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Deception and Ethics in Sectarian Medicine

In January I had the pleasure of attending TAM 5.5 in Fort Lauderdale. On the last day of the conference the JREF had an open house where anyone interested could come see the inner workings at the JREF facility. Since I had a rental car I decided to go through the lobby to see if anyone needed a ride, and sure enough one Dr. Harriet Hall took me up on my offer.During the 20 minute drive that I had Harriet captive we were able to have a pleasant and illuminating (for me) conversation, during which I told Dr. Hall about an experience I had with a chiropractor in my neck of the woods. This got me thinking about honesty and purposeful deception in alternative medicine, and for this reason I’m going to start this blog entry off with a personal anecdote about an incident that occurred some years back just after I graduated from Nursing and had become a full-fledged registered nurse.

After having some back problems I decided to go to a respected chiropractor in Calgary (a city of about 1 million people). Since it was my first visit I needed to go through a full ‘assessment’ and the chiropractor took my blood pressure, had me step on two scales (one for each foot) so that he could weigh both sides of my body simultaneously, and he also took a single anterior X-Ray of my chest/spine (anterior means an X-Ray taken straight on with my back against the photographic plate – actually I think the technical term for that is an AP or anterior-postero X-Ray).

After the assessment and a few questions he took me into a treatment room and cracked my back in about 10 different ways. I insisted that he NOT touch my neck at all and while he tried to talk me out of it, he at least respected that request. During the cracking I asked him about some mild crunching I noticed in my neck when I turned my head and he immediately said to me “that’s because you’re not eating right”. I informed him that I had a significant knowledge about nutrition and that I ate very well. He then said “yes, but it’s the food that you’re eating, it’s not as good as it used to be. You need to take these supplements to ensure that your dietary needs are fully met and then the problems with your neck can go away.”

I may have been only 22 years old and relatively naïve, but I was having a hard time swallowing what he had to say about my neck and how he miraculously diagnosed my minor problem as a nutritional deficiency without even as much as a look at my neck or a question about my eating habits. After I had decided that he was a quack trying to sell me supplements that only he could provide me, he took me over to a treatment room where he unveiled my X-Ray. To my significant shock and amazement I found myself staring at a spine that was significantly altered by scoliosis; indeed, a visible S-shaped curve lay before me illuminated by a light box. I remember asking the chiropractor why, if my back was so dramatically curved that I hadn’t experienced more significant symptoms? To be honest I can’t remember what his rationale for this was, but I do remember that he started telling me stories about other patients he had seen with significant scoliosis and that he was able to straighten their spines completely. The catch was that I had to go see him every day for 2 years. Yep, if I did that then he could pretty much guarantee that my spine could be straightened out. Needless to say I didn’t return to him, but I went through the next few years believing that my spine was racked with scoliosis.

Eventually I had another chest X-Ray after I sustained a shoulder injury playing football, and I happened to get a look at that X-Ray. Imagine my surprise when I saw that my spine looked perfectly straight and normal. I won’t lie to you, it took me about an hour to connect the dots and realize that all those years before the chiropractor had put someone else’s X-Ray in front of me in a sort of bait-and-switch scam where eventually he could use my real X-Ray to ‘prove’ that his treatments worked to cure my scoliosis. That is, of course, after I had dropped $25 a visit every day for 2 years (that’s $13,000.00 assuming 5 visits per week).

Not surprisingly I was enraged by the realization that this chiropractor tried to scam me. I contacted the chiropractor’s office and demanded that they release my medical records (specifically my X-Ray) to me and they refused saying that they could only release them to a physician, but when my physician requested the X-Ray the chiropractor’s office informed him that they had destroyed the X-Ray and all of my medical records (why was never made clear). I then made several attempts to contact the Alberta College and Association of Chiropractors, with all telephone and email correspondence going unanswered.

Of course, this is only my personal, highly subjective and anecdotal story. But it does make me wonder how much of this sort of thing is going on out there in the alternative medical field. After all, most lay-people are completely exposed to being exploited by pseudo-scientific jargon coming from a person in a white coat with the prefix ‘Dr.’ before their name. What is most disturbing to me is that the Alberta College of Chiropractors, supposedly the governing and disciplinary body for these practitioners didn’t feel that it was necessary to respond to my concerns.

In my neck of the woods there are several chiropractors, for example, who subscribe to NAET therapy, homeopathic remedies, and even anti-vaccine doctrine. To me these all represent deceptive and unethical practices since their patients stand to lose plenty of cash and perhaps even contract deadly disease by following their advice. Is it any of my business if someone uses these services and is deceived? Actually, for me and my fellow Canadians it does matter since we are part of a universal health care system where chiropractic care is subsidized by the government. In Alberta Chiropractic treatments can be claimed on universal health care at a rate of $14 per visit up to a maximum of $200 per year. That makes it everyone’s problem.

Chiropractors are certainly not the only ones engaging in what could be interpreted as deliberate deception (NAET Therapy). Indeed, in Alberta there are eight registered NAET practitioners. Some may argue that NAET is not dangerous, but since it purports to eliminate allergies through what basically amounts to magical thinking. NAET is based on the concept that allergies are caused by an ‘energy blockage’ that can be diagnosed with muscle testing and cured with a bizarre combination of acupressure and other modalities. I wonder how a NAET practitioner can engage in these treatments with someone who has a severe nut allergy? Surely they must understand that if their ‘treatment’ fails the results could be fatal for the patient. It is a these times when deception in alternative medicine takes on a far different meaning than merely trying to extract money by claiming a herbal supplement or chiropractic adjustments are going to improve a patient’s life. I think a good start would be to ensure that the governing bodies of these organizations actually seek out and quash deceptive and dishonest practices. In the case of my province, a good start would be merely responding to complaints in the first place.

Posted in: Chiropractic, Health Fraud, Medical Ethics

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10 thoughts on “Deception and Ethics in Sectarian Medicine

  1. Diane says:

    Just want to let you know that the issues raised in this post by Bart are examined closely in numerous threads on a publically viewable discussion forum called Chirotalk.
    http://chirotalk.proboards3.com

    Chirotalk features several ex-chiropractors who share information on topics related to dubious chiropractic sales/practice methods, educate/warn the public, and try to steer young people away from becoming chiropractors.

  2. Harriet Hall says:

    Thanks again for the ride, Bart!

    Your comments on NAET reminded me that I filed a complaint against a Washington State chiropractor who was practicing NAET, using muscle testing to diagnose allergies, which is not on the list of approved procedures for chiropractors in this state.

    First, the chiropactor lied to the board and said he didn’t do it. They took his word for it and closed the case. I eventually got them to re-open the case. I told them I had multiple witnesses that he had given a public talk saying he DID do it, and I had a handout that he had passed out describing NAET.

    We had established that he was lying, either to the Board or to the people who heard his talk. It seemed clear from my reading of the regulations that he was practicing beyond the legal scope allowed for chiropractors in this state.

    I expected a reprimand for the lying and an order to cease and desist the NAET.

    They took no action because there was no evidence that he had harmed patients.

    The “spine experts” on the state Chiropractic Board are curiously “spineless.”

  3. BlazingDragon says:

    It sounds like chiropractors are allowed to essentially self-regulate. We all know how well that works out. Sigh.

    Medical doctors are much better, but I went to check the license the other day of a surgeon who will be performing a tonsillectomy on me in a few weeks. I was surprised at the dearth of information (other than his license is current and no major sanctions). The guy appears to have been practicing for 20-25 years… there has to be a few real complaints about him, yet they weren’t online and available for viewing.

    Would it hurt to have more information about complaints and how they were resolved for each doctor? They specifically said that resolved complaints were taken out of the record… which I found quite odd (yes, I know unscrupulous people might mis-use the information somehow, but it’d be nice to know what types of complaints have been lodged against the guy and how they were resolved, considering he’s going to be performing an operation on me that, by all accounts, is pretty bad when one is 37 years old).

    I don’t expect more from the quacks and nutcases that “practice” “medicine” (the CAM nutjobs). They are out to make a buck and until they are reigned in by tough, specific legislation, they will continue to fleece the public and evade responsibility. I do expect more from actual medical professionals.

  4. happyhumanist says:

    The cracking sound in your neck is the same problem I had. I went to a chiro, one who helped my friend with a bad back. This was many years ago, when I thought that chiros were legit.

    He took x-rays and told me the reason for the cracking was calcium building up inbetween my vertebrae. He told me that if I didn’t do anything, soon I would be unable to move my neck. So I permitted treatments (covered by insurance)–back and neck adjustments. Yeah, I know. I didn’t like the neck ones, and told him to stop doing them. For several appointments, he respected my wishes, and then one day attempted to grab my head. I stopped him, berated him, and stopped coming.

    He did his level best to get me back in. But I was done.

    This occurred over 20 years ago. Guess what? I have no trouble moving my neck. Liar, liar, pants on fire!!

  5. Not to take any position on this (because it’s a complex dilemma) – but just to add that the prospect of publicly listing complaints and complications against physicians is a double-edged sword. This leads physicians to avoid complex or “difficult” patients – ones that will hurt their practice by giving them a bad rating. Market forces are complex, and if you don’t think them through regulations often cause more harm than good.

  6. llysenwi says:

    My understanding is that part of the concern about making the complaints public is a combination of reporting bias and . Individuals who had a negative experience (whether or not it was actually due to the doctor’s errors) are more likely to submit than those with a positive experience. This could make even competent doctors look incompetent, especially when compared with the quacks who don’t regulate themselves at all.

    For someone with some knowledge, information about complaints and, particularly, how they were resolved would be very useful. It may in practice be very difficult to correlate the complaints with competency with .

    Does this mean the data should not be made available? No. But, given that the public does not seem to understand that complaints are frequently generated in the absence of any errors, I can understand the thinking of the professional organizations that handle the complaints.

  7. sandswipe says:

    Surprisingly few people know what to look for when they check for complaints, and something that is essentially white noise which had nothing to do with the doctor will jump out at a lot of non-professionals as a major issue, dissuading them from going to several real doctors and eventually turning them to a quack who doesn’t display his problems for patients.

    I would prefer to be able to see these things, but if making them invisible to the public means that a larger number of people are able to get treatment and survive their diseases then I support hiding the records.

  8. Joe says:

    Thanks for this. I have long wondered about the possibility of faked X-Rays. In many cases, it seems unnecessary since laypeople cannot interpret them, so they (we) are left at the mercy of the chiro to identify the subluxation. Although that was debunked in the 1960s, some chiros continue to make such claims today.

    Moreover, I have seen (sorry, the link is inactive now) where a chiro posed a customer for the “before” picture, with the subject’s head cocked slightly to one side. Thus, the skull was not aligned with the spine. The “after” picture showed the customer ramrod-straight. Anyone with two ears to hear with could see that the chiro had corrected the problem. Or …

    Basic chiro “education” prepares few of them to adequately take, or read, X-Rays. http://www.chirobase.org

  9. Zetetic says:

    Revealing provider ratings, complaint & disciplinary records to the public is a veritable minefield. I’ve worked in health care for almost 40 years, first as an RN and clinical manager and more recently in data analysis support for health care quality, risk management and physician peer review programs. I’ve witnessed the development and pitfalls of public transparency in this realm. Peer review used to be entirely internal with virtually no teeth with a “good old boy” (or girl) mentality where professional discipline was all too often just a light knuckle rapping. Public ratings can become anecdotal where a single incident reported to some sort of clearing house can color an outstanding provider’s long and successful career. The public doesn’t intelligently acknowledge that a negative malpractice lawsuit is the decision of a lay jury, often unduly influenced by paid “experts”. A well functioning and unbiased professional peer evaluation which focuses on best practice principals is more likely to fairly evaluate the an untoward event.

    All these things said, at least modern evidence based medicine is, unlike CAM, policing itself!

  10. BlazingDragon says:

    I don’t agree that modern medicine is policing itself. It does a hell of a lot better than any of the CAM quacks, but too often patients are left in an information vacuum when trying to seek out information on a provider. We get their medical school, residency, etc., but that doesn’t tell one how good/bad the doctor is going to be.

    If doctors don’t start releasing some of this information, it will go on the internet, where doctors have a lot less of an ability to control it. I agree that too much information is bad for the doctors, but too little will leave a void that will be filled by many people of varying quality (and scrupulousness). This is already happening in message boards for various diseases (but the information is fragmented and not easily searchable, yet).

    If you think modern medicine polices itself well, you must work at a much better institution than I’ve ever seen. Too often things are left to the “discretion” of another physician (benefit of the doubt), which leads doctors with poor temperaments to do whatever the hell they want (I’m not talking about criminality, but poor treatment of patients).

    As for doctors avoiding “difficult” patients… how would that be a change from how most physicians practice medicine today? Yes, that is a bitter and sarcastic statement, but I’ve seen two or three doctors willing to actually try to solve difficult medical problems… well over a dozen say “it’s all in your head,” “I don’t know, see someone else,” or “it’s not my area of expertise, here see so-and-so.” For the patients who fall between (or across more than one specialty), their problems need to be very severe (and show up obviously on laboratory tests) before they are taken seriously.

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