Jan 24 2013
The DC as PCP? The battle continues
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25 Responses to “The DC as PCP? The battle continues”
Chiropractor Perlstein is well-known to longtime participants and readers of the Healthfraud discussion list. Several years ago he spent considerable time on that forum trying to convince us that there is a sweeping “reform movement” within chiropractic and that DCs were renouncing pseudoscience in droves. I don’t remember that anyone bought his “reform movement” folly. In fact, many of us questioned his claim. But he stuck to his guns, despite our offering overwhelming arguments to the contrary. Now Jann shows us that he isn’t as science-based as he would have everyone believe. Really, chiropractor Perlstein – biopuncture???
I, too, stick to my guns, expressing my belief that chiropractic isn’t as much a healthcare profession as as it is an elaborate marketing scheme.
Jann: ” This liberalization of their practice acts includes the right to use acupuncture and to give nutritional advice, including the sale of dietary supplements and homeopathic products. Now some of the mixers want to dump the subluxation altogether and become, by legislative fiat, real primary care doctors who use the same diagnostic methods and treatments as primary care M.D.s and D.O.s, while at the same time skipping the education and training the latter must go through.”
The above reinforces my long-held contention that “mixers” (the majority of DCs) are really crypto naturopaths. The defining characteristic of chiropractic, its sine qua non, is the subluxation. Ol’ DD Palmer built his glass house out of them. What, I ask, do diet and homeopathy (to say nothing of the myriad other non-subluxation disciplines) have to do with chiropractic? Not much! Here’s what I think: the whole business foundered when it became apparent that those pesky subluxations don’t exist and that, in order to stay in business, most of the DCs had to glom onto whatever they could to keep from going bust.
I find it interesting to note that many “straights” look down their noses at “mixers,” insisting that they aren’t even genuine chiropractors.
MEA CULPA!
I have confused Stephen Perlstein, DC with Stephen Perle, DC. My sincere apologies to Stephen Perle for the error!
It boggles the mind to think that any state legislature would take any of these proposals seriously. Well, not really, I guess, when you think what other nonsense they’ve been up to lately in many states!
You know how it is if you’re shopping for, say, lawn furniture, and you go to Home Depot, Lowe’s, and Wal-Mart only to find the same crappy stuff from China everywhere? This happens because American companies can’t compete with Chinese companies, due to safety, environmental, and fair wage standards here.
The same thing is happening with health care. Less intelligent, less well trained people are entering the front lines. Business people with no understanding of the complexities of maintaining a physicianly culture of peer review now run hospitals and clinics. The day is coming –it might already be here– when the higher ups where I work will include naturopaths and chiropractors. How will I uphold sound, evidential standards then?
People like me are going to go elsewhere as the New Age creeps closer. So maybe one day only the moonbats will be left to see the patients. Sad thing is, America probably won’t notice the loss.
Thanks, Jann, for digging into these attempts to expand the scope of chiropractic. It makes me sick just to hear what they’re doing, and investigating and writing about it must be much worse. Thanks for sacrificing yourself!
I had to read Lemons a couple of times to get what he/she is talking about. Our standards for training physicians haven’t slipped, but apparently you’re decrying the increasing prevalence of non-medically trained management types in hospital executive jobs. I’m not sure that’s really the problem — they’re in business to make money, so they’ll offer what insurers will pay for, or people will pay for out of pocket. Well crafted payment and accountability structures should, if anything, be more effective with provider institutions run in a businesslike way. There is a growing presence of industrial and systems engineering in medicine, at least in hospitals, which I do not think is a bad development. They aren’t medically trained, but they are trained to focus on getting results, cost effectively. That should not bode well for chiropractic or any other pseudoscience.
Or so it seems at first blush.
@ Harriet Hall
“It makes me sick just to hear what they’re doing . . .”
It makes me sick too — at the least, people are being ripped off and it only gets worse from there. Thanks for your nice comment. I am happy to be part of the SBM team (ok, maybe not every other Wednesday night when I’m working late to get the post up) — I think SBM is making a difference. Many times I am rewarded in my investigations with claims that are so absurd or pompous, or both, that they are laugh-out-loud funny.
As a Chiropractor I admit to drinking the cool-aid at first. But now, there are quite a few of us who are focusing on evidence-based practices. I know, it must sound ridiculous to you. Truth is, I love getting my spine and other joints adjusted and many others do too. Maybe it is a placebo affect as recent research posted by this site suggests. Who knows? But research also suggests that a placebo can be a good thing. A few more things. In most states, Chiropractors are considered PCPs. We are therefore required to differentially diagnose and refer to the appropriate provider. That is how I practice. I don’t attempt to diagnose out of my scope of practice, but I must be aware that the differentials are possible, and then refer out. I don’t take this as actually diagnosing a condition. I only diagnose musculoskeletal conditions and that is my focus. I don’t think that Chiropractic can “cure” anything, I hate the word “subluxation” and I definitely do not want to prescribe (or un-prescribe, which is what DCs really want to do) medications. Chiropractors are fools for focusing on all this foo-fooey stuff and I don’t like being associated with them.
Some of us think that Chiropractic has a place in the orthopedic world, why else would they be doing research on manipulation and teaching it in schools? And some of us want to see the Chiropractic profession move away from all this nonsense. But unfortunately, there are way too many Chiropractors out there preaching the subluxation.
An interesting and reasonable post from KBDCMV, but one that raises some questions from this unabashed chiro-skeptic.
Apart from eschewing subluxations, do you practice any of the other unscientific modalities favored by most of your more traditional peers? I refer to, for example: applied kinesiology; “nutrition;” x-rays (unscientific in standard chiropractic practice); and neck manipulation.
Do you favor immunizations and fluoridation?
My assumption, based on your post, is that the answer to to the first group is no and to the the second, yes.
Which leads to my conclusion that you are, in essence, a physical therapist with a chiropractic degree – which appears irrelevant to your modus operandi. It also makes me wonder why you don’t simply give up the chiropractic title (and all its negative baggage) and call yourself a physical therapist.
“These [homeopathic] vaccines also stimulate an immune response to a flu virus, but, unlike the conventional ones which rely on the actual virus itself which has changed, these homeopathic preparations stimulate an immune response designed to strengthen resistance to all flu viral elements, whether last year’s or any other years, making the mutating quality of flu virus irrelevant and not a factor in the effectiveness that conventional flu vaccines demonstrate.”
WHAT? HOW? And no mention of “Quantum” in sight!
I have a modest proposal for all of the DCs and NDs and whatnot who wish to be primary care physicians. Let them sit for either the American Board of Family Practice or the American Board of Internal Medicine. Their choice! And let the test be blinded. The examiners can’t know who is an MD and who is a DC and who is an NP. The exams are written, the orals are taken and everyone who passes gets to be a primary care provider. Fair is fair, right? The NDs claim ‘the same’ training as MDs. Let them put up … or shut up.
My health insurer isn’t going to give me a rebate for going to an Earl Scheib* primary care provider so why on earth should I settle for someone who isn’t board certified in a relevant discipline?
*Earl Scheib(sp?) is or was a paint and body shop that back in the ’60s advertised that they would paint “any car any color for $19.95″
There is an interesting thread on chiros right now at Andy Lewis’s Quackometer site. Several UK chiros have written in to passionately defend their profession. Each one denied they believe in subluxations or innate intelligence, claiming “that’s old fashioned” and “nobody believes that anymore” even though they were shown it’s all included in recent versions of chiropractic school curricula. So it’s still being taught and endorsed, but nobody believes it anymore?
Chiros want the “alternative” veneer, as they attract many customers who either mistrust real doctors or feel that the medical profession has nothing to offer. And yet as this story and many others show, chiros also want the stamp of legitimacy from the medical profession.
Many chrios support and sell homeopathy, supplements, cranial-sacral therapy, reflexology, BodyTalk, crystal healing and other New Age “wellness” woo. It supplements the bottom line and once you have a “believer” on the table it’s easy to suggest other products you just happen to sell or services you just happen to provide. Or a partner in your “wellness” or “holistic” clinic provides.
Why are so many chiros supporters of quackery like Gerson cancer therapy or German New (Non) Medicine/Biologie Totale? If you look at the websites for that quackery, you see a lot of DCs listed. Any chiro who would support either of these regimes has absolutely no understanding of science or medicine.
One of the British chiros wrote me back and said “so what if some chiros support Gerson? What’s wrong with advocating eating a healthy diet with lots of fruits and vegetables when you have cancer?” Beside showing no understanding of cancer, he also showed no knowledge of what Gerson really is. And that’s what scares me about chiros.
If a DC wants to be a PCP they should indeed sit for the ABFP or ABIM PDQ or simply get an MD in the first place.
If a person wants to be a doctor then they should be a doctor and not, say, try to be an auto mechanic when all they have studied is astrology.
And windriven? You may have tarnished the sacred memory of Earl Scheib by comparing him with chiropractors.
At least he did indeed get some paint on the car and actually do more or less as claimed and advertised, if cheaply and sloppily, which is more than chiros do when they claim to treat anything other than a minor lower back ache.
Ah, even I could “do” an EKG given a lead set and the magic box. Reading one is… a tad different.
@windriven:
I’ve made a similar comment somewhere in the past. I’ve challenged them to sit the USMLE – not even the specialty boards. I’d be willing to bet they couldn’t pass those. Hell, I have colleagues who have actually tried studying the right material for two years and still failed the Step 1. And there is no chance they could pass the Step 2 because it is all about management of conditions… conditions they have no knowledge of how to diagnose or properly manage.
Of course the out I see is they cry foul that the tests are designed to evalute our medical practice, not theirs. They are, after all, claiming equivalency not saying they are identical to us. This then just moves the burden to show that their outcomes are the same as ours and we fall right back into the old canard that a “complete health system” that is internally logically consistent is just as valid as any other internally consistent health system (i.e. the one you and I practice). For instance, I doubt that I could pass a chiropractic board exam. However, the pesky details about the foundational premises upon which that internally consistent logic is built is always conveniently sidestepped.
So they could weasle out of failing the Step 2 and the ABIM for that reason – a very bad reason and certainly not a valid excuse, but they could manage it. I believe that the same cannot be said for the Step 1. It is supposed to test basic science knowledge, not management, and since they claim the school curricula are essentially the same and they learn the same anatomy, physiology, microbiology, etc as we do they should be able to technically pass it. There is some pharmacology on the Step 1, but not that much. So maybe they won’t get a great score, but barely passing should be feasible if any of their claims are true. I’d be willing to bet they can’t pass it. And I’d further bet that if they studied enough to actually pass it, they’d learn enough to likely get them to see the light and leave chiropractics entirely.
And I just read through the curricula that Jann provided. It is very strange indeed.
If you look at the OSHU curriculum you find 600 hours of instruction in the first 2 years. Then second two years do not have fixed hours since clerkships have highly variable hours. But based on my experience so far, I’d say it is reasonably to estimate that at another 400 hours. So 1,000 hours total.
The UWS curriculum totals it up at the bottom with 418 hours for all 4 years combined. They then somehow calculate a “clock hours” of 4598. I’m not sure what “clock hours” are or how they differ from “lecture and lab hours” but making up a ~4000 hour deficit seems highly implausible. They may not be factoring in clinical clerkships in the “lecture and labs hours” section, but I can’t fathom 4,000 hours of time being spent on the clinical clerkships the chiros go through in 2ish years. Being generous that means 50 hours of clinical work per week for two solid years, which simply does not exist in their curriculum.
But even if you take the credit hours and add them to the “lecture and lab hours” (which I am not even sure is valid and may be double dipping) they still don’t have 1,000 hours of instruction.
And of course, yes, this does not even touch the post graduate training we must go through. If I had to actually go out and see patients entirely on my own after I graduate this year I would be a nervous wreck and probably harm a lot of people! After internal medicine residency I would feel much more confident… because that is an extra 10,000 hours of training! (minimum)
Mind boggling.
Yep- I have been a Doctor of Chiropractic for 10 years. I have found many who are VERY opposed to chiropractic are usually the one’s who have never gone to one.
While, I agree, there are a lot of DC’s who are not worth anything but are very good marketer’s; there are also some; like me who dare you to try.
Spinal Manipulation has been an age old way of fixing the body. Doctors of Osteopathy know/knew it; American Indians knew it; the Greeks and Egyptians have records of it also.
While the philosophy of chiropractic is still hotly debated within the profession itself, but it seems short sighted to say it doesn’t work. Especially when peer reviewed journals (JMPT and SPINE) as well as leading hospitals (Mayo) agree it does. (Im not citing it- you can look it up)
As for Expansion of the Chiropractic Scope of Practice- HELL YES! But not for vitamins and crap- Pain killers and NSAIDS and Steroid shots.
As for a safer place for these things to be administered- has anyone ever heard of nosocomial and iatrogenic infections?
And yes, I have fixed many things in one visit. Including asthma.
Cheers!
- Dr. Adam Paul Thom
chirowithresults@gmail.com
Mr. Thom,
Why does your website have a picture of you “manipulating” a baby?
If I understand Adam’s website correctly, he is denying germ theory and states that subluxations are the source of disease. He also states that chiros can prevent cancer.
And he employs a reiki saleperson at his shop. Not much science there, is there?
I didn’t need to go any further than his claim he has fixed asthma.
Utter, total, unequivocal, quackery.
At first I thought he may be one of those chiros that is really more like a PT, but that one bit gave out the whole show. No point in even engaging.
Sorry Adam, you aren’t a doctor but you are a quack. And if you are convincing people you are treating their asthma (let alone cancer) you are a dangerous one at that.
Yeah, Adam claims he was in (real) medical school when he realized it was all bogus so a professor suggested he switch to chiroquackery. His website is amateur, and hilarious: way too many blocks of text and incredulous “questions and answers”
At least he offers a “money-back guarantee” if a customer isn’t satisfied after three sessions.
I can’t tell you how much it makes me cringe when I hear “physical therapy” being used in the same sentence as “chiropractic”, unless of course it’s a sentence revolving around how underqualified chiros are to be performing physical therapy. Congratulations, you don’t believe in subluxation theory anymore! Welcome to reality, where the rest of us have been for the last century. What is amazing to me is not the gall of this group of “practitioners” who claim to be a one-stop shop as pediatricians, internists, orthopods, and dieticians, but rather the amount of discourse within their group. Have you ever heard of half of any other medical profession suddenly rejecting the ENTIRE PREMISE THEY WERE FOUNDED ON?! I find it so obscenely convenient that as skepticism reaches all time highs (boosted by the fact that there is literally no science to support subluxation theory) there arises a new movement of chiros who try to pretty themselves up by agreeing with all of us–”I’m not like THOSE chiropractors, I swear!–and in the same breath “curing asthma” and claiming to be qualified as a PCP. I’m sorry, but if you can admit that there was a time that you “drank the kool aid” i.e. believed a LIE that was perpetuated by the same people you associate yourself with on a daily basis, how could you possibly justify continuing with that profession, given the assumption that it apparently takes a while after graduating to stop drinking said kool aid? What’s to be said for the army of chiropractors your non-accredited schools are pumping out? Do you not have a MORAL obligation to correct the lies being taught to your classmates and associates?! I read a fantastic article called “why I quit chiropractic” that literally says that students are exposed to contradictory chiropractic systems and are encouraged to find one that they can support even if they disbelieve the others.
And Adam Thom, of course manipulations work! Physical therapists have been proving that in evidence based research long before you people decided that it would probably help to have some science to back you up. Manipulations to SPECIFIC JOINT LEVELS (vs.
a gross, and I do mean gross, approach) for patients that have undergone judicious testing and are found to be appropriate for that manipulation (i.e. decreased joint mobility) benefit! The problem is that you pervert these findings as proof to “realign and adjust” thrice a week for the rest of a sucker’s life, which is just as much crap as the subluxation theory. Just because you CAN manipulate a joint doesn’t mean you SHOULD, and that’s where you lose patients. A person with instability or excessive joint mobility can absolutely experience a cavitation in a joint–What you call an “adjustment”! But consider a person who has suffered with back pain for 10 years and needs instruction on better posture and stabilizing exercises for weak core and lumbar musculature. The LAST thing they need is increased joint mobility, which is exactly what your manipulation does. That patient example, by the way, was a real patient I saw a month ago who was facing surgery but after 3 weeks of the aforementioned treatment was discharged with 100% improvement in function and pain. Of course the kicker is…he’d been going to a chiro for “adjustments” for TEN YEARS with no relief before he finally sought out an orthopod who got him to my clinic. It’s not rocket science, but it does take critical thinking, and putting the patient’s function and quality of life before your pocketbook.
My point is this: if you love all the hard work and research various health care providers have done, why not join us? If you love correcting musculoskeletal dysfunction, become a physical therapist. Most chiros are already falsely and illegaly claiming they can perform PT. You want to become a real doctor? Go to medical school. But stop trying to demand respect when you haven’t earned it. We can’t blame you for being naive when you chose the profession, but you’ve got no excuse anymore.
And for the love of God, stop calling yourselves doctors. PT’s are now Doctors of physical therapy–we’re just not pompous or stupid enough to put it in front of our names.
I noticed on Adam Thom’s website that he talks about “staff” infections. Pretty bad taxonomy for someone studying as much as he can to be a better doctor. Probably why he switched.
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