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324 thoughts on “Chiropractic and Stroke

  1. nwtk2007 says:

    Mr Maynard,

    I guess the web site is you. I’ll take a look.

  2. Michelle B says:

    The Guardian has an ‘angry’ article on the fraud that is alternative medicine. It is excellent. Rosemary is mentioned in it.

    http://www.guardian.co.uk/lifeandstyle/2008/jul/24/healthandwell

  3. Michelle B says:

    Oh well, it seems the clickable link doesn’t work.

  4. Michelle B says:

    Geesh, I may be posting this twice, but hopefully here is the working link: http://www.guardian.co.uk/lifeandstyle/2008/jul/24/healthandwellbeing.radovankaradzic

  5. nwtk2007 says:

    Mr Maynard,

    I earlier called you Dr Maynard. I knew of a Dr Maynard and it just seems natural.

    I have read through a lot of your site and would like to hear all of your story.

    To be perfectly honest, I am skeptical of how this skull fracture occurred. It seems improbable given what I have read of your incomplete story.

    How ’bout you finish it here? Then I might have some questions for you.

    For example, who finally diagnosed the skull fracture? Why wouldn’t they treat you? Was it their opinion that the chiropractor actually fractured your skull?

    It seems unbelievable that if there is any reasonable proof that the chiro did this that you would not have some cause of action against them.

    Also, what is your life style? Did you play sports? What sports? Have you ever had any previous untreated head injury in sports or an MVA or even possibly ever been mugged?

    You see, I am pretty strong in the arms and I really don’t think I could fracture a skull even if I tried without actually striking it with my fist, and that would be problematic at best.

    Strokes are one thing. Bilateral tearing of the vertebral artery is a pretty strong argument for cause by manipulation. But you are talking about a skull fracture.

  6. Graham Maynard says:

    Hi # nwtk2007,

    Your response is typical of what I have had to put up with from ‘Professionals’.

    Who/what are you ?

    Who diagnosed – nobody will put it in writing – nobody wants to get involved.
    I am on the scrap-heap of life because of Professionals !

    Who diagniosed – it is irrefutable from imagery.
    As stated by a NHS Radiologist without prompting – but only verbally.

    Surely you can read X-rays as well as they did ? As well as anyone can see after a little study.

    As I write on my website – No Professional statement = no injury = no claim.

    And don’t insult me (and through me the entire World) by asking about MVAs, muggings etc.
    There was only one cause – *repeated* oblique head jerking – with ever *increasing* force because my neck would not ‘click’.
    until suddenly I was badly injured.

    And what do you think your questions will do for me or poor Sandy Nette ? What arrogance you have !

    I am not here to serve you – but to warn everyone of the possible *real world* dangers.

    Graham.

  7. nwtk2007 says:

    Sorry Mr Maynard, but just saying it was caused by repeated chiropractic manipulations and having radiographic evidence of a skull fracture, does not mean the manipulations caused it.

    There might be something I don’t know about fractures, but I have never heard of a skull fracture occuring over a gradual period of time like a stress fracture might.

    Only the complete story will suffice to give your story credability, otherwise it doesn’t even rate as anecdotal.

    I also have a hard time believing you couldn’t come up with an MD who would not want to help you out. In the states, if a person goes to a neurologist and says a chiro hurt’em, the chances are that the neurologist will assist to coroborate it. There are plenty of MD’s who are not fond of chiropractic at all who would be glad to help you out if possible.

    Given sufficient information, I dare say that someone on this very blog would be able to help.

    Tell the story. Let’s hear how it happened or finish your web site.

    It is not arrogance to want to know the truth.

  8. Graham Maynard says:

    Hi # nwtk2007,

    Who am I communicating with ? Why are you hiding ?

    You obviously do not understand medicine in UK.
    Doctors are debtors to fellow Professionals, not to Patients.
    They control the procedures and the evidence and NONE were willing to become involved.

    Maybe you have never heard of skull injuries because MDs refuse to get involved and you refuse to accept truth that is not reported Professionally – My MDs could see the direct challenge to chiro, and they wouldn’t ! Too controversial ! As well YOU know !

    >>”Only the complete story will suffice<<” As I say – you are arrogant.
    Come tell my wife that Graham hasn’t told the whole story to you !

    Frankly I use what quality time I have doing much more important things than satisfying those who treat me like a liar !

    No one can help me. The damage was caused by chiro and became exacerbated by lack of necessary treatment due to lack of diagnosis. If you refuse to accept – you call me a liar, besides, I cannot respect your annonymity, why are you hiding ?

    You have not got a clue what I have gone through and how I still suffer. So maybe I had better leave it at that.

    Look at the other Victim X-rays on my website. Look at the sphenoid region, the carotids the soft tissues around C1. All reported NORMAL in USA, and you try to tell me it does not happen. Wise up. You say it is different in USA – not from what I have heard.
    The person injured last year 2007 has physically skull injury which is externally obvious, but will MDs formally report it – heck no.

    You do know someone had their *pelvis* fractured by a chiro impact don’t you ?
    This is so much stronger than fragile sphenoid bones which cannot be protected against pharyngeal hyper-extension.

    Come on Mr/Mrs ???? it is time you woke up to reality – reality which is not reported, and thus not statistically reported by Cds or MDs, but is still reality, and especially so to those of us who are left suffering.

    So via the Internat, also Sandy’s class action, maybe something can at long last be done about chiro’s NON MEDICAL neck jerking !

    http://www.gmweb1.net/

    Graham.

    PS I have answered here, but am not going to waste my time with you any more, because you treat me as a liar.

  9. nwtk2007 says:

    Graham, I am not calling you a liar and do not mean to make you feel like one. I can see that you believe that is what happened to you.

    You said the doctors in the US said the films are normal? Is that what you are saying here:

    ##Look at the sphenoid region, the carotids the soft tissues around C1. All reported NORMAL in USA, and you try to tell me it does not happen.”###

    When you say all reported normal, I assume you mean the films and they were looked at by a doctor or possibly a radiologist?

    That is pretty unbelievable since I would imagine the doctors in the US are about as good as they get at reading films. And even if I do criticize them, they are a very ethical group and not easily swayed by an establishment. Not in the US.

    Have you been to a facility in the US and had any new films taken? X-ray or CT or even MRI?

    If there is an injury it will be reported if seen; of that I would imagine that the forum hosts here would vouch for that. As to how it happened that will depend on your story and what you can prove.

    As to your story. Did the change happen immediately and if so did you go directly to a hospital? When were the films made and where?

    If you want some help, you need to be forth coming in all details of your story. Otherwise you will be alone. You are accusing DC’s of causing great harm. Your story must corroborate your injury. It must be timely and it must make sense.

  10. Graham Maynard says:

    Hi # nwtk2007,

    You have read my main page. No one can make an MD/Radiologist report something they don’t want to. Ethics DO NOT come into it !

    ##Look at the sphenoid region, the carotids the soft tissues around C1. All reported NORMAL in USA, and you try to tell me it does not happen.”###
    This refers to a Victim already living in the US. Films taken/read *last year* !
    That radiologist cannot report ‘everything’ they show because the chiro works in the SAME hospital. Just not done !!!
    That radiologist merely reports what he is asked to by a ‘knowing’ specialist. eg – brain + cranial nerves normal.

    Don’t try to make out that Radiologists are upon a higher plain; they are part of the system and have their own separate system too.
    Then doctors see the word ‘normal’ and start looking at everywhere else !
    It happens over and over again, as with me and the two others I mention with skull damage.

    So maybe it you who needs to open your mind – shit happens.
    Maybe you find these scenarios hard to believe because you have not been on the recieving end, or have not directly witnessed it – yet.

    There is no way I could now come to US for help, I suffer just for visiting my very sick Mom 3 miles down the road.
    My ambition is to outlive her, but I am finding it increasingly difficult.
    Besides I have no income so who do you think is going to pay ?
    What can be done for bones that resorb instead of knit back together – surgery ? inside my head ? risks ?
    Am I now expected to trust a profession which was significantly responsible for me ending up where I am ?

    ***As to your story. Did the change happen immediately and if so did you go directly to a hospital? When were the films made and where?***

    Of course the change happened immediately. Hospital – No. I had to work to support my family so I worked on through incredible pains and worsening symptoms whilst my GP made one consultants appointment after another, everyone belittling my problems, and saying a chiro simply could not injure you. Also common to the others head injured like me.
    A pathetic GP referred medical run-around to specialists who all went through the motions, took their fees, and refused to get involved. A system which is so inadequate for ordinary people.

    As I became worse with numbnesses, left eye wandering, falling down etc. the original flawed reporting still held, and still does.
    Once a Radiologist reports, it becomes a legal document.
    Heck the first Radiologist who reported on me, took a head scan which disappeared and reported my upper neck, but he was not even neurology qualified. When I complained, someone else signed off his reports but the head scan was gone. A legal case ruined and no one will get involved because MDs covered up too !
    I deteriorated because I did not get help.
    As did one of the others with skull injury, who’s GP even sent them back for more chiro ??????

    Head pulling to ‘treat’ the neck should be a criminal offence.

    Even second opinion on my scans (Hammersmith) was between doctors, not to me, so I cannot know what was forwarded !!!!
    A truthful comment was something like ‘other aspects are noted’ (as you to can see, and blooming obvious even to an untrained eye), but of course those aspects are still not formally reported.
    Radiologists are not going to whistle-blow on each other. Would you ?

    *** If I want some help ***
    There is no way I could now come to US for help, I suffer just for visiting my very sick Mom 3 miles down the road, let alone travel 3000.
    Besides what can be done for bones which resorb instead of knitting back together – surgery ? inside my head ? risks ?
    *** Otherwise you will be alone. ***
    And isn’t that just the point. That is what injury and pain does to individuals.
    Old friends move on or die, and you cannot go out to make more. Being ‘alone’ is what *chiros* do to people.

    You write as if it me who needs to wise up.

    No it is MDs and polititians who need to recognise the scurge these chiro charlatans are within our societies, so that more like me and Sandy do not have their lives ruined.
    DCs do complex harm to those injured, and in ways which MDs cannot help !

    How often are both vertebral arteries damaged in real everyday life ?
    Is this not the most significant problem with chiro – where the obliquely applied powerful forces nip and internally tear both during a single ‘treatment’ session.

    Maybe one day my story will be completed, but what is left of my life is for *me* much more important than satisfying your attitudinal requirements.
    ***it must make sense.*** It can never make sense to those who will find reasons for not accepting the plain truth.

    I am Graham Maynard Who are you ?

    It really is about time you in return answered my only question.

  11. nwtk2007 says:

    I can assure you that radiologists in the states are not going to hide a radiographic finding to protect a doctor. They usually don’t even know the story behind the films they read.

    Where was this hospital with the chiro? I don’t think there are very many hospitals in the US with chiro’s on staff.

    Also, a rad report is a legal document, but films can be re-read and even the original radioligist can re-read and make changes to his original report.

    As to who I am, I’d better just stay Nwtk2007. There are a few fanatics on these forums and given how unbalanced they sound here and elsewhere, it is probably not a good idea to reveal your true identity.

  12. Harriet Hall says:

    As nwtk2007 points out, we don’t have enough documented information to understand what happened in Graham Maynard’s case.

    We do have enough documented information to convince us that chiropractic neck manipulations can cause stroke.

  13. Graham Maynard says:

    Hi Harriet,

    I have not provided enough documentation because I have not the ‘quality’ time to do it even for my own website.
    Maybe I’ll copy and upload some of my medical reports too – without signatures.
    I had not intended to do this – but I can see it is the only way to convince doubters, or those who support chiro.

    Why won’t chiropractic sort out their own ? Because there are so many different types – like different Churches – all independent.

    Completely ban head-neck manipulation or clean sweep all chiros out of existence, because otherwise no one can guarantee safety for everyone.
    It as simple as that !

    Hi # nwtk2007,

    Which hospital it was in the US ? – I cannot publish such information here for the same reason you don’t ID yourself here, for that would go towards violating the confidentiality I granted this sufferer ?

    Tel you what.
    You provide the name of an honest independent neuro-radiologist who is not scared of chiro/establishment backlash and I will pass on the information.
    In fact ask any radiologist you know to look at the excerpts I publish. Victim 1.
    Best just say Oregon/Washington/BC areas would likely be suitable for easy travel.

    http://www.gmweb1.net/
    Cheers ……. Graham.

  14. Harriet Hall says:

    Graham,

    Even if you document your case, it is only one case. Unless you can show that it is not an isolated fluke, it’s going to be hard to convince people that it’s evidence for abolishing chiropractic.

    What might do more good is to report it to whatstheharm.net or other websites that are collecting examples of harm from chiropractic. If other cases fall into a pattern, it could direct further investigations.

    In the meantime, we do have good evidence that neck manipulation can cause strokes and that there is no compelling reason to favor it over other treatments. That’s something that we ought to be able to convince everyone of, even chiropractors.

    And even then, guaranteeing safety may not be an achievable goal. We could guarantee safety by eliminating tobacco and automobiles, but society won’t let us do that. People insist on their right to take those risks.

    How about starting with some simpler, achievable goals like informed consent or like insurance companies refusing to cover neck manipulation?

  15. quackdoctor says:

    “I suffered serious injuries in 1993 – complex skull fracturing from above neck to behind nose, also around left ear and pituitary; these last two aspects did not ‘heal’ properly, never will, and are steadily becoming worse. With these were – intra-cranial bleeding, a dislodged left styliod still floating amongst muscles, nerves, artery etc. behind my jaw, torn pharyngeal + head-neck + cranio-spinal tissues, and much more; ”

    Sir:

    I am an expert witness that has testified may times both against and in defense of chiropractors. I have seen many injuries. This did not happen from a manipulative proceedure. Also the terminology is strange. So either you were in another accident and are blaming a chiropractor or you are manufacturing this. If you beleive this you are delusional.

    Now as far as radiographic findings. They do not prove a causal relationship with the chiropractic treatment. And to be quite blunt your description of the whole affair is so evassive and vague that it is impossible to know what you are saying.

    So please if you are going to make a case at least make it a resonible one

  16. quackdoctor says:

    And also…Let me tell you something. We use Chiropractic radiologists all the time in court. And even THEY testify against DCs all the time. So if THEY will testify against a DC then I am sure others will. I know it

  17. Graham Maynard says:

    # quackdoctor

    As a Write on my website – deny, convince and discredit: the exact ‘Pseudo-professional’ attitude which has perpetuated this chiro injury situation all along.

    You wrote >>This did not happen from a manipulative proceedure.<<
    Well this shows just how factually wrong and incompetent YOU can be to.

    WARNING. A chiro based injury will be denied just as is being done here by someone who does not even have all the facts !!!

    WARNING chiro treatment could lose your health and your life, whereupon this kind of person will defend chiropractic by stating a case which denies the sufferer’s truth.

    Such ‘quackdoctors’ (your word – not mine) delay, obstinate and make so much ‘noise’ that real doctors can’t afford to waste their time becoming involved.

    So.
    What about the other two like me, they are still not reported amongst chiro or medical statistics either.
    I suppose you’d write the same about them and thus not count them either.

    Easy for you who does not have to try to live *through* the reality of these problems. Not *with* these problems, but *through* the way they interfere your pre-chiro capabilities.

    We all have one thing in common.
    We walked out of chiro ‘treatment’ with skull injuries not present when we entered because any half sensible person would refuse to touch anyone with injuries like ours ! (Including doctors unless to save life!)

    In the 2007 injury case I mention the Chiro is reported saying.
    ” I can’t believe I just did that.” as the injured patient walked out (and now has the same probs/symptoms as me).
    As I said the injuries are externally visible and he saw what he had just done.

    Refusing to believe rather than attempting to understand is the real problem here, just as it has been regarding chiro treatment induced artery damage too.

    Hey # quackdoctor, CHIRO FORCES TO THE HEAD HAVE CAUSED SOME VERY SERIOUS INJURIES – WHETHER DENIED OR NOT !
    Makes me wonder what the Coroner will write on my Death Certificate.

    Thank you for your suggestion Harriet.

    One of the problems of a Blog like this is finding yourself in a position where you are obliged to defend yourself from folk who do not have a clue about your own situation.
    They don’t actually get involved in doing anything good, they just interfere and jeer from afar.

    Cheers ……… Graham.

  18. quackdoctor says:

    Sir:

    You have not addressed any of my points in a logical manner. We are very clear on what injuries can happen from spinal maipulation. And to say a skull fracture can defies logic and history. You do not deal in any coherent manner with any statement I have made. Your posts here and on your website are disorganized and irrational.

    If you would report in a coherent and logical manner I would respond. I mean no offense but is it possible that you suffer from some mental illness? Because the relationships you are constructing and your responses make me suspect that.

    I mean the claims you are making are so outrageous. It would seem that you have some problem with making connections with reality or you are making the whole thing up.

    Now I am not saying that something could not have happened to you from a manipulative proceedure. But most of what you say happened could not have happened.

  19. quackdoctor says:

    “We all have one thing in common.
    We walked out of chiro ‘treatment’ with skull injuries not present when we entered because any half sensible person would refuse to touch anyone with injuries like ours ! (Including doctors unless to save life!)”

    And also just look at this statment. First you say you did not have injuries then you say that the person should not have touched you because you had injuries. It just does not add up.

    “Hey # quackdoctor, CHIRO FORCES TO THE HEAD HAVE CAUSED SOME VERY SERIOUS INJURIES – WHETHER DENIED OR NOT !”

    There is no doubt that manipulation of the upper cervical spine has caused stroke. And some other things. Like cracked ribs. But you keep talking about forces to the head. Please provide any case where this has happened. You have made a bold statement. I just would like to see ANY documentation of this.

  20. Graham Maynard says:

    Hi Harriet,
    I am afraid that “quackdoctor” here is doing what supporters of Chiro almost always do; as if it is those they injure who are the problem, and not their own kind for the way in which they leave the public with serious injuries.
    These folk really do not care about the suffering and sad outcomes endured by chiro injured victims and their families. It has already happened for far too long in regard to strokes !
    Quackdoctor writes as if the forces being applied, supposedly to manipulate the neck, are not being applied to and through the head/skull and its related anatomy.
    From my personal point of view, everyone knows I cannot possibly post my med files here. Also, from quackdoctor’s shameful “is it possible that you suffer from some mental illness?” there really is no way I can respond because any future discussion from that point onwards has already been tainted.
    Sadly this is what I have come to expect, and is why I wrote “obstinate and make so much noise”.
    Such outbursts, from supposed experts whom we are supposed to be able to rely upon, are inuendo which specifically illustrates a lack objective foundation; words like those saying so much more about the speaker than those they are so deliberately aimed at ! They are intended to devalue discussion and degrade any possibility for sensible outcome.
    I still look forwards to “# nwtk2007″ responding in a manner which would further the truth in relation to another person injured like me. Frankly I do not expect this to happen because no-one wants to become involved.
    So I leave with apologies for my own specific stand against ‘chiro head induced forces’ intruding upon your ‘stroke’ thread.
    Cheers …… Graham.

  21. quackdoctor says:

    Sir:

    You are very wrong if you think you are making sense what so ever. And you well could post your medical files. And when a manipulative operator works with the neck there are very little forces applied to the head. And furthermore anyone fore or against chiropractic with any common sense and medical knowledge realizes the amount of force it takes to achieve the injuries described. I have simply called you on your statements. You have not substantiated anything. In any evidence based manner. And outside of evidence based your injuroies do not add up with common sense. So you are either out right lying or you believe a manipulation caused a skull fracture and a number of the extrem injuries you mentioned. No if you have convinced your self of that you are in a delusional state. And we come back to the concept that you will provide no proof at all. And you could easily putyour records on the web site. They are your records. If you said you had a stroke or a fracture or even paralysis from a manipulative treatment I would have all the sympathy in the world for you and give you the benefit of the doubt. But with claims of virtually impossible injuries as you have described I simply ask for substantial evidence.

  22. Fifi says:

    Chiro=a manipulative operator. Graham, I’d keep that in mind that you’re trying to discuss what happened to you with quackdoctor and nwtk who are chiropractors – quackdoctor also “whores” himself out (his words, not mine) as an “expert witness” for courtcases. Nwtk showed no compassion for Sandy Nette and quackdoctor is just having a go at you because he can. Personally I think it’s pretty disgraceful.

    Earlier quackdoctor said this, which shows just how sincere he is when he says he’d have compassion for you if you’d suffered a stroke due to chiropractic manipulation – “As far as the stroke issue. It has been even said in a major medical journal that this has been used as a weapon against chiropractors. It is extremely rare. A handful of cases are used by the anti chiropractic camp to discredit a procedure that is very safe.” Clearly he’s just playing games with you and trying to make you feel bad and defend his profession.

    Whatever the original cause of your present suffering, I hope you find some relief and help. I respect your desire to make sure that the same thing doesn’t happen to another innocent person.

  23. quackdoctor says:

    Again we come back to another individual that is unwilling to look at the facts. And putting the blame on a methjod that clearly could not cause such injury. All else is irrelvent except the facts. I can be totally objective and am. I testify against chiropractors. I have nothing to gain here. I find it interesting how this individual extracts so much sympathy when his claimes just do not make any sense.

    I am not trying to defend chiropractic. I do not even practice any form of it. Hell I would be just as happy if I had more chiropractors to testify against. The more chiropractors being sued the merrier for me. But I have to be honest. I mean I have clearly stated what injuries that cervical manipulation may cause. And by the same token I have an equal responsibility to say when I know an injury could not be related to manipulation.

    And stroke is rare statistically and the proceedure is statistically safe when lloking at the prodceedure alone and not benefit risk ratio. And even then we do not really know as adequate studies have not been done into cervical manipulation for neck pain and stiffness.

    And as far as compassion for a person who has a stroke. I have plenty of compassion. Enough to testify at a very low fee. Hell I would wave the fee if need be. But I would do the same for a DC that was falsly accused. But none of this matters anyway. Because the point here is that the injuries described did not come from cervical manipulation. And there are NO chiropractic techniques that put forces into the skull of any magnitude. In fact the handfull that do are accused of being so low force they could do nothing.

    So whether I “whore myself” or “have no compassion” or what ever is not the issue here. The issue is that this person has made a claim. A very outrageous claim. This is an evidence based web site. So all I am asking is some evidence. And I know this did not happen based on the injuries described. Now if the person was in a motorcycle accident well that is a different issue. But they are saying they came from manipulation of the C spine. How pray tell did this happen. By what mechanism?

    I mean really folks think rationally here. If this did happen it would be a major case and possibly even be in a journal. So based on the injuries described if this individual had these injuries from some cause. He would have seen numerous physicians and those physicians surely would have told him that manipulation did not cause the injuries. Therfore either this individual is manufacturing this. Or did have injury and is blaming it on the DC. Now if he really believes the injury was caused by the DC then he is delusional. As many physicians would have told him it was not.

    Do you not realize that when a DC causes an real injury that tons of MDs who are experts will come forth to testify. But do we see that here? No because no matter what the hourly fee no one is going to defend such an outrageous claim. It is simple as that.

    The only oter case I know of similar to this is when we had a DC accused of causing a herniated IVD with an “Activator” instrument. The patient was going aroud to a bunch of physicians seeking tertimony on her behalf. When the physician that testified against for her was asked if he ever saw the instrument he said “No”. When the attorney clicked the instrument on the physicians palm. He got red in the face and said that there was no way that the injury could have been caused that way. I mean even the most antagonistic physician againt chiropractors is not gointg to make a fool out of himself

    I cannot believe how logical people can be so overtaken by bias. It is just as bad as the chiros that claim there has never been a stroke from manipulation despite it happening right on the operators table.

    Skewed logic and thaws in conclusions never cease to amaze me. We burn witches because they are witches not because thay have pointy hats. What is going on here is similar to what the alt med group does. I submit the following. Harriet may find it amusing as applied to drawing conclusions from flawed methods.

    http://www.youtube.com/watch?v=zrzMhU_4m-g&feature=related

  24. Joe says:

    Fifi,

    You are spot on 29 Jul 2008 at 4:53 pm, except- when you write “Clearly he’s just playing games with you and trying to make you feel bad and defend his profession.”

    Chiropracty is not a “profession” in the traditional sense, it is a cult (in the traditional sense). In the modern sense, chiro is a “profession” in the same sense that any “identifiable group” is a profession. That includes baby-sitters and dog-walkers.

    Chiros are “identified” by their opposition to criticism, everything else they do is ad hoc.

  25. nwtk2007 says:

    FiFi – “Nwtk showed no compassion for Sandy Nette and quackdoctor is just having a go at you because he can. Personally I think it’s pretty disgraceful.”

    You know FiFi, I really don’t give a rat’s whether you think I have compassion for Ms Nette or not.

    What I would like to hear, however, is if you and Joe here think chiropractic manipulation could cause a skull fracture which apparently gradually manifests it’s self into some kind of chronic limbo.

    I would also like to hear if you and Joe there think this story has any credibility. I would remind you that his “films” have apparently been read by American Radiologists who, from what I can gather, said they were negative.

  26. nwtk2007 says:

    And Quackdoctor, you don’t have to be an insurance whore to testify as an expert witness, unless of course, you are saying what the insurance carriers are telling you to say or you are compromising your opinions in order to secure your “job” as an insurance whore.

  27. quackdoctor says:

    “Chiropracty is not a “profession” in the traditional sense, it is a cult (in the traditional sense). In the modern sense, chiro is a “profession” in the same sense that any “identifiable group” is a profession. That includes baby-sitters and dog-walkers. ”

    You are completely out of touch with chiropractic when practiced as a profession that treats musculoskeletal problems. Employing traditional medical diagnostic methologies, imaging, MRI, CT, manipulative medicine and physiotherapy modalties, bracing, casting, excersize and more. Hell you do not even have the knowledge to not call it “chiropracty”. Many chiros are cultists and many are not. So it all depends.

  28. Fifi says:

    nwtk – You’ve pretty much single handedly moved me from perceiving chiropractors as being generally pretty decent people (who are just misinformed and into some flaky stuff) to the understanding that there are lots who don’t actually give a rat’s ass about harming their patients and lack basic patient/dr ethics so are therefore a danger to the public. Your total lack of compassion for Sandy Nette sealed it for me.

  29. quackdoctor says:

    “And Quackdoctor, you don’t have to be an insurance whore to testify as an expert witness, unless of course, you are saying what the insurance carriers are telling you to say or you are compromising your opinions in order to secure your “job” as an insurance whore.”

    Well I was kind of kidding about the “whore” comment. I do not only testify for insurance companies. I testify for plantiffs frequently. And as far as testifying in malpractice cases you can be anything you want. But you are more apt to get retained with good sheepskin anda track record. In the present state of affairs you do not need to make anything up or lie. Things are usually pretty clear cut.

    Now in personal injury usually there is a lot of lying going on on both sides. I mean most car accident victums that see chiropractors for spinal injuries are playing up the injury. If the injury is present at all. Which usually it is not. So the personal injury game is different.

    Now I did testify for a young gentleman that was electricuted badly by a wire on a second floor building and fell to the ground. It was very legit. But I really stay away from auto accidents.

    But I would never ever testify for an insurance company and contruct a lie to hurt a chiropractor if it was unjust. There are people that would.

  30. nwtk2007 says:

    OK Quackdoctor, that’s better. Based upon what FiFi had said you can see how I might have thought the worst.

    Of course you know even mentioning PI and chiropractic that you are opening a huge bag of worms for the skeptics, not that it doesn’t bear looking at.

    I know what you mean about the injury not even being there. I do a lot of PI work and frequently come under fire from patients and attorneys and even some insurance companies when I have little or nothing to offer in the way of treatment to “substantiate” an injury. (So, obviously, there are quite a number of patients I won’t even bother to see even for an exam if they are represented by certain attorneys.)

    At one time I had a stack of paper over 6 inches thick, each page representing a patient or patients who I did not accept as a patient. When I turn’em down I usually send them to the local MD run PI clinic.

    I also think you are right about Mr Maynard. It just doesn’t sound plausible and why he thinks he can’t post his records is beyond me. Maybe he means he physically doesn’t know how to do it on his web site.

  31. nwtk2007 says:

    FiFi –

    “nwtk – You’ve pretty much single handedly moved me from perceiving chiropractors as being generally pretty decent people (who are just misinformed and into some flaky stuff) to the understanding that there are lots who don’t actually give a rat’s ass about harming their patients and lack basic patient/dr ethics so are therefore a danger to the public. Your total lack of compassion for Sandy Nette sealed it for me.”

    You just go on believing that FiFi.

    Isn’t there a name for a response to an argument such as, “you have no compassion”, when you are confronted by a good counter to your position? Is “You have no compassion” actually meant to be, “I’m wrong but don’t want to admit it”?

  32. quackdoctor says:

    “At one time I had a stack of paper over 6 inches thick, each page representing a patient or patients who I did not accept as a patient. When I turn’em down I usually send them to the local MD run PI clinic.”

    Well good for you. I have heard there are honest chiropractors out threre. When I was in PI I used to mill through 100 people a day and I cared not at all if they were real ot not. As long as they did not get me involved in being exposed. I mean yeah…If someone told me point blank that the accident did not happen or that they really had no symptoms I would let them go. But I cannot count that on one hand. As long as my bases were covered I would keep my mouth shut if I thought nothing was wrong and who was I to say they had no pain?

    But then I got out of that and went into legit NMS practice. And then got tired. Then got into being a witness.

    But I do think that people misunderstand that there are quite a few chiropractors that are not cultists or quacks. I think people are exposed to more quackery because there are more chiropractor and since people need patients they are more apt to do quackery. If there were less chiropractors and every chiropractor had back pain patients in decent numbers then people would not have time for selling quackery.

    Now your PI chiropractors are not quacks. many are frauds but usually not quacks. They usually got into PI because they could not bring themselves to lie to patients about health issues but could not make enough money in back pain care without PI.

    But people just do not understand that many of us are in shock by what some or many chiropractors are doing. I remember this one MD who was antagonistic to me when I called him to report on his patient. He said he hated chiros because he said we claimed to treat all these internal disorders he named. I was shocked and tried to explain I did not do such things. I then dropped a few names of MDs I was friends with and he warmed up. But as I became less sheltered I found out he was not totally off base. There is a lot of nonsense going on.

    But people seem to focus on that and not those DCs that are well trained and rational and set limits on the practice. And then we have a few high profile reformist chiros that are very imbalanced as well. These guys are older and did not really get such a great education in school or may have not been the brightest in practice. So there is imbalance in both directions.

    The thing that ruined chiropractic was health insurance in addition to other things. Like schools cranking out too many students. And I think Sid Williams did a hell of a lot of damage. There are way too many schools and there are way way too many chiropractors. But it is a great profession if you can eliminate the riff raff. And to do that you have to limit the ratio of Dcs to the population. I would say in a town of 30 thousand about 2 chiropractors at the most would be the limit. Not like 20 as in the current situation.

  33. Joe says:

    quackdoctor on 29 Jul 2008 at 7:29 pm wrote “… You are completely out of touch with chiropractic” … “Many chiros are cultists and many are not. So it all depends.”

    I am in touch with the McDonald survey “How chiropractors think and practice” William P. McDonald et al “Seminars in Integrative Medicine” 2004 V.2 #3 92-98
    ISSN 1453-1150

    Abstract http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B75KC-4F1H9GS-5&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=754fe88415cd702aa52be6484f7005b8

    That survey shows that most (ca. 90%) are cultists. As for the rest, I do not believe many of you are dumb-enough to get a DC and then become smart-enough to practice EBM on your own. I acknowledge that some do; but the lowest common denominator is that DCs are il-educated fools.

    If you are bright-enough to abandon the quackery, why continue to call yourself (albeit, reluctantly) a chiro? Why not renounce the cult? Ninety percent of them make you look like a fool. Study PT and become a legitimate practitioner.

  34. Joe says:

    It seems I did not close the “bold” tag, above.

    quackdoctor on 29 Jul 2008 at 9:13 pm wrote “The thing that ruined chiropractic was health insurance in addition to other things.”

    What “ruined” chiropracty were the initial (silly) notions of subluxations and Innate and non-belief in the germ theory and the idea that 95% of illness is a result of spinal mis-alignment and the fairy tale that you can cure deafness and heart disease by “adjusting” the thoracic vertebrae and the practice-building “maintenance” adjustment. I could go on …

    Chiropracty was “ruined” from the start. Place the blame where it belongs- with DD, and BJ; and yourself for being foolish-enough to follow them.

  35. Joe says:

    nwtk2007 on 29 Jul 2008 at 8:01 pm wrote “Isn’t there a name for a response to an argument such as, “you have no compassion””

    Why don’t you demonstrate your sophistication and tell us? I think you cannot.

  36. quackdoctor says:

    “If you are bright-enough to abandon the quackery, why continue to call yourself (albeit, reluctantly) a chiro? Why not renounce the cult? Ninety percent of them make you look like a fool. Study PT and become a legitimate practitioner.:

    Well we really do not need to study PT. A number of chiropractic colleges teach excellent science and excellent physiotherapy such as modalities, beacing, casting ect..As a matter of fact it was broad scope chiropractors that pioneered many modalities in NMS conditions. It all depends where you go to school. And a chiropractor who practices chiropractic medicine is different than a PT. We are highly educated in radiology for example. And get very good education in physical diagnosis at a number of schools.

    “That survey shows that most (ca. 90%) are cultists. As for the rest, I do not believe many of you are dumb-enough to get a DC and then become smart-enough to practice EBM on your own. I acknowledge that some do; but the lowest common denominator is that DCs are il-educated fools. ”

    You are way way out of touch with what is taught in a top school or any school for that matter. You have made ignorant statements. I have a PhD in anatomy and a DC. I can tell you that in a good chiropractic college that DCs are not il educated fools.

    DC Program Course Descriptions
    Academics > Doctor of Chiropractic Medicine > D.C. Curriculum > DC Program Course Descriptions

    AN5101 Spine & Extremities Anatomy – Credits 5.0

    In this course, students will learn in lecture and group formats, the normal structure and function of the spine and extremities. In the first portion of this course, students will be required to demonstrate core knowledge of the gross anatomy of spinal structures, including the pediatric spine, and relevant structures of the back. Students must also demonstrate an anatomical and functional understanding of the spinal cord, its meninges and the spinal nerves. In the second portion of the course, students will explore the gross anatomical structures of the extremities and their functions. The integrated gross anatomy laboratory exercises will address related basic science issues.

    Corequisite: AN5102

    AN5102 Spine & Extremities Anatomy Lab – Credits 3.5

    In this course, students will learn in laboratory format, the normal structure and function of the spine and extremities. In the first portion of this course, students will be required to demonstrate core knowledge of the gross anatomy of spinal structures, including the pediatric spine, and relevant structures of the back. Students must also demonstrate an anatomical and functional understanding of the spinal cord, its meninges and the spinal nerves. In the second portion of the course, students will explore the gross anatomical structures of the extremities and their functions. The basic science component will integrate with the laboratory issues.

    Corequisite: AN5101

    AN5107 Histology & Embryology I – Credits 2.5

    In this course, students will be introduced to human developmental biology and histology by the use of lecture, group, and laboratory experiences. In the developmental biology portion, students will learn about the events of the first three weeks of development. In coordination with the gross anatomy courses, students will also learn about the development of the main structures of the back and limbs. In the histology portion of the course, students will learn about cellular anatomy. In addition, and again in coordination with the gross anatomy courses, students will learn about the histology of the main tissues in the back and limbs, including skin, muscle, nervous tissue, and connective tissues, including blood, vascular tissues, and lymphoid tissue.

    Corequisite: PH5103

    AN5201 Head & Neck Anatomy – Credits 3.0

    In this course, students will study, in lecture and group formats, the normal structure and function of the regions of the human head and neck. This includes gross anatomical structures as well as neuroanatomical structures. In addition, the embryology and histology of specific structures of the head and neck will be presented. This course is fully integrated with laboratory dissections presented in AN5202. Gross anatomy and neuroanatomy exercises will address related basic science issues.

    Prerequisites: AN5101, AN5102

    Corequisites: AN5202, AN5203

    AN5202 Head & Neck Anatomy Lab – Credits 2.0

    In this course, students will study in laboratory format, the normal structure and function of the regions of the human head and neck. This includes gross anatomical structures as well as neuroanatomical structures. This course is fully integrated with lecture topics presented in AN5201. Gross anatomy and neuroanatomy laboratory exercises will address related basic science issues.

    Corequisite: AN5201

    AN5203 Neuroanatomy – Credits 5.5

    The purpose of this course is to study the structures of the brain, spinal cord, and autonomic nervous system (ANS) and their functions. The structures of the brain, spinal cord, and ANS, and their functions, will be introduced to students through the following methods: lectures, group activities, self-directed learning, readings, and laboratory participation. The functions of these structures will be emphasized and their relevancy to clinical practice will be demonstrated through the use of patient paper cases and problems.

    Corequisites: AN5201, AN5202, PH5208

    AN5304 Thorax, Abdomen & Pelvic Anatomy – Credits 2.0

    Students will study, in lecture and group formats, the normal structure and function of the organ systems associated with the thorax, abdomen and pelvis. Specifically, this course will cover the gross anatomy of the respiratory, cardiovascular, gastrointestinal, reproduction, and urinary systems. Laboratory exercises will help guide students toward understanding the anatomical concepts associated with these systems. In addition, students will interrelate their anatomical knowledge with the Histology and Embryology II course.

    Prerequisites: AN5201, AN5202, AN5203

    Corequisites: AN5305, AN5307

    AN5305 Thorax, Abdomen & Pelvic Anatomy Lab – Credits 2.0

    Students will study, in laboratory format, the normal structure and function of the organ systems associated with the thorax, abdomen and pelvis. Specifically, this course will cover the gross anatomy of the respiratory, cardiovascular, gastrointestinal, reproduction, and urinary systems. Laboratory exercises will help guide students toward understanding the anatomical concepts associated with these systems. In addition, students will interrelate their anatomical knowledge with the Histology and Embryology II course.

    Corequisite: AN5304

    AN5307 Histology & Embryology II – Credits 2.5

    In this course, students will continue to learn about human developmental biology and histology by the use of lecture, group and laboratory experiences. In coordination with the gross anatomy course, students will learn about the development and histology of the main systems of the chest, abdomen and pelvis.

    Prerequisite: AN5107

    Corequisites: AN5304, AN5305

    BC5104 Human Biochemistry – Credits 4.0

    The structure and functions of proteins, carbohydrates, lipids and their reactions in metabolic pathways are investigated.

    Corequisite: BC5105

    BC5105 Clinical Biochemistry – Credits 1.5
    An introduction to techniques used in clinical analysis of amino acids, enzymes, redox states, serum cholesterol and lipoprotein quantification, and body composition.

    Corequisite: BC5104

    BC5308 Nutritional Biochemistry – Credits 2.0
    Vitamins and minerals will be studied with an emphasis on their biochemical involvement within human metabolic pathways and physiology. Non-essential nutrients will also be investigated with respect to their role in biochemistry and physiology.

    Prerequisites: BC5104, BC5105

    BU5209 Introduction to Business Principles – Credits 1.0

    The purpose of this course, the first part of the comprehensive course in the Ethical Practice Management Program, is to introduce certain practical issues that students will encounter in the future to help prepare them for the rigors and realities of their chiropractic practices.

    BU6201 Principles of Marketing & Communication – Credits 2.0

    The main emphasis of BU6201 addresses several areas of practice that are essential for the health care practitioner to know, understand, and utilize. Concentration is on the following topics: ethically and effectively marketing and promoting a health care practice; developing effective written, verbal, and electronic communication skills; addressing Risk Management issues including boundaries; and discussion of protective strategies.

    Prerequisite: Completion of Phase I

    BU6306 Business Planning – Credits 2.0

    This course focuses on preparing students to create a functional business plan for their future practices. Experts from the business field discuss the necessary elements and give direction to students to assist in the development of their business plans.

    Prerequisite: BU6201

    BU6404 Ethical Management of the Chiropractic Practice – Credits 3.0

    This course is a continuation of the Ethical Practice Management Program. This course comprehensively examines and discusses many different practice topics and situations that the new doctor will shortly encounter. Also, each student will submit their business plan to a local banker who will evaluate it. The banker will then interview the student to give feedback and possibly suggest revisions to make the plan more useful to the student in their future practice. A business plan that is considered acceptable to the banker is a requisite to begin the Clinical Internship.

    Prerequisite: BU6306

    BU6407 Jurisprudence & Ethics – Credits 2.0

    The purpose of this course is to study the rights, privileges, duties, and obligations of the chiropractic physician in the general practice of chiropractic. Emphasis is placed on understanding liabilities, malpractice and risk management, giving testimony, report writing, and documentation. Common aspects of business law are also discussed as related to leases, licenses, and advertising. Throughout the course, specific ethical issues are discussed as they relate to topics.

    Prerequisite: Completion of Phase I

    CL6402 Student Clinic – Credits 10.0
    Student Clinic, although designated as a laboratory in a curricular sense, marks the advent of the student’s practical application of the basic and clinical sciences in a clinical setting. Students will receive close supervision, guidance and instruction in the delivery of health care by licensed clinical personnel. The patient populations evaluated and managed by the student will be confined to University students and the students’ immediate family members (spouse and children). Students participating in the Student Clinic course will be expected to exhibit clinical competence and professionalism (including knowledge of and strict adherence to confidentiality and privacy policies). With the exception of the patient populations served, Student Clinic operations will closely mirror that of the University’s (main) outpatient clinics, including but not limited to clinic forms, diagnostic and therapeutic procedures. Clinical competencies relating to skills of historical interviewing, medical record documentation, physical examination (general, regional and specialty), laboratory testing (selection, performance and interpretation), evidence-based therapeutics, differential diagnoses development, ethics, professionalism, and interpersonal communication will be assessed (Competencies I-IX). Additionally, the course will assess students’ knowledge on the practical application of select physical therapy modalities during designated teaching modules carried out throughout the term. Special Topic Rotations, scheduled as part of the Student Clinic experience, will serve to provide the student with additional clinical skills or enhance those skills already acquired through other educational experiences.
    Prerequisites: Completion of Phase I, Student Clinic Performance Exam, EC6303, RA6302, FR6307
    Corequisites: EM6403, RA6409, RA6408

    EC6303 Ambulatory Trauma Care – Credits 2.0
    This course places emphasis on the practical application of emergency care procedures that can be employed in a primary care clinic setting if required. This course provides instruction in open and closed wound management techniques that encompass sterile procedures, the application methods of roller bandages, and suturing techniques. To receive a passing grade in this course, students must show current CPR certification from the American Heart Association, BLS for Health Care Providers.

    Prerequisite: Completion of Phase I

    EM5207 Evaluation & Management of the Chest & Thoracic Spine – Credits 4.0

    The primary objective of this course is for students to learn the basic concepts and skills necessary for a broad-based conservative care (primary health care) physician to evaluate and manage the chest and thoracic spine. Students will learn methods for obtaining a history specific to the chest and thoracic spine, as well as examination skills for these areas. Skills covered in the course will include, but are not limited to, taking vitals, inspection, joint and soft tissue palpation, auscultation, percussion, range of motion, orthopedic evaluation, and basic neurological examinations. This course will teach treatments applicable to the chest and thoracic spine, such as joint and soft tissue manipulation. The clinical presentation of normal anatomy, biomechanics, and physiology will be emphasized, along with an introduction to the evaluation and management of uncomplicated common conditions. This course will integrate basic concepts in (i) preventative medicine, (ii) biochemical and nutritional foundations of health, (iii) determinants of health, and (iv) lifestyle counseling involving the chest and thoracic spine. Teaching methods will include lectures, demonstrations, skills laboratories, and problem-based large group discussions that focus on skills development and clinical reasoning.

    This is the students’ first Evaluation and Management course. It will lay the foundation for other Evaluation and Management courses by teaching concepts related to (i) the patient interview, examination, and management process; (ii) joint and soft tissue evaluation and manual therapies; and (iii) the doctor-patient relationship.
    Prerequisites: AN5101, AN5102
    Corequisite: FH5106

    EM5309 Evaluation & Management of the Abdomen, Pelvis & Lumbar Spine – Credits 4.0
    The primary objective of this course is for students to learn the basic concepts and skills necessary for a broad-based conservative care (primary health care) physician to evaluate and manage the abdomen, pelvis and lumbar spine. Students will learn methods for obtaining a history specific to the abdomen, pelvis and lumbar spine, as well as examination skills for these areas. Skills covered in the course will include, but are not limited to, inspection, joint and soft tissue palpation, auscultation, percussion, range of motion, orthopedic evaluation, and basic neurological examinations. This course will teach treatments applicable to the abdomen, pelvis and lumbar spine such as joint and soft tissue manipulation. The clinical presentation of normal anatomy, biomechanics and physiology will be emphasized, along with an introduction to the evaluation and management of uncomplicated common conditions. This course will integrate basic concepts in (i) preventative medicine, (ii) biochemical and nutritional foundations of health, (iii) determinants of health, and (iv) lifestyle counseling involving the abdomen, pelvis and lumbar spine. Teaching methods will include lectures, demonstrations, skills laboratories, and problem-based large group discussions that focus on skills development and clinical reasoning.
    Prerequisite: EM5207

    EM5408 Evaluation & Management of the Head, Neck & Cervical Spine – Credits 4.0

    The primary objective of this course is for students to learn the basic concepts and skills necessary for a broad-based conservative care (primary health care) physician to evaluate and manage the head, neck and cervical spine. Students will learn methods for obtaining a history specific to the head, neck and cervical spine, as well as examination skills for this area. Skills covered in the course will include, but are not limited to, inspection, joint and soft tissue palpation, auscultation, percussion, range of motion, orthopedic evaluation, and basic neurological examinations. This course will teach treatments applicable to the head, neck and cervical spine, such as joint and soft tissue manipulation. The clinical presentation of normal anatomy, biomechanics, and physiology will be emphasized, along with an introduction to the evaluation and management of uncomplicated common conditions. This course will integrate basic concepts in (i) preventative medicine, (ii) biochemical and nutritional foundations of health, (iii) determinants of health, and (iv) lifestyle counseling involving the head, neck and cervical spine. Teaching methods will include lectures, demonstrations, skills laboratories, and problem-based large group discussions that focus on skills development and clinical reasoning.
    Prerequisites: AN5201, AN5202, EM5309

    EM6101 Evaluation & Management of the Extremities – Credits 4.0

    The primary objective of this course is for students to learn the basic concepts and skills necessary for a broad-based conservative care (primary health care) physician to evaluate and manage the upper and lower extremities. Students will learn methods for obtaining a history specific to the extremities, as well as examination skills for this area. Skills covered in the course will include, but are not limited to, inspection, joint and soft tissue palpation, range of motion, orthopedic evaluation, and basic neurological examinations. This course will teach treatments applicable to the extremities, such as joint and soft tissue manipulation. The clinical presentation of normal anatomy, biomechanics and physiology will be emphasized, along with an introduction to the evaluation and management of uncomplicated common conditions. This course will integrate basic concepts in (i) preventative medicine, (ii) biochemical and nutritional foundations of health, (iii) determinants of health, and (iv) lifestyle counseling involving the extremities. Teaching methods will include lectures, demonstrations, skills laboratories, and problem-based large group discussions that focus on skills development and clinical reasoning.

    Prerequisite: Completion of Phase I
    Corequisite: EM6102

    EM6102 Evaluation & Management of the Musculoskeletal System – Credits 4.0
    This course is designed to help students develop knowledge necessary for the diagnosis and management of selected common musculoskeletal conditions encountered in a broad-based conservative care (primary health care) setting. Content from the previous Evaluation and Management courses will be incorporated. All course content will be discussed in lecture format.
    Prerequisite: Completion of Phase I
    Corequisite: EM6101

    EM6103 Evaluation & Management of the GI/GU & Reproductive Systems – Credits 4.0
    This course focuses on the clinical manifestations of disorders of the gastrointestinal, genitourinary, and female reproductive systems. The emphasis is on the etiology, presentation, diagnostic identification, management, and prevention of system conditions. Learning is driven by class lectures, case-based learning and self-directed small group assignments. Diagnostic evaluation includes appropriate laboratory testing, special testing and imaging. Management of system disorders includes the study of clinical aspects of nutritional therapy to include diet modification, botanical medicine, manipulation, and physical therapeutics.

    Prerequisite: Completion of Phase I

    EM6104 Evaluation & Management of the Cardiovascular & Respiratory Systems – Credits 3.0

    This course focuses on the differential diagnosis and management of common disorders of the cardiopulmonary system. Students are expected to develop skills in history collection, physical examination, laboratory evaluation, critical thinking, and differential evaluation. In addition to history taking and the physical exam, diagnosis of these conditions will include evaluation of electrocardiograms and various laboratory tests. Students are introduced to the various modalities that are available for the treatment of these disorders. Case presentations include, but are not limited to, disorders such as myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, peripheral vascular disease, pneumoconiosis, and pneumonia. Management of these conditions will encompass the study of the clinical aspects of nutritional science including diet therapy and botanical medicine, manipulation, physiologic therapeutics, and rehabilitation.

    Prerequisite: Completion of Phase I

    EM6105 Evaluation & Management of the EENT – Credits 3.0

    This course focuses on the clinical manifestations of disorders of the eyes, ears, nose, and throat. The emphasis is upon the etiology, presentation, diagnostic identification, management, and prevention of these disorders. Diagnostic procedures include laboratory testing, special testing, and appropriate imaging. Management of these conditions will encompass the study of the clinical aspects of nutritional science including diet therapy and botanical medicine, manipulation, physiological therapeutics, and rehabilitation. There is a portion of the course that will address complaints of dizziness and vertigo. The emphasis is upon the etiology, presentation, diagnostic identification, pathophysiology, and on the conservative management of these complaints. Learning will be driven by the class lectures, case-based presentations and self-directed small group assignments.

    Prerequisite: Completion of Phase I

    EM6106 Evaluation & Management of the Neurological System – Credits 3.0

    This course presents a study of the procedures of the neurological history and examination, clinical correlation of neurological findings with other clinical data, an introduction to functional neurology, and the application of manipulation, massage, exercise, and other sensory input in the management of patients with neurological disorders. Methods of instruction include lecture, patient video presentations and clinical cases presented in a large group. Small group and self-directed learning activities outside of class include specific readings about neurological diseases/disorders and written assignments based on the readings.

    Prerequisite: Completion of Phase I

    EM6202 Physical & Laboratory Diagnosis – Credits 8.0

    The primary objective of this course is for students to learn laboratory diagnostic skills, and to reinforce history taking and physical diagnostic skills taught in the Evaluation and Management courses. This course will include comprehensive instruction about the laboratory testing process, including indications, the collection and preparation of samples, the interpretation and evaluation of laboratory test results, and associated recordkeeping techniques. The context of this course will be a broad-based conservative care (primary health care) setting. The course will include commonly run profiles of hematology (including venipuncture skills), chemistry, urinalysis, fecal and sputum studies. This course’s laboratory activities will require students to perform complete (head-to-toe) physical examinations on each other using skills that are introduced and reinforced in the course. Male and female sensitive examinations will be performed on plastic models.
    Prerequisites: Completion of Phase I, EM6101, EM6102, EM6103, EM6104, EM6105, EM6106

    EM6207 Pediatrics, Geriatrics & Female Health Issues – Credits 3.0

    This course focuses on the differential diagnosis and management of common conditions that present in the pediatric and elderly populations. Patient presentation, identification, prevention, and management are addressed in lectures and large group experiences. Learning is driven by clinical cases and enhanced by the lectures. Management of these conditions includes the study of the clinical aspects of nutritional science (including diet therapy and botanical medicine), manipulation, physiological therapeutic, and rehabilitation.

    Prerequisite: Completion of Phase I

    EM6304 Advanced Diagnosis & Problem Solving – Credits 2.0
    The primary objective of this course is to give students an opportunity to master the diagnostic skills, and the associated psychomotor skills used in a broad-based conservative care (primary health care) setting. The laboratory portion of this course will use simulated patients to help students synthesize and refine their history taking, examination, and diagnostic skills. This laboratory will require students to perform male and female sensitive exams on simulated patients. Emphasis will be placed on the doctor-patient relationship, including appropriate ethical boundaries and effective communication skills. Students will also practice recordkeeping skills, including the preparation of SOAP notes.
    Prerequisites: Completion of Phase I, EM6202, EM6207, MM6208

    EM6305 Psychopathology & Health Psychology – Credits 3.0

    This course includes:
    (i) review and discussion of the major topics in health psychology including examination of the relationships of psychopathology, lifestyle and personal relationships to physical health. Topics include risk factors and treatments for physical disorders such as cardiovascular disease, cancer, and chronic pain as well as the exploration of the co-morbidity of physical and psychological disorders;
    (ii) an examination of the nine basic categories of psychopathology (depression, anxiety, somatoform, substance use disorders, sleep disorders, eating disorders, sexual dysfunction, cognitive disorders, and psychosis) with emphasis on screening, diagnosis and management in a primary care setting. Students are asked to review current theories and their implication for practice;
    (iii) lecture time consists of one hour per week of psychopathology and health psychology. The group time (one hour per week) and self-directed learning (one-half hour per week) is spent with cases, discussion and application of the principles of the lectures, article reviews, guest presentations, and field projects.

    Prerequisite: Completion of Phase I

    Corequisite: EM6310

    EM6310 The Clinical Encounter – Credits 2.0

    This course focuses on the practical issues of patient management and their relationships to health care outcomes. Students explore the literature to broaden their understanding of the issues in the field and then evaluate clinical encounters. In addition, students will reflect on and actively develop their personal communication skills with patients.

    Prerequisite: Completion of Phase I

    Corequisite: EM6305

    EM6403 Clinical Natural Medicine – Credits 3.0

    The primary objective of this course is to give students an opportunity to practice managing conditions in a broad-based conservative care (primary health care) setting. Student will apply a comprehensive skill set, including manual therapies, nutritional aspects of care, functional rehabilitation, and exercise prescription, and the application of physiological, biochemical and pharmacological therapeutic modalities.

    Students will be presented with a variety of case studies and will derive appropriate diagnoses and treatment plans. Students will also practice associated treatments on each other, as well as skills, including the preparation of SOAP notes. Patient management within the whole health oriented paradigm will be emphasized. This course will be presented through a combination of lecture and laboratory sessions.
    Prerequisites: Completion of Phase I, EM6304, FR6309, MM6209, FR6307, NN6206, NN6301, NN6308,
    Corequisite: CL6402

    EM6405 Doctor – Patient Relationship – Credits 2.0

    This course focuses on the practical issues of patient management in practice and its relationship to health care outcomes. Students are asked to explore the literature to broaden their understanding of the issues in the field and then reflect on and actively develop strategies for their relationships with patients. Lecture and discussion topics include: structures in doctor-patient interaction; models of the doctor-patient interaction; doctor-patient boundaries; the impact of the doctor-patient relationship on health care outcomes; the impact of the doctor-patient relationship on patient satisfaction; culturally responsive health care; the sociological context of patient suffering; co-creation of the patient’s story in a therapeutic relationship; death, dying and palliative health care; management of the abused patient; and the doctor’s responsibilities to the community and society. Group time is used to discuss and practice relationship issues through case guest presentations, structured interpersonal exercises, article reviews, and discussion.

    Prerequisite: EM6305, EM6310

    EM6406 Dermatology – Credits 1.0
    This course is designed to help students develop necessary knowledge for the diagnosis and management of common diseases of the skin encountered in a broad-based conservative care (primary health care) setting. All course content will be discussed in a lecture format.

    Prerequisite: EM6202

    EP5301 Evidence Based Practice I: Study Designs for Biomedical Research – Credits 0.5

    This course provides an overview of study designs used in clinical research to answer clinical questions of therapy, diagnosis, screening, prognosis, harm, and others. Students will sharpen their skills recognizing and developing patient-centered clinical questions and the type of question posed as well as the research hypothesis and the study design used. Students will learn the strengths, limitations and applications of various study designs, as a prelude to analyzing biomedical research articles critically. The course will be developed to include approximately eight hours of online learning content and a final exam to be taken in person on campus at a specified time at the end of the trimester.

    Prerequisites: FH5106, MI5205, Students must have adequate computer skills for the use of online learning resources

    EP5401 Evidence Based Practice II: Critical Appraisal of the Biomedical Literature – Credits 1.0

    The focus of this course is research literacy, appraisal of clinical research studies, and the application of the best research evidence to patient care and clinical practice. Students will sharpen their skills recognizing and developing both the research hypothesis and patient-centered clinical questions as well as searching the highest quality and most significant clinical and basic science literature and databases, including complementary and alternative medicine (CAM) specific databases. Students will learn to appraise and analyze the research studies and evaluate the evidence before deciding to apply the best evidence to patient and health care issues. Students will learn to effectively communicate literature reviews, analyses and conclusions in written, oral, and electronic formats to patients, peers and professionals. Students will develop the skills for effective and efficient information management, research literacy and evidence based practice (EBP) habits to accelerate learning and expand basic and clinical science knowledge.

    Prerequisite: EP5301

    EP6401 Evidence Based Practice III: Applied Evidence Based Practice – Credits 1.0

    Building on the skills learned in EBP I and EBP II, this course emphasizes the professional application of Evidence Based Practice (EBP). Applied EBP is emphasized, including questioning, researching, analyzing, and communicating clinically relevant information. Focusing on clinically relevant topics such as headache, neck, thoracic, and low back pain, as well as non-musculoskeletal problems such as asthma, hypertension, etc., students will form appropriate clinical questions and search the research and clinical literature, including complementary and alternative medicine (CAM) databases using limits, MeSH terms, etc. Students will develop and demonstrate the skills to analyze and evaluate the literature, and determine the clinical value and relevance of the evidence. The course will also focus on communication: the presentation of the evidence, analysis, evaluation and conclusion in written and oral and electronic formats to peers, professionals and patients. Students will develop clinical reasoning, critical thinking, creativity, resourcefulness, and coping skills, using an evidence based practice approach to professional development and continuing education. CAM professionals will present applied EBP content as guest lecturers at various times during the trimester.

    Prerequisite: Completion of Phase I
    Corequisite: EM6304 (or prior successful completion)

    EP7101 Evidence Based Practice IV: Journal Club – Credits 0.5
    This class is an interactive course designed to sharpen students’ research literacy and evidence based practice (EBP) skills. Applied EBP is emphasized, including questioning, researching, analyzing, and communicating clinically relevant information. The overall objective of this course is to create sound EBP habits in students preparing to become physicians. Students will research, develop and present a journal of clinically relevant, important and applicable research literature to a small group of peers and practicing clinical mentors and professionals, using key evidence based practice skills (asking, accessing, appraising, applying, and assessing) along with the concepts of critical appraisal of the literature. Emphasis is placed on how the research and clinical literature impacts clinical decisions.

    Prerequisite: Completion of Phase II

    FH5106 Fundamentals of Natural Medicine & Historical Perspectives – Credits 3.0

    Students are introduced to the historical perspective of the common principles and origins on which natural medicine concepts were founded and developed with emphasis on naturopathic and chiropractic medicine. The concepts of the science of manual therapy and its effect on tissue physiology, neurological processes, and psychophysiological aspects are introduced. The whole health concept of patient care will be introduced in this course. This course will also introduce concepts of personal and collective duties of professionalism, ethics and self-reflection that must be developed by future physicians.

    FH5310 Whole Health Concepts & Philosophical Perspectives – Credits 1.0

    This course will expand on the whole health concepts that were first introduced in the Fundamentals of Natural Medicine course. Concepts to be explored will include, but are not limited to, the dynamic interrelationship between various body systems in both normal and pathological states; the impact of external factors on various body systems, such as environmental, life style, nutritional, physical fitness, psychosocial, and stress; integrating whole health concepts into everyday life and patient care. Logical analysis of the principles underlying philosophical perspectives will also be discussed.

    Prerequisite: FH5106

    FR6204 Functional Rehabilitation – Exercise Physiology – Credits 3.0
    The primary goal of the course is for students to develop an understanding of concepts and techniques used in functional rehabilitation and exercise prescription. Concepts and techniques will include functional movement patterns and gait analysis, functional goal setting, functional stabilization, functional reactivation/rehabilitation and cognitive-behavioral education. These concepts and techniques can be applied to primary and secondary injury prevention, overall fitness, chronic pain management and performance enhancement. This class will emphasize low-tech tools and active care procedures, and will integrate previously taught manual therapies such as joint and soft tissue manipulation. Course content will be presented in lecture and lab settings utilizing a variety of active learning methodologies.
    Prerequisites: EM6101, EM6102

    FR6307 Physiological Therapeutics – Modalities – Credits 4.0

    This course introduces therapeutic modalities and their practical application in the clinical setting. Therapies include actinotherapy, thermotherapy, hydrotherapy, cryotherapy, mechanotherapy, and various electrostimulation modalities.

    Prerequisite: Completion of Phase I

    FR6309 Functional Rehabilitation – Advanced Manual Medicine – Credits 2.0
    The primary objective of this course is for students to learn advanced concepts and techniques relating to the treatment of neuromusculoskeletal conditions. A variety of concepts and techniques will be taught relating to, among other things, (i) manual and low-tech soft-tissue therapy and manipulation, (ii) functional taping, (iii) joint mobilization, (iv) neuromobilization, and (v) sensory motor stimulation methods. Course content will be presented in both a lecture and lab setting.
    Prerequisite: FR6204

    GE5404 Medical Genomics – Credits 2.0
    The first half of this course is focused on the underlying basic sciences concepts required to understand the human genome (biochemistry, molecular biology and pathology), and students will be introduced to the biotechnology utilized for genetic analysis. The second half of the course will focus on the clinical, ethical, legal, and psychosocial aspects of medical genomics.

    Prerequisite: BC5308

    IC7102 Clinic Internship I – Credits 17.0

    Students will further develop skills needed for successful management of patients and their conditions. Students will participate in off-campus rotations to expand their experience and knowledge base. All students will be evaluated for skill development, adjustive technique and case management. Students must provide a written case narrative on 10 cases that they have managed or co-managed in the clinics. Students will participate in Quality Assurance activities to ensure that the patient chart is in compliance with the University’s Quality Assurance program. In-service training will be given in personnel issues for the practice, OSHA compliance issues for the private practice office, provisional credentialing of the chiropractic intern, and Medicare issues for the private practice.
    Prerequisites: Completion of Phase II, Phase II Performance Exams, CL6402, American Heart Association BLS for Health Care Professionals with AED CPR certification

    IC7201 Clinic Internship II – Credits 17.0

    Students enter the senior intern phase of training. Skill development and evaluation continues. Students will participate in the development of junior interns and begin advanced technique electives. Students will explore off-campus observations and assignments to expand their knowledge base and obtain exposure to private practice via mentoring with a licensed field doctor. In-service training will consist of advanced diagnostic procedures such as EMG, MRI, ultrasonography, etc. There will be a continuation of rehabilitation training and advanced treatment techniques to help refine the skill levels of the intern prior to graduation. Business office rotations and insurance submission experience is offered.
    Prerequisites: IC7102, American Heart Association BLS for Health Care Professionals with AED CPR certification, Performance Exam IV
    Corequisite: Case Defense

    MI5205 Fundamentals of Microbiology & Public Health – Credits 3.0

    This course provides an introduction of microorganisms and their interactions with humans. It also discusses introductory concepts in public health as applied to communicable and non-communicable diseases. Extensive use of visual aids with the latest computer technology helps students to visualize different concepts in microbiology and the microbial world. The appropriate clinical correlates with case studies are discussed as well. All content will be discussed in lecture and group activity/discussion format.

    MI5303 Medical Microbiology I – Credits 4.0
    Considered in this course are the infections affecting the nervous system upper respiratory system, blood and lymphatic system, skeletal system, and integumentary system. The discussion would include microbiologic characteristics, epidemiology, clinical aspects, treatment and prevention of various pathogens where appropriate public health aspects of these infections would be elaborated upon. In addition, basic and clinical immunology including immunologic disorders will be discussed in detail. All the content will be discussed in lecture, group and case-based format.

    Prerequisite: MI5205

    MI5403 Medical Microbiology II – Credits 5.0
    Considered in this course are the infections affecting the respiratory, gastrointestinal, reproductive, and urinary systems. The discussion will include microbiologic characteristics, epidemiology, clinical aspects, treatment, and prevention of various pathogens. Where appropriate, public health aspects of these infections will be elaborated upon. All the content will be discussed in lecture, group and case-based format.

    Prerequisite: MI5303

    MM6208 Correlative Orthopedics – Credits 1.0
    This case-based course stresses orthopedic management of common conditions encountered in a broad-based conservative care (primary health care) setting. It includes review of the most frequently used orthopedic tests for the appendicular & axial skeleton.
    Prerequisites: Completion of Phase I, EM6101, EM6102

    MM6209 Advanced Manual Therapy Techniques – Credits 2.0
    This course is designed to allow the student to refine their skills in all avenues of manual therapy techniques. Topics will include examination and treatment with manipulation of the entire appendicular and axial skeleton. Also included in this course will be flexion-distraction techniques, blocking techniques and instrument-aided adjustive techniques.

    Prerequisites: Completion of Phase I, EM6101

    MM6311 Comparative Techniques & Listing Systems – Credits 1.0
    This course will explore the various listing systems for a functional articular lesion in the application of manual therapies. It will also allow students to communicate with other doctors that utilize listing systems. Scientific principles will be employed to illustrate the validity of the various listing systems. Discussions of the rational of continued use of listing systems will also be discussed.
    Prerequisite: Completion of Phase I

    NN5406 Science of Diet & Nutrition – Credits 3.0

    This course provides a basic understanding of the fundamentals of human nutrition and stresses the essentials of the basis for good nutritional status. It serves as the basic nutrition course that follows the basic science presentation of the macronutrients and the micronutrients presented in the Nutritional Biochemistry course (BC5308). Topics presented in this course include a review of the macronutrients and micronutrients with emphasis on the health properties of each as well as the severe deficiency states for both micronutrients and macronutrients. Digestion, absorption and transport of the nutrients, and consequences of malabsorption care are covered. Energy production, energy balance and weight management are also described. Food habits in the United States and nutrition across the life cycle are discussed in the course. Male and female health, sports and exercise nutrition, enteral and parenteral nutrition procedures as well as an introduction to the science of food preparation and handling are included. An introduction to nutritional status assessment using food frequency questionnaires and diet history is given.

    Prerequisite: BC5308

    NN6107 Pharmacology – Credits 3.0

    This course provides a basic understanding of the use of drugs in Western medicine for the treatment of disease. Topics covered in this course will be descriptions of drug names and classification, general principles of drug action and metabolism, which will cover the area of pharmacokinetics and pharmacodynamics. Factors influencing drug action and a discussion of drug safety are addressed. A large part of this course will be a description of the drug actions on body systems including all the major organ systems and the disorders and diseases in each of the systems. Included will be a description of the mechanism of action, major untoward effects and contraindications for each drug and drug category. Interactions with other drugs and botanicals as well as a description of the nutrients that are depleted by each of the drugs will be covered. Drug actions on infection and immune system regulation as well as chemical dependency and substance abuse will be described. A discussion of poisons and their antidotes is included.

    Prerequisite: Completion of Phase I

    NN6108 Botanical Medicine I – Credits 3.0

    This course presents the fundamentals of herbal science and pharmacognosy. Topics included are herbal terminology, principles of herbal pharmacology and treatment, as well as mechanisms for optimizing safety. Dosage forms and preparations and standardization are covered in detail. Extraction and purification of the active ingredients are explained in the course. Herbal approaches to maintenance of health and treatment of disease as well as the strengthening of organ systems are presented for all the major organ systems of the body and many of the primary care diseases found in each of those organ systems. A major focus in the second half of this course is a description of the Materia Medica for 30 of the common botanical medicines used in Western medicine. Active ingredient, part of the plant used, major therapeutic use, untoward effects, contraindications and interactions with drugs, and other botanical medicines are covered in detail.

    Prerequisite: Completion of Phase I

    NN6206 Medical Therapeutics – Credits 3.0

    The Medical Therapeutics course will encompass a discussion of first and second level drugs for the common disorders of each organ system and the art of prescribing these medications. The course addresses the development of medical protocols for the patient by the physician using current pharmaceutical agents for the prevention and treatment of disease. Included in the course are discussions of treatment duration as well as dosages and side effects of common drugs. Differences in individual reactions according to CyP450 typology and idiopathic reactions to drugs are stressed. The administration of the drugs including the effects of enteral and parenteral administration as well as depot and subcutaneous routes will be discussed. Drug-drug, drug-herb and drug-nutrient as well as drug-food interactions and nutrient depletion by drugs will be addressed. Students will be given the opportunity to develop an appropriate course of treatment for the drugs most often prescribed in the United States. Students will be given case studies and will be expected to develop appropriate protocols and specific medications for patients across the life cycle. Students will be given a description of the scope of license regarding medications of legend and over-the-counter drugs.

    Prerequisite: NN6107

    NN6301 Clinical Nutrition – Credits 4.0

    This course offers a nutritional approach to the prevention and treatment of disease, with an emphasis on maintenance of health and homeostasis and specific disease conditions and their prevention. Nutritional assessment methods are covered in detail and the methods for obtaining a physical exam of nutrition health and means to assess nutritional status are covered. A description of the approach to nutrition counseling and the nutrition counseling session are described. Topics covered are food frequency questionnaires (FFQ), health history and physical exam forms, and food diary and intake forms. The diseases of the major organ systems in the body are covered with the musculoskeletal, joint health, gastrointestinal, and cardiovascular systems covered in depth. Metabolic diseases such as diabetes and thyroid diseases are also described. Liver detoxification, adrenal stress syndrome and a functional medicine approach to the liver, adrenal, thyroid, and gastrointestinal tract are described. Other diseases covered are central nervous system disease and infectious and dermatological conditions. A discussion of immune up-regulation, glandular products, chelation therapy, and glyconutrients is held. The use of all nutritional therapies, botanical medicines and other functional medicine approaches to maintenance of health and prevention and treatment of disease are described.

    Prerequisite: Completion of Phase I

    NN6308 Botanical Medicine II – Credits 4.0
    This advanced course will engage the subject of therapeutic herbalism in great detail. The strategies for addressing dysfunction in the organ systems will be outlined. Specific aspects of botanicals will be studied including: constituents, pharmacognosy, specific indications, contraindications, toxicity, and dosing parameters. In the traditional manner, the herbs will be studied according to therapeutic category (nervines, hepatics, anodynes, etc). Close attention will be paid to the potential for herb-herb and herb-drug interaction. Students will practice compounding and dispensing as part of their clinical rotations, but this course will provide the theoretical information to enable them to do so.
    Prerequisite: NN6108

    PA5204 Fundamentals of Pathology – Credits 3.0

    This course provides an introduction to the basic changes in the morphology of the cells, tissues and organs in diseased states. Extensive use of visual aids with the latest computer technology helps students to differentiate abnormal from normal, and to correlate the clinical aspects of the alterations. Included also is discussion on general characteristics, classification and differential diagnosis of cysts, benign and malignant tumors and other neoplastic entities. All content will be discussed in lecture and group activity/discussion format.

    Prerequisites: PH5103, BC5104, BC5105, AN5107

    PA5302 Systems Pathology I – Credits 4.0
    Considered in this course are the pathologies peculiar to and characteristic of the various systems of the body. The systems examined are the nervous system, myopathy, neuropathy, bone and joint pathology, immunopathology, hematopathology, and dermatopathology. Each condition is studied from the standpoint of general characteristics, gross and microscopic appearance, and clinical course.

    Prerequisite: PA5204

    PA5402 Systems Pathology II – Credits 6.0

    Considered in this course are the pathologies peculiar to and characteristic of various systems of the body. The systems examined are respiratory, cardiovascular, reproductive and mammary, gastrointestinal (inclusive of liver, gall bladder and pancreas), urinary, and endocrine.

    Prerequisite: PA5302

    PH5103 Cellular Physiology & Hematology – Credits 4.0

    In this course, students will review, in a problem-based setting, some of the basic science concepts related to the physiology of cellular membranes and organelles, along with the integrated functioning of the blood as a tissue. The physiology laboratory exercises, using the individual examples of erythrocytes and yeast cells, will address the related basic science issues of diffusion, osmosis, membrane transport, etc.

    Corequisite: AN5107

    PH5208 Neurophysiology – Credits 3.5

    The purpose of this course is to study the neurophysiology of the nervous system. The complex signals created and utilized by the nervous system to control most bodily functions will be studied in depth to gain a better understanding of how the human nervous system functions. Areas of study will include: synaptic transmission; autonomic control; sensory systems including the special senses of vision, hearing, touch, balance (vestibular function), taste and smell; signal integration in the CNS; control of the motor system (including skeletal muscle physiology); and higher cortical functions such as speech, sleep and associational areas of the brain.

    Prerequisite: PH5103

    Corequisite: AN5203

    PH5306 Neuroendocrinology, GI & Reproductive Physiology – Credits 4.0
    This course will address neuroendocrine mechanisms that operate to maintain homeostatic control over various systems and states within the body. The primary focus will be upon the normal mechanisms and reflexes that operate to maintain a healthy state. Specific topics will include regulation of the reproductive, gastrointestinal and thermoregulatory systems. Neuroendocrine feedback pathways that regulate metabolic and mineral homeostasis will also be discussed. Course instruction will be through lecture and group discussion of selected problems and cases.

    Prerequisite: PH5208

    PH5405 Cardiovascular, Respiratory & Renal Physiology – Credits 5.0
    This course will present the normal physiologic function of the respiratory system (breathing, ventilation and gas exchange), circulatory system (blood pressure, cardiac output, pressure and flow homeostasis, and cardiac electrophysiology), and the kidney (conservation and excretion, and volume homeostasis). Content will be presented through lecture, laboratory, and supplemental problem exercises. Structure-function relationships and mechanisms of regulation will be emphasized. Laboratory based measurements on human subjects will be used along with computer simulations to demonstrate and illustrate core concepts. Supplemental problem exercises will provide students the opportunity to demonstrate and test their understanding and capability to apply core concepts toward explanative assessment of how each of these systems function.

    Prerequisites: AN5304, AN5305, PH5306

    RA5206 Normal Radiographic Anatomy & Variants – Credits 1.5

    Chiropractic and naturopathic physicians must have a thorough understanding of the normal radiographic anatomy of the skeletal system if they are to detect abnormal pathology in these regions. This course provides background information as a basis for courses in musculoskeletal imaging diagnosis, essentially designed to help students differentiate a normal structure from pathology. The study of normal variants and anomalies of the skeletal system and skeletal measurement procedures are presented to give students an overall understanding of variations of normal, which both mimic pathology and often present with unique clinical challenges. Laboratory exercises reinforce case material.

    Prerequisites: AN5101, AN5102

    RA5407 Radiation Physics & Technology – Credits 1.0

    This course explains the basics of X-ray production, interaction with matter, image production, and patient protection. Emphasis is on troubleshooting common technical errors that create artifacts and poor diagnostic image quality, explained in a case study format. Radiation biology is also presented to provide the student with a healthy respect for the intrinsic dangers of ionizing radiation and the principle of quality films at the lowest possible exposure.

    Prerequisite: RA5206

    RA6203 Fundamentals of Imaging: Arthritities & Trauma – Credits 2.5
    Arthritic disorders and associated connective tissue disorders are discussed including distinctive radiographic characteristics and associated clinical presentations of the basic categories of joint disease. Traumatic conditions are presented with special emphasis on the musculoskeletal system, both spine and extremity. Laboratory exercises reinforce and apply core material.

    Prerequisite: Completion of Phase I

    RA6205 Fundamentals of Imaging: Tumors – Credits 2.5

    A systematic and orderly approach to interpretation of plain film radiography is stressed, complemented by associated findings relative to special imaging modalities. Clinical correlation of anomalies, bone pathology, joint abnormalities, and soft tissue changes are presented. Laboratory sessions focus upon the development of skills necessary for the acquisition of patient information, and the interpretation of X-rays pertaining to bone pathology. Furthermore, laboratory sessions afford students the opportunity to study actual case studies, including clinical presentations and imaging of material presented during lecture.

    Prerequisite: Completion of Phase I

    RA6302 Fundamentals of Imaging: Chest & Abdomen – Credits 2.5
    A systematic and orderly approach to interpretation of plain film radiography is stressed, complemented by associated findings relative to special imaging modalities. Normal radiographic anatomy, anomalies and pathology of the chest and abdomen are presented with associated clinical presentations. Laboratory sessions focus upon the development of skills necessary for the acquisition of patient information, and the interpretation of X-rays pertaining to pathology of the chest and abdomen. Furthermore, laboratory sessions afford students the opportunity to study actual case studies, including clinical presentations and imaging of material presented during lecture.

    Prerequisites: RA6203, RA6205

    RA6408 Radiology Management & Report Writing – Credits 1.0

    This course teaches the basics of writing a detailed and accurate radiology report emphasizing findings, impressions, and recommendations. The reports are written on a variety of normal and abnormal cases exposing the student to a variety of pathologic processes. Additionally, this course presents guidelines for the design of an office X-ray facility, selection of equipment and quality control that is needed to maintain optimum image formation. State and federal regulations governing these installations, the medico-legal aspects of diagnostic radiology, ethics, and record keeping are emphasized.

    Corequisite: CL6402

    RA6409 Radiographic Positioning & Advanced Imaging – Credits 2.0

    This course considers the practical parameters of X-ray technology including patient positioning, technique calculations, instrument operation, film processing, and other pertinent phases of technology. Students gain experience in the practical application of routine radiographic procedures via the use of energized and non-energized units and lab partners. The positioning portion of this class/lab focuses on radiography of the extremities, abdomen and chest. The advanced imaging portion of this course focuses on the different types of advanced imaging, their uses and limitations as well as clinical decision-making regarding proper indications to order advanced imaging.

  37. Joe says:

    So, you can just present your credentials and pass the licensing exam. Not.

  38. Joe says:

    It seems you forgot the “chiropractic school paradigm”
    http://www.chirocolleges.org/paradigm_scopet.html
    “Chiropractic is Concerned with the preservation and restoration of health, and focuses particular attention on the subluxation.”

    I know that PTs don’t study this fairy tale. And PT students don’t practice in make-believe clinics that are attended by their young, healthy friends who are cajoled to pose as patients (as is common in chiro school). If you want to replace PTs, you have a lot of education to make up.

  39. quackdoctor says:

    “So, you can just present your credentials and pass the licensing exam. Not.”

    That has to be about the most ridiculas comment I have heard yet. Why the heck would you want to? A DC can do infinately more than a PT. Can perform and read MRI and imaging , do bloodwork, diagnose, perform electrodiagnostics, do nutrition and much more. And is primary access I might add. And without MD referral most PTs would not survive. Because when the public has a back problem they do not think of a PT as an option in general. If they do not go to their MD. The public thinks chiropractors. And how many PTs do you see in court testifying for big bucks in injuries??

    I mean do not get me wrong the PTs are some fine people and help a lot of people. But they have there area and NMS chiropractic has another.

  40. quackdoctor says:

    ” If you want to replace PTs, you have a lot of education to make up.”

    Well no one is looking to replace them. They are more educated in certain areas. Like stroke rehab for example. And the education I posted speaks for it’self. Like I say you have no clue at all what a chiropractor that practices chiropractic MS medicine does at all. Not one bit.

  41. Blue Wode says:

    Quackdoctor wrote: “You are completely out of touch with chiropractic when practiced as a profession that treats musculoskeletal problems…..Many chiros are cultists and many are not. So it all depends.”

    How helpful is that? In other words, what is being done to eliminate the *many* cultists – and, until they are gone, what widespread action is being taken to warn patients and the public about the chiropractic ‘bait and switch’?

    Quote:
    “Chiropractic is perhaps the most common and egregious example of the bait and switch in medicine…..someone may go to see a chiropractor and think they will be seeing a medical professional who will treat their musculoskeletal symptoms, but in reality they will see the practitioner of a cult philosophy of energy healing…The bait – claims that chiropractors are medical practitioners with expertise in the musculoskeletal system. The switch – practitioners of discredited pseudosciences that have nothing to do with the musculoskeletal system…..A more subtle form of the bait and switch among chiropractors is the treatment of musculoskeletal symptoms with standard physical therapy or sports medicine practices under the name of chiropractic manipulation. Ironically, the more honest and scientific practitioners among chiropractors are most likely to commit this subtle deception. The problem comes not from the treatment itself but the claim that such treatments are ‘chiropractic’…. But by doing so and calling it ‘chiropractic’ it legitimizes the pseudoscientific practices that are very common within the profession – like treating non-existent ‘subluxations’ in order to free up the flow of innate intelligence.”

    http://www.sciencebasedmedicine.org/?p=156

  42. nwtk2007 says:

    nwtk2007 on 29 Jul 2008 at 8:01 pm wrote “Isn’t there a name for a response to an argument such as, “you have no compassion””

    Joe – “Why don’t you demonstrate your sophistication and tell us? I think you cannot.”

    Joe, you speak for FiFi now?

    I don’t indulge myself in the same self gratifying BS as you and FiFi. I simply point out that you and she employ the very same responses as those you try to “intellectually” chastise with your “sophisticated” terminology. Please.

    So Joe, do you really think that chiropractic manipulation actually fractured Mr Maynard’s skull? Do you FiFi?

    I know I am not being very compassionate by asking, but I seriously doubt that Mr Maynard even has or ever had a fractured skull.

  43. Fifi says:

    nwtk – I consider you a troll here to disrupt conversation and promote chiropractice so this will be the last time I respond to you. I don’t know if a chiropractor hurt Graham Maynard’s skull – there simply isn’t enough evidence to know one way or the other so really it’s all anecdotal at this point. I consider it quite possible, particularly if he had osteoporosis or some other contributing factor – without the evidence we cannot know. I do know that chiropractors engage in dangerous practices without informed consent since I’ve had that experience myself. Despite your claims that it couldn’t happen, you only have your personal belief that it couldn’t be due to chiropractic treatment to base it upon (a claim you also make regarding Sandy Nette). What you doubt or believe has absolutely no bearing on whether Graham Maynard was actually injured by a chiropractor, and you obviously have a vested interest and bias that pretty much precludes you from having any kind of objectivity. Your continuing lack of compassion speaks to who you are as a person and as someone who claims to be healer. Feel free to continue promoting your beliefs about chiropractice on this blog that supports science-based medicine and EBM, I’ll have you on “ignore the troll” from this point on and won’t even bother reading what you post.

  44. Fifi says:

    BlueWode – Exactly – a 1 in 10 odds of getting a chiropractor who doesn’t believe in magical subluxations (and twisting necks) just isn’t very good. Particularly since the ones who claim not to believe in magical subluxations graduated from the same schools and got the same education!

  45. nwtk2007 says:

    Really FiFi,

    In other words, if one doubts your position then one is a troll? That’s what it sounds like.

    And your own lack of objectivity is evident in your comment from above, “I do know that chiropractors engage in dangerous practices without informed consent since I’ve had that experience myself.” Obviously that means each and every chiropractor out there does exactly that.

    FiFi, you also continue to make it up as you go. For example, you said, “Despite your claims that it couldn’t happen, you only have your personal belief that it couldn’t be due to chiropractic treatment to base it upon (a claim you also make regarding Sandy Nette).” You want to show me where I said Ms Nette’s condition wasn’t related to her chiropractic manipulation?

    Once again your bias comes through. I do have questions about Ms Nette’s case. That’s for sure. It doesn’t mean I don’t think there is any connection between the manipulation and her stroke. Quite the contrary, by asking we might be able to find ways of avoiding this situation in the future.

    I think the only question I even asked was why she went to a DC for seven years and what benefit was she receiving from that treatment. I might have also asked what she was specifically being manipulated for on the day of the stroke and had she gotten the same treatment for it before.

    If your personal bias precludes you from asking questions then how could you even begin to suggest that you have any clue about science and EBM?

  46. Joe says:

    nwtk2007 on 30 Jul 2008 at 8:20 am asked “Joe, you speak for FiFi now?”

    No, I just address chiroquackery. If I may add, Fifi got it right.

    nwtk2007 on 30 Jul 2008 at 9:25 am wrote “… by asking we might be able to find ways of avoiding [Ms. Nette's] situation in the future.”

    This is so simple, one would think even a chiropractor could figure it out: If you don’t twist someone’s neck you avoid causing a stroke. When a toddler burns his hand on a stove, he learns to avoid doing that. One would hope that a chiropractor (minimally, a high school graduate) would be at least that sophisticated.

  47. quackdoctor says:

    “I don’t know if a chiropractor hurt Graham Maynard’s skull – there simply isn’t enough evidence to know one way or the other so really it’s all anecdotal at this point. I consider it quite possible, particularly if he had osteoporosis or some other contributing factor – without the evidence we cannot know. ”

    If you were educated in medicine or diagnosis and human biolgical science you would see the error in this statement. We do not go seeking evidence for things that cannot happen. That are so implausible that they do not dignify exploration. A manipulative proceedure cannot produce that kind of trauma with or without osteoporosis. And the complaint was not a skull fracture only. There was more to it than that.

    And again we come back to the understanding that no one would support the man’s opinion of what he says happened to him. And that outside of the injury being totally implausible pretty much sums things up.

  48. nwtk2007 says:

    Joe, your total anti-chiro bias is a-foot again. Do you even know if the cervical manipulation of Ms Nette was a “twist”?

    There are so many ways to mobilize and manipulate the spine, some putting less stress on the vertebral arteries than merely looking over ones shoulder or looking into the sky above.

    Maybe we should never move our necks at all so as to avoid what you appear to be saying caused Ms Nette’s stroke.

    Joe – “One would hope that a chiropractor (minimally, a high school graduate) would be at least that sophisticated.”

    You like that word, “sophisticated” don’t you Joe. And “minimally”. For your insult to be effective, don’t you mean “maximally”. Difficult to say. It makes no sense. How is one “minimally” a high school graduate? Does this imply that one skipped the wonder years of education, grades 1 – 8? Is a college grad “minimally” a college grad. Now you could say that the minimum requirement for something might be a high school degree, but it doesn’t fit into your “sophisticated” way of speaking, now does it Joe?

  49. Joe says:

    quackdoctor on 30 Jul 2008 at 10:10 am wrote “If you were educated in medicine or diagnosis …”

    That’s rather presumptuous, do you imagine that you are? Where did you learn it? Those topics are not really taught in chiropracty school.

  50. nwtk2007 says:

    Hey Quackdoctor,

    You ever wonder why there aren’t more strokes in football or something like rugby? I know they wear a lot of protective equipment, but most don’t have anything that would restrict “twisting” the neck and believe me, there is a lot of neck twisting and pulling and bending and hitting in football.

  51. nwtk2007 says:

    Joe, you just hate it that some of us learned a great deal in chiropractic school don’t you.

    I don’t know about some of the other colleges, but Parker College was top notch in the basic sciences and medical sciences.

    Which one did you go to Joe?

  52. nwtk2007 says:

    Joe – “Those topics are not really taught in chiropracty school.”

    What topics are those Joe? At Parker there is quite a bit in terms of diagnosis, pathology, etc.

    What specifically are you saying is not taught in chiropractic colleges like Parker College?

  53. quackdoctor says:

    “That’s rather presumptuous, do you imagine that you are? Where did you learn it? Those topics are not really taught in chiropracty school.”

    The course structure of chiropractic college is posted above for your reference. You obviously did not read it. You can be an adult and read it or a 5 year old mentally and refuse to, It speaks for it’self. You are fixated on seeing only what you want to see.

    And along the wame lines I will submit to the authority of a trauma physician or to honestly say if the injuries describes could be caused by a manipulation of the cervical spine.

  54. Fifi says:

    Right, nothing to do with magical subluxations at the chiropractic colleges pretending to teach a science-based curriculum….

    “The chiropractic adjustment is intended to remove any disruptions or distortions of this energy flow that may be caused by slight vertebral misalignments called subluxations. Chiropractors are trained to locate these subluxations and then to remove them to restore the normal flow of nerve energy, in terms of both quality and quantity.”

    http://www.parkercc.edu/Chiropractic_defined_by_Parker_College_of_Chiropractic.aspx

    And what students say about what they’re learning… One assumes that trying to make sense out of the woo that’s being taught (that even they recognize is kinda wooish but feel pressured to believe) is what makes it so “hard” for these students!

    http://reviews.planetc1.com/Parker_College_of_Chiropractic.html

    Is this where you teach quackdoctor?

  55. Joe says:

    nwtk2007 on 30 Jul 2008 at 10:21 am asked “Do you even know if the cervical manipulation of Ms Nette was a “twist”?”

    Let me try to make this really simple for you: if you don’t mess with the neck, you are less likely to cause a stroke. It is not a very sophisticated concept. Do you still burn yourself on stoves?

    nwtk2007 on 30 Jul 2008 at 10:21 am wrote “For your insult to be effective, don’t you mean “maximally”.”

    No, if I wrote that chiros were “maximally” high school grads, that would mean that none of you ever went to a real college. “Minimally” refers to the entry requirements for your cult schools. I did not think that would be too sophisticated for you to understand; perhaps, I should have known better.

  56. Fifi says:

    Clearly the efforts of Harriet and others is having some impact and public influence if these people are working so hard to try to pretend their woo is science-based medicine. Yay for Harriet! :-)

  57. nwtk2007 says:

    Poor Joe and FiFi,

    Your biases against chiropractic are so strong that you can’t even converse about the topic at hand.

    And Joe, just so you know, I am pretty sure Parker College now requires a BS to get in although in the past there was a partial college pre-req and no BS required, just as SW Med School was then and might still be now. But you know this right? You just don’t want to point out the truth of it.

    I had previously asked, for the sake of conversation, “You ever wonder why there aren’t more strokes in football or something like rugby? I know they wear a lot of protective equipment, but most don’t have anything that would restrict “twisting” the neck and believe me, there is a lot of neck twisting and pulling and bending and hitting in football.”

    I had also mentioned, “There are so many ways to mobilize and manipulate the spine, some putting less stress on the vertebral arteries than merely looking over ones shoulder or looking into the sky above.”

    To me, with all the severe neck movement in sports like football and rugby, if there was a connect there, then it would show up in these sports much more than it does.

  58. quackdoctor says:

    I was wondering what the feeling of you guys are about a person that claims manipulation can treat

    asthma
    sinus disorder
    carpal tunnel syndrome
    migraines
    menstrual pain

    And can even replace drugs and surgery. And,

    believe that all parts of the body work together and influence one another. and are specially trained in the nervous system and the musculoskelatal system (muscles and bones).

    What would you say about a licensed health care provider that makes such claims and instutitutions that make the claims as well as the professional organizations that support the claims?

  59. Joe says:

    nwtk2007 on 30 Jul 2008 at 11:59 am wrote “And Joe, just so you know, I am pretty sure Parker College now requires a BS to get in although in the past there was a partial college pre-req and no BS required”

    Yes, I am aware that chiro schools are trying to put lipstick on their pigs. The fact remains that, when one encounters an ‘older’ chiro, one does not know if s/he ever went to college. One does know that they were sufficiently ignorant to attend chiro school and study Innate and subluxations. Whatever improvements chiro schools have made in recent years, the average chiro is still mostly unaffected. And, requiring a college degree does not mitigate the misinformation are still taught.

    I am also aware that a few chiros were smart-enough to realize they were being fed a load of nonsense; yet the stayed and graduated. I do not understand why they did not quit.

  60. quackdoctor says:

    “To me, with all the severe neck movement in sports like football and rugby, if there was a connect there, then it would show up in these sports much more than it does.”

    You see it is hard to compare the two. Sports like football and rugby are hard on the cervical spine. However that does not imply that they expose the cervical spine to the same forces that upper cervical manipulation does. You cannt compare apples and oranges. And we have to step up to the plate and freely admit that extension and rotation high velocity techniques to the upper cervical spine can cause arterial injury and stroke on occasion. Rare thou it be. And then the profession needs to take measures to eliminate the risk as much as possible.

    Because any rational DC knows damn well that things have happened. And I am sure it is dependent on the techniques employeed. So we must look deeper into this. So I am the first to say injuries are rare and the whole thing has been used to demonize the profession. But that opinion dies not change the fact that there are people who have been completely disabled from upper cervical manipulation. And I personally want that sityation to be avoided. And based on my knowledge of many chiropractic manipulative methods I really do know we can put a stop to this pretty well.

  61. Joe says:

    quackdoctor on 30 Jul 2008 at 12:01 pm “What would you say about a licensed health care provider that makes such claims and instutitutions that make the claims as well as the professional organizations that support the claims?”

    I would say the license is bogus, conferred by ignorant legislators, and (in health-care terms) not worth the powder to blow it to oblivion. Their institutions and organizations are equally worthless.

    What would you say about a certified astrologer? They have their institutions and organizations, too. It doesn’t make them useful.

  62. quackdoctor says:

    “I would say the license is bogus, conferred by ignorant legislators, and (in health-care terms) not worth the powder to blow it to oblivion. Their institutions and organizations are equally worthless.

    What would you say about a certified astrologer? They have their institutions and organizations, too. It doesn’t make them useful.”

    OK Joe…Now what would you say about an institution that taught those things and a professional organization that supported those views and practiciners that held those views but also did legitamite health care? Should they be allowed to practice? Or does the fact that they believe and support such views make them irrational and unable to practice anything that is legitamite?

  63. nwtk2007 says:

    I think the profession will do something about the stroke risk and upper cervical manipulation. I thought the informed consent had been in effect for a long time now. I know at Parker we had one and where I work now we have one.

    I am surprised the malpractice companies aren’t involved more with this issue. Since they are so heavily involved with the chiropractic profession, financially I mean, you would think they would be more involved. And they might be, we just don’t hear much about it.

    What about NUCCA? I don’t remember any of their techniques employing rot. and ext.

  64. quackdoctor says:

    That is true. I do not believe you will find one case of Toggle Recoil induced stroke. It mechanically would not comprimise the vertebral arteries. And Gonstead technique would be a consideration as well. They do not extent and rotate almost at all. And if you go on Youtube and watch Clarence Gonstead adjusting cervicals he uses almost no force usually and doed not extend and rotate. I doubt serioopusly if Gonstead cervical chair adjusting domne properly could put a patient at much risk at all. It simply would noy comprimise the region.

  65. Joe says:

    Quackdoctor you are becoming even more incoherent than usual.

  66. Joe says:

    nwtk2007 on 30 Jul 2008 at 1:10 pm wrote “I think the profession will do something about the stroke risk and upper cervical manipulation.”

    What about “don’t mess with peoples’ necks” don’t you understand? It is just that simple!

    nwtk2007 on 30 Jul 2008 at 1:10 pm wrote asked “What about NUCCA?”

    I think those idiots have been addressed earlier. Are you suggesting that they are correct- all illness is due to subluxation of the Atlas? When you ask a rhetorical question, you should know the answer. NUCCA’s are uneducated as well as the rest of chiros.

  67. Fifi says:

    quackdoctor – It’s great that you’ve moved from denial to acceptance that the majority of your profession (9 out of 10) believe in subluxations and that there’s a stroke risk associated with forceful neck manipulations. Nwtk has been vociferously denying all this – even though the college he attended seems to put great emphasis on subluxations and chiropractic philosophy and essentially tries to dress up magic as science.

    My question is, if you think there’s a need for reform in your profession why aren’t you out there reforming your profession? AND learning about what’s really going on? Why are you here arguing that chiropractic practices are evidence based and don’t involve magical thinking about subluxations, that no one believes in the woo anymore except a couple of old guys and not actually trying to prevent other chiropractors from doing dangerous things? The only other chiropractor here is nwtk – put down the lipstick and attend to the actual pig! Actions really do speaker louder than words, even online at times.

  68. quackdoctor says:

    “I would say the license is bogus, conferred by ignorant legislators, and (in health-care terms) not worth the powder to blow it to oblivion. Their institutions and organizations are equally worthless.

    What would you say about a certified astrologer? They have their institutions and organizations, too. It doesn’t make them useful.”

    Well that is funny Joe because you are then judging the American Osteopathic Association and all DO schools as all Dos that are members of the AOA. Because I pasted the quotes from the AOA website. And why do you not look at some DO schools and see what THEY teach and say? Hell they even teach you can cure ear infections with cranial pressure. And much more. I mean even most chiropractoc colleges do not go so far as to teach crainal bone manipulation.

  69. quackdoctor says:

    “I would say the license is bogus, conferred by ignorant legislators, and (in health-care terms) not worth the powder to blow it to oblivion. Their institutions and organizations are equally worthless.

    What would you say about a certified astrologer? They have their institutions and organizations, too. It doesn’t make them useful.”

    Well that is funny Joe because you are then judging the American Osteopathic Association and all DO schools as all Dos that are members of the AOA. Because I pasted the quotes from the AOA website. And why do you not look at some DO schools and see what THEY teach and say? Hell they even teach you can cure ear infections with cranial pressure. And much more. I mean even most chiropractoc colleges do not go so far as to teach cranial bone manipulation.

  70. nwtk2007 says:

    Joe, if anyone here sounds incoherent, it is you. But then that’s always the case with you, which ever web site you are on, saying the same old things over and over again.

    Hey Quackdoctor, go to the topix web site and read through some of the posts. Without even saying it, you will figure out who old Joe here is.

    So, what I am wondering is what kind of manipulation was Ms Nette’s doctor performing? Some extreme version of one of the Diversified set up’s?

  71. pmoran says:

    Re NUCCA and Gonstead: these are surely less likely to cause a stroke, but they are also far less likely to abut why are we not entilted to beleive that the less vigous the manipulation of the cervical joints, the all rationality suggests that .

    That is true. I do not believe you will find one case of Toggle Recoil induced stroke. It mechanically would not comprimise the vertebral arteries. And Gonstead technique would be a consideration as well. They do not extent and rotate almost at all. And if you go on Youtube and watch Clarence Gonstead adjusting cervicals he uses almost no force usually and doed not extend and rotate. I doubt serioopusly if Gonstead cervical chair adjusting domne properly could put a patient at much risk at all. It simply would noy comprimise the region.

  72. Joe says:

    nwtk2007 on 30 Jul 2008 at 1:10 pm asked “What about NUCCA?”

    I was right, it was addressed in the OP. A woman was killed by a NUCCA nut treating her tailbone (through her neck)!!?

    nwtk2007 on 30 Jul 2008 at 1:10 pm wrote “I don’t remember any of their techniques employing rot. and ext.”

    What you ‘remember,’ and what they claim, is irrelevant. Chiros messing with necks kill people, and there is no corresponding benefit to make the risk worthwhile. Instead of whining, cite good evidence that I am wrong.

  73. nwtk2007 says:

    Well it seems only the anti-chiro boys are given free reign here. Comments in moderation all day long for anyone trying to be objective about this issue.

    I assume whoever will moderate this comment.

  74. nwtk2007 says:

    Instead of whining, cite good evidence that I am wrong.

    Done that Joe.

    It just gets ad hominemly shunted aside for more insults. When given the chance to analyze the evidence presented regarding benefits of cervical manipulation, there were no takers. Just as you refuse to acknowledge the above list of course work chiro’s must take, you also refuse to read the evidence presented for manipulation benefits.

    What I had tried to ask before which was left on prolonged moderation, was, what kind of manipulation was Ms Nette receiving when her stroke occurred and what was the doctor apparently trying to treat? Was it some extreme form of Diversified set up?

    As mentioned earlier, NUCCA doesn’t rotate and extend at the same time.

    And Joe, where is this story of a woman being killed by a NUCCA manipulation?

  75. nwtk2007 says:

    Joe – “Instead of whining, cite good evidence that I am wrong.”

    It might be easier if you bring forth any study that shows benefit from manipulation and show us where is is flawed and why. If you are what you appear to claim to be then you know it is out there, just waiting to be looked at critically.

    It has been an utter waste of time for me or any other chiro to produce studies supporting manipulation of the cervical spine for any condition to skeptics because either they are unable to read it and analyze it or, more likely, are unwilling to.

    On another thread I was given a link to an article about vit C and kidney stones as evidence of a link between the two. I took the time to read it and see what was really being said and this “evidence” of a “link” between vit C and kidney stones turned out to be miniscule indeed, and only over a small range of vit C intake. And it was a survey, no less, with a veritable plethra of unaccounted for confounding factors.

    I’m willing to read it and analyze it Joe, you should be too.

  76. nwtk2007 says:

    Here’s one for you Joe:

    Aust N Z J Med. 1978 Dec;8(6):589-93.

    They were actually comparing manipulation by chiro’s to MD’s or PT’s. But the summary is here, and no, I have not read the entire article so if we can get it, we can all look at it objectively, and figure out why you will say it is no good.

    Abstract – “The efficacy of cervical manipulation for migraine was evaluated. In a six-month trial, 85 volunteers suffering from migraine were randomly allocated to three treatment groups. One group received cervical manipulation performed by a medical practitioner or by a physiotherapist, another received cervical manipulation performed by a chiropractor, while the control group received mobilization performed by a medical practitioner or by a physiotherapist. For the whole sample, migraine symptoms were significantly reduced. No difference in outcome was found between those who received cervical manipulation, performed by chiropractor or orthodox therapist, and those who received the control treatment. Chiropractic treatment was no more effective than the other two treatments in reducing frequency, duration or induced disability of migraine attacks, but chiropractic patients did report a greater reduction in pain associated with their attacks.”

    A DrE presented this one on another forum but no one cared enough to look at it. They just scoffed and said it couldn’t be any good because they don’t believe manipulation has any benefit in the cervical spine.

  77. pmoran says:

    I don’t know how this matter is going to be resolved. Cervical manipulation (CM) is not so obviously superior to other management for any condition as to justify the small risk of stroke — or even the potential risk, should some wish to keep on arguing about the evidence.

    So the rational response would be to regard CM as an inappropriate first line of treatment for any condition, and especially to immediately suspend use for “wellness”, preventative and other dubious objectives. If CM has a place in medicine it is as a late resort in the management of fully informed patients who have resistant neck pain and wish to try CM, but even here the evidence for benefits is weak.

    However, it is most unlikely that chiropractors will give up such a large segment of their practice.

    Moving to less vigorous forms of manipulation is likely, and would almost certainly reduce the risk of stroke, but it further reduces the credibility of CM, while associating chiropractic with quackier elements. Gentler “adjustments” would be even less likely to do anything useful, and I suspect many patients would regard the adjustment gadgetry as a joke.

    I can sympathize with more sincere chiropractors for the bind that they are in as the result of certain accidents of medical history.

  78. nwtk2007 says:

    Joe, here is another, although, it involves both manipulation of test groups and survey information. Sorry.

    J Manipulative Physiol Ther. 2000 Feb;23(2):91-5

    Abstract – “OBJECTIVE: To assess the efficacy of chiropractic spinal manipulative therapy (SMT) in the treatment of migraine. DESIGN: A randomized controlled trial of 6 months’ duration. The trial consisted of 3 stages: 2 months of data collection (before treatment), 2 months of treatment, and a further 2 months of data collection (after treatment). Comparison of outcomes to the initial baseline factors was made at the end of the 6 months for both an SMT group and a control group. Setting: Chiropractic Research Center of Macquarie University. PARTICIPANTS: One hundred twenty-seven volunteers between the ages of 10 and 70 years were recruited through media advertising. The diagnosis of migraine was made on the basis of the International Headache Society standard, with a minimum of at least one migraine per month. INTERVENTIONS: Two months of chiropractic SMT (diversified technique) at vertebral fixations determined by the practitioner (maximum of 16 treatments). MAIN OUTCOME MEASURES: Participants completed standard headache diaries during the entire trial noting the frequency, intensity (visual analogue score), duration, disability, associated symptoms, and use of medication for each migraine episode. RESULTS: The average response of the treatment group (n = 83) showed statistically significant improvement in migraine frequency (P < .005), duration (P < .01), disability (P < .05), and medication use (P80%) of participants reported stress as a major factor for their migraines. It appears probable that chiropractic care has an effect on the physical conditions related to stress and that in these people the effects of the migraine are reduced.”

    Now that’s just two in about 10 min of effort. You want to just spit at each other or converse?

  79. nwtk2007 says:

    Hey there pmoran,

    our posts are overlapping.

    I see your point, but let’s say, for migraine and manipulation, how does the risk of the meds for migraine and manipulation compare, as well as the side effects.

    I am willing to take a look. What are the meds used for migraine besides anti-depressants like Elavil. It should be easy to find out their risks and side effects as well as their cross reactions with other meds which it is likely many who treat for migraines will be, in many cases, taking.

  80. nwtk2007 says:

    I just thought I would bring this down from earlier in this thread to give a little perspective.

    “For proper perspective, the risks of chiropractic neck treatment should be compared to the risks of other treatments for similar conditions. For example, even the most conservative “conventional” treatment for neck and back pain, prescription of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), may carry a significantly greater risk than manipulation. One study (16) found a 4/10,000 annual mortality rate for NSAID induced ulcers among patients treated for non-rheumatic conditions such as musculoskeletal pain and osteoarthritis; that extrapolates to 3,200 deaths in the US annually.”

    I don’t mean to be too critical, but the anti-chiro guys and the anti-alts, tend to ignore perspective. At least from what I can tell.

    Usually when I bring up perspective, they come back with some remark about some hoc doc spoc quo pro or another thing and say it doesn’t matter.

  81. nwtk2007 says:

    Harriett,

    Do you have any evidence to support your “concern” about the added risk of MVA in going to and coming from the DC’s office for his/her treatments? As opposed to the risks from medications.

    You may very well be onto something there. The roads are dangerous and it is a world gone mad to be sure.

  82. Harriet Hall says:

    nwtk2007,

    You are changing the subject. My original post had a link to a Cochrane review showing manipulation was no better than gentle mobilization for musculoskeletal neck pain. Now you bring up manipulation for migraines. The first study you cited showed there was no difference in frequency, duration or induced disability of migraine attacks between manipulation and mobilization. Patients did report less pain with manipulation, but since there was no change in disability, I don’t know what those self-reports mean.

    The second study you cite is the only study in PubMed to address migraine specifically. A review of SMT for headaches concluded

    “SMT appears to have a better effect than massage for cervicogenic headache. It also appears that SMT has an effect comparable to commonly used first-line prophylactic prescription medications for tension-type headache and migraine headache. This conclusion rests upon a few trials of adequate methodological quality. Before any firm conclusions can be drawn, further testing should be done in rigorously designed, executed, and analyzed trials with follow-up periods of sufficient length.” http://www.ncbi.nlm.nih.gov/pubmed/11562654?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    That was in a chiropractic journal. A medical journal reviewed all types of headache in 2006 and concluded
    “There are few published randomized controlled trials analyzing the effectiveness of spinal manipulation and/or mobilization for TTH, CeH, and M in the last decade. In addition, the methodological quality of these papers is typically low.” http://www.ncbi.nlm.nih.gov/pubmed/16596892?ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    This is certainly not very impressive evidence, and anyway, the argument that pills do more harm is not convincing because manipulation vs pills is a false dichotomy. Even the study comparing amitryptyline to SMT for migraine prophylaxis might only be telling us hands-on placebos are more effective, and a safer hands-on treatment might be available.

  83. Harriet Hall says:

    “Do you have any evidence to support your “concern” about the added risk of MVA in going to and coming from the DC’s office for his/her treatments?”

    Well, duh! There are published statistics for the risk of an MVA per mile driven. It’s a small risk, but I don’t think anyone would deny that several trips to a chiropractor’s office for manipulation are riskier than one trip to a doctor’s office for a prescription. Unless the chiropractor’s office is next door and the doctor’s office is in another town! :-)

  84. quackdoctor says:

    “I am willing to take a look. What are the meds used for migraine besides anti-depressants like Elavil. It should be easy to find out their risks and side effects as well as their cross reactions with other meds which it is likely many who treat for migraines will be, in many cases, taking.”

    Well there are things like Imitrex and Cafergot. Both can case a heart attack. Imitrex more so. Especially when combined with other things and in patients with coronary artery disease. I have seen Initrex cause problems. I had one patient whose internist combined Imitrex with Viagra have an MI despite clean arteries and good bloodwork, not being overweight and getting plenty of excersize. Long term Imitrex can cause black(green) blood. sulfhemoglobinemia integrating sulfur into hemoglobin. SulfHb. From a cardiac standpoint I think Imitrex is the more dangerous. The ergotamine tartrate component of Cafergot can cause claudication of the extremities like ergot and lysergic acid poisoning can. But the drugs do help people. If I had migraine and needed meds I would take cafergot but not Imitrex. Of course there are other drugs used as well.

  85. quackdoctor says:

    Relative to migraine headaches annd manipulation. My experience is that patients with migraines are not fixed with manipulation long term. But the patients claim that the manipulation makes them feel better. But I have never seen it abort a full blown migraine. But th epatients with migraines many times claim they feel better immediately. So that is all I have seen. I mean subjjectively. Now cluster headaches I have found to really not respond well at all. Now “tension” headaches seem to have the most relationship relative to cervical manipulation. Severe migraine? I say shoot them up with morphine/demerol. The same for cluster. But mostly cluster. And yeah…you can crack um or streach um if they want a little. It seems to help the migraines a bit. I mean the patients think so but not with the cluster. So that’s all on that. I mean if they have a migraine and are non responsive to ergotamine tartrate. But I am kind of scared of Initrex based on what I have seen, read and what a trusted internist has said to me.

  86. quackdoctor says:

    “Well, duh! There are published statistics for the risk of an MVA per mile driven. It’s a small risk, but I don’t think anyone would deny that several trips to a chiropractor’s office for manipulation are riskier than one trip to a doctor’s office for a prescription. Unless the chiropractor’s office is next door and the doctor’s office is in another town!”

    I don’t think you get it Harriet. A trip in your car to see the chiropractor is infinately more dangerous than a trip to the MD or getting cervical manipulation. Don’t you understand that we put our offices in bad neighborhoods to get the personal injury business? You could be shot in your car. And we also position ourselves in bad neighborhoods because poor people are more gullible. And furthermore an MD is unlikley to be next to a DC because we drive the property values down.

  87. nwtk2007 says:

    Harriett – “You are changing the subject. My original post had a link to a Cochrane review showing manipulation was no better than gentle mobilization for musculoskeletal neck pain. Now you bring up manipulation for migraines.”

    Sorry, I thought the real gist of the discussion was benefits of cervical manipulation vs risk.

    As to the first study, you mention disability. Disability is a relative term and hard to judge based upon patient respomse. But you are correct. The point was that there is benefit from cervical manipulation and that it is performed by others besides chiropractors.

    I also see your point in the second study I cited. My point here would go back to the risk of meds vs manipulation. I am not sure what first-line prophylactic prescription medications for tension HA’s are, but the risk can now be compared. What are those drugs and what is their risk as opposed to manipulation?

    One quote from you – ““There are few published randomized controlled trials analyzing the effectiveness of spinal manipulation and/or mobilization for TTH, CeH, and M in the last decade. In addition, the methodological quality of these papers is typically low.”

    This an assessment from a medical source, right? I would expect that. What I would like to hear is why they say “low methodological quality”. It is typical but never explained as to why they might think that is so. Since it is medical, are we to just take their word for it? We can’t dismiss all studies because “they” say the quality is “typically” low. To use the term “typically” implies that at least some are of good quality.

    You also say – “This is certainly not very impressive evidence, and anyway, the argument that pills do more harm is not convincing because manipulation vs pills is a false dichotomy.”

    I am not sure what you mean by that, but for what I am trying to point out, if the risk of meds is great (much more so for NSAIDS like ibuprofen), and the risk of stroke and manipulation is small, then wouldn’t the risk vs benefit ratio favor the manipulation? (Ignoring cost and driving hazards)

    Throw in that added “something” people get from their chiropractors (otherwise they would not continue to go), and wouldn’t that be a fairly good reason to give cervical manipulation a chance, at least in treatment of HA (I say HA because migraine is almost never the true diagnosis)? (Especially if a good informed consent is in place an the chiro avoids manipulation combining extension and rotation.)

  88. nwtk2007 says:

    Again, why are my comments awaiting moderation? Am I flagged as an “opposing” point of view?

  89. pmoran says:

    Not the answer. CM probably does help some patients with migraine, but almost certainly mainly as placebo. Now, I can sympathize with the notion that relatively harmless placebo treatments may sometimes be a preferred first treatment option for self-limiting conditions, rather than unnecessarily powerful and side effect ridden pharmaceuticals. But if you are going to choose a placebo treatment for migraine, why choose one that causes stroke? You would try massage or acupuncture in preference. They perform as well, or nearly as well in clinical studies.

    The worst result for a migraine sufferer may be that they have a good initial outcome from CM, because that may lay the groundwork for a lifetime of risk from repeated CMs.

  90. nwtk2007 says:

    pmoran – “CM probably does help some patients with migraine, but almost certainly mainly as placebo. ”

    I think for anyone objectively looking, there are plenty of sources showing that manipulation of the cervical spine for various conditions, in the above instances HA, is beneficial and more than a placebo effect. Yes there are studies that don’t show any benefit but there are plenty that do, or in some cases, a benefit at least as good as a medication.

    So given the risk of stroke as it stands right now, extremely low, and the risks associated with meds like NSAIDS or Elavil, well documented (not to mention the others mentioned by Quackdoctor), and given manipulations benefit as is also documented, wouldn’t it be safe to say that manipulation is a good choice, for some, over medication for HA at the least? Especially if the chiropractic community gets on the ball and educates itself about the risks of combining extension and rotation and implements the use of an informed consent, which many if not most of us use already.

  91. Harriet Hall says:

    Let’s back up a minute. Migraine is a specific kind of headache of intracranial origin, often preceded by an aura of scintillating scotoma or other neurologic phenomena. Other headaches have a musculoskeletal origin (cerivicogenic, muscle contraction HA, etc. I don’t think there’s any convincing evidence that manipulation has any specific effect for migraine beyond placebo. It’s a false dichotomy to think there are 2 equally effective choices: manipulation or drug X.

    While manipulation may make headache patients “feel” better, in the review I cited there was no difference in frequency, duration or induced disability of migraine attacks between manipulation and mobilization.

    And when “there are studies that don’t show benefit and some that do” it’s appropriate to do a systematic review considering the quality of the studies. I’ve offered the conclusions of two such reviews, one from the chiropractic and one from the medical literature. Both pointed out that there were few studies of good quality.

    You have not given us any objective reason to prefer manipulation over gentle mobilization, massage, or other non-pharmaceutical treatments.

  92. Joe says:

    nwtk2007 on 31 Jul 2008 at 9:26 am “I think for anyone objectively looking, there are plenty of sources …”

    Why not cite them?

    Concerning artery dissection: “One hundred seventy-seven published cases of injury reported in 116 articles were reviewed. The cases were published between 1925 and 1997. The most frequently reported injuries involved arterial dissection or spasm, and lesions of the brain stem. Death occurred in 32 (18%) of the cases. Physical therapists were involved in less than 2% of the cases, and no deaths have been attributed to MCS provided by physical therapists. Although the risk of injury associated with MCS appears to be small, this type of therapy has the potential to expose patients to vertebral artery damage that can be avoided with the use of mobilization (nonthrust passive movements). The literature does not demonstrate that the benefits of MCS outweigh the risks.” http://www.ptjournal.org/cgi/content/full/79/1/50

    The reasons that PTs don’t cause strokes are : 1- they don’t manipulate necks needlessly. Remember that the propositus for this thread was a woman with a tailbone injury. We also have the example of Ms. Nette, who did not even have any health problems. 2- When PTs do manipulate the cervical spine, they are better at it. http://ph-ms.ouhsc.edu/ah/rehab/kinsinger.wmv

    Chiropractors are incompetent at cervical manipulation because they administer it indiscriminately and without the requisite skill.

  93. quackdoctor says:

    “Chiropractors are incompetent at cervical manipulation because they administer it indiscriminately and without the requisite skill.”

    Perhaps the commentt about indiscriminate use is valid in specific cases. However. The comment that DCs are not skilled is nonsense. The art of spinal manipulation or osseous manipulation of any type takes a “knack”. This goes back to the families that taught it in the midwest before there were osteopaths or chiropractors. This has been stated many times. And we know this. But even with natural ability it must be taught. And then on top of that it must be practiced over many years to get good.

    Now the DC is seeing a lot more patients for manipulation than a PT. Also the DC has many many more hours in instruction in spinal manipulation than the PT.

    And being able to manipulate requires a knowledge of joing end feel and play. As well as the ability to develope muscles in the operator and senses to achieve the technique.

    So as one good Osteopathic physician that was expert in OMT said. It takes a minimum of 5 years of frequent practice to begin to get good. I would agree with this.

    Additionally PTs do not usually see their patients on an immedicte PRN basis as DCs. Meaning that you do not just get an acute back and call up a PT and get into the office immediately for care like a DC. So the DC is more experienced with acute management. And there is a big difference between that management and chronic back pain.

    Additionall the PT almost never has the correct tables that can position the patient into prone antigravity, prone lumbar flexion and extension or achieve circumduction of the lumbar spine.

    So if you want to make a case about chiros applying manipulation to frequently that is fine. However when large amounts of education are focused toward it in college. Bot hands on and in biomechanics and the DC does it all day every day…Day in and Day out. They get extremely good at it.

    So manipulation requires training and experience. Years of it. So you really cannot compare a DC with anyone else in this area. They get extensive training. And tons of experience. I mean come on. I have seen just about everything that can happen with manipulative therapy after doing around 200 thousand proceedures.

    Now if a PT takes a lot of post grad training and specializes in manipulation. They can emerge competent. The DOs for example that specialize in OMT can be excellent. But if you are not doing it all the time forget it.

    I mean I have spent many years on manipulation. I have even tried to break necks and spines by putting in maximum forces. To see if I could fracture the spine and tear the soft tissues. To see what the anatomy would bear. All in the learning process.

    I have fractured bones and had a couple of neurological events. And from those episodes I learned how to avoid those things. And the thing is in order to learn to sail a boat you have to have been through some rough seas.

    So you cannot caompare the experience of a manipulating DC with anyone else. Most people are not close at all to being as good a manipulator as even the most quack chiropractor that moves bones.

  94. Fifi says:

    The problem is that the vast majority of chiropractors are treating mythical things like “subluxations” – imaginary biology (no matter how long someone studies it) isn’t “knowledge” and no matter how much experience one has with a magical ritual it doesn’t change it from being essentially a magical ritual. And why deny that many chiropractors do potentially dangerous neck manipulations despite no evidence that they actually work (and argue they work even when faced with the evidence) instead of working within your profession to change this practice? Being an apologist for dangerous chiropractic procedures on a science-based medicine blog is doing the opposite of advocating for change amongst your professional peers.

  95. quackdoctor says:

    I have never condoned dangerous methods in any way. I never defended a dangerous procedure. No as far as what works and what does not. Let us get on thing straight. There is no evidence that physical therpy modalities work yet they are in PT departments in hospitals and clinics all over the country. There is no evidence that osteopathic manipulative medicine works and the osteopathic colleges teach it. And the AOA condones it. I do not see the medical hospitals demanding that residents and staff physicians drop membership in the AOA. I mean really.

    Why are the “scientific” DOs not reforming their own instutions and state boards. I mean you cannot get a DO license without being tested on OMT that has no evidence base to it.

    So why is medicine not keeping their own house clean? Why are the DOs in practice that claim to be evidence based (which is most) not speaking up to get the blatent quackery out of their profession. And why are medical hospitals permitting people that are refusing to speak up against quackery work in the hospitals. Why are federal funds and state funds going to DO schools when they teach quackery? I mean why is the term”osteopathic medicine” even recognized as medicine? It the “Osteopathic” part is pseudoscience? Why is medicine tolerating this? Why are the rational DOs tolerating this?

    Why when a student is in DO school do they not in class call the professor on his lies? Why is it that many DO students think OMT is a bunch of nonsense but has the official saying “Cooperate to graduate” as was and possibly still is the mantra of many in osteopathic college? But no they just shake their head yes when old Doc so and so explains how pushing on somebody’s head will cure their respiration or how to milk the liver. Why is it that DO state boards defend DOs that have been accused of rendering innappropriate care (OMT) in cases where MDs have said..”What the hell was that lady thinking?”. But because she is an old DO and practicing OMT little action is taken.

    Sp why is THIS tolerated. That is what I want to know. Because it would seem that medicine should clean their own house before (or during) pointing fingers at others.

  96. Fifi says:

    quackdoctor – The Tu Quoque “but they’re dicks too” doesn’t answer my question as to why you’re here making excuses for non-evidence based chiropratice rather than out getting to know what’s really going on and believed in your profession and advocating for the necessary changes. Are you even a member of the group of EB chiropractors that Harriet has written about?

  97. nwtk2007 says:

    Quackdoctor, I was going to warn you but FiFi jumped in really quickly. If you point out the problems in medicine, you will get Tuy Quoque’ed almost immediately by someone. I guess it happens a lot that someone expects medicine to judge itself on the same level as it judges other groups.

    Joe, I have presented evidence, you just didn’t read it as usual.

    Harriett presented two studies of the literature and although they both agreed the evidence is weak, neither said there is none, which is what we hear a lot. Within both of those studies I suspect there are at least a few good studies and one group’s summary of “all” literature is not how I prefer to approach evidence.

    But even with that, Harriett said – “You have not given us any objective reason to prefer manipulation over gentle mobilization, massage, or other non-pharmaceutical treatments.”

    But given the very real risks of pharmaceuticals, I think there is good reason and evidence to go that route prior to the drugs.

    And also, one of the studies I sited above, compared the manipulative skills of MD/PT/DC’s.

  98. Harriet Hall says:

    “why is THIS tolerated. That is what I want to know. Because it would seem that medicine should clean their own house before (or during) pointing fingers at others.”

    In the first place, we’re not tolerating anything; we’re trying to promote science-based medicine and we’re pointing out practices that are not based on good science – whether they’re found in mainstream medicine, in chiropractic, or in deliberate quackery.

    In the second place, do you really mean that medicine ought to achieve perfection before it points fingers? Think through the implications. That’s like saying a doctor who smokes shouldn’t advise his patients that smoking is unhealthy.

    In the third place, shouldn’t every profession be cleaning its own house? Medicine has a long history of trying to improve its practices. If chiropractic had done half as much as medicine to clean its own house, we probably wouldn’t be having this discussion.

  99. Joe says:

    quackdoctor on 31 Jul 2008 at 11:12 am “Also the DC has many many more hours in instruction in spinal manipulation than the PT.”

    There are people with many, many hours of (accredited) instruction in astrology. That does not improve their results. The hours you wasted learning to adjust subluxations were not educational. The fact remains, PTs learn to manipulate the neck without killing people. Instead of writing “tis not” in response, why don’t you cite reliable studies.

    quackdoctor on 31 Jul 2008 at 12:09 pm wrote “I have never condoned dangerous methods in any way.”

    Since this is a thread about the danger of the chiro neck-snap you seem to be defending a dangerous method. Try to keep in mind, it is not just the danger, it is the inutility of that procedure compared to safer methods (as Harriet has cited). Rather than writing “tis not” can you cite some reliable data?

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