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Chiropractic scope of practice includes . . . well, you won’t believe it

Ladies, how would you like a chiropractor to deliver your baby? How about perform your annual well-woman exams, such as breast exam, bi-manual pelvic exam, speculum exam, recto-vaginal exam and Pap smear?

Sound out of their league? I thought so too. Way out. But, in some parts of the U.S., the law allows chiropractors to do all of these things and a great deal more. Including “adjusting” your basset hound.

chiropractor-adjusting-basset-hound

A 2011 survey asked chiropractic regulatory officials whether their jurisdictions (all states, plus D.C., Virgin Islands and Puerto Rico, but I’ll refer to them collectively as the “states”) allowed 97 different diagnostic, evaluation, and management procedures. The results were recently reported and interpreted in the Journal of Manipulative and Physiological Therapeutics, in an article authored by Mabel Chang, DC, MPH, who was primarily responsible for the survey. Missouri allows the most procedures (92) and Texas, the fewest (30). A handful of states did not respond or did not respond to all questions, but the overall response rate was 96%. Results from a survey of Canada, Australia and New Zealand will be reported in a separate article.

One wonders whether there was some stagecraft at work in deciding which procedures to include. Although the survey was willing to ask about homeopathic products and colonic irrigation, other quackery is nowhere to be seen. For example, diagnostic techniques such as applied kinesiology, contact reflex analysis and various EAV devices are not mentioned. And although “subluxations” were mentioned, the fact that their detection and correction is the centerpiece of all chiropractic state practice acts was not. For example: “In Michigan, procedures . . . are permitted if they relate to the subluxation complex.” (This would include “glandular supplementation” in that state, according to the survey.)

Chiropractic OB/GYN?

So, how many states allow chiropractors to perform much, perhaps all, of your well-woman exam or deliver your baby? (We’ll get to the rest of surveyed procedures in a minute.) Here are the results:

  • Obstetrics: 9 states (2 require additional training); can order an obstetrical exam in 2 states. Chiropractors can sign birth certificates in 10 states.
  • Breast exam: 29 states (2 with additional training); can order in 3. Mammography was not included in the survey, but thermography, which is used (but shouldn’t be) for diagnostic breast imaging, can be performed by chiropractors in 32 states (6 with additional training) and can be ordered in 9.
  • Bi-manual pelvic exam: 24 states (1 with additional training); can order in 5.
  • Speculum exam: 24 states (2 with additional training); can order in 6.
  • Recto-vaginal exam: 23 states (2 with additional training); can order in 5.
  • Pap smear: 17 states; can order in 10.

I mention these procedures not to be titillating, but because they are extremely invasive and can be embarrassing and painful for women. They should never be performed by anyone without proper medical training. Yet chiropractic schools offer, at most, only the most cursory classroom instruction in these subjects. I would hazard a guess that chiropractic in-school clinics, where the vast majority of their clinical training takes place, do not include any OB/GYN training. Chiropractic post-graduate training generally consists of weekend lectures in hotel conference room settings. They do not do residencies before going into practice.

Regulators in a few states themselves seem to question the inclusion of these services in chiropractic scope of practice. Some recommended referral to “a more appropriate professional.” Others said “documentation of appropriate setting and clinical rationale” is recommended, adding that a chiropractor could be subject to investigation and sanctions without same. Which makes me wonder: why don’t these regulators ask their legislatures to remove these procedures from chiropractic scope of practice by statute?

Survey results

The survey provides a list of all 97 procedures and tells us, state by state, whether a chiropractor can perform it, can perform with additional training/certification, can order it, or cannot order/perform. The survey also calculates what percentage of the states consider each procedure within the scope of practice, whether it be performing (with additional training or not) or ordering. The article divides these procedures into 3 groups, presented in three tables:

  1. Diagnostic and examination certifications
  2. Physical examination, gender-specific services, physiotherapeutics, and specialty training techniques
  3. Adjunctive and specialty service

While overall this information is valuable, how the author groups them is not. As is true of chiropractic scope of practice, these groupings don’t necessarily make any logical sense, and most certainly do not conform to any medical taxonomy. I’ve discarded in them in my analysis, because how a chiropractor would group them doesn’t matter. What matters is whether they should or should not be included in their scope of practice. I include the percentage of states allowing chiropractors to perform or order procedure, in parentheses. Here is my determination. Your results may vary.

Appropriate for chiropractic scope of practice, if limited to musculoskeletal conditions and evidence-based:
Impairment ratings (100), extremity exam (100), orthopedic exam (100), neurological exam (100), hydrocolation (hot packs, etc.) (100), cryotherapy (cold packs, etc.) (100), massage (98), traction (100), orthotic supports (100), spinal supports (100), lifestyle counseling (100), rehabilitation (98), recommendation of OTC (63)

May be appropriate to order, with adequate clinical rationale, but not perform:
Full spine X-rays (100), skull x-rays (98), soft tissue X-rays (98), tomography (85, most order only), CT scan (100, most order only), MRI (100, most order only), diagnostic ultrasound (95, most order only), surface scanning EMG (100), needle EMG/NCV (93, many order only)

Appropriate with limitations to insure against overuse or use in inappropriate circumstances:
TENS (100), electrical stimulation (100), shortwave therapy (95), vitamin supplementation (100), diet formulation (100), botanical therapy (100), intrarectal manipulation of coccyx (83)

Not appropriate for chiropractic practice:
Barium studies (74), cholecystography (X-ray visualization of gallbladder after administration of radiopaque substance) (80), thermography (95), electrocardiography (88), venipuncture (98), blood analysis (100), urinalysis (98), sputum analysis (95), fecal analysis (95), semen analysis (84), throat swab (92), skin scrape (92), school physicals (86), US DOT physicals (98), pre-employment physicals (95), pre-marital physicals (77), sign birth certificates (38), sign death certificates (50), EENT exam (90), abdominal exam (95), stethoscopic exam (98), sphygmomanometry (blood pressure) (95), bi-manual pelvic exam (73), speculum exam (72), recto-vaginal exam (72), Pap smears (79), female breast exam (80), rectal exam (85), male genital exam (85), prostatic exam (digital) (85), hernia exam (85), ultrasound (treatment) (100), IFC (interferential therapy) (100), microcurrent therapy (100), iontophoresis (not with prescription medication) (100), Russian stimulation (100), non-ablative laser therapy, nonadjustive treatment of female pelvic conditions (72), ear irrigation (83), TMJ (100), oral chelation therapy (76), IV chelation therapy (39), vitamin injection (43), limited prescription privileges (7), oxygen therapy (57), dry needling of trigger points (64), minor surgery (9), obstetrics (22), extremity casting sprains (71), extremity casting uncomplicated fractures (58), hypnosis (66), electrolysis (44), hyperbaric chamber (62), manipulation under anesthesia (71)

Pseudoscience/quackery:
Hair analysis (93), magnetic therapy (90), extremity adjusting (assuming “adjusting” is related to “subluxations”) (98), soft tissue manipulation of the abdominal viscera (95), craniopathy (98), glandular supplementation (desiccated animal glands) (98), homeopathic preparations (95), colonic irrigation (74), endonasal technique (84), nasal specifics (75), needle acupuncture (70), electro-acupuncture (75), veterinary chiropractic (63)

What should the scope of practice be?

If you are startled, as I was, by the breadth of the procedures allowed, keep in mind that the opinion of chiropractic regulators is not the last word. Many of the procedures surveyed are not explicitly included in the state chiropractic practice acts. Some are permitted by regulations, which are usually enacted by the chiropractic boards. Others are included in policy memos or other informal guidance issued by the boards. Yet others are not specifically mentioned at all in state statutes, regulations or policies. When asked, some regulators included them because they were not explicitly prohibited yet thought to be consistent with the statutory scope of practice.

State statutes are the ultimate authority on what chiropractors can and can’t do and all regulations and policy statements are subject to challenge on the ground that they are outside the authority granted by the legislature. This occurred recently in the Texas Medical Board’s court challenge to the Texas Chiropractic Board’s rule allowing chiropractors to perform vestibular-ocular-nystagmus testing, manipulation under anesthesia, and needle electromyography. The Medical Board won. Nor does the fact that a chiropractic board says a procedure is within chiropractic scope of practice prevent a chiropractor from prosecution by the authorities or another board which feels the practice poaches on their territory, a scenario that played itself out when two chiropractors practiced “functional endocrinology.”

The author, to her credit, cautions that interpretations are subject to the ever-changing regulatory authority members (such as chiropractic boards). She also cautions that where a statute does not address a particular procedure, “upon challenge there may be a possibility of sanctions depending on interpretation.” There also were several comments by regulators that, even though “DCs are qualified in the procedures, the procedures must be related to a spinal condition as stated in the statutes.” For the life of me, I can’t see how many of these could possibly be “related to a spinal condition” unless one takes the extreme view of the straight chiropractors that everything is related to the spine.

In an understatement one can only agree with, the author concludes that “chiropractic practice in the United States can vary widely between jurisdictions.” She also advises “studies to assess whether quality or safety of health care is jeopardized in states with broader scopes.” I agree, although the time to research the possible implications for safety would be before enacting statutory practice expansion or liberal interpretation of scope of practice, which never seems to occur to state legislators or chiropractic regulatory authorities. I would add that research into whether the proposed practice is quackery, unsupported by evidence of effectiveness, or is the subject of adequate education and training in chiropractic schools is also appropriate, another area of inquiry which seems to regularly escape the notice of legislators and regulators.

Unfortunately, citing the presumed physician shortage, the author makes an argument for greater use of chiropractors:

to accommodate the demands for health care, especially in states that are already experiencing health care workforce shortages. Using all health care providers to the fullest extent of their training is one solution that will provide timely relief to these problems.

This comment appears to be based on the same deeply flawed premise as Section 2706 of the Affordable Care Act: state practice acts are based on a reasoned determination that adequate education and training underlies scope of practice. In fact, the author seems to believe that the practice acts underrepresent what chiropractors are actually educated and trained to do.

Education and training of limited scope health care providers is broader than what state practice laws allow. For instance, as part of The Council of Chiropractic Education [CCE] accreditation process, chiropractic schools are to educate and train students to become a “competent doctor of chiropractic who will provide quality patient care and serve as a primary care physician,” yet the variances in practice regulation do not allow this to occur.

Some states have bought into the idea that the CCE should have the final word in what the legal scope of chiropractic practice should be. As the article notes:

Kentucky and Montana affirm that DCs may perform procedures as long as they were taught them at an accredited chiropractic school.

Chiropractic scope of practice should never be conflated with adequacy of education and training. Nor should the CCE be allowed to determine scope of practice. But as long as warring chiropractic factions, overreaching chiropractic regulators, and credulous legislators are allowed to form a three-ring circus whose main event is deciding what chiropractors should and should not be allowed to do, we’ll likely be stuck with the current system.

Posted in: Acupuncture, Chiropractic, Diagnostic tests & procedures, Herbs & Supplements, Homeopathy, Legal, Obstetrics & gynecology, Politics and Regulation

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133 thoughts on “Chiropractic scope of practice includes . . . well, you won’t believe it

  1. Missmolly says:

    ‘Diagnostic breast imagining’…
    Delightful pun, or most appropriate typo ever?!
    Either way, a welcome light relief to this saga of iniquity. I don’t understand why on earth any chiropractor would think they were qualified to perform or interpret diagnostic breast or pelvic examinations. It’s like a plumber suddenly thinking they can install electrics- the result will be people going on fire.
    Actually, on second thoughts it’s like a spiritual medium thinking they’re qualified to install electrics- I mean, they both deal in ‘energy’, right?

    1. Jann Bellamy says:

      You gave me my first laugh of the day — at 5:45 A.M.! I reluctantly corrected it, although one must wonder whether the real purpose might be “imagining.”

  2. Peter S says:

    In my view, they should stick to treating lower back pain, period.

    1. goodnightirene says:

      I don’t really see why they should treat anything, anytime. The entire thing should be abolished and tossed into the dustbin along with phrenology, tarot cards, and the Tooth Fairy. The entire “education” of a chiropractor is a farce to begin with and their right to practice healthcare is the biggest joke on reason since creationism.

      1. Windriven says:

        Irene, to give the dufuses their due, there is evidence of some utility for chiropractic in the treatment of LBP. Now it may well be that chiropractic offers no benefit over physical therapy for LBP. That would be an interesting study. Beyond LPB, I couldn’t agree more.

        1. Thor says:

          Dunno, W, depends. If they’re just performing “adjustments”, there may not even be that much efficacy. If they combine the adjustment with hydrotherapy, massage, stretching, lying on a cushy table and relaxing, etc, then perhaps. But, then credit can’t be solely given to the thrust manipulation. Again and again, clients have told me how much more effective getting neuromuscular massage was as opposed to just chiropractic manipulation.

          1. Windriven says:

            True enough, Thor. I’m just going by the medical literature. There are studies that show benefit above placebo for LBP. I can dig them up if you’re interested. But again, I have serious doubts that DC efficacy is better than PT for LBP.

            1. Thor says:

              Yes, and those studies don’t really validate a glowing endorsement. Perhaps a small benefit, but not necessarily when the cost/benefit is factored in. We really do need a study such as you’ve suggested. Many DCs, if not most, utilize a bunch of ancillary modalities along with SMT. But, that usually gets all the credit, being the “meat” of the therapy. I actually think that, by and large, chiropractic is an elaborate, ritualized placebo, similar to acupuncture. And both share a belief in vitalism, the real mechanism of healing.

        2. Tim B says:

          Chiropractic manipulation was found to be less costly and more effective than alternative treatment compared with either physiotherapy or GP care in improving neck pain.

          http://www.ncbi.nlm.nih.gov/pubmed/24986566

          1. Thor says:

            In the same Results section you quoted from (without putting quotes around it), ALL manual therapies were considered; chiropractic was considered with or without other treatments. This tells us zilch about the isolated “neck crack”. Doesn’t it stand to reason that a manual therapy for pain will be more effective than not having the affected area touched at all (actually, sometimes it won’t be due to the regression to the mean)? Manipulative therapy is not what GPs do. That’s why the various “bodywork” fields exist. When your neck hurts you generally rub it a bit.

      2. Jann Bellamy says:

        I struggle with this issue and tried to put all sort of qualifiers on the first three categories, which include what to allow DCs to do or order. I think there are some chiropractors out there, like Sam Homola, who are willing to offer patients conservative, evidence-based musculoskeletal diagnosis and treatment. Unfortunately, with the exception of Sam’s valiant efforts, either they aren’t trying at all or aren’t making any headway in trying to reform their profession. I recently did a post on what I thought the solution might be, “The Cure for Chiropractic.” http://www.sciencebasedmedicine.org/a-cure-for-chiropractic-2/ If the “good” ones don’t show some guts and speak up about reform soon, I think I’ll have to give up on the whole lot of them.

        1. Windriven says:

          That was a good piece and I agree with your prescription. But I think it has as much future as meaningful banking reform.

        2. goodnightirene says:

          But it remains nothing more than arguing about the merits of any particular Tooth Fairy Science. Show me a study that shows clearly that chiropractic (which is not based on anything real) has any benefit over physical therapy or even a good massage. If it does, what is the mechanism for said benefit? Stop babying these quacks and start lobbying to undo their phone credentialing movement–which has been spectacularly successful.

      3. Drew says:

        I disagree. Chiropractic is far more unreasonable than Creationism.

    2. Thor says:

      Having known quite a few chiropractors in my day, you and Jann shouldn’t hold your breath. The last thing most chiropractors want is having their scope limited, especially to just treating LBP. It would force them into the role of quasi-PTs. They, in essence, become superfluous. And how boring just cracking low backs when the whole healthcare market is at their fingertips (and apparently up for grabs), as Jann’s article makes painfully clear.

      1. Thor says:

        My comment above may be misplaced—it is a response to Peter S (#2).

  3. CS says:

    You don’t think a chiropractor can take a blood pressure? Why on earth not, considering that it is done routinely by medical assistants with 3 months of training?

    1. tgobbi says:

      “You don’t think a chiropractor can take a blood pressure? Why on earth not, considering that it is done routinely by medical assistants with 3 months of training?”

      It’s not that a chiropractor can’t _take_ someone’s blood pressure – it’s what he/she does with the results. You can’t correct high blood pressure by adjusting non-existent subluxations or with other mystical and occult treatments.

      1. Tim B says:

        It is preliminarily suggested that cervical adjustments may result in parasympathetic responses, whereas thoracic adjustments result in sympathetic responses. Furthermore, it appears that these responses may demonstrate the relationship of autonomic responses in association to the particular segment(s) adjusted.

        http://www.ncbi.nlm.nih.gov/pubmed/19646369

        1. Windriven says:

          Tim, let’s not waste each other’s time. The only studies of which I’m aware that clearly show chiropractic to have benefit over placebo is for lower back pain. Period. If you have something else, not preliminary, not speculative, well powered, blinded and peer-reviewed in serious technical literature, let’s have it. The rest of this is just jaw-jaw.

          1. Thor says:

            Sorry, to be redundant – our comments crossed at exactly the same time.

        2. Thor says:

          Quotes belong to your comment as it is verbatim from the study.

          The key word is “preliminarily”.
          Also, what does this information prove or imply? That high velocity thrust adjustments elicit certain neurological responses. Increasing pulse rate?Wow, go figure.

          Also: small study, unblinded, no controls; performed by chiropractors and published in a chiro-journal. Impressive? Hardly.

        3. WilliamLawrenceUtridge says:

          Great Tim, now all you need to do is replicate and extend that study with high-quality controls in a variety of patient populations, both healthy and unheathly, to demonstrate that this effect safely and effectively controls blood pressure over the long-term, with no hitherto-unrecognized adverse effects, and is superior to first placebo, and second safer alternative treatments.

          Presenting this paper as if it validates your entire practice doesn’t help your case. Would you accept a new drug from Pfizer that was proven effective with this study? If not, why are you such a hypocrite?

      2. tbizz says:

        What if they were to take BP in order to screen for possible complications from manipulation?

        Or why can’t they screen for high blood pressure and educate the patient on how to lower it?

    2. goodnightirene says:

      The medical assistant simply records the reading for the doctor’s evaluation–same as I do when I monitor my bp at home. She decides when to tweak my medication, not the medical assistant or myself–let alone a chiropractor.

    3. WilliamLawrenceUtridge says:

      It’s not the taking of blood pressure; a pigeon can learn to pilot a homing missile. It’s what you do with it afterwards. It’s how that measure fits into the overall paradigm of health care. It’s how to treat abnormal values (because with chiropractors, you’ve basically got exercise and diet which are redundant to real doctors, botanicals and homeopathy which are worthless, or spinal adjustments, which are also worthless for blood pressure).

      There’s a reason why you get an x-ray tech to take the image and a doctor to interpret it and provide a treatment plan. There’s an even bigger reason you don’t get a psychic to do either.

  4. R Miller says:

    It’s sort of fascinating to see chiropractic rhetoric in action and its attempt to have things both ways: It manages to present itself as an alternative school of thought, providing an alleged service to customers who believe their concerns and ailments are ignored or unhelped by scientific medicine; yet, when it’s time to pay the bills and the profession tries to expand they do so by encroachment on “allopathic” practices.

    Then again, that’s always been an internal struggle within the profession – the TrueBeliever subluxationist bone shamans v. the people that want to play doctor.

    1. goodnightirene says:

      …’the TrueBeliever subluxationist bone shamans v. the people that want to play doctor.’

      Best definition of chiro I’ve ever seen! I especially love “bone shamans” :-))

  5. Peter S says:

    I have had two experiences that cured me of ever seeing a chiropractor.

    One, a chiropractor I had been seeing for some pain issues told me I should wear a titanium necklace because it would have a positive effect on my energy field.

    Two, a chiropractor who I saw for a knee problem ordered an MRI (I guess they can do that) and then opined that, while of course I should double check with a surgeon, I needed a total knee replacement. While I didn’t get entirely consistent advice from surgeons I saw either, nobody came close to recommending that; and in fact, the better advice I got was that the findings on my MRI were just age-typical junk that didn’t indicate any surgery was necessary.

    Both of these people were, allegedly, at the top of their profession. As I mentioned in another thread, the first was the chiropractor for a nationally known sports team, and the second treats elite runners.

    1. Frederick says:

      “One, a chiropractor I had been seeing for some pain issues told me I should wear a titanium necklace because it would have a positive effect on my energy field.”

      He probably thought you were a Space cyborg, Titanium Armour and Energy field are mandatory to protect against cosmic rays, micrometeorite etc. :)
      What a ridiculous advice.

    2. goodnightirene says:

      Almost anyone involved in sports (medicine) is superstitious in the extreme, to say the least. Saying that a chiro is “at the top of his game (or her for pedants–no I will not use the ungrammatical “they/their”) is rather like saying a climate change denialist is at the top of her professional game. Who rates them anyway? Let me guess–OTHER CHIROS?

  6. Harriet Hall says:

    Something like doing a Pap smear is easily learned. I could teach a 2nd grader how to do it in a matter of minutes (but I wouldn’t, for several obvious reasons!). Much of what we learn in medical school is a matter of “see one, do one.” That’s not the problem. The problem is what chiropractors do after the Pap smear. And before. Surveys have shown that about half of them discourage immunizations, and HPV vaccine can prevent some of the cases of cancer that Pap smears are meant to detect. Surveys have shown that most chiropractors still believe in mythical spinal subluxations and many of them use applied kinesiology and similar nonsense. Their understanding of science-based medicine is deficient, and they don’t have the experience with sick patients that doctors get in internship and residency. They don’t have the opportunity to develop good clinical judgment. Patients who seek their services for things like Pap smears haven’t developed good judgment either.

    1. Peter S says:

      The titanium necklace dude I mentioned above was definitely into applied kinesiology. He used it to show me that his adjustments had worked; prior to the adjustments he allegedly could push down my arm easily but afterwards he couldn’t. In hindsight, what a total crock.

      1. WilliamLawrenceUtridge says:

        He used it to show me that his adjustments had worked; prior to the adjustments he allegedly could push down my arm easily but afterwards he couldn’t.

        I’m certain he could; changing where you push, and how hard you push, would do that.

        1. Peter S says:

          So you don’t think it was because I was back in balance and alignment? LOL

      2. Frederick says:

        Really? I thought It was the power balance Band that those that! But Chiro does it TOO?? WOW it is mamamamagik!

  7. CK says:

    It almost seems like cruelty to animals to allow an individual to manipulate their spines and do these other unproven procedures with no probable benefit and possible serious damage. In my state, a chirpractor is limited to the human body; however, a vet tech (under the direction of a licensed vet) can perform chiropractor procedures on an animal. This makes no sense to me.

    I asked my vet how he felt about it, and while he did not encourage it, his view was “if it gives relief to the animal, who am I to argue?” A little disappointing, but at least he doesn’t think it’s the best idea, and he does not offer it.

  8. e canfield says:

    I’d sooner have my mother deliver my baby. How much knowledge of first aid are chiros required to have? Mom at least had a solid grounding in first aid and cpr for her job, with annual refreshers, and when our dog delivered her (only) litter, Mom was able to resuscitate the puppy with the cord wrapped around her neck.

    Slightly OT: MIL took DH to a chiro as an adolescent for some back pain (upper, I think). He was impressed by the joint cracking, and by the chiro being called Dr. For some reason he thinks it’s illegal to use the title unearned, despite knowing about “Dr.” Phil. I’ve tried explaining why chiropractors are redundant at best but my knowledge is minimal. Would someone give me a succinct explanation I can pass along, please? Thank you.

    1. Calli Arcale says:

      I’m assuming you’re in the US; other countries have different practices regarding the title of “doctor”. In the US, the title should indeed be earned, though there is no governing body enforcing that overall. It doesn’t indicate that you’re medically competent, though. My favorite lit teacher in high school was a PhD. She could’ve called herself Doctor. She definitely earned that degree. But as it was in English Literature, it wouldn’t have been all that meaningful when it comes to medicine. Also, in this country not only chiropractors but also dentists get called “doctor”. So point that out to your husband. “Doctor” is definitely an earned title, but it doesn’t automatically mean the person’s got good advice for managing your asthma or whatever. You have to look further and see what *kind* of doctor.

      And then bring up ND. You gotta earn that too, but that doesn’t generally require a whole heck of a lot of effort. In some states, it requires little more than the effort needed to fill out a form and write a check.

    2. R Miller says:

      In the United States, in general (there is considerable variability by state), the title of doctor is not legally protected; however, the title of Medical Doctor (MD) in a title is.

      How these titles are used says a lot about a profession, in my opinion. For example, pharmacists (after 1998) possess a doctorate (PharmD), but very few will insist they be called a doctor, especially in a health care setting, because they are cognisant of the unnecessary confusion it causes for the patient. In contrast, many alternative practitioners strongly identify as “doctor” in an attempt to make themselves appear on equal grounding with qualified physicians.

      1. Peter S says:

        No disrespect to anyone intended, but Ph.D.’s calling themselves doctors bothers me too. I have a JD but would never dream of calling myself doctor and would probably in fact be violating some canon of ethics if I did.

        1. Windriven says:

          I frequently call my lawyer buddies ‘doctor’ because it makes them a little uncomfortable. I generally refer to PhDs in serious areas of study as Dr. because in my estimation they’ve earned it. I even occasionally call a close friend who is an itamae Dr. Kim – because he performs delicate surgery on loins of tuna and fillets of salmon. Interestingly enough, few of my friends and acquaintances with PhDs refer to themselves as ‘doctor’ outside of rather formal settings.

          1. MTDoc says:

            I always supposed that was so they wouldn’t be put on the spot when someone asks if there is a doctor in the house. I know there are many valid doctorates, but our cultural usage implies someone you call when you are ill or hurt. Most MD’s avoid using Dr. in print, preferring the more specific suffix. In fact, when you see “doctor”before a name, you can assume he or she is not a medical doctor.

            1. Windriven says:

              “Is there a doctor is the house?”

              “Why yes, is there a Navier-Stokes equation you need solved?”

          2. WilliamLawrenceUtridge says:

            because it makes them a little uncomfortable

            If I had to guess, I would guess that a significant portion of your life revolves around this phrase :)

            How do I know? Takes one to know one.

            1. Windriven says:

              Keeps people on their toes. Keeps me on mine too. :-)

        2. Egstra says:

          “No disrespect to anyone intended, but Ph.D.’s calling themselves doctors bothers me too.”

          Depending on the context … I used to introduce myself as Dr. Egstra when doing formal psychological evaluations in jails and hospitals, followed by an explanation of what the “Dr.” meant.

          But use it socially or in settings where it simply wasn’t relevant? No way … and not just because of the fear and trembling caused by the word”psychologist.”

          1. Windriven says:

            “and not just because of the fear and trembling caused by the word”psychologist.””

            No doubt you’ve read Nabakov’s trill on ‘therapist’ (that was in Lolita, no?) and you’ve probably heard every lame wannabee try their hand at one-upping him (as if) so I’ll spare you and all our gentle readers. But it is always amusing when in a large social setting to watch the reaction of people when introduced to a psychologist or psychiatrist.

            1. Egstra says:

              ” But it is always amusing when in a large social setting to watch the reaction of people when introduced to a psychologist or psychiatrist.”

              No kidding — one many actually jumped back a foot, while stuttering, “I don’t believe in any of that.”

              Now, when they ask if I am analyzing them, I simply say “Only if you pay me huge sums of money.”

              1. Windriven says:

                My take has always been that a therapist is someone you discuss very personal issues with and who is paid to be objective. Wives and lovers, friends and relatives, all have preconceptions about you and a wagon load of their own issues to boot. A therapist has the training, context and remove to be much more useful.

                In any event whenever I see someone react fearfully to a shrink I figure either they have no problems (no brain, no pain) or they are so fLicked up they wouldn’t dare breathe a word to anyone. Sometimes you see these ones later on the blood spatter shows on A&E (the husband/wife/lover did it).

              2. n brownlee says:

                @Windriven

                I’ve always valued therapists for exactly that quality- the quality that helps me stop thinking in circles… “I HAVE to leave” “Oh, no the kids…” “Bur- I HAVE to leave!” “Oh, yeah. kids…”

                That circle, and others.

        3. E-rook says:

          The etymology of the word doctor is the Latin, docere (to teach), and it’s an honorific used in place of Mrs, Miss, Mr. I have a PhD and I appreciate in a professional context being called Dr Erook, instead of my first name when being introduced for a talk, etc. or from a student, staff or technician (unless we have a close relationship, the business office just calls all of us Dr Soandso, so there’s zero awkwardness), ‘Dr Erook, here is the data you asked for. … etc.’ I would never introduce myself as Dr Erook, that’s like introducing yourself as Mr or Miss. Even in professional setting (say to a prof in another dept), “hi I’m Firstname Erook, I’m an Assistant Professor in the Dept of Herbology,” so that the person has all the information they need to place me and what to expect from me (my field, experience level) and can look up my work if they want and can call me by my first name in conversation. Most people don’t know this but their institution should have a style guide to make it easy on how to address people in writing. In the address line, it’s Firstname Lastname, PhD, etc. Next line title: Assistant Professor of Herbology. Then at salutation: Dear Dr Soandso. If they are full professor, put Dear Professor Soandso. I think context matters. If I were writing a letter to you, I’d write Dear Dr S in the salutation.

    3. Jann Bellamy says:

      Actually, I wrote a post on this very issue last year: Dr. Who? http://www.sciencebasedmedicine.org/dr-who/

      1. Calli Arcale says:

        And it was an excellent article, too.

        Of course, the Doctor will always get to call himself that, and always create confusion as a result. But he’s the definite article, you might say. ;-)

    4. e canfield says:

      Thank you, all, although I wasn’t asking about the definition of doctor. My husband is a year into the phd kind …in philosophy…; I just had to remind him of “Dr.” Phil. I was actually asking about why chiropractic is problematic. Happily, James and Windriven’s dialogue below might just do the trick.

  9. LIz Ditz says:

    Interesting and nuanced take on chiropractic’s role in patients’ lives

    More than a medical service, chiropractic — like religion — helps explain life’s struggles, cope with present stress, and anticipate the future with hope. Whereas patients often experience medical doctors and clergy as unsympathetic, chiropractors spend up to an hour with patients at each of frequent appointments, touching, listening, and validating the legitimacy of complaints. Chiropractic fills a vacuum of meaning with an appealing explanation of pain: Something is simply out of adjustment, and balance can be restored without making either the hurting person or God morally culpable.

    Chiropractic: Is it Nature, Medicine or Religion?

    1. Thor says:

      Excellent link, thanks Liz. Everyone, especially customers, should accept that this really is the background story of chiropractic. It is what it is, and that is no secret.
      But, if this were upfront, the profession would lose people in droves. They know this, so are forced to pretend that it’s about medicine and science, or at least integrate them. They have a difficult task, reconciling two distinct aspects—vitalism (as it applies to the “healing arts”), and modern medicine. It’s a losing battle, only kept alive by an ongoing campaign of dis and misinformation. They count on the ignorance of customers regarding medicine and pseudo-medicine, and on the propensity for believing in irrational things. Another reason, among hundreds, why SBM is so important.

      1. goodnightirene says:

        @Liz and Thor

        Kudos to you both for excellent insights!

  10. John Barnes says:

    I’m a Ph.D in biochemistry and molecular biology and worked in both discovery and clinical development in the pharma industry.

    At one point, I attended a medical conference organized by my company where most of the company attendees were PharmD’s. As I introduced myself to one of the MD’s attending the conference, I presented by business card. He noticed the Ph.D after my name and he said, “oh, so you’re real doctor”?

    He explained that he viewed Ph.D.’s as real doctors since they have conducted and published research, whereas most PharmD’s and even MD’s have not. So it’s clear to me at least that whether you’re entitled to the title “Doctor” or not is somewhat dependent on an individual basis. In my everyday world, I do not introduce myself as Dr. so-and-so. In fact, in my world, almost everyone has a Ph.D. or MD., so it would appear to be an affectation.

  11. Richard Donley says:

    Gotta love it! Most of the above responses seem to be planting their anti chiropractic flag on the dubious molehill of accepted medical science. Bloodletting was once considered scientific.
    I’m 66 yrs and all of my contemporaries are gulping down statins.
    My doc is furious that I declined the offer.
    I find it curious that 80% of heart attacks victims have normal cholesterol levels.
    Unlike chiropractic… medicine is scientific…so the story goes…
    Let’s see…We have high cholesterol because the body is statin deficient. Yeah! Makes Cent$!
    Most of my friends take at least 5 different prescription med$.
    Don’t kid yourself, big Pharma$$ dictates what’s scientific relative to the human body.
    Just follow the money. Their reps educate the allopaths and they push it on the dumb.
    Simple aspirin can create gastrointestinal havoc… Others swear by it and take it everyday. Scientific?
    Beating up on the Chiros isn’t going to change the fact that 100k unfortunate folks die each year from medical mistakes.
    And with all this harsh vitriol how unqualified the bone cracker is as a healthcare practitioner one would expect said krill to be paying malpractice out the gazoo!
    Chiropractors pay 80% less than the saintly MD for the same coverage.
    Sorry to rearrange your brain waves but since you’re stuck on science you may have to concede that the no good chiro down the street may just be better for your health than the MD.
    Bottomline… It would very simple for the godly MD’s to rid society of this chiropractic menace.
    Get all of your patients well and they won’t come to us.

    1. Peter S says:

      How do the issues you raise with some physicians’ prescribing habits validate chiropractic? They seem irrelevant to the question at hand.

    2. Windriven says:

      Instead of oblique epigrams, how about bellying up to the bar with some actual evidence and logical analysis, assh0le? Scattering your screed with dollar signs and incoherent notions about science, medicine and statins doesn’t make it compelling. It just marks you as a dilettante and a poseur. But then in the last sentence you self identify as a chiroquackster so I guess I shouldn’t be surprised.

      “dubious molehill of accepted medical science. Bloodletting was once considered scientific.”

      Clearly demonstrates illiteracy regarding science and medicine. It was the incorporation of scientific rigor in the practice of medicine that drove prescientific notions like bloodletting out of favor. Science is the triumph that lets you broadcast your inanities to the larger world; science has transformed the human condition beyond recognition in the last 150 years. But idiocies like chiropractic and homeopathy cling to old superstitions, unchanging, stenotic, decrepit.

      I’ll make the same challenge to you that I’ve made to others: name the top 10 medical conditions that chiropractic has mastered, conditions that have plagued mankind and have been vanquished or significantly controlled by chiropractic. Then I’ll name 10 for medical science.

      Not a single one of the quacks, delusionals, or belly-button gazers who appear here from time to time, like scum on the surface of a pond, has taken me up on that challenge. Why do suppose that is, Dick?

    3. Calli Arcale says:

      “My doc is furious that I declined the offer.”

      If you have that bad a relationship with your doctor, why do you keep him? There are many other doctors, most of whom are respectful of their patient’s choices. Or could it be your doc is really a hypothetical amalgam representing what you wish to attack in mainstream medicine in lieu of presenting a reasonable defense for chiropractors acting far outside their realm of expertise?

      (Or do you seriously think chiropractic provides adequate competency for obstetrics?)

      Beating up on doctors isn’t going to provide a shred of evidence that your particular fairytale is an appropriate substitute.

      1. Windriven says:

        “If you have that bad a relationship with your doctor, why do you keep him? ”

        In fact, why have a physician at all? Why not just a chiropractor? Seriously, I’d love to know the answer.

        1. Richard Donley says:

          “If you have that bad a relationship with your doctor, why do you keep him? ”
          Oh windriven your sails are a flapping and the dramamine has failed to keep you from a spinning!
          I’m sorry but your reading comprehension skills are clearly abysmal.
          I never said that I had a bad relationship with my doctor.
          Unlike your imaginary phd and attorney friends that your boast about, the doc and I have been friends for 40 years and sometimes/often times disagree.
          Windriven, you are a definite Christopher Hitchen want-a-be. It’s just too bad you can’t quite past the physical.
          Your feeble challenge of 10 medical condition proves it.
          By your standards the Podiatrist and Optometrist should be eliminated since their services are duplicated and they probably could not brag about a single medical miracle. It’s what your idol Hitch would call a non sequitur.
          I’m guessing that perhaps your anger is the result of failing the medical boards for the fifth time.
          Chin up you will eventually pass…something.

          1. Windriven says:

            An, Dickie-bird, I’ve ruffled your feathers. Good!

            Yes, reading is awfully difficult for me but I do my best to sound out the words, look up their meanings, and cobble together a rough sense of what each sentence is intended to convey. When I read your sentence about the fury of your physician at your refusal to take statins, I looked up fury and realized that your cholesterol must be very high to elicit that response. Then I thought, what a stupid ass you are for declining the advice of a skilled professional; advice you seek and pay for. Most of the imaginary primary care physicians that I know would consider yours to be a bad doctor-patient relationship.

            Now perhaps it is you who should look up the definition of non sequitur. Podiatrists and optometrists have – and embrace – very limited scopes of practice. Their diagnoses and treatments are based on solid medicine, not on the febrile ravings of a religious nut and his half-wit son. They have earned valued places in the medical armamentarium. Chiros, not so much.

            Now, feeble as the Windriven Challenge might be, you really should stoop to take it; slam me into my place as I much deserve to be slammed.

            “I’m guessing that perhaps your anger is the result of failing the medical boards for the fifth time.”

            Ahhhh, I shriek in pain and anguish. You’ve cut me to the quick! No, wait, that’s not pain and anguish, it is laughter and amusement. I’m not the one running around in a lab coat playing doctor. You are. Struggle with the MCAT did you, Dickie-bird?

            1. simba says:

              Podiatrists are part of medical science, they follow the same ideas and embrace the same standards of medicine. They also, as a profession, are happy to stay within their scope of practice (though you will always get individuals who will decide they have to do ‘more’)- they know what they can and can’t do, and the best stick to what they can do and do it well. Just IMO.

          2. Thor says:

            As expected, you give yourself away by the way you communicate. Now that’s what I call a comment containing absolute zilch. Not an iota of substance, as usual. Typical reactionary, emotion-laden drivel.
            Are you incapable of answering any valid, serious questions?
            Congratulations on representing your profession in such a positive way.

    4. Thor says:

      What do you say about Thinking_Chiro’s take on this? Or Sam Homola’s?
      You seem a bit at odds, no?

  12. James says:

    Chiropractic is based on 5 principles validated by science and logic.

    1) Natural ecosystems need no help, just no interference. 2) The human body is a self healing and self regulating ecosystem. (Stress the word ecosystem.). 3) The brain and nervous system supervenes in self healing and regulation. 4) Sickness comes from environmental stressors, not genetic weakness or the inability to self regulate. 5) Health care must address the cause, not just treat the symptoms.

    The medical profession is based upon the religious belief that the gene controls function, and it must be a genetic defect that causes sickness. Does, “The Central Dogma” sound familiar to anyone. Better google the word dogma first. Epigenetics has proven this theory to be outdated, as is the medical profession, unless there is a trauma, or emergency situation.

    Keep prescribing toxic pills and potions for things that are lifestyle related, and removing gallbladders because a twenty year old female “belches” too much. Or, prescribe anti-depressants for someone with mid back pain. Who’s on quack watch now dr’s? You can have the title “dr” if you want. By the way, dr means teacher in Latin. The only thing I’ve been taught by a GP is how much they don’t know about real health and wellness. My chiropractor has saved my life, my families life, and thousands more.

    Any GP that prescribes a toxic drug for a lifestyle related illness should be put in jail. You are promoting a hopeless health care system that is dangerous, expensive, and bankrupting citizens and governments. The public is seeing this, and responding. Just look at the cholesterol debacle. How good is “your Science”? Ancel Keyes anyone?

    The future of health care is coming around. The public understands more than ever the lifestyle practitioners, like chiro’s are the future.

    You probably won’t have the guts to post this truth.

    1. Windriven says:

      “You probably won’t have the guts to post this truth.”

      You’re just as wrong at the end of your comment as you were at the beginning. You’re batting 1.000 there Sparky!

      “1) Natural ecosystems need no help, just no interference.” Yeah, huh? The ecosystems of today bear little resemblance to those of 1 million years ago and those bear little resemblance to those of 100 million years ago. Better than 90% of all the species that ever existed on this planet are extinct.

      “2) The human body is a self healing and self regulating ecosystem.” In some cases this is, of course, true. In many it is not. Every life that has ever existed on this planet has died … and it died of something. The body does not generally self-heal from TB or from pancreatic cancer. Many conditions are self-limited. Many are not.

      “3) The brain and nervous system supervenes in self healing and regulation.” Partially true regarding regulation though I’d probably challenge the appropriateness of the word ‘supervene’. I’d love to see your “scientific evidence and logic” that broadly supports this assertion for “self healing”.

      “4) Sickness comes from environmental stressors, not genetic weakness or the inability to self regulate.” Rarely true in the broad scope of disease. Besides, I thought you claimed that natural ecosystems were self-regulating. Try to maintain at least a tissue of logical consistency. But I digress. Your grasp of genetics is as woeful as your understanding of the limits of self-regulation.

      “5) Health care must address the cause, not just treat the symptoms.” Finally, an assertion that we can almost agree upon! Of course in some cases addressing the cause is not yet possible, at least not definitively. Antibiotics, for instance, attack the cause of bacterial infections. HAART addresses the cause of AIDS – but not yet potently enough to cure it. Sometimes the cause of emphysema is chronic tobacco use. We understand the cause and have addressed it in a number of ways. But when you can’t effing breathe, treating the symptoms makes pretty good sense.

      You started out with a broad claim:

      “Chiropractic is based on 5 principles validated by science and logic.”

      But only one of those comes remotely close to validation by either science or logic.

      1. Peter S says:

        Even if those principles are true, what do they have to do with chiropractic and treating “subluxations”?

    2. Calli Arcale says:

      If your first principle is true, then clearly Chiropractic is utter nonsense since the body doesn’t need chiropractors interfering with the body’s healing process. I think you might need to think your arguments through a little better. It’s not usually smart to start out with an argument that your favored treatment is worthless. ;-)

    3. Thor says:

      Same comment as left for Richard:

      What do you say about Thinking_Chiro’s take on this? Or Sam Homola’s?
      You seem a bit at odds, no?

  13. Thinking_Chiro says:

    Good article and many good comments.
    One comment really hit the mark for me:
    ” I think there are some chiropractors out there, like Sam Homola, who are willing to offer patients conservative, evidence-based musculoskeletal diagnosis and treatment. Unfortunately, with the exception of Sam’s valiant efforts, either they aren’t trying at all or aren’t making any headway in trying to reform their profession. I recently did a post on what I thought the solution might be, “The Cure for Chiropractic.” http://www.sciencebasedmedicine.org/a-cure-for-chiropractic-2/ If the “good” ones don’t show some guts and speak up about reform soon, I think I’ll have to give up on the whole lot of them.”
    Couldn’t agree with you more Jann.
    That Sam wrote what he did in the 1960′s is remarkable. Huge fan!
    Here is a sample of what is going on in Australia to offer you some hope:
    National registration for all health professions with standardised rules and regulations for ALL:
    http://www.ahpra.gov.au/
    Recently, AHPRA clamped down on the web and social media, largely in response to patient testimonials on chiropractic websites. The subsequent rules applied to everyone and the doctors were a tad upset. The physio board still hasn’t dealt with breaches by physio’s yet! They need some skeptics to put them under the microscope!
    Chiropractic association with clear guidelines and policy statements on pro-vaccination, evidence, research, subluxation, xrays, interprofessional relations etc:
    http://www.coca.com.au/
    I have heard through the grapevine that COCA is to become more vocal. :-)
    I have been a member for close to 20 years and they have always been proactive on the important issues.
    Our other association, the CAA:
    http://www.chiropractors.asn.au/
    Has some excellent chiro’s and some evangelical subbies in their ranks. They are in the process of changing, often under protest, but still in the right direction.
    The Australian Spinal research Foundation (associated with the CAA) has been shaken up by an excellent blog last year by The Rogue Chiropractor:
    http://theroguechiropractor.wordpress.com/
    Right now I think their still in witch hunt, blame and head in sand mode!

    There are also excellent things going on which would get your approval in Canada, Australia, Denmark and Switzerland in regards to research and education. Even Palmer College in the USA is producing some good research from the likes of Pikar!
    Headway is being made!

    I read that article cited in your blog above and I had to reach for a medical dictionary then scratch my head trying to figure how so much of what was described came within chiropractics scope of practice. The US has chiropractors like Sam Homola, Joel Pikar, Stephen Perle et al……. who I admire greatly. It also has the total nut jobs (this also applies to medicine).
    I could easily treat every patient that walks in, but what is far more important is knowing when not to treat and refer on. So far this year I have had two patients that presented with atypical back pain and were actually having heart attacks, for one, the hospital rang to thank me and said one more hour and the patient would have been dead. I have also picked up two spinal metastasis this year and immediately referred. Working with doctors in a medical centre has its advantages, especially for my patients!

    The chiropractic profession has a very poor history of self criticism. That is changing and the process is accelerating. This has resulted in the subluxation true believers become more vocal and digging in. This means that the critics and reformers within the profession need all the support possible. A civilized dialog with critics from outside the profession is also vital to the reform process!

    1. Thor says:

      As I may have mentioned to you before, I thoroughly appreciate your willingness to reform, modernize, and scientifically and medically validate your profession.

      That said, although Australia isn’t the US, I’m still not sure why chiropractic as a professional entity is even needed at all. Other than the actual neck and low back thrust manipulation, what actually distinguishes it from PT, osteopathy, various forms of massage, and even standard medical care? It seems a superfluous entity. For example, as a neuromuscular massage therapist, I would routinely perform hydrotherapy, soft-tissue manipulations, ROM, active stretching, assigning home exercises. Then, they’d go into the room next door to receive the cherry on the cake, namely the “adjustment” of the neck or back. I’d spend a half hour to one hour doing my work; they’d spend five minutes! Strange, since there is only scant evidence for neck benefits, and only a bit more for LBP.

      Although I share your and Jann’s hope, I have serious doubts. The track record so far isn’t compelling. The comments from your colleagues on this post underscore my assessment.

    2. tgobbi says:

      Thinking Chiro: “The chiropractic profession has a very poor history of self criticism. ”

      They also have an incredibly poor history of self-policing. As far as I can determine, the associations allow their members to get away with murder (sometimes literally). And I contend that the situation is not changing and the belief that “the process is accelerating” is a chimera. I don’t see it on the websites, in the offices or in the advertisements.

      Any criticism, no matter how accurate or small, is assumed to be an attack on the entire business.

      I contend that “Reform” or non-subluxation D.C.s, with all due respect to Thinking Chiro, (and with the exception of Sam Homola who has led a decades-long but, alas, futile crusade to clean up a disgraceful industry) are irrelevant and redundant. As we’ve stated over and over, they simply have nothing to offer that can’t be delivered by healthcare professionals with legitimate degrees and, for the most part, greater understanding and orientation in science.

    1. egstras says:

      Let’s see … the link attacked Novella’s hair, his clothes, and his association with Randi. It commented about his hypothesised sexual orientation, and disparaged his personal style.

      Oddly enough, I saw nothing critiquing what he actually said. Somehow, that doesn’t surprise me at all.

    2. Windriven says:

      Oh James, The Bolen Report? Really? Flack for all things woo? And did you actually read the ‘article’ that you linked? There is not a fact to be found. It is one long ad hominem. Very professional, huh? Very convincing.

      Facts talk and bullsh!t walks, James. Get yourself some education, learn about science, understand the history of where we were in, say, 1650 and how we got from there to here. It wasn’t by the efforts of quacks and delusionals. It wasn’t by the Oz’s of the world and their ever changing ‘one true miracle cure for xxx.’ Oz is marketing, not science. Chiropractic is prescientific shamanism. Homeopathy is … well it is just silliness.

      Take the Windriven challenge: name the 10 most significant medical conditions that your favorite woo has brought to heel, conditions that have plagued mankind and are now, if not curable, certainly manageable. Take your very best shot. Then I’ll name my 10 for scientific medicine. Think about that James. Avoid embarrassment by making the two lists yourself.

      1. Thor says:

        Whew! Thank Darwin for you, Windriven. You’re in fine form here in your responses to Richard and James. Even though their inanities are abundantly apparent, with the writing being typically inflammatory and laced with ad hominem and other logical fallacies, it is a relief to read your rebuttals. These guys quack so loud and unabashedly that anybody with even a little bit of critical thinking ability deduces ducks. I can’t shake the feeling that the “new” chiro-movement is simply a dressing change similar to “alternative” changing to “complimentary” changing to “c + a”, changing to “integrative”. Or like creationism changing to intelligent design. Like Hitch’s challenge (re: morality), yours will forever remain untaken.

        1. Windriven says:

          Thanks Thor. It has been a while since I hoisted a glass of pure amber Scotch in memory of the singular Christopher Hitchens. I’ll do it tonight.

          ” I can’t shake the feeling that the “new” chiro-movement…”

          There are some guys like Sam Homola who appear in these pages from time to time who, I believe, are sincere in wanting to reform chiropractic. The problem is they seem to be a tiny minority. Some advocate following a path similar to that taken by podiatry and I think that is a good model. But I still wonder what chiropractic hopes to bring to the armamentarium that isn’t already provided by professional physical therapists. None of the chiros I’ve had exchanges with have been able to give me a convincing answer.

          1. Peter S says:

            “But I still wonder what chiropractic hopes to bring to the armamentarium that isn’t already provided by professional physical therapists. ”

            Here’s a chiropractor who could answer that for you.

            http://www.medicinehatchiro.com/nutri-energetics-system/

            http://www.medicinehatchiro.com/quantum-collapse-process-/
            http://www.medicinehatchiro.com/total-body-modificaton/

            Are chiros like this an aberration? I don’t know, but it seems like every time someone calls an absurd modality to my attention, it’s being offered mostly by chiros.

            1. Windriven says:

              Oh. My. Goodness.

              “The Quantum Collapse Process™ is a systematic pre-determined series of questions and actions directed toward the objective of bringing to your conscious mind the states of presence and certainty and to your heart the feelings of gratitude and love. It is an enlightening procedure, which neutralizes your emotional charges and balances your mental and physical reactions. It is a reproducible science enabling you to discover the underlying order governing your apparent daily chaos. Millions of individuals have now heard of this stress reducing, conflict resolving and heart opening method. now you can benefit from learning how to use this most inportant (sic) and life changing tool for the rest of your life.”

              You have to be sh!tt!n’ me.

              1. Peter S says:

                Sorry, I prefer this one.

                “The aim of NES therapy is to return the integrity to the “human body-field” and support the body’s inherent natural abilty to heal itself at a chemical, physical, mental, and informational level. From your body-field our computer will generate a comprehensive report detailing over 150+ factors about your well-being including: body organs, acupuncture meridians, nervous system, digestive system, enviromental toxins, nutritional status, emotional imbalances, and joint issues.

                By analogy, the NES scanning device can be thought of as a radio antenna, tuned into the “human body-field”. The scanning process is like a radio scanning through radio stations, with the signal strength for each station indicated by the bar graph. Based on your scan, infoceuticals may be given which are simply “information” that your body uses to restore its natural healing abilities. The active part of the NES infoceuticals is not chemical (herbal, nutrtional or pharmaceutical) in make up- neither is it a homeopathic preparation or flower essence. Instead, the NES infoceuticals contain micro quantities of colloidal minerals whose subatomic structure has been encoded with information which connects to the “human body-field”.

                Excited? We are! Dr. Clarke and Trish Clarke are two of the only Practitioners for NES in western Canada!!!”

                Introduction to NES: http://www.neshealth.com/en-gb/nes-explained-video.aspx

  14. Thinking_Chiro says:

    Reform and reformers are definitely not irrelevant or redundant. Associations like COCA are pushing the reform agenda that the skeptics demand, as do I. Supporting chiropractic researchers like Lynton Giles, Charlotte Leboeuf-Yde, Bruce Walker, Simon French, Joel Pikar, Martin Descarreaux to name a few is important, as are reformers like Bruce Walker, Sam Homola, Rod Bonello, Stephen Perle et al.
    Carpet bombing the chiropractic profession damages the reformers and that is unacceptable collateral damage. You need to make the distinction between outdated and modern chiropractors. The profession has its problems, but any meaningful reform must come from within the profession supported by well written and well informed criticism from without. Both are vital!
    I work closely with doctors in a medical centre and a collaborative approach to patient care is an absolute necessity. The collaboration between Craig Liebenson (Chiro), who wrote the core text used by chiro’s and physio’s, “Rehabilitation of the Spine” and Stuart McGill (Kinesiologist) and Gray Cook (Physio) is producing great results. I’m going to their seminar later in the year!
    Point out the BS, but balance it with support for the reformers.

  15. Thor says:

    The following excerpt is from the CAA, the website you gave a link to. I’d like to post it to see what others think. Forgive me TC, although sounding a bit better, it still appears to espouses the same concepts. Yes, minus the subluxations (at least overtly). Again, it’s Australia. Btw, what US organization is comparable to your COCA?

    “What is Chiropractic?
    SpineChiropractic is a health care discipline based on the scientific premise that the body is a self-regulating, self-healing organism. These important functions are controlled by the brain, spinal cord, and all the nerves of the body. “Chiropractic” comes from the Greek word Chiropraktikos, meaning “done by hand.”

    The practice of chiropractic focuses on the relationship between structure (primarily the spine, and pelvis) and function (as coordinated by the nervous system) and how that relationship affects the preservation and restoration of health.

    The skull protects the delicate tissues of the brain. The moving bones of the spine protect the intricate communication pathways of the spinal cord and nerve roots. If these nervous system pathways are impaired, malfunction of the tissue and organ function throughout the body can result.

    Chiropractic also places an emphasis on nutrition and exercise, wellness* and healthy lifestyle modifications.”

    1. Windriven says:

      ( ) That’s the sound of a bubble bursting. :-(

      1. Thor says:

        I hate to even bring it up at this point, Windriven, as it’s low-hanging fruit by now, BUT the other site ThinkingChiro gave a link to, COCA, is almost embarrassing. Not because of claims made as they don’t appear to make too many, but just the meagerness of substance on offer, especially for an educational site. The reason to mention it is because this and the CAA site are ThinkingChiro’s examples representing the new breed of chiropractor.

        1. Windriven says:

          That seems to be the whole problem in a nutshell, Thor. When you siphon off the woo there isn’t a whole lot left to build a profession around.

  16. Sam Homola says:

    This definition of chiropractic by the CAA leaves the door open for use of spinal manipulation to treat a broad scope of ailments without using the word “subluxation.”

    I quit trying to reform the U.S. chiropractic profession in the early 1980s when the National Association for Chiropractic Medicine failed to attract a sustaining membership made up of chiropractors who were willing to publicly reject chiropractic subluxation theory, requiring limitation of care to back pain and related musculoskeletal problems. The articles I write about chiropractic today are designed primarily to support appropriate use of generic spinal manipulation and to help patients and providers avoid the nonsense associated with subluxation-based chiropractic under any name. My heart goes out to those good chiropractors who continue with efforts to reform the chiropractic profession while providing individual examples of what chiropractic should become.

    1. Thor says:

      Thanks for all the good work you do. And for being part of SBM. I value your input.

  17. Keln says:

    Chiro-quacks need to be abolished. They are little better than physical therapists, and in some cases worse. Dealing with the spine is serious business. If they just worked the muscles of the back, it wouldn’t be a big deal, but many of them try to “align” the spine, and that can lead to serious trouble. They don’t have anything close to the education and experience that a full doctor of medicine does. Many people swear by them, and it is hard to argue with results, but the possible danger to someone’s spinal cord should be known to anyone going to a chiropractor. You are better off going to a specialists DOCTOR of MEDICINE.

    1. Peter S says:

      Why is it hard to “argue with results”? There isn’t any modality out there in the world that can’t claim results via the placebo effect, etc.

  18. Trae Palmer says:

    I remember back in HS when inquiring about joining the swim team, they told students that we’d need to get a physical first, and the coach recommended a chiropractor up the street because he was cheaper than going to one’s regular physician. Needless to say, I went to my regular doctor to get it done.

  19. Thinking_Chiro says:

    In reply to Thor:
    The CAA has deservedly taken a hammering over the last few years and they are slowly changing under duress, but as I said previously, they still have a ways to go. Their site reflects this. COCA’s site has policy statements on topics like vaccination, subluxation etc. They run interdicilpinary seminars, but have only recently started online education modules. Have a closer look at their history, executive, what they have achieved and past and present seminar content. You will see that they have been consistently on message for decades. Your criticism of COCA is carpet bombing the reformers. As for similar associations in the USA, I am not familiar with whats going on there, but Stephen Perle of the University of Bridgeport, who has regular interactions with COCA, would be a good starting point.

    You also need to look at the researchers I cited above, take these two:
    http://www.researchgate.net/profile/Charlotte_Leboeuf-Yde
    http://www.ncbi.nlm.nih.gov/pubmed/?term=leboeuf-yde+c
    http://www.ncbi.nlm.nih.gov/pubmed/?term=walker+bf
    Worthy of yous support!
    COCA’s journal C&MT (Chiropractic and Manual Therapies) has consistently pushed the research agenda and their editors regularly publish articles critical of the profession, as is noted on Chirobase, a chiropactic skeptics site. It has now been taken up by the Royal College of Chiropractors and The European Acadeny of Chiropractic.

    Thanks for yous support Sam. COCA represents a large chunk of the profession here and has around 1200+ members out of 4500 chiro’s in Australia. So that is a large block pushing reform. The CAA has around 1600 members. COCA is becoming more vocal in pushing their message of reform, which may ruffle a few feathers in the CAA, but good to see! The CAA feel that they should be the sole voice of the profession! Some of the more evangelical subluxationists in the CAA executive have been given the boot, so they are getting the message. One of those evicted then tried to set up a breakaway hardcore association, but it never got off the groung due to lack of support! :-)
    Do you still talk at seminars Sam, as it would be great to see you at a COCA seminar?

    1. Thor says:

      Sorry for the late response; I just now saw your post.

      Regarding the links to the studies you gave, they don’t show anything.

      The first study has reached no conclusion as the results are not even in yet, and haven’t been reported on. Regardless, this kind of “study” is highly subjective by design. It is based on the use of questionnaires. How could it possibly prove anything about an isolated spinal manipulation?

      The second one is, again, only questionnaire-based and is only meant to measure how chiropractors rate themselves. It will determine nothing about the efficacy of chiropractic treatment, let alone high-thrust adjustments for low-back and neck pain.

      Perhaps I’m missing something, as I’m not a statistician (or particularly fluent in reading studies). I welcome others to analyze them.

    2. Thor says:

      I should add, TC, that regardless of the state of the evidence (other than for LBP), I find it laudable that you’re in the “good-guy” camp of chiropractic. You obviously take the need for reform very seriously and this appreciated. You may very well be the kind of DC that another health-care professional might be inclined to refer to.

  20. Thinking_Chiro says:

    P.S. A centralised national registration board like AHPRA is an absolute necessity!

  21. Christopher Stuart, DC says:

    I will be brave and speak among the chiro. haters.

    IN practice for 17 years. Like Obama’s position on homosexual marriage, chiropractic does seem to be “evolving.”

    It’s better than it was 17 years ago. Less “hoo-rah” seminars and more with substance. The focus seems to be on outcomes now. If I have to listen to a lecturer on Neck Disability Index and Revised Oswestry Questionnaire one more time. . .sheesh. . .we were actually taught this 17 years ago. Yes, I’ll hand them the questionnaire.

    We use “algorithms” just like allopathy, although they may be altered/differ a bit. For instance, a whiplash algorithm may go with an early introduction of spinal manipulation + exercise whereas an allopathic one would be “anti-inflammatories, wait and see.” (I am oversimplifying both in name of keeping the discussion moving). Usually by the time they reach me anyway, they have “waited and seen.”

    I don’t adjust asymptomatic necks as much as I did when first in practice. I barely have a patient report dizziness post-adjustment by why tempt fate, right? I follow informed consent on that even if the research is split on causalty.

    We both have to think about the chance of a malpractice suit so I think a standard of care IS there for chiropractic, despite your spin contrary.

    That said, if you would like to offer me some kind of malpractice immunity because I am “alternative”, I’ll glad accept and not adhere to a standard of care that you seem the profession collectively lacks.

    I’ll just do what I feel like, which you think I have a broad license to do.

    I agree we have this tenacious clingyness to subwuxation. . .we can’t seem to let it go. Part of that, or a major part of that, may be legal practice acts/Medicare are hard to change. A bone of out of place WAS the model back in the 20th century, even among some allopaths. Now, it’s not. (the metaphysical innate intelligence NEVER was a part of allopathy i realize). I had to work hard at scrubbing the word from my website (canned company I contracted with). I am not finished sdrubbing yet so that’s why I don’t post the link. Too much for the chiro haters to jump on at this point (there’s one section on colic I need to get out of there)

    I told them the reason is I want my diagnoses to be portable. Subluxation is completely non-portable as a diagnosis.

    So, this brings me to the discussion – the “broad practice acts.” I don’t really know ANY chiropractors performing these procedures that they may have the legal power to do so. That’s not to deny it doesn’t happen but yes, I agree with the politicians on this one. . .I would not support limiting the scope unless, UNLESS a full scope of practice was modernized to demonstrate post-graduate education can be obtained in certain areas such as needle EMG (with post-grad education) as you cited, or maybe OTC drugs.

    Quid Pro Quo, my allopathic friends.

    1. Christopher Stuart, DC says:

      PS: 2 points to add (hit submit before I was done)

      A. I have been regarded as a pseudo Sam Homala by the profession. I admire his attempts at reform. Nice guy too, from what I have heard. Very classy, unlike me (thus the “pseudo”).

      B. I posted this video at my website from Dr. Evans (it’s one of those lay chalkboard videos, 11 minutes long – worth the look):

      https://www.youtube.com/watch?v=BOjTegn9RuY

      Mandatory viewing for all of my patients now.

      Ironically, it took a Medical Doctor to summarize the chiropractic belief system very well:

      A. LBP is not a disease; more a chronic vulnerability
      B. You’re psychosocial state is very important to outcomes.
      C. 8-10 sessions of spinal manipulation may be valuable, you max out at that (I would take this “per episode”)
      D. Active care is superior than passive care
      E. Early outreach to your “team” is an effective strategy on exacerbations.

      I pretty much have been practicing by these tenants for 17 years. (the quack that I am)

      I think pretty much a LOT of DC’s do.

      I think Dr. Evan’s points on low back pain extend to neck pain, headaches, shoulder pain, etc, but I realize the research has not gone this far (yet). But intuitively, it makes sense, my hypothesis.

      1. Thor says:

        Just watched the video which I found to quite good, and except for one or two points – acupuncture, as it has not been shown to work for anything other than perhaps a placebo effect; and how diagnostic MRIs show that many asymptomatic people actually have structural anomalies, implying that incidental findings are clinically significant (there are routine findings with many diagnostics) – actually totally acceptable. And enjoyable. And appropriate.

        But with all due respect, Christopher, it is far less of a glowing endorsement about chiropractic care for LBP – the only proven method of chiropractic manipulation – that you seem to be making it out to be. In fact, chiropractic was only briefly mentioned once I think, and at the end of the presentation. It was almost an aside, mentioned in passing, and on a par with acupuncture and massage. If only chiropractors in the real world practiced according to his guidelines! The vast majority do not. Period. Instead of back manipulation having a small place in the subject of LBP care, most DCs jump right in to thrust adjustments. They usually consider the “back-crack” as what they do; chiropractic is synonymous with high-thrust spinal manipulation. And if they can, they’ll also go to the neck as quickly as possible. And many want to be PC “doctors”.

        In my mind, with this video clip (by an MD even), you’re offering a blatant, yet sophisticated, “bait and switch”. You are to be commended for being such a conscientious chiropractor, like Sam Homola and Thinking-Chiro. You guys certainly exist. What many here are saying is that you guys are a rare breed in the field. And there is precious little evidence that it is in the process of a major overhaul, or make-over, if you will.

  22. Adam says:

    I am deeply discouraged to see such hateful rhetoric. The world is really going into the toilet. I remember when we loved our fellow neighbor, and Doctors and Teachers were actually paid well and even respected in the community.

    Now its the MBA who is in charge of the hospital staff and he makes twice what the Docs make and tells them what to do. 5 MDs can be replaced by 10 low paid medical assistants and if you notice how young EMTs are getting, you’ll see costs are being cut everywhere in healthcare. Quality in general is obviously plummeting but its not the fault of Chiropractic that healthcare itself is going through massive sweeping changes!

    We naturally attack what we dont understand and Chiropractic is very difficult to understand. Once you do however, you look for the best Chiro in town, and never look back. MDs need to protect their turf, because they’ve been shitting all over so many people for so long, their practice of doing so little for so many as fast as possible, without noticing the trail of wreckage left behind, is becoming more than suspicious. This conversation just got a truth injection!

    1. simba says:

      You really have never read history before, have you? Go to archive.org and look up basically anything written not-in-the-modern-age. It may help.

      In fact, read about the history of Chiropractic, you might learn something.

    2. Chris says:

      “We naturally attack what we dont understand and Chiropractic is very difficult to understand.”

      No it is not difficult to understand. Especially since they cannot prove their claims. This was quite evidence in a UK legal case:
      http://en.wikipedia.org/wiki/BCA_v._Singh

      By the way, what is really terrible are folks who claim to have effective treatments, but they either do nothing or cause harm:
      http://whatstheharm.net/chiropractic.html

      Of course if you evidence that chiropractors have effective treatments for things other than lower back pain, say like for the OB/GYN items listed early in the article, then please produce those peer reviewed papers.

    3. AdamG says:

      Once you do however, you look for the best Chiro in town, and never look back.

      What exactly can the “best Chiro” offer that I can’t get from my Physical Therapist?

      1. WilliamLawrenceUtridge says:

        A wide range of unnecessary and expensive goods and services?

    4. KayMarie says:

      Really, you break your leg and you are only going to chiropractor, or get appendicitis and he’ll adjust it right out of your body?

      Hopefully your best chiro in town knows when to send your butt to the hospital if you are going to never go them again on your own.

    5. WilliamLawrenceUtridge says:

      We naturally attack what we dont understand and Chiropractic is very difficult to understand.

      No it’s not. Chiropractic claims that either there is an “innate intelligence”, a form of vitalism, that keeps the body healthy, that is delivered through the nerves (straights) or the nerves are powerfully responsible for, in fact necessary for, the healthy functioning of the organs (mixers). Nerves are allegedly kept healthy by removing small, undetectable impingements on the nerves known as “subluxations” (both), though these subluxations have never been demonstrated in any objective tests and wen two chiropractors are given the same patient, they can’t agree where they are.

      The problem is that chiropractic is understood by skeptics, but not by legislators. And that chiropractors want, in fact insist on, greater respect than they deserve – the title and respect of doctors, when they are really just physiotherapists.

      If the MBA you complain of were an honest and informed broker, they would ensure chiropractors were kept out of hospitals and not treated as the peers of doctors.

      Once you do however, you look for the best Chiro in town, and never look back. MDs need to protect their turf, because they’ve been shitting all over so many people for so long, their practice of doing so little for so many as fast as possible, without noticing the trail of wreckage left behind, is becoming more than suspicious. This conversation just got a truth injection!

      How do you know who the best chiro in town is? The most lucrative practice? Does that indicate skill and experience – or does it indicate they’ve attended many of the “practice-building” seminars that are so necessary to make chiropractic profitable? Doctors may be protecting their turf (from quacks), chiropractors keep trying to forcibly expand theirs into nutritionists (selling vitamins), homeopaths, primary care practitioners, pediatricians, neurologists, etc – but that doesn’t change the fact that they are at best physiotherapists with an embarrassing history and worse central dogma.

  23. Adam says:

    I dont see how a random legal case in the UK can be cited as a good example an entire profession isnt backing up their claims. Truth is, as any solid business person worth his salt knows, no business that does nothing or worse can surive, period.

    No Chiropractor survives in business unless he is very good at several key things: Adjusting well, referring appropriately, and being a sound business person which means delivering a valuable service for a fair price.

    Adjusting well is a highly sensitive skill that takes tens of thousands of hours to attain, and no PT has any idea what I am talking about, because they focus on exercise; more specifically rehab after surgery and even more specifically rehab after a stroke. This is a difference in training.

    To adjust a human body without hurting the patient, in a way that helps a hurting, bent over limping person stand up again and sends the patient home walking with a normal reciprocating gait, able to sleep again, able to at least temporarily function in their daily lives again, work again- all without medicine, just with their hands: this is what Chiropractors do and are trained for. I suppose with the latest understanding of the harms and overuse of opiates in medicine, it might be tempting to say that its the Chiros hurting people, not little ol’ me.

    Its pure survival of the fittest. The market really does weed out the bad apples. Good doctors of all sorts survive with their exceptional skills. Bad doctors dont, period.

    Of course, this type of disgruntled patient might eagerly generalize their experience and extrapolate their single experience into representing the whole field of Chiropractic as being quackery, which is what I think fuels such hateful rhetoric as I see here. You just have to find the Chiropractor with the most highly honed skills in town and you will appreciate what I am talking about, and that my friends, just isnt taught in PT school.

    If you ever saw with your own eyes the kind of skills I am talking about, believe me you wouldnt dare utter such hateful words toward such skill and respect for the human frame. Thomas Edison said, ‘The Doctor of the future will not give medicine but will rather interest the patient in care of the human frame, in diet, and in the cause and prevention of disease.’ This level of skill takes decades and tens of thousands of hours of intense study and hands -on experience to perfect.

    No offense meant, but seriously no PT can even come close to the kind of manual therapy I am referring to, unless your goal is to get stronger. This kind of expertise can only be marveled at, no matter who you are.

    Dont get me wrong the right PT for the right job certainly has his or her place. Many Chiropractors work closely with PTs and MDs, & there are integrated clinics opening up all over as we begin to settle into our new integrated cooperative healthcare model. Skills are converging into a better integrated whole. There are only a few still stuck in old ideas, and the market takes quick care of them.

    Some people just suffer and decide against going to the Chiropracor and dont ask around to find the best one, and thats fine too. Nothing worth the effort is ever easy, and that includes finding the best Chiropractor in town. If you just want to exercise on top of your dysfunctioning joints, you are free to do so.

    Those of us who have found great relief in exceptional Chiropractors remain grateful. The real fight isnt between DCs and MDs or PTs. The real fight should be between the big thriving business of giant hospital conglomerates underpaying Doctors and overpaying MBAs to continue cutting their employees pay, and improving margins for shareholders.

    Its the divide thats forming between Doctors and patients while shareholders are running to the bank with profits once belonging to highly trained Drs, driving down the income for all Doctors, and eliminating the stand alone sole- proprietor Doctor trying to keep his private practice above water. The loss of quality in healthcare as the Walmart effect is experienced by all of medicine should be the real topic of discussion here if you were at all concerned with patient outcomes. It isnt as simple as you want to make it. Its much more complicated and accelerating.

    1. simba says:

      This caught my eye:

      ” Truth is, as any solid business person worth his salt knows, no business that does nothing or worse can surive, period.

      No Chiropractor survives in business unless he is very good at several key things: Adjusting well, referring appropriately, and being a sound business person which means delivering a valuable service for a fair price.

      Its pure survival of the fittest. The market really does weed out the bad apples. Good doctors of all sorts survive with their exceptional skills. Bad doctors dont, period.”

      So do you believe that psychics, reflexologists, acupuncturists, moxibustion specialists, love spell specialists, and angel healing card readers are all doing ‘something’, i.e. performing a real psychic service, real therapeutic effects, or actually communicating with angels/demons?

      Is it not instead possible that it is the interaction, the reassurance, the feeling of ‘doing something’ and the experience that keeps the customers coming back for more?

      Heck, doctors and quacks of 300 years ago or more had plenty of customers even though basically everything they were doing was useless, because they had no way other than anecdotes of telling what worked. Most problems are self-resolving or susceptible of being interpreted as ‘improving’ via the placebo effect, so even if you have the most useless treatment alive, most of your customers will go away happy. All you have to do is cultivate a good bedside manner and a big smile as you charge ‘em.

      My grandmother attended a chiropracter. Her walking steadily deteriorated as she continued to be convinced it was ‘working’ (though only for short periods of time immediately after the treatment), the chiro told her she had to come back regularly (once a week or more) for treatment since ’10 years of arthritis can’t be cured in a year’. By most chiropractic standards that one would be considered a ‘bad apple’, let alone by skeptic standards. But hey, their patients loved them. They’re still going.

    2. WilliamLawrenceUtridge says:

      Truth is, as any solid business person worth his salt knows, no business that does nothing or worse can surive, period.

      Homeopaths, hedge fund managers, Stanislaw Burzynski, Bernie Madoff, naturopaths, After the Rapture pet care, chiropractors and priests.

      Adjusting well is a highly sensitive skill that takes tens of thousands of hours to attain, and no PT has any idea what I am talking about, because they focus on exercise;

      Canadian Physiotherapy Association says 150 hours. Oh, and they offer manipulation, not merely exercise.

      I suppose with the latest understanding of the harms and overuse of opiates in medicine, it might be tempting to say that its the Chiros hurting people, not little ol’ me.

      False dilemma, you’re pretending chiropractic care and opiates are the only two possible treatments available, and that chiropractic care presents no risks. False – there are myriad treatments for a world of conditions, and chiropractic care is only proven to help with back pain (oh, and chiropractic care appears to increase the risks of stroke.

      Of course, this type of disgruntled patient might eagerly generalize their experience and extrapolate their single experience into representing the whole field of Chiropractic as being quackery, which is what I think fuels such hateful rhetoric as I see here.

      I had a very nice chiropractor, and she also seemed to help with my msk pain. On the other hand, she kept adjusting my neck even when I didn’t want her to, and I have found that since I stopped going, I don’t really miss her help.

      No offense meant, but seriously no PT can even come close to the kind of manual therapy I am referring to, unless your goal is to get stronger.

      Your incredulity is matched only by your ignorance. Now that physiotherapists include spinal manipulation as part of science-based practice, what will you do? Expand into nutrition some more?

      1. Harriet Hall says:

        If adjusting well is a skill taking tens of thousands of hours to attain, we can assume that recent graduates of chiropractic schools don’t have that skill and should be avoided.

        1. William says:

          @Dr.Hall, no one should argue that.

          1. Windriven says:

            Why not?

      2. William says:

        @WLU Duh… and you’re not ignorant? You didn’t even read your own link which refers to post-certification, shall I repeat it brains ? Manipulation is not part of a Canadian PTs core. It’s an ELECTIVE for a masters degree.

        The Canadian Physiotherapy Association offers a curriculum of continuing education courses in orthopaedics and manual therapy. The program consists of 5 levels (7 courses) of training with ongoing mentorship and evaluation at each level. The orthopaedic curriculum and examinations takes a minimum of 4 years to complete. However, upon completion of level 2, physiotherapists can apply to a unique 1-year course-based Master’s program in advanced orthopaedics and manipulation at the University of Western Ontario to complete their training. This program accepts only 16 physiotherapists annually since 2007. Successful completion of either of these education streams and their respective examinations allows physiotherapists the opportunity to apply to the Canadian Academy of Manipulative Physiotherapy (CAMPT) for fellowship.

        Here’s your 150 hours!

        Our chiropractic quarrel here is limited to MDs,DOs, and actual PTs. Period!
        How many times have I heard you and the other amateur internet sleuths who want to be lap dogs to the writer/editors spouting off without really knowing what you’re talking about. It’s you layman usually hurling profanities.

        1. Jopari says:

          Profanities? We all refrain from that, if you took the time to read the comments section in other articles, and the articles themselves, you would notice that profanities are uttered by the illogical supporters of quackery.

          1. Andrey Pavlov says:

            Well, not entirely Jopari. A couple of others here are known to let a few fly. Myself included.

            Though it is very rarely (if ever) the opening volley, of course.

          2. Windriven says:

            “We all refrain from that,”

            That may be a bit of an overstatement.

          3. Jopari says:

            Apologies, tend ro refrain.

            1. WilliamLawrenceUtridge says:

              Ruh-ro, sperring error :)

        2. Jopari says:

          Physiotherapy is NOT chiropractice. You mentioned thousands of hours, not 150.

        3. WilliamLawrenceUtridge says:

          You didn’t even read your own link which refers to post-certification, shall I repeat it brains ? Manipulation is not part of a Canadian PTs core. It’s an ELECTIVE for a masters degree.

          I didn’t read it, no, because the point is – now that it has been tested, PTs are offering it too. Soon it will probably be part of their core education, and chiropractors will be even more unnecessary and underskilled.

          Besides, my real point is that a science-based assessment of spinal manipulation suggests that it requires only 150 hours, not tens of thousands. I’m not sure what your point is. That it’s not part of the core curriculum? So what?

    3. Jopari says:

      Give me an example of a chiropractor you have decided has gained skill to the point that we don’t have anything bad to stay, and provide his address of work, so that some of us may be able to evaluate what the person is doing.

      Now, also provide evidence that what he did actually helped, what does he treat? How did the symptoms recede? Was it replicable? Was it better than placebo? Is the illness one of those that gets better and worse erraticly?

      Truly, if a chiropractor like the one you mentioned exists, and he can actually perform the miracles you say he can, I wouldn’t have anything to say save one sentence.

      BEFORE A CHIROPRACTOR HAS ATTAINED THAT PROFICIENCY HE OUGHT NOT PRACTICE.

      1. Windriven says:

        “Give me an example of a chiropractor you have decided has gained skill to the point that we don’t have anything bad to stay”

        He has done the honorable thing and retired. Not the skill maybe. The wisdom.

  24. Adam says:

    Practice… It means working towards becoming proficient. & thats why we call it practice. But sure, I’d recommend finding the one who has had the most practice. If you practice almost anything for ten thousand hours -ish, you become really good at it.

    Its no different with Chiropractic or music or medicine or law or engineering or mathematics. After formal training, one learns much more as he practices his skill regularly, putting that training to good use and refining it further, much like how you practice your writing and naturally it improves with practice.

    This further demonstrates how extremely difficult a task it actually is, to perform Chiropractic well. It cannot be taught in 150 hours elective courses and it isnt something one can pick up at a weekend seminar. If you got your wish and it disappeared, it would be at your own detriment, or that of your loved ones.

    The scope of practice issue, (which is expanding by the way, not diminishing), is an effort for DCs who are willing and able to train further and successfully pass specialty board certification in Advanced Clinical Practice, the right to prescribe a limited formulary of medicines, like anti- inflammatories, that are recommended in Best Practice Guidelines for treating musculoskeletal injuries, thereby integrating healthcare further for optimum public health. It is not an effort by DCs to give more breast and proctology exams, as implied,

    1. WilliamLawrenceUtridge says:

      According to the Canadian Physiotherapy Association, or whatever it is called, all you need is 150 hours to perform the basic techniques necessary for the sole scientifically-proven intervention, which is the relief of back pain. Everything else a chiropractor does is unproven nonsense and shouldn’t be encouraged. They are not primary care providers and to pretend they can do anything but treat musculoskeletal conditions is to betray patient trust in the medical system.

      Its no different with Chiropractic or music or medicine or law or engineering or mathematics. After formal training, one learns much more as he practices his skill regularly, putting that training to good use and refining it further, much like how you practice your writing and naturally it improves with practice.

      I’ll just point out that chiropractors get four years of education or something, then are unleashed onto the world. That would be reasonable if they were just a type of physiotherapist. But they’re not. They pretend to be doctors. Real doctors get four years of medical school followed by several more years of internship where the real learning begins, and more if you want to specialize.

      And those 10,000 hours of practice are worthless if you are trying to learn something that is impossible (i.e. that spinal manipulation can impact organ health or disease progress).

      This further demonstrates how extremely difficult a task it actually is, to perform Chiropractic well. It cannot be taught in 150 hours elective courses and it isnt something one can pick up at a weekend seminar. If you got your wish and it disappeared, it would be at your own detriment, or that of your loved ones.

      Can you prove this by providing a scientific citation of a controlled trial that demonstrates chiropractic care offers superior health benefits beyond mere muscle and joint pain?

      The scope of practice issue, (which is expanding by the way, not diminishing), is an effort for DCs who are willing and able to train further and successfully pass specialty board certification in Advanced Clinical Practice, the right to prescribe a limited formulary of medicines, like anti- inflammatories, that are recommended in Best Practice Guidelines for treating musculoskeletal injuries, thereby integrating healthcare further for optimum public health. It is not an effort by DCs to give more breast and proctology exams, as implied,

      Except some chiropractors are trying for primary care status. I assume you are active in the state legislators attempting to restrict their scope of practice to just muscle and joint conditions?

  25. William says:

    @WLU
    I’ll bet you didn’t know that it takes 18 months for a Canadian PT to take that 150 hour course. So 18 months to learn that one scientific intervention for LBP? And why don’t you tell us what those PTs actually learn during that course. Just Low back technics? Bear in mind this is an elective course and not part of their core.
    And while you’re at it, it’s only been about 25-30 years that MDs and DOs take 3 years + post degree training. In the early to mid 80s, US DOs could do a one year internship and hang there shingle out to practice family medicine.
    You don’t know what you’re talking about based on your one chiropractic experience.

    1. William says:

      So WLU, whether it’s in a residency or in an office, you learn what you practice on the job .

      1. WilliamLawrenceUtridge says:

        I’m not sure what your point is. It may be spread out over 18 months or 18 days, it doesn’t matter – a science-based approach to spinal manipulation doesn’t take three years and above all, doesn’t claim to cure anything but musculoskeletal pain. There’s nothing special about chiropractic that can’t be delivere by a physiotherapist, beyond the unwarranted criticisms of real medicine and hyperbolic, inaccurate information about the benefits of chiropractic care.

        And while you’re at it, it’s only been about 25-30 years that MDs and DOs take 3 years + post degree training. In the early to mid 80s, US DOs could do a one year internship and hang there shingle out to practice family medicine.

        For one thing, DOs are a bit of a special case because of their history as former quacks who abandoned their quackery. For another thing, this is a laudable indication that a gap was noted in the training of DOs that was addressed by further training (and probably one of the reasons DOs are now seen as MDs, and why the standards for their schools have risen to be on par with MD schools). And for a third, this has nothing to do with the scope of practice of chiropractors (ludicrously broad and getting broader for the most part by direct lobbying rather than scientific evidence) or physiotherapists (appropriately limited to problems of bone, muscle and joint).

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