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349 thoughts on “Chiropractors as Family Doctors? No Way!

  1. Harriet Hall says:

    @jhawk,

    “Will this monetary award pass through my portable mercola-toxin elimanation-life extension water filter?!”

    I’m not sure. Ask your homeopath.

  2. nybgrus says:

    I don’t think this is the case in many instances though. Scar tissue can be laid down due to a chronic degenerative process without inflammation.

    Fair enough and I agree. I was not intimately familiar with the details of tendinosis vs tendonitis so I looked it up.

    However, there is no descriptors I could find anywhere of tendinosis of the back. It does not seem to be a recognized entity. Nor would it coincide with much of the arguments here about facet joint and capsular problems proferred by the chiros, since that would not fall under the tendinosis umbrella anyway.

    Furthermore, every single evidence based guideline I could find on treatment and management was essentially of very low quality – in other words, no good evidence to support any particular treatment regimen. However, what evidence there was all seemed to converge on some common points:

    Eccentric exercise, movement within non-painful ROM and extended gradually, rest, ice, compression, and well, that’s about it. In the sum of my readings, I couldn’t find anything that would support something like HVLA or other forcible mobilization as a treatment.

    When laid down in this degenerative manner it makes sense, IMO, to apply physical mobilization to increase range and reduce scar tissue.

    Since it is, by definition, a non-inflammatory chronic misuse issue, I fail to see how physical mobilization of the chiropractic type would be of benefit… let alone the fact that it is not described as a source of back pain outside of hamstring tendinosis or other such secondary issues (in other words, you would treat the distant tendinosis to fix the back pain, not the back directly).

  3. nybgrus says:

    Sorry, I meant to include this link which sort of sums up a lot of what I had been reading. I can’t link to the bulk of it though, since it was through DynaMed and UpToDate which require pay access.

  4. jhawk says:

    @nybgrus

    “However, there is no descriptors I could find anywhere of tendinosis of the back. It does not seem to be a recognized entity. Nor would it coincide with much of the arguments here about facet joint and capsular problems proferred by the chiros, since that would not fall under the tendinosis umbrella anyway.”

    I agree. I have never heard of tendonosis being described as a back condition. It only seems to show up in a few tendons (achilles, patellar, proximal hamstring, ecrb, supraspinatous and bicep). I was just using the tendonosis/itis as an example that scar tissue can be laid down with minimal to no inflammation but tendons, ligamnents and facet capsules all share similar composition and therefore are subjeect to similar degenerative and inflammatory processes.

    “Furthermore, every single evidence based guideline I could find on treatment and management was essentially of very low quality – in other words, no good evidence to support any particular treatment regimen. However, what evidence there was all seemed to converge on some common points:
    Eccentric exercise, movement within non-painful ROM and extended gradually, rest, ice, compression, and well, that’s about it.”

    Yep, there is not much if any high quality evidence for Tx of tendonosis and I agree that eccentric exercises have the most support via research and my clinical experience. The trouble is, IMO, eccentric loading exercises are tough to perfrom (except for the achilles) due to problems of recruitement and actual full lengthening of the tendon.

    “In the sum of my readings, I couldn’t find anything that would support something like HVLA or other forcible mobilization as a treatment. Since it is, by definition, a non-inflammatory chronic misuse issue, I fail to see how physical mobilization of the chiropractic type would be of benefit… let alone the fact that it is not described as a source of back pain outside of hamstring tendinosis or other such secondary issues (in other words, you would treat the distant tendinosis to fix the back pain, not the back directly).”

    I didn’t mean to imply HVLA was being used to treat tendonosis (again just an example that not all scar tissue lay down requires inflammation). I would treat tendonois with soft tissue mobilization though (along with eccentric’s). Basically putting tension on the area and using movement to lengthen the tissue. In the link you posted this type of treatment would fall under therapeutic exercises. Thanks for the link, wish I could get to all of info but it at first glance it looks like you have be a medical doctor/student.

  5. nybgrus says:

    @jhawk:

    Well it seems we are pretty much in total agreement on the topic.

    However, the whole point it was brought up was that I was discussing the bread and butter of chiropracty – HVLA maneuvers (or other forcible maneuvers to induce mobility) of the back and why there isn’t any evidence to support it. You’ve further confirmed this. Everything else we discussed on the topic of tendinosis is well within the purview of physical therapists.

    I’d be happy to dig up the links I looked at and put them up here later today (well, at the end of my day, whenever that may be) if you have access to DynaMed and/or UpToDate.

    And yes, I am a medical student, starting my first day of vascular surgery service at a bright and cheery 05:30.

  6. jhawk says:

    @nybgrus

    “I’d be happy to dig up the links I looked at and put them up here later today (well, at the end of my day, whenever that may be) if you have access to DynaMed and/or UpToDate.”

    I have access to DynaMed but not uptodate. No need to dig up your links.

    “And yes, I am a medical student, starting my first day of vascular surgery service at a bright and cheery 05:30″

    I thought I heard you mention you were a med student before. I am not sure how you find the time to post here! I meant to say the link to AAPMR was full of good info but it looks as though one has to be a medical doc/student to get full access.

    “However, the whole point it was brought up was that I was discussing the bread and butter of chiropracty – HVLA maneuvers (or other forcible maneuvers to induce mobility) of the back and why there isn’t any evidence to support it. You’ve further confirmed this.”

    I disagree here. I think there is evidence of efficacy of HVLA for uncomplicated LBP, but HVLA is not more effective than other treatments.

    “Everything else we discussed on the topic of tendinosis is well within the purview of physical therapists.”

    Agreed. I actually have quite a few patients that “argue” with me that I am a PT and not a chiropractor! IMO, it is not the letters behind your name but how you apply the knowledge you learned while earning those letters.

  7. nwtk2007 says:

    There is some evidence supporting manipulation of the spine, both cervical and lumbar, which has been presented ad-nausium within the threads of this blog and I won’t post more about that. Its not strong evidence but there is just a bit. look back thru the threads on chiropractic if you wish.

    As to motion being a key to recovery of joint related injury, here is a link with many references of recent origin regarding the importance of mobilization in recovery after knee surgery.

    http://drmillett.com/attachments/article/87/Rehabilitation%20of%20the%20arthrofibrotic%20knee.pdf

    There are a few articles regarding deep vein thrombosis and mobilization after knee replacement but this is relatively new and still rare in most of the population after arthroscopic knee surgery. The emphasis to mobilization in the literature appears to be a return to normal function more quickly amongst other factors.

    Motion is pretty clearly important in recovery of a joint after injury. When a neck or back are injured after trauma, (MVA, slip and fall, sports injury, etc), fibrotic repair is the norm where there is connective tissue damage. It seems clear that recovery to full function more quickly is a function of motion.

  8. @jhawk, unfortunately it *is* about those letters behind your name. “, D.C.” will always be associated with quackery.

    @jhawk, @nwt, why did you pursue chiropractic instead of PT?

  9. nwtk2007 says:

    At least you admit it skepticalhealth.

    I was looking into PT and a girl friend of mine, who is a PT, recommended that I go into Chiropractic since the chiro’s, in her opinion, seemed more highly trained in musculoskeletal rehab, could do all the PT’s could do in that regard, and could do so without referral from an MD. Its all her fault!

    Her most recent licensing seminar at that time was also taught by a chiro.

    We had little notion of some of the silliness many chiros were and still are into. Heck, at the time the PT and ortho offices I visited had the reflexology posters on their walls. It seems one can be a quack in all areas of health care. Or not.

  10. Harriet Hall says:

    @nwtk2007,

    “There is some evidence supporting manipulation of the spine, both cervical and lumbar, which has been presented ad-nausium within the threads of this blog and I won’t post more about that. Its not strong evidence but there is just a bit.”

    The whole discipline of chiropractic was based on spinal manipulation. How does “just a bit” of evidence justify its existence?

  11. jt says:

    Without resorting to the ad hominem attacks that seem to be customary here, I will direct your attention to a study supporting Chiropractic which you will undoubtedly disparage and ignore:

    http://www.ncbi.nlm.nih.gov/pubmed/22213489?dopt=Abstract
    http://www.annals.org/content/156/1_Part_1/1.full.pdf+html

    I know you will disregard this because this information is dissonant with the cognition “Chiropractic is unnecessary and possibly harmful” which you have accepted and internalized based on negative anecdotes and perhaps an old epidemiological study showing a mild correlation between Chiropractic and a rare form of stroke.

    In addition, it is helpful to you to protect your in-group at all costs to ensure your survival and improve your positive self concept–which is understandable. After all, fundamentally there is a competition taking place here which you are uncomfortable to admit you may be losing. After all, alternative health care is a fast growing phenomenon which is out of your control to subdue (15188733, 9820257).

    Modern medicine has helped a great many people, but it has hurt them as well. There is a certain balance at play here which should be considered. Unfortunately, this balance has tipped in the wrong direction–Iatrogenic deaths outnumber all other deaths in this country:

    http://orthomolecular.org/library/jom/2005/pdf/2005-v20n01-p021.pdf

    Condition Deaths Cost Author

    Hospital ADR 106,000 $12 billion Lazarou,1 Suh 31
    Medical error 98,000 $2 billion IOM 6
    Bedsores 115,000 $55 billion Xakellis,7 Barczak 8
    Infection 88,000 $5 billion Weinstein,9 MMWR 10
    Malnutrition 108,800 ———— Nurses Coalition 11
    Outpatient ADR 199,000 $77 billion Starfield,12 Weingart 70
    Unnecessary Procedures 37,136 $122 billion HCUP3,13
    Surgery-Related 32,000 $9 billion AHRQ 71

    TOTAL 783,936 $282 billion

    You have no legal power to continue your conspiratorial boycott of the Chiropractic profession since federal District Court Justice Susan Getzendanner ordered that you stop in 1987 with this permanent injuction order:

    http://jama.ama-assn.org/content/259/1/81.extract

    She asserted, “The final question is whether this concern for scientific method in patient care could have been adequately satisfied in a manner less restrictive of competition. It would be a difficult task to persuade a court that a boycott and conspiracy designed to contain and eliminate a profession that was licensed in all fifty states at the time the Committee on Quackery disbanded was the only way to satisfy the AMA’s concern for the use of scientific method in patient care.” ( http://www.chiro.org/abstracts/amavschiro.pdf )

    Ouch. So, where do you go from there? It seems you have moved to the internet to preach to the congregation; extolling the virtues of the scientific method as a way to cover up your deep seated hatred of the competition.

    That’s a shame, because what is in the patients’ best interest is multidisciplinary patient-centered care. All health care providers should be working together with open minds to achieve the best outcomes for patients. Look in the mirror and ask yourself if you are putting the patient first.

  12. nybgrus says:

    I thought I heard you mention you were a med student before. I am not sure how you find the time to post here!

    I think quickly, I type fast, and I am blessed with little need for sleep! Lol, well, the last two at least are definitely true. I am quite content averaging 5-6 hours per night.

    Also, I find that posting here and my interactions with the authorship and commentariat (including those I disagree with and/or I find to be cranks) has actually helped me immensely in school. Couple that with my solid undergrad education, post-grad molecular pharm research, and 3 years of being an ER, ortho, and trauma tech prior to starting med school and I manage to find the time.

    I meant to say the link to AAPMR was full of good info but it looks as though one has to be a medical doc/student to get full access.

    Ah yes, I was running my VPN for institutional access, so it may well have been and I didn’t realize it.

    I disagree here. I think there is evidence of efficacy of HVLA for uncomplicated LBP, but HVLA is not more effective than other treatments.

    Well, we are dancing around a central issue here. I don’t disagree with this statement either. However, my personal opinin would be that the HVLA aspect is superfluous to the encounter (though I am very ready to change my opinion on that) and more importantly the link between this and the concept of tendinosis as a non-inflammatory cause of joint point is missing, as I outlined.

    To tie in what nwtk said:

    Motion is pretty clearly important in recovery of a joint after injury. When a neck or back are injured after trauma, (MVA, slip and fall, sports injury, etc), fibrotic repair is the norm where there is connective tissue damage. It seems clear that recovery to full function more quickly is a function of motion.

    I can agree with this statement… superficially. However, the statement does not imply a role for HVLA. Nor does it imply (or necessitate) chiropractic type treatment for chronic joint issues. Remember, that the crux of what I had posted earlier was that a return to ROM within pain limits was key for rehabilitation. This is an ongoing and progressive process, not a rapid back-cracking sort of process (which I would argue is not helpful in acute cases, and is mostly – but I will admit not all – placebo response in chronic cases).

    Agreed. I actually have quite a few patients that “argue” with me that I am a PT and not a chiropractor! IMO, it is not the letters behind your name but how you apply the knowledge you learned while earning those letters.

    And that is what I have been driving at in all these posts, which SH echoed as well – the sad part is that DC is intimately and fundamentally associated with quackery. And, quite frankly, you sound like a reasonable chiro that I would be inclined to refer my patients to – but I would not be able to do so merely based on your credentials. I could only justify it after extensive conversation with you and an understanding of what it is you do and believe in.

    Of course, as nwtk points out, every profession has its quacks – and we here are more than happy to point them out, whether they are PT, NP, MD, or PhD. A quack is a quack. The thing is that for MD the quacks are truly the exception, whereas the opposite is true for DC. And that is the sad state of reality.

    And of course, Dr. Hall closes with an argument I have made numerous times as well – the evidence exists, in a minimal and narrow fashion for a small part of what chiros do. How does that justify an entire profession, with an entire post-grad college system, asking for rights to be PCPs? The point of SBM here is to say that you can’t assume your idea-du-jour will be vindicated at some point since:

    1) That is bad science
    2) History shows us that vastly more often than not, this is not borne out.

  13. nybgrus says:

    boy, no ad hominem necessary and this is much too easy.

    First off, both the articles you linked to… are the same article.

    Secondly, the article demonstrates something we have all known, agreed upon, and further agree is very, very slim pickens for chiros. Namely that manipulation doesn’t seem to do that much better than just giving some advice and talking to people.

    Third, anything from orthomolecular is pretty much pseudoscience, and especially if the lead author is Gary Null, crank extraordinaire.

    Fourth, legal precedent is not a valid basis for scientific medical discourse, as has been explained ad nauseum here.

    Sorry, but you’ve added absolutely nothing to the conversation whatsoever.

  14. @jt, I love that you didn’t include this quote from the same Judge:

    The plaintiffs clearly want more from the court. They want a judicial pronouncement that chiropractic is a valid, efficacious, even scientific health care service. I believe that the answer to that question can only be provided by a well designed, controlled, scientific study… No such study has ever been done. In the absence of such a study, the court is left to decide the issue on the basis of largely anecdotal evidence. I decline to pronounce chiropractic valid or invalid on anecdotal evidence.

  15. @jt, how do you feel knowing that you feed your family only by stealing from the sick and dying?

  16. nwtk2007 says:

    Cheap shot skepticalhealth. I’m sure that the bills for those many thousands literally killed by medical mistakes and errors were paid, whether by individuals or insurance companies or the government. Not to mention the after death cost. And many of those mistakes and errors were probably repeated multiple times.

    Any chiro’s contribution to that pales in comparison.

    How do you think all those medical health professionals feel?

  17. [citation needed]

  18. @nwtk, read the comments in the supplements post (I think more recent than this one), your mythical “doctors kill so many thousands of patients!!!11!!” is discussed there. As to be expected coming from a chiropractor’s mouth, it simply isn’t true.

  19. nwtk2007 says:

    http://www.justice.org/cps/rde/justice/hs.xsl/8677.htm

    This is most likely taken from an article be the Dept of Health and Human Services. In too big a hurry to dig it up but I’ve posted it here more than once.

    No chiro’s in that dept.

  20. Harriet Hall says:

    @nwtk2007,
    You just can’t give up the tu quoque arguments, can you? You provide evidence that conventional medicine can cause harm but you fail to put that fact into perspective with the good that conventional medicine does, and you don’t seem to realize that pointing out problems with conventional medicine doesn’t do anything to further the cause of chiropractic. Your store of arguments is so bankrupt that you are reduced to claiming that chiropractic doesn’t do much harm. Homeopathy is arguably even safer than chiropractic, so why not use it instead?

  21. nwtk2007 says:

    Harriet – “You just can’t give up the tu quoque arguments, can you?”

    Just a response to skepticalhealths comment; same form. OK, I get it, its not tu quoque if a skeptic does it.

    Harriet -”You provide evidence that conventional medicine can cause harm but you fail to put that fact into perspective with the good that conventional medicine does, and you don’t seem to realize that pointing out problems with conventional medicine doesn’t do anything to further the cause of chiropractic.”

    As the sixth leading cause of death being the healers themselves, that being a low estimate, its difficult to put that into perspective no matter how many lives are saved by them. Are you saying thats the price the populace has to pay for decent health care in the medical arena?

    Harriet -”Your store of arguments is so bankrupt that you are reduced to claiming that chiropractic doesn’t do much harm.”

    I don’t recall using that as an argument for chiropractic. In fact, I haven’t tried to further chiro’s cause at all. You misjudge me.

    I see your anti-chiro bias is as strong as ever. Going back to my original position when I entered this silly discussion, this is exactly why you continue to write about chiropractic. Bait. You enjoy the game as well.

  22. @nwtk, your homework assignment tonight is to track down the reports that you are blatantly misquoting. I’m looking at them right now, so the first thing you’ll see is why your numbers are completely wrong and do not represent reality. Next I want you to consider when the report was written, what the data sources were (actually look them up, and see what they considered a “medical related death”), and what technological advancements we have experienced since that time. Finally, I want you to consider why patients are in the hospital in the first place.

    After that, I want you to look at your own profession, and ask if an “adjustment” has ever saved a life. Ask yourself if chiropractic has contributed anything positive to humanity whatsoever.

  23. weing says:

    “As the sixth leading cause of death being the healers themselves, that being a low estimate, its difficult to put that into perspective no matter how many lives are saved by them. Are you saying thats the price the populace has to pay for decent health care in the medical arena?”

    My 2 cents, FWIW, could part of the reason for the deaths due to medical errors be from diversion of resources to CAM, like chiropractic, leaving less resources available for actual medical care?

  24. nwtk2007 says:

    The Institute of Medicine estimates that as many as 100,000 Americans die each year from preventable medical errors in hospitals. That’s about the number of annual deaths caused by auto accidents, AIDS, and breast cancer combined.

    http://www.medicalnewstoday.com/releases/11856.php In this report much of the same information but also suggests that there has been little improvement.

    The sheer amount of material out there regarding medical errors is amazing. Look for your self and get us some accurate quotes skepticalhealth. Its really not relevant to this thread but why not.

    Hello weing. I think your suggestion would be a far reach but not surprising that the medical community would think they might pass the buck on medical errors to CAM and the like. Sounds very republican.

  25. @weing, honestly I could not make that claim. Real medicine is far from perfect. There is still so much we do not know. We constantly update our standard of care in light of new information, and many things that were done in the past it turns out weren’t necessarily benefiting the patient as much as we think. In my reading of the cause of medical errors, one of the largest parts is communication.

    For example, I admit a patient for ischemic colitis. She happens to have high blood pressure on admission, and I choose to continue her 4 anti-hypertensive medications. I do not have access to her medical records and the patient has no insight into the nature of her disease, so I have no information on her “baseline blood pressure.” In my admit orders, I write “Notify the physician if systolic blood pressure is > 180, or diastolic blood pressure is > 100.” That is for the nurse, and I also leave orders for the nurse to take her vital signs every 6 hours. Furthermore, orders are written to let the nurse know that its ok to push 10mg labetalol every 10 minutes for blood pressure readings above the same parameters. These orders, together, should ensure that the patient’s BP is never extraordinarily elevated.

    I admit the patient at 2 AM. She will go for colonoscopy on the following day. Now, at our hospital, nurses don’t take vitals. They have a tech go around and take vital signs. The tech puts them in the computer, and (supposedly) alerts the nurse if any of them are abnormal. Also, there is a shift change between nurses, lets say at 4pm. So now the care of this patient is being transferee to another nurse. The next day I round on this patient, and I see that her blood pressures were 192/105, 198/110, and 197/103 since I last checked on her. No body paged me. Two nurses, multiple techs, all (should have) saw these extraordinarily high blood pressures and a trigger should have gone off in their head, but nobody thought to let me know, despite the fact that I had put an order in the chart to alert me to these circumstances. Also, no labetalol was ever given to the patient to lower her blood pressure.

    This patient very easily could have stroked out overnight and it would be a medical error.

    Who do we blame? Do we blame me for not going to each nurse and saying “Ok, be sure to read the chart and look at all of my orders.” Do we blame the nurse and say “Ok, why did you not notice that one of your six patients had elevated BPs all night long and do nothing about it?” Or do we blame the tech who possibly did not alert the nurse to the elevated BPs? (I’m not a nurse, so I don’t fully understand how all of their workflows fit together.) I suppose the real problem in this case would be a lack of communication between doctors and nurses, inadequate communication at sign-out during shift change, and apathy of a low paid, unskilled tech.

    That is an example of a real error in medicine, which is something that could have been prevented and should not occur in the hospital. Some “errors” are just stupid:

    I recently wrote a complaint to our hospital after observing meals being passed out to patients. The “meal lady” (for lack of a better term) was checking the temperature of the fruit she was passing out. She would take her dirty hand and place it on the patient’s fruit, stick a thermometer in it, and then take the thermometer out and wipe it off with a paper towel. She went to each patient’s room, passing out food, after having touched it with her dirty hands and wiped off the thermometer with the dirty towel. One of the biggest things in hospitals is that as soon as we admit a patient, we are figuring out how soon we can get them out. There is nursing staff dedicated to doing nothing else but expediting patients’ dispositions. One of the reasons for this is nosocomial infection – that is, infection picked up from the hospital. With so many sick people, and so much staff running around, it’s unavoidable, try as we may. A lady going room to room touching patient food with dirty hands is absolutely unacceptable, and who knows if she transmitted any illness that day.

    Other errors occur because medicine is hard. Patients don’t just present with a perfect set of symptoms that we can run a test on that says “this patient has this disease!” And no two patients are the same; some have no other medical conditions, and some have a dozen co-morbidities. A patient may present with chest pain, and we initially think it’s an acute coronary syndrome type thing, but quickly realize once they’re on the floor that it’s an acute decompensated heart failure, which requires a radical shift in treatment. Sometimes you just miss things. Some things just aren’t clear. I think Dr. Crislip (?) from SBM is an infectious disease doctor. A friend of mine went hunting and came down with a weird illness. No one could figure it out, it turns out it was Hantavirus, and an infectious disease doc figured it out. Saved my friend’s life. It would not have even been in my differential. (This was so long ago and before I was in medicine so I may even have the virus wrong.)

    Speaking of… Consider this case. A lady comes to the ER with acute heart failure, so her heart isn’t pumping well enough to adequately perfuse her body, which means that her brain, kidneys, etc, are all receiving less blood than they should. She’s obese, has diabetes, high blood pressure, elevated lipids, and sleep apnea. She’s stabilized in the ER and admitted to the floor for treatment of her heart failure. She needs CPAP because of her sleep apnea, and her family brings her unit in from home. During the night, her sister sees that the mask is slipping off the patient’s face and takes it off instead of repositioning it or alerting the nursing staff. Patient suffers from anoxic encephalopathy because of this (too little oxygen to the brain, causing brain damage.) So the patient died in the hospital, under medical care, but … was completely unavoidable. Due to stupidity.

    There’s a lot of things that go on. Again, medicine is far from perfect. But to spout out these ridiculous numbers, especially when the person saying that is a chiropractor who has never helped “heal” a single human being, is just ridiculous.

  26. Harriet Hall says:

    @nwtk2007,
    “I don’t recall using that as an argument for chiropractic. In fact, I haven’t tried to further chiro’s cause at all.”

    Rubbish! You brought it up on a thread about chiropractic. Am I to imagine that you spontaneously brought up the irrelevant issue of medical errors out of the blue, just out of your disinterested concern for the welfare of the patients of conventional medicine? With no intention of implying any comparison with chiropractic? When you specifically said “Any chiro’s contribution to that pales in comparison.”

    It is obvious from this and earlier threads that you support chiropractic’s cause. If you “haven’t tried to further chiro’s cause” it’s only because there is no way you could accomplish that.

  27. @nwtk, you’re just a dishonest idiot. If you read the repeat from the IOM, it says “estimates from 44,000 to 98,000″, and the estimates are extrapolations from already bad data. That’s why your homework assignment is to read the data sources and read the actual report.

    Pretty sad, to be honest. You crap on real medicine, which saves hundreds of millions of lives each year, and yet you practice quackery that contributes nothing to humanity. I can’t imagine what it feels like to be a zero.

  28. Josh Berndt says:

    I think the root of this long-winded debate can be summed up by the quote…
    “I actually have quite a few patients that “argue” with me that I am a PT and not a chiropractor! IMO, it is not the letters behind your name but how you apply the knowledge you learned while earning those letters.”

    Most us completely disagree with this statement. This topic is about boundaries defined by credentials. Those without credentials and training Should Not have the opportunity to practice like those with the credentials….period.

    Chiros treat non-specific low back and neck with manips…great! That’s it though. They shouldn’t replace family practice docs and practice medicine, they shouldn’t perform rehab and replace PTs, they shouldn’t replace neurologists and treat patients with neurologic disorders claiming to be a chiropractic neurologist, etc…

    Why not? Because credentials matter.

  29. nwtk2007 says:

    skeptical, you and Harriet are the dishonest folk here. But you, especially, as if you couldn’t look at all the data available on medical errors. Its always the same. If a study doesn’t support the SBM’s position, then it must be bad data; has to be.

    And Harriet, I brought it up on another thread, not this one. The ad hominem attacks on the chiros on this thread alone are enough to throw into question your credibility and reason for writing about chiropractic.

    Josh, credentials do matter Josh, I agree. It is simple fact that chiro’s are much more well trained to perform exams and diagnose musculoskeletal conditions that PTs for sure. Replace them? We hire them as assistants. Being point of entry health care, I examine, diagnose, formulate treatment plans, make referrals if needed, and manage cases. The PT’s here in Texas can’t be trusted with that. They don’t have the credentials. Yes, credentials do count.

  30. Uh oh, it looks like nwtk2007 finally cracked :)

    I have *never* seen a PT work for a chiropractor. You guys don’t make enough money nor do you have practices large enough to afford the extra help. Well, at least in our area. This is why you have to resort to scummy marketing techniques and convincing perfectly healthy people that they have mythical diseases. Within a 60 mile radius I have approximately 10 PTs that I refer to (depending on where the patient lives), and none of them have a chiropractor working with them, and they especially do not work under one. I’m not saying there’s not a PT out there somewhere that works with a chiropractor, but I would seriously question the situation if a PT was working for a chiropractor as an “assistant.”

    You are not point of entry health care. You do not provide health care. You do not provide any positive service for patients. You do not treat disease. You, as a “medical professional,” are absolutely useless. In fact, you do nothing but cause harm. You rob from the sick and dying, and you contribute nothing positive to them. You cause stroke, paralysis, and death, while providing nothing positive. A little risk is acceptable if the reward outweighs it, and this very rule of medicine is what completely invalidates chiropractic. There is never an indication to see a chiropractor because the positive (none) is grossly outweighed by the negative (stroke, paralysis, death, robbing the sick and dying, delaying time till patient can receive legitimate treatment, and depleting them of moneys necessary for receiving previously mentioned legitimate treatment.)

    Tell me, chiropractor, how you would handle these cases, as a “point of entry health care professional”?

    1. Systolic blood pressure of 195
    2. FEV1 40% of predicted
    3. DM1
    4. Diabetic ketoacidosis
    5. DVT
    6. Lower extremity cellulitis
    7. Pseudomonas pneumonia
    8. HIV
    9. Pre-eclampsia
    10. Epiglottitis
    11. Acute Stroke
    12. Diverticular abscess
    13. Afib with RVR
    14. MI
    15. Cryptococcal meningitis

    (I’m waiting.)

  31. In fact, it’s an impossibility that a chiropractor would be better educated or trained than a PT. Chiropractors spend a portion of their schooling on marketing, running your practice, and learning about mythical subluxations, and all the other quackery you practice. My first Google result for a PT curriculum (“physical therapy curriculum) did not return anything about marketing classes or other wastes of time in pursuit of their “doctorate.”

    However, my first Google result for “chiropractor curriculum” returns many classes that are a waste of time, including “the scientific basis for chiropractic care” (I almost fell out of my chair, I’ve never read such an oxymoron in all of my life.) But I also see classes in “coding, billing & documentation”, “business & practice management”, “chiropractic office billing essentials”, “chiropractic office management simulation”, “getting into practice”, and “marketing strategies for healthcare professionals.” And that’s just scratching the surface.

    Haha, a significant portion of your “doctorate” is in learning how to run a business. What are you, a doctor of marketing or chiropractic? F-ing pathetic! I hope you realize how pathetic that is. Do you know that there is no equivalent to those classes in legitimate medical schools? My school had exactly zero hours of classes for coding, billing, running a practice, business management, marketing, etc. We simply do not have time to waste on that. You graduate, you go into residency, you learn a little about billing there just an essential when you’re already doing 80+ hour weeks, and then you typically go in with someone, and only then, after 7 to 9 post-college years of education do you learn, as you go along, about running a practice. We don’t waste valuable doctorate hours.

    The even more pathetic thing is that you likely took out student loans to pay for these classes. Yikes.

  32. jt says:

    Do you know what I’m skeptical about?

    I’m skeptical about the validity of a health care system that causes 98,000 preventable deaths per year due to human error ( http://www.nap.edu/nap-cgi/report.cgi?record_id=9728&type=pdfxsum ).

    I’m skeptical about the ethicality of drug companies increasing spending on seductive television ads from $791 million to nearly $2.5 billion From 1996 to 2000 (http://www.nejm.org/doi/full/10.1056/NEJMsa012075 ).

    I’m skeptical about a system that exposed around 4 million people to unnecessary hospitalization in 2008 and likely continues to do so ( http://www.ahrq.gov/research/dec10/1210RA22.htm ).

    I’m skeptical about a a system that produced 429,827 medication errors from 1,081 hospitals in 2002; and likely continues to harm a minimum of 90,895 patients annually (http://www.ncbi.nlm.nih.gov/pubmed/11837551 ).

    Harriet Hall: “You provide evidence that conventional medicine can cause harm but you fail to put that fact into perspective with the good that conventional medicine does, and you don’t seem to realize that pointing out problems with conventional medicine doesn’t do anything to further the cause of chiropractic.”

    Can you provide enough evidence of the efficacy of the conventional medicine system to justify all of the harm that it does? Do you deny that the majority of health care issues are lifestyle-related and mostly preventable? Why is it your life’s mission to disparage and destroy Chiropractic, Acupuncture, and other professions you deem “unscientific” when they help patients without placing them in unnecessary risk? Do you honestly believe that the 74.6% of Americans that use some form of complementary and alternative medicine annually get no benefit whatsoever and are completely deluded ( http://www.cdc.gov/nchs/data/ad/ad343.pdf )? Why would that many people continuously seek out complementary and alternative medicine if the conventional system is doing such a great job of meeting their needs?

  33. Harriet Hall says:

    @nwtk2007,

    How dare you accuse me of being dishonest! I’ve not only looked at the data on medical errors, I’ve written about it at least twice:
    http://www.sciencebasedmedicine.org/index.php/death-by-medicine/
    http://www.sciencebasedmedicine.org/index.php/reducing-the-risk-of-adverse-drug-events/

    “And Harriet, I brought it up on another thread, not this one.”

    Now you are really in denial. Anyone can read your comments on this thread and see that you not only brought up medical errors on this thread, but you made comparisons with chiropractors. What does that say about your honesty and credibility?

    “The ad hominem attacks on the chiros on this thread alone are enough to throw into question your credibility and reason for writing about chiropractic.”

    Apparently you missed one of my comments above, so i’ll repeat it: “I’ll stand up in favor of one thing about what chiropractors do. Spinal manipulation therapy is an effective treatment for common low back pain, although it is not more effective than other treatments. It is also offered by non-chiropractors like DOs, PTs, and Physical Medicine and Rehabilitation specialists, but arguably chiropractors are the most skilled at those manipulations.” Where’s the ad hominem in that? Does that “throw my credibility and motives into question?”

  34. nwtk2007 says:

    skepticalhealth, I’ll give you a little leeway in that you know nothing of that which you speak. You still refer to the host of chiro’s who treat subluxations and a clinic where they rub necks and sell nutritional supplements. There are many of us who treat injuries, work injuries, MVA’s, etc and have very thriving businesses. I run this clinic and also run a CARF certified rehab facility. We do and have hired and trained PT’s dude. Sorry but as I said, you have no idea of that which you speak.

    We are also, in fact, point of entry health care providers who need no referral and practice within our scope of practice. Your quaint little example would not be a scenario for a chiro. We treat musculoskeletal injuries and conditions with physical medicine. How would I handle them? Referral to a proper medical provider. Der.

    How do you handle dental caries?

  35. Please provide the name of your clinic so I can look at its website and see the PTs working for you as an assistant, and not a colleague.

  36. BTW, I’m not elating PTs to be the pinnacle of evidence based physical rehabilitation. I can pick up any list of therapies offered by most PTs and identify more than a handful that are either less than evidence based or wholly disproven. Especially older ones. It’s just that between the two, I’d *infinitely* rather a PT because while they may do things that the patient won’t benefit from, they’re not going to recruit them into their quack practice and shake them down for every penny.

  37. Thank you for not bothering to comment on the fact that a rather large portion of your schooling (“doctorate”, as you claim) is based on learning how to run a practice, while a PT does not take classes in such thing. I’m fascinated that you believe you are more qualified than one, and yet you received less training.

  38. nwtk2007 says:

    I think with the nature of this site and the fact that I do not own the clinic I will refrain from disclosing my where abouts and identity. There are a few ruthless folk here and abouts.

    As to learning about practice management, we only had classes in business law as I can recall. I could have benefited from some classes on how to run a practice, however.

    Also, in this area of chiropractic, we don’t recruit patients into anything. They are hurt, we treat them and they are released from care. Believe me, I like nothing better than releasing patients from care. But I know what you mean. Like LA Fitness and their trainer program. Sign on for a year with so many sessions per month and an initial cost of $200 or so. Believe me, I am no salesman.

    I went to Parker College of Chiropractic. Look on line for the curriculum. I would imagine that the classes that chiro’s take in other colleges regarding how to run a practice are elective also.

  39. Wow.

    Your school’s admission requirements:
    - 2.75 GPA (a “C” average)
    - 75 credit hours from college (what is that 2.5 years of college?)

    From the “techniques” page:

    https://parker.edu/future/Academics_and_Programs/Chiropractic_Technique/

    Activator Technique: Activator I is Basic Activator Protocol. It is a full-spine technique developed by Dr. W. C. Lee and Dr. A. W. Fuhr. [b]The technique uses a system of analyzing body mechanics for diagnosis and utilizes a small, hand-held instrument called an “Activator” for delivering a precise adjustment to correct subluxations.[/b] This technique stresses the necessity of not only knowing when and where to adjust, but also when not to adjust.

    Extra Spinal Analysis & Technique:[b] This course presents students with the fundamentals of detecting and correcting extra-spinal subluxations.[/b]

    … not to mention the courses teaching completely quacky chiropractor adjustment tables, the quacky instrumentation, etc.

    But, Parker College also offers electives in:

    Upper Cervical Technique
    Upper cervical technique originated with the famous “toggle recoil” of chiropractic’s historical developer, B.J. Palmer. Because of the unique anatomy, biomechanics, and neurophysiology of this region, upper cervical chiropractic care focuses primarily on the correction of the atlas and the axis (C1 & C2).

    ^^ NUCCA quackery. Pure, unadulterated quackery.

    Sacro Occipital Technique
    A technique which assesses the patient using a number of particular physical indicators to determine which of three primary categories the patient is presenting with. This in turn gives rise to a specific procedure for that category, along with further ancillary procedures to work with the patient’s skeletal, cranial, and neurological systems in order to restore a more optimum level of balance and function.

    “Restore balance and function.” QUACKERY.

    Applied Kinesiology Technique
    Applied Kinesiology (AK) is a health care system based on the work of Dr. George Goodheart that evaluates the structural, chemical, and mental aspects of health using manual muscle testing combined with other standard methods of diagnosis. AK is a non-invasive system of evaluating body function that allows for the detection and correction of subluxations, fixations, pelvic categories, and cranial faults.

    Subluxations AND Applied Kinesiology? In the same class? You guys paid money for this!! How can you not be outraged?? You actually paid $9000/trimester to have someone teach you a completely fake and bogus diagnostic technique.

    … Classes in the “nerv-o-scope.” Was it required that all students buy one?

    And *wow*, BEST therapy (for those who don’t know, it stands for “bio-energetic synchronization therapy”):

    BEST
    BEST is a non-forceful, energy-balancing, hands-on procedure used to help reestablish the full healing potential of the body. BEST principles acknowledge the concept that nerve interference caused by sub-conscious emotional memory override can cause imbalance in our autonomic nervous system leading to exhaustion of our organ systems over time with concomitant ill health.

    COMPLETE QUACKERY. Question: Did you believe this garbage when you learned it? Do you still believe it?

    NET
    Neuro Emotional Technique (NET) is a physical stress reduction approach that can improve many chronic and unresponsive conditions. The course includes lecture and practical workshops utilizing a unique synthesis of muscle testing, Korzybski’s semantic responses, Freud’s repetition compulsion, emotion-neuropeptide theory, emotion/meridian correlations, reflex testing, and memory dynamics.

    In fact, “subluxation” is mentioned 5 times on the “techniques” page from your school. That’s fascinating that a school can teach so much about something that *does not exist.* Again, you PAID MONEY, for a “doctorate” from this “school.” Aren’t you outraged?

    But… Ouch. I just looked at your tuition costs. I take back everything bad that I said about you, because I feel absolutely horrible for you. Your school was $9300 per trimester, and you had 10 trimesters, meaning you spent $93,000 just for tuition to learn completely fake concepts using fake instruments to earn a useless doctorate. Not to mention all the other fees, books, living expenses. Damn. If I were you, I’d be on the phone with a lawyer filing a lawsuit against the school.

    nwtk, do you believe in subluxations? If not, how do you rationalize that your school teaches so many courses that focus on them? Also, do you believe in the utility of a “nervoscope”, BEST, NUCCA, NET, or NSA (network spinal analysis?) [Man, anything with an acronym must be legit, right!?]

    How can you POSSIBLY say that you are qualified to treat *anything*, and especially how can you say that you are better qualified than a PT when the main classes and techniques that are advertised on your school’s page are 100% quackery? (And why aren’t you outraged at having wasted 4 years and likely over $150,000 on this? You should see me if I’m shorted $20.)

  40. I just don’t see how someone can, with a straight face, write “I am a point of entry health care provider” while they attended a school that advertises teaching completely fake crap to pursue a profession whose skill-set utilizes fake diagnostic techniques to find fake pathologies to fake-treat non-existent diseases.

  41. Harriet Hall says:

    @SkepticalHealth,

    Thanks for posting that info. If I remember correctly, I only paid $600 medical school tuition a year as a state resident. I didn’t realize how fortunate I was to get a quality education for a pittance. Granted, that was a while ago: I graduated in 1970. But even considering inflation, $93,000 a year for a chiropractic education sounds like a real rip-off, especially to study some of the things they offer. Current average medical school tuitions are listed here http://services.aamc.org/tsfreports/report_median.cfm?year_of_study=2012 WAY less than what Parker charges. Now I feel sorry for those poor defrauded chiropractic students. ! I wish they could get together and file a class action lawsuit.

  42. dougdude10 says:

    so i’ve read a few of the articles and comments on the topic of chiropractic and my thought is, “wow” why? because there seems to be some hatred toward chiropractors here. The questions i’d ask are these: so who is better? the MD that got straight D’s and passed? or the chiro from an accredited college that got straight A’s? I’m currently attending a chiropractic school and i will fully admit that i’m biased on this; however, i’d like to share some of the classes that I am/have personally taken: regional anatomy, spinal anatomy, head and neck anatomy, anatomy of the extremities, biochemistry, histology, biomechanics, biomechanics of extremities, General & NMS pathology, systemic pathology, x-ray physics, neuroscience, microbiology, parmacology, toxicology, differential diagnosis, and many more. Actually, if you look at hours spent in a graduate school for chiropractors vs MDs, it shows that chiros have a far greater understanding of anatomy and other areas. Everyone is entitled to an opinion too and i respect those that have an opinion against chiropractic. I’m not anti MD either, i like MDs, i just choose chiropractic because it helped me–a lot. We are taught correct ways to manipulate and shown what can cause damage. Chiropractic may be attacked for an adjustment that has caused a stroke and i’m not going to debate against that b/c i’m not experienced enough to; however, what about a MD that perscribes the wrong drug? a surgeon that cuts off the wrong leg? Get into a car, there is a risk you can die. Go see an MD, they might not know, they might just perscribe something that could potentially kill you or yes, even a chiropractor may claim to cure your cancer (<—-i disagree with those ones).

    Bottom line: chiros have ALOT of training in basic sciences and actually more hours in certain area…for example anatomy and we can be comparable to an MD in that aspect.

    Second bottom line: where are the ethics here? why is it all bash and crash and name calling like we are in 3rd grade? why belittle people? why bully people? state your opinion that you're entitled to and let someone else have thiers.

  43. jt says:

    What is the moderation policy here? It seems like you “forget” to moderate what you disagree with. Censorship of opposing ideas–very scientific.

    Do you know what I’m skeptical about?

    I’m skeptical about the validity of a health care system that causes 98,000 preventable deaths per year due to human error ( http://www.nap.edu/nap-cgi/report.cgi?record_id=9728&type=pdfxsum ).

    I’m skeptical about the ethicality of drug companies increasing spending on seductive television ads from $791 million to nearly $2.5 billion From 1996 to 2000 (http://www.nejm.org/doi/full/10.1056/NEJMsa012075 ).

    I’m skeptical about a system that exposed around 4 million people to unnecessary hospitalization in 2008 and likely continues to do so ( http://www.ahrq.gov/research/dec10/1210RA22.htm ).

    I’m skeptical about a a system that produced 429,827 medication errors from 1,081 hospitals in 2002; and likely continues to harm a minimum of 90,895 patients annually (http://www.ncbi.nlm.nih.gov/pubmed/11837551 ).

    Harriet Hall: “You provide evidence that conventional medicine can cause harm but you fail to put that fact into perspective with the good that conventional medicine does, and you don’t seem to realize that pointing out problems with conventional medicine doesn’t do anything to further the cause of chiropractic.”

    Can you provide enough evidence of the efficacy of the conventional medicine system to justify all of the harm that it does? Do you deny that the majority of health care issues are lifestyle-related and mostly preventable? Why is it your life’s mission to disparage and destroy Chiropractic, Acupuncture, and other professions you deem “unscientific” when they help patients without placing them in unnecessary risk? Do you honestly believe that the 74.6% of Americans that use some form of complementary and alternative medicine annually get no benefit whatsoever and are completely deluded ( http://www.cdc.gov/nchs/data/ad/ad343.pdf )? Why would that many people continuously seek out complementary and alternative medicine if the conventional system is doing such a great job of meeting their needs?

  44. jt says:

    What is the moderation policy here? It seems like you “forget” to moderate what you disagree with. Censorship of opposing ideas–very scientific.

    Do you know what I’m skeptical about?

    I’m skeptical about the validity of a health care system that causes 98,000 preventable deaths per year due to human error ( http://www.nap.edu/nap-cgi/report.cgi?record_id=9728&type=pdfxsum ).

    I’m skeptical about the ethicality of drug companies increasing spending on seductive television ads from $791 million to nearly $2.5 billion From 1996 to 2000 (http://www.nejm.org/doi/full/10.1056/NEJMsa012075 ).

    I’m skeptical about a system that exposed around 4 million people to unnecessary hospitalization in 2008 and likely continues to do so ( http://www.ahrq.gov/research/dec10/1210RA22.htm ).

    I’m skeptical about a a system that produced 429,827 medication errors from 1,081 hospitals in 2002; and likely continues to harm a minimum of 90,895 patients annually (http://www.ncbi.nlm.nih.gov/pubmed/11837551 ).

    Harriet Hall: “You provide evidence that conventional medicine can cause harm but you fail to put that fact into perspective with the good that conventional medicine does, and you don’t seem to realize that pointing out problems with conventional medicine doesn’t do anything to further the cause of chiropractic.”

    Can you provide enough evidence of the efficacy of the conventional medicine system to justify all of the harm that it does? Do you deny that the majority of health care issues are lifestyle-related and mostly preventable? Why is it your life’s mission to disparage and destroy Chiropractic, Acupuncture, and other professions you deem “unscientific” when they help patients without placing them in unnecessary risk? Do you honestly believe that the 74.6% of Americans that use some form of complementary and alternative medicine annually get no benefit whatsoever and are completely deluded ( http://www.cdc.gov/nchs/data/ad/ad343.pdf )? Why would that many people continuously seek out complementary and alternative medicine if the conventional system is doing such a great job of meeting their needs?

  45. jt says:

    What is the moderation policy here? It seems like you “forget” to moderate what you disagree with. Censorship of opposing ideas–very scientific.

    Do you know what I’m skeptical about?

    I’m skeptical about the validity of a health care system that causes 98,000 preventable deaths per year due to human error
    ( http://www.nap.edu/nap-cgi/report.cgi?record_id=9728&type=pdfxsum ).

    I’m skeptical about the ethicality of drug companies increasing spending on seductive television ads from $791 million to nearly $2.5 billion From 1996 to 2000
    (http://www.nejm.org/doi/full/10.1056/NEJMsa012075 ).

    I’m skeptical about a system that exposed around 4 million people to unnecessary hospitalization in 2008 and likely continues to do so
    ( http://www.ahrq.gov/research/dec10/1210RA22.htm ).

    I’m skeptical about a a system that produced 429,827 medication errors from 1,081 hospitals in 2002; and likely continues to harm a minimum of 90,895 patients annually
    (http://www.ncbi.nlm.nih.gov/pubmed/11837551 ).

    Harriet Hall: “You provide evidence that conventional medicine can cause harm but you fail to put that fact into perspective with the good that conventional medicine does, and you don’t seem to realize that pointing out problems with conventional medicine doesn’t do anything to further the cause of chiropractic.”

    Can you provide enough evidence of the efficacy of the conventional medicine system to justify all of the harm that it does? Do you deny that the majority of health care issues are lifestyle-related and mostly preventable? Why is it your life’s mission to disparage and destroy Chiropractic, Acupuncture, and other professions you deem “unscientific” when they help patients without placing them in unnecessary risk? Do you honestly believe that the 74.6% of Americans that use some form of complementary and alternative medicine annually get no benefit whatsoever and are completely deluded ( http://www.cdc.gov/nchs/data/ad/ad343.pdf )? Why would that many people continuously seek out complementary and alternative medicine if the conventional system is doing such a great job of meeting their needs?

  46. jt says:

    What is the moderation policy here? It seems like you “forget” to moderate what you disagree with. Censorship of opposing ideas–very scientific.

  47. nybgrus says:

    Well, I can’t imagine how anyone can rebut from that.

    Though I’ll hazard a guess that it will involve some sort of “Well, it really wasn’t that big a focus, and well, nobody really believed it anyways. And I certainly don’t practice it like those other guys you keep talking about that totally aren’t me because I went to Parker…”

    “Well, how to you explain that it testing on your licensing exam?”

    “Well, it was just a really small part of the exam.”

    “But still, how do you justify that your school teaches it as a core concept and you are now, by your own admission either practicing rank quackery or practicing outside your scope and education?”

    …. crickets….

    /thread

    Nicely done SH.

  48. nybgrus says:

    I can assure you JT there is no censorship. I have had many a comment get hung up in approval limbo for quite a while because the automatic filter caught 3 or more links or a curse word. And every one has gotten published eventually.

  49. nybgrus says:

    *it is tested on your licensing exam

  50. Harriet Hall says:

    dougdude10 asks “who is better?”

    The chiropractor is better at spinal manipulation. He is worse if uses applied kinesiology or other quackery, if he discourages immunizations, if he treats non-musculoskeletal conditions, or if he misleads patients with claims he can’t support.

    Did you read my comments? I support chiropractors who limit their practice to appropriate short-term treatment of musculoskeletal conditions. I don’t “hate” any chiropractors. I just hate some of the things they do. I think most of them sincerely believe in what they do, but scientific evidence trumps belief. The bottom line is that manipulation works for certain limited conditions, but it doesn’t work any better than other treatments, and it clearly doesn’t work for many of the conditions many chiropractors profess to treat (like asthma and ear infections). Is there any reason a physical therapist couldn’t become just as proficient in treating back pain with manipulation? Is there any justification for a separate discipline called chiropractic?

    You learn a lot of real anatomy, but aren’t you also learning things based on fantasy, like NUCCA, craniosacral, applied kinesiology, etc.? I hope you will be one of the minority of “rational” chiropractors and will try to do something towards reforming chiropractic.

  51. Harriet Hall says:

    @jt,

    We are the first to admit there are a lot of problems with conventional medicine, and conventional medicine is working hard to improve. It is also working hard to identify and ameliorate those lifestyle-related conditions. CAM may be “safer” but it has little to offer that is effective. It has also been notoriously less effective than scientific medicine in monitoring its own ranks, in testing procedures to eliminate useless ones, and in making progress over time.

    “Why is it your life’s mission to disparage and destroy Chiropractic, Acupuncture, and other professions you deem “unscientific” when they help patients without placing them in unnecessary risk?”

    My mission is not to destroy them, but to get accurate information to patients so they can give informed consent. Patient satisfaction can be based on misinterpretations. If there were any credible evidence that these modalities were “helping” patients in any objective way, they would be part of mainstream medicine and I would support them just as I support other evidence-based practices. And we have shown evidence that these modalities do occasionally put patients at unnecessary risk.

  52. jhawk says:

    @SkepticalHealth

    “@jhawk, @nwt, why did you pursue chiropractic instead of PT?”

    Similar story to nwtk2007. I was working in pharmacy with plans on becoming a pharmacist and good number of pharmacist I spoke with said: ” If I had to do it over again I would be a chiropractor.” So, I checked into it and the two chiro’s I shadowed focused on msk, actually had PT’s working in their office and thouroughly enjoyed their career. I was also unaware of the criticisms of the profession at that time.

    @nybgrus

    “And that is what I have been driving at in all these posts, which SH echoed as well – the sad part is that DC is intimately and fundamentally associated with quackery. And, quite frankly, you sound like a reasonable chiro that I would be inclined to refer my patients to – but I would not be able to do so merely based on your credentials. I could only justify it after extensive conversation with you and an understanding of what it is you do and believe in.”

    Fair enough. There are many chiro’s I would not send my patient’s to as well. With that said, I also do not willy nilly refer to MDs (or PT, or DO, NP) just becasue of their credentials either.

    “I can agree with this statement… superficially. However, the statement does not imply a role for HVLA.”
    Nor does it imply (or necessitate) chiropractic type treatment for chronic joint issues. Remember, that the crux of what I had posted earlier was that a return to ROM within pain limits was key for rehabilitation. This is an ongoing and progressive process, not a rapid back-cracking sort of process (which I would argue is not helpful in acute cases, and is mostly – but I will admit not all – placebo response in chronic cases).”

    Agreed. Many ways to increase ROM without HVLA.

    “Well, we are dancing around a central issue here. I don’t disagree with this statement either. However, my personal opinin would be that the HVLA aspect is superfluous to the encounter (though I am very ready to change my opinion on that) and more importantly the link between this and the concept of tendinosis as a non-inflammatory cause of joint point is missing, as I outlined.”

    I am a little confused by your last sentence. Link between HVLA and tendonosis? Are you asking for a mechanism of HVLA for LBP?

    “And of course, Dr. Hall closes with an argument I have made numerous times as well – the evidence exists, in a minimal and narrow fashion for a small part of what chiros do. How does that justify an entire profession, with an entire post-grad college system, asking for rights to be PCPs? The point of SBM here is to say that you can’t assume your idea-du-jour will be vindicated at some point since:
    1) That is bad science 2) History shows us that vastly more often than not, this is not borne out”

    Yes, chiropractic was basically founded on spinal manipulation and is the major form of treatment performed by chiro’s today but there are many other conservative msk treatments that are offered by chiro’s as well. I agree we can not assume vindication due to the reasons you posted. The school I attended trained its students to be portal of entry conservative msk providers with spinal manipulation as one treatment option.

    @Josh Berndt

    “Most us completely disagree with this statement. This topic is about boundaries defined by credentials. Those without credentials and training Should Not have the opportunity to practice like those with the credentials….period. Why not? Because credentials matter.”

    I think you misunderstood my post. Obviously you must have the credentials and license to practice but just becasue somebody has these credentials does not make them a good doctor/therapist/provider.

    “Chiros treat non-specific low back and neck with manips…great! That’s it though. They shouldn’t replace family practice docs and practice medicine,” agreed.

    “they shouldn’t perform rehab and replace PTs”. Many chiro’s are trained in rehab. Agreed chiro’s should not replace PT’s.

  53. @dougdude10, there is no such thing as a “MD who made straight D’s.” A “D” is a failing grade and you would not pass college, nor would you pass medical school (nor would you *get into* medical school.) The admissions for the chiropractic school nwtk2007 listed was a joke, only requiring a 2.75 GPA and 2.5 years of college (basically, do you have a pulse? Will you pay us $100,000? Ok, you’re in! That’s hilarious. Medical school requires a full college degree, its rare to get in with less than a 3.5, and you have to compete with other overachievers with the MCAT.

    As far as who is better at what, that’s a silly question too. MD’s treat disease. We treat essentially every disease, and we save and prolong hundreds of millions of lives per year. Yes, mistakes happen and some patients do get hurt in the process and it’s a terrible thing and we do everything we can to minimize these mistakes. This is what happens when you deal with life and death situations on a daily basis.

    Chiropractors do not treat disease. Outside of the slim possibility that they can help with some types of back pain, chiropractic is completely useless. Dr. Hall has written multiple times that chiropractic manipulation may be as good as other treatment modalities for specific types of lower back pain, but no better. My argument is that even if chiropractic manipulation for LBP is somewhat useful, there is no place for it because of the risks inherent in chiropractic (stroke, paralysis, death.) Why would I send a patient to a chiropractor if I can send them to a PT and they can achieve the same or better relief in pain without exposing my patient to dangerous practices? There just isn’t a place for chiropractic. Outside of the possibility that a chiropractor can help with the few types of LBP, the entire profession is absolutely worthless.

    Also, you state that a chiropractor has lots of training in the basic sciences and compare yourselves to MDs. I simply do not believe that. Please do not fool yourself. You remind me of a girl we all read about here that was going through naturopathic school. She wrote a blog and said something along the lines of “People ask me what I’m doing. I say that I’m going to be a doctor. When I get out, I will be a real doctor.” No, she wasn’t. She got a completely useless degree in absolutely pure quackery (the worst kinds of quackery.) She had fooled herself into believing that her simple little garbage naturopathic school was the same as a legitimate medical school. Do not fall for this same trap. While a chiropractor may have a solid background in anatomy, your basic science classes are simply not up to par. Chiropractic schools recruit poorer performing students. The admissions sets the bar ridiculously low, meaning even the average (IQ) Joe can get in. Further, I wonder about the anatomy knowledge of a chiropractor when they believe that vertebrae can readily subluxate, when they believe that there is “nervous system interference”, or that they can readily manipulate the atlas by pushing on the nuchal ligament. While I don’t doubt that chiropractors learn a lot of anatomy, their beliefs about what they can accomplish implies that they have absolutely no understanding of anatomy or physiology whatsoever. By the way, there’s more to medicine than anatomy. :)

    If you are early in chiropractor school, my advice is to drop out immediately and pursue a legitimate career in a respectable field.

  54. @dougdude1, by the way, in practice, it is not MD vs DC. If anything, it’s PT vs DC. PTs are the (mostly) science based practitioners that are qualified to treat musculoskeletal disorders. The vast majority of MDs don’t do any sort of physical treatment modalities. We refer to the PT. A DC is not remotely comparable to a MD.

  55. JMB says:

    “I’m skeptical about the validity of a health care system that causes 98,000 preventable deaths per year due to human error ”

    There is a basic problem with a retrospective judgement of a preventable death. The hypothesis that a recorded death could have been prevented cannot be tested. It is pure speculation. If you argue that the authors were unbiased in their estimate, then I would merely point out that they failed to give an estimate of the number of deaths prevented. An ordinary judgement about the effectiveness of modern medicine would have to consider the number of deaths prevented versus the number of deaths that we failed to prevent. Leaving out that assessment suggests bias in the study design. The authors were looking for a number to highlight the problem of preventable deaths.

    “I’m skeptical about the ethicality of drug companies increasing spending on seductive television ads from $791 million to nearly $2.5 billion From 1996 to 2000″

    No disagreement about ethical problems there.

    “I’m skeptical about a a system that produced 429,827 medication errors from 1,081 hospitals in 2002; and likely continues to harm a minimum of 90,895 patients annually”

    The identification of medication errors is an objective process. In the report cited they noted 5.22% of patients were subjected to medical errors. If the average hospitalized patient received 50 administrations of medication, then the error rate would have been about 0.1% per administration. Not good, but not as dramatic a figure. Of course that study was reported in 2002. The data was obtained from 1992. Since 1992 there has been a significant upgrade in safeguards available in most hospitals. I would speculate there has been at least a tenfold improvement in the medication error rate due to new technologies. The number of people harmed by those medication errors is a subjective estimate by the authors. The authors were pharmacists arguing for expansion of duties of hospital pharmacists. That is a possible source of bias in the subjective estimate of harm.

    “I’m skeptical about a system that exposed around 4 million people to unnecessary hospitalization in 2008 and likely continues to do so ”

    One of the annoying characteristics of the dialogue between politicians, government, and the press about unnecessary procedures and hospitalizations is the implication that the distinction between necessary and unnecessary is so easy. When a physician is faced with a decision about whether hospitalization is necessary, they have an initial set of information available at the time of admission on which their judgement is based. Bureaucrats also ignore how social and emotional issues of the patient and the patient’s family can enter into those decisions. Those that decry statistics on unnecessary hospitalizations are often basing their judgement after much more information is available (retrospective review of charts). For example, imagine a surgeon is faced with a decision on a group of 10 patients as to whether to recommend a surgery that has a 1 in 10 chance of saving their life. However, the surgeon does not know which of the ten will have their life saved. The surgeon also knows that without the surgery, all 10 will die. Would it not be ethical to offer all 10 patients the surgery, in the hope that one life could be saved. Then after the surgeries are performed, and one life is saved, along comes the bureaucrat that complains that 9 of the surgeries were performed unnecessarily. If that bureaucrat gets away with that assertion of unnecessary surgery, and the “unnecessary surgeries” are banned, then we won’t even save that 1 patient.

    In regards to the effectiveness of modern medicine I suggest a simple review of life expectancy changes since 1970. Most of the improvements in life expectancy due to public health measures and sanitation were in effect in 1970. Some of the effects of medical intervention (antibiotics) had already begun to improve life expectancy. However, the majority of improvement in life expectancy since the 1970′s can be attributed to advancements in modern medicine (although reductions in smoking also plays a large part). The best measure of the effect of modern medicine is the improvement in life expectancy of those who are 65. The number of years of life expectancy at age 65 has increased dramatically in the last 40 years. That represents many millions of lives saved.

  56. nybgrus says:

    state your opinion that you’re entitled to and let someone else have thiers.

    While the tone and manner in which it is delivered may vary, the bottom line is that around these parts opinion matters extremely little. Myself, SH, Dr. Hall, and a few others on this thread are not writing opinions (with some exception and it is usually clear when it is so). We are all citing evidence and science, and demonstrating that the fundamantal basis of chiropractic is flawed and unscientific.

    An opinion on a matter like this would be “Surgery is the best field of medicine to go into! Way better than endocrinology!”

    Comparing DC to MD hasn’t even entered the realm of opinion, since the validity of DC is very much in question and has consistently been shown to be mostly illegitimate. While I haven’t actually written a post here on it, I have written extremely extensively on the topic as well, primarily from a licensing exam and curriculum standpoint.

    I would second SH’s advice – leave chiropractic school and find something better to do. You even state you do not agree with the quackier chiros, yet the professional associations that respresent you and the licensing exam you have to take supports the quackery of subluxation.

    If MD and DC were really so equivalent, equally trained, and merely a matter of opinion, why don’t you apply to medical school? Get an MD and be confident you are practicing real medicine.

  57. nybgrus says:

    Can you provide enough evidence of the efficacy of the conventional medicine system to justify all of the harm that it does?

    As pointed out… yes, in so much abundance that it baffles anyone even asks the question.

    I love it when the healthy person, already outlived his great grandparents and expecting another 30 or 40 years of life, knowing that if his/her knees or hips should fail we can trivially restore function, that if a car wreck were to live him/her in critical condition were to happen we could bring him back from the brink of death, expecting that if diabetes (type I or II) were to befall him we could keep him alive for decades longer with nearly no morbidity than his own parents could have expected, sits there asking if there is evidence for the efficacy of modern medicine.

    It reminds me of the creationist flying across the world to an atheist convention, using an e-ticket on his iPhone to board the plane, and having a more pleasant flight because those antibiotics he took cleared up his sinusistis just in time, and using his iPad to blog a post about how science doesn’t know what it is doing and is clearly wrong on the age of the earth and evolution from the 40th floor of his hotel which he got to using the GPS navigation on his Tom-Tom.

  58. nybgrus says:

    There are many chiro’s I would not send my patient’s to as well. With that said, I also do not willy nilly refer to MDs (or PT, or DO, NP) just becasue of their credentials either.

    Sure, and there are MDs that I would not send my patients to as well – in fact, some of my colleagues are people I am already thinking that of.

    My point was that sending a patient to a random MD has a much, much higher likelihood of a good science based outcome than sending him to a random DC. In other words, the percentage of quack/non-quack between the two diegrees is vastly different.

    Agreed. Many ways to increase ROM without HVLA.

    Yet that forms the very basis of chiropractic, is the primary modality taught and practiced, and is the mechanism by which subluxations are relieved. The rest of it would fall precisely under the umbrella of PT. And while the argument may be made that PTs could do better at it, and the chiros may be better at it, that is not a justification for the existence of chiropractic. It is a call to improve PT training.

    By analogy, one could say that a homeopathic auto mechanic can do tire changes and steering alignments much better than a traditional auto mechanic. But the rest of his practice is total garbage – like waving his hands over the engine to unclog fuel injectors and banging on the rear passenger door to fix the coolant pump. But that doesn’t mean we should train homeopathic auto mechanics so that they can augment the failings of the traditional ones. It means we should do away with the HAMs and improve the training of actual auto mechanics.

    I am a little confused by your last sentence. Link between HVLA and tendonosis? Are you asking for a mechanism of HVLA for LBP?

    As I elucidated above, my focus is on the core of chiropractic – the HVLA manipulation of the spine. You brought up tendinosis, and I am saying that the existence of it doesn’t really apply to the core of chiropractic.

    The school I attended trained its students to be portal of entry conservative msk providers with spinal manipulation as one treatment option.

    I have yet to see a chiropractic school that does not teach a large amount of quackery. Nwtk tried to claim his did. Perhaps you’d be willing to brave SH’s review of your school’s curriculum?

    But regardless, your licensing exam tests you on the quack aspect of chiropractic. So it doesn’t matter what your school actually taught you – to be licensed you must know the quackery to a degree, or at least that it exists. And as I said in my prior comment, the professional organizations that represent you support said quackery and even get rather irate when it is not stated as the core of chiropractic.

  59. nybgrus says:

    lastly, well said JMB

  60. dougdude10 says:

    our 1st licensing exam actually is just all basic science and about 60% of it is pathology

  61. jt says:

    Claiming that conventional medicine saves millions of lives without a shred of evidence other than vague referrals to increased life expectancy after 65 is not convincing and certainly does not justify the 98,000 preventable deaths occurring each year due to doctor’s errors.

    We are an overdiagnosed and overmedicated population.

    http://www.huffingtonpost.com/allen-frances/america-is-over-diagnosed_b_1157898.html

    http://newoldage.blogs.nytimes.com/2010/01/11/study-nursing-home-residents-overmedicated-undertreated/

    Who cares if you live a few extra years if all you have to look forward to is lying in a cold hard hospital bed, dragging an oxygen tank around, and eating handfuls of bitter pills while you wait for nocosomial infection or cancer to set in.

  62. dougdude10 says:

    @Harriet

    “Is there any reason a physical therapist couldn’t become just as proficient in treating back pain with manipulation? Is there any justification for a separate discipline called chiropractic?”

    i’d say that as long as a PT was trained in the techinques of manipulation then they should be able to, creating a separate discipline? I see it as evolving as there are specialists for each field chiropractic is as such.

    “You learn a lot of real anatomy, but aren’t you also learning things based on fantasy, like NUCCA, craniosacral, applied kinesiology, etc.?”

    simple answer is no, the longer answer is that some chiropractors go that direction. I personally do not believe in AK; however, it has helped people I know (placebo effect? no idea)

    “I hope you will be one of the minority of “rational” chiropractors and will try to do something towards reforming chiropractic.”

    It is a goal of mine to do this :)

    1. Harriet Hall says:

      @dougdude10,

      “I personally do not believe in AK; however, it has helped people I know (placebo effect? no idea)”

      This statement epitomizes the faulty reasoning typical of many chiropractors. It’s not a matter of “believing” but of testing and determining what works. AK has been tested and has been clearly shown not to work. There’s no evidence that it has ever “helped” anyone except through suggestion and placebo effects. If you are unable to recognize that, it means you are throwing science out the window in favor of anecdotal testimonials and you fail to understand the many ways humans reach false conclusions.

      Check out http://en.wikipedia.org/wiki/Applied_kinesiology#Scientific_research and http://www.quackwatch.com/01QuackeryRelatedTopics/Tests/ak.html and read the story about Ray Hyman here: http://www.skepdic.com/akinesiology.html There are also several articles about it on SBM.

      Applied kinesiology is one of the silliest things in all of CAM. There is no scientific rationale behind it; it’s magical thinking and fantasy. If you don’t reject it wholeheartedly and try to persuade your compatriots to reject it too, I can’t believe you are capable of doing anything to reform chiropractic.

  63. @dougdude, if you have yet to take your first set of NBCE “board exams”, then I *URGE* you to drop out of chiropractor school. Go back to college, finish your degree. Get a degree in nursing, and then apply to medical school. You obviously have a drive to help people. Unfortunately as a chiropractor you will not help anyone. The practice does not allow for it, because you simply don’t do anything useful. If you do the RN -> apply for medical school pathway, then you have a legitimate career to fall back on should you not get into medical school, and if that occurred then you could always apply for nurse-anesthetist school, nurse practitioner, etc.

    Seriously. You are heading into a failing career that is 95% quackery. Look at the stuff I posted about nwtk2007′s school. It blatantly advertises quackery all over its website (he’s been strangely quiet since then.) Would you readily post the name of the school you’re going to?

  64. Oh my god, I just read what you wrote about AK helping people you know. Sigh, I take it back. Do no go into nursing or medicine. We do not want you in a hospital.

  65. jhawk says:

    @nybgrus

    “Sure, and there are MDs that I would not send my patients to as well – in fact, some of my colleagues are people I am already thinking that of. My point was that sending a patient to a random MD has a much, much higher likelihood of a good science based outcome than sending him to a random DC. In other words, the percentage of quack/non-quack between the two diegrees is vastly different.”

    No argument here.

    “Yet that forms the very basis of chiropractic, is the primary modality taught and practiced, and is the mechanism by which subluxations are relieved. The rest of it would fall precisely under the umbrella of PT. And while the argument may be made that PTs could do better at it, and the chiros may be better at it, that is not a justification for the existence of chiropractic. It is a call to improve PT training.”

    There is overlap between chiro and PT for sure. From personal experience of referring, treating and being refferd to by Pt’s we do work well in conjuction arriving at some differences in treatment which, IMO, is in the best interest of the patient. I don’t think chiropractic is going to go away so I think the focus should be on improving both chiro and PT.

    “By analogy, one could say that a homeopathic auto mechanic can do tire changes and steering alignments much better than a traditional auto mechanic. But the rest of his practice is total garbage – like waving his hands over the engine to unclog fuel injectors and banging on the rear passenger door to fix the coolant pump. But that doesn’t mean we should train homeopathic auto mechanics so that they can augment the failings of the traditional ones. It means we should do away with the HAMs and improve the training of actual auto mechanics.”

    The problem I see with this analogy is there are no homeopathic auto mehcanics but there are chiropractors.

    “As I elucidated above, my focus is on the core of chiropractic – the HVLA manipulation of the spine. You brought up tendinosis, and I am saying that the existence of it doesn’t really apply to the core of chiropractic.”

    Tendonosis does not apply to HVLA IMO but does fall under the scope of chiropractic. As I said before, spinal manip is the core for the majority of chiro’s but not the only treatment modality we are trained in.

    “I have yet to see a chiropractic school that does not teach a large amount of quackery. Nwtk tried to claim his did. Perhaps you’d be willing to brave SH’s review of your school’s curriculum?”

    I posted my school on here before for conspicouscarl (I believe), as he seemed eager to lamblast it but I never heard back. University of Western States.

    “But regardless, your licensing exam tests you on the quack aspect of chiropractic. So it doesn’t matter what your school actually taught you – to be licensed you must know the quackery to a degree, or at least that it exists.”

    We have discussed this before. The licensing exam has about 3% BS. This BS was taught from a historical perspective at UWS.

  66. @jhawk,

    Can you explain the last paragraph on this page from your schools website?

    http://www.uws.edu/Clinics/Chiropractic_Services.aspx

    Additionally, many patients have used chiropractic treatment for the successful treatment of their non-musculoskeletal conditions such as allergies, digestive disorders and otitis media.

    Your tuition was $25,000 per year, with an estimated total cost of $45,000 per year, meaning you spent $180,000 for a worthless degree. Your school’s website provides almost no information on the chiropractic program so that’s why it’s hard to publicly humiliate. It greatly over sells a chiropractor as a “point of entry chiropractic physician.” It very falsely gives the illusion that a chiropractor will be a primary care provider. If you’re going to be honest about anything, you have to admit a chiropractor is in no way, shape, or form remotely qualified to be any type of PCP. And you start “adjusting” on day 1.

    I just can’t get over it. You spent $180,000 dollars on a skill-set you could have picked up over a weekend by sitting in a massage school class. I am speechless at the fact there isn’t more class action lawsuits against these schools of quackery for misrepresentation.

  67. nwtk2007 says:

    In the 90′s Parker was 36,000 for nine semesters. I’ve made a very good living doing what I’m doing and am well respected by my patients and the medical community with which I work; MD’s, DO’s, PT’s surgeons, etc.

    I certainly wouldn’t do it again for many of the reasons you have stated. And, I certainly wouldn’t recommend it to anyone either. But then I wouldn’t recommend anyone go into the insurance business either.

    Really, all education is too expensive. A person going to a school like SMU to get a teaching degree would spend well over 200,000 to go into a field in which the chances of paying this off would be essentially nill.
    State schools in Texas are at the $400 to $500/credit hour level now. My old Com College I went to was $6/credit hour in the early 70′s and is now at $36/hour I think. It’s all gone up and almost all jobs pay little enough such that it is difficult to pay off loans no matter what.

    Chiro’s have a chance to make a decent living even without practicing the crazy stuff although people will actively seek you out as a chiro because they feel as if much of what other chiro’s did for them was so beneficial. Chiro’s can also use their degree as a step off to teaching certification and other professions as much of the course work at the chiro colleges, the basic sciences portion, also transfers to other colleges and universities; in which case they are not much worse or better off than the graduate of state and private colleges.

  68. I wholly agree that university education is way too expensive. I also believe that many of the classes one is “forced” to take are wholly worthless, too. Most 4 year college degrees have more than a year of “padding” built into them, which really just makes the student take out more loans, spend more money on housing, and become further in debt before they graduate.

  69. nybgrus says:

    We have discussed this before. The licensing exam has about 3% BS. This BS was taught from a historical perspective at UWS.

    Yes, we have. And by my research (since I wasn’t willing to pay for sample exams) it is a minimum of 3%. But that is besides the point – why on earth would a legitimate degree require its licensing exam to test rank BS?

    And it is most certainly not “from a historical perspective.” I referenced the texts recommended by the chiro board of examiners that is clearly a text devoted to the active use of the quackery, not just a “hey, quacky chiros did this a long time ago.”

    But even then “historical perspective” is not a legitimate thing to test on a licensing exam! I mean seriously… do you know how much there is to test? No exam could possibly cover everything an MD is supposed to know. Why would you take up valuable question space on questions that are nothing more than historical trivia? Do you think my medical licensing exams have questions about miasm theory or bloodletting?

    The point is, that however small it is, it shouldn’t be there. And the fact that it is there belies the very point we here have been making – the basis, core, and fundamental understanding of pathology that is taught is simply false.

    dougdude says:

    our 1st licensing exam actually is just all basic science and about 60% of it is pathology

    Yeah, well, part of the core curriculum of a local homeopathy school involves chemistry, pharmacology, and research training. Do you really think they actually apply it properly??

    Tendonosis does not apply to HVLA IMO but does fall under the scope of chiropractic. As I said before, spinal manip is the core for the majority of chiro’s but not the only treatment modality we are trained in.

    Right. And that is the point I have been making. The actually evidence based aspect of manipulation is very small. The rest of what you are trained in is either rank quackery or already done by PTs. Why create a separate degree, a doctorate, that claims it could and should act as primary care, when PTs can effectively do exactly the same thing but without the added baggage of quackery?

  70. @nybgrus, the question isn’t why create a separate degree, the question is why [i]not[/i] create a separate degree? Did you see how much those schools were charging? newt2007 paid $90,000 in tuition. jhawks’s school charges $100,000 for the “doctorate.” Hell yeah they are going to be making up new degrees (his institution also offered degrees in massage therapy, a masters in “nutrition and functional medicine”, distance learning (I wonder if it’s telepathic?), etc.) These fraudulent quack institutions just make up new degrees and sell them to people. I can’t imagine what they must feel when they get out in the real world and see what a joke it all is.

    @dougdude, your statement was already addressed by nybgrus. Just because you get a mickey mouse introduction to a few science classes doesn’t mean anything.

  71. nwtk2007 says:

    Did I say $90,000? I meant $36,000. $4000 per semester for nine semesters.

  72. jhawk says:

    @Skepticalhealth

    Can you explain the last paragraph on this page from your schools website?

    Nope. I wish it was not there. At least they didn’t say there was any evidence for it.

    “Your school’s website provides almost no information on the chiropractic program so that’s why it’s hard to publicly humiliate.”

    It shows prerequisites, full course cirriculum by quarter and hour, tuition cost, and entrance requirements. What else would you need to humiliate?

    “It greatly over sells a chiropractor as a “point of entry chiropractic physician.” It very falsely gives the illusion that a chiropractor will be a primary care provider. If you’re going to be honest about anything, you have to admit a chiropractor is in no way, shape, or form remotely qualified to be any type of PCP.”

    I began by posting on this article with a comment that quite clearly stated chiropractors are not qualified to act as PCP.

    “And you start “adjusting” on day 1.” First adjusting course is in third quarter.

    “I just can’t get over it. You spent $180,000 dollars on a skill-set you could have picked up over a weekend by sitting in a massage school class.”

    A lot of cash for sure. Saying you could pick up the knowledge I have obtained at chiro school over a weekend massage class is absolutely ridiculous and completely misinformed.

  73. jhawk says:

    @nybgrus

    “Yes, we have. And by my research (since I wasn’t willing to pay for sample exams) it is a minimum of 3%. But that is besides the point – why on earth would a legitimate degree require its licensing exam to test rank BS?”

    politics I guess.

    “And it is most certainly not “from a historical perspective.” I referenced the texts recommended by the chiro board of examiners that is clearly a text devoted to the active use of the quackery, not just a “hey, quacky chiros did this a long time ago.”

    I said: “This BS was taught from a historical perspective at UWS.” My school taught it from a historical perspective.

    “But even then “historical perspective” is not a legitimate thing to test on a licensing exam! I mean seriously… do you know how much there is to test? No exam could possibly cover everything an MD is supposed to know. Why would you take up valuable question space on questions that are nothing more than historical trivia? The point is, that however small it is, it shouldn’t be there. ”

    I completely agree. I wish the test had 0% BS but sadly that is not the case.

    “And the fact that it is there belies the very point we here have been making – the basis, core, and fundamental understanding of pathology that is taught is simply false.”

    I don’t think a small percentage of a licensing exam being bs equates to a fundamental misunderstanding of pathology.

    “Why create a separate degree, a doctorate, that claims it could and should act as primary care, when PTs can effectively do exactly the same thing but without the added baggage of quackery?”

    As far as I know PT’s can not see patients without referral in many states and can not order imaging. This is a big reason for the added years of chiro school, to be able to rule out non-msk issues.

  74. JMB says:

    “Claiming that conventional medicine saves millions of lives without a shred of evidence other than vague referrals to increased life expectancy after 65 is not convincing and certainly does not justify the 98,000 preventable deaths occurring each year due to doctor’s errors.”

    When the published work is cited claiming 98000 preventable deaths, then you need to understand what is counted as a preventable death. The vast majority of preventable deaths (I don’t know if the authors break down the percentages, but I would guess greater than 90%) occur in those patients who would have died without medical care, but the reviewers felt that errors occurred in the provided medical care that circumvented the expected life saved by proper application of medical care. That is a retrospective subjective assessment by an armchair quarterback (my criticism). So on the one hand, you cite 98,000 preventable deaths, but on the other hand, you deny there is evidence of the effectiveness of modern medical care. There is a deep irony in citing the study, and then challenging whether modern medical care provides real benefits! Even if we use a very pessimistic estimate of 10 lives saved for every preventable death, then citing 98,000 preventable deaths per year implies we are saving 980,000 patients a year. Again, a less biased review of charts would give an estimate of the ratio of prevented deaths versus preventable deaths (although there is still a very subjective assessment going on there).

    The vast majority of medical errors do not resort in a preventable death or disability. They are statistics we track in the quality assurance/improvement process.

    If the significance of life expectancy at age 65 is not understood, let me explain further. There are about 40 million people over age 65 in the USA. If the life expectancy goes up by 1 year, then there are 40 million life years saved (not really that precise, but close enough). That doesn’t mean that every person gets an extra year of life, there will still be a distribution of the number of life years gained (or unchanged, or lost), and the mathematical description would be fairly involved. However, the increase in life expectancy observed between 2000 and 2006 for the age group over 65 was observed to be 0.9 years. This would represent millions of lives saved (I won’t cite a precise figure because I don’t have immediate access to census statistics from 2000 and 2006, or the distribution of how those extra life years are spread around). Part of that improvement can be attributed to smoking cessation, better diet, and more exercise. However, most people like to forget that encouraging people to stop smoking, eat a balanced diet, and exercise regularly are part of the approach of modern medicine.

  75. JMB says:

    Sorry about my grammar errors.

    The vast majority of medical errors do not result in a preventable death or disability.

  76. nybgrus says:

    I don’t think a small percentage of a licensing exam being bs equates to a fundamental misunderstanding of pathology.

    No, not in and of itself. But in the context that the curriculum of pretty much every chiro school, the professional bodies representing chiro, the articles published in chiro journals, and the outcry from the relevant chiro bodies when “subluxation” was removed from the language of chiropracty… yeah, it seems reasonable to say that most, if not all, of chiropractic is framed from the context of BS and thus equates to a fundamental misunderstanding of pathology. The fact that the licensing exam continues to test on this topic belies all this, since that is the ultimate descriptor of what the “powers that be” of chiropractic deem important.

    As far as I know PT’s can not see patients without referral in many states and can not order imaging. This is a big reason for the added years of chiro school, to be able to rule out non-msk issues.

    Right. Which is why we here are stating that chiros should be in the same boat – since the added years of chiro school are significantly devoted to quackery and marketing and thus, despite claims otherwise, do not adequately prepare graduates to see patients without referral nor order imaging.

  77. As far as I know PT’s can not see patients without referral in many states and can not order imaging. This is a big reason for the added years of chiro school, to be able to rule out non-msk issues.

    @jhawk, THERE IS NO EVIDENCE THAT CHIROPRACTIC MANIPULATION IS EFFECTIVE FOR ANY MEDICAL CONDITION THAT IS DIAGNOSED BY X-RAY. Chiropractors have NO REASON to EVER x-ray a patient. If you x-ray a patient and happen to see a bony abnormality that needs legitimate medical care and refer to an orthopedic, then he is going to repeat the x-ray. No orthopedic is going to trust the impression of a chiropractor who has minimal training and minimal skills in both reading and taking x-rays. All the chiropractor has done in this situation is caused the patient to be exposed to extra radiation and increased their cost of care and delayed the time until treatment.

    You have 4 years total of school. In those 4 years, you supposedly learn “how to be a chiropractor”, how to adjust, you learn about subluxations, you learn about fake shit like AK, BEST, NSA, supplements, quackery, “botanicals”, you learn how to run a business, how to bill clients, how to market chiropractic, AND how to properly x-ray patients, protect patients from radiation, etc. Oh, and how to rule out non-msk issues.

    Our local college offers a degree in “rad tech”, which is a person who takes x-rays and operates related machinery. It’s a 4 year program, the first 1.5 years are general classes, and the next 2.5 years are required to learn to properly take X-rays, etc. And yet the chiropractic curriculum knocks this down to a semester or so. This explains why chiropractors utterly suck at taking x-rays. It’s absolute insanity that chiropractors are allowed to take their own xrays.

    It’s just insanity. Exactly as nybgrus said, the chiropractic education does not prepare graduates to see patients without referral nor order imaging.

    Why didn’t any chiropractor comment on nwetk2007′s school, advertising teaching students applied kinesiology, BEST, NSA, subluxations, etc?

  78. Chiropractic – where you learn a little about a lot of things, but don’t really learn much about anything.

  79. Chiropractic – we needlessly expose you to cancer causing radiation only to tell you to avoid your doctor and that we can cure your cancer with adjustments and supplements. It’s natural, btw.

  80. Chiropractic – obviously our 2.5 GPA and no standardized test admissions requirements means we are smart enough to learn in 4 years everything that a PT, an orthopedist, x-ray tech, historian, and marketing major learns in a combined 34 years.

  81. Adam Rufa says:

    I have been doing my best to stay out of this conversation but I just want to correct jhawk above.

    “As far as I know PT’s can not see patients without referral in many states and can not order imaging. This is a big reason for the added years of chiro school, to be able to rule out non-msk issues”

    The only setting in the US where PTs can order imaging is the military. And most states (maybe 2-3 without direct access) allow PTs to see patients without a referral. There is a small movement in the profession to work on getting image ordering rights however I agree with SkepticalHealth that imaging is not that helpful for conservative musculoskeletal care (biggest role is ruling out sinister problems).

    The PT profession has its problems and its quacks. However, we are working hard at being scientific (still a work in progress).

    PT schools must teach thrust manipulation in order to get accredited, so all new PTs are getting trained in manipulation. I would agree that not all PTs will be good at manipulation because it is only a small part of our practice. Some PTs may be working in hospitals, with kids, in rehab etc.. so you can be a very good PT and not have good manipulation skills. However, there are many PTs who are very skilled at manipulation and as a profession we have produced some great literature on manipulation.

    Documents like this practice guideline: http://www.jospt.org/issues/articleID.2744,type.2/article_detail.asp are a great example of how the PT profession is embracing and inseminating EBP.

  82. jhawk says:

    @skepticalhealth

    “@jhawk, THERE IS NO EVIDENCE THAT CHIROPRACTIC MANIPULATION IS EFFECTIVE FOR ANY MEDICAL CONDITION THAT IS DIAGNOSED BY X-RAY.”

    I never stated anything remotely close to this.

    “Chiropractors have NO REASON to EVER x-ray a patient.” rule out fracture after an acute injury, non-responsive to care to name a few.

    “If you x-ray a patient and happen to see a bony abnormality that needs legitimate medical care and refer to an orthopedic, then he is going to repeat the x-ray. No orthopedic is going to trust the impression of a chiropractor who has minimal training and minimal skills in both reading and taking x-rays. All the chiropractor has done in this situation is caused the patient to be exposed to extra radiation and increased their cost of care and delayed the time until treatment.”

    I send my patients to an imaging center and have the radiologist read the imaging and fax the report. I really don’t have to send out for imaging that often. problem solved.

    “You have 4 years total of school.” plus undergrad.

    ” In those 4 years, you supposedly learn “how to be a chiropractor”, how to adjust,” yep.
    “you learn about subluxations,” yep. a hypomobile joint.
    “you learn about fake shit like AK, BEST, NSA,” nope.
    “supplements, “botanicals”, a little bit with evidence for and against
    “you learn how to run a business, how to bill clients, how to market chiropractic,” nope
    “AND how to properly x-ray patients, protect patients from radiation, etc. Oh, and how to rule out non-msk issues.” yep.

    “Our local college offers a degree in “rad tech”, which is a person who takes x-rays and operates related machinery.”

    Rad tech’s teach our rad tech courses in chiro school.

    “It’s a 4 year program, the first 1.5 years are general classes, and the next 2.5 years are required to learn to properly take X-rays, etc.”

    Hmmm. Many of these programs are 2 years.

    “Why didn’t any chiropractor comment on nwetk2007′s school, advertising teaching students applied kinesiology, BEST, NSA, subluxations, etc?”

    I personally don’t think they should be advertising this. I would imagine they are electives though. Is this the missing info you couldn’t find to humiliate my school?

  83. Your school gives barely any information on its chiropractic program. It doesn’t give an overview of its philosophy, the techniques you’ll learn, or anything. It merely says “Join now and you too can be a primary care chiropractic physician! Only $100,000!” and lists a few courses, with no descriptions, and links to the very poor board scores that chiropractors achieve on the NCBE (laughably bad board pass rates.) So, no, I can’t make fun of it because it doesn’t give any information out. Oh, but it does advertise that chiropractic can be used to treat ear infections and allergies – lol.

    You don’t seem to get that you should not be ordering or taking x-rays or other imaging modalities. You are not capable (knowledge, skill, license) to treat any condition that is diagnosed with imaging. If a *client* of yours is non-responsive to your treatment, then send them to a real medical doctor. Do not delay their treatment any longer or further.

    This is why doctors cannot stand chiropractors. You have been tricked into believing that you actually treat patients, when in reality you just provide sub-standard physical therapy and nothing more. Chiropractic contributes nothing positive to the entire world of health care and we’d all be better off if it was wiped off the face of the planet in one fell adjustment.

  84. God, it is extremely enraging to read what these absolute quacks believe is in their scope of practice. They are already poor students to begin with (2.5 GPA without a college degree, no standardized tests — by comparison a typical PT program would require a 3.0 GPA, a college degree, and a certain score on the GRE, and also experience working in a PT office), they learn the basics of a handful of trades, then learn a whole lot of quackery, then their quack school which typically offers other bogus degrees convinces them that they are “primary care physicians.” Damn. These goobers graduate and believe all the garbage that they’ve been brainwashed with.

    Damn, chiropractic had some good lawyers at a particularly ridiculous period of time in the USA to be able to get away with the thievery and quackery that they do. I believe Penn Jillette called them “fucking assholes.”

    http://www.youtube.com/watch?v=9246yX1u0t8

  85. nwtk2007 says:

    skepticalhealth – “You don’t seem to get that you should not be ordering or taking x-rays or other imaging modalities. You are not capable (knowledge, skill, license) to treat any condition that is diagnosed with imaging.”

    I will refrain from telling you just how stupid this statement is. I’ll just let you know that chiro’s most of the time take xrays to rule out conditions which might indicate a need for referral care (fractures) or contradictions to treatment or the use of some modalities, confirm that a patients pain is not related to some bone pathology, pre-existing degeneration, disc thinning and vertebral joint instability, etc, etc. (Of course the imaging is only secondary to an initial examination and imaging findings have to be correlated to patient past and current history.) Even for the folks who have been previously seen at the ER, I am more than likely going to xray for the simple fact that I have found many instances of fractures which were missed by the hospital and basically, if I assume no fracture on the basis of the hospital saying there is none and subsequently injure the patient, I will be held responsible for the injury despite hospital xray reports in hand that there was no evidence of acute trauma or fracture seen on their xrays. The most recent example would be fractured rib-1, patella fracture, TVP fracture, lytic pars fracture, and a few months ago a scaphoid fracture (that would be that bone in the wrist which is at such a great risk of osteo necrosis when fractured). Of course in some of those cases I made the referral to an ortho, and in others I simply had to consider treatment which would not be exacerbative or contraindicated. In the past and one of the most significant was an odontoid fracture in which the patient had returned twice to the same hospital and twice sent home. This was actually found by one of our other doc’s and not myself.

    Of course these are all things which we were taught to look for in chiropracty school.

  86. Again, every condition and fracture you listed is completely untreatable by a chiropractor. Simply put, chiropractic is a complete waste of space, time, and money. What role are you playing in any of this? None. You do nothing. Chiropractic, as a “point of care entry” is absolutely ridiculous. Why should any patient see *you* first when you can offer them *nothing.* You’re basically a receptionist who tries to sell the *client* on something else as they walk in the door.

    Scummy quacks.

    http://www.youtube.com/watch?v=9246yX1u0t8

  87. For example, you have no business every x-raying a patient’s hand. If they fell and possibly fractured their scaphoid, then obviously they’ll initially go to the ER and have an x-ray performed there. Every ER doc is well aware that early imaging in a scaphoid fracture is unrevealing, and that anatomic snuffbox tenderness is sensitive for fracture. Therefore, management of symptomatic patients with negative x-rays usually is a short-arm thumb spica cast followed by reimaging in 7-10 days. Upon re-evaulaton we can then decide if it needs to go to orthopedics or not.

    Chiropractic has no role in this. Your “manipulations” have zero science supporting their use in a patient’s hand, or on any condition related to the hand (or upper or lower extremities, or really the human body, if we look at the latest systematic review of chiropractic.) If a patient is complaining of pain in their hand and they have tenderness on the anatomic snuffbox and a history of a fall, nobody needs the chiropractor to image the patient’s hand. You should send them to the ER. You are not an orthopedist. You should not x-ray their hand. You can do nothing for this patient, and you are only likely to injure them and expose them to radiation unnecessarily.

    I repeat that: you are not an orthopedist. I wish that I could get you to fully comprehend the monumental f-ing gap in knowledge between a chiropractor and an orthopedic (or neuro-) surgeon. It’s a gap bigger than the distance from the earth to the moon. You are an ant, and an orthopedist is a giant.

    Substandard care. That’s what chiropractic is. It’s substandard care. For idiots, by idiots.

  88. Harriet Hall says:

    @nwtk2007,

    I can see x-raying to rule out contraindications to manipulation and need for referral, but wouldn’t it be in the patient’s best interests to get the x-rays from the ER and review them rather than subjecting the patient to more radiation and cost?

  89. @Dr Hall, but x-raying in what respect? We who demand science-based treatment protocols agree that manipulation (along with many other modalities) may or may not provide modest, but temporary, relief of certain types of back pain. But if a patient has a history and physical exam that’s consistent or suggestive of fracture or other significant pathology then they should see a legitimate health care provider, because chiropractic care is absolutely inappropriate in this setting. The chiropractor should not be taking x-rays and making these decisions, because they are indisputably unqualified to do so, and can not provide anything beneficial to the patient.

    In short: Chiropractors, if you think you need to x-ray, then refer the patient to a real doctor. Do not screw this patient’s life up just because you think you know something. You don’t.

    I am not a radiologist. A radiologist (for those who don’t know) is a medical doctor who scored near the top of their class on the USMLE exams. I had to look it up, but I believe that a radiologist does 5 years of residency (including their internship, but that seems long, perhaps its 1 year internship and 3 years of residency?) to become a “doctor who reads radiographic images.” So we are looking at incredibly smart people, who completed college, then completed medical school, and then completed 5 years of training after medical school. That is *9* years of education *after* college to be able to identify different pathologies and diagnose patients.

    And yet, these quack morons who have no college degree and 4 years of quack training (I sure hope you paid attention in applied kinesiology class) think they are able to do the same thing with just a few months of training. They are indisputably less educated, less qualified, less skilled, and less intelligent, and yet they just go on their merry way.

    Wow. Man, did our country *screw up* when they got hoodwinked into allowing chiropractor quacks to be licensed.

    Again, newt2007, what did you think of your classes in applied kinesiology, BEST, NSA, etc? Did you pay attention? Did you ask the professor why they are teaching complete BS? Or did you believe it? Didn’t you question your profession at the time when they were teaching something that is indisputable a complete lie? Do you feel like a fraud calling yourself “Doctor”? And most importantly, do you believe that you benefit patients beyond possibly helping with several types of back pain?

  90. I just noticed I failed to make the point about what the X-rays are of. A chiropractor has no business staying anything period, but especially no business xraying nothing other than the spine. But you gotta appreciate the compete nut jobs who practice NUCCA, as taught at nwtk2007′s school, who take a ridiculous number of X-rays of C1 & C2, needlessly and completely pointless and dangerously exposing the brain to radiation. Why aren’t they put in jail?

  91. nybgrus says:

    So we are looking at incredibly smart people, who completed college, then completed medical school, and then completed 5 years of training after medical school. That is *9* years of education *after* college to be able to identify different pathologies and diagnose patients.

    I think that is the key here – it takes 5 years of dedicated training after medical school to be qualified as a radiologist.

    So even if we were to assume that at graduation the level of education between an MD and a DC are equivalent, there is still a 5 year gap (or 19,720 – yes nineteen thousand – hours of training) that a DC is lacking in order to properly read radiographic studies.

    The same goes for being primary care – to be a family medicine doctor or internist requires 3 years (11,400 hours of direct supervised patient care training) of post-graduate education.

    Of course, the level of education at graduation is not equivalent, but as we can see that doesn’t even remotely matter.

    I will be called “doctor” in a mere year and half. I have no illusions that I will be capable of safely acting as a physician on my own, let alone as a primary care physician. And that is an interesting point. I know enough about actual medicine to be deathly afraid of the concept of practicing entirely on my own – even in a nice little private community practice – right out of medical school. Yet DCs seem to have no qualms and think they are plenty well qualified to do so.

  92. Dang, alcohol plus typing on an iPad makes my posts impossible to read!

    -

    @nybgrus, isn’t the thought of your first day of internship terrifying?

  93. nwtk2007 says:

    Harriet, the problem with trying to get x-rays from a hospital is time. That is IF they will send them at all. I request records on any patient who has gone to the ER prior to coming to me, but if I waited for the records prior to beginning treatment then I would have to deal with the problems of delayed treatment of an acute injury; aproblem for both the patient and the doctor. The few times that I have gotten x-rays from a hospital, I have still had to take more because of the inadequate nature of them.

    skeptical, I really don’t think you get it. You sound very knowledgable but I’m guessing that your ego is the talk of your co-workers. If you worked with me, you’d have a leash.

  94. @nwtk2007, no comment on your classes in AK, BEST, NSA, botanicals, etc?

  95. Cowy1 says:

    All,

    Checkout this gem from the president of one of the largest (if not the largest) chiropracty school in the land.

    http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=55898

    Chiros qualified to be family docs? I think not.

  96. @cowy1, I almost just died. “Experts in human neurology?” Oh my. These are the same idiots who tell us that “nervous system interference” is causing all of our day-to-day problems. I love the part where he acknowledges that he “rearranges the vertebrae.” I do not believe that these people have any understanding of the human body.

  97. Pingback: URL
  98. nwtk2007 says:

    Whats to comment skeptical? I didn’t take a class on BEST and I don’t even know what NSA is. We had a good class on nutrition but nothing was available on botanicals. What I saw about BEST was that it was pretty stupid though. I saw a presentation on it where the actual BEST “inventor” claimed to have cured an enlarged heart. He had the “before” chest x-ray but no “after” x-ray. When I asked about that I was pretty much booed to silence.

    There truly was quite a bit of BS to be seen, no doubt. I just focused on what I could see as “non-magic” and went from there. One can get what one wants from any school I think. But how folks believe some of the silliness is beyond me. However, some very scientific folk out there also believe the earth once was inhabited by two naked people who frolicked about, naming animals and were completely unaware that they were naked with no knowledge of good or evil; yet became enlightened upon consumption of a fruit, ostentatiously placed there by an all powerful being who strolled too and fro across the earth.

  99. Scott says:

    How in the world can you trust a school which uncritically presents what you recognize as “quite a bit of BS” to have anything be legitimate? Answer – you can’t. It all becomes suspect. And a student can’t reliably distinguish unless they already know in which case there’s no point to being there.

    This is an issue in real medicine too (see “quackademic medicine”) but to nowhere near the same extent.

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