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Integrative Medicine Invades the U.S. Military: Part Two

An unfortunate side effect (if you will) of states licensing of “CAM” practitioners is their ensuing insinuation of themselves into the nooks and crannies of the American health care system. Sometimes this is voluntary, such as their inclusion as providers of health care services in medical practices and other institutional settings in the form of integrative and quackademic medicine. Where voluntary action is not forthcoming, CAM practitioners and integrative medicine proponents are not shy about petitioning the state legislatures and Congress to wave the wand of legislative alchemy. “Poof!” and they appear. One example of this is the legislative mandates that their goods and services be covered by private insurance. Another is including CAM providers in publicly-funded health insurance, such as Medicare. And next year we will see the effects of the non-discrimination provisions of the Affordable Care Act begin to unfold.

Two bills currently before the U.S. Congress invoke the magic of legislative alchemy by expanding the availability of CAM to military veterans and funding CAM research at the expense of legitimate research. One deals with chiropractic, the other with CAM in general. As we saw last week, one of this country’s foremost supporters of integrative medicine, Wayne Jonas, M.D., recently testified before the Senate Committee on Veterans’ Affairs in favor of these bills. I think any fair review of his testimony would find it unpersuasive and I hope the Committee will agree.

VA chiropractors

Chiropractors have already forced their way into the Veterans Administration (VA) medical system. For our readers not familiar with the fragmented American health care system, in addition to having a combination of public and private health insurance, or, in some cases, no health insurance at all, we have an entirely separate system of medical care solely for the military that includes its own hospitals and out-patient clinics. Military veterans have had access for some time to chiropractors at a limited number of these VA hospitals and clinics. According to the American Chiropractic Association (ACA), the “military’s medical bureaucracy continues to try to impose new barriers to chiropractic care.” This meant the ACA had to get its supporters in Congress to pass several bills to speed up implementation of the 1995 law requiring the current limited chiropractic benefit. The subtext I read in all of this is that the Veterans’ Administration, or at least those in charge of medical care, was not particularly thrilled with having chiropractors working in their facilities and has dragged its feet in implementing the law.

Perhaps one reason for resistance is the fact that under the current law

chiropractic care and services available . . . shall include a variety of chiropractic care and services for neuro-musculoskeletal conditions, including subluxation complex.

VA health care providers, such as medical doctors, nurses and physical therapists, were undoubtedly aware that there is no such thing as the chiropractic subluxation or “subluxation complex,” the latter being one of the many terms chiropractors have adopted to make it appear they have refined their “theory” when the real purpose is to paper over the fact that these subluxations don’t exist.

As part of continued efforts by the ACA and the International Chiropractors Association (ICA) to expand benefits even further, Sen. Richard Blumenthal (D-CT) and 7 co-sponsors (including, of course, Sen. Tom Harkin) have introduced Senate Bill 422, the “Chiropractic Care Available to All Veterans Act of 2013.” A similar bill, House Bill 921, has also been introduced.

As I learned from reading Dr. Paul Offit’s fine new book about alternative medicine, Do You Believe in Magic?, Sen. Blumenthal has a soft spot in his heart for quackery. And he doesn’t mind using taxpayer money to support crank theories. As Attorney General of Connecticut, he sued the Infectious Diseases Society of America (ISDA) and the American Academy of Neurology (AAN) for antitrust violations because both groups reached the same conclusion regarding the non-existence of Chronic Lyme disease.

According to Blumenthal, both groups’ reasoning in reaching the same conclusion “at times used strikingly similar language.” He smelled a conspiracy. In his view, the guidelines “improperly ignored or minimized consideration of alternative medical opinion and evidence regarding Chronic Lyme disease.” Apparently, Blumenthal knew so little about science he didn’t realize that when the same evidence is reviewed by two different groups it is perfectly reasonable for them to come to the same conclusion. Nor did he realize that, in reviewing evidence, it is not appropriate to consider any quack theory that comes along, no matter how ludicrous. The irony is obvious: Blumenthal was willing to accept Chronic Lyme disease despite the lack of evidence that it exists. He then turned around and sued the doctors’ groups for relying on good evidence to support their conclusion that it didn’t.

In any event, SB 422 would expand chiropractic “care and services” to all veterans’ medical centers by the end of 2016. The bill would also add chiropractic to rehabilitative services for veterans, which already include

such professional, counseling, and guidance services and treatment programs as are necessary to restore, to the maximum extent possible, the physical, mental, and psychological functioning of an ill or disable person.

Of course, any physical rehab services veterans need are now being provided by physical and other therapists, so this is completely duplicative of what is already available. As the American Physical Therapy Association’s (APTA) website says:

More than 1,000 physical therapists are employed by the Veterans’ Health Administration providing rehabilitation services to our nation’s veteran population. The need for physical therapist services is expected to increase with the aging of the veteran population and due to the complex impairments associated with the returning veterans from Iraq and Afghanistan. APTA supports measures that aim to help meet this growing need for physical therapist services.

Unfortunately, according to the APTA, “chiropractors have initiated action at . . . the Veterans Health Administration” to limit what PTs can do by seeking “to prohibit PTs from using TJM [thrust joint manipulation].”

In addition, preventative health services, which now include, among other things, periodic medical and dental exams, immunizations, and mental health services, would include “periodic and preventative chiropractic examinations and services.” Now there’s a real opportunity for mischief.

We can safely assume that these “periodic” exams must be for the purpose of providing “preventative” services, as the purpose of this section of the law is to list what preventative services are available. And we can safely assume that these exams and services address “neuro-musculoskeletal conditions, including subluxation complex” as is also specified in the law. Finally, we can also assume that the condition to be prevented is asymptomatic, because if it were causing symptoms the law already allows a veteran to see a chiropractor.

Let us posit, then, a veteran with an asymptomatic neuro-musculosketal condition going to a chiropractor for a periodic checkup. Exactly what would the chiropractor be looking for in these exams, how would he find it, and what preventative services would the chiropractor provide? After all, absent symptoms, one does not regularly see an orthopedic surgeon or neurologist or physical therapist just to have him poke around for a neuro-musculoskeletal condition.

I suspect the primary purpose of this section of the proposed law is to give chiropractors the authority to “detect” and “correct” subluxations in a patient with no symptoms. In other words, what is known as “maintenance care” or (the newer term) “wellness care.” This is a nonsensical exercise which purports to get rid of non-existent subluxations before they cause problems. Perhaps this is why the ICA is so excited about the prospect of the bill’s passage. I suspect chiropractors employed in the VA hospitals and out-patient clinics might be reluctant to try this stunt for fear of having to explain it to the medical staff. But the law also authorizes referral to chiropractors in private practice.

Or perhaps I am underestimating the chiropractors’ motive here. Maybe this is yet another attempt to refashion chiropractors into primary care physicians.

Forcing more CAM on the VA

Another bill, Senate Bill 852, has been introduced by Sen. Bernie Sanders (I-VT) to “improve health care furnished by the [VA] by increasing access to complementary and alternative medicine.” Notice the unfounded assumption that health care will improve via increased access to CAM. The bill does have some uncontroversial provisions creating access to fitness centers for overweight veterans and a provision of “wellness care,” although the latter could simply serve as another vehicle for the entry of CAM into the system, as is the case with chiropractic “wellness care” discussed above. The bill supports further infiltration of CAM into health care for veterans in three ways.

First, “centers of innovation” will be established to figure out how to spread CAM further throughout the VA medical system. This includes such activities as training health care professionals on how to furnish CAM services, including how to make referrals to CAM providers. In one especially disturbing provision, funding research on implementing CAM services will be siphoned off from the Medical and Prosthetics Research Account. Even worse, if the research projects involve providing CAM to veterans in rural areas, funding requests receive priority status. Considering the large number of veterans returning from the Iraqi and Afghanistan wars needing prosthetics and the potential for research to improve these devices, this is absolutely unconscionable.

Second, in tandem with figuring out how to spread CAM throughout the VA, 15 centers in the VA medical system will be established “to promote the use and integration of complementary and alternative medicine services for mental health diagnosis and pain management.” For some unexplained reason, these services “shall be administered by clinicians who exclusively provide services consisting of complementary and alternative medicine.”

I can imagine the VA doctors will just love having roving bands of reiki masters, cranial sacral practitioners, reflexologists and assorted other CAM providers running around their facilities. And I wonder how these providers will be credentialed by the VA? What level of reiki training would one have to achieve to have privileges at a VA hospital?

Veterans will be able to get CAM services for mental health and pain, whether or not they are receiving “traditional” (which presumably means “conventional”) treatment. So, let’s say a veteran addicted to drugs chooses to rely solely on “auricular acupuncture”, which has zero plausibility and, not surprisingly, no good evidence of effectiveness. In the meantime, effective “traditional” treatments that could actually improve his health are eschewed. Now multiply this by the hundreds and you will have enriched auricular acupuncture providers at the expense of the taxpayer and have a lot of veterans still addicted to drugs.

Third, the bill requires a study of “barriers encountered by veterans in receiving complementary and alternative medicine from the [VA].” The study will also look at whether veterans are aware of the availability of CAM services, the “effectiveness of outreach to veterans on the availability of CAM”, and their satisfaction with CAM in primary care. Of course, none of this has anything to do with whether the treatments themselves are safe or effective.

And so it is that the attempt to infect the American health care system with implausible and unproven (or disproven) treatments continues apace. It is especially disturbing that these bills are aimed at forcing the Veterans Administration health care system to embrace CAM. It is heartbreaking to see all the young soldiers returning from two wars plagued by physical injuries and mental health issues. CAM (that is, real CAM, not plausible treatments such as exercise rebranded as CAM) will not help them one bit. And to think funds are being diverted from medical and prosthetics research is sickening.

On it goes

It appears CAM researchers have found a new cash cow in the form of the U.S. Military. Whether these bills pass or not, the NCCAM is poised to hand out money for “Non-Pharmacological Approaches for Managing Pain and Co-Morbid Conditions in U.S. Military Personnel, Veterans, and Their Families.” These “non-pharmacological, complementary, and integrative approaches” include (but are not limited to) acupuncture, and “multidisciplinary or integrated models of care” which could “include physicians, physical therapists, psychologists, or complementary therapists, etc.”

Why?

Research has suggested that some approaches hold promise for helping individuals manage chronic pain conditions and for the amelioration of symptoms but additional research is warranted.

Of course it is.

Posted in: Acupuncture, Chiropractic, Energy Medicine, Legal, Politics and Regulation

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70 thoughts on “Integrative Medicine Invades the U.S. Military: Part Two

  1. Joey H. says:

    Most CAM, when harmful, is harmful mainly to the patient. But in a scenario that’s going to involved many patients with PTSD, this becomes even more serious. I don’t think I’m being extreme when I think of a situation where a chiro or acupuncturist or someone declares a patient cured of PTSD, and that patient proceeds to harm or even kill others due to forsaking actual medicine for placebo. Especially since PTSD is one of those “god of the gaps” problems that is targeted by many, many sCAMmers.

    1. Beamup says:

      I disagree with that statement. When taxpayers are funding said CAM, the waste of money is directly harmful to everyone.

      1. Joey H. says:

        I meant “harm” here to mean medical damage (physical, psychological, whatever) to the patient. But I absolutely agree with your statement. As the wife and daughter-in-law of veterans, I find whole thing wrong and insulting on many levels.

      2. windriven says:

        “When taxpayers are funding said CAM, the waste of money is directly harmful to everyone.”

        My only quibble would be differentiating sCAM funding and funding sCAM research. I used to froth at the mouth about the money spent by NCCAM studying nonsense. But I have come to believe that the only way we can kill sCAM is to prove over and over and over again that it doesn’t work. Damned near 15 years of NCCAM and it still doesn’t work.

        Over the last 10 years alone we’ve funded NCCAM to the tune of $1,230,000,000 to prove that it doesn’t work. I guess that just isn’t enough for our nation’s best and brightest up on Capitol Hill. So let’s spend whatever we need to spend to get the message across to the average consumer if not the deadheads in DC. Tested it again and it still doesn’t work.

        It is frustrating as hell but I see no viable alternatives. The political battle is lost and is going to stay lost until there is a sufficiently vocal and powerful constituency to fight it. Today that constituency does not exist.

  2. windriven says:

    ” I think any fair review of his testimony would find it unpersuasive and I hope the Committee will agree.”

    Unfortunately, legislative testimony is unlike trial testimony in that legislative testimony is often window dressing to support a decision already taken. If I remember correctly from the first post in this series, there was not even token testimony opposing Jonas’s.
    This is not all that unusual. But even when there is opposing testimony it heeds to be blockbuster testimony to change the course of events. Usually, sides have been picked and positions solidified long before the chairman’s gavel hits the table.

  3. windriven says:

    I beg your pardon. The above comment should have read – [O]pposing testimony needs to be…

  4. windriven says:

    “It appears CAM researchers have found a new cash cow in the form of the U.S. Military. ”

    The skirmishes continue but the war is lost. ACA was the superweapon that assured victory to the sCAMmers. The rest of this is noise and inertia.

    The AMA and other professional medical groups could have killed this flat out in exchange for their support during the days when ACA was anything but certain to pass. Instead, it and they rolled over like a lap dog wanting its tummy rubbed. Exactly what strategic objective did AMA achieve in exchange for their support? That Rohack didn’t get stricken from Nancy Pelosi’s party list?

    I’m not saying that we should simply shrug and go home. But the supply side is a fait accompli. The battle is now for hearts and minds on the demand side.

  5. David Gorski says:

    In one especially disturbing provision, funding research on implementing CAM services will be siphoned off from the Medical and Prosthetics Research Account. Even worse, if the research projects involve providing CAM to veterans in rural areas funding requests receive priority status for funds. Considering the large number of veterans returning from the Iraqi and Afghanistan wars needing prosthetics and the potential for research to improve these devices, this is absolutely unconscionable.

    This is truly horrific. The wars in Iraq and Afghanistan have produced thousands of veterans missing limbs. Although prosthetic limb technology has advanced markedly in the last decade (unfortunately, largely due to the impetus of these thousands of amputees), if there’s one area where the VA should not be cutting back on research, prosthetic limbs are not it. And to divert funds from prosthetics research to pure quackery is beyond belief.

  6. Michael says:

    I will (hopefully) be going to medical school in the fall of 2014 – I am currently applying. I am long-standing member of the reality based community, huge fan of this blog, and QuackCast.

    It is worrisome to see CAM spreading it’s non-reality-based tentacles throughout the system, whether it be through the VA, hospitals, or even medical school itself. Going through the application process and looking at some admissions brochures, the trigger words “integrative” and “holistic” are readily found along with the usual diatribe. Where are the schools advertising a zero-tolerance for woo curriculum – sign me up!

    I have had dreams (nightmares?) of being taught CAM as part of a medical school curriculum and being one of the few people in the lecture hall that would give two shits; I saw myself arguing with a professor teaching us the merits of acupuncture and the auditorium was looking at me like I was some sort of heretic. In social situations, some of my peers disconcertingly lap this “alternative to Western medicine” diatribe up.

    What advice would you give to students in my situation? Or perhaps this topic merits its own blog post.

    1. Dave858 says:

      As someone not in the medical field, the idea that medical schools are being infiltrated by this sort of thing really bothers me. How can I trust a doctor to diagnose and treat me if (s)he periodically suggests quack medicine and pseudoscience? That sort of thing will drive me out of the doctor’s office faster than anything.

      1. windriven says:

        Choose your physician wisely, Grasshopper. It is expensive and time-consuming but absolutely worthwhile. Ask open-ended questions that don’t betray your position. You’ll be amazed what people will tell you.

        1. Dave_858 says:

          Thanks Windriven. I wonder if I’m being unreasonable though. My knee-jerk response is to my doctor suggesting pseudo-medicine is to run away as fast as possible (though the fight response occurs to me too). But is asserting my unwillingness to participate in SCAMs enough? I generally think of alt-med as something that hurts other people, not me. So will most doctors, with SCAMs explicitly off the table, fall back on the SBM standards of care?

          1. windriven says:

            My personal belief is that it is important to share a common philosophy about medical care with your physician. It encourages open communication. And a physician who shares your science-based outlook is, I believe, more likely to refer you to specialists who are similarly rigorous.

            That said, it is perfectly reasonable for you to tell your wooish physician why you are leaving their practice. There are consequences to believing in magic. The physician should understand that.

    2. David Gorski says:

      You will be taught CAM as part of the medical school curriculum. It can no longer be avoided, as it is now required as part of the curriculum for medical schools to be accredited. Depending on the medical school, at best it will be taught from a (somewhat) skeptical viewpoint. At worst (and, unfortunately, this applies to a lot of medical schools), it will be taught from a completely credulous standpoint or even touted as something you should refer patients for.

      My advice to skeptical medical students in these situations is hard, but, I think, strategic. Don’t rock the boat too much, and, above all, don’t do anything that gets you into trouble with the administration or in any way jeopardizes your chance of passing. Take the long view, because this will be a long struggle. In medical school, you are not in a position to substantively oppose this in actual class. Moreover, some medical students get dragged before the dean of medical students (or whatever dean is responsible for enforcing a code of conduct at the medical school) for being too critical. Indeed, a few years back our very own Tim Kreider got into trouble for blogging about a presentation at his medical school by a CAM practitioner, who had been invited to give it by the student CAM club. (Don’t even get me started on student CAM clubs.) His resulting blog post wasn’t disrespectful, sarcastic, or anything offensive, but the practitioner complained, as did the president of the student CAM club,. Tim had to explain himself to the dean of students.

      Instead, just get through your classes and medical school and vow to oppose the pseudoscience and quackery it after you have your MD.

      1. Bobby Hannum says:

        I’m an M2 and I absolutely second this. Especially the part about being dragged before the dean for “critical” comments. You should be aware that from here on out, you’re essentially being evaluated all the time. Not everyone will evaluate you, and not for everything, but you will be be surprised who actually does and on what grounds, and it’s not something you can predict or prepare for beyond a blanket policy.

        The one thing I have had good experience with is talking to classmates. It depends on your class, and how you all interact (and especially in what medium), but (mostly) friendly discussions on general topics (what constitutes evidence, proper statistical analysis, prior probability, etc.) can at least take the sting out of institutional credulity.

          1. Bobby Hannum says:

            Hah, that’s hilariously close to my experience. Hilarity only to keep me from crying.

            The depth to which CAM has sunk its roots in medical schools is shocking, even for someone in the system. They’ve parlayed touchy-feely humanistic terms and tendencies that nobody would argue against focusing on, and made them inseparable from CAM treatments. I was not allowed to start a student group for science in medicine because of the heresy inherent in betraying the “humanistic” part of the curriculum reflected in CAM. In essence they’ve made their claim of cold, unfeeling “scientific” physicians true by fiat. By definition.

      2. Michael says:

        Thank you, and Bobby, for the advice! I will begrudgingly hold my tongue and be sure not to “rock the boat” (too much).

      3. windriven says:

        Jesus. I had no idea that CAM was now required for accreditation.

        Medical school is obviously quite different from university where speaking truth to power is sometimes genuinely appreciated – occasionally even by the power spoken to.

        I’d love to hear what a conversation between a science minded medical student and a dean about the teaching of abject quackery would sound like.

        “You wanted to see me Dean Kafka?”

        1. Bobby Hannum says:

          I can tell you the word “professionalism” gets thrown around a lot.

          1. Michael says:

            “Professionalism” ought to not be used to squash dissent. That seems homogenizing and antithetical to science, and more generally, the process of learning and education.

            Surely, a component of medical professionalism entails speaking up to those ideas which have no basis in reality =)

          2. Bobby Hannum says:

            No argument from me….literally. My experience has been that “professionalism” is the “because I said so” from childhood. Anything not specifically forbidden falls under the purview of “professionalism”.

            As a student, even if you’re correct, it really doesn’t matter.

      4. Janet Camp says:

        It is shocking that you feel compelled to give this advice! I’m not so much questioning it as not being able to comprehend that we really are to this point.

        1. David Gorski says:

          I didn’t use to give this advice, as you would see if you perused earlier posts. Tim’s experience led me to change my mind a bit. We need skeptical medical students to get through medical school with the highest grades they can, so that they get the best residencies and end up in positions of authority. Medical school is not the place for trainees who are completely under the authority of faculty to make their stand. It’s the place for those of us who are already established to make ours for the medical students.

          1. Dave858 says:

            What scares me about this is that both science-based and crap-based people are slyly going through medical school not speaking up too loudly about what they believe. They bide their time for the day when they can freely practice science-based or crap-based medicine, respectively.

    3. Janet Camp says:

      A very refreshing attitude–I hope you are accepted soon. Don’t give up questioning the quacks.

      I just spent three days with someone who had to call her aspiring medical student son on a landline the whole time because he won’t use cell phones (brain cancer, you know). He wants to be Dr. Weill or Dr. Oz. Depressing–so your post comes as just in time to save me from utter despair.

    4. There was a lot of sympathy given to SCAM/Woo at my medical school under the guise of “open-mindedness”. Thankfully, I was able to find refuge in two of the department heads, who were proper skeptics and agreed with me that it shouldn’t be taught, or at least taught from a skeptical viewpoint.

      For our student newsletter, I got their support in authoring articles to distribute to the student body about critical thinking in medicine. How interesting it was to find out that everyone else’s articles were always published, and mine were strangely left out ;)

      Dr. Gorski and the others are sadly correct. Don’t be afraid to voice your opinion reasonably if directly asked, but you pretty much have to keep your head down to avoid any academic issues. Faculty who are very SCAM sympathetic can make life incredibly difficult for you if they want to.

      Get in, get out, get even!

  7. brewandferment says:

    Jann,

    Has the content of this information been shared with any of the veteran’s advocacy groups? MOAA is one of the most influential voices for veterans on Capitol Hill, and they have been consistently on DOD’s case about raising Tricare rates for retirees before DOD’s health system roots out some of the waste and inefficiency. Seems like this is material they need to have. I’m happy to share with them if there’s some other way than just sending a link to this article and saying please read; I would think they receive way too much material for that approach to be successful.

    Also, when I get emails from MOAA or other organizations that I support asking me to write to my congressperson, there are links to an automatically generated e-letter that is sent to my Senator or Representative with options to add a short personal comment if desired. It definitely makes it easier to both communicate with Congress as well as ask others to weigh in. Is there something like that available to send for this particular set of bills?

    Thanks in advance.

    1. Jann Bellamy says:

      @ brewandferment

      I don’t know what MOAA is but I appreciate your interest in sharing this information with them if you think it would help. I don’t know of a way to send them the posts other than sending a link although you could certainly cut and paste. One problem with not reading the post itself is that there is no way I know of to include the links in the post which provide some good explanatory information. Perhaps you could summarize the contents and tell them they need to read the posts for a more complete treatment of the subject? (I say “posts” because I think this one needs to be read in conjunction with Part One.) As for automatically-generated links to your representatives in Congress, we don’t have that capability, although if MOAA or another organization could do this for these bills it would be great. Unfortunately, the chiropractors are able to provide these automatic links via their websites and they are asking their representatives to support these bills. While those who promote “CAM” have lobbyists and these automatic contact systems, nothing like that exists for science-based medicine. (As you can see from the fact that the only person who spoke if favor of the bills was pro-CAM.) I will be glad to talk to anyone from any veterans’ or military organization about the infiltration of CAM into the military health care system if that would help. You can contact me via the information on this blog.

      1. brewandferment says:

        Jann,

        I will contact you shortly. But for the sake of readers, my acronym habits broke free from where I stuffed them after I finished my military service. Military Officers Association of America is MOAA. I’ll investigate their website and see what I can figure out.

    2. Jann Bellamy says:

      @Andrey Pavlov:

      Good for you! Keep up the good work.

  8. Andrey Pavlov says:

    Dr. Hall was kind enough to inform me that this conversation about CAM in medical schools from the med student perspective has sprung up here and felt I could contribute.

    Firstly, I have to agree with Dr. Gorski… mostly. It is absolutely true that we are but the lowliest of the rungs on a very large ladder and that we can get squashed by a quackademic in a powerful position. And, in reality, med school is not where we can directly make the necessary changes; certainly not changes that are worth the time, effort, and risk (for the most part – I would say that if you feel particularly convicted and have a very well thought out game plan, predicted outcomes, and have run it by a few people whom you know and trust you should go for it; but that would likely be a rare situation).

    That said, I also have my own track record of not standing for CAM and calling out lecturers both during and after lecture. I have emailed the Deputy Dean of my SoM to inform her of what I felt were egregious examples of quackery. And I have discussed it with the Dean of Curriculum at my clinical school as well.

    The two things I have going for me are that I actually don’t see much CAM quackery at all, and certainly not in my clinical years (it is almost entirely restricted to a few lectures during Years 1 and 2) and that I am consistently rigorous. I argue points of medicine with attendings, but when I do, I have read extensively to really know what I am talking about. But even more important than that is how I do it; I always frame it as a question – “Dr. Jones, in my reading it seems to me that…” When I am rebuffed, I ask “Why is this case different? What is the rationale? In an meta analysis I read in NEJM they said…”

    I find that for the most part I get respect for standing my ground and working to find out the answer (even though in some cases I know it already) and on the occasions that I get stymied or get the response of “Well, you should look it up and learn more about it”… I do! I look it up, learn it well, bring the data, and bring up the conversation again. I do it respectfully and always ask if the attending has the time to discuss it further and help me understand the evidence I have brought to bear.

    That is my general strategy whether I am discussing black cohosh or plasmapharesis in the case of supposed TTP secondary to lupus (which is a patient I have right now and I disagree with the course of treatment). I believe it is this consistency in my approach that shields me from too much rebuke – I don’t come across as some anti-CAM crusader but rather work hard to make it clear that I am a pro-evidence based medicine crusader. And few people can really argue with that.

    As for CAM specifically as I said, I encountered little of it but definitely some. And some pretty egregious stuff (like lectures thats aid personality type influenced incidence of cancer and the outcomes of treatment!) at that. However, twice I have approached such lecturers after and – using the same approach outlined above – challenged them. In one case the lecturer was all smiles and quite frankly a little condescending until he realized that I actually knew what I was talking about and then suddenly stiffened, asked my name, said I was a “very bright young man,” shook my hand and said he had a meeting and rushed off. In the other case the conversation lasted nearly an hour and the lecturer was astounded to learn the things I was talking about (such as the fact that acupuncture is not a “thousands of years old tradition”) and commented that she had her material handed down from the big regulatory folk and that I should really consider becoming one of them some day!

    As I said, I also emailed my Deputy Dean. I imagine that I may have been rebuked as Tim Kreider did, except that I already had a good relationship with her and had earned her respect, so instead I merely got radio silence. That, to me, was the hint to leave it be.

    Once during my third year OB rotation, the attending prescribed black cohosh to a patient. I already knew that it was not only useless but dangerous (thanks to SBM of course!) and so I began questioning the attending as if I didn’t know and just said “I recall reading somewhere it didn’t really work and may be harmful to the liver.” The attending stated that she didn’t think it would work but that it might and sometimes people are just more amenable to “natural” stuff. So basically, she just didn’t care enough about the topic.

    Which brings me to the real point – most of the people you will run into are shruggies or ignorant. I can’t tell you how many of the faculty at my program really have no idea about most of this CAM stuff – what it is, what it really means, and that it is actually being taught to us! These guys really are sneaking in under the guys of “humanism in medicine” (which is a concept I wholeheartedly support, just not in the quacky woo-woo way). And the true believers you’ll never convince anyway and they could indeed cause you trouble that just isn’t worth it.

    Which brings me to the real point (finally!). What does one actually do in med school?

    My advice would be to learn as much as you can about it. Come armed with knowledge and unleash it at the right moments (I convinced a shruggie PA that acupuncture really was a load of BS because I simply knew more about it and applied consistent logical principles). Store it up for when it counts. But most importantly, develop friendships with classmates who are like minded. Take opportunities to teach classmates, residents, and attendings who want to listen why they shouldn’t be shruggies. Let the ideas speak for themselves and realize that convincing just one person every once in a while is all you really need to do. Because they will do the same when the time comes for them and exponentially good ideas will spread. Which is why being consistently rigorous is important (well, besides the fact that that is the best way to practice medicine). Lead by example, educate when asked. Put yourself in positions to influence others. Dr. Hall also helped me compile a reading list for the science based med student which I ended up sharing and talking about to around 80 of the 1st and 2nd year students earlier this year in my role as President of the class. I had earned their respect by the work I had done and they actually asked for my reading list. So I stacked it with a lot of SBM, NeuroLogica, Simon Singh, Ben Goldacre, and talked about the importance of a rigorous scientific basis for the practice of medicine.

    And yes, as Dr. Gorski said, I am gunning for a competitive residency and will keep doing my best to get into positions of influence over curricula, teaching, students, and policy so then I can actually make real changes. But in the meantime the best thing any med student can do is learn as much as possible (duh!), but also specifically about these topics to be prepared to be those leaders down the line. Whether at a community level or a national level it is all important. And engendering that ethos in your classmates is probably the best way to combat quackademia as a med student. Earning the respect and bending the ear of a senior faculty member doesn’t hurt either ;-)

    And don’t be put off by the idea of trying to learn this stuff “plus” medicine. Dr. Hall once commented to me that she couldn’t have imagined reading even more than she did in medical school and asked how I had the time to keep up with SBM and all my commentary here (in case it isn’t obvious to the commentariat here I am nybgrus). The answer is that SBM really helped me learn the first few years of medicine really well. My course study was through SBM and the comments, because I read the links, referenced my own commentary heavily, and made damned sure I was right before I posted a rebuttal by looking up the relevant data and science before posting it. I also had some luck in that regard – when we were covering cancer in general and breast cancer specifically was exactly the same time that the USPTF mammogram recs changed and Dr. Gorski blogged about it extensively. So that became my text book for those weeks. My comments were long and heavily referenced because I was studying for class while writing the comments. And it has paid off. I’ve been told numerous times after a conference, morning report, grand rounds, whatever that it is obvious that I read a lot and to keep it up.

    The real point is to just educate yourself, stand up for your passions, and do your best to hold the line. After all, we are all in this because we want to help people. And scientific rigor is the best way to do it. So as long as you frame your attitude, your tack, and your ethos from that perspective I believe you will do just fine. I believe it was Tim Ferriss who said that if you aren’t pissing at least some people off you either aren’t doing anything or aren’t doing anything worthwhile. So you will inevitably rub some people the wrong way. But if you are consistent in your own personal demand for excellence and rigor because that is the best way to help your patients the right people will have your back.

    [sorry for the really long post, I don't comment much these days but this seemed like a good time to write one in my old logorrheic style. I hope at least some of it proved helpful]

    1. David Gorski says:

      Now, I’m not advocating that medical students do nothing. What I’m cautioning them not to do is to do or say anything that jeopardizes their career. Unfortunately, as Tim Kreider showed, that can be something as seemingly minor as blogging about a CAM practitioner who speaks at one’s medical school, which means medical students have to be very cautious. If you as a medical student have found a strategy to oppose CAM in your school that doesn’t get you into trouble, then I say more power to you!

      1. Andrey Pavlov says:

        You’re right Dr. Gorski. Which is why I did say I agreed with you and indeed feel that a couple of times I flirted with possible trouble that I probably shouldn’t have in retrospect.

        But I also had the support of a few of my classmates which makes it a bit easier going.

        And I have also been told by the the Deputy Dean and a few other top faculty that they have read my writing and think highly of it. I’ve linked them to my SBM articles and they have known my ‘nym for a while. While it hasn’t garnered me anyone leading a charge, it is nice to know that I can speak my mind in a professional and evidence based manner and at least have it respected.

        But I also get the feeling that in many cases CAM material is outside of their direct authority to regulate since it tends to come in from outside the school under the guise of “integrative medicine” and other such trojan horse monikers.

        And, quite frankly, if my writing does get me called in to explain myself I am more than happy to do so. I believe that I have evidence, reason, science, and logic on my side and I know that is highly respected at my institutions. Which is why I also do my darnedest to write in a professional manner at all times – I never assume anonymity will shield me. I am not disparaging people nor the institution or the curriculum at large. I am saying that certain ideas are poor, not supported by the evidence, and should not be taught in any medical school, let alone a prestigious one.

        Since there is a lot of shruggie-ism, starting a conversation about it is the best way to actually do something about it. And thanks to SBM I feel pretty well equipped to be a part of that conversation.

        So if there are other medical students out there reading – yes, be cautious but more importantly be professional and be respectful to people. Ideas should be dissected and bad ones discarded. Be a proponent for your education because that is what enables you to be an advocate for your patients. And at the end of the day, if that is your focus and you work hard at it, you will always succeed.

        Oh yeah, and always be willing to admit when you are wrong and apologize for it. It happens to us all and there should be no shame in it.

        1. Michael says:

          Thank you for your advice, Andrey!

    2. windriven says:

      “Let the ideas speak for themselves and realize that convincing just one person every once in a while is all you really need to do.”

      Amen. If each of us did that instead of hiding behind the shield of politically correct silence, the bloggers here would have to work a lot harder for subject matter.

    3. Thor says:

      So you’re the nybgrus of yore! Your comments were always some of my favs, and was a bit saddened at your sabbatical, although medical school certainly qualifies as a valid excuse for a pause. Nice to see that you’re back in full (and increased) ‘force’. What a great piece, infused with clear-headedness, knowledge and expertise, seemingly beyond your years. Your active involvement and dedication is just plain heart-warming, and gives me renewed confidence in the human condition (gush-gush). Have you considered applying as a guest poster to SBM? Your contributions would be inspirational for all. In any event, please do comment whenever you can.

      PS. I guess the continuation of the debate with you and WLU will have to wait until the occasion arises again.

      1. Andrey Pavlov says:

        LOL. Thanks Thor. Your words are much too kind. Especially the “beyond my years” part. I’m officially “old” as I turned 30 earlier this year. (Shhh… don’t tell some of the old fogies I said that :-p)

        And yes, I am actually now a contributing author… sort of. I would like to be writing more but ’tis the season for residency applications which also means I need to be wrapping up my research projects so I can list them on said applications…

        As for my argument with WLU – yes, that has been tabled for exactly those reasons. Plus, we essentially agree and are more or less splitting hairs which means that to argue it well would actually require even more effort than usual.

        In any event, thanks again for the kind words.

  9. Andrey Pavlov says:

    Sorry, one other anecdote to support Dr. Gorski’s view on the matter:

    Also during my OB rotation a (different) attending was talking about cranberry juice for the treatment of UTI as part of our review for an upcoming exam. Dr. Crislip would have been delighted.

    I commented about what I knew and the attending said she was not aware of that data, etc. and that the correct answer for the exam would be to trial cranberry juice in a mild uncomplicated UTI (which of course means allow regression to the mean to work). That day she sent out an email with some review materials and I responded by sending all the relevant primary source documents to demonstrate the disutility of cranberry juice in UTI.

    The response was a brief “that’s great, but learn it for the exam anyways!”

    So… a useless outcome. I gained nothing from it and did expose myself potentially to some kind of rebuke. Luckily this attending really is an awesome person and so nothing more than that simple email came out of it, but the reality of it was that nothing useful came out of it either. I don’t regret bringing it up in the review session, but I do regret having sent out the email. The former made me an EBM crusader, the latter and anti-CAM crusader.

    1. Jann Bellamy says:

      Sorry, Andrey Pavlov, I posted my reply to you to the wrong comment. In any event, as I said before, good for you and keep up the good work.

      1. Andrey Pavlov says:

        Thanks Jann. Please just call me Andrey, no need for formalities.

  10. Carl says:

    We need a leaks website for medical students so they can remain anonymous while we publicly mock their idiotic professors.

    1. Michael says:

      A leaks website would be beneficial (but maybe not for your purpose hah ..); in the UK, they have gone the exact opposite way:

      “But in the updated guidelines, the GMC (General Medical Council) has included new rules about doctors’ use of social media. In an unprecedented move, it now bans doctors from using aliases or noms de plume.”

      I have verified this on the GMC’s “Doctors’ use of social media (2013)” document.

      1. David Gorski says:

        Wow. That’s about as misguided a proposal as I can think of. What about doctors who might want to expose big pharma wrongdoing or problems with the NHS? Such a rule would give such entities a powerful tool to suppress legitimate dissent.

        1. Michael says:

          Yes, it is a troubling development especially when considering the history of literature and historical documents and the types of works that have been written under aliases (Common Sense, for example) and the reason why pseudonyms were chosen (to avoid a public beheading in Paine’s case for publishing inflammatory content). Anonymity is important for shining the sunshine in on places where the gatekeepers rather it not go.

  11. Dr. Bill Hendon says:

    Wow. This article doesn’t seem to have an agenda at all. I hope the author who was paid by the AMA continues to not get his or her spine checked for subluxation. That would be good justice for them. Subluxation Centered Chiropractic will save the nations health care system millions of dollars. People are looking for natural ways to acheive better health and Chiropractors are very skilled at removing subluxations which decreases nerve interference and improves spinal function. The real scientific Chiropractors are those who diligently work on perfecting the reduction of the vertebral subluxation complex. The others are working on???? Going to a chiropractor who doesn’t work on the vertebral subluxation complex is like going to a dentist who doesn’t work on cavities. If you don’t know what I’m talking about then you haven’t seen a good chiropractor. Find a good Chiropractor and change your life for the better.

    1. WilliamLawrenceUtridge says:

      Wow. This article doesn’t seem to have an agenda at all.

      It does have an agenda. As it says in the url, it’s about science-based medicine. Don’t like how it addresses your woo? Get some research.

      I hope the author who was paid by the AMA continues to not get his or her spine checked for subluxation.

      Just so you know “this person is bribed to say what they say” is just an intellectually lazy way of avoiding any substance. What it says about you is “I can’t think of anything that might prove their argument wrong, so I’m going to try to distract people”. Are you so unintelligent or uninformed that you can’t rebut Jann Bellamy’s points in a meaningful way? Or do you concede that she is right, and you just don’t like this fact?

      Subluxation Centered Chiropractic will save the nations health care system millions of dollars.

      How? Subluxations don’t seem to exist. And while back pain is a major problem, and chiropractic “low amplitude, high velocity” manipulations, the only thing you really bring to the table that physiotherapists don’t, wouldn’t seem to be of much use when it comes to helping someone with a leg amputated by a roadside bomb or bullet. Not to mention, now that there is a research base supporting LAHV for back pain, physiotherapists seem to be adopting it, thus eroding the one claim you reasonably had to be somehow unique from an actual science-based perspective. You should retrain as a physiotherapist.

      Note as well that chiropractors may add to the cost of health care due to cervical artery dissection.

      People are looking for natural ways to acheive better health

      How on earth is contorting someone into an uncomfortable position, then dropping your weight on them or twisting their spine with rather considerable force, natural? I thought Palmer developed his theories after fiddling with the spine of a deaf guy, not observing bonobos performing spinal manipulations on each other in their natural habitat.

      and Chiropractors are very skilled at removing subluxations which decreases nerve interference and improves spinal function. The real scientific Chiropractors are those who diligently work on perfecting the reduction of the vertebral subluxation complex.

      …except that there’s no proof that the chiropractor’s version of subluxations exist or cause symptoms. Actual subluxations do exist, can be seen on an x-ray, and interfere with mobility – not nerve function. What evidence do you have that the “vertebral subluxation complex” even exists, let alone causes symptoms?

      The others are working on????

      What “others” are working on doesn’t matter. This is a false dilemma. If physiotherapists (or doctors) are following complete blind alleys, if their research and activities produce no benefits – they have a problem that needs correcting. It doesn’t mean you automatically win by default. If your treatments work, particularly for anything but muscle and joint pain, prove it. Don’t pretend the lack of cures for all diseases by other specialties justifies chiropractic care.

      Going to a chiropractor who doesn’t work on the vertebral subluxation complex is like going to a dentist who doesn’t work on cavities.

      Have you ever heard of Sam Homola?

      Seeing a chiropractor who works on subluxations is like seeing a dentist who relies on the tooth fairy to fix cavities. Seeing a chiropractor who doesn’t work on subluxations is like seeing a physiotherapist.

      Find a good Chiropractor and change your life for the better.

      …because you’ve got too much money and you should put it back into the economy! Never mind that the money could be much more fruitfully spent on something useful!

      1. Andrey Pavlov says:

        I’m sure you’ve noticed the penchant for DC and other quack “doctors” to use their title as part of their name at all times whereas legitimate physicians and others holding legit doctoral degree eschew titles entirely or simply put the credential at the end of their name.

        This is something even my fiance picked up on her own over the years. We were driving through Florida a couple of weeks ago and we both saw a sign for “Dr. So and So” who treats “allergies, skin rashes etc” and she was immediately skeptical of him being anything but a quack. I agreed because it would be odd for an actual allergist or rheumatologist to advertise in such a way, especially without the relevant credentials at the end of the name (e.g. “So and So, MD FACP, FACR”)

        Sticking “Dr.” in front of your name is a red flag of the inferiority complex of not being a legitimate doctor and only holding the title.

    2. David Gorski says:

      I hope the author who was paid by the AMA continues to not get his or her spine checked for subluxation.

      Pharma shill gambit. You lose.

  12. Carl says:

    Some of this sounds like doctors over there are officially employees of the government 24/7:
    http://www.gmc-uk.org/guidance/ethical_guidance/21186.asp

    They warn about the Internet blurring the line between public and private life, and yet their “guidance” seems to be saying that doctors don’t have a private life.

  13. Carl says:

    “Dr.” Bill Hendon said,
    ” Going to a chiropractor who doesn’t work on the
    vertebral subluxation complex is like going to a dentist
    who doesn’t work on cavities”

    Well, I almost agree with that. But it is more accurate to say that going to a chiropractor who doesn’t work on subluxations is like going to a magician who doesn’t actually try to trick the audience.

    “The real scientific Chiropractors are those who
    diligently work on perfecting the reduction of the
    vertebral subluxation complex.”

    Yeah, it must take a lot of dedication to keep trying to find better methods of fixing problems which don’t exist. That must be a LOT of work.

  14. Dr. Bill Hendon says:

    Well Cael and William I almost agree with you on one thing. Some o the changes I see while the patient is on the table and the changes they experience in between visits does at times seam like magic.

    As far as vertebral subluxations not existing, why does Medicare, private insurance companies and automotive insurance companies pay me to remove them. Because they have seen enough research that proves that removing subluxations improves the symptoms the patient comes in with. Why do PTs want to gain the right to manipulate the spine in most states? Because it works. So you see the research you speak of has already been done by insurance companies and the federal government.

    As far as twisting and cracking the spine, that is only one form of joint mobilization. This is the only form the PTs know how to do. Saying I am uninformed about this subject is funny. . Have you ever heard of Activator Methods, Chiropractic Biophysics, SOT, Torque Release Technique, Upper Cervicle Tenhnique, Thompson Technique….. And believe me the list goes on and on. The thing these techniques have in common is that they all work with the nerve system to find the subluxation. Gone over extensively inChiropractic School. PTs can only manipulate the spine in some states and Ironically because they won’t recognize the neural part of the subluxation they can’t use Chiropractic methods to correct them. So you see the sword … It cuts both ways.

    1. While I am sure you see what appears to be improvement “on the table” with some of your patients, you surely know that anecdotal evidence is really no evidence of efficacy. It may be a starting point for further research, but the body of evidence currently does not support the existence of the subluxation.

      Government support of Chiropractic in no way verifies it scientifically. In fact, most of it is due to intensive lobbying, or “legislative alchemy” as our own Jann Bellamy has so brilliantly demonstrated.

      Speaking of spinal manipulation, it’s often the other way around. Spinal Manipulation is under the PT scope of practice, and always has been. It has a very niche use when utilized properly with supporting evidence. Chiropractors have oftentimes tried to block or limit PT’s access to manipulation, believing almost that they “own” the technique. My personal opinion on the matter is that it’s a simple turf war, with the DC’s viewing the writing on the wall and knowing they have to protect the only thing keeping them relevant against the onslaught of superior medicine. However, I am not a PT and would welcome a PT’s perspective in this matter.

      It is also patently untrue that PT’s only know one form of joint mobilization. Having had the pleasure of working with PTs on my patients, they have a wide range of techniques available at their disposal, depending on the specific injury of the patient.

      Regarding Activator Methods, Chiropractic Biophysics, SOT, TRT, UC, TT, all of these have scientific discourse available at Dr. Stephen Barrett’s website, QuackWatch. When reviewing the evidence of efficacy of these methods, they result as nothing more than a hodgepodge of techniques pulled out of whole cloth by DCs, each seeking to develop their niche in the business. Again, we cannot rely on patient testimonies. The research behind these techniques is what matters, and just because they are being taught in Chiropractic colleges does not make them valid or effective. The same can be said about quackery like Homeopathy and Acupuncture, both heavily discussed on this site.

      For the sake of ending the discussion, I would ask you to provide for us evidence that the vertebral subluxation complex exists. Preferably something of the peer reviewed variety, as patient testimonials are not satisfactory evidence of…well, anything!

    2. WilliamLawrenceUtridge says:

      Well Cael and William I almost agree with you on one thing. Some o the changes I see while the patient is on the table and the changes they experience in between visits does at times seam like magic.

      Jesus, normally I don’t spell-troll, but “seam like magic”? Two different fingers on two different sections of the keyboard, it’s an effort to misspell that.

      It’s hardly remarkable if you are working with simple misplaced joints. It’s like being amazed that when you put the pin back into the hinge, the door opens properly again.

      As far as vertebral subluxations not existing, why does Medicare, private insurance companies and automotive insurance companies pay me to remove them.

      Geez, what next, you’ll claim that homeopathy works because there is an officially regulated degree system? The most meticulously regulated nonsense is still nonsense. Insurance companies are companies, not regulatory bodies – they pay because there is a demand from their customers. Can you point to scientific literature that experimentally verifies the existence of subluxations? And real ones, not the fake ones you pretend cause cancer.

      I’ve argued with chiropractors here that I respect, who simply view themselves as physiotherapists. You appear to be of the other, nutter variants who attempts to over-reach yourself even more so.

      Because they have seen enough research that proves that removing subluxations improves the symptoms the patient comes in with.

      Can you cite any of this research? Or are you just taking their words for it?

      Why do PTs want to gain the right to manipulate the spine in most states? Because it works.

      Absolutely it works to improve the mechanical function of bones, joints and muscles. Nothing else. If I have back pain, a chiropractor is an option. Now that physios are adopting the technique, you seem wholly redundant.

      Have you ever heard of Activator Methods, Chiropractic Biophysics, SOT, Torque Release Technique, Upper Cervicle Tenhnique, Thompson Technique….. And believe me the list goes on and on.

      Let’s see:
      - activator methods
      - chiropractic biophysics
      - SOT
      - upper cervical technique
      - I can’t find anything justifying “Thompson technique” on quackwatch or pubmed
      I’m not sure what you’re bragging about – chiropractors made up a bunch of proprietary techniques they could claim as uniquely theirs, and charge to deliver and treat – but not actually testing it. See, real doctors will do the same thing, but will publicize their results through the scientific literature, which will let people determine whether there is a risk-benefit ratio that makes it worth doing. What you’ve got here is a list of techniques you claim to work – but in no way demonstrate this is actually the case. For instance, I can claim that you are a violent Marxist whose breath causes tumors – but that doesn’t make it true. Just like you can claim chiropractic biophysics is magic, but that doesn’t mean it’s not just a sciencey word salad.

      Gone over extensively inChiropractic School.

      They’re trying to teach creationism in school, does that mean Jesus rode a dinosaur?

      1. Michael says:

        It seems some chiropractors and associated governing bodies even doubt the existence of this fundamental (to chiropractic care) concept:

        General Chiropractic Council – “Guidance on claims made for the chiropractic vertebral subluxation complex”
        “The chiropractic vertebral subluxation complex is an historical concept but it remains a theoretical model. It is not supported by any clinical research evidence that would
        allow claims to be made that it is the cause of disease.”

        An epidemiological examination of the subluxation construct using Hill’s criteria of causation
        “There is a significant lack of evidence to fulfill the basic criteria of causation. This lack
        of crucial supportive epidemiological evidence prohibits the accurate promulgation of the chiropractic subluxation.”

    3. Andrey Pavlov says:

      As far as vertebral subluxations not existing, why does Medicare, private insurance companies and automotive insurance companies pay me to remove them.

      First off, this is a common trick of the language chiros use. A verbal sleight of hand if you will. Which I have documented in comments here (as nybgrus). You are also free to peruse any other chiropractic article comment threads and look for my name – particularly in conversation with a poster with the ‘nym of NMS-DC.

      But in short, the subluxation Medicare recognizes is not the same subluxation that chiros think they are treating. One is an actual medical term which means a bone slipping past a bone – something that can be objectively identified with high inter-observer reliability and has a distinct and narrow set of symptoms and ways to fix it. A chiropractic subluxation is the magical displacement of bones that is undetectable, has extremely poor inter-observer reliability (when you get two chiros to try and detect subluxations in the same person, they rarely agree. Yet somehow two orthopods or PTs can detect an actual subluxation and agree on it) and causes a whole host of symptoms from muscle pain to limb weakness to diabetes and colic and atopic dermatitis. The former is real, the latter is magic. And thanks to the fact that the two share a same name, the sleight of hand worked on the legislative bodies. Which is exactly the point of Jann’s series on “Legislative Alchemy.”

      And lastly, just because you can get someone to pay you for something – particularly if it is a group of politicians who wouldn’t know what science is if it bit them in the ass – doesn’t mean anything. It just means you duped the politicians. But you haven’t fooled actual medical scientists.

      Have you ever heard of Activator Methods, Chiropractic Biophysics, SOT, Torque Release Technique, Upper Cervicle Tenhnique, Thompson Technique….. And believe me the list goes on and on.

      And Harry Potter can cast the Alohomora, Aparecium, Cave Inimicum, Colloportus, Deletrius, and the list goes on. Just because you can make up a bunch of words and call them interventions doesn’t make them so. The things you are referring to have no evidence to support them doing anything, nor any prior plausibility, and plenty of evidence and reason to consider them made up. Homeopathy makes up a bunch of stuff too. They have a huge pharmacopeia. Their list doesn’t impress me either.

      The thing these techniques have in common is that they all work with the nerve system to find the subluxation. Gone over extensively inChiropractic School.

      Which is precisely why chiropractic is relegated to the realm of quackery. You are taught ridiculous magical principles. I am guessing by your tone and post that you are a “straight” chiropractor? I’ve tussled with a few mixers who think that subluxation is a remnant of the past – taught minimially for historical purposes. Even your own field can’t come to terms with itself on the topic. Yet, of course, the professsional bodies and exams still require and demand magical subluxation theory as the basis of chiropractic because otherwise you would end up being essentially PTs.

  15. pmoran2013 says:

    “Well Cael and William I almost agree with you on one thing. Some o the changes I see while the patient is on the table and the changes they experience in between visits does at times seam like magic”

    I have no problem accepting that there may be a subgroup of back pain patients who will be helped by spinal manipulation. The scientific evidence can be stretched to accommodate that hypothesis.

    It is a different question altogether as to whether all chiropractic visits, or even all visits for back pain should be allowed to draw upon taxpayer or insurance funds. That is almost certainly an cost-inefficient use of those funds, as well as potentially exposing some patients to the dubious practices that the chiropractic profession has allowed itself to become notorious for.

    The subluxation has become too nebulous a hypothesis to be useful. In any case, in the long run, it is measurable results that count.

    What you may choose to do at the patient’s own expense and risk is not entirely in anyone’s hands.

    .

  16. Carl says:

    Dr. Bill Hendonn August 3, 2013
    As far as vertebral subluxations not existing, why does Medicare, private insurance companies and automotive insurance companies pay me to remove them.

    They don’t. They pay you to make the patient settle the case.

    Why do PTs want to gain the right to manipulate the spine in most states?

    Maybe because “manipulating” the spine in the broadest sense might actually be helpful for people with certain spinal problems. It in no way implies the sort of bullshit on which “chiropractic” is based. That’s like saying, “podiatrists want to touch people’s feet, therefore reflexology must be real.”

    So you see the research you speak of has already been done by insurance companies and the federal government.

    It says a lot that your playland profession would have to resort to insurance companies as a substitute for scientific institutions.

    As far as twisting and cracking the spine, that is only one form of joint mobilization. This is the only form the PTs know how to do.

    That second sentence sounds like an outright lie. You might want to clarify it, if it is possible to do so without sounding even worse.

    Have you ever heard of Activator Methods, Chiropractic Biophysics, SOT, Torque Release Technique, Upper Cervicle Tenhnique, Thompson Technique….. And believe me the list goes on and on. The thing these techniques have in common is that they all work with the nerve system to find the subluxation.

    The development of multiple techniques to treat non-existent problems is not a show of knowledge.

  17. Carl says:

    Dr. Bill Hendon
    August 3, 2013
    As far as vertebral subluxations not existing, why does Medicare, private insurance companies and automotive

    insurance companies pay me to remove them.

    They don’t. They pay you so the patient will settle the case.

    Why do PTs want to gain the right to manipulate the spine in most states?

    Maybe because things which might be call “manipulations” of the spine in a broad sense might be helpful for patients

    with actual spine issues. That in no way implies the sort of bullshit on which “chiropractic” is based. That’s

    like saying, “podiatrists want to touch feet, therefore reflexology is real.”

    So you see the research you speak of has already been done by insurance companies and the federal

    government.

    It says a lot that your playland profession would have to resort to insurance companies as a substitute for

    scientific institutions.

    As far as twisting and cracking the spine, that is only one form of joint mobilization. This is the only

    form the PTs know how to do.

    That second sentence sounds like an outright lie.

    Have you ever heard of Activator Methods, Chiropractic Biophysics, SOT, Torque Release Technique, Upper

    Cervicle Tenhnique, Thompson Technique….. And believe me the list goes on and on. The thing these techniques have in

    common is that they all work with the nerve system to find the subluxation.

    Listing multiple methods for addressing a non-existent problem is not a show of knowledge, it is a sign of quackery.

    Gone over extensively inChiropractic School.

    I’m sure, since chiropractic schools have little real medical knowledge to teach. Lots of anatomy, lots of

    techniques, but little in between to explain why pathology in the first actually relates to the second.

  18. Carl says:

    Man, this new website blows.

    1. windriven says:

      “Man, this new website blows.”

      And it has been a while since the change over. I would have expected it to blow a lot less by now.

      1. Andrey Pavlov says:

        Yeah, I agree. Not sure what is up with it. The other thing I don’t like – and part of what is keeping me from being more active a commenter (though certainly not the only thing!) – is that there doesn’t seem to be an RSS feed for the comments anymore. Which makes it much tougher for me to go through and keep up quickly.

        1. David Gorski says:

          There most certainly is an RSS feed for the comments. It’s way down at the very bottom of the page to the right:

          http://www.sciencebasedmedicine.org/comments/feed/

          I don’t use RSS for comments because I’ve tried it and found it a pain in the rear, but I understand that others do. In any case, where do you guys think the RSS feed should go?

          1. Andrey Pavlov says:

            When I load the page and search for “RSS” the only thing that comes up is when I wrote it. I don’t see an RSS anywhere on the page at all. I’ve also loaded the pages in Firefox, Safari, and the internal browser of my RSS reader. Nowhere can I find an RSS feed.

            1. David Gorski says:

              It’s not listed as RSS. Scroll to the very bottom of the page and look again. Or just use the link I provided.

          2. Andrey Pavlov says:

            If I put the link you provided into my RSS reader I do actually get a comments feed but it is for all comments on SBM, not just restricted to one post. Which I suppose would work OK, but I still personally like having each one segregated into separate RSS feeds for each post. I have all the old threads that I commented on archived so I can look up what I wrote and reference it when needed.

        2. WilliamLawrenceUtridge says:

          I use the “recent comments” webpage, which comes in “grouped” and “ungrouped” flavours. I find it adequate, but you do have to check the page repeatedly throughout the day. One could even describe it as “obsessive”.

          But I’m consciously avoiding learning about RRS because I’m an internet-using Luddite.

  19. Andrey Pavlov says:

    See, I don’t even need to post here anymore. In the time it took me to throw up mine, 3 or 4 others saying essentially the exact same thing popped up. Mine was kind a middle ground in terms of snark though… much less than WLU but more than Chris Repetsky.

    1. WilliamLawrenceUtridge says:

      I see your implied compliment and say “thank you” :)

  20. Andrey Pavlov says:

    You are welcome, and well deserved at that.

Comments are closed.