone via the rectum.

        1. Thor says:

          You’re one tiresome dude. You lack due diligence, reading and comprehension skills. Plus, for an allegedly academic qualification, your grammar and punctuation skills border on imbecilic. Even though I can tell how much you love this site by your eagerness to contribute incessant spewings, the only purpose I see for you is to serve as an example of everything that can go awry with human mental processes, especially when it comes to medicine and science. You verify this with every sentence uttered.

          Trigger points are simply not muscle/neuromuscular units (sic). The muscle/nerve unit (muscle end-plate) is a well know anatomical reality. Most pain in the body comes from muscles (and tendons, ligaments, fascia) and nerves. Duh.

          The alleged trigger points according to the working definition from Wikipedia are:

          “Trigger sites or muscle knots, are described as hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers”. Allegedly they refer pain to other related parts of the body, thus the term ‘trigger’. See the difference?

          Btw, I have, indeed, spent decades practicing neuromuscular therapy protocols. One of the weakest elements of them is the fact that trigger points are undetectable. We don’t know for certain that they don’t exist, but they have yet to be found anatomically, or isolated, excised and analyzed. There is no proof of their existence other than the concept itself. Similar to claims in any number of systems, such as acupuncture points, meridians, muscle testing, sacral-spinal rhythms, etc. Plus, have 10 trigger point therapists examine a person with pain and they’ll come up with 10 different locations of where the trigger point is.

          I pity the health-care consumer (patient), whom you’ve convinced (or duped) into spending their hard-earned dollars following your methods.
          You are exactly why SBM is not just needed but vital.

          1. @thor
            Excuse me I used the term muscle/neuromuscular unit to describe an entity that is in debate as to encompass all the uncertainty. I know what a trigger point is and is not and sir you seem to be lost is your definitions and clinical ability. For educational purposes I would want you to read a few text books that I have listed on the blog. The books will help to round out your knowledge of a TrPs and how to treat them. Your patients will benefit if you care to expand your mind. TrPs are not like a widget they have unique character depending on perpetuating factors. You are foolish to think of them as per your training or your personal puny thought process.
            Thank you but I have only a have tens of thousands of patient encounters of complex Myofascial pain under my belt and I truly don’t need a you making assumptions. I turly don’t give a warm brown one what you think of me, it is the data for your practice and patient care. Shake your testosterone and become enlightened and master the art of medicine or lap is the luxury of your stupidly. My concern are patients who are counting on you to help them.
            Delays in the proper therapy will allow the Trps to spread and seed into the spinal muscles and cause Spinal Segment Sentitization which is like RSD on steroids. They are counting on you. If you care not to be further educated then refer these patients to a more talented provider.

            1. windriven says:

              Rodrigues is an intellectual fraud and coward. He uses these pages to peddle his infantile delusions but refuses to confront the fact that modern medicine has changed the human condition in revolutionary ways while the quackery that he advocates only seems to ‘work’ where actual outcomes can’t be objectively measured.

              We do not have “alternative chemistry” or “alternative aeronautics” or “alternative physics” because these delusions have nothing to offer while their non-alternative counterparts have delivered everything from smart phones to supersonic flight. So too the difference between medicine and the quackery that masquerades as “alternative medicine”. I’ve offered Rodrigues untold opportunities to prove me wrong, to humiliate me with the power and majesty of his quackery.

              So far, only the sounds of silence.

            2. Thor says:

              Do you ever proof-read your comments? Again, how embarrassing.
              Your concern, compassion and care for the well-being of my clients is truly saint-like. Not only do you have magical healing powers, but a highly advanced ethical/moral stance. You’re such a deep thinker.

              PS. I’ve never heard another professional in somatic practice use the term muscle/neuromuslcular unit before. How inane to repeat the word ‘muscle’.

              1. Hmm getting somewhere.

                We know that my spelling and proofreading is C +. But my real world experience is vastly more complete, that is just the truth.

                My concern is that the patients you guys are managing may not be receiving the best care! This is due to your resistance on expanding your knowledge and insistence on believing flawed data which is leading to flawed thought processes. The especially Novella and Hall’s comments. This is harming patients which against our oath and may lead to malpractice.

                Oh, did you understand that trigger points can spread and migrate to cause even more intent pain and misery so any delays in therapy will add to their pain and suffering.

              2. WilliamLawrenceUtridge says:

                How do you know your patients are getting “the best care”? All you would see as feedback would be them returning to you, or not. And if you’re not tracking those who don’t return, you have no empirical justification for claiming universal, or even high rates of success. And if you say “they all return”, I would seriously question that. Human memory is incredibly failable. It selectively reconstructs itself in a self-justifying manner. If you self-congratulatorily claim success, your memory will actively feed you only examples and instances where you were successful, unless you are highly vigilent (or regularly refer to your records in a comprehensive manner), you will not even realize how many patients never showed up for a referral, or showed up once and never returned.

                Further, how do you know your approach is superior to the self-care recommended by Paul Ingraham, vis. a hot bath and a firm rubber ball? I self-treated with such for some nasty low back pain, and it basically went away – acutely within hours, then chronically over the course of several weeks. I am now pain-free. The cost? $5 for a lacrosse ball. What do you charge for a consultation?

                As usual, Steve, the point is that your experience, in particular your testimonials, are inadequate (and vague, and totally lacking in proof). Your few-and-far-between references are old, and hypothetical, not empirical. You are unconvincing, no matter how many times you repeat yourself.

          2. Oh yes save the writing grade for your staff or kids or wife, if you get stuck on grammar that is your choice. My suggestion is the read my authors they are more well rounded. My skills are uncovering lies, deception, bs, and narrow minded people. My goal is to help you help your patients.

            Oh I could care less about you as a person … Don’t take it personal.

            Your patients need the best care options available!

            1. windriven says:

              Rodrigues is an intellectual fraud and coward. He uses these pages to peddle his infantile delusions but refuses to confront the fact that modern medicine has changed the human condition in revolutionary ways while the quackery that he advocates only seems to ‘work’ where actual outcomes can’t be objectively measured.

              We do not have “alternative chemistry” or “alternative aeronautics” or “alternative physics” because these delusions have nothing to offer while their non-alternative counterparts have delivered everything from smart phones to supersonic flight. So too the difference between medicine and the quackery that masquerades as “alternative medicine”. I’ve offered Rodrigues untold opportunities to prove me wrong, to humiliate me with the power and majesty of his quackery.

              So far, only the sounds of silence.

            2. Thor says:

              This blog is not about grammar; I’m not stuck on grammar at all. It is endearing to read Dr. Crislip’s posts as they often contain minor grammatical errors (he’s getting much better). But you are off the charts. Your grade in English wouldn’t be a C+ but a D, as every sentence is unbelievably ill-conceived and miswritten. Your grammar, spelling, punctuation, and above all sentence structure is most times wrong. Words, both written and spoken, reveal insight into the way a mind works and one’s thinking ability. Not only are your ideas the most ludicrous expressed on this blog, with the possible exception of stanmrak’s, but so is your language. It is easy to extrapolate that your sloppy language capabilities equates with sloppy thinking. Actually, no need to assume—both are in full display. It is actually painful at times to witness.

              1. Stephen S. Rodrigues, MD says:

                Hey lets stick to the facts and not make them up!! You really lose credibility using personal attacks argument, outside of this blog. In this blog the personal attacks are a way of stimulating one’s ego. Please feel free to use my post to get a thrill. Please try not post an opinion on a comment that you have no idea of what it is, have never had it done or talked to anyone who has had it done.

                I know beyond a doubt that Acupuncture as it relates to myofascial release therapy with hands-on and with needles is not what you think and is the best set of tools in pain and dysfunction medicine.

                I also know for a fact that massage, chiro adjustment, myofascial release with leverage, trigger points, Dry Needling, Gunn-IMS, cupping, Yoga, regular stretching, Active Isolated Stretching. foam rolling, brushing, Swimming, Aqua-Therapy, Hot-tub Spa therapy, Graston Technique, Reflexology and related options, Acupressure, T-cane, Use of Cupping, Use scraping or Gua Sha, “Spray and Stretch,” Zero Balancing, traction, inversion tables and Cold Lasers when used in a well rounded therapeutic package is the best way to deal with complex pain and dysfunctions.

                Even Injection therapy with various substances; Prolotherapy, Steroid Injections and Botox will work but not for the reasons that are written in articles.

              2. WilliamLawrenceUtridge says:

                What facts, Steve? You assert, constantly and repetitively. But you provide no real facts. Your knowledge is questionable, stemming as it does from unconfirmed anecdotes. Your list of treatment modalities are mutually-contradictory, massively long, and outrageously expensive, not to mention substantially unproven. Basically what you are saying is “if I treat a patient with a series of hypothetical interventions, they get better”. Well guess what – if you treat a patient with nothing and just wait, they also get better. How do you know your laundry list of options aren’ts imply a form of entertainment while the body repairs itself in spite of your efforts?

                You don’t. And that’s rather the point.

          3. MadisonMD says:

            Shake your testosterone and become enlightened and master the art of medicine or lap is the luxury of your stupidly.

            Brilliant. Did you hear this on SNL deep thoughts, Stephen? Anyway, Thor, I really we need to shake our testosterone and become enlightened. Too funny. It is the SSR meme.

            1. Thor says:

              Yes, quite funny, doc. Yet sad at the same time, as he charges people for inflicting his deluded belief system on them in the name of ‘healing’. Actually, SSR is expediting my enlightenment process. I now know more than ever what we’re up against, and how bats..t crazy the Wonderful World of CAM is. I’m learning never to be surprised or to underestimate anti/pseudo science conviction.

        2. windriven says:

          Rodrigues is an intellectual fraud and coward. He uses these pages to peddle his infantile delusions but refuses to confront the fact that modern medicine has changed the human condition in revolutionary ways while the quackery that he advocates only seems to ‘work’ where actual outcomes can’t be objectively measured.

          We do not have “alternative chemistry” or “alternative aeronautics” or “alternative physics” because these delusions have nothing to offer while their non-alternative counterparts have delivered everything from smart phones to supersonic flight. So too the difference between medicine and the quackery that masquerades as “alternative medicine”. I’ve offered Rodrigues untold opportunities to prove me wrong, to humiliate me with the power and majesty of his quackery.

          So far, only the sounds of silence.

        3. windriven says:

          Rodrigues is a complete intellectual fraud and coward. He uses these pages to peddle his infantile delusions but refuses to confront the fact that modern medicine has changed the human condition in revolutionary ways while the quackery that he advocates only seems to ‘work’ where actual outcomes can’t be objectively measured.

          We do not have “alternative chemistry” or “alternative aeronautics” or “alternative physics” because these delusions have nothing to offer while their non-alternative counterparts have delivered everything from smart phones to supersonic flight. So too the difference between medicine and the quackery that masquerades as “alternative medicine”. I’ve offered Rodrigues untold opportunities to prove me wrong, to humiliate me with the power and majesty of his quackery.

          So far, only the sounds of silence.

          1. Stephen S. Rodrigues, MD says:

            Who are you windriven ?

            1. WilliamLawrenceUtridge says:

              Why does it matter who windriven is? His arguments are not more or less convincing merely because of his anonymity, just like your stacked log cabins of logical fallacies and unsubstantiated assertions are not more convincing merely because there is a picture next to your name.

              1. Sawyer says:

                I’ve suggested to SSR before that if he does not want to put any trust in the anonymous commenters here he is more than welcome to ignore us. This still doesn’t provide him with an iota of evidence for his beliefs, nor does it change the fact that the scientists and doctors here that do offer their credentials are making the exact same criticisms that the rest of us make.

                And his creepy obsession with us is making me far less likely to ever provide him with RL information.

              2. mousethatroared says:

                Sawyer “And his creepy obsession with us is making me far less likely to ever provide him with RL information.”

                Good Choice!

                Now SSR seems to think that you need to be an MD to have opinions on ethics and critical thinking in health care. Not so! Patients have a right and responsibility to voice their opinions, especially once they witness a doctor who engages in predatory practices, such as using misinformation and scare tactics to discourage a patient from pursuing proven therapy so as to push his overpriced placebos, as SSR did here.

                http://www.sciencebasedmedicine.org/treating-pain-psychologically/

            2. windriven says:

              I avoid telling you ‘who I am’ for the precise reason that WLU touched on above: this is not about personalities.

              This is about facts, not about the people who mount the arguments. That is how science works. The fact that E=IR remains regardless of who cites it.

              So let’s stick to the facts. Not your wishes. Not your anecdotes. Not what in your world passes for common sense. Facts. This is not Hogwarts or Narnia. There is no magic. There is evidence. There is science. If those rules discomfit you perhaps you should have a close look at your mindset and motivations.

          2. Thor says:

            Funny as hell, windriven, and completely appropriate method of responding, as every viable communication with him always goes in one ear and out the other. (At first I thought it was an input glitsch-ha.) Using this mo gives him a taste of exactly what he does—endlessly repeating the same tropes. Only yours is an accurate description/assessment while his is essentially out of touch with the real world, as everyone can plainly see. Ironic how he seems to be so devoted to reading and participating on this blog. He probably views himself as the representative, if not protector, of the CAM world-view.

            1. Did you read the textbooks?
              Are you convinced that TrPs need to be treated aggressively?

              It is amazing how a different view and experiences will alter your differential diagnosis and therapy. Yall need the help and I will continue to try expand your outlook on health care.

      2. “But, the very concept of trigger points is not settled, by any sense of the word, and their very existence is under scrutiny. For reference,” Something is there corrupting the skeletal muscles and associated nerves and driving pain and dis-ease.

        If you believe Ingraham then expand your reading to Rachlin, Gunn and Hackett,
        he, Mckay, Quintner and others all have adapted their ideas from those MDs.
        Borrowed and repackaged without all the work and efforts of those MDs.

        Ingraham should give Gunn a call, they both live in Vancouver.

        1. WilliamLawrenceUtridge says:

          Gunn is mentioned a dozen times in Ingraham’s tutorial. You can see a comprehensive list of the references used on his website here.

          How long is your bibliography?

          Your error is in claiming that you know, based on personal clinical experience, what the “something” that corrupts skeletal muscles are, and that you can treat it (and that your personal experience is a valid source of information upon which to base treatment).

          1. OMG, he must have miss a few pages in his textbook. Reading Gunn is vastly different that using Gunn’s protocols for a decade.

            Ask Gunn, email him or call him yourself!

            Gunn’s protocols are beautiful and simplistic but are labor intensive and time communing. Delays in therapy will drive pain deeper in the the molecular structures of the tissues and torment patients and that is why I’m here.

            Gunn’s discovery or awareness is the missing link.

            1. WilliamLawrenceUtridge says:

              OMG I think Paul recognizes the difficulty of treating trigger points, which is why he recommends cheap self-care over expensive doctor care while not overselling the abilities of doctors, massage therapists and even self care.

    2. windriven says:

      Rodrigues is an intellectual fraud and coward. He uses these pages to peddle his infantile delusions but refuses to confront the fact that modern medicine has changed the human condition in revolutionary ways while the quackery that he advocates only seems to ‘work’ where actual outcomes can’t be objectively measured.

      We do not have “alternative chemistry” or “alternative aeronautics” or “alternative physics” because these delusions have nothing to offer while their non-alternative counterparts have delivered everything from smart phones to supersonic flight. So too the difference between medicine and the quackery that masquerades as “alternative medicine”. I’ve offered Rodrigues untold opportunities to prove me wrong, to humiliate me with the power and majesty of his quackery.

      So far, only the sounds of silence.

  17. Dr. Demetrios Kydonieus, Chiropractor says:

    This is the biggest bunch of BS I’ve read in a while. I’ve been in practice for 26 years now and have never come close to endangering anyone or wasting tax payers’ money. Chiropractors perform a unique Healthcare service and we aren’t leaving.

    Evidence for pediatric primary care providers….helped more babies by adjusting their spines and no medical over-seer had to be there to ensure those babies vwete safe. Like to see a PT with the training and technical skills to do that. Yes chiropractic does make the body more healthy, 30 years of chiropractic adjustments and only 28 Tylenol in my body says so. Take that to your medical congressman!

    What’s the problem with SUBLUXATION it’s a word, a way to communicate or describe a condition. Get over yourselves and move on. I’ve got to go now and help people who could care less about this profession bashing. Good day!

    1. Way to go doc! These guys are lost and need to be challenged. If not they will discourage the needy away from vetted safe care. That would be malpractice for a licensed provider. A lay person can profess crap and not be liable. That is why most hide behind avatars.

      1. windriven says:

        Rodrigues is an intellectual fraud and coward. He uses these pages to peddle his infantile delusions but refuses to confront the fact that modern medicine has changed the human condition in revolutionary ways while the quackery that he advocates only seems to ‘work’ where actual outcomes can’t be objectively measured.

        We do not have “alternative chemistry” or “alternative aeronautics” or “alternative physics” because these delusions have nothing to offer while their non-alternative counterparts have delivered everything from smart phones to supersonic flight. So too the difference between medicine and the quackery that masquerades as “alternative medicine”. I’ve offered Rodrigues untold opportunities to prove me wrong, to humiliate me with the power and majesty of his quackery.

        So far, only the sounds of silence.

        1. Stephen S. Rodrigues, MD says:

          There are inherent truths in Alternatives; Acupuncture, Chiropractic medicine, integrative medicine so an open minded group of scientist would attempt to find these answers.

          A testimony is how a patient feels after a treatment is valid scientific evidence. If a patient states something benefits them while other prior options did not is the raw data for a study. Repeat, repeat, repeat the treatment and tally the results.

          A testimony about an out of body experience, a spiritual event, a dream, an hallucinogenic state or a deduction based online old stale faulty research is not. This is totally personal and can’t be duplicated, this is not science.

          You all idea of a set science equation is flawed and are leading innocent patients away from viable safe pain therapies. Law suits!!!!

          1. Thor says:

            And once again, to quote a famous saying, “So far, only the sounds of silence”.

          2. kschang777 says:

            I’m sorry, what exactly is “inherent”?

            If it’s proven via science, then it’s science-based medicine. If not, then it’s UNPROVEN medicine, or worse, woo.

            Nothing “inherent” about it.

            1. Stephen S. Rodrigues, MD says:

              Do all things have to be proven by science? YOU ALLs idea of science is flawed and is not working very well!

              How does common sense, observations, ingenuity and trial and errors factor into your definition. A dogmatic scientist or physician following the protocols of the AMA will eviscerate people’s lives!

              These people don’t concern you?

              Why do we still remove appendixes that are normal because we were sure it needed to be removed?

              Why do we still replace knee joints when a lot of them fail and have very poor outcomes?

              Why do we perform ESIs when the science has proven that they do not work and will do harm?

              I have dozens of them!

              If YOUR definitions of science can answer all of these questions why are we even in this discussion?

              1. windriven says:

                “Do all things have to be proven by science?”

                Yes, you braying burro. And if you’ll pose your questions rationally, we will happily answer them. But barking and flailing doesn’t rise to the level of intelligent questions.

                Consider this:

                “Why do we still remove appendixes that are normal because we were sure it needed to be removed?”

                What the hell is anyone to make of this? You offer no citations to suggest a serious problem with negative appendectomies. Is this, like most of your jabbering, just throwing your delusion du jour against the wall to see if anyone will pay attention?

                A recent study in the American Journal of Surgery noted:
                “There was a consistent decrease in the negative appendectomy rates from 14.7% in 1998 to 8.47% in 2007. ”

                This is how things get better in medicine. Scientifically. Studying, measuring, counting, analyzing. Not collecting anecdotes marinated in confirmation bias.

              2. WilliamLawrenceUtridge says:

                Do all things have to be proven by science?

                Uh, if you’re presenting them as effective medical treatments and if you’re charging money for them – yes, yes they do. To do otherwise is unethical.

                YOU ALLs idea of science is flawed and is not working very well!

                How so, because it doesn’t justify your personal beliefs? That’s how science works, it systematically attacks and dismantles individual beliefs, leaving behind only slightly-better-understood and -truer facts. It’s uncomfortable, it’s iconoclastic, it’s a blowtorch to precious illusions, and it’s what is responsible for the standard of living (and longevity) you enjoy.

                These people don’t concern you?

                Why do we still remove appendixes that are normal because we were sure it needed to be removed?

                Why do we still replace knee joints when a lot of them fail and have very poor outcomes?

                Yeah, medicine systematically investigates things like these so the people we are concerned about don’t have to undergo unnecessary apendectomies and knee joint replacements. Anyone unnecessarily removing appendicies and knees should be sanctioned, and real medicine is just as concerned about them as you are – which is why it continues to conduct research and publish the results.

                Also – hilarious! Your justification of practicing unproven medicine is to point to treatments that practice guidelines agree shouldn’t be done? If you consider that “proof”, no wonder you have such a skewed view of science.

                If YOUR definitions of science can answer all of these questions why are we even in this discussion?

                My definition of science doesn’t include performing unnecessary surgeries, thank you very much. This is apparently only a thing in your own deluded consciousness.

          3. WilliamLawrenceUtridge says:

            There are inherent truths in Alternatives; Acupuncture, Chiropractic medicine, integrative medicine so an open minded group of scientist would attempt to find these answers.

            What is “inherent” about them? They are all supported by dogma that has repeatedly failed empirical testing. Why are you so willing to defend approaches to health care that consistently fail to show benefits? I mean, aside from the fact that you personally charge money for them.

            A testimony is how a patient feels after a treatment is valid scientific evidence.

            If that’s how you understand science, no wonder you are consistently disappointed by it. A testimonial is barely a starting point. Patients will reliably testify that they hear the voice of God coming from their dog, that they can see their dead aunt, that they can detect water through dowsing, that their HIV has gone away. Patients are consistently wrong, as are doctors, in the absence of empirical checks on their claims. There is a reason the modalities you prefer are all in the gutters of unscientific medicine – they all rely strongly on patient testimonial as the sole evidence for their efficacy. Much like bloodletting and prayer to the god of healing Thoth did – both doctors and patients believed them to be instrumental in their recovery.

            If patient testimonials accurately reflect the realities of their conditions – this would be reflected in the empirical research. Because why would an effective treatment cease to be so once you happen to track its effectiveness using objective measures?

            But hey, I understand – you’ve got to maintain your bottom line and keep charging customers, even if what you offer is ineffective. An argument that Pfizer would be profoundly comfortable with. So, you lie to yourself and your patients.

        2. Thor says:

          Funny as hell, windriven, and completely appropriate method of responding, as every viable communication with him always goes in one ear and out his ass. (At first I thought it was an input glitsch-ha.) Using this mo gives him a taste of exactly what he does—endlessly repeating the same tropes. Only yours is an accurate description/assessment while his is bullshit, as everyone can plainly see. Ironic how he seems to be so devoted to reading and participating on this blog. He probably views himself as the representative, if not protector, of the CAM world-view.

          1. Thor says:

            Sorry for the repeat comment. This one didn’t get posted for the longest time, listed as being under moderation. Then it completely disappeared. Usually, there is no wait time for my comments. I assumed it was because of language, so I amended it (see above), replacing ‘ass’ with ‘ear’, and ‘bullshit’ with ‘out of touch with the real world’.

      2. WilliamLawrenceUtridge says:

        These guys are lost and need to be challenged

        A genuine challenge would be appreciated, particularly if published in the peer-reviewed literature where it stands a good chance of improving patient care. What Dr. Kydonieus is doing is asserting that an entity exists, despite ample evidence that chiropractors can’t agree on what it is, where it is, and its effects. This neither challenges the medical understanding of biology, disease and sufferning, nor does it help anyone find their way. It does add confusion and imprecision to what is taught to chiropractic students, and what is told to customers of chiropractors.

        Further, the care is not safe – cervical adjustments can cause arterial dissection – getting your neck cracked can lead to paraplegia or death. The fact that I use no picture and do not independently identify myself doesn’t change these facts. You are merely bringing them up to distract from the poor quality of your own arguments, and your inability to respond to the criticisms ventured of your own alleged professional practice.

    2. Dan says:

      Manipulating the spines of infants is a sickening and deplorable practice. Physical therapists ought to be applauded for not stooping to that level.

      1. Stephen S. Rodrigues, MD says:

        If this innocent maneuver is sickening and deplorable why stop here! I see failed backs weekly and these patients were deceived and abused. Where you are ready to joint forces to stop these egregious acts — let do it!

        1. windriven says:

          Rodrigues is an intellectual fraud and coward. He uses these pages to peddle his infantile delusions but refuses to confront the fact that modern medicine has changed the human condition in revolutionary ways while the quackery that he advocates only seems to ‘work’ where actual outcomes can’t be objectively measured.

          We do not have “alternative chemistry” or “alternative aeronautics” or “alternative physics” because these delusions have nothing to offer while their non-alternative counterparts have delivered everything from smart phones to supersonic flight. So too the difference between medicine and the quackery that masquerades as “alternative medicine”. I’ve offered Rodrigues untold opportunities to prove me wrong, to humiliate me with the power and majesty of his quackery.

          So far, only the sounds of silence.

    3. MadisonMD says:

      What’s the problem with SUBLUXATION it’s a word, a way to communicate or describe a condition.

      What, exactly, is the condition it describes?

    4. Jann Bellamy says:

      I viewed your “Chiropractic 101″ youtube video. You appear to be just the sort of chiropractor that makes my case for statutory reform:

      https://www.youtube.com/watch?v=J7Vf5uvRKSs

      BTW, when I took biology in the tenth grade, eggs and sperm were cells, not “half-cells” as you describe them in the video. Perhaps that has changed?

      1. Andrey Pavlov says:

        when I took biology in the tenth grade, eggs and sperm were cells, not “half-cells” as you describe them in the video. Perhaps that has changed?

        No, they are cells. They are haploid cells rather than the typical diploid cells of the rest of our bodies. I don’t have time to listen to the whole thing, but perhaps our esteemed videographer is confusing “haploid cell” for “half cell”?

        1. Blue Wode says:

          It wouldn’t be the first time that biology terminology has caused confusion in the realm of chiropractic. On page 15 of chiropractor Preston Long’s new book – Chiropractic Abuse: An Insider’s Lament – he describes how the head of the Biology Department at the chiropractic college where he studied used the word “pacific” to refer to ‘specific’ microorganisms.

          His book is an absolute must buy for anyone wanting an in-depth look behind the chiropractic facade:
          http://tinyurl.com/phebaxv

          1. kschang777 says:

            Maybe the head just have a really bad accent. :D

            Speaking of Mr. Long… when I mentioned him and his 20-item list, the other side dismissed him as “courtroom mercenary” for his various testimonials at trials, ignoring his almost 30 years as a chiropractor and professor.

            Ah, the wonders of human brain and its cognitive bias…

        1. Harriet Hall says:

          His videos are full of claims that are out of touch with reality. He believes that Innate is the order of the universe that is focused on all living things, a kind of spiritual energy that has to be communicated through a physical pathway and that knows how to handle everything that goes wrong in the body. He believes subluxations are actual bones out of place, and that the birth process subluxes babies’ necks. He believes bones out of place in the spine cause internal disorders like ear infections and colic in infants and high blood pressure in adults. He says 50% of cancers are diagnosed on routine physicals. He says every cell in your body and every molecule(!) is connected to nerves from the brain. (I defy you to demonstrate a nerve that connects a molecule to the spine.) He calls himself a chiropractic nutritionist, says you don’t get health from a pill bottle but his office has shelves full of pills. He explains cancer thusly: “We live in a polluted world and no matter how “natural” you try to live toxic things can happen. We all have different DNA and that DNA can be triggered by environmental events, so even the most natural vitamin-chiropractic person can get cancer or diseases. Chiropractic and nutrition doesn’t prevent this it just give you the best possible outcome based on your DNA.” He recommends lifelong maintenance adjustments on asymptomatic patients and claims that a chiropractic tune-up before surgery can make the body stronger so you recover better. He diagnoses subluxations by leg length differences and uses an activator instrument to push the bones back into place. He uses a Pharmanex Biophotonic Scanner to measure antioxidant levels in his patients, citing a Dr. Oz episode (the device measures only skin carotenoid levels, not overall levels of antioxidants in the body). He did refer the brain tumor patient for surgery after noticing obvious neurologic abnormalities, but it’s telling that she resisted referral for a time because she trusted alternative treatments more. He is a good example of exactly the kind of things the chiropractors who wrote the three papers on reform want to get rid of.

    5. Vicki says:

      It’s a word for a thing that doesn’t exist, at best a discarded hypothesis, like phlogiston. Why should anyone pay for you to cure demonic possession and make sure their black bile is properly balanced with their phlegm?

      The existence of a word does not imply the existence of a referent: no zoo can display a hippogriff, nor any museum its fossil.

    6. WilliamLawrenceUtridge says:

      Dr. Kydonieus,

      How do you know you have never endangered anyone, would you know if you caused a cerebral artery dissection and your patient died two days later?

      Don’t you think it is a problem that subluxations are either undefined, or have mutually-contradictory definitions depending on the chiropractor, school and document? Real doctors don’t have different definitions for the germ theory of disease, or congenital defects (unless it’s an active area of research).

      How do you know you’ve helped babies by adjusting their spines? What problems were you addressing, and how do you know their problems woudln’t have gotten better on their own?

      Does your own personal health somehow invalidate criticisms of chiropractic? If a chiropractor gets cancer, does that mean that all of chiropractic care is useless? What an odd approach.

      Why does the chiropractic profession seem so enamoured of shoddy research, and why does it consistently criticize real medicine? Why not conduct high-quality research that actually answers questions, and why not attempt to improve your own practice rathe than pretending tearing down real medicine is somehow within the chiropractic mandate?

      Good bye.

  18. Marion says:

    Wow! Mr Rodrigues regurgitates like the blind religionist he is the rhetorical talking points of EVERY scam out there.
    chiro
    accupuncture
    reiki
    sacred geometry
    anti-vax
    HIV AIDS denial
    AGW-denialism
    Holocaust-denialism
    peak-oil/finite resource denialism

    You would think that MAYBE he might at least show SOME variation by disagreeing with SOME of them, just to show that he “stands out from the crowd”, just to at least feign SOME sort of “critical thinking” or “objectivity”. But, no. He goes for every single one of these.

    1. Stephen S. Rodrigues, MD says:

      Hey lets stick to the facts and not make them up!! You really lose credibility using personal attacks, outside of this blog. In this blog the personal attacks are a way of stimulating one’s ego. Please feel free to use my post to get a thrill. Please try not post an opinion on a comment that you have no idea of what it is, have never had it done or talked to anyone who has had it done.

      I know beyond a doubt that Acupuncture as it relates to myofascial release therapy with hands-on and with needles is not what you think and is the best set of tools in pain and dysfunction medicine.

      I also know for a fact that massage, chiro adjustment, myofascial release with leverage, trigger points, Dry Needling, Gunn-IMS, cupping, Yoga, regular stretching, Active Isolated Stretching. foam rolling, brushing, Swimming, Aqua-Therapy, Hot-tub Spa therapy, Graston Technique, Reflexology and related options, Acupressure, T-cane, Use of Cupping, Use scraping or Gua Sha, “Spray and Stretch,” Zero Balancing, traction, inversion tables and Cold Lasers when used in a well rounded therapeutic package is the best way to deal with complex pain and dysfunctions.

      Even Injection therapy with various substances; Prolotherapy, Steroid Injections and Botox will work but not for the reasons that are written in articles.

      1. MadisonMD says:

        If you were trying to refute Marion’s contention that you favor scams indiscriminately….

        then you failed miserably.

      2. irenegoodnight says:

        Hey, Stephen, how about telling us where you got your claimed MD? Or does that just stand for Mad and Demented? I realize I am making a personal attack, but the evidence does seem to warrant it.

        1. Stephen S. Rodrigues, MD says:

          How would you help this patient?

          45 y/o male s/p fusion of C5-6 and L3-4 still having radicular pain from rt upper back to his radial wrist thumb and hand? He can sleep due to the pain, can’t raise his arms up to comb his hair or easily turn the steering wheel while driving. The opiates do not touch the pain and wants off of them plus they alter his concentration and falls asleep while evaluating clients.

          Meds: Pristiq 100 mg Neurontin (Gabapentin), Norco (Hydrocodone-APAP) 10/325, Flexeril and Vistaril (hydroxyzine pamoate).

          His surgeon states that his fusion looks good and can’t understand why he still has pain. The surgeon sends him to the interventional pain management team for another ESI.

          1. windriven says:

            Rodrigues is an intellectual fraud and coward. He uses these pages to peddle his infantile delusions but refuses to confront the fact that modern medicine has changed the human condition in revolutionary ways while the quackery that he advocates only seems to ‘work’ where actual outcomes can’t be objectively measured.

            We do not have “alternative chemistry” or “alternative aeronautics” or
            “alternative physics” because these delusions have nothing to offer while their non-alternative counterparts have delivered everything from smart phones to supersonic flight. So too the difference between medicine and the quackery that masquerades as “alternative medicine”.

            I’ve offered Rodrigues untold opportunities to prove me wrong, to humiliate me with the power and majesty of his quackery.

            So far, only the sounds of silence.

            1. Stephen S. Rodrigues, MD says:

              How would you help this patient?

              45 y/o male s/p fusion of C5-6 and L3-4 still having radicular pain from rt upper back to his radial wrist thumb and hand? He can sleep due to the pain, can’t raise his arms up to comb his hair or easily turn the steering wheel while driving. The opiates do not touch the pain and wants off of them plus they alter his concentration and falls asleep while evaluating clients.

              Meds: Pristiq 100 mg Neurontin (Gabapentin), Norco (Hydrocodone-APAP) 10/325, Flexeril and Vistaril (hydroxyzine pamoate).

              His surgeon states that his fusion looks good and can’t understand why he still has pain. The surgeon sends him to the interventional pain management team for another ESI.

              1. WilliamLawrenceUtridge says:

                How would you help this patient?

                I wouldn’t try to diagnose someone over the internet.

              2. Stephen S. Rodrigues, MD says:

                Acupuncture, myofascial, needle therapies are not given the proper opportunity to prove effectiveness.

                If that happens … healthcare will survive.
                If not, it will implode under the weight of all the deceptions.
                YES, I have a crystal ball.

              3. windriven says:

                Rodrigues is an intellectual fraud and coward. He uses these pages to peddle his infantile delusions but refuses to confront the fact that modern medicine has changed the human condition in revolutionary ways while the quackery that he advocates only seems to ‘work’ where actual outcomes can’t be objectively measured.

                We do not have “alternative chemistry” or “alternative aeronautics” or
                “alternative physics” because these delusions have nothing to offer while their non-alternative counterparts have delivered everything from smart

                phones to supersonic flight. So too the difference between medicine and the quackery that masquerades as “alternative medicine”. I’ve offered Rodrigues untold opportunities to prove me wrong, to humiliate me with the power and majesty of his quackery.

                So far, only the sounds of ducks quacking in the marsh grass.

              4. WilliamLawrenceUtridge says:

                Acupuncture, myofascial, needle therapies are not given the proper opportunity to prove effectiveness.

                Steve, acupuncture has been the subject of over 3,000 separate research studies. How is that not sufficient to prove effectiveness? And you’re missing the point – research tests effectiveness, it doesn’t prove it. Saying “prove” assumes that the intervention is effective and the testing is just a rubber-stamp. Which, unsurprisingly, misses the point.

                If acupuncture and needling are so effective, why does the scientific research so consistently fail to find evidence of effectiveness?

            2. Stephen S. Rodrigues, MD says:

              Show me who you are and we’ll have a debate on FB!

              1. windriven says:

                Nothing to debate, Steve. I’ve put up my ten. You put up yours.

                This isn’t about personalities – it is about facts. You show up here waving your hands and repeating – ad nauseum, I must say – the same crap, over and over and over.

                New flash: repeating a lie does not make it true. Josef Goebbels proved that repetition will convince the weak-minded. But you won’t find too many of those here.

                Medicine has, for the umpteenth time, remarkably changed the human condition in just the past 50 years. Acupuncture has supposedly been around for centuries and it has changed NOTHING.

              2. Stephen S. Rodrigues, MD says:

                “Acupuncture has supposedly been around for centuries and it has changed NOTHING.”

                Hand-on and needle care will be a part of our system PERIOD. It is fact. Science zealot who are dogmatic and only care about the profits margins are holding things back.

                That is because we can not accurately determine which appendixes to remove, we think we can fix defects on an MRI to treat pain and forget that common sense should trump science if the data disproves something that was FDA approved.

                Modern medicine and it’s methods has dramatically improve lives in ER and catastrophic care — but it has also failed to keep what was working in an attempt to quick fix pain.

              3. windriven says:

                Quack, quack, quack, quack, quack.
                .
                Another SSR incoherent spasm of idiocy:

                “That is because we can not accurately determine which appendixes to remove, we think we can fix defects on an MRI to treat pain and forget that common sense should trump science if the data disproves something that was FDA approved.”

                What the hell is that mess even supposed to mean? You have mashed together appendicitis dx, MRI to treat pain(?!), common sense trumping science, and the FDA all in one sentence.

                How many SSRs banging on a keyboard would it take to produce one coherent sentence?

              4. WilliamLawrenceUtridge says:

                Hand-on and needle care will be a part of our system PERIOD. It is fact. Science zealot who are dogmatic and only care about the profits margins are holding things back.

                Why would you claim this, on what evidence base?

                How do you account for the consistent failure of acupuncture to demonstrate any signficant benefits in well-controlled research?

                Why do you claim that mainstream medicine doesn’t practice hands-on care, particularly when referal to physiotherapists and massge therapists is routine?

                Modern medicine and it’s methods has dramatically improve lives in ER and catastrophic care — but it has also failed to keep what was working in an attempt to quick fix pain

                Yeah, that’s kinds the issue, isn’t it? You think that because you can fix pain (which is debatable, even horrific low back pain gets better without treatment) that somehow validates all the things that you do, and invalidates everything real medicine does. Well, if you can demonstrate that your approach indeed works to improve pain better than usual care or watchful waiting, then it will become medicine. But you don’t bother trying to demonstrate it, you just insist you’re right and that the number of appendectomies that occur every year somehow proves it. A curious assertion.

  19. kschang777 says:

    I like the idea of reforming Chiro. It seems a lot of more “choosy” patients already know how to pick the “right” chiro… those with a MSci (Chiro) and a DC. Any one else is likely a charlatan.

    Though seems DCs are out there fighting a PR campaign too, claiming they are trained at least as much as most med school graduates (if not more), minimum of 4200 hours of education, blah blah blah, and need to pass the national exam by ACA.

  20. Thinking_Chiro says:

    To make a summary of all the posts above.
    Subluxationists are into the science, art and philosophy of chiropractic with a big emphasis on philosophy. Philosophy means “critical thinking” and that is all too often in short supply within the chiropractic profession. Medicine has a great culture of critical thinking leading to reassessment and change. Does medicine have some huge issues, Absolutely, but they have a culture of critical self examination.
    In chiropractic we should be celebrating our critical chiropractors, not accusing them of disloyalty and high treason.
    This is the future of chiropractic:
    http://www.danskkiropraktorforening.dk/English/Chiropractic-in-Denmark/
    This is not the future of chiropractic:
    http://californiajam.org/
    It comes down to Science and critical thinking versus Spizz!

    1. Stephen S. Rodrigues, MD says:

      I’ve looked at both sites and I see are a fun way to educate and a conservative way … both can be effective or ineffective.

      Chiro works has been around since the beginning of time and it works! Plain and simple! Once you really squeeze out what it is actually doing is a paraspinal stretch which resets all those little rotors of the vertebra. Vital to complex pain therapy as per Edwards.

      The problems arise as to who will pay and who will profit — IMO the insurance companies will fare well and patients will benefit if this is covered in first line pain and wellness care. Even without co-pays or co-insurance — a few pennies upfront will save dollars.

      1. windriven says:

        Quack, quack, quack, quack…

        Honk, honk, honk, honk.

        1. Stephen S. Rodrigues, MD says:

          LOL how would you help the case of the day?

          1. windriven says:

            SSR: “Chiro works has been around since the beginning of time and it works! ”

            I guess that in what passes for your mind, time began in 1896. I guess that also makes you a (VERY) young earther.

            Seriously, do you ever think before you write? Some of the stuff that you say is so crazy that I really have to wonder if you are all there.

            1. Stephen S. Rodrigues, MD says:

              Sorry u r getting trapped in the word and need a translation.

              Tissue and joint/spinal manipulations-adjustments have been used since humans have evolved in the treatment of illness.

              1. WilliamLawrenceUtridge says:

                Tissue and joint/spinal manipulations-adjustments have been used since humans have evolved in the treatment of illness.

                Absolutely true. Many things have been used to treat illness, it’s just that most were ineffective. Tissue, joint and spinal manipulations have some limited utility for musculoskeletal complaints, and that’s that. They are also of questionable utility in many cases, and over the long term achieve outcomes that are indistinguishable from simply doing nothing. What does this suggest to you?

            2. WilliamLawrenceUtridge “most were ineffective. “ Totally or partly ineffective treatments from the past is actually what we have to deal with today. Have you heard of the NNT/NNH?

              What do you mean “doing nothing?” That is the treatment of choice for a lot of ailments we see today. The body recovers from a lot of illness all by itself while doing nothing; an infection, a laceration, and abrasion, food poisoning, headache, dizziness. You know “doing nothing” is a loaded statement! In most illnesses, folks will not go to the doctor but instead go to the druggist or use a home remedy for comfort. What do you call this natural event?

              Some providers will “do something” when “doing nothing” is the treatment of choice to streamline patient flow or get patients to follow up for the sake of a business opportunity.

              Musculoskeletal aches, pains and stiffness will go away all by nature in time. The issues is how modern medicine will insert an MRI (2 grand)and blood test (1 grand) in the equation for the sake of a business opportunity. Today, I call that waste, fraud and abuse. I have had patients bring in envelopes with ½ inch of films for a simple piriformis muscle syndrome (none of the prior providers did not bother to do a palpation examine) which only needs a tennis ball. What do yall call this medicine? Good or bad?

              Patients need to be empowered with health care matters so they can uncover providers who over treat and who order unnecessary tests and scans for the sake of a business opportunity. Hey that is a good idea! Actually, I have been audited many times by chart, by investigator and by clandestine surveillance (my patients tell me). It is a hassle but I think more needs to be done in the areas of pain and pain treatments.

              1. MadisonMD says:

                Dude, what is the NNT for acupuncture?

      2. WilliamLawrenceUtridge says:

        Vertebrae have rotors? Can I use them to drive a boat?

        1. Stephen S. Rodrigues, MD says:

          :) add an a.

          Now that you know about those muscles use that knowledge to help someone in chronic pain.

          Or just be happy in your own blissful oblivious ignorance.

          1. windriven says:

            Rodrigues is an intellectual fraud and coward. He uses these pages to peddle his infantile delusions but refuses to confront the fact that modern medicine has changed the human condition in revolutionary ways while the quackery that he advocates only seems to ‘work’ where actual outcomes can’t be objectively measured.

            We do not have “alternative chemistry” or “alternative aeronautics” or
            “alternative physics” because these delusions have nothing to offer while their non-alternative counterparts have delivered everything from smart

            phones to supersonic flight. So too the difference between medicine and the quackery that masquerades as “alternative medicine”. I’ve offered Rodrigues untold opportunities to prove me wrong, to humiliate me with the power and majesty of his quackery.

            So far, only the sounds of ducks quacking in the marsh grass.

          2. WilliamLawrenceUtridge says:

            I wouldn’t try to help someone in chronic pain, since I realize my limitations. I would suggest they talk to a doctor and possibly a physiotherapist. Or massage therapist. Or take a hot bath and use a rubber ball to work on muscle knots. But mostly I would listen sympathetically since I am not a doctor and don’t have the arrogance to assume I know how to fix them.

            1. “arrogance to assume I know how to fix them.”

              That is what this site seems to be promoting is the same mechanical materiel dogmatic medicine.

              1. WilliamLawrenceUtridge says:

                Again you use “dogma” when what you really mean is “evidence”. There is astonishingly good evidence that people are essentially wet, messy meachines. While those machines are governed by, and can enact feedback on, the cerebral and perceptual processes found therein, one does not need to violate Occam’s razor to help people.

                Me pointing out that your confidence is unjustified is not dogma, you moron. You holding to your confidence in the presence of contrary evidence – that is dogma. You’ve got it completely backwards.

            2. WilliamLawrenceUtridge This is an interesting set of thoughts!!
              I’m doggett about what works (NOT dogmatic) for complex chronic pain. I do have certain truths that I follow that are — well true. I will hold on to them until I discover they fail future scrutiny. These truths are kinda like rules because they follow the 1 to 1 effect at a very high percentage. These truths are revisited frequently and may or may not become a “law of nature” which are unbreakable.
              Here are a few; (you have to accept the metaphysical)
              If the human body is injured or ill, nature will heal or the body will die. (Innate healing)
              Chemicals, pills, potions and the surgical blade can not heal but can only assist innate healing.
              Pain that can not be found with a scan or test, still has to be treated with Therapy.
              Chronic pain has the potential to spread to distant regions of the body and deeper to the bone.
              The human body is NOT a static machine!
              The human body is NOT wet and messy.
              The human body is more complex that a human mind can ever comprehend.

              1. WilliamLawrenceUtridge says:

                Science is not about “truths”, which have the appearance of being unquestionable and eternal. The fact that you adhere to “truths” is pretty much why you are not taken seriously. You do not give consideration to the flaws and dangers of your practices, and you do not consider whether what you are doing works beyond placebo.

                Your “truths” are a mish-mash of innane buzzwords, simplifications, facts and falsehoods. Not to mention – quite physical for the most part. Despite your attempts to portray medicine as dogmatic, it recognizes most or all of these issues as existing problems and topics for future research.

                Also, you’re a naturopath, your profession is inherently irrational and antiscientific. Your care provides nothing that is not redundant or unsupported.

  21. Sharon says:

    Lots of controversy in this article Jann, kind of busy now but I’ll come back and read it.

  22. Sean Duggan says:

    So… perhaps this is a question more appropriate for cult deprogramming, but what do you do to convince others who’ve bought into it? My wife goes to a Dr. [REDACTED] in the area on a weekly basis and has recently upped it to two visits a week after he managed to convince her that it would help her migraines. He’s got all of the hallmarks of one of the bad practitioners from using “subluxations” to describe the terms to offering infant neck cracking to peddling supplements (he even tried to suggest “Airborne” because it “boosts the immune system”, and agreed cheerfully when I pointed out that the symptoms of a cold are due to the immune system reaction in the first place, and anything that “boosted” it would just result in people getting sicker… I’m not sure if he really heard me) to claiming that her joints, and even her vertabrae, have “popped out of place” and need to be “pushed back” and that the louder popping of her neck each time is good news because “that means it’s working better”. I’ve posted here before about his practice of waiving fees when the insurance-allowed number of sessions per year are met and I believe it was Dr. Hall that pointed out that this practice is technically illegal. Problem is, my wife thinks he’s a wonder-worker.

    I’ve done my best. I’ve pointed out the statistics on strokes via neck manipulations. I’ve pointed out that his use of the term “subluxation” suggests that he’s doing the equivalent of a doctor referring to the vital humours when deciding on medicine. I’ve suggested trying a physical therapist, but she apparently had a bad interaction with a PT in the past, and fails to see the difference between a PT and a D.C. since “they both do the same thing”. Sadly, my attempts to use science to explain why “adjustments” don’t work have backfired horribly. My wife, God bless her, was never given any advanced science classes in school, so my attempts to explain things scientifically led to accusations that I was just trying to make her feel dumb. From her point of view, she has less pain going to these sessions, and given how subjective it all is, I have a hard time supporting my claim that it isn’t helping her (frankly, her migraines seem to be getting worse, not better, which really scares me given the neck manipulation going on). No matter how bad the pain works, it’s like that old saw about the woman given the wrong medicine for her cat during air travel, “Thank goodness you gave me that treatment, Doc. It would have been a lot worse otherwise!”

    So, what do I do? I feel like I’m stuck in a losing position. I can either speak up, and look like the guy complaining that she’s getting “help” or I stand by and fear for her every time she comes back from an adjustment session.

    1. MadisonMD says:

      I don’t think you can do much. Your wife has to make her own choices and you have to love her.

      Perhaps you can talk to her about critical thinking in areas that don’t cause cognitive dissonance– e.g. the story of N-rays or stories of quackery. Once she develops/strengthens critical thinking skills, she can apply to her chiropractic experience. But this might not work. So long as she does not put herself in danger you can register your disagreement but, I think, will have to accept.

    2. mousethatroared says:

      @Sean DugganSC – It’s a difficult situation. I agree with MadisonMD – you’ve given her information, now, as an adult, she has to make her own decisions. My husband used to try to encourage me to be more healthy, exercise more, eat more home cooked meals and I finally had to tell him, “Just stop! I need to do things in my own way and time.” Somehow doing something for someelse just nixes my motivation. Often, if a person feels pressured they tend to dig in their heels and defend their turf.

      Once the pressure is off for a while it may be easier to draw a line at some things that is most problematic, like chiropractic pediatric care or choosing an alternative treatment over conventional for something more dangerous like asthma or diabetes (just examples).

      If you have been having a lot of conflict over treatment, now is not a good time to bring it up with her, but if your wife hasn’t already journaled her migraines it might be helpful for her at some point. Some people have triggers that can be identified that way. My sister discovered that her triggers are red wine and a change in sleep schedules. It might (or might not) also show her something about her chiro treatments.

      Best of Luck!

    3. Andrey Pavlov says:

      Sorry to hear of your plight Sean. MadisonMD and MTR covered it well. The only thing I would add is to make sure and frame all of your discussions clearly and explicitly from the perspective that you are genuinely concerned, you only want the best for her, and that is not about being right or wrong, but that to the best of your understanding you are concerned that this will ultimately be harmful for her at the end. Basically, tell her the truth – you don’t have anything personal against this (or any) chiro, but that out of love for her you sought the best possible information and, as best as you can figure, it shows she is not doing anything effective and possibly dangerous.

      Focus in on tangible things that both of you can agree on. Ask her to help you feel better about it by logging her migraines and being objective about whether it is actually helping her. If it is then perhaps the benefit (in the short term) outweighs the risk. If it isn’t and she is just deluding herself having her realize it is the way to go. Ask her to explain why she thinks he is helping and ask her if she can think of anything that would change her mind.

      And yes, some waiting may be required to let it all sink in and give her an opportunity to think about it. Make it clear she doesn’t need to answer on the spot. And just gently nudge her to doing something more objective and encourage critical thinking.

      Best of luck!

    4. WilliamLawrenceUtridge says:

      One thing to consider is ensuring that chiropractic is truly complementary – ensure that she is seing a real physician, ideally also a specialist in migraines, to make sure it’s not something serious. While chiropractic has the potential to cause serious adverse outcomes (notably cervical artery dissection), this is a low-likelihood event on an individual basis. More important is ensuring that she is otherwise healthy. And over the long term, with a good physician she trusts, she might improve through conventional care, thus obviating the need for a chiropractor.

      It’s mostly intellectually dishonest money-wasting, the risks in absolute terms do exist, but are pretty low. But it shouldn’t be an alternative.

  23. Ryan N says:

    My language for the update would be as follows:

    1. Making medical claims about the nature and effectiveness of chiropracty without a medical degree and subject to all the limitations that implies, shall be illegal.

    You really only need one bullet for that.

  24. ste5e says:

    Let’s leave all the whys and wherefores behind.

    ANY MANUAL THERAPY FOR ACUTE BACK PAIN IS NOT EFFECTIVE.

    http://www.ncbi.nlm.nih.gov/pubmed/24480940

    “Of 84% acute pain variance, 81% was from non-specific factors and 3% from treatment.”

    Manual therapy accounts for 3% of the variance of the improvement. What mug is going to pay for something that will account for a three per cent improvement?

    This paper has been discussed nicely over at BiM.

    http://www.bodyinmind.org/spinal-manipulative-therapy-a-slow-death-by-data/

    Let’s stop the argument about which manual therapy for acute back pain is best. The question has an answer. None.

    Kind thoughts,
    Steve

    1. Stephen S. Rodrigues, MD says:

      I don’t care much for meta-analysis studies they are not useful in the clinic. I would want to know how the adjustments were performed and what was a sham.

      Any study that has to do with pain especially back pain can really be fit in a nice statistical package because all people and cases are different.

      For acute or chronic pain you have to personalize the therapy … the vending machine or assembly-line idology are good for business but not for clinical practice.

      I love needles, adjustment, tissue release and spray and stretch! Better and a lot more safe and therapeutic than surgery.

      1. Harriet Hall says:

        “I don’t care much for meta-analysis studies”

        You don’t care much for scientific studies period. We don’t care much for unsupported claims without any scientific evidence.

        1. Stephen S. Rodrigues, MD says:

          Neither do I … Science w/o common sense is flawed and dangerous.

          Are you saying science is flawless?

          Your use of science is or can be inappropriate in the clinnical setting where wit and wisdom or the art of medicine will help patients too.

          Prime example is back pain, my wisdom tells me that fusions are malpractice.
          oh
          Statins wreak havoc on patients wellbeing.
          Sleep studies in a sick patient will always be abnormal and once these pts are restored the study will normalize w/o cpap.

          1. Harriet Hall says:

            “Are you saying science is flawless?”
            Of course not. Are you saying your wisdom is flawless?

          2. WilliamLawrenceUtridge says:

            Science often challenges common sense (for instance – common sense says the sun orbits the earth, and heavy things fall faster than light things). Science is the iterative process of finding out if common sense is correct. What you are really saying is “science contradicts my common sense, therefore science is wrong“. That’s not a way to help people.

            Also, you might have a point if spinal fusion were standard of care. It’s not. The utility to treat back pain with spinal fusion is an open, contested question. You’re setting up a straw man that doesn’t reflect actual medical practice, which is no surprise since that’s your second favourite argument after “it works for my patients”.

      2. windriven says:

        Rodrigues is an intellectual fraud and coward. He uses these pages to peddle
        his infantile delusions but refuses to confront the fact that modern medicine
        has changed the human condition in revolutionary ways while the quackery that he advocates only seems to ‘work’ where actual outcomes can’t be objectively measured.

        We do not have “alternative chemistry” or “alternative aeronautics” or “alternative physics” because these delusions have nothing to offer while
        their non-alternative counterparts have delivered everything from smart
        phones to supersonic flight. So too the difference between medicine and the
        quackery that masquerades as “alternative medicine”. I’ve offered Rodrigues
        untold opportunities to prove me wrong, to humiliate me with the power and
        majesty of his quackery.

        So far, only the sounds of ducks quacking in the marsh grass.

      3. WilliamLawrenceUtridge says:

        I don’t care much for meta-analysis studies they are not useful in the clinic.

        Of course you don’t care for meta-analyses regarding acupuncture* because they refute a pre-existing conclusion that you hold dear. I guarantee that if a meta-analysis found acupuncture* useful for something, anything, you would be screaming it from the rooftops, waving it in our faces and probably walking around with a giant boner, because you don’t care about the evidence, merely justifying what you already believe. It’s very human, that doesn’t make it right (morally, or empirically).

        Also note that even personalized therapies can be tested.

        There are lots of things that are safer than surgery, that doesn’t mean they work. Real doctors require safety and efficacy.

        *Or chiropractic, or homeopathy, or anything not considered “mainstream”, because your position like so many quacks appears to be “anything mainstream is bad, anything not mainstream is good”. The ironic thing being, as soon as there is good empirical evidence that an intervention reliably works, it will start being adopted by real medicine. Meaning your adolescent rejection of whatever Doctor-Daddy would have to find a new target. But I’m sure there would be lots of gloating involved first, followed by claims “they are doing it wrong”.

        1. Stephen S. Rodrigues, MD says:

          I think you have to review your definitions of the art and science of clinical medicine.

          Trickle down from a study take a while … besides to help pain patients we are disguising old treatments with just name changing adding to the expense no better outcomes. The business of healthcare has new allies — You all!

          1. windriven says:

            Rodrigues is an intellectual fraud and coward. He uses these pages to peddle his infantile delusions but refuses to confront the fact that modern medicine has changed the human condition in revolutionary ways while the quackery that he advocates only seems to ‘work’ where actual outcomes can’t be objectively measured.

            We do not have “alternative chemistry” or “alternative aeronautics” or
            “alternative physics” because these delusions have nothing to offer while their non-alternative counterparts have delivered everything from smart

            phones to supersonic flight. So too the difference between medicine and the quackery that masquerades as “alternative medicine”. I’ve offered Rodrigues untold opportunities to prove me wrong, to humiliate me with the power and majesty of his quackery.

            So far, only the sounds of ducks quacking in the marsh grass.

          2. WilliamLawrenceUtridge says:

            Steve, you might have a point if the editors and commentors were boosters for spinal fusion and other surgeries for back pain. We aren’t. Generally we acknowledge the complexity of the literature and the horrible, horrible results for most acute and chronic back pain.

            Not that you care, you just want to keep doing what you’re doing.

  25. kevin sharpe says:

    ” windriven says:
    February 24, 2014 at 9:19 pm
    Quack, quack, quack, quack…

    Honk, honk, honk, honk.”

    ” windriven says:
    February 24, 2014 at 7:03 pm
    Rodrigues is an intellectual fraud and coward. He uses these pages to peddle his infantile delusions but refuses to confront the fact that modern medicine has changed the human condition in revolutionary ways while the quackery that he advocates only seems to ‘work’ where actual outcomes can’t be objectively measured.”

    with respect windriven, childish utterances and endlesly repeated invective do not advance this debate one bit. As a further observation, it’s been my experience that people that hide behind user id’s that aren’t their names like you and irenegoodnight do are much more likely to indulge in such behaviours. It didn’t surprise me at all when you declined Stephen S. Rodrigues, MD’s invitation to identify yourself

    1. WilliamLawrenceUtridge says:

      Windriven’s repeated rebuttal is a response to Steve’s incessant repetition of nonsense and self-congratulatory praise of his own beliefs and efficacy. Steve doesn’t ever, has never, advanced the debate one bit. What can one do to a commentor who repeatedly states, on a website dedicated to science, that his personal beliefs supersede the scientific literature? And you appear to have fallen for Steve’s distraction – the idea that identity has any bearing on the quality of an argument.

      Congratulations, you’ve just illustrated why the contributors to this blog despair at the Sisyphean task they attempt.

      1. Sawyer says:

        I think windriven’s posts here are kind of overkill, but they are a perfectly rational response to SSR. Those of us that have made the mistake of trying to talk science to him have found he’s quite content wasting hours and hours of our time, and won’t budge one inch once the discussion is over. The only winning move with him is not to play.

        Kevin, please look over the last month of topics if you think we are being unfair to SSR.

  26. ste5e says:

    Mr Rodrigues – We use meta-analyses to overcome our biases, Stephen. Otherwise we all fall prey to the theatrical placebo that best fits our world view – whatever that may be. We all have something that we are susceptible to. Needles? They are not “Do no harm” see Edzard Ernst’s meta analysis of the 90+ deaths worldwide associated with acupuncture. But then is that another meta analysis you don’t like?

    Dr Hall – I don’t quite get the specific technique that is used in this study and if anyone here wants to look at this piece and do an article on it I would be very grateful. This article is the first to say that no more research into manual therapy for acute back pain needs to be done because the evidence is now adequate to say that it does no good. That is a big claim behind some esoteric statistical techniques. So how strong are those techniques to make that big claim. This is important – not just for PTs, chiros, osteos and MTs but for the public and the insurers and the other folk who foot the bill and are made into passive dupes.

    But I think it is more important than that because if this technique can do this to manual therapy what could it do to the even less well science based interventions.

    Kind thoughts,
    Steve

    1. Stephen S. Rodrigues, MD says:

      Is it possible to factor out bias?

      In a relative since and with a cautious provider – acupuncture needles “do no harm”
      More training for hypodermics is important and still when used wisely are harmless.
      Did you compare the deaths from needles with all other iatrogenic or post-op or medication error deaths? (cherry picking to make a point!)

      I’m certain you guys are mixing placebo with innate healing. The problem with some alternatives therapies is that they need a new standard or methods of study. The chemical or pill methods do not factor in individuality, human emotions and nature.

      1. WilliamLawrenceUtridge says:

        acupuncture needles “do no harm”

        Google “Kim Ribble-Orr” then repeat this statement.

        Other points:
        - placebo effects include “innate healing” as one of the contributors that need to be factored out to isolate treatment effects
        - there’s no reason why alternative therapies require novel study methods, quacks trot this line out because standard study methods consistently fail to demonstrate benefit, but they don’t want to consider that what they do simply doesn’t work (i.e. exactly what you are doing now)
        - one conducts science to reduce (not eliminate) bias, and reviews the totality of the literature to reduce it further; the fact that one can’t completely eliminate bias does not mean one should abandon science in favour of the horribly more biased “personal opinion”

      2. MadisonMD says:

        @SSR. This NIH-sponsored CME opportunity just came in my inbox. Since you claim to experiment on your patients, I thought, well you might like to actually have the training to do so. This is the NIH Protecting Human Research Participants course and comes with CME credit. It may be valuable to you and certainly would be of value to your patients.

        1. Many standard of care protocols today which have past the keen eyes of the FDA, I would consider contraindicated or malpractice and in essence experimental.

          Since you all do not witness this end of the scientific method spectrum, you will have no idea what I’m referring to.

          Give it time and you will be enlightened too. (Hopefully)

          1. Harriet Hall says:

            “Many standard of care protocols today which have past the keen eyes of the FDA, I would consider contraindicated or malpractice and in essence experimental.”

            And we would consider what you do contraindicated or malpractice and in essence experimental.

            So there we have it: two opinions, ours based on the best evidence from scientific studies, yours based on personal experience, untested beliefs, and rejection of scientific consensus. This is a science-based medicine blog, and your comments serve as a prime example of non-science-based medicine. Our readers will appreciate the contrast.

            P.S.The FDA doesn’t determine standard of care.

            1. You guys are word vultures and kinda know what is meant — the system.

              Do you put that much effort into each word of a history of present illness?

              I will be here defending patients from the flaws of science based medicine. If this site was thought provoking and inquisitive instead of dogmatic, narrow minded and down right ignorance, I would not be here.

              The Science of medicine starts on the front lines not on paper and data points.

              1. WilliamLawrenceUtridge says:

                You guys are word vultures and kinda know what is meant — the system.

                That’s funny coming from the guy charging patients for unproven and disproven treatments.

                I will be here defending patients from the flaws of science based medicine. If this site was thought provoking and inquisitive instead of dogmatic, narrow minded and down right ignorance, I would not be here.

                Again you use “dogma” to mean “anything I don’t like”. “Dogma” means “adhering to an opinion in the presence of contradictory information”. You are dogmatically insisting your experience trumps the scientific literature. You are narrow-minded in that you don’t accept alternative explanations for your outcomes. You are ignorant of the scientific literature.

                The Science of medicine starts on the front lines not on paper and data points.

                Medicine has always started at the “front lines”, from ancient China, Egypt and even possibly Otzi the iceman. It was only when paper was used to track data points and medicine became scientific that human lifespans began to creep up and fewer children died. If you restrict your practice to only what you directly experience, you are a substandard doctor and a regressive force overall. Caring for patients is a vital part of medicine that is being re-emphasized as part of medical education. Pretending that it is the only thing that matters will kill people. Doctors have always cared, but that doesn’t mean they have always helped.

          2. windriven says:

            Hey Steve-
            Past does not mean the same thing as passed. And delusional does not mean the same thing as enlightened. It’s true! You could look the definitions up.

            And that is one of the many reasons that what you “consider contraindicated or malpractice” impresses exactly nobody.

            The good news is that you are a shoo-in for the 2014 Pyrite Pintail Award.

            1. LOL I think the same of you too.

              Your knowledge can not match my experience and enlightenment of alternatives.

              Patients need better than this narrow minded idea you guys are promoting.

              Change the title of this site to Narrow Minded Science Base Medicine and I will move on to another battle.

              1. WilliamLawrenceUtridge says:

                Your knowledge can not match my experience and enlightenment of alternatives.

                Your experience can never match the distilled insights and experiences of millions of doctors, patients and researchers that the scientific literature represents. Never, ever.

                Patients need better than this narrow minded idea you guys are promoting.

                You know what is narrow-minded? The idea that you have all the answers and that you never need to change your mind or practice. The idea that you can never be wrong. That’s the definition of narrow-minded, and that’s what is driving your comments here. Your experience is not a reliable guide to reality.

          3. MadisonMD says:

            How foolish of me to think you might try to learn something, SSR. Mea culpa.

            1. Back at you!

              The problem is I know what you know but you have no idea what I have read, tried and experienced.

              And the worse is that you ALL care nothing about the souls you may be sacrificing worshiping at the feet of these flawless science methods.

              1. WilliamLawrenceUtridge says:

                And the worse is that you ALL care nothing about the souls you may be sacrificing worshiping at the feet of these flawless science methods.

                Which shows greater care for patients – very carefully and scrupulously ensuring that patients are happy and satisfied through constant care and treatment, or making sure they don’t need care or treatment in the first place? You offer the first, boutique treatments of people with muscle pain. Science offers the second, but requires us to abandon the idea that we already know best.

      3. windriven says:

        Rodrigues is an intellectual fraud and coward. He uses these pages to peddle his infantile delusions but refuses to confront the fact that modern medicine has changed the human condition in revolutionary ways while the quackery that he advocates only seems to ‘work’ where actual outcomes can’t be objectively measured.

        We do not have “alternative chemistry” or “alternative aeronautics” or “alternative physics” because these delusions have nothing to offer while their non-alternative counterparts have delivered everything from smart phones to supersonic flight. So too the difference between medicine and the quackery that masquerades as “alternative medicine”. I’ve offered Rodrigues untold opportunities to prove me wrong, to humiliate me with the power and majesty of his quackery.

        So far, only the sounds of ducks quacking in the marsh grass.

        1. Witnessing one on one encounters with everyday patients with their past painful histories and seeing how they improved with myofascial protocols over weeks, months and years is not technically delusional. Observational is a better term.

          Delusional is if one has been convinced that a natural joint can wear out and the indication of this is pain which can be viewed on an x ray and a replacement is the best option. If your delusion is based on your human logic of the human body and you do harm with that stupidity, then you should be charged with a felony.

          Medicine has a made great advancements in –some — human diseases, but not what I have witnessed in my office which are all the failures. So how would you address all of these failed issues in your sophisticated methods?

          Alternative medicine and medicines are actually what humans have used and will continue to use until we are no more. A massage and a twist of the spine for an aching back. A deep hip stretch for a pain in the butt. Rest fluids and chicken soup for a cold. Eating clay for minerals. Exercising after sitting in a chair all day. Soap and water for an abrasion or a cut. Dilute red wine for rheumatism. Soaking in hot springs or mineral springs for wellness. Wait wait are these not alternatives? I think what you are defending is a narrow edge of medicine that has been promoted by the wealthy, powerful and influential in our society, some good and a lot is bad medicine.

          Ok … I will not judge you for making such a glaring mistake by confusing the physical laws of the universe and carbon life forms. Carbon life forms are much more complex than those puny science and technology discoveries.

          1. windriven says:

            Your anecdotes are just that. If you had a scintilla of intellectual depth you would understand why anecdotes are steeped in confirmation bias and wholly unsuitable for fueling understanding.

            Alternative medicines are what people used before they could get scientific medical care. You should get out more. Travel. China is a perfect example. Chinese still use all sorts of herbs and potions to “treat” the vague and to ward off the frightening. Until they actually get ill. Then off they trot to the hospital (which is where one goes to see a physician in China) where they clamor for – and get – the best of modern scientific medicine*. One is a cultural artifact. The other is a reasoned response.

            Your last paragraph is simply stupid.

            * I lived in China for a couple of years and was quite surprised to learn just how good Chinese physicians are. In my time there – in the medical industry – I never encountered a single physician who used or even believed in acupuncture. I’m sure there are some who do. But they don’t seem to be much in evidence – at least in urban areas.

          2. WilliamLawrenceUtridge says:

            If your delusion is based on your human logic of the human body and you do harm with that stupidity, then you should be charged with a felony.

            Medical treatments are not based on logic, they are based on careful empirical testing. What you are doing is conducting uncontrolled experiments with any patients that happen to be repeat customers.

            A massage and a twist of the spine for an aching back. A deep hip stretch for a pain in the butt.

            Rest fluids and chicken soup for a cold.

            Eating clay for minerals.

            Exercising after sitting in a chair all day.

            Soap and water for an abrasion or a cut.

            I think what you are defending is a narrow edge of medicine that has been promoted by the wealthy, powerful and influential in our society, some good and a lot is bad medicine.

            This is yet another straw man. As you point out – what you are describing is in many cases not “alternative” (though in some cases it is sub-optimal, in particular I’m sure there are more bioavialable sources for minerals than clay). It has been co-opted by quacks, but the recommendations are soundly mainstream. And in most cases, these preventive acts are not expensive. At times they can be inconvenient, which is why patients often don’t like doing them – but doctors can’t be blamed for patients who don’t listen. Your substitute seems much more closely related to maximizing your patient satisfaction scores than practicing medicine.

            Carbon life forms are much more complex than those puny science and technology discoveries.

            That’s hilarious. You’re claiming that the discoveries of science results in a less complicated life form? Versus alternative practitioners whose modus operandi is to propose single causes for all disease?

            Hilarious.

            Science humbles by proving us wrong, and CAM practitioners hate that fact because most of their successes are based on confidence and natural healing.

              1. MadisonMD says:

                @SSR
                Your citation says acupuncture:
                1. has a specific needle-dependent effect on pain 7.5% of the time;
                2. has a placebo effect 12.5% of the time; and
                3. has no effect 80% of the time, although pain improves anyway 30% of the time.

                Is this what you have been trying to tell us?

              2. MadisonMD, I have been attempting to dig your heads out of the static dogmatic material mechanical world of science.

                You seem to think that you can use the SBM as a concrete, end of story edict, beyond doubt. That is not science but a game you guys are playing. A scientist should relish controversy and discussion, if there is none, you are not using the methods of a good scientist, and your imagination — using observations from multiple sources, experimentation, testing, and modifying concepts. Even Darwin’s work requires updating.

                Besides what are you going to do with these discussions anyway? It seems you are answering personal vendettas not production information useful to the public. All I get is bickering, personal attacks, among know-it-alls.

                Hmmm maybe this is your game that you have been paid to do which is be crotchety, dismissive and disrespectful? Well if that is your jobs, fine, I hope the readers can see through your ruse.

              3. Harriet Hall says:

                @SSR,

                Are you capable of saying “I might be wrong”? And if you are, what would it take to convince you that you were wrong about any of the treatments you use?

              4. MadisonMD says:

                @SSR:
                YOU posted the citation. Now you refute the results contained therein? And then you complain about me engaging dishonestly?

                WTF?!?!

              5. WilliamLawrenceUtridge says:

                MadisonMD, I have been attempting to dig your heads out of the static dogmatic material mechanical world of science.

                What’s dogmatic about asking for evidence before accepting that something works? What’s dogmatic about asking for evidence before a patient or insurance company shells out money for it?

                Sounds like common sense to me…

            1. Have you lost your reality!!! All of medicine relies on the assistance of natural healing!!!

              I do not think you know what science means!

              1. windriven says:

                “Have you lost your reality”

                Par for the course, Rodrigues. We do not get to have “our reality” and “your reality.” There is one reality. Science is the method by which we investigate reality.

                What you imagine as “your reality” is a delusional hallucination informed by your wishes and your dreams and your intentions.

                You are a quack. You proclaim it with your rigor-like clutch on your anecdotes and your dismissal of all science that exposes your delusions for what they are.

                So we always come back to the same thing:

                Rodrigues is an intellectual fraud and coward. He uses these pages to peddle his infantile delusions but refuses to confront the fact that modern medicine has changed the human condition in revolutionary ways while the quackery that he advocates only seems to ‘work’ where actual outcomes can’t be objectively measured.

                We do not have “alternative chemistry” or “alternative aeronautics” or “alternative physics” because these delusions have nothing to offer while their non-alternative counterparts have delivered everything from smart phones to supersonic flight. So too the difference between medicine and the quackery that masquerades as “alternative medicine”. I’ve offered Rodrigues untold opportunities to prove me wrong, to humiliate me with the power and majesty of his quackery.

                So far, only the sounds of ducks quacking in the marsh grass.

              2. WilliamLawrenceUtridge says:

                Have you lost your reality!!! All of medicine relies on the assistance of natural healing!!!

                Yes, this is well known. That’s why studies are conducted that attempt to answer the question “is this better than doing nothing?”

                When it comes to acupuncture, the answer, after more than 3,000 separate studies, is “no”.

                I do not think you know what science means!

                Science means, at least in part, not assuming that if the evidence contradicts your opinion, the evidence is the problem. It also means recognizing that experience can be deceptive.

  27. ste5e says:

    Menke’s discussion.

    DISCUSSION
    From 1974 to 2010, 8,400 patients were observed over 13,000 times in SMT research on that likely cost between $32 to $80 million. Equivocal outcomes are a poor return for the investment. The error is perpetuated by the inadequacies of null hypothesis significance testing (NHST) and that SMT stakeholders interpret ambiguity as supportive evidence requiring more research. Indeed, the indeterminacy has to a proposed moratorium on future SMT research. However, more research is not needed. That which is already known about SMT for back pain is quantifiably all that is worth knowing. Failsafe N calculations suggest it would take another 3000 (95% CI: 2100 to 3900) studies to change current effectiveness estimates.

    He trained as a chiropracter. So there is hope ;)

    Kind thoughts,
    Steve

  28. Daily,MD says:

    Acupuncture is alternative medicine. Is this seriously a necessary debate? Why entertain the idea? Move along. Opiates such as heroin are great for depression too…right?(obviously being facetious) There is currently a once renowned psychiatrist from Washington D.C. on trial for this right now. There is a reason clinical trials and a real scope of proven results are necessary. For the record anesthesiologist will hold either an M.D. or a D.O. Anesthesiologist are not quacks in reference to osteopathic medicine practitioners being quacks. Promise;) Statistically there are a few I’m sure.

    1. Stephen S. Rodrigues, MD says:

      Acupuncture is valid but not for the reasons you know.

      We have know for a while that some cases of depression, anxiety and bipolar can not be weaned off of opiates. The safest most humane option is to keep them on a standard rx protocol and document-document — this the where the artistry of medicine is a life saver for a few lives.

      1. WilliamLawrenceUtridge says:

        And despite being asked, you can never give the actual reasons why it’s valid (but that validity has never been demonstrated in well-controlled trials). You just revert to schoolyard, douchebag coyness. “Oh, it’s on my website.” “Oh, you just don’t understand like I do.” You have never been able, or even willing, to lay out in clear language any rational explanation for how or why acupuncture works. And that’s why nobody takes you seriously – because it gives every indication that you simply can’t and you know it.

        1. “well-controlled trials”
          There are none that have been done. All of the prior studies are flawed with stupidly and ignorance because the authors did not explicitly define these terms.

          Actually all of the studies that include these words need to be reevaluated, redesigned or thrown out. These definitions;
          Acupuncture; type, style, points used, what medication the subjects were taking, all comorbid problems, frequency under what cost constraints. The types and length of needles.
          If used solo or in combo with other therapeutic options.
          Pain-was it individualized or a check box.
          A painful joint-what is a painful joint?
          A joint-what is a joint?
          etc

          Answer these!
          Why do scientist have to disavow and discredit all of Acupuncture? Is it cost, too mysterious, too complex for puny minded beings?

          Why is it that modern medical surgeons are still removing normal appendixes in abdominal pain cases?

          1. windriven says:

            Rodrigues is an intellectual fraud and coward. He uses these pages to peddle his infantile delusions but refuses to confront the fact that modern medicine has changed the human condition in revolutionary ways while the quackery that he advocates only seems to ‘work’ where actual outcomes can’t be objectively measured.

            We do not have “alternative chemistry” or “alternative aeronautics” or “alternative physics” because these delusions have nothing to offer while their non-alternative counterparts have delivered everything from smart phones to supersonic flight. So too the difference between medicine and the quackery that masquerades as “alternative medicine”. I’ve offered Rodrigues untold opportunities to prove me wrong, to humiliate me with the power and majesty of his quackery.

            So far, only the sounds of ducks quacking in the marsh grass

          2. WilliamLawrenceUtridge says:

            So define them Steve, and provide those definitions to researchers. Do you actually have several different types of needles, or only the fine, filiform steel needles that were invented in the 1950s? Do you have various points on your needles? And inclusion of the comorbidities and existing medications are part of the standard medical history that doctors take.

            It’s up to the claimant to prove the claim. If needle type, point shape, drug interactions and comorbidities are all vital to the success of acupuncture, then well-controlled studies that account for these features will demonstrate this. But consistently, this is not what we find. Needling location doesn’t matter, needling depth doesn’t matter, penetrating the skin doesn’t matter. It’s not up to everyone else to disprove your claims. If you’re making them, it’s incumbent on you to prove they have merit. But that would require a) challenging your beliefs and b) not charging patients for them.

            Why do scientist have to disavow and discredit all of Acupuncture? Is it cost, too mysterious, too complex for puny minded beings?

            Because there’s no good evidence that it’s effective for anything but pain and nausea, and both of those symptoms are easily accounted for by placebo effects. Both symptoms will vanish given the right mental state.

            Why is it that modern medical surgeons are still removing normal appendixes in abdominal pain cases?

            Are they? Where’s your proof? And what is the risk to benefit of leaving a potentially infected appendix untreated and having it burst versus taking it out?

  29. RS says:

    I have a Chiropractor friend who indeed told me that clients come through her door seeking medical advice other than spinal needs, and she is diagnosing and advising on meds. These clients tell her they have no insurance coverage.

    1. windriven says:

      Theoretically at least, after the 31st of this month insurance should not be an issue for anyone.

    2. MadisonMD says:

      Kinda like a discount doctor without the education? You get what you… well, you know.

      1. Stephen S. Rodrigues, MD says:

        What good is the science of medicine when no one can afford the costs.

        Just because a physician has credentials does not grant then common sense or wisdom.

        1. windriven says:

          Rodrigues is an intellectual fraud and coward. He uses these pages to peddle his infantile delusions but refuses to confront the fact that modern medicine has changed the human condition in revolutionary ways while the quackery that he advocates only seems to ‘work’ where actual outcomes can’t be objectively measured.

          We do not have “alternative chemistry” or “alternative aeronautics” or
          “alternative physics” because these delusions have nothing to offer while their non-alternative counterparts have delivered everything from smart

          phones to supersonic flight. So too the difference between medicine and the quackery that masquerades as “alternative medicine”. I’ve offered Rodrigues untold opportunities to prove me wrong, to humiliate me with the power and majesty of his quackery.

          So far, only the sounds of ducks quacking in the marsh grass.

          1. mousethatroared says:

            SSR is a predatory practitioner who’s demonstrated his willingness to use scare tactics on patients to discourage proven treatments so that he can sell his overpriced placebos.

            Love the cut and paste campaign, windriven tactics. Thanks!

            1. windriven says:

              Rodrigues says the same thing over and over. I’m simply following his lead. Except that my contentions are supported by science and accurately reflect his behavior in these pages.

              I worry that somewhere, sometime, someone will happen upon one of these blogs and read a Rodrigues comment that no one has bothered to respond to. So I have made it my mission in life (after working on the Quackwatch to SfSBM conversion project) to dog that quack every time he appears here.

              Speaking of SfSBM, as I recall it wasn’t convenient for you to join. If that is still the case, I’ve easily earned a free year’s membership (the “perk” for working on the project) that I don’t need and will happily give to you. Let me know if you want it.

              1. The truth is the truth and there are only a few ways to state it.

                This one insight I will give you is that all of your logic is flawed and please do not offer any case management suggestions to any healthcare entity.

            2. Ok mister — what is a proven treatment for pain in the knee. How would you work up and treat such a case??

        2. MadisonMD says:

          Just because a physician has credentials does not grant then common sense or wisdom.

          Agreed! In fact you’ve proved this point again and again on this very blog, SSR.

        3. WilliamLawrenceUtridge says:

          What good is the science of medicine when no one can afford the costs.

          That’s not an argument to abandon science, that’s an argument to have a federally-funded healthcare system. You know, like all other first-world nations on Earth have, while maintaining lower health care costs and achieving better outcomes for more citizens. But these are issues of political will, not science.

          Just because a physician has credentials does not grant then common sense or wisdom.

          Yes, and you are living proof of this because of your continued special pleading to avoid having to change your practice in the face of changing evidence. Good doctors must be humble, and follow where the best evidence lies. Lazy, crappy doctors stopped learning after they graduated, and just stuck with whatever maintains their income.

          1. Politics, medicine and science are part of our present system of governance.

            You guys are suppose to be the smartest citizens who are the gifted ones. But I see you have the same vices as everyone else-I don’t really care about medicine or people or healthcare or how the AMA is mucking up things – just the science.

            So easy to blame and cloak yourselves in science.

            1. WilliamLawrenceUtridge says:

              All I see in your comment is an attempt to hand-wave away my point and blame the contributors to this blog (????) for the failure of the United States to have a decent health care system.

              I don’t think anyone here claimed to be the smartest citizens, most of us merely try to adopt a rigorous critical attitude to our own claims and those of others. Any medical system that doesn’t use science as a driver of care is doomed to fail – because we’re left with people like you. People who refuse to change, who refues to improve, who refuse to admit error.

              The thing is, if science tells us doctors and skeptics they are wrong – they change their minds. Often quickly. You are the one cloaking yourself in “patient care” as an excuse to ignore science and refuse to change how you practice.

              “For the patients”, much like “think of the children”, shouldn’t be an excuse to ignore criticisms.

              1. Harriet Hall says:

                “if science tells us doctors and skeptics they are wrong – they change their minds”

                You’ve hit on a crucial point. We are always willing to admit we might be wrong about something, we follow the evidence, and we change our minds accordingly. I’m quite willing to change my mind about SSR’s treatment system. What would it take to convince me?
                High quality controlled studies showing that patient outcomes were consistently and significantly better with SSR’s treatments than with the best conventional treatment, ruling out as many possible confounders as possible, replicated by independent researchers, followed by further studies to pin down which components of his treatment were essential for its success (similar to finding the active ingredient(s) in an herbal remedy). In essence, the same kind of evidence we require for any claim and the kind of evidence the FDA requires for marketing a drug. That kind of evidence would convince the entire scientific medical community and we would readily adopt the treatments into our practice.

                Now let’s ask SSR what it would take to convince him that he is wrong about any element of his practice. SSR, can you even say the words “I might be wrong”?

              2. windriven says:

                “Now let’s ask SSR what it would take to convince him that he is wrong about any element of his practice. SSR, can you even say the words “I might be wrong”?”

                He’ll never admit to being wrong. He clearly lacks the intellectual framework to understand confirmation bias and its insidious ability to distort perception. In his mind ‘he has seen it with his own eyes’ so it must be true; the same sad delusion held by a thousand quacks and cranks before him.

            2. @Hall
              “In essence, the same kind of evidence we require for any claim and the kind of evidence the FDA requires for marketing a drug. ”

              I am glad the FDA is foolproof!

              One of my goal would be for you to get some needles to help you patients in pain.

              1. Harriet Hall says:

                “I am glad the FDA is foolproof!”
                No one ever suggested the FDA is foolproof. The kind of evidence they require is necessary but not sufficient to prove once and for all that a drug works.

                “One of my goal would be for you to get some needles to help you patients in pain”
                I would gladly do that if you could present a body of credible replicable evidence from controlled trials showing the effectiveness of those needles.

              2. @Hall “credible replicable evidence”

                It is there to the people who want to see it. For those who have an agenda that is not based in the truth you will be disappointed. So prepare yourself.

                I’m amazed that you would give your patient a caustic medications but will not consider needles. This position is counter to the scientific methods and very close to having an ulterior motivation for some unGodly cause.

                You should really get Gunn’s book or talk to some of the physicians who trained under him. Investigation for real life First hand accounts, data, documents will hopefully break you free from your stance.

              3. WilliamLawrenceUtridge says:

                @Hall “credible replicable evidence”

                It is there to the people who want to see it.

                So cite it.

                You should really get Gunn’s book or talk to some of the physicians who trained under him. Investigation for real life First hand accounts, data, documents will hopefully break you free from your stance.

                Do you still not understand why patient testimonials are unreliable? How do you know the patient wouldn’t have gotten better on their own? How do you know the treatments aren’t making things worse? How do you know how many patients it didn’t work for?

                There is a difference between asking for reasonable proof before accepting a statement as fact, and dogmatically insisting something can never be so. If it actually works, it will show up in clinical trials and be used much more widely – that’s why clinical trials and publication are used.

                You clearly don’t understand science, but then again you are a naturopath.

            3. Why do I have to admit I can be wrong when you already know that.
              Gee, so everyone else is 100% correct.

              The beauty of myofascial release therapy it is both diagnostic and therapeutic, so in essence you are never correct until the patient makes the statement they are feeling better.

              If they do not make that statement and double check for one of the deadly problems, then the blame falls on the practitioner.

              The buck should stop at the providers!!

              1. Harriet Hall says:

                “so everyone else is 100% correct.”

                No, no one has ever suggested that. We are only saying that people like you who rely on personal observations and patients’ statements instead of testing their beliefs with the scientific method are likely to be wrong.

              2. MadisonMD says:

                Gee, so everyone else is 100% correct.

                It would be closer to the truth to say that most regular posters here average around 80%, and you are closer to the 10-20% range (when your post makes sense).

              3. WilliamLawrenceUtridge says:

                Steve, you’re a naturopath who thinks that because you can treat back pain, that invalidates all of medicine. Even if you can successfully treat back pain better than usual care, that only means you can treat back pain better than usual care. It doesn’t mean the rest of medicine doesn’t work. Myofascial release doesn’t replace vaccines, antibiotics, disease-modifying drugs, surgery, exercise, diet and the other tools and recommendations of real medicine.

  30. CDP says:

    Evidence-based-medicine (EBM), huh? Medications are evidence based right? Chemistry and all that stuff equals science. You have to have studies of this and that sort to pass an FDA panel to be released on the MARKET- yes, market. It is a market – it is about selling. Well, someone tell me how so many EBM medications are pulled from the market because they kill a number of people? Someone? Please?
    It is not about science. This whole diatribe here is about negative marketing I’m afraid.
    Let’s get back to the chemistry. Have you any idea of how little MD’s and Jann here know about chemistry? This little thing called fluoride – Group 17 halogen. According to the above, this is a reason to knock alternative care. They don’t buy the fluoride thing. Well kudos to them. They may not know it, but they protecting you all from one of the most toxic elements on the PERIODIC TABLE. That Periodic Table is the basis to chemistry as the alphabet is to the written language. Studies are merely written pieces by individuals funded by someone or other to investigate a parameter or two who then come to THEIR conclusion. Then it gets discussed by others to see if it is worthy. How many times are these studies contradicted or reversed? That’s EBM.
    Those Group 17 halogens aren’t going anywhere no matter how much you might like to discuss them. And guess what? They kill things. That’s why you put it in your pool and hot tub – to kill things. Fluoride just happens, by way of that PERIODIC TABLE, to be more toxic. Sorry folks – there is no argument. But why not just say it is good for you. That’s science!
    So back to the medications, my wife has been visiting with MDs too numerous to mention for the past 8-9 months. EIGHT medications with all number of side effects, a surgery later, and $27000 in testing alone. NO CHANGE!!! Evidence based medicine!!!!!!

    1. WilliamLawrenceUtridge says:

      Hi CDP,

      Medicines are pulled from the market for a variety of reasons, but generally because of postmarketing surveillance. Initial clinical trials may be inadequate to illustrate the existence of serious, but rare adverse effects, and this is why we have such a “phase IV clinical trial” system. If you want medications to never be pulled from the market, what you are really asking for is perfect knowledge. This is not achievable in reality, and is impractical because of the cost. Unless you want drug development to essentially stop, and unless you want to pay 10-100 times the price that current new drugs cost, then the existing imperfect system is the best we have. Hopefully with things like GSK getting a $3B fine, the biggest imperfection in drug development (deceptive companies) will be somewhat ameliorated. Another option is to push for higher investment in government-funded research so we don’t have to worry as much about conflicts of interest from for-profit companies polluting the results. One solution I suggested was to have Big Pharma hand the money to fund drug trials to the NIH and allow for independent testing based out of universities.

      Fluoride isn’t particularly toxic in the form consumed by most humans. According to your diatribe, sodium and chlorine should be equally dangerous (Na+ is explosive enough to blow your head off if you bit into a chunk, CL- is toxic enough to strip your lungs to bloody shreds if inhaled) but in reality we eat gram-quantities every day because the specific form of the element is nontoxic. You can’t extrapolate the characteristics of a single atom in a single context to every possible role or state an atom might occupy in any other context. Certainly there is no argument – just a whole bunch of assumptions and poor understanding of chemistry.

      I’m sorry to hear about your wife. Yes, medicine is imperfect, but it is being enacted on imperfect beings who are the result of evolution’s “good enough” process.

    2. CDP is correct, chemistry is hard core science but medicine is part science and artistry.
      These guys have forgotten that notion of medicine is an art form. The artistry comes in when the all the tests lead nowhere and all the pills do nothing.

      The artistry of medicine can not really be taught from a protocol, in a lecture or read from a book. It can not be developed in a “box” which is where these guys are living. You can not understand illness without the proper tools for which these guys have not used and actually trying to disavow and marginalize. All because of dogmatic thinking.

      An alternative physician or naturopath should be able to piece the puzzle together which is where you should take your wife. Most naturopath or alternative providers are not stupidly and stubbornly bound to an ideology, tool or discipline, they use everything that has ever worked in the the black-bag of the past 100 years.

      I would assume that your wife is “safe” from the most deadly problems which are cancers, tumors, aneurysms or an infectious diseases. These deadly issues are what drives a patient crazy worrying with no resolutions. If the providers have not explicitly made those statements within reason then ask.

      If they have excluded the deadly issues, then they must consider the one issue that will masquerade as all of the above. It is not deadly and is actually very treatable. That is Myofascial Pain and Dysfunctions which can be a long list of loose ends of symptoms from head to toe. Pain is a clue.

      If you like follow my links and email me. I will do my best to help

      1. WilliamLawrenceUtridge says:

        CDP is correct, chemistry is hard core science but medicine is part science and artistry.
        These guys have forgotten that notion of medicine is an art form. The artistry comes in when the all the tests lead nowhere and all the pills do nothing.

        The artistry of medicine can not really be taught from a protocol, in a lecture or read from a book.

        All of which is regularly acknowledged both on this blog and in the literature. Clinical practice must be informed by science, but cannot be dictated by it. It is learned through the grueling internship that is part of every medical student’s training.

        Most naturopath or alternative providers are not stupidly and stubbornly bound to an ideology, tool or discipline, they use everything that has ever worked in the the black-bag of the past 100 years.

        …except for the ideology that a “vital energy” exists and it can be manipulated. Often with mutually-contradictory explanations and tools. And these are stupid ideologies because they have never been supported by research and upon testing, they don’t matter. Naturopathy has never found an unsupported treatment modality it doesn’t like, no matter that they completely contradict each other.

        I would assume that your wife is “safe” from the most deadly problems which are cancers, tumors, aneurysms or an infectious diseases.

        How ballsy of you to assume this after never meeting her, I sure hope she doesn’t die of something in the meantime. And you call me arrogant?

        If they have excluded the deadly issues, then they must consider the one issue that will masquerade as all of the above. It is not deadly and is actually very treatable. That is Myofascial Pain and Dysfunctions which can be a long list of loose ends of symptoms from head to toe. Pain is a clue.

        And here is your central dogma, the idea that everything is due to myofascial pain and dysfunction. This is your hammer, and everything looks like it can be nailed with it.

        1. LOL yall actually think I am stupid!!! To some degree everyone can’t know everything. I know what I know and will not perpetuate outside of my base of pain and how to treat it! If someone has a different take or outlook, they will be seen as stupid only to a dogmatic group.

          You are good at reading my mind and making assumptions. Both are not good attributes of an investigator but of someone who needs an emotional boost. If you need an emotional boost play a kid in scrabble.

          I assumed that 27,000 would have been an extensive workup that would have or should have uncovered the deadly diagnosis.

          My attempt was to give a few ideas that could help his wife who is suffering without a proper diagnosis and thus an unresolved disease which has the potential to evolve into a more sinister syndrome. This is where my authors shine, you can being therapy without interfering with further workups. If the therapy helps great the patient suffering and needs can be addressed while high-tech rules-out the deadlies.

          All physicians are not created equal so all Naturopaths are not equal, this is the main issue with concrete thinkers who lump issues into neat piles or boxes. People are not widgets and have to be treated as individuals.

          I would suggest to you that you develop your imagination and creativity which will improve your logic. Oh yes, this site where everyone is of the same mindset, is not a good place to develop.
          I hope my input generates critical thinking and not resentment.

          1. windriven says:

            The secret, Stev-o, is to know what you don’t know. That seems to be your blind spot. There are things that you may honestly believe that you know that are just wrong. And there is much, including any clear and embracing understanding of science, that is as alien to you as the !Kung language is to me.

            “I would suggest to you that you develop your imagination and creativity which will improve your logic.”

            Imagination and creativity are essential. I have made my money on their backs. But they have always (at least those times when I have been successful) been informed and constrained by logic. You might try that logic part sometime.

            “I hope my input generates critical thinking and not resentment.”

            Your input generates ennui; nothing more, nothing less. Yours is the rant of countless tyros who think they’ve discovered the fountain of Ponce de Leon. But Steve, what you’ve found is Desani.

          2. WilliamLawrenceUtridge says:

            LOL yall actually think I am stupid!!!

            Yes, a very specific kind of stupidity that is very close to arrogance. Specifically, an inabilty to understand how your opinions can be shaped by the self-serving brain, and ignorance of how deceptive experience can be. You got through medical school, I assume that means you can recognize facts and how those facts can fit together. What I don’t think you have is a recognition of how your brain can re-assemble facts to avoid changing your mind.

            All physicians are not created equal so all Naturopaths are not equa

            Naturopaths also aren’t equal to physicians. Naturopaths believe blatant untruths about the body. Naturopaths have homeopathy as a core discipline. Naturopaths treat the age of an intervention dogmatically, as if longevity guaranteed truth.

            Naturopaths are idiots.

            1. There you go using your own personal definitions to blanket the entire discipline. If you preface your statements with “this is my personal belief” then some of your readers will not be confused.

              I consider myself a Best of All Worlds Naturopath! :)

              from wiki;
              Naturopathic practitioners in the United States can be divided into three categories: traditional naturopaths; naturopathic physicians; and other health care providers that provide naturopathic services. Naturopathic physicians employ the principles of naturopathy within the context of conventional medical practices. Naturopathy comprises many different treatment modalities such as nutritional and herbal medicine, lifestyle advice, counseling, flower essence, homeopathy and remedial massage.

              1. WilliamLawrenceUtridge says:

                All naturopaths are either redundant to conventional recommendations, or are actively dangerous because they suggest unproven, disproven, or flat-out nonsense treatments. Homeopathy is taught in all naturopathic schools, and that alone is enough to disqualify them from any meaningful discussion involving biology, or physics, or chemistry.

                I don’t believe that naturopaths are worse than doctors, I know it. That you are a naturopath is revealing, and explains your knee-jerk criticism of real medicine (since naturopaths must disparage doctors to justify their existence) and your lack of critical thinking skills (see again, homeopathy).

      2. windriven says:

        “The artistry of medicine can not really be taught from a protocol, in a lecture or read from a book. It can not be developed in a “box” which is where these guys are living. You can not understand illness without the proper tools for which these guys have not used and actually trying to disavow and marginalize.”

        “Most naturopath or alternative providers are not stupidly and stubbornly bound to an ideology, tool or discipline, they use everything that has ever worked in the the black-bag of the past 100 years.”

        No, they – and you – have stopped in the distant past. The difference between you and a “naturopath” is that the naturopath would go to prison for using much of the medical science learned in the last 100 years. They would go to jail because medical science is extremely powerful and therefore dangerous in the hands of the incompetent. Unlike the naturopath, you are a trained medical doctor. So what exactly is your excuse?

        1. windriven medicine is dangerous in the hands of boxed-up programmed robotic competent providers.

          There are a large group of patients who need alternative especially for pain and myofascial dysfunctions. YOUR site will not have an impact on their use.

          Why are you beating this dead horse.

          1. windriven says:

            “medicine is dangerous in the hands of boxed-up programmed robotic competent providers.”

            Oh, you mean the programmed robotic competent providers like the ones who save 1 kg premies and the ones who help AIDS patients to live long and fruitful lives and the ones who cure childhood leukemias and the ones who stop gunshot victims from bleeding out on the ER floor?

            And you do what, exactly? Convince grandma that her knee hurts a little less today than it did yesterday?

            You are such an ass, Rodrigues.

            BTW, I thought you were flouncing. Talk about great expectations.

            1. windriven- No I am referring to the ones who replace knees and fuse backs for dubious reasons at the drop of a hat.

              Ignore me windriven if you have personal issues with me.
              Oh, you forgot to put the BAD in front of the ASS as in excellent. :)

              1. Jim Borgman says:

                Lurker here. Hi, Stephen.

                Do you have any legitimate published numbers to support your assertion of all the “…ones who replace knees and fuse backs (vertebrate, I assume) for dubious reasons at the drop of a hat”? Very. Strong. Claim.

                I’ve seen a number of MDs over the years, mostly on the part of family members (some with serious conditions), and I’ve never felt like they didn’t present viable, sensible treatment options (or modalities as the learned say). From reading your many posts, you come across as having some sort of Quixotic delusion toward medical doctors. Maybe you live in a place where it’s that way, but it seems to me your brush is far too broad.

                I’m unsophisticated enough to do anecdote vs anecdote, but how can you justify your broad claim that medical science and medical doctors (in the US for arguments sake) offer inferior options to your anecdotes? I know you’re convinced, but your case is unconvincing to me…as in very unconvincing. Sell me. I do have skin in the game.

              2. WilliamLawrenceUtridge says:

                Steve, can you point to any recommendations that unequivocally state “knee replacements and spinal fusion are the first choice modalities for joint pain”? Because otherwise it just seems like you’re making stuff up to justify your own poor practice.

                I know that it’s common for naturopaths like you to justify your practice by attempting to badmouth real medicine, as if that somehow provided evidence your approach works. Why not provide some actual proof that what you are doing is effective?

  31. Chad D. Hedges says:

    My response to my peers at National University of Health Sciences: We need to remember that National’s version of “Chiropractic” isn’t even close to what “Chiropractic” really is to the masses that practice it. This article is heavily biased and obviously written with an anti-chiropractic purpose. However, there were truths in the article and these truths need to be addressed by our profession or our profession will be short lived in modern times with healthcare reform and the need/requirement to practice scientific evidence-based medicine. Comparing the education of the CAM practitioner to that of the medical practitioner is also very difficult. Although the curriculum of chiropractic school looks very similar to that of medical school, is the academic depth and breadth the same? Who knows? Unless you have both degrees and have experienced both programs first hand it is very hard to say which profession is academically superior or inferior. I think it would be beneficial to hear from those who have experienced both sides of the coin, DC-MD or MD-DC. Heck, let’s just ask National Alum Dr. Rand Swenson D.C., M.D., Ph.D. (now that’s someone with some academic weight). I do believe our clinical training is far inferior given our “legal” scope of practice. If we only stuck to the musculoskeletal system then I would say our four years of education and training would be adequate, similar to dentist (Oral physician) or Optometrist (Ocular physicians), but CAM practitioners believe their scope should encompass the ability to diagnose and treat the entire human condition. We do this without the 3-8yrs of clinical residency REQUIRED of our medical counterparts. To quote Dr. Hodges-“If we want to play in the big leagues we need to act like big leaguers.” In my opinion, with the current standards of our respective professions, we’re AAA at best!

    1. WilliamLawrenceUtridge says:

      This article is heavily biased and obviously written with an anti-chiropractic purpose

      Yes, because chiropractic is either physiotherapy with delusions of grandeur, or complete lunacy based on an outright wrong premise (subluxations exist and cause disease).

      Chiropractors and doctors have virtually no overlap in terms of scope and learning, except for gross anatomy. Chiropractors should not treat anything beyond musculoskeletal conditions, and should not believe that they can. Joint manipluation fundamentally does not change organ health or disease states, only mechanical problems of the body. A valuable thing, but not what a doctor concerns themselves with.

      1. “Joint manipluation fundamentally does not change organ health or disease states, only mechanical problems of the body. A valuable thing, but not what a doctor concerns themselves with.”

        YES it can!!! Read Travell, Rachlin and Gunn

  32. pmoran says:

    I still question whether there Is sufficient scientific substance to Chiropractic to justify its persistence as a distinct branch of Medicine proper.

    Spinal manipulation itself is a generic intervention, used by orthopoedic specialists and physiotherapists. It has also been generally disappointing in controlled studies. What else is there?

    A case can be made that chiropractic’s modest success so far as a part of the medical landscape depends upon a combination of forces that have little to do with the intrinsic efficacy of its activities — mainly that mainstream doctors have had little reason to be interested in an often depressing condition (back pain) where no treatment works very much better than any other, and they are in consequence inclined to manage it in a desultory fashion — but also through exaggerated public perception as to the usefulness of spinal manipulation, as commonly reinforced by word of mouth and the media.

    A nominally “science-based” chiropractic may thus survive, perhaps patchily, and mainly through these factors, inertia within medical systems and politics rather than through “science” (in the “working better than placebo” sense that this means to many) .

    An offshoot of chiropractic will certainly go fully “alternative”, if history is any guide — there is always a word-of-mouth market for that.

    I genuinely feel for those who find themselves in this situation but I cannot go along with those who encourage chiropractors to see hope where a possibly clearer vision sees mainly hurdles.

    Your best hope is to produce a swathe of high quality studies showing that spinal manipulation gets back pain sufferers back to work in a cost-effective way. Even then there would be argument as to whether that is due to any intrinsic efficacy of spinal manipulation or any other uniquely “chiropractic” phenomenon, but it would weigh well with politicians, industry and health care funders.

    1. “no treatment works very much better than …. commonly reinforced by word of mouth and the media.”

      If we combine all the therapies into to a plan of action the results will be much better.
      If you believe Ingraham you have to accept spinal adjustment they are actually doing the same type of therapy tissue release with hands on or leverage.

      The denial of TrPs and myofascial issues are cuts the link that connects all of these pain issues.

      1. WilliamLawrenceUtridge says:

        If we combine all the therapies into to a plan of action the results will be much better.[citation needed]

        Fixed that for you.

        The denial of TrPs and myofascial issues are cuts the link that connects all of these pain issues.

        Paul doesn’t deny that trigger points exist or that myofascial pain isn’t real. I don’t deny that trigger points exist either. Paul promotes the existence and treatment of trigger points rather strongly. He just does so by a careful reading of the scientific literature with a heavy emphasis on self-treatment and avoidance of those approaches that lack proof or promise. He digs into the scientific research and finds reasons not to believe – like a good scientist should.

        You keep treating this as if it were my expert against your expert, and you’ve somehow decided that Paul is “my” expert. That’s not how it works. It’s not a zero-sum game. The right answer is found through iterative research, questions and testing, not through assumptions followed by desperate rearguard efforts to resist change. I don’t say that acupuncture doesn’t or can’t work (though there is a lot of research to suggest both are true for at least some aspects of acupuncture), merely that there’s a lot of evidence to suggest it doesn’t work, it doesn’t relieve pain over the long term, and that there is a lot of unrecognized safety issues.

        To which you could contribute catastrophically, since you don’t sterilize the skin before you needle.

        But then again, as a naturopath, do you even believe in the germ theory of disease?

  33. Steve says:

    SSR
    Where are your trigger points beyond the consensual illusions that you generate within your own mind and your patients? That is why there has NEVER been inter-tester reliability for the assessment of trigger points. That is why they have NEVER been observed on MRI, US or cadaver. They are artifacts of mind not body.
    And “trigger point” as a theory when it does not work has more ‘get out of jail free’ cards for the practitioner than any treatment approach I have ever looked at. There are 60 pages dedicated to perpetuating factors in Travell and Simmons – sixty pages of excuses you can make when the patient does not improve.
    Travell – surely it has been discredited.
    Kind thoughts,
    Steve

    1. @ Steve, I am not sure of your educational background but I will make an assumption that you have not treated with any success anyone who has failed disc/back or knee surgery.
      It frightens me that you would discredit TrPs and Travell an icon who was on the forefront of pain care, wow you have confidence! There is a entire world of data on myofascial pain/TrPs and how to treat the pain and misery that they cause. So do you also discredit Rachlin, Gunn and the International Myofascial/TrP societies?
      TrPs are not what you or I think they are but something is there corrupting muscle function and activating pain signals. For the TrP naysayers, I coined a new term called Pain and Dysfunction Generators or PDGs.
      TrPs/PDGs, I hope in my lifetime, will be uncovered whenever we get the wherewithal to deploy unbiased histologist. A histologist is the person who will find these buggers and today there are microscopic evidence of disrupted cellular architecture. This is also why these patients get labeled mental cases because our scientific instruments can not “see” these entities.
      These artifacts are definitely present in the flesh and will over a while lead to a patient’s declining mental wellbeing.
      Everyone is correct that the textbook descriptions needs an update. Here are my thoughts; some do not twitch, can eliminate pain randomly or erratically, are usually not singular point, can grow in size and migrate throughout the involved muscle and (worse of all) can metastasize into adjacent muscles and into distant regions. This full body infection or myofascial tissues is called Spinal Segment Sentication which is the pain of hellfire and brimstone.

      1. Harriet Hall says:

        “This full body infection or myofascial tissues is called Spinal Segment Sentication ”

        That makes even less sense than you usually do. I think you mean “sensitization” and “of” myofascial tissues. And it is not logical to say that a myofascial spinal segment problem constitutes a “full body infection.” Perhaps you have your own nebulous idiosyncratic definition of infection just as you do for acupuncture.

        1. You fell for my trap!

          Instead of focusing on the issues at hand which is a life altering pain syndrome you turned yourself into a spell checker and made no comment about the disease entity.

          I hope you research this pain entity because your patients will benefit if you care enough to get out of your dogma.

          Why don’t you write an article about SSS and let us all discuss it. I have a few ideas and comments that you will not find in modern literature.

          1. Harriet Hall says:

            Are you capable of saying the words “I might be wrong”?
            If you are, please tell us what it would take for you to admit you were wrong about your treatments.

            1. I was mostly wrong from 1983-1998, then I found Gunn who helped me to clarify my role as a provider, not per my traditional training. How I’m never correct until the results prove my therapy is effective and the patient makes that statement.

              ====

              I do not think I am helping the regular bloggers and sincerely hope that the some of the other readers will look up my authors so you can really begin to help your patients in pain.

              1. Harriet Hall says:

                Can you say “I could be wrong about acupuncture”?
                Can you acknowledge that other people have been wrong when they relied on the same evidence you do – your observation that the patient has improved and the patient’s statement to that effect?

              2. Sorry to disappoint you but I can’t be wrong. Why would I deny what I have seen with my own eyes and refute what thousands of patients have stated. Why!!! We are in this situation of poor pain and dysfunction treatments because we wish for the a possibility that we have always had at our fingertips.

                I will say that there are a lot of unanswered questions related to the science, physics, physiology, biochemical and histology of “Needles” that needs further study.

                Besides Acupuncture is the wrong word to use! Acupuncture is not what you think it is! I suspect that you envision a Chinese man in a tiny room with incense and thin needles. That is a true image but an incomplete one. Acupuncture is a word that includes many disciplines and ideologies that uses a needle as a tool. It includes a wide variety of techniques that anyone can master if they want to begin the journey.

                The Guru of needles in my opinion is C. Chan Gunn, MD. Gunn actually refutes and then reconfigure a new paradigm around the needle as a tool. His idea is called Intramuscular Stimulation or Gunn-IMS. IMS makes more sense in modern anatomy and physiology terms. Gunn’s reconfigured therapy has much better and consistent results. (I also have to admit that Gunn has a few limitations that are easily overcome.) http://www.istop.org/

              3. Harriet Hall says:

                “I can’t be wrong. Why would I deny what I have seen with my own eyes and refute what thousands of patients have stated. Why!!! ”

                Because bloodletters in the Middle Ages would have said exactly the same thing. Because surgeons who did internal mammary artery ligations would have said the same thing. Because Perkins, the inventor of Perkins’ tractors, said the same thing. Because self-deluded quacks throughout history have said the same thing.

                Because doctors who were every bit as sure as you are, for the same reasons you are, have been proven wrong, over and over throughout history. Doctors who do not understand how human psychology works, who do not make allowances for the natural course of illness and the placebo effect, who are flattered by positive feedback from patients, and who have the monumental hubris to think they are infallible can easily convince themselves that bogus treatments work. Why do you think you are the only human who is too smart to have to test his beliefs with the scientific method? Because “medicine’s beautiful idea” http://www.sciencebasedmedicine.org/medicines-beautiful-idea/ is that every belief, every hypothesis, must be tested, no matter how sure you are.

              4. MadisonMD says:

                Sorry to disappoint you but I can’t be wrong.

                I didn’t realize I was conversing with an omniscient super-being. SSR, please go converse with the wisest human to over live on earth. He is so advanced in knowledge, that us mere mortals find it difficult to comprehend the depths of his advanced knowledge. Once you and the wisest human figure everything out there will be no death, no suffering, and no disease and us mere mortal physicians will be superfluous and bow in awe to your superness for eternity.

              5. windriven says:

                You’re just totally incapable of linear thought, aren’t you Steve? You make an outrageous and incoherent statement, someone calls you on it, and you respond with another statement unrelated to the first.

                In Rodriguesland, words mean whatever Rodrigues wants them to mean and often enough they mean nothing at all. Evidence is meaningless while anecdote is the gold standard for judgment.

                You are one frightening guy.

            2. All I said in a different way – as a physician who uses traditional and alternatives, I get to understand processes and events that a lot of people haven’t witnessed because of lack of exposure, awareness, education or experience.

              I think you all are mixing the 3 types of “truths;”

              The laws of nature like physics, math, chemistry which can not be broken but to some degree these laws can be overcome with other natural laws.

              Personal truths come in two types;

              those which are accumulated over a lifetime and can be modified or correctable depending on motivation. These are the truths that make up your personality and are completely individual.

              Then there are the truths that are formulated with logic and awareness and are the ones that should be prefaced with “in my experience or my opinion” and as we all know when you assume you can make an ASS out of U and ME. These observations must be verified by the many methods that scientists use to proof or disproof a point.

              Then there is a totally made up ideology that is totally in the imagination of the individual, community or society. Whether they are learned or adapted for survival purposes. Politics, religion or a government.

              So if an individual reports that they can reproduce and event over and over again at a high rate and someone else can do the same over and over again at a high rate them that observation should become a law of nature. A prime example is a cuts which will heal 100% of the time.
              Why? Does it matter! It just does and we can take advantage of this natural event.

              The same reproducible situation happens with a needle, time after time the needle does something that is documentable without failure and that should be a function of a law of nature. Whether our technology will uncover the reasons or we see the changes in histologic samples are important but irrelevant today. We just need to accept that this is truth so we can take advantage of this natural event and help those who are suffering.

              Please those weak analogies and personal attack are not for true scientist, investigators, analysers to use in an argument.

              1. MadisonMD says:

                And you know a control group is not needed in your experience with needles? i.e. pain never goes away, the body never heals on its own, and therefore the improvements you observe could not possibly have occurred without needles?

              2. @MadisonMD you are asking me if and my clinical practice I use control groups, the answer is no. my job is to treat patients as they come in. In some respects I do not need to have a control group, because the patient is his or her own control. By the time of pain patient comes in to see they have had pain for months to years and they have tried all traditional options whether it’s steroid injections joint injections epidural injections or actually had the corrective surgeries which have failed miserably.

                In, the most simplistic of experimental design, a control is not necessary. Particularly when it is a one-on-one encounter, and one-to-one result. An example of a one-to-one trial is when you put water on a fire and the fire is extinguished. 1 to 1 trials have an inherent truth about them that defies perceived bias.

                As per C. Chan Guns protocols, it requires that the patient has improvement subjectively and objectively on that particular day, at that particular moment.

                You know what might be a good idea is if I get patients to sign affidavits stating the past history, the past treatments and the treatments that I employ and comparing the two in their own words.

              3. weing says:

                I think he said
                “i.e. pain never goes away, the body never heals on its own, and therefore the improvements you observe could not possibly have occurred without needles?”

                “An example of a one-to-one trial is when you put water on a fire and the fire is extinguished.”
                Works fine until you come to an electrical fire.

              4. MadisonMD says:

                @SSR: The lack of a control is the crux of why you will not convince anyone here– and me in particular. I don’t really expect you to use controls in your clinical practice. But I don’t expect to draw any useful generalizable conclusions from your clinical experience. This is because some of your patients would have improved and or healed naturally without any intervention whatsoever. (Harriet has said this to you nicely and in several different ways already, but you seem to reject.)

                You yourself cited an acupuncture paper which concluded that 30% of patients have improved pain without any intervention whatsoever… for many of the same chronic pain conditions that you claim to treat.

                So if you want some credibility and fewer jeers, you need to accept and address this criticism– we accept your data (though it still has bias), but not the conclusions you draw for them.

              5. windriven says:

                Hey Bozo-

                “The laws of nature like physics, math, chemistry which can not be broken but to some degree these laws can be overcome with other natural laws.”

                How about an example of overcoming say, matter-energy equivalence with some other natural law. And tell us what overcoming one of the laws of physics with some other natural law even looks like. The Rodriguesverse must work much differently than the universe that I habit.

                You have packed so much ignorance into that one sentence that my head hurts from thinking about it.

              6. @ windriven, you like that statement, found it somewhere.

                You can not corrupt or fool or trick or cheat the laws of nature PERIOD.

                When a patient states they feel better by this therapy … that is all I need to know to help this person. This is what we do in the office setting.

              7. WilliamLawrenceUtridge says:

                You can not corrupt or fool or trick or cheat the laws of nature PERIOD.

                Yeah, but the nice thing about laws is, they always apply and they can be empirically demonstrated. You’re asserting that laws exist without really showing any evidence that they do (or that they justify your naturopathic practice).

                When a patient states they feel better by this therapy … that is all I need to know to help this person. This is what we do in the office setting.

                Yes, and that’s why you aren’t taken seriously. You don’t know how many patients got worse and never came back. You don’t know how many patients died. You don’t know how many patients got better in spite of your treatment, and you can’t attribute causality.

                You have no appreciation for why your confidence is unfounded. This is why you are mocked.

  34. I’m out of here for a while, so if you have insults save them for later.
    If you want info on pain and therapeutic options email me.

    Your patients deserve the best of what all of medicine has to offer!

    1. windriven says:

      “Your patients deserve the best of what all of medicine has to offer!”

      A point on which we agree!!! Except that you and I would define medicine rather differently.

      As to the rest: adios, auf wiedersehen, quod absit. I will miss you as I would miss a bout of tinea pedis.

      1. Gee, I was hoping you would be sad and distraught :(

        I decided to hang around to throw monkey wrenches into your narrow minded, dogmatic, seriously biases logic.

        Are you at least thinking about what or how you think about science and medicine?

        1. WilliamLawrenceUtridge says:

          You’re an idiot and you add nothing new to any conversation you join aside from straw men and self-confirming assertions. I would personally be delighted if you left and never returned.

          1. WilliamLawrenceUtridge, Sorry I’ve made it part of my job as a Medical Acupuncture or non-traditional practitioner to defend sane reasonable safe therapeutic options for patients who have FM, chronic pain and medical conundrums.

            YOU have the option of ignoring any post. Actually it seems that my posts have not inspired you, though I have tried. Once you decide to venture out away from this site you will smile, laugh and say, “Wow I was really stubborn and stupid.” (don’t take that personal)

            1. WilliamLawrenceUtridge says:

              to defend sane reasonable safe therapeutic options for patients who have FM, chronic pain and medical conundrums.

              Do you know who Kim Ribble-Orr is? How safe was her treatment approach?

              Your “inspiration” has largely consisted of criticizing real medicine and asserting your personal experience takes precedence over research – while not showing any understanding of how deceptive personal experience can be. And that’s why I mock you and call you an idiot (well, that and you are a naturopath, an entire discipline based on “trust me, it’s old, now give me money for this treatment I have no proof works”).

              I don’t respond to your posts for you anymore, you have long since demonstrated you are too dogmatic in your beliefs to ever change your mind or even consider that there might be flaws in your thinking. I mostly write these posts as a public service for any lurkers out there who might find your empty assertions superficially convincing.

              1. What is your background. If you have not read and practiced Travell/Simons, Rachlin or Gunn … shut the hell up.

              2. WilliamLawrenceUtridge says:

                Hi Steve,

                Please see my comment here.

      2. Thor says:

        Hey windriven. Just mentioned to WLU that I can’t believe this “discussion” is still going on three weeks, and 320 comments later. What great entertainment! Was pleasantly surprised to see you join in hands-on, as I thought the repeated statement (awesome) was going to be the extent of your participation. Glad you had a change of mind; your blood probably started to boil and simply needed venting. I don’t envy SSR’s position going up against you two, and Dr. Hall.
        What’s jaw-drop amazing is his deluded, dogmatic, blind, bulldog approach, combined with a mind only capable of flawed reasoning and malfunctioning logic. I think it likely he suffers greatly from the Dunning-Kruger effect.
        Anyway, there are always fence-sitters that need to have the right
        information, the record kept straight. We need you!

        1. What is your background. If you have not read and practiced Travell/Simons, Rachlin or Gunn … shut the hell up.

          1. WilliamLawrenceUtridge says:

            Hi Steve,

            In response to this comment, or similar comments posted repeatedly, I will point you to this comment I made on another page. Since you’re repeating this assertion repeatedly, I thought I’d follow a similarly comprehensive response pattern.

  35. @Ingraham is at the root of this situation of misinformation. Come out to discuss your finding.

    1. WilliamLawrenceUtridge says:

      Correctness is settled in the scientific literature, not in public debate. Quacks love public debates because they can Gish gallop in a way that sounds impressive until you realize how wrong every point is, and because laypeople are convinced by impressive-sounding anecdotes.

      Which is why you want a debate rather than a discussion of the literature.

      1. “Correctness is settled in the scientific literature, not in public debate.”

        OK we really do not need to debate but lets discuss the information in the textbook of C. Chan Gunn, MD. There are a few pages he may have overlooked in his quest to understand these disciplines of myofascial tissues disease and therapy, Acupuncture and Gunn-IMS.

        If he or any of you wish to review the test book, then we can have an insightful, intelligent and meaningful conversation.

        So until then any comments made about “needles” need to be prefaced with “Without studying Travell/Simons or Gunn’s textbook I’m giving you my uneducated personal opinion.”

        1. WilliamLawrenceUtridge says:

          Having read Paul’s trigger points tutorial, I don’t feel the need to read Gunn’s book. Paul is scrupulous in citing not just textbooks, but also primary literature, and he points out that Gunn doesn’t have much.

          The thing is, there’s really not much oversight on most books, particularly in niche markets. What primary literature supports his work? On amazon, the only book I see by him was published in 1996, has he not updated or produced any new research in the past 18 years? There aren’t many medical specialties that stop researching for nearly two decades, in pretty much any field, 18-year-old information is borderline worthless.

          See, what it looks like you are trying to do is find a reason to justify your beliefs rather than challenge them. You already believe that acupuncture works and doesn’t need to be changed, and you’re merely using Gunn as a crutch to lean on, a rationalization for your existing beliefs. Real doctors engage with an ongoing literature and question fundamentals, looking for new information and getting continuing education.

          But of course, you’re a naturopath, not a real doctor.

          1. Thor says:

            Not a reply to a specific post so why not here at your latest.

            It’s been three weeks since I may have initiated the trigger point debate and can’t believe the “discussion” is still going on! I just happened back to the thread and can’t believe my eyes! Nothing has changed—SSR’s inanities keep bubbling up like sewage from a congested toilet bowl. I just wanted to say that I admire your patience, tenacity and overall diplomacy. I’d be screaming and don’t know how do you do it? I bet you are using the opportunity to practice and hone your writing skills, strengthen your dialectical ability, and clarify for the fence-sitters. You’ve found yourself in the position of continually setting the record straight and I, for one, thoroughly appreciate your time and effort into the endeavor. (Plus it’s fantastic entertainment.)

            1. WilliamLawrenceUtridge says:

              @Thor

              1) Diplomacy? Ahahahaha go read some other comments threads. I may have suggested someone deliberately give their child cancer for…totally defensible reasons. Totally. My “diplomacy” comes and goes, but usually it goes.

              2) As for how, mousethatroared makes a point of challenging me when my civility drops to a standard that is above Hitler but below Mussolini.

              3) It’s mostly for my own amusement. Sometimes my wife’s also.

              1. Thor says:

                Haha! I know, WLU, was just being ‘diplomatic’. I read all your comments and thoroughly enjoy them. Your at times caustic verbiage is one of the best qualities in them. Still, your ardent efforts in responding to people like SSR (and questionable claims in general) is admirable, and requires patience and time on your part, not only on this thread but consistently throughout. Keep honing your scalpel of words. Putting it to use is not in vain.

            2. @ WilliamLawrenceUtridge and Thor, the data for Trps is vast and can not be dispelled in a whim. Something is causes and triggering pain that can not be fix with a scalpel or medicated with drugs.

              How are you to chime in on this topic? What is your background. If you have not read and practiced Travell/Simons, Rachlin or Gunn … shut the hell up.

              1. MadisonMD says:

                @SSR
                Go to pubmed.gov, find the scientific article and link it here so we can see the data you speak of.

                I don’t think it exists because you repeatedly refuse to do this. (Except the one time you posted an article without reading it and it turned out to say acupuncture doesn’t work.)

              2. WilliamLawrenceUtridge says:

                Hi Steve,

                Please read this comment, where I point out why these specific sources aren’t necessarily the best, and why your reliance on them might be misplaced.

              3. Thor says:

                The more you write the more I think you’re just a troll all dolled up with fancy-schmancy CAM word-salads for clothes. At this point ALL the issues have been clarified ad nauseam. Not only on this thread but virtually every thread you appear in. No matter how many times things are explained, you have zero ability to process information, think rationally or critically, or show the remotest hint of humility and openness to concepts that differ from your dogmatic, myopic view of the world. It’s probably time for everyone to accept that you are a hopeless case and stop feeding you, as the more you get fed the bigger your ego-filled delusion manifests. You’ve “threatened” many times that you’re leaving (huff-huff), so why not make good on your word and finally make a permanent exit? There will be plenty of other opportunities for fence-sitters to get proper information. You just aren’t needed and are starting to stink up the place.

                I’ve told you my background. It is on record for anyone to view.
                I own Travell’s book, have read it, and have tried consistently to apply techniques for treating trigger points (for too many years to count). The verdict on them is just not in. But because you believe in them so strongly and everything you believe is apparently flawed and off the wall, it stands to reason that the final assessment of the trigger point question will be nil.

          2. “Having read Paul’s trigger points tutorial, I don’t feel the need to read Gunn’s book. Paul is scrupulous in citing not just textbooks”

            As you wish, but if you have not taken his course or seen him in action the book is only a starting points. You can look at a surgical atlas of an Appendectomy and think you know all there is about an appendectomy. That would be arrogance and illogical, the human body is much more complex but much more forgiving. Bottom line: All providers have no idea what Gunn is all about or his techniques.(I don’t think Gunn realizes how profound his logic is because he focuses on his own and not very much outside of his scope.)

            The thing is, there’s really not much oversight on most books, particularly in niche markets. What primary literature supports his work? On amazon,… published in 1996 … information is borderline worthless.

            That is the the exact opposite of what science is all about. Just because you believe someone to be “beyond a doubt accurate” than both of you will be proved wrong by testing and time. Gunn is precise in his ideas and techniques. Gunn’s course complements the book and vise versa, so one or the other would seen lacking. Gunn is much more profound that anyone without experience in myofascial experience can comprehend. To see Gunn in the text and see Gunn in action is vastly different. Besides, it is very difficult to put in words what you have experienced.

            “See, what it looks … find a reason to justify your beliefs rather than challenge them. You already believe that acupuncture works … you’re merely using Gunn as a crutch to lean on, a rationalization for your existing beliefs. Real doctors engage with an ongoing literature and question fundamentals, looking for new information and getting continuing education.”

            You have give the best critique to what this site is all about. Confirming what you already believe about alternatives which is that they have no value whatsoever, and that modern science medicine is all knowing and all perfect.

            Please, you do not know Gunn and neither does Ingraham!! In Gunn protocols, each patient is a unique test case so all the data points are derived from said case. It’s a customizable technique which is where the power resides. NOt just a static assembly line procedure like removing an appendix or fixing a back disc.

            “But of course, you’re a naturopath, not a real doctor”

            If I have to continue to work as a robot … I do not want to be your definition of a real doctor.

            What is your background. If you have not read and practiced Travell/Simons, Rachlin or Gunn … shut the hell up.

            1. WilliamLawrenceUtridge says:

              Hi Steve,

              Please see my comments here in response to your reliance on these authors. Also:

              As you wish, but if you have not taken his course or seen him in action the book is only a starting points.

              Yeah…no. A “course” is not evidence. To justify a practice being adopted as “medicine”, it needs careful testing to isolate the non-placebo factor. That doesn’t appear to have happened, he seems to have just lept straight to selling his ideas. Seems a little greedy and unethical to me. If his approach actually works, then it can be tested in clinical trials and its effectiveness will be obvious. He doesn’t appear to have done this, or you would be able to point to pubmed-indexed trials.

              You can look at a surgical atlas of an Appendectomy and think you know all there is about an appendectomy.

              Appendectomies have been studied and found to improve survival. The mechanism of pathology is well-understood. The results are repeatable. A burst appendix is a known, generally lethal medical event. You’re comparing the wrong things. This is more like the early 80s when H. pylori was being studied as a causative agent for ulcers. Now if Marshall and Warren had stopped at the point of theory and simply started selling H. pylori-removing kits, then you would have a comparison. But they didn’t. They undertook the careful and tedious work that demonstrated the causative nature of the infection and the effectiveness of the treatment.

              So…exactly what your heroes haven’t done, before they started writing and selling books, presentations, seminars, etc.

              That is the the exact opposite of what science is all about. Just because you believe someone to be “beyond a doubt accurate” than both of you will be proved wrong by testing and time.

              It’s funny, because you claim something is the “opposite” of science, then talk about testing. See…science is all about testing. Claiming results, victory, mechanism, before testing is kinda the opposite of science. Gunn wrote a book in 1996, then didn’t test it. That’s the opposite of science.

              You have give the best critique to what this site is all about. Confirming what you already believe about alternatives which is that they have no value whatsoever, and that modern science medicine is all knowing and all perfect.

              This site makes frequent reference to the scientific literature, and thus ultimately a massive pyramid of empirical results, the apex of which are specific treatments. The contributors to this site will change their minds in the face of adequate evidence.

              The problem you have is your lack of such evidence, but your dogmatic insistence on correctness. You ask us to trust you when you have nothing to back up your opinions but further opinions.

              In Gunn protocols, each patient is a unique test case so all the data points are derived from said case. It’s a customizable technique which is where the power resides. NOt just a static assembly line procedure like removing an appendix or fixing a back disc.

              Yeah…CAMsters love to claim that “you can’t test my protocol because it is customized”. Actually, you can, even in medical intervention. In this case, you would do a Gunn-style work-up, figure out exactly what should be done…then randomize your groups into active treatment (Gunn’s actual protocol) and control (massage would probably work, but you can also use watchful waiting, pharmaceutical placebo, usual care, etc.). It’s a little more complicated than pill-based approaches, but it’s still quite do-able.

  36. Ste5e says:

    I studied the Travell and Simmon’s book and tried for a long time to make it work and when it did not the book offers 60 pages of reasons why. Nuff said. I like Woolf’s criticism of Travell – stating that when a patient did not respond she quickly used the excuses presented to say why the patient had not improved.
    Is sixty years not too long to find histological evidence? Is sixty years of advancing resolution of MRI or ultrasound not enough? To refine a techniques inter-tester reliability? They are the fairies of MSK medicine.
    By the way in my opinion the evidence Gunn puts forward is riddled with anecdote – electroTENS is a placebotron. There I said it. Placebotron.

    I am glad you spend so much time contributing here – As first “Do no harm.”
    Kind thoughts,
    Steve

    1. William says:

      @ Ste5e
      Next lets drop manual muscle testing ( and I don’t mean AK) for the same
      inter-rater reliability reasons.

    2. Thor says:

      Thanks for your couple of comments putting the trigger point issue into perspective. I think I started the discussion on them toward the beginning of the thread and can’t believe it is still going on.
      Travell’s book is so wonderfully illustrated; I found that to be it’s best quality.
      But, the theoretical base and practical application regarding trigger points was always baffling. Talk about amorphous! Nice to read your comments.

    3. “I studied the Travell and Simmon’s book and tried for a long time to make it work and when it did not the book offers 60 pages of reasons why. Nuff said.” Nuff said?!!!!

      I have discovered that wet needling as per T/S is dependant on experience, time and effort plus addressing all of the precipitating factors. Inexperience and cutting corners will deny a patient freedom from pain. If you are treating complex pain patients they will need T/S protocols, I can give you some pointers. Please refer those patients to a more qualified practitioner, if you care not to tackle this discipline. To contact me, just click the links.

      “I like Woolf’s criticism of Travell – stating that when a patient did not respond she quickly used the excuses presented to say why the patient had not improved.”

      I have heard this before from others, I am not sure of it’s origination. For variation, do you have a link or reference site? In those ”failed” cases she was demonstrating with spray and stretch which I consider just the tip of the MF release options iceberg. Spray and stretch she used a lot in her later years and is a complement to wet needling and a valuable ally, but when used alone may fail. The therapeutic options are many, if you care to investigate the philosophy you can check the references I have listed.

      “Is sixty years not too long to find histological evidence?”
      Has anyone really actually looked?

      “Is sixty years of advancing resolution of MRI or ultrasound not enough?”
      You do not need high-technology to treat chronic pain issues. Those tools will lead you astray and just add to the overall expense and waste time.

      “By the way in my opinion the evidence Gunn puts forward is riddled with anecdote”
      Not really Gunn!! IMS is right as rain! It has it’s downsides but it is a great tool in the battle again complex chronic pain. If you care to spend time googling data you will be able to find the convincing data.

      1. WilliamLawrenceUtridge says:

        I have discovered that wet needling as per T/S is dependant on experience, time and effort plus addressing all of the precipitating factors

        Did you test your discovery using blinded control groups?

        If you are treating complex pain patients they will need T/S protocols, I can give you some pointers. Please refer those patients to a more qualified practitioner, if you care not to tackle this discipline. To contact me, just click the links.

        Wow. Just wow. You’ve got balls the size of an 18-wheeler, and nothing between your ears.

        Spray and stretch she used a lot in her later years and is a complement to wet needling and a valuable ally, but when used alone may fail

        And your proof for this is…what?

        Has anyone really actually looked?

        Have you?

        Those tools will lead you astray and just add to the overall expense and waste time.

        …because no pain ever has a mechanical origin, or comes from a tumor pressing on a nerve, and bulged disks or occult fractures don’t exist either.

        I mean you appear to believe that literally every single pain is caused by trigger points. Wow.

        Not really Gunn!! IMS is right as rain! It has it’s downsides but it is a great tool in the battle again complex chronic pain. If you care to spend time googling data you will be able to find the convincing data.

        The very fact that you use “google” rather than pubmed, or even google scholar, really illustrates the problem.

  37. aaron thomas says:

    A different perspective:
    An interesting read although it is very stuck in 20th century “treat and fix” find a symptom and alleviate that world of allopathic medicine in my opinion. That is great, but since there is a huge increase in functional illness in western society and huge increased health care costs that the “treatment” model only doesn’t address, patients/consumers are not surprisingly looking at different options.
    The Chiropractic paradigm of improving function and wellbeing does not fit into the medical “treatment” allopathic model. It simply doesn’t make sense in that model. Its a different paradigm.
    Here in New Zealand the Chiropractic college is function/wellbeing based. It has Chiropractors heading up the research department with PhDs in neuroscience, it is looking at the needs of the population and healthcare challenges for the 21st century and doing research accordingly (not just treatment of symptoms) and how it can play a bigger role in meeting those needs of a healthy, better functioning, prevention minded population.
    Its not about what model is better, which profession has the biggest ego. Its about an integrative approach to healthcare, and mostly, as always, its always about people living healthier lives.
    thank you

    1. WilliamLawrenceUtridge says:

      Actually Aaron, chiropractic is simply asserted to treat numerous non-musculoskeletal conditions, without any evidence that it actually does so. Before Pfizer can sell a drug that treats diabetes, it has to prove that it actually treats diabetes. Chiropractors don’t have to do this, and endlessly spin out novel etiologies and treatment approaches with nary a study to bother seeing if they do anything at all.

      What evidence do you have that chiropractic can treat functional illnesses? I assume you mean this definition, where there is no evidence of any disorder, a condition indistinguishable from being “worried well”, on “maintenance treatment”, for various somatoform and psychogenic disorders, and situations where the symptoms are things like fatigue and poor sleep, and strongly linked to life stressors. I know there are recognized syndromes that cause symptoms in the absence of empirical tests as well, but I doubt there are that many. Indeed, it is not surprising that these customers would look for another treatment option, but that doesn’t mean chiropractic care provides anything meaningful beyond peace of mind (for which you pay a premium per visit, with multiple “wellness visits” per week).

    2. @aaron thomas says:

      I have seen the best of all common major disciplines in the healing arts, I would tear down the barriers and use the best them all!

      Mainstream med is a vending machine, if it works great! If it fails, move on to a different paradigm. My favs are in the world of myofascial tissue release techniques works with hand-on and needles. (This class starts sith massage to intensive spinal manipulations to intensive needling work. Then add in CBT, Mind-Body, Proactive care, social sciences, longer vacations better security in the country and this will set us up to be have the best healthcare system in the world. NOT the >40th of 100.

      In the world of myofascial tissues, we understand that a lot of the dysfunctions that are expressed in the office that do not fit or respond to the vending machine paradigm will usually respond to the above therapies. NOT a single fix but with the overall idea behind therapy.

      A lot of the bloggers here have never treated eyeball to eyeball or hand to hand patients who needs relief from chronic pain, so they have absolute no idea what is involved. Using all the tools from the boxes will yield the best results. You can’t just be narrowly scientifically minded, you have to use most of the artistry from the trade.

      1. WilliamLawrenceUtridge says:

        I have seen the best of all common major disciplines in the healing arts, I would tear down the barriers and use the best them all!

        How do you know which the “best” are? How do you distinguish them from watchful waiting?

        Mainstream med is a vending machine, if it works great! If it fails, move on to a different paradigm.

        Maybe the way you did it, most doctors attempt to apply the science within a clinical context. You on the other hand, exemplify “when all you have is a hammer, everything looks like a nail”. Everything is trigger points to you. Everything.

        Also, I don’t think you know what a “paradigm” is. Doctors don’t “switch paradigms”, that would be like saying “drugs didn’t work, let’s try manipulating qi, or homeopathy”. Only quacks, particularly naturopaths, do that.

        My favs are in the world of myofascial tissue release techniques works with hand-on and needles. (This class starts sith massage to intensive spinal manipulations to intensive needling work. Then add in CBT, Mind-Body,

        So…you went to medical school, or possibly naturopathic school, and you’re basically redundant to a four month massage course and a weekend certification in acupuncture? I would say “what a waste”, but given my concerns for your patients, it’s for the best.

        Proactive care, social sciences, longer vacations better security in the country and this will set us up to be have the best healthcare system in the world.

        Do you note that the problems you list here are not problems with healthcare? Even the problems with “healthcare” are really problems of economics and politics. Your suggestions are good ones (except for leading to better health, not better healthcare) but have absolutely no bearing on the practice and problems of scientific medicine.

        1. @William Lawrence Utridge
          “How do you know which the “best” are? How do you distinguish them from watchful waiting?”
          It is called experience!
          Watchful waiting is a valid “treatment” if it works, along with the placebo effect and a therapeutic MRI. The question is – what do you do if it fails??!!

          Vending machine medicine is ““when all you have is a hammer, everything looks like a nail”.”
          I don’t do that anymore, haven’t you noticed?
          Because you have no idea what a TrP is or how it can affect tissue and cause many dysfunctions, you should not comment. Read the book list and ignore Ingraham concepts for a few months while you gain more data. I don’t know who you are or your background but disregarding myofascial disease is costing society and health care many dollars and destroying innocent lives.

          Healthcare is familycare, lifecare, politicalcare, socialcare, peoplecare, spiritualcare … the points you are making is a function of the boxed-in vending machine philosophy. If you read the books you may get a hint of how all is related. If you read and practice you definitely will understand how health, science and healthcare are inextricably linked.

  38. WilliamLawrenceUtridge says:

    It is called experience!

    In the experience of surgeons performing joint debridement, mammary artery ligation, elective appendectomies, spinal fusion, homeopaths giving customers nothing but water and bloodletters lancing their patients, these acts helped. How you see your experience as somehow superior is beyond me.

    Watchful waiting is a valid “treatment” if it works, along with the placebo effect and a therapeutic MRI. The question is – what do you do if it fails??!!

    What’s a “therapeutic MRI”? Is that where you turn the power up high enough to heat the tissues, kinda like a whirlpool bath?

    Watchful waiting and placebo are not treatments, you may be referring to the reassurance felt just by speaking to a doctor. Bedside manner is very important, but if your doctor doesn’t bring something else to the table, they are not helping. That’s false reassurance, and it can kill people.

    Because you have no idea what a TrP is or how it can affect tissue and cause many dysfunctions, you should not comment.

    Yeah, the whole point of our interactions touching on Paul’s work is that nobody knows what a trigger point are. There are lots of theories, they are flawed and for the most part have little good-quality emprical bases. You may find them personally convincing, but that doesn’t mean you are right. Explanations for the geocentric universe were personally convicing – and wrong.

    Read the book list and ignore Ingraham concepts for a few months while you gain more data. I don’t know who you are or your background but disregarding myofascial disease is costing society and health care many dollars and destroying innocent lives.

    And your sources for that are…(chirp, chirp) Why don’t you try engaging with Paul’s objections to the sources and claims you are so fond of, and seeing if you can refute them through anything other than personal experience?

    Pain is a tremendous economic drain and is awful for people. Attributing all pain to myofascial issues is stupid and wrong.

    Healthcare is familycare, lifecare, politicalcare, socialcare, peoplecare, spiritualcare … the points you are making is a function of the boxed-in vending machine philosophy. If you read the books you may get a hint of how all is related. If you read and practice you definitely will understand how health, science and healthcare are inextricably linked.

    Yes, we know that these issues are related to health, you’re basically saying “stress is bad for people”. That is not news. But the process to deal with, prevent, alleviate stress, they are not purely medical problems and the simplistic solutions you provide doesn’t solve them. Further, for you to attempt to address many of them using expertise you don’t have puts you and your patients in danger, blurs your role and grossly overextends your competence, to everyone’s detriment.

    Final point – I really don’t think you understand how health and science are related. That’s kinda been a theme. You think you understand how your personal beliefs and health are related, but you don’t grasp how deceptive personal beliefs and personal experience can be.

    1. “What’s a “therapeutic MRI”?”
      Sorry, you are definitely not a clinician! That is when a miserable patient coerced a provider to do a scan that you know will be negative, but the patient is so fearful, agitated, angered and adamant you conceived. Once the normal MRI results return the patient is “healed.”

      “Because you have no idea what a TrP … Paul’s work is that nobody knows what a trigger point are.”
      I’m inclined to believe my authors and let Pauls concepts wither away or he can blend them into the TrP idea. He, Quintner and Mckay have an uphill battle to nowhere. I have seen their data and it does not reach the level of proof to disavow or discredit Trps as they related to myofascial pain and dysfunction. Have you googled Trigger Points yet?!

      “Attributing all pain to myofascial issues is stupid and wrong.”
      Again, anyone who understands MF pain will know that this a misinformed statement. MF issues should be the first few in the differential in all complex pain problems.

      “simplistic solutions you provide doesn’t solve them.”
      I’m not trying to solve major problems just educate on the one most ignored, neglected, costliest, miserable and that is MF pain and dysfunction.

      Final point!! Actually back at y’all and most in this blog — “I really don’t think y’all understand how health and science are related. That’s kinda been a theme. Y’all think y’all understand how your personal beliefs and health are related, but y’all don’t grasp how deceptive personal beliefs and personal experience can be. (well stated)

      1. WilliamLawrenceUtridge says:

        Sorry, you are definitely not a clinician! That is when a miserable patient coerced a provider to do a scan that you know will be negative, but the patient is so fearful, agitated, angered and adamant you conceived. Once the normal MRI results return the patient is “healed.”

        You should read Overdiagnosed by Gilbert Welch et al., a mainstream medical doctor highly critical of the current trend towards excessive screening and the needless anxiety it causes. Your “therapeutic MRI” may ease the concern of the patient – but it may also locate an incidentaloma and a cascade of interventions that can end in premature death. A problem increasingly recognized within the medical system, but one that is also difficult to deal with.

        Have you googled Trigger Points yet?!

        I’m waiting for you to provide me with the amazing proof you apparently have that shows what trigger points are, how they are caused, and the best treatment intervention. There’s a lot of shit on google.

        Again, anyone who understands MF pain will know that this a misinformed statement. MF issues should be the first few in the differential in all complex pain problems.[citation needed]

        Fixed that for you. Again, your clinical experience is not a reliable guide, because personal experience deceives. You have no way of knowing if your treatment actually worked, or if nonspecific factors (or simply time) healed your patients. Or, for that matter, if you healed your patients, since I assume you have a variety that you only see once. And you have no idea if they left cured of their affliction, or in disgust.

        m not trying to solve major problems just educate on the one most ignored, neglected, costliest, miserable and that is MF pain and dysfunction.

        When all you have is a hammer…

        Final point!! Actually back at y’all and most in this blog — “I really don’t think y’all understand how health and science are related. That’s kinda been a theme. Y’all think y’all understand how your personal beliefs and health are related, but y’all don’t grasp how deceptive personal beliefs and personal experience can be. (well stated)

        Are you quoting yourself? Is that “well stated” some sort of masturbatory self-congratulations? The faux-”Y’all” to make youself sound approachable and folksy just reinforces the fact that you are attempting to distract from how weak your position is. Most of the contributors to this blog are, or were, practicing clinicians. Dr. Gorski? Researcher and surgeon (active). Dr. Hall? Family practice (retired). Dr. Novella? Clinical neurology (active). Dr. Crislip? Infectious disease (active). Scott Gavura? Pharmacist (active). Dr. Jones? Pediatrician (active). Paul Ingraham? Massage therapist (retired).

        So please stop waving the whole “you don’t know what it’s like to treat patients” around. They do. I don’t, but I don’t need to be a practicing physician to recognize how poor your arguments are, how much they are based on anecdotes, and how deceptive memory can be.

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