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Chiropractic Practice Building: A Doctor’s Confession and the Report of Findings

“I’ve got to get this off my chest!”

Dear chiropractic practitioner,

Confessions are tough…Real tough. They are painful, awful things. But, sometimes a confession can set the record straight, and I want to give credit where credit is due. Before I talk about my confession though, let me say a few other things first. You may want to sit down.

You know, when I meet people in town they usually say, “Oh, yeah, I know you, you’re Dr. Jones. I’ve seen your posts with that picture of you and the two cute little girls.” Well, I’m the guy on the left. Aren’t they cute? Now do you feel like you can trust me?

Years ago, something happened to me that changed my life forever. And I would love to tell you all about it, but first I need to give you my report of findings.

I’ve correlated the findings of your examination, and I’ve put it into a package that I’m going to review and send home with you, so you’ll know what we found and what we’re going to do to help you. In the next 10 minutes or so I’m going to review what we found, explain what these findings mean, recommend a course of action and discuss the results you can expect in the future. Feel free to ask any questions as we go along.

First a quick review. You’ve come to our website suffering from an inability to recognize your complete lack of effectiveness in the treatment of headaches, ear infections, asthma, or any other condition with the possible exception of acute musculoskeletal pain involving the back. You have difficulty accepting that any treatment you offer which is effective is provided by physical therapists, minus all the ”baggage”, and that nothing you offer which is unique to chiropractic is effective. You are in denial over how the majority of your profession is woefully ignorant of, or exists in a state of denial of, so many of the advancements in modern medicine, like life-saving vaccines, made since chiropractic was invented by D.D. Palmer in 1895.

Don’t worry, we have had excellent results with these sorts of problems. Well, actually, the proponents of irregular medicine tend to stick their fingers in their ears when faced with criticism and evidence that doesn’t support their world view. In fact, I’m surprised we’ve made it this far. I take that as a good sign.

To locate the specific cause of your problem, we conducted a thorough examination. Here’s what we found:

Making it as a chiropractor is hard. The numbers just don’t add up despite how CAM use is portrayed in the media and defended by proponents. Certainly some chiropractors do very well, with the median salary a few years out of training being about seventy thousand dollars a year, but because of low demand and marketplace oversaturation many practices fail. With debt that rivals physicians coming out of medical school, and families to provide for, chiropractors often turn to so-called practice building or management firms to help right the ship. Many of the methods recommended by these companies are quite shady, encouraging manipulation and misrepresentation unbecoming of a group of practitioners with a goal of being regarded as primary care practitioners.

The most recent National Health Interview Survey data on CAM use revealed that 8.6% of people polled underwent some form of manipulation in 2007, which was up from 7.5% in 2002. But these numbers aren’t really comparable. We don’t know what percentage of the patients in the 2007 data were actually seen by a chiropractor rather than an osteopath, because unlike in 2002 they did not differentiate between the two fields. Some osteopaths do continue to provide manipulation-based therapy but most practice or at least incorporate science-based practice. In fact, most osteopaths train with and practice alongside medical doctors.

The number of chiropractors in the United States is somewhere around sixty thousand based on numerous sources. There were 52,000 chiropractors in 2010 according to the Bureau of Labor and Statistics, so I will go with that, and there are currently about 316 million Americans. Based on the NHIS data it appears that about 27 million people get manipulated yearly, which works out to 500 or so people per manipulator. Again, we don’t know how many people are actually visiting a chiropractor but it is probably the majority, and we don’t know what percentage of those are regular visitors. That is not a large patient panel by any stretch of the imagination, and of course it would not be evenly distributed. Some newer practices likely have far fewer patients.

Knowing how the numbers actually break down is interesting considering some of the claims that I have come across researching the chiropractic presence on the internet. A common chiropractic meme (chiromeme) I see is bragging about large patient loads, often with numbers that hint at an ability to interact with space and time in fundamentally new ways. This is a practice-building technique. The bragging, not the manipulation of time.

Claims of seeing hundreds of patients a day, or performing millions of adjustments over a career, are common. Sharon Gormon, for instance, “has cared for thousands of patients and has performed over half a million adjustments in her career.” Over a twenty year career that works out to at least 68 adjustments a day, if she never took a day off. Even taking into account that many patients are diagnosed with multiple subluxations at the same visit it is still a hectic schedule. The ability to claim to have that degree of popularity in order to impress potential patients, while also denigrating physicians for not ”treating the whole patient”, is impressive and perhaps unrivaled in the natural world.

Another chiromeme I came across recently, while perhaps not as commonplace, was still repeated word for word on several different chiropractic websites and is considerably more comical:

If you think that chiropractic is a new science, it is. However, you might be surprised to know that spinal manipulation has been utilized for a very long time. The first pictures depicting spinal manipulation were discovered in prehistoric cave paintings in Point le Merd in southwestern France. The historical cave paintings can be dated as far back as 17,500 BC.

A quick search revealed that Point le Merd is not an actual location in France or anywhere else. It is however suspiciously close in spelling to “pointe le merde”, which translates to “the very tip of the shit”. Make of that what you will.

With so few patients at their disposal, I am not surprised that chiropractors are more likely to default on student loans than any other health-related profession. It is also easy to see why so many turn to these practice-building techniques and the seminars run by companies promising to bring more patients in and increase profits. I don’t have a problem with a business trying to succeed and make enough money to feed their family and pay their debts, but I do have a problem with how it is sometimes done. The ends don’t justify the means in this case because they require deceiving patients. The evidence simply does not support the vast majority of the claims being made.

Usually these practice-building techniques come in the form of setting up information booths at local gyms or fairs, ads containing coupons for free spinal exams and pseudo-journalistic press releases run in smaller local publications. The easiest to recognize are the bogus personal testimonials placed on practice websites (1, 2, 3, 4). I’m sure you have seen these “confessions” before, but you may not have realized that they involve the use of a standard template purchased from practice-building firms. Here is a video version which hits all the high points as well. I highly recommend watching all three installments. Here is another one, just for fun.

These seemingly personal stories always follow the same pattern, with many being identical except for the picture of their adorable offspring and specific practice information. The chiropractor always sheepishly admits that he or she has something to confess and then tells the story of how they, or a family member, were injured and could only find relief in the caring hands of a chiropractor, usually after a bad experience with conventional medicine. Thus they are inspired to join the field of chiropractic.

Then comes the confession that they have been taking the credit for healing patients over the years when really it was the chiropractic all along. They simply remove roadblocks to the body’s innate healing ability. They can treat your pain, get you off your meds and save your life naturally. Check out the links above and you’ll see. And trust me there are thousands more, like this one, that are easily accessible online. I can’t help but imagine that they choose from a list of personal tragedy options, and the testimonials typically placed in the ad are likely invented as well. I could be wrong but if not then these are a very accident-prone bunch. They should probably have a special restriction on their driver’s licenses.

Many of these phony personal confessions disparage the medical profession or make questionable claims about the side effects of childhood vaccines. Or they simply complain that medical doctors only know how to push drugs and treat symptoms. Here is one that gives highly questionable medical advice such as bringing your child to the chiropractor if they are injured falling from a high place. It also contains the following gem:

However, have you ever wondered what would happen if you gave a healthy child the same medicine you give a sick child? Don’t parents usually tell their kids “don’t take drugs” if not needed because it’ll make them sick?? So it seems if drugs make healthy people sick, wouldn’t they make sick people even sicker?

Makes sense. I for one would never put a healthy child on a dopamine drip.

Another post on this particular site lists some reasons why chiropractic might not work:

Invalidating Comments: When a patient has a family member (or other close person) who is making them wrong about using chiropractic care, then those people have up-and-down results. The person is better after I treat them, but after coming in contact with that person, they are doing worse again.

I think that Dr. Erica might be on to something. I told a family just today not to speak ill of the gentamicin or it might interfere with its ability to kill bacteria. And if they just had to they should have the decency to not do it in front of the IV. I don’t think this is a chiromeme that will catch on though.

While some rogue chiropractors like Dr. Erica do sometimes go off point on their websites, virtually everything you read on a chiropractic website or in an advertisement for a chiropractic practice is part of a prepackaged practice-building scheme. The wording is carefully chosen to have the biggest impact. Every flyer or handout found in a chiropractor’s waiting room is designed to indoctrinate you so that you not only come back, you go out and spread the word. Here is a nearly ubiquitous example from a chiropractic website’s FAQ section:

Who needs to be evaluated by a chiropractor?

EVERYONE!

Anyone with a spine can benefit. Due to its positive effects on the nervous system, chiropractic can help correct many health problems.  Our clinic typically treats patients with fatigue, scoliosis, allergies, asthma, menstrual disorders, headaches, and low immune function.

Another example:

How long will you need chiropractic care?

You’ll need chiropractic care as long as you live in Hanover Park and encounter physical, chemical or emotional stress that you cannot adapt to or accommodate. Ready to get started? Call our office today.

And yet another from a different chiropractic website’s “Story of Chiropractic” page:

Ultimately, the goal of the chiropractic treatment is to restore the body to its natural state of optimal health.  In order to accomplish this, I use a variety of treatment methods, including manual adjustments, massage, trigger point therapy, nutrition, exercise rehabilitation, massage, as well as counseling on lifestyle issues that impact your health.  Since the body has a remarkable ability to heal itself and to maintain its own health, the primary focus is simply to remove those things which interfere with the body’s normal healing ability.

But these boilerplate “confessions” and FAQ sections are hardly the worst that chiropractic practice building has to offer. That would be the report of findings, or the ROF.

The ROF sounds simple enough as explained to the potential patient on many websites:

After Chiropractor Jones has had time to sit down and thoroughly analyze your exam findings, he will give you a detailed report of all findings and answer any questions including:

  1. What is causing my problem?
  2. Can you help me?
  3. What will my treatment cost?

After reviewing your health history, goals, and examining your spine and X-rays, Chiropractor Jones will discuss recommendations and notify you if  your condition requires care with other providers. Chiropractor Jones will provide the best treatment and wellness program for your needs.

Well that sounds lovely, and not much different than when I discuss a treatment plan with the family of a hospitalized child. I go over exam findings and test/imaging results that might have been obtained with the family, I explain my diagnosis and I make treatment recommendations. And I make sure that the family has all of their questions answered.

But there is more to the chiropractic ROF. In the world of chiropractic practice building, the ROF is the sales pitch. It is what all the bells and whistles of the chiropractic office, the x-rays, the neurocalometers, leg length measurements and even simple palpation of the spine are designed to lead up to. It is the chiropractor’s chance to convince the patient of the validity of what B.J. Palmer called the Big Idea. This is the notion that the subluxation is the root of all your health problems and correcting the subluxation will fix all of your health problems. Palmer imagined a world without subluxations. Lennon did not.

The ROF is also the chance to convince the patient that there is more to chiropractic than fixing the acute problem. That pesky subluxation could return at any time. Thus the patient is convinced of the need for transitioning into maintenance care. As insurance does not typically long-term chiropractic care, this tends to require cash. And naturally if you pay up front, they can pass the savings on to you. Many practice-building resources refer to the ROF as a means of achieving the ”killer close.” Classy.

I learned how to discuss the nuances of a patient’s diagnosis and management by reading, role play and observation. There are a number of excellent resources for physicians to improve their ability to communicate. I am still learning after ten years of practice. Recently I’ve focused on learning how to better discuss the management of pain because my wife has transitioned into a career in pediatric palliative care and she made me do it. There is absolutely nothing wrong with the desire to hone these skills. The chiropractic ROF is clearly not the same thing.

There are a number of practice-building programs offer ROF scripts and coaching for purchase, many with claims of superiority in growing a practice, but a great deal of information is available online. There are many different approaches. This particular practice-building consultant, for instance, believes that patient autonomy is a nuisance:

When a chiropractor crosses the line from controlled office procedural and patient management into procedural exceptions and patient management decisions based on patient debate and input, that chiropractor is entering the realm of ineffective practice.

Here is a complete script. I’ve provided some of the highlights:

2. Opening statement with an assertive, We can help you!
-Susan, your radiological findings indicate that we can help you. But we have a lot of work to do.
-The purpose of your visit today is to first show you how the structural biomechanics of your spine differ from a healthy spine.
-The second goal is to give you our recommendations for relief and correction.
-Does that sound good?
-Patient responds, “Yes”

** Use a model of a spine to show the patient what a healthy spine looks like.
-Do you remember the term we use when a bone in your spine is out of alignment?
-Patient responds “Subluxation”
-If the patient doesn’t respond with, “Subluxation.” Show the patient a poster with the word subluxation on it.
-Then make the patient say it, “Subluxation”.

8. Express urgency
-If we don’t address this, what do you think will happen?
-Patient responds, “It will get worse.”
-That’s correct.
-You mentioned during the consultation you have been having difficulty working and sleeping. If your subluxations get worse, how do you think that will affect those areas of your life?
-Patient responds, “I might not to be able to work at all.”
-That is what I am concerned about.

9. Relate subluxations to the organs innervated and associated conditions
-You have a subluxation here at C1. These nerves supply your heart, pituitary gland, and lungs.
-Subluxations at this level are associated with headaches, migraines, neck  pain and stiffness, high blood pressure, anxiety, depression, insomnia and  asthma.

(Cardiopituitopulmonary depression is very serious.)

10.How long
-I can’t give you an exact date because there are many factors that play a role and impact your body’s ability to heal: what you eat, how you exercise, genetics and how much stress you are under.
-However, if we stop at relief care the hole in the roof will not be corrected.
-Corrective care for an adult with this severity of subluxations can take between 24 weeks and 24 months.
-I know that seems like a longtime, but how long does it take to straighten  teeth?
-Patient responds, “A couple years.”
-That’s correct, it takes time to move bones.

11.Find level of commitment
-Are you committed to correcting your subluxations?
-Patient responds, “Yes.”
-Are you a 100% committed?
-Patient responds, “Yes.”

12.How much
-You can pay 55 a visit for the 48 visits plus two re-x-rays. That comes to 2838.
-You can pay 239 per month for 6 months and that will include three x-rays. That comes to 1434 and saves you 444 dollar
-You can also pre-pay for the 24 weeks and receive a 15% discount. That comes to 1219 and saves you 215 dollars over the monthly plan

I’m hard on the practice of chiropractic because it involves lying to patients and parents. I realize that not all chiropractors subscribe to subluxation theories or disparage vaccines, and not all chiropractors make use of slimy practice-building schemes, but there are just not very many out there like Sam Homola. And whether they continue to make claims of effectively treating or preventing non-musculoskeletal conditions despite the reams of negative evidence is because of gullibility or guile, I do not care.

I have no doubt that there are similar tactics put into use by some medical doctors. I cringe every time I see another “health and wellness” medical spa pop up with an MD as a director. It burns me up every time a medical clinic starts offering bogus bio-identical hormone therapy or selling supplements.

I spent a long time trying to see what kind of shady practices go on in the world of pediatrics to drum up business. Outside of some reasonable discussions of website design and establishing a presence in the community, which is also something that chiropractic practice-building techniques cover, my search for the sordid underbelly of pediatrics came up empty. What I did find, using the same search terms minus the word “chiropractic”, were countless examples of pediatricians trying to make a practice better rather than a busier or more profitable.

What does having a better practice entail? Primarily it means providing better care for patients through quality improvement initiatives. It means improving efficiency, limiting the ordering of diagnostic studies like labs and imaging that aren’t supported by good evidence and incorporating more effective educational interventions for families. There is no place in the practice of medicine for the chiropractic model of practice building.

Posted in: Chiropractic

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82 thoughts on “Chiropractic Practice Building: A Doctor’s Confession and the Report of Findings

  1. tgobbi says:

    Clay states: “Usually these practice building techniques come in the form of setting up information booths at local gyms or fairs, ads containing coupons for free spinal exams and pseudo-journalistic press releases run in smaller local publications. The easiest to recognize are the bogus personal testimonials placed on practice websites… ” (And their print ads as well).

    The similarities and recurring themes, now that Clay points them out, appear obvious. But I’ve only been peripherally aware of this in the past. Reading today’s blog made me realize that I hadn’t realized that they all seem to be variations on the same story. Plus they’re all young family men and women with healthy, squeaky-clean kids.

    But that’s not at all surprising because many of the monthly chiropractic chiropractic newsletters also seem like they come from the same source. Only such details as names of the “doctors” and the office venues change.

    Another common factor is the “homeyness” of the pitch. It always tries to emphasize the small-town, up-close-and-personal nature of the practice and the fact that the D.C.s are just normal family folk like the rest of us. Years ago, when I moved my own business from one location to another, the old venue was taken over by a chiropractor whose first newspaper ad stated: “There’s a new doctor in town.”

    It all goes to emphasize what I’ve been saying for years: chiropractic doesn’t impress me as a healthcare profession as much as it does as an elaborate marketing scheme.

    One more thing: I’ve often had the impression that the seminars the chiros boast about attending aren’t about learning more about learning about putative new ways of addressing health issues; they’re going to practice-building sessions and calling them chiropractic education.

    1. Reply to Devout Catalyst (reply button not working)

      Hubby shared the same alligator article with me yesterday and it made me think of the recent post here about the turtle who got needled as well. This stuff is being presented without the slightest skepticism and vets are participating–what’s to stop the average person from thinking it’s all completely legitimate–to say nothing of major medical centers offering it.

      How does a turtle or alligator have blocked “chi”? I ask. (How does a person, but leave that aside for now).

  2. windriven says:

    Following the links that Dr. Jones provided left me dumbfounded. Some of the techniques promoted are the similar to those taught to used car salespeople.

    Sadly, as Jones acknowledged, there are a few MDs who use similar tactics. In Seattle there is one Jerry Mixon, MD who runs something called Longevity Medical Clinic which he promotes with relentless advertising and meet-and-greet sales pitches (seminars) in hotel conference rooms. His clinic appears to be a testosterone and HGH mill based on the advertising. Apparently he and three MDs are currently under investigation by the WA State Board of Health for inappropriate HGH prescriptions.

    Mixon’s ‘practice’ stands out because it is rare. Apparently in chiropractic practice it is not.

    http://www.komonews.com/news/local/Local-doctors-accused-of-illegally-prescribing-HGH-148219585.html

    http://www.jewishworldreview.com/0503/dangerous_waters.asp

    1. tgobbi says:

      Windriven: “Following the links that Dr. Jones provided left me dumbfounded. Some of the techniques promoted are the similar to those taught to used car salespeople.”

      What a perfect description! I wish I’d said that.

  3. AndrewL says:

    Great post! For some reason I get many advertisements for these chiro practice building companies on my Facebook page. I don’t know why (I am an anesthesiologist not a chiropractor). It is amazing to see the comments and the pure focus on the bottom line rather than the patient. It just looks bad. However, it is a nice guilty pleasure of mine to comment about the pseudoscientific BS that chiro is and get them angry with me!

    1. wzrd1 says:

      One ponders you practicing your profession, removing (non-essential and wasteful, if not harmful) things.
      Things like intubation with general anesthesia with these jokers.

      But then, in the real world, that would be called murder.
      Killing kids by brainwashing adults into not vaccinating their children is totally cool.

  4. There is a horrible glut of chiros (on nearly every corner) in my area of Milwaukee and I see them in every small town I drive through on my wanderings as well. I always wondered how they make a go of it, and now I know. Ugh.

    Another tactic I’ve noticed is to offer classes through the adult education programs the City sponsors. They are listed under “Health and Wellness” and only identify the person as Dr. Jones, DC (which is redundant I think). The class descriptions must be pulled from the type of thing you report because they are all very similar and center on “wellness”, “the whole person”, “prevention” and the like. And “nutrition”, of course.

  5. bluewode says:

    Great post. I would add that it tends to be standard practice for the spouse of a potential chiropractic patient to be invited along to the ROF, particularly if the patient is female with children and dependant on her spouse’s income. It means that the deal has to be closed on two people. Also, having the spouse along presents a further recruitment opportunity for the chiropractor – i.e. the spouse and children will be encouraged to become long-term patients, even if they’re asymptomatic. It’s an absolute scandal.

  6. Carl says:

    I have an idea for all of these struggling chiropractors, and in fact for anyone with huge student loans and a worthless degree. They should be able to declare intellectual bankruptcy, even if they don’t yet qualify for financial bankruptcy. They should be able to go to court and say, “Your honor, I may be paying all of my bills on time right now, but the fact is I am a chiropractor. I have over $100,000 in student loans, and I never really learned a darned thing.”

    1. windriven says:

      “They should be able to declare intellectual bankruptcy”

      And if they refuse, we should be able to declare it for them :-)

      1. James says:

        Pots calling the kettle black

        1. Clay Jones says:

          And your evidence to support that comment?

          1. James says:

            Does my evidence fit your standard?

          2. James says:

            The kettle is still black.

            Dr Jones, My comment was juvenile I apologize.
            My issues is really with Windriven and Carl’s lack of intellectual integrity and unnecessary personal attack on me and my medical condition.

            Again I apologize

          3. windriven says:

            “unnecessary personal attack on me and my medical condition.”

            James, I’ll be happy to respond but you make these nebulous statements to which I cannot easily connect an antecedent. What medical condition do you have other than gullibility? I would never stoop to attacking someone’s medical condition.

            “I am not sure your question really about wanting to know or your just being a jerk.

            Regular readers here know that I am entirely capable of being an asshole. That is quite different from being a jerk. A jerk doesn’t know he is being offensive, an asshole does it on purpose.

            “I guess you are not man enough to deal with your own biases”

            Ah James, man enough I am. But you see I have a life outside these pages. I have been with friends in from the Midwest seeing sights, eating well and drinking very well. But I won’t regale you with tales of a fine $20 Meritage that drinks like a $40 bottle.

            You have or claim to have narcolepsy which your medical doctor did not diagnose. You then claim that chiropractic or some other patent nonsense parted the waters and made you whole. I believe that you sincerely believe this to be true.

            I have said:
            1. That chiropractic has not cured or meaningfully ameliorated your presumed condition;
            2. That the appropriate action would have been to have sought out a physician more responsive to your concerns;
            3. That you are, judging from your comments to date, incredibly gullible and disengaged from a scientific approach to understanding the world around you in general and your possible medical condition in particular.

            If you in fact have narcolepsy or some other medical condition I would want nothing but the best possible outcome for you. Regardless of what you might think that outcome will not be found in chiropractic, coffee enemas, naturopathy, macrobiotic rice or homeopathy.

            I would never argue that medical science is complete and infallible. Medical science is very young and there is much yet to be learned. But that learning is not done by scurrying around like a blind squirrel looking for an acorn. For a blind squirrel there is as much chance that an acorn will be two steps forward and one to the right as one forward and two to the left.

            Science approaches this by learning about acorns and that they come from oak trees and then learning about oak tree ecology and where oak trees are likely to grow and then going to a grove of oak trees.

            The blind squirrel finds many things and may even believe that some are acorns. Occasionally, one even is an acorn! Meanwhile, the scientific squirrel feasts on acorns. Including the acorn that the blind squirrel found by accident.

          4. wzrd1 says:

            Quite true, Windriven.
            However, it’s far more often that blind squirrel ends up being dinner for the wolves of woo and finds no acorn.

        2. windriven says:

          “Pots calling the kettle black”

          How so James?

          1. James says:

            Windriven please find anywhere where I said that I believe in the tooth fairy, chiropractic, coffee enemas, naturopathy, macrobiotic rice or homeopathy if any of my statements had made you believe that then you should have opted for the $40 bottle.

            “That the appropriate action would have been to have sought out a physician more responsive to your concerns”

            I guess in your neck of the woods doctors grow on trees.
            Of course that was the appropriate action I wish I could have he was the closest doctor for two hours.
            If I would have gone any further I could have lost my job.

            Unfortunately I was in a holding pattern in my life trying to juggle a pregnant wife, demanding job and health concerns.
            That time in my life is over however it has still left very bad taste in my mouth about the practice of medicine not the science of medicine.

            If reread my previous statement it really about the disfunction of the medical industry how it is broken from a functional point of view not a scientific point of view.

            But of course being an asshole stop you from to noticing the difference.

          2. windriven says:

            James, it is very difficult to believe that you live somewhere that has only one doctor unless you live in some remote place in Alaska.

            “If reread my previous statement it really about the disfunction of the medical industry how it is broken from a functional point of view not a scientific point of view.”

            James, with all due respect, your previous comments are nebulous. You don’t think doctors take you seriously or speak nicely to you or something. I’m sorry but it is very hard for me to take you seriously.

            What precisely is your complaint, what is your argument supporting it, and what would you have the medical community do about it?

          3. James says:

            Alaska not quite.

            I was in a transition period moving from Florida to Canada to live with my wife who is from there.
            I was working remotely for a company in the US waiting for my residency paperwork to be finished.
            During this period I started getting bad at work. I was always able to handle myself being tired by moving or coffee but this time my usual tricks we not working.
            So I decided to go see a doctor. I found it was cheaper for me to take a bus to the US since my insurance (remember from florida) only had emergency coverage out of the country.
            I looked at the bus schedule and found the schedule that had the best times was 2 hour ride one way.
            So I could leave in the morning and be back at night.
            However there were only a few PCP that took my insurance.
            So I called the few PCP and found one that was accepting people.
            My options of doctors was very limited also my time and money.
            My problem was my immediate surrounding had plenty of doctors but my insurance would not pay the 200+ per visit for a private doctor not including test.
            Or get a 40 dollar bus ride +25 copay then work from the local library with wifi so I could be available for my job then at the end of the day come back home before bed time.
            Even after I was diagnosed I started calculating the cost of provigil $65 and $10 when the generic came out vs 160 in canada (much better than 1600 in the US out of pocket).
            Plus 65 (out of pocket) per session for the shrink to help with the stress.
            So decided I was just buy my time with that doctor for so I could get my paperwork over with and find a doctor much closer to me.

            As for my conditions.
            The move is why I had my vitamin D deficiency (dark skinned guy moving north).
            Narcolepsy my dad and uncle were people would slept a lot so I always thought it was somewhat normal to fall asleep quickly.
            I had techniques to help me self medicate but they stopped working when I came to canada.
            Low testosterone who knows.
            High blood sugar that should not have been a surprise my dad was a diabetic.
            Since I always tried to eat well so it did catch me off guard.

            I will never say that my situation is typical because it was not.
            But getting that doctor move on things was difficult.

          4. James says:

            After sitting back thinking I realized the following.
            I had some good/bad experiences with doctors as a whole.
            Some took my complaints seriously other did not.
            The last one really got my skin because of my perceived lack of choice during that time and the stress of everything.
            That is what made it stick in my head.
            Also since a good percentage of my peers already distrust doctors http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924632/
            However not without reason http://en.wikipedia.org/wiki/Tuskegee_syphilis_experiment.
            So the survey of friends and family were already biased.

            The reason I keep coming back to trust is that in my peer group there is a problem with it.
            I did not want to bring up my background because I thought it did not matter.
            However sitting back and thinking about it seem to have coloured my experience in ways I did not realize.

          5. WilliamLawrenceUtridge says:

            James, you may want to consider the self-reflective and improving nature of medicine as well. While the Tuskegee experiment was a hideous error, the medical profession has since enacted research regulations and guidelines, such as true informed consent and independent institutional review boards, to protect patients and experimental subjects. They have actually eroded their social status and in many ways the nonspecific aspects of their profession in ways that directly reduce their ability to improve patient satisfaction. Doctors are routinely confronted with evidence of their fallibility during medical training in the form of morbidity and mortality presentations that are a routine part of medical school. They must carry expensive malpractice insurance and undergo yearly continuing education as well as re-qualify for their specialties. The scientific literature is also rich with studies and data showing flaws in practice, deficits in training, and highlights of best practices (indeed, in several comments you have cited that very literature to support your points and your own experience).

            Medicine is imperfect, but it tries to be better – and in much the same way you are doing right now (and should be commended for, by carefully examining past behaviour and assumptions, and attempting to correct them – good for you).

            Incidentally, you might find Mistakes Were Made (but not by me) by Carol Tavris an interesting read.

            And because this is SBM, I have a tangent to bring up that you have (to your credit) never diverted down or raised – and that is CAM’s complete lack of comparable self-reflection and self-improvement efforts. Again, nothing to do with what you’ve ever posted or said, it’s just kinda obligatory here. If you stick around and read more comments, you’ll see why – most new commenters will venture criticisms similar to yours (anecdotal experiences of bad treatment by MDs or DOs) and then pretend acupuncture, homeopathy, chiropractic and herbs are the solution. That fact is the root of your initial hostile reception.

            Even skeptics are human, and thus victims of cognitive biases and self-confirmation. And in particular, once a decision has been made, humans are extremely reluctant to change their minds or admit error. That’s the main thrust of Tavris’ book. Good book!

        3. WilliamLawrenceUtridge says:

          I think it’s worth considering that James may be the unlucky sonovabitch who got four one-in-a-hundred conditions, leading him to be one of three one-in-100,000,000 expected to have this confluence of diagnoses in the United States. I think he unjustly smears the medical system as a whole for his one bad experience with a doctor (who, as I’ve said elsewhere, really had reason to be skeptical) but I haven’t seen any evidence that he’s a woo-pusher. He’s merely venting about a medical system not geared to deal well with people like him.

          That’s my assessment, take it or leave it. And thank manly Jesus I’m healthy. Hope your symptoms are getting better James.

          1. James says:

            They are better thank you and modafinil

          2. WilliamLawrenceUtridge says:

            I’d love to take credit, but it’s probably just the modafinil :)

    2. I see this issues in a different light. Medical doctors have disparaged this hands-on, touch part of the healing arts as too simple and common.

      If I could implement a few of the truths I have found in medicine … these guys would be on the front-lines of pain care.

      Respected and trusted.

      Over the past couple of decades, I have seen medicine get “top heavy” full of super surgeons and their support doctors. Big incomes = big egos and primary care providers and nurses get the dirt end of the stick.

      The system has to change … towards Charity and the patients.

      1. windriven says:

        “Medical doctors have disparaged this hands-on, touch part of the healing arts as too simple and common.”

        ???

        Where does this come from? Please be coherent. Medical doctors have disparaged exactly what? Chiropractic? Massage? Palpating?

        “If I could implement a few of the truths I have found in medicine … these guys would be on the front-lines of pain care.”

        So what “truths” do you have for us? Enlighten us! Lead us from the darkness.

        1. wzrd1 says:

          I eagerly await a response as well, as a physician, complete with an MD at the end of his name, prescribed massage for me after a duty related injury.
          Said physician also took great care in noting and advising on every aspect of my life, such as food, recreation and leisure.

          I’ve also had osteopaths do two things.
          1: desire to manipulate a joint.
          2: more common, refuse to consider anything like manipulation. Something I call “bone cracking”.
          But then, category 2 is evidence based, the former referred to my wife’s gynecological issues as “female hysteria”, which removed him immediately from further consideration of our medical management.

          The *real* world is *so* out of that Victorian mindset of medicine by rumor and so into medicine by evidence based practice.
          Small hint, for the obtuse:
          Anecdote is not evidence. Evidence is massive correlation at a minimum, controlled studies at its best.

          But then, today’s Chiroquack insists on ignoring even germ theory of disease and insists that manipulation can cure all infectious disease or some other tripe.

          I’m more amazed at the pro-quackery types who showed up today.
          I guess they get paid well on Sunday.
          Yes, I do believe that.

      2. WilliamLawrenceUtridge says:

        I see this issues in a different light. Medical doctors have disparaged this hands-on, touch part of the healing arts as too simple and common.

        No they don’t, they just want some real medicine to effect actual improvements in patient health along with their role of reassurance-provider.

  7. SalG says:

    Nice article, but I have a question regarding Chiropractic in general. Does it work for some of the more standard stuff? My father had a back problem (he eventually had surgery), but claimed that the chiropractor helped ease his pain on a short term basis. I have had multiple people tell me that their back issues are made better by having a chiropractor straighten things out. I am aware this is anecdotal.

    I feel like you may have touched on this where you mentioned Sam Homola, but I am not familiar with his work.

    1. tgobbi says:

      SalG: “I have a question regarding Chiropractic in general. Does it work for some of the more standard stuff?”

      The short answer is “yes” although it’s no better (maybe not as good as) PT and a few other mainstream modalities.

      The problem, however, is that “doctors” of chiropractic want to be accepted as proper doctors and many of them lure their back pain customers into the web of mysticism and the occult that defines chiropractic as a putative alternative to real medicine. They have no training or qualifications in diagnosing and treating disease conditions despite their claims that they only use different (i.e. pseudoscientific) approaches to systemic problems. I suggest that SalG use the search feature on the SBM site to learn more about the nonsense that comprises chiropractic. He (or she) should also do the same on the “Respectful Insolence” blog and on

      On SBM, look specifically for entries by Sam Homola, a retired chiropractor who gives an insider’s viewpoint to this whole business.

    2. Harriet Hall says:

      Spinal manipulation therapy works for certain types of low back pain, but it doesn’t work any better than other treatments, and it is not “chiropractic” but a therapy also used by DOs, PTs and some MDs. If it is done for short-term relief of a musculoskeletal problem it is legitimate, evidence-based medicine. If it is used by a chiropractor to treat mythical “subluxations” or non-musculoskeletal problems, that is quackery.

      1. duggansc says:

        Although, as has been discussed occasionally on this very blog, we have a shortage of doctors in this country, and appointments can be difficult to get booked in a reasonable amount of time. So if all you have is lower-back pain, and know where to draw the line on chiropractic treatments, a chiropractor might be a valid person to go to for an on-the-spot fix.

        1. Harriet Hall says:

          “a chiropractor might be a valid person to go to for an on-the-spot fix.”

          Agreed, but only if you could find a chiropractor like Sam Homola. I have yet to hear of any chiropractor in my area who rejects the subluxation myth, supports immunization, eschews the woo-woo and limits his practice to appropriate short-term treatment of musculoskeletal problems.

        2. goodnightirene says:

          “So if all you have is lower-back pain, and know where to draw the line on chiropractic treatments, a chiropractor might be a valid person to go to for an on-the-spot fix.”

          How would you know what your problem was? I wouldn’t let a non-medical person touch my back if it hurt bad enough to make me seek treatment! A PT needs an rx from an MD–you don’t just wander in and say that your (fill in body part) hurts. I’d go to a walk-in clinic or ER if I didn’t have a regular PCP.

          I also would bet that Chiros get people who have no insurance and no regular PCP who may have god-knows-what causing their pain. If it’s just a backache from too much heavy work/play, then you would be better off resting, taking an anti-inflammatory, and waiting for an appointment to make sure, rather than getting mixed up with a quack. If you have a chronic problem that is helped by PT, then MAYBE see a Chiro, but I’m being generous and I would always be worried about overlooking some other medical source of the problem–one that a Chiro just isn’t trained to diagnose.

          1. wzrd1 says:

            I’ve done both the ER thing and the PCP thing.
            Long ago, when I was naive, I did try a chiro. It was a massive waste of time and misdirected effort, as the chiro failed to notice the herniated disc.

            Before I’d bother with a chiro, I’d directly seek a physical terrorist, err, therapist.
            (Ever had PT, you’d understand the term physical terrorist. Every physical therapist I’ve met chuckled and agreed with the term as one of endearment).

          2. wzrd1, in an ideal world, with chiropractors that follow EBP, then one would find it difficult, when it comes to treating back pain, to tell the difference between a chiro and a physio delivering manual therapy. I hope to see that day eventually.

          3. wzrd1 says:

            That would be the only reason I’d see a chiropractor, for PT.
            One did give excellent PT, until he wanted to start manipulating. Then, I went to a regular PT under a competent physician’s supervision.

          4. windriven says:

            @wzrd1

            Was it Vladimir Nabakov who parsed therapist as ‘the rapist’?

            Different type of therapist but similar sentiment :-)

  8. Cynical Pediatrician says:

    I’ve always wondered how the body can have such wonderfully perfect innate healing powers…yet nearly everyone has profound subluxations that need extensive chiropractic manipulation…
    I also wonder if a “patient” has ever been told, “your spine is normal, you’re in great shape, you don’t need to come back unless anything comes up.”

    1. Cynical,
      I am a skeptical chiropractor, if you could believe such a term. Chiros claim that the adjustment is a natural intervention aimed at restoring unnatural subluxations. Now, I don’t want to get all philosophical, but I would have thought that a “subluxation” (if it does exist) is a natural adaptation to one’s environment. There is nothing “natural” about manipulating a vertebral segment in relation to another – the stresses placed on the Z-joints, the discs, etc.
      I may have digressed off point a little bit, but I want to come back to it – if the body expresses innate intelligence (sounds like a creationist theory-crafting), then surely subluxations by their nature are expressions of innate intelligence adapting to the environment, and spinal adjustments or manipulations are in fact INTERFERING with the expression of innate intelligence?
      As for your wonderings, it has happened. I’ve done it, colleagues have done it. I can’t answer how often it happens.
      RC

  9. Josh says:

    Coincidentally, just after reading this article I got an email about a Groupon for a local chiropractic husband-and-wife team. $45 for $589 worth of services (four or eight visits).

  10. Harriet Hall says:

    Several years ago I perused one of those practice-building websites for chiropractors. Two things stand out in my memory.
    (1) Never ask if the main problem is better. Instead ask “What’s better?” and get the patient to admit anything like “I slept better last night.” Then persuade them that your treatments were responsible.
    (2) When examining a child, ask the mother if he tended to nurse longer on the right side or the left. Whichever side she answers, say “I thought so” as if your examination of his spine had told you which side. Then put on a concerned face and ask “Did your pediatrician ever ask you that?” This helps destroy the patient’s faith in the pediatrician and place more faith in chiropractic.

    1. goodnightirene says:

      OMG, that sounds a lot like the “cold-calling” techniques of psychics!

    2. wzrd1 says:

      Had a cold call from a psychic outfit once.
      I suggested to the caller that if they wanted my business and most importantly, my money, they could tell me my credit card number.

      I strongly suspect that they already knew what I was thinking. One did not need to be “psychic” to get that one.

  11. lizditz says:

    I ran across this practicebuilding scam on twitter three years ago, and wrote a blog post about it

    http://lizditz.typepad.com/i_speak_of_dreams/2010/10/youre-doing-it-wrong-chiropractic-marketing.html

  12. duggansc says:

    You know, I’ve sometimes wondered if we couldn’t establish that for more degrees. I know that I, as a computer engineering graduate, have worked for over a decade in computers and I still feel like a bit of a fraud at times, and wonder if I should retrain for something else. But, the thing is, once you have your degree and some work experience, it gets really difficult to move from getting paid for 40 hours of work to paying for 50+ hours of work for a degree that may or may not actually get you a job, especially since you’re no longer as young and flexible as you once were.

  13. Carl says:

    Whichever side she answers, say “I thought so”

    They could do even better if they took some tips from the psychics. They can start with group therapy. “I’m sensing that someone over in the area of the waiting room has a problem starting with an M or maybe a B or L?”

  14. Rick says:

    Since Chiropractors always post at school events and other local happenings here, I am going to print several of the “please forgive me” pages and carry them with me. When I visit their booth, I can pull them out and match them to their “real life story”. I’ll make sure I get other people’s attention while doing so.

  15. lilyz says:

    I never saw a chiropractor, never wanted to – but was in a car accident and was having whiplash & low back pain. My doctor, my friend in the accident with me and other people around me kept saying “try a chiropractor” so I went to a “reputable” one – so reputable that he tore one of my disks and gave me sciatica that will now never completely heal.

    4 years later I’m still dealing with the nerve damage caused by that visit.

    As for going for simple things – my father and brother went to a chiro for years (2 “reputable” ones) and are now facing disabling arthritis in their necks where they’d been manipulated.

    Never again…

    1. Clay Jones says:

      Lilyz I’m really sorry to hear that.
      James, I don’t care.

    2. I’e been in medicine for 30 yrs and what you have went thorough is horrendous but the blame is misdirected. I have seen dozens of similar stories and I have discovered the key reason this happens.

      Ignorance … plain and simple.

      I see a lot of failed surgeries and it is the same with them also.

      A chiro adjustments can’t harm you.
      A massage can’t harm you.
      Acupuncture can’t harm you.
      Yoga can’t harm you.
      Jogging can’t harm you.
      Pilates can’t harm you.
      Zumba can’t harm you.
      Floor stretching can’t harm you.

      ALL of which are in the list of Therapy needed to treat complex pain issues.

      The disease is called Myofascial Pain and Dysfunction and it is the scourge of most chronic pain and misery. It has a tendency to erupt with a sneeze and move about the body like a evil gremlin. It can masquerade as many traditional problems and cause everyone to get of track with the the correct therapy.

      I would not want you to blame the chiro … he or she was only trying to help with the tools they had available.

      I will post a link to all the modalities that are included in the list of Therapies.

      1. weing says:

        “A chiro adjustments can’t harm you.”

        Really? Try adjusting an osteoporotic spine? One with Potts disease?

        “A massage can’t harm you.”

        http://saveyourself.ca/articles/whats-the-harm.php

        “Acupuncture can’t harm you.”

        Try perusing this website.

        “Yoga can’t harm you.”

        http://www.nytimes.com/2012/01/08/magazine/how-yoga-can-wreck-your-body.html?pagewanted=all&_r=0

        “Jogging can’t harm you.”

        Heart attacks, orthopedic injuries, rapes, even mountain lion attacks.

        “Pilates can’t harm you.”

        http://www.dailymail.co.uk/health/article-2161301/Pilates-make-bad-worse-Experts-agree-help-reduce-pain-improve-posture-hidden-dangers.html

        The point is, anything can hurt you. There is nothing absolutely safe. It’s the risk benefit ratio you need to look at.

  16. Clay Jones says:

    James don’t sweat it. I was not privy to the conversation on the other post.

  17. IMO, what you guys are doing is mixing an healing art and capitalism.

    A healing art is any ancient discipline that uses touch, manipulation and earth to ignite healing and promote well-being. By this definition you can include a lot of holistic disciplines.
    This is the disconnect … in a holistic society wellness, balance and sanity is promoted and is a part to the Therapy.

    We do not live in a holistic society.

    We live in a consumerism, capitalistic, egocentric and deceptive model of living.
    To make a living in this environment we are bombarded with sale pitches full of deceptive tactics.

    Please don’t mix the two or twist them into a similar paradigm.

    The miraculous keys to the healing arts are touch, wellness, proactive living, earthly living and caring.

    1. Lynn says:

      “The miraculous keys to the healing arts are touch, wellness, proactive living, earthly living and caring.”

      Right… and forget medication or proof of efficacy or any of the nasty science stuff.

    2. Marion says:

      Stephen S Rodrigues: Please don’t mix socialism or anti-capitalism with antiscience woo-woo “medical” scams. I tried to read Karl Marx’s “Das Capital”. It is an incredibly deep, difficult, complex and massively researched book about labor and factory owner relations throughout Europe. Marx’s writings were Eurocentric: which is hardly surprising for the time (19th century), given the limits on how much he could travel and witness and research. It is almost entirely a commentary one what is (what was going on at the time) not about what SHOULD be. ONLY at the VERY END of this book did Marx advocate “workers of the world uniting”. By worker, Marx meant those who actually did extremely difficult, dirty, stressful work and produced things of value. He advocated these factory workers getting paid more, being given more power & control over the resources – the capital – at the expense of pre-existing capital owners, who were given access to capital for free by the government. Same as today: bankers being corporate welfare queens being bailed out by the government, but then lending money out at high rates of interest, or speculating / gambling with that money on bad bets. This is what socialism, Marxism was meant to fight. NOTHING to do with increasing bailing out the rich or bailing out banksters. NOTHING to do with giving more power to scam artists like chiropractors to get rich by promoting fraud. NOTHING to do with “cultural Marxism” or placing cultural practices above fairness, justice, ending cruelty to animals (e.g. there is nothing in “Das Capital” that advocates promoting the hideous practice of bullfighting just because it’s a “cultural” thing in Spain). NOTHING to do with silencing free speech to make whatever racist, sexist, heterosexist, homosexist, etc etc jokes you want to those around you. There’s nothing in basic chemistry books or basic math books about that, either!

      Yes – I vote Green Party and am a Green Party member, even though I disagree with their bullshit “blaming America for everything” or their anti-GMO crap or their anti-war position: precisely because I support war for the major Green Party causes!
      (e.g. billion-to-one wealth disparities which
      Whether by nation or individual. I make no distinction. All choices are by individuals only.

      There are the codes I live by:
      1. Everything differs in magnitude, not in kind.
      2. ALL thinking is modeling the outside world: mathematical modeling just does it better.
      3. Reasoning is abstract, but one should never do things for abstract reasons.
      That means, ultimately, only computations of how much pain, suffering actions cause
      and upon whom that suffering is forced (justice), is what matters.
      4. I’m a pro-quality-of-lifer, not a pro-lifer. Since we all die anyway, it is ultimately only quality of life that matters.

      1. wzrd1 says:

        “That means, ultimately, only computations of how much pain, suffering actions cause and upon whom that suffering is forced (justice), is what matters.”

        An interesting statement after stating that you support war. ;)

        Seriously though, that was half-serious. Wars cause by their very disorderly nature horrific suffering by those uninvolved, desiring to remain uninvolved and wanting nothing to do with war. I saw that firsthand far too many times in my half century of life and near 28 year military career.
        That it is a necessary evil on rare occasions is true, something that is now calculated in, where it was not previously and it bit us in the butt currently.

        As for “Blame America for everything”, can’t agree more. It’s close to half the fault of the USA, close to half the fault of the former USSR, the rest is shared about fairly equally about Europe. But, one most certainly cannot blame Mexico or Canada, let alone Central and South America, so I rather object to the term “America” when referring to my home nation of the USA.
        Or as I more simply say, “There ain’t no saints, but there are loads and loads of sinners!”
        As some cases in point, Somalia: The US made that mess, cold war stuff supporting a corrupt POS regime when client states switched between the US and USSR.
        Afghanistan was also a lot of a US problem. An officer that trained me, decades ago, had mentioned the Afghan mess and those who he personally trained. Men whose names only became general knowledge after 9-11. Men who were so hateful of everything west and north of their location that the agents advised Carter to eliminate them after the Soviet-Afghan war was over.
        Carter said, “We don’t do business that way”.
        And so, decades later, two towers fell, 3000 men, women and children died. One happened to be a cousin of mine, died on the 84th floor of the south tower.
        We’ll suffice it to say, I have a great deal of specific information of whose fault what was and is over the past century. No saints, plentiful sinners.

        As for socialism, it’s an absolutely perfect system notable for the dearth of perfect participants.
        Humans are greedy by nature. Each wanting what the neighbor has and more.
        Well, save for me.
        I’m perfect.
        A perfect 10 on the Richter scale. ;)

      2. windriven says:

        Interesting codes, Marion. I’ll give them closer thought. You have an interesting and textured political stance. Very unusual in these days of starkly bifurcated discourse. Socialism is indeed alluring though it has never met its promise in practice. Your recollection of Marx’s examination of the relationship between labor and capital is especially cogent as the GINI coefficient in the US drifts upward.

        As an aside, it amuses me that the religious right loves their Jesus but despises Marx.

        1. duggansc says:

          Probably has something to do with the whole “religion is the opiate of the masses” quote. :)

          On a more practical note, I suspect that part of it is also that, historically, the Church keeps finding that a strong infrastructure with a command hierarchy overall works better with humanity. It’s kind of like how most anarchists admit that some degree of government is probably necessary for infrastructure, that a purely anarchic society is more akin to a warlord society where the strong rule supreme.

          Of course, one can also suggest that the issue has to do with what happens when non-organized religion hits organized politics. Just look at the Shakers. They were a growing prosperous religious group despite their prohibition on sex until the government decided that orphans were better off in poorly kept orphanages than to be adopted by Shakers and given a roof over their head and an opportunity to build a trade.

          1. windriven says:

            What is it with Abrahamic religions and sex? From Augustine to Saul of Tarsus to Mohammed to John Smith. They either want too much* or they want none at all.

            *Well, I’m of the free love generation so too much is more a rhetorical figure than an moral position. Ahhh, the days before AIDS…

    3. WilliamLawrenceUtridge says:

      Capitalism? How exactly do you think this site makes money? No advertising that I can see, and as a commenter I certainly am not reimbursed for my time. If you mean medicine in general – what, you don’t charge for your services? The rest of your post is just word salad, to the point that I start wondering about Turing engines.

      1. WLU “How exactly do you think this site makes money?”

        They should charge a quarter for folks who want to get their comment through moderation without delay…I bet that would raise a bit of revenue. ;)

  18. Carl says:

    I notice that James has switched from his previous demand, where he wants me to show him where he said the thing I copied and pasted as a quite directly from his own post, to now claiming that I “misquoted” him in the Ctrl-C. Here it is again, James:

    James says:
    August 29, 2013 at 11:14 am
    My biggest issues with the way medicine is practiced in the US today is the following.
    * Most of the time diet, sleep, exercise, and stress are never addressed.

    What a transparent troll. His arguments rely on switching from outright lies (like the above statement) to platitudes stated in the negative (like when he asks if I think food has nothing to do with health). Very lame, James.

    1. wzrd1 says:

      No matter how you label it, some fertilizers start out and end up as shit.
      Such has proved true here with the pro chiro-quackery proponents who I strongly suspect are paid assets. The timing was too close in those joining the conversation and scattergunning the comments with uncomposted fertilizer.

      1. James says:

        wzrd1 you came late to this conversation.
        I have never said I support quackery.
        These is a difference between complaining about the practice of medicine and supporting CAM.

      2. James says:

        Also let me make this perfectly clear this an issue with Just Windrive (which at least I can respect for admitting he is an asshole) and Carl. That spilled over in this post.

    2. James says:

      Let play the quote game
      “No, I am saying that you are a total BS artist for claiming that doctors “never address” those things. Your statement is false and ridiculous.”

      Please explain to me the difference between “Most of the time” and “never” your english teacher must be horrified

  19. James says:

    “MOst of the time” != never

  20. Carl says:

    James, I never attacked your medical condition. Unless your medical condition is that you are delusional and/or full of $#it.

    1. James says:

      Carl you are right you never did not attack my condition.
      A statement Windriven made made me feel he was mocking the fact I have narcolepsy.
      However I did feel misquoted me or at the very least misrepresented what I said.

  21. Carl says:

    You said both, so go ahead and sort out your own words.

    1. James says:

      If you do not understand the difference between someone saying.
      Most of the time something never happens.
      And
      Something never happens.
      That is your right

      However in my eyes saying they are equal is a misrepresentation of someone statement but again that is your right as a person.

  22. WilliamLawrenceUtridge says:

    May I suggest James, and everyone piling on James, take a break for say, three days then revsit if there’s any merit? There seems to be a lot of friendly fire here.

  23. The extremes always exist and in these cases where someone gets worse can be explained by Travell/Simons, Myofascial pain and dysfunction where a latent trigger point gets activated, thus cause a pain. Not truly new but awakening of an old dormant trigger point.

    In these cases I tell my patient this is a “good” thing so now the we ave an additional focus to treat. T/S notes that adults are loaded with under resolved trigger points.

    The treatment is more therapy … dancing, yoga, massage, gardening, Pilates etc. Therapy is life and should never be stopped.

    1. WilliamLawrenceUtridge says:

      Do you get a lot of eye-rolls from your patients with your use of empty platitudes?

      What kind of doctor are you?

  24. duggansc says:

    @windriven:
    I always associate that joke with the Sean Connery Jeopardy sketch myself, although I’d swear I saw a Scientology ad that seemed to be taking it seriously.

    1. windriven says:

      I missed the Sean Connery / Jeopardy sketch. Sorry I did; probably wicked! But Scientology clearly disdains psychotherapy. Tom Cruise is pretty much living proof that that aspect of Scientology is seriously effed up.

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