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Dr. Who?

If the “Health Freedom” movement has its way, everyone in the United States will be able to practice medicine. It may be quack medicine but that doesn’t seem to bother them. Short of that, chiropractors, naturopaths and acupuncturists are aiming to reinvent themselves primary care providers and even physicians. As David Gorski pointed out, this will reduce medical doctors to just another iteration of physician, the “allopathic” type, equal in stature to the chiropractic, naturopathic and acupuncture types. These “physicians” already call themselves “doctor” (e.g., “Doctor of Oriental Medicine”) and claim to graduate from four-year “doctoral” programs. This despite the fact that their schools operate outside the mainstream American university system and avoid some of the basics of typical graduate programs, such as entrance exams, as well as the extensive clinical training required for medical doctors.

Consumers are confused by all of this, and who wouldn’t be? In 2008 and 2010, surveys done for the American Medical Association by outside firms revealed that many patients did not know the qualifications of their healthcare provider. The comparisons were between allied health professions (e.g., audiologists and nurse practitioners) and medical doctors, but chiropractors were included. In 2008, 38 per cent of those surveyed (n=850) thought chiropractors were medical doctors, although that dropped to 31 per cent in 2010. Still, we are talking about roughly one-third of the survey participants.

The surveys also asked about the use of the term “physician” and confusion in advertising materials.

AMA survey 2

(Sorry, my visual aids are not as titillating as Dr. Gorski’s, but I couldn’t find any Penthouse covers relevant to this topic.)

Etiquette weighs in: a digression

Before we go any further, let’s digress into a topic raised in the comments of a previous post: who should use the title “Doctor,” at least in what is referred to somewhat quaintly as “social settings.” But first, a disclaimer: This advice only applies to the United States. Your country may have a totally different set of rules.

I consulted the experts on this, that is, the etiquette experts, people no one pays much attention to anymore. I found what is known in the legal field as a “split of authority.” Miss Manners (Judith Martin) says “Dr.” should be reserved for those in the medical profession, although she also thinks people should be called what they want to be called. So, if someone insists, then “Dr.” it is. On the other hand, Letitia Baldridge, who served as social secretary to Jacqueline Kennedy Onassis when she was first lady, is (or was, she passed away last year) of the opinion that your academic title is also your social setting title. Emily Post sides with Miss Manners. In social settings, she advises one start with by addressing both Ph.Ds and medical doctors as “Dr.” and if the former prefer some other title, they will tell you.

So now you know.

Truth in Healthcare Marketing

A bill introduced in the U.S. House of Representatives, with bipartisan support, aims to clear things up in the professional, if not social, setting. H.R. 1427, the “Truth in Healthcare Marketing Act,” would prohibit any “deceptive or misleading” statement or act that “misrepresents” a person’s “education, training, degree, license or clinical expertise.” If H.R. 1427 becomes law, such misrepresentations would be a violation of the Federal Trade Commission Act, which prohibits, among other things, any unfair or deceptive advertising or marketing practice.

Under the proposed Act, the information must be deceptive or misleading, but the bill also specifies that it must “misrepresent” the education, training, degree, license or clinical expertise. But if information is deceptive or misleading, I would argue that it by definition it “misrepresents” so I am not clear whether, as a practical matter, that is an additional requirement or not.

In any event, misrepresentation of a license or degree should be pretty clear cut, but I’m not sure where the boundaries might fall around misrepresentation of one’s education, training, or clinical expertise. Of course, there are always the egregious cases, like the Colorado chiropractor claiming to be an endocrinologist whose treatments could “reverse diabetes.” Having a wimpy chiropractic board administer a delicate wrist slap is one thing; having the Feds after you is quite another.

As we’ve noted on SBM, both naturopaths and chiropractors claim their education and training is sufficient to practice as a primary care physician. They promote the idea that their schools offer an education that is either the equivalent of, or close to, that of a medical doctor. A chart handed out by naturopaths in support of their Colorado licensing bill claims they have more hours of education in pharmacology than medical doctors. And a chart published by the American Chiropractic Association (ACA), posted below, purports to show that chiropractic students have more combined classroom and clinical hours than medical students. (The ACA made similar overblown statements in a brief filed with a Colorado court.) Assuming these claims are made in a context otherwise covered by the Act (such as advertising by a chiropractor) would representations like this pass muster under the proposed “Truth in Healthcare Marketing Act of 2013”?

Let’s look at a description of chiropractic education from the American Chiropractic Association’s website. [Emphasis added.]

Chiropractic Education

Educational requirements for doctors of chiropractic are among the most stringent of any of the health care professions.

The typical applicant at a chiropractic college has already acquired nearly four years of pre-medical undergraduate college education, including courses in biology, inorganic and organic chemistry, physics, psychology and related lab work. Once accepted into an accredited chiropractic college, the requirements become even more demanding — four to five academic years of professional study are the standard. Because of the hands-on nature of chiropractic, and the intricate adjusting techniques, a significant portion of time is spent in clinical training.

Doctors of chiropractic — who are licensed to practice in all 50 states, the District of Columbia, and in many nations around the world — undergo a rigorous education in the healing sciences, similar to that of medical doctors. In some areas, such as anatomy, physiology, and rehabilitation, they receive more intensive education than most medical doctors or physical therapists.

 

ACA chart chiropractic v medical education

 

Like other primary health care doctors, chiropractic students spend a significant portion of their curriculum studying clinical subjects related to evaluating and caring for patients. Typically, as part of their professional training, they must complete a minimum of a one-year clinical-based program dealing with actual patient care. In total, the curriculum includes a minimum of 4,200 hours of classroom, laboratory and clinical experience. [Then why does the chart say 4820?]  The course of study is approved by an accrediting agency which is fully recognized by the U.S. Department of Education. This has been the case for more than 25 years.

Before they are allowed to practice, doctors of chiropractic must pass national board examinations and become state-licensed. Chiropractic colleges also offer post-graduate continuing education programs in specialty fields ranging from sports injuries and occupational health to orthopedics and neurology. These programs allow chiropractors to specialize in a healthcare discipline or meet state re-licensure requirements.

This extensive education prepares doctors of chiropractic to diagnose health care problems, treat the problems when they are within their scope of practice and refer patients to other health care practitioners when appropriate.

[Hmmm. The ACA says that “intricate adjusting techniques” are taught in chiropractic college as part of the “significant portion of time” spent in clinical training? And what do chiropractors “adjust”? Subluxations! So much for the claims that detecting and correcting subluxations is not emphasized and is taught only as a historical concept in chiropractic schools.]

Misleading or deceptive?

Before we parse this description, note some of the relevant criteria by which the information is judged under the FTC Act.

  • No intent to deceive must be present. Innocent misrepresentations are covered by the FTC Act.
  • How an average or unsophisticated person, not the expert, would view the information is the standard. Would it mislead an average consumer?
  • The information is looked at as a whole and can be deemed deceptive even though the individual statements made are literally true.
  • The claims made must be material to the consumer, that is, the information must be important to consumers and likely to affect their choice of, or conduct regarding, a product or service.

It is interesting to note that the ACA’s discussion of chiropractic education may be, for the most part, literally true. (Although I seriously doubt that the chiropractic student’s education in anatomy or physiology is more “intensive” than that of a medical student, especially considering their narrow focus on the musculoskeletal system.) But, as we know, literal truth is not the standard. We have to look at the information taken as a whole.

Here is where I think the information might be deceptive or misleading as interpreted by the average consumer who would consider a health care provider’s education to be important but who is not familiar with the health professional educational system. Those more familiar with medical education can likely add to my observations.

  • Hours and calendar years are used to compare education, when in fact the number of hours or years is not an indication of quality or rigor. (By this standard, elementary school is more demanding than college.) Nor are classroom and clinical hours inclusive of all time spent in learning. What about time spent in independent research?
  • While the chart notes the years spent in residency are not included, failing to count those leaves out a substantial and important difference between chiropractic and medical education.
  • There is no mention of the chiropractic student’s focus on the musculoskeletal system or the fact that medical students have far more education in any number of subjects, such as pharmacology, primary care, and pediatrics as well as the body’s other systems, such as cardiovascular and reproductive. Nor do chiropractic students have clinical training in a variety of specialties.
  • There is no mention of the focus on the musculoskeletal system in actual chiropractic practice. In fact, chiropractors are referred to as primary health care practitioners.
  • The mention of “post-graduate” educational programs leading to “specialties,” fails to note that these are mostly limited to courses taken over a number of weekends with little (perhaps no) actual clinical training.

My conclusion is that this description viewed as a whole would leave the average consumer with the false impression that chiropractic education is equal in rigor and breadth to a medical education and qualifies graduates to practice as primary care physicians. Under federal law, this need not be the only interpretation possible to violate the FTC Act, but it is certainly one a reasonable consumer could reach. Again, about one third of survey participants actually thought chiropractors are medical doctors. To the extent that chiropractors use similar information in their advertising and other communications with the public they would be vulnerable to suits claiming violation of the FTC Act.

But that’s not all.

The bill also requires the FTC to undertake a study of healthcare professionals to:

  • Identify acts and practices constituting a violation of the new law, their frequency, and instances of harm or injury caused.
  • Determine whether health care professionals are complying with state laws requiring disclosure of the type of license they hold.
  • “Identify instances where any State public policy has permitted acts and practices which violate section 3(a),” the section prohibiting deceptive or misleading statements, discussed above.

I, for one, will be more than happy to “identify . . . State policy” permitting these deceptive practices. For instance:

  • Licensing chiropractors, naturopaths and acupuncturists as primary care providers, either explicitly or de facto through wide scopes of practice.
  • Effectively giving out licenses to practice quackery by permitting such practices as the “detection” and “correction” of subluxations, prescribing homeopathic “remedies,” iridology, cranial sacral therapy, energy healing . . . well, I could go on and on. I will quote state laws and regulations, chapter and verse.
  • Allowing self-regulation (including the right to write their own regulations) through the creation of state board dominated by “CAM” practitioners. Once these practitioners are governed by their own boards, which have exclusive jurisdiction to discipline them, it is difficult to hold them accountable.
  • Blindly accepting, lock, stock and barrel, whatever education, testing, certification, training, continuing education, and the like these practitioners chose to create for themselves without any outside scrutiny (other than the Department of Education accrediting agency requirements, which reject science as an appropriate standard for health care education).

If done properly, this report could be at least a PR disaster for CAM providers. (Or not. Government reports about problems with dietary supplements do not seem to have tempered the public’s enthusiasm for supplements.) And it might even embarrass some states into actually instituting reforms, such as, say, a single, science-based standard for all health care practitioners.

If H.R. 1427 becomes law, I’ll be sitting by the computer, Federal Trade Commission, waiting for your e-mail. You can reach me through the SBM website.

Posted in: Acupuncture, Chiropractic, Health Fraud, Legal, Naturopathy, Politics and Regulation, Science and Medicine

Leave a Comment (66) ↓

66 thoughts on “Dr. Who?

  1. Scott: leave the average consumer with the false impression that chiropractic education is equal in rigor and breadth to a medical education and qualifies graduates to practice as primary care physicians.

    The average consumer is perfectly able to decide what type of practitioner he wants to consult! The list of accredited physicians is already available from the state’s medical board, the list of chiropractors from the board of chiropractic examiners and if you need a certified homeopath, just click on my name (not an advertisement, just saying..)

  2. norrisL says:

    How about you lot over there in the USA get serious and make any form of medical quackery illegal, with relevant jail terms. Just like we have here in Australia…….hang on, where did those laws go?

    At least what we have done over this side of the ditch is to ban certain “therapies” from being able to claim against private health insurance. Note that as of 12 months ago, 45.7% of Australians were covered by private health insurance. The odd thing is that patients of chiroquacktors and acupuncturists are exempt.

  3. windriven says:

    I loved this tiny appendage to the chiropractic table purporting to show the equivalence of medical and chiropractic education:

    *Does not include hours attributed to post graduation residency programs

    A residency in internal medicine, one of the shorter residencies, is 3 years, other residencies are as long as 8 years. Chiros, as I understand it, have zero requirement for postgraduate residency.

  4. DugganSC says:

    Hmm… one’s academic title as one’s social title. I could do with insisting that everyone around me call me Master Duggan. ^_^

  5. WilliamLawrenceUtridge says:

    The average consumer is perfectly able to decide what type of practitioner he wants to consult!

    The average consumer understands that homeopathy is nothing but sugar pills, acupuncture is nothing but placebo, naturopathy is what happens when gullible people pretend to be doctors and chiropractors are just physiotherapists with a penchant for dangerous wrenching of the cervical vertebra? This is one of the areas within economics where state intervention is a good thing – assymetrical information. It’s deceptive false advertising based on lies, errors or ignorance about how the body (in fact, chemistry and even physics) works. It’s why we have publicly-paid building inspectors, health inspectors, any kind of inspector really – because the average citizen lacks the knowledge and experience to know what to look for. Certainly you aren’t aware of this, given your advocacy for “certified homeopathy” below. Exactly what does a homeopath need to be certified in, all you’re doing is handing people lactose pills sprinkled with water or alcohol.

    The list of accredited physicians is already available from the state’s medical board, the list of chiropractors from the board of chiropractic examiners and if you need a certified homeopath, just click on my name (not an advertisement, just saying..)

    Nobody needs a certified homeopath. It’s a form of self-soothing for the worried well, or a dangerous way of delaying treatment for the truly sick.

    The problem is, there’s no federal or state list of professions that are nonsense. Physicians, for the most part, are not nonsense practitioners of toothfairy science. Homeopaths, are, as are acupuncturists, chiropractors and naturopaths. Redundant to real doctors when they are doing good, corrosive to health, science and medicine when they are not.

  6. windriven says:

    @WLU

    Well stated, though I’d take exception to your assertion that the average consumer understands homeopathy/chiro/etc. The average consumer is barely able to find their buttocks using both hands and a mirror. The sales volume of “nutritional supplements” alone demonstrates that. Dangerous quacks would be back to dealing three card monte on seedy street corners if the average consumer understood the distinction between medicine and nonsense.

  7. WilliamLawrenceUtridge says:

    Note that my first sentence has a question mark at the end :)

    I don’t think the average consumer is that bad, they’re just specialized to whatever niche in life they have. Of necessity, given the complexity of our modern world and our desire to live long, healthy lives, we must trust each other and the governing institutions that work for our protection. That’s why Jann’s posts are so important, because they point to failures of these institutions.

    I have far less issue with supplements than I do with quacks pretending to be doctors. They’re mostly worthless and waste a bit of money (mostly, there are exceptions that are outright dangerous of course) and even in cases where they are used as treatments for serious conditions, normally the patient is doing so at the behest (directly as a patient or indirectly as a consumer of magazines or websites) of a quack. Taking vitamins usually just wastes money. Taking vitamins to cure cancer should invite prosecution as it’s not normally the bottle that is the problem, it’s the “doctor”.

  8. Professional certification and accreditation allow the physician to boost his credentials and inform the patients of his qualifications on his marketing materials:

    AP – Acupuncture Physician
    APH – Advanced Practitioner of Homeopathy
    DC – Doctor of Chiropractice
    DOM – Doctor of Oriental Medicine
    MD – Doctor of Medicine
    ND – Doctor of Natural Medicine
    PT – Physical Therapist
    FH – Faith Healer
    RN – Registered Nurse
    RPh – Registered Pharmacist
    VMD – Veterinarian

  9. WilliamLawrenceUtridge says:

    …except six of that list are credentialed in nonsense. It’s like having a certification in therapeutic bleeding and emetics to adjust the blood and yellow humors. The certification gives the false sense of reassurance to the ignorant patient that their “doctor” has some sort of government or professional approval, when it’s really about as meaningful as being a certified snake handler (and the “talking to God” kind, not the “I can get snakes out of your basement” kind).

    It’s false confidence. It’s worse than having no form of credentialing or certification. It’s lies told for no purpose other than to enrich a very specific set of practitioners. They add nothing to health care. They add nothing to the health of their patients. They are an absolute drain on the economy. The opportunity cost of having these practitioners is significant.

  10. windriven says:

    @WLU

    Re: question mark … my bad :-(

    @FastBuckArtist (such an appropriate nom de quack!

    AP – ah-puncturer (in some Asian cultures prepending or appending ‘ah’ or ‘oh’ suggests special or honorable).
    APH – Grifter
    DC – Masseur with a white coat
    DOM – Shaman
    MD – Doctor of Medicine
    ND – Pretentious Quack
    PT – Physical Therapist
    FH – Santeria Priest(ess)
    RN – Registered Nurse
    RPh – Registered Pharmacist
    DVM – Doctor of Veterinary Medicine

    You can call a goat turd a Tiffany vase (read vahhhzz) but it still stinks on ice*.

    *stinks on ice is a registered TM of The PusWhisperer

  11. SomePapa says:

    I know it’s a mere anecdote, but it’s one of my favorite stories. When I entered graduate school to become an NP, one our fellow students was also a Naturopath. She looked at the program and was up in arms because she had to “retake all these classes” she’d already taken. Later, once resigned, she told us her experience would help us get through them.

    Guess who struggled through the program?

  12. bgoudie says:

    Does the value of one’s certification as a homeopath increase with how little real science went into the training? Just wondered how things work over there in the world of magic.

  13. goodnightirene says:

    My despair sinks ever deeper.

    Today I went to PT and one of the questions on the form relating to previous treatment asked if I had seen: A) specialist, B) PT, C) forget, but was a real medical person D) Chiropractor

    Eek! I crossed it out and wrote NEVER!

    I don’t mind them asking because maybe they need to know the history, but the way it was all lumped into one question made it look as though the Chiro was just another medical professional. The PT herself asked me once if Chiros were “doctors”. She was somewhat under the impression that it is a sub-specialty like orthopedics or perhaps in there with Optometrist or Pharmacist! She seems a bright and well-educated young woman in general and thinks that acupuncture and massage therapists who claim to be “healers” are total quacks. I’m happy to report that this woman is one of my few success stories as she now knows to put chiros in with the rest of the quacks–although I hope she came to that because I gave her solid facts, not just because she finds me “such a hoot”.

  14. windriven says:

    @irene

    ” this woman is one of my few success stories”

    If we all could claim just a few success stories every year, and some of those success stories earned success stories of their own …

  15. windriven says:

    @bgoudie

    “Just wondered how things work over there in the world of magic.”

    I’ve heard something to the effect that it isn’t the size of the wand but the magic within ;-) The homeos must have hella magic to keep a fraud that transparent going for as long as it has been.

  16. elburto says:

    Windriven – you forgot one:

    FBA – Quackpeddler in Extremis, who’s also a PhD* in Wooliganism.

    *Privilege-holding Dickwaver.

  17. windriven says:

    @SomePapa

    “Guess who struggled through the program?”

    Perhaps it was a struggle because her undergraduate program was actually based on science. Unlearning that could be a real problem for a rational person.

  18. windriven says:

    @elburto

    “*Privilege-holding Dickwaver.”

    Made me laugh out loud! :-)

  19. Chris says:

    windriven, I was thinking “NP” stood for Nurse Practitioner. I suspect the naturopath suffered because she was not taught real science as an undergraduate.

    And one more example of why acronyms are confusing.

  20. windriven says:

    @Chris

    Sh!t. Right you are. I need a homeopathic brain remedy. Yesterday I attributed one of Novella’s quotes to Gorski. Today I missed a question mark on one of WLU’s comments and totally misconstrued SomePapa’s comment. Ah, the ravages of early onset senility :-(

    I think I’ll go pour a glass of wine and put on an old SomeMamas and SomePapas record and relive the days when all 73 of my neurons functioned properly :-)

    Seriously, thanks for pointing that out.

  21. Chris says:

    No problem. :-)

    I actually had to use the googles to make sure I had the right acronym. Now I am going to go some stitching in the sunshine, because I have to be at home to sign for a computer that is being delivered in the next four hours.

  22. windriven says:

    @Chris

    I propose that NP@< be adopted as the recognized credential for naturopaths to differentiate it from NP for honored and esteemed nurse practitioners. The @< is the best I can do with the limitations of ASCII to simulate a duck quacking. If you or anyone can improve on it I would be much beholden.

  23. nickmPT says:

    @goodnightirene

    Most PT’s know (or should) who/what Chiro’s do/are. Chiropractic associations are often a thorn in PT advancement (either challenging direct access or trying to limit PT scope under the guise of ‘safety’) as they often claim that PT’s are not qualified to perform certain treatments (almost exclusively manipulations) or do not possess the knowledge of the body as thorough as Chiro’s do.

    Ultimately, if you go to a Chiro or PT and they do not give you current science-based explanations for your pain (usually what most people are going to either discipline for), and just perform ‘manual magic (massage, manipulation, whatever),’ slap some modalities on you (e-stim, ice/heat, ultrasound), and/or some form of choreographed, ‘sexy’ exercise that will ‘fix’ your problem, hell you may as well go to the spa.

    Now, if your therapist (or Chiro) listens intently to you, explains your problem with less-wrong science, helps reduce the threat of movement through some sort of manual contact (that only needs to adhere to the rule of not being threatening, i.e. painful), empowers you to take charge of your problem, and encourages you to move in something that you enjoy, then you may have found a true bodily therapist. The therapist is not there to ‘fix’ you, they are there to help guide you back to your life.

    A good website for therapists (and this includes massage therapists, Chiro’s, etc.) is somasimple.com.

    TL;DR: avoid the therapist who is focused on fixing you with their ‘tools.’ Find the therapist that is focused on helping you empower yourself by reducing threat and improving knowledge.

  24. goodnightirene says:

    @nickmPT

    Yes, it surprised me that this PT was mis-informed about chiro as I think that might come up in a three or so year training regimen, but perhaps not.

    Thank goodness PT’s don’t do “manipulations”–for that would make them quacks.

    In my state (and other states I’ve had PT) it must be prescribed by an MD for a specific diagnosis. You don’t just go to PT like a spa or Chiro. The PT simply provides specific exercises/movements to ease the problem, or in the case of post-surgical situations, assists in recovery of movement. There’s never been anything about “empowerment”, “taking charge”, or “move (ing)” in something you enjoy. I am not looking for a “bodily therapist and am not sure what you are getting at. I AM there to be “fixed” and have no clue what “reducing threat and improving knowledge” mean outside of being informed of activity or movements not to be done while the problem persists and maybe explaining the problem in more detail if the patient has questions.

    I’ll look at your link but I should say that I’m skeptical.

  25. Chris says:

    windriven:

    I propose that NP@< be adopted as the recognized credential for naturopaths to differentiate it from NP for honored and esteemed nurse practitioners.

    Well, ND already means “Naturopathic Doctor.” And one way to remember that is this phrase: Not a Doctor.

    Hmmm… let me look at FBA’s list just like you did:

    AP – Acute Poker
    APH – Anti-Physics Hooey
    DC – Dangerous Crap
    DOM – Deviant Old Malarkey
    MD – Doctor of Medicine
    ND – Not a Doctor
    PT – Physical Therapist
    FH – Fake Help
    RN – Registered Nurse
    RPh – Registered Pharmacist
    VMD – Veterinarian

  26. goodnightirene says:

    @windriven

    I missed the ? as well (and was really mystified by what I therefore construed as a very odd comment by LWU).

    I misconstrued the same comment by SomaPapa in the same way.

    I made the same NP mistake.

    Either great minds think alike or we’re both past our neurological prime. I guess “all the leaves are brown–and the sky is gray” Skoal!

  27. windriven says:

    @Chris

    Nicely done and ! And yes, NP is not apparently used by

  28. mousethatroared says:

    nickmPT – I feel threatened by people who try to “empower” me. Perhaps you could try to say what you are getting in plain language.

    I’m with goodnightirene. I’ve been in PT three times (for different body parts). Each time I felt the therapist did a good job and explained their recommendations/approach. As far as I can see their approaches were science based and helpful. They never talked about empowering, reducing threat or improving knowledge…although my last session I did get some coaching that slouching irritated shoulder impringement problems – so I’m trying to improve my posture. Is that what you are talking about?

    Also I’m not sure what you mean about “not being painful”. Apparently, I have capsulitis of the shoulder and pretty much any movement was painful to start. But between the PT and a cortisone shot I seem to be getting some ROM back.

  29. windriven says:

    @ Chris

    Nicely done and quite creative! NP is apparently not used by naturopaths; I led myself down a blind hole. I still like the little quack emoticon though :-)

    @irene

    “Either great minds think alike or we’re both past our neurological prime.”

    Or maybe both! ;-)

    Sorry about the stutter on the preceding comment.

  30. Chris says:

    Yes, the little quacker emoticon is adorable. @<

  31. mousethatroared says:

    goodnightirene “Thank goodness PT’s don’t do “manipulations”–for that would make them quacks.”

    This reminded me of something that happened to me quite awhile ago. Way back when I was in my twenties, I went to see a chiropractor for hip/back pain (actually a pain in my butt). At the time, I was highly suspicious of chiropractor’s for reason’s I won’t go into right now, but a coworker told me “Oh this isn’t one of those wacky chiropractor’s. He just works on back pain”. So I gave him a try. Went for two sessions. He did adjustments and gave me exercises where I would lift the leg on the painful side behind me…to “adjust” the spinal do-hicky that was supposedly out of place. The pain got worse and I didn’t go back. Eventually it went away on it’s own, unless I did any jogging or other high impact activities.

    About 6 or 7 years latter the pain came back, only worse. Hard to sit, walking any distance hurt, etc. After waiting a number of months to see if it would go away on it’s own, I went to the doctor, who sent me to P.T. After some evaluation, the PT said she suspected that the pain was caused by SI joint inflammation that was aggravated by a slightly twisted pelvis. The Orthopedic back guy doctor I consulted agreed. The PT person gave me exercises that push my pelvis back into “alignment” causing less stress on the SI joint (The Orthopedic doctor agreed and gave me an additional adjustment exercise to do). The exercises work really well, to the point were I could jog or do other high impact activities with no butt/hip pain.

    Sorry, long way around the block, but here’s the kicker. The exercises that the chiropractor gave me actually pushed my pelvis in the opposite direction from the exercises that work. He was literally making the problem worse.

  32. mattyp says:

    It’s entirely possible your chiropractor a) was t very good or b) mis-diagnosed your problem.

    Interesting that, a lot of patients I see tend to have lower back pain that comes from SI joint and surrounding tissues. What got my attention was that your orthopod agreed that it was SI jt related. I had one very angry orthopod telephone me saying the SI jt will not move, under any circumstances.
    For what it’s worth, I have no issue with chiropractors being primary CONTACT practitioners. Most licensed chiropractors SHOULD have the diagnostic ability to recognise something that is within their scope of practice & treat accordingly. If not, refer to the appropriate provider. I know the majority of issues arise when chiropractors either fail to recognise this, or are blinded by the dogma that chiropractic fixes everything.
    Primary CARE practitioner seems a *little* too far outside scope of practice. To me primary care involves intimate knowledge of a patient’s (or family’s) medical health, pharmaceutical needs & prescription, vaccination promotion and delivery, in depth knowledge of male & female health/illness issues from infancy to geriatry & everything in between, epidemiology, current trends in health & disease, the list goes on. So we want to be in charge of ALL this and be experts in diagnosing & treating back pain?
    There’s only one way you get to do all that. Once you’ve finished Chiro college go to medical school, work your arse off, complete your internship, residency & GP training, stay current with your Chiro registration & then once you’re finished, combine the two.
    Then, once you are both a practicing medical doctor and chiropractor, complete your CPD hours for both.
    There are no short cuts.

  33. Davdoodles says:

    “The average consumer is perfectly able to decide what type of practitioner he wants to consult!”

    I would have thought that homeopathy’s business model is entirely dependent on the above sentence not being true.

    I’m feeling unwell and some ridiculous mumbo-jumbo and over-priced water is just what I need.

    Yep.
    .

  34. nickmPT says:

    I am certainly glad you are skeptical, I am just pointing out the pain neuroscience. The link I provided is a site for manual (hands-on) practitioners and other “therapists” – PT’s, Chiro’s, MT’s, etc – where we discuss the latest science and de-construct treatment paradigms and their explanations.

    The bit about “empowerment” simply means, helping the patient take charge of their pain and problem, as we can not do it for them. Helping the person think differently about their pain, based on “less-wrong” neuroscience explanations.

    Manual contact and progressive exercise/activity (starting as gentle as need be) refers to the bit about “reducing threat” to the nervous system and reintroducing the things that the patient actually cares about like biking, hiking, or even just your normal household stuff.

    Sort of a non-sequitur to this thread anyways, for that I apologize.

    In regards to the Chiro’s being Primary Care, they are mostly manual therapists with a sprinkle of supplements and wonky thinking. There are certainly some good ones who understand their scope and stay within it and refer out as necessary, but the very founding of their practice is built upon the erroneous explanation of subluxations.

    Now with the addition of Chiropractic physician specialties and “functional medicine” there are certainly many who see themselves as on par with the MD (perhaps even above as they “actually fix the problem” not just “treat it”). They certainly muddy the waters (on purpose I’m sure) and I know some people who see them as their “regular” doctor. It seems (as I don’t have any data for this) that the public sees the DC or acupuncturist as a “holistic” provider that looks at thing from a different perspective (i.e. non-scientific) and are not trying to pump them full of drugs (but supplements are okay).

  35. mousethatroared says:

    mattypon – “It’s entirely possible your chiropractor a) was t very good or b) mis-diagnosed your problem.”

    Yes, I’m pretty sure the reason that he missed the diagnoses was because he was so focused on the spine and subluxation, which is sort of the foundation of chiropractic.

    Just like the chiropractor that treated my friend for severe new headaches was sure it was a subluxation in her neck and didn’t think to refer her to a doctor to rule out other causes – like the meningioma (luckily benign) the size of a tennis ball.

    Now the chiropractor who sold my grandma a salve for the large hard dimple that formed in her breast, but didn’t tell her to see her regular doctor to have it checked out (breast cancer, went a year before being found at the annual MD appt) doesn’t even have the excuse of being blinded by subluxation theory.

    Or there’s the chiropractor who’s performing craniosacral therapy to treat a learning disability and severely impaired eye sight on a child in our local adoption group.

    Yup, those are just anecdotes too.

    I also have anecdotes about misdiagnoses or other misses from MDs. But they are balanced by lots of anecdotes about MDs who actually properly diagnosed and treated illnesses.

    The chiropractor “positive” anecdotes are all from people who swear by their chiropractor, but still have enough pain that they have to keep returning every one or two weeks.

    Not terribly impressive results from my consumer minded perspective.

  36. mattyp says:

    The subluxation isn’t the foundation of how I practice chiropractic. But I know there are many, many chiropractors for whom the subluxation is everything.
    I am wondering – was it Black Salve that the Chiro “prescribed” to your grandma? Either way, that, the cranial sacral “intervention” are entirely inappropriate interventions.
    I used to get craniosacral therapy every 3-6 months until I went bald @ no longer visited the hairdresser with the complementary wash…

  37. tgobbi says:

    Jann states: “…let’s digress into a topic raised in the comments of a previous post: who should use the title “Doctor,” at least in what is referred to somewhat quaintly as “social settings.” …
    I consulted the experts on this, that is, the etiquette experts, people no one pays much attention to anymore. I found what is known in the legal field as a “split of authority.” etc…

    This has been a contentious issue for me over a period spanning several decades. My view has triggered the wrath of a number of “doctors” of chiropractic (one of them reacted almost psychotically when I called him “Mister,” posting much of my personal information online along with directions to my home). Most have contented themselves with citing their legal entitlement to be referred to as such or how how hard they’ve had to work to earn their “doctorates.” Another, president of a large chiropractic college, chided me for having overlooked his accomplishments – totally missing the point that this was EXACTLY WHY I refused to call him Doctor.

    My bottom line: if your degree is in the equivalent of flat earth-ology, I’m not about to concede that you’re a doctor of anything. Stubborn? Okay, I’ll concede the point. But no one has convinced me that I’m wrong.

  38. tgobbi says:

    mattyp states: “The subluxation isn’t the foundation of how I practice chiropractic.”

    My concern isn’t whether or not subluxations are the foundation of your practice. Rather, I’d like to know if the subluxation plays any part at all in it.

    My comments would depend on your answer:

    • If you’re a believer to any degree in the chiropractic subluxation, do you deign to call yourself a science-based practitioner?

    • If you’re not a subluxation believer, do you think you’re a chiropractor? I guess you could call this a trick question because it’s my firm belief that the subluxation is pretty much what defines chiropractic. Without it you’re basically either a physical therapist (with a chiro degree) or practicing naturopathy which constitutes about 1/2 of subluxation-believing mixers do. (For those who aren’t all that familiar with chiropractic, “straights” concentrate entirely on diagnosing and treating subluxations while “mixers” combine subluxation elimination with selling vitamin pills and supplements – naturopathy).

  39. Scott says:

    I guess you could call this a trick question because it’s my firm belief that the subluxation is pretty much what defines chiropractic.

    Not just your firm belief – it’s the legal definition, and also the position of the major chiropractic associations and colleges.

  40. WilliamLawrenceUtridge says:

    @mattyp

    If you had to do your education all over again, would you still go into chiropractic, or would you go into physiotherapy?

  41. mattyp says:

    @tgobbi: I know of it. I know how other chiropractors use it to describe their findings. I still think I am a chiropractor and call myself a chiropractor, but then if people care to see me as essentially a physiotherapist who focuses on the spine, I’m cool with that too. I like to think of myself as a science-based practitioner. Where the science is uncertain or inconclusive, then I need to make a clinical judgement based on the best evidence, my experience, safety, ethical considerations.

    WRT “selling vitamin pills & supplements”, I don’t do this. I do try to get the patient to take a look at their diet & other lifestyle factors the same way any healthcare practitioner would. You know, get them to exercise appropriately so that their spinal stabilisation muscles aren’t littered with fatty deposits and can actually play an active role in stabilising the spine, etc.

    @WLU: I find that hard to answer. The reason is that, as I saw it when I entered uni (as a mature-aged student), my experience with physiotherapy was one of a) sports injuries and b) stretches. My experience of chiropractic was one of immense pain relief from a crippling condition, and I really wanted to be a part of that. If I’d have known of the politics, dogma, intra-profession & inter-profession bickering, I might have just not bothered going to university at all and not enter health-care. I’m actually glad I didn’t know all that before I entered, because I feel that from the inside I can make a difference, whereas I mightn’t have bothered before.

    But to finally answer your question, I’d probably skip chiro & physio and have attempted medicine.

  42. WilliamLawrenceUtridge says:

    Have you heard of or read Sam Homola’s work? It seems like you would find it of interest. He sometimes contributes here.

  43. mousethatroared says:

    mattyp – I don’t know what the salve was. My grandma didn’t know what the salve was or that a dimple in the breast was a classic sign of breast cancer. She was of that era where people didn’t talk about such things except with their doctor and she thought the chiropractor was a medical doctor (although a kind of specialist who worked on backs).

    I am not one to paint all the folks of any walk of life with the same brush, so I wouldn’t try to say that ALL chiropractors are like the ones I mentioned. I just don’t like the odds.

  44. mattyp says:

    WLU – yes. And I’ve corresponded with Sam (briefly). Thank you.

    Mouse – yes, sorry, the type of salve wasn’t the point you were trying to make. I dunno in what generation that chiropractor was taught, but if a patient comes to me saying “I have a dimple in my breast” I would send them to their GP with a courtesy phonecall to tell the Dr I am sending them and for why. That gets to the point of Jann’s original post in the article – misrepresenting ones self to the consumer. The reason I asked about the salve is that Black Salve (Canselum) is illegal here in Australia. I have seen people selling it at market stalls as a cure-all for skin conditions and cancer. I have also seen the permanent scarring and tissue damage that results. I was not sure of it’s legal status where you are.

  45. WilliamLawrenceUtridge says:

    And this is where I take issue with blanket condemnation of chiropractors. Chiropractic, yes, but not all chiropractors are nut jobs (uh…no offence mattyp).

  46. tgobbi says:

    mattyp states: “For what it’s worth, I have no issue with chiropractors being primary CONTACT practitioners. Most licensed chiropractors SHOULD have the diagnostic ability to recognise something that is within their scope of practice & treat accordingly. If not, refer to the appropriate provider. I know the majority of issues arise when chiropractors either fail to recognise this, or are blinded by the dogma that chiropractic fixes everything.”

    This comment registered on me well after the fact. Indeed, I woke up out of a sound sleep thinking about it and how much it disturbs me. Admittedly I’m a layman with no professional qualifications to pass judgement. But I’m old enough, smart enough (I hope) and familiar enough with chiropractic to recognize the inconsistency vis-a-vis the facts concerning the claim.

    Most (not all, but damned close to all) of the many, many DCs I’ve had contact with over the past 30+ years have struck me as less than bright enough to be healthcare professionals. (One or two even struck me as cretinous semiliterates and I’ve had correspondence from them that backs me up)! Couple that with the further limitations of chiropractic training and whatever impulse led them to chiropractic (as opposed to the scientific mainstream) in the first place to mitigate against their qualifications and trustworthiness to be relied upon as such. I believe that chiropractic training prejudices them in favor of chiropractic solutions at the expense of medical ones and that their decision to become D.C.s is based, at least in part, by an anti-medicine bias. The majority of the D.C.s I’ve interacted with have some degree of animus against doctors and have no compunctions about communicating it to anyone who will listen.

    Bottom line: I remain unconvinced that chiropractors are qualified to do anything other than treat simple musculoskeletal complaints and that they are unqualified and unreliable primary care OR primary contact physicians. As previously stated I don’t even accept that they are physicians. Unless there’s an earth-shattering change in chiropractic education and practice I’m not about to change my mind. It happened in osteopathy (at least here in the U.S.A.) but D.C.s are too intent on their “otherness” or “separate-but-equal” philosophy to change.

  47. nickmPT says:

    And one gained national recognition to be on the level of the MD (practically) and the other is having more trouble getting insurance to reimburse.

    Either way, how we treat pain in the developed nations has to change as these persistent pain problems are sucking up a lot of healthcare dollars. Science is the key, and there is enough of it out there that should be leading us away from the old models.

  48. Artour says:

    Medical officials continue to ignore clinical research and published medical studies related to breathing retraining. In particular, there is one breathing method called the Buteyko breathing technique that teaches patients to slow down breathing back to the medical norm since people with chronic diseases have heavy and deep breathing at rest or hyperventilation:
    http://www.normalbreathing.com/buteyko-method.php
    The above page provides over 40 studies that measured breathing in people with asthma, heart disease, COPD, cancer, diabetes and many other conditions.
    But doctors learn nearly nothing about breathing retraining. They do not know how to sleep, exercise, eat, etc. in order to have more oxygen in body cells, while hundreds of studies proved that, on a cell level, chronic diseases are based on low body oxygenation.

  49. Chris says:

    Artour, please stop with your idiotic spam.

  50. mattyp says:

    @tgobbi:
    I’m a tad concerned I woke you from a sound sleep…
    It’s disappointing to hear your experience regarding chiropractors & chiropractic in general. I don’t for a minute doubt your experiences either.
    There was a change in chiropractic education that has been happening over the last 20 years here in Australia. However, Macquarie University has elected to “sell off” it’s chiropractic program to another institution in favour of its newly opened school of advanced medicine.
    It’s a shame, as they were teaching a science based curriculum, with many hours spent on diagnosis of pain sources (not just by chiropractors but by MDs).
    But I’ll concede, there is a group of chiros who wear their “otherness” as a badge of honour. This sucks as it besmirches all of us, even those that want to limit our scope & work with a medical model.

  51. tgobbi says:

    mattyp states: “There was a change in chiropractic education that has been happening over the last 20 years here in Australia. However, Macquarie University has elected to “sell off” it’s chiropractic program to another institution in favour of its newly opened school of advanced medicine.”

    Osteopathy “sold off” its pseudoscientific aspects some years ago in the U.S.A. (for the most part) and became a legitimate healthcare profession. The problem with chiropractic in this country is that 50,000 DCs constitute a group of tenacious bulldogs who have clamped down their jaws on the subluxation/separate-but-equal philosophy that keeps them orbiting on the distant fringes of the known universe. Even the chiro school that’s touted as the most “scientific” of the bunch has now expanded into a “university” that teaches naturopathy, acupuncture and oriental medicine. That doesn’t look like “scientific” to me!

    and: “But I’ll concede, there is a group of chiros who wear their “otherness” as a badge of honour. This sucks as it besmirches all of us, even those that want to limit our scope & work with a medical model.”

    Yes, this “otherness” is a serious problem which isn’t helped by the fact that the overwhelming majority want to capitalize on what makes them different from and, in their own minds, for many, superior to mainstream healthcare practitioners. They tout their “we treat the causes rather than the symptoms” philosophy (as if science-based doctors don’t) even though the cause is generally a subluxation, not a real condition. They don’t “cut, burn & poison.” The procedures they lump into this category have a proved track record; they can and do cure diseases or, at least, help to improve the quality of the lives of patients. D.C.s (I’ve seen figures that top 50%) oppose vaccinations, one of the greatest advances in saving lives in the history of healthcare. We have specialist chiropractors who regard themselves as qualified pediatricians, neurologists and other preposterous affronts to science. I even attended a lecture given by a chiropractic “cardiologist” who wouldn’t know how to read an electrocardiogram!

    Chiropractic doesn’t see itself as the pseudoscientific cult it is. As far as the D.C.s are concerned, it’s science-based healthcare that’s the bad guy, not chiropractic. Nothing is about to change in the bizarre world of “mondo chiropractic.”

  52. lilady says:

    (My two cents)

    I would add to Chris’ list DDS (Doctor of Dental Surgery). Dentists undergo rigorous training (four years in a school of dentistry, leading to the DDS degree, plus post grad residencies).

    One of my pet peeves is how celebrities who have been awarded honorary doctoral degrees…or actual doctoral degrees, in fields far removed from the medical field, are introduced to the public:

    http://articles.latimes.com/2013/jan/22/news/la-ol-jill-biden-doctorate-titles-20130122

  53. mattyp says:

    tgobbi said “The problem with chiropractic in this country is that 50,000 DCs constitute a group of tenacious bulldogs who have clamped down their jaws on the subluxation/separate-but-equal philosophy that keeps them orbiting on the distant fringes of the known universe.”

    Many chiropractors have ditched this notion. Many other chiropractors are worried that if they ditch this, they will disappear into nothingness. My advice (to them) – take the plunge. It’s not as bad on the other side as you think.

    tgobbi said : “D.C.s (I’ve seen figures that top 50%) oppose vaccinations, one of the greatest advances in saving lives in the history of healthcare.”

    Besides being outside our scope of practice, this is an even bigger problem, in my opinion, than any debate about subluxations/bone out of place. We can’t be taken seriously as a healthcare profession until the boneheads who believe that vaccinations cause disease and “too much too soon” are either weeded out, or actually embrace the science. But again, see the problem of disappearing into nothingness.

  54. tgobbi says:

    mattyp states: “Many chiropractors have ditched this notion. [of subluxations and separate-but-equal].

    “Many” is a very abstract number. My guess is that it’s not enough to make a dent in the overall picture. As I’ve said numerous times, the subluxation is what defines chiropractic. Without the subluxation there is really no chiropractic – just naturopathy, which is pretty much all that DCs do when they’re not adjusting subluxation. In fact, for many of them the vitamins and other supplements they sell somehow also address subluxations. Respectfully, mattyp, you can continue to practice whatever you do that doesn’t include subluxations, but all the protesting in the world isn’t going to change the fact that the majority of you colleagues (at least in North America) are practicing pseudoscience and exposing their customers to dangerous non-substitutes for medical care. Yes, I’ve met and corresponded with a few relatively reality-based DCs who treat only backaches. But they’re not really practicing chiropractic, only variations of PT and massage therapy.

    “Many other chiropractors are worried that if they ditch this, they will disappear into nothingness. My advice (to them) – take the plunge. It’s not as bad on the other side as you think.”

    It ain’t gonna happen for all the reasons I keep running on about. And, yes, for them it is plenty bad because they’re too committed to their chiropractic-ness and, in many cases, not bright enough to accept the fact that they’re misguided in their chiropractic belief system.

    tgobbi said : “D.C.s (I’ve seen figures that top 50%) oppose vaccinations, one of the greatest advances in saving lives in the history of healthcare.”
    “Besides being outside our scope of practice, this is an even bigger problem, in my opinion, than any debate about subluxations/bone out of place. We can’t be taken seriously as a healthcare profession until the boneheads who believe that vaccinations cause disease and ‘too much too soon’ are either weeded out, or actually embrace the science. But again, see the problem of disappearing into nothingness.”

    Precisely!

  55. mattyp says:

    tgobbi said: “Precisely!”

    Glad to see we have some common ground. :-)

  56. niftyblogger says:

    Mattyp — Dr. Matthew is that you? LOL

    Here’s a story. I took homeopathic supplements while I bled and bled from my colon until I passed out and had to go to the ER. Yay alternative medicine. Shame on me for believing for so many years.

  57. @Nifty: a competent homeopath would not have ignored your rectal bleeding. This requires a colonoscopic examination. Did you find what was causing the bleeding?

  58. Scott says:

    There is no such thing as a “competent” homeopath. By definition a homeopath is a con man and a fraud.

  59. @Scott

    The definition of homeopath is “like cures like” from greek homeios = similar pathos = disease

  60. WilliamLawrenceUtridge says:

    Scott, you are wrong. A homeopath can also be a well-intentioned vicitm of self-delusion and ignorance.

    Nifty, if it makes you feel any better, the homeopathic stuff you took a) wasn’t a supplement (unless you were low on lactose) and b) wasn’t responsible for your rectal bleeding. Your circumstance does however indicate one of the true harms of CAM – delay of treatment – and anecdotes like these are powerful in countering the assertion that “CAM is harmless”.

    I think it was Snake Oil Science that had an interesting discussion of why people associate effectiveness with CAM. One was that CAM is usually reached for when symptoms are at their worst, thus are generally going to get better on their own no matter what they do (regression to the mean). Good book.

  61. Scott says:

    I didn’t say they were DELIBERATELY con men and frauds. Even the ones who are genuinely wrong, in the end are indeed fraudulent. They may not KNOW they are, but they SHOULD… which is sufficient to justify the characterization.

    @ FBA:
    By definition a homeopath practices homeopathy. The claims of homeopathy have been empirically shown to be false. Taking money from people based on false claims is fraud. QED.

  62. WilliamLawrenceUtridge says:

    Sorry Scott, I meant my comment to be tongue-in-cheek but it comes across as rather accusatory. Should have used a smiley :(

    Of course, I agree with you – homeopathy is nonsense.

  63. mattyp says:

    @ windriven:

    “DC – Masseur with a white coat”

    Only if your name is “Dr Steve” or “Dr Steffi”, surely?

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