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Journal of the American Dental Association Falls for Tooth Fairy Science

The Tooth Fairy

The Tooth Fairy

Another venerable scientific journal has fallen prey to “alternative” medicine research. The Journal of the American Dental Association (JADA) has joined the New England Journal of Medicine and Annals of Internal Medicine, among others, with its publication of “A pilot study of a chiropractic intervention for management of chronic myofascial temporomandibular disorder,” in the October, 2013, issue.

And what “chiropractic intervention” is this? The Activator Method Chiropractic Technique (AMCT) as taught by Activators Methods International (AMI), which also conveniently sells its own line of Activator Instruments. (Practice-building seminar DVDs sold separately.)

What is this Activator Method? In short, it is a method of detecting and correcting subluxations (the chiropractic version, not the medical one). Thus, the underlying premise of this study was that subluxations could cause myofascial temporomandibular disorder (TMD) pain and that finding and vanquishing these subluxations could bring about pain relief.

Now, as regular readers of this blog know, vertebral subluxations are a figment of the chiropractic imagination. They do not exist, as we have pointed out many, many, many times. And here is where alternative medicine has it all over conventional medicine and dentistry. In alternative medicine, once you invent a non-existent condition you can proceed to invent all sorts of diagnostic techniques and remedies to treat patients with this condition. The AMCT is a perfect example of this. Conventional medicine and dentistry, on the other hand, are saddled with the scientific method, biological plausibility, having to discard therapies when studies no longer support their use, and all sorts of other persnickety limitations.

The Activator Method Chiropractic Technique is a complete diagnostic and treatment package. The diagnostic method is laughably nonsensical. Here, we turn for an explanation to SBM contributor and chiropractor Sam Homola, writing for Chirobase:

The AM system is based on a concept of “pelvic deficiency (P.D.)”—also called “functional short leg”—which proponents define as an “apparent” difference in length, not an anatomical difference. To determine where the alleged problem is located, the practitioner holds the patient’s feet in various prescribed ways while the patient lies facedown on an examining table. Other parts of the body may be tested in various other ways.

AMI sells these shoes for patients to wear during their leg length analysis to “ensure accuracy.”

Leg-length Analysis Shoes

Leg-length Analysis Shoes

Now, to the treatment itself, which is equally nonsensical “chiropractic gimmickry,” again quoting from Chirobase:

If any inequality or “imbalance” is found, the practitioner taps various points along the spine, pelvis, and/or elsewhere with a handheld, spring-loaded mallet [called an Activator] until the legs appear to be equal in length . . . Slight variations of hip position or normal spinal muscle tension are probably responsible for the “imbalances.”

Ironically, the Activator design was derived from a dental impactor. Here’s the Activator IV, used in the JADA study:

The Activator

The Activator

I’ve used a similar Activator, to great comic effect, in my talks to medical students on complementary and alternative medicine. They seem to enjoy passing it around and thumping each other.

Here’s the latest model, described on the website as “revolutionary not evolutionary.”

New, improved Activator

New, improved Activator

Climbing the stairway to FDA approval

Yet, the FDA has issued a 510(k) medical device clearance for the Activator Adjusting Instrument for “chiropractic adjustment of the spine and extremities.” How could that happen?

According to FDA records, Activator I (still for sale on the AMI website) was in use prior to the effective date of the federal law requiring pre-market approval. Such devices were grandfathered in under the law. After the law’s enactment, AMI applied for pre-market approval of its newer model, Activator II. It did so on the basis that II was “substantially equivalent” to I, as permitted by law. However, applicants must show that the device submitted for approval is similar in safety and effectiveness to the device already on the market. The required 510(k) summary submitted to the FDA cited a 1986 study published in the Journal of Manipulative and Physiological Therapeutics (JMPT): “Accuracy of Piezoelectric Accelerometers measuring Displacement of a Spinal Adjusting Instrument.” Unfortunately, I cannot access the full article or provide you with a link to this abstract, from which this quote is taken:

The impedance-head-equipped spring-loaded Activator chiropractic adjusting instrument had a low velocity when used on the patient and appeared to cause bone movement and a measurable EMG response.

According to the summary, this “demonstrate[s] the effectiveness of the instruments to cause vertebral movement for chiropractic adjustment at very low energy.” Note that there is no statement in the abstract about whether this “bone movement” actually did anything for the patient or even that its putative effect was measured at all.

But progress marches on, and eventually the Activator III appeared. Its premarket approval was based on substantial equivalency to Activator I and II, with no citation of additional studies of clinical effectiveness in the 510(k) summary. Activator IV apparently did not require FDA approval, or at least I didn’t find any evidence that AMI got it. That brings us to Activator V. This application was based on similarity to III and to two similar devices (FDA approved here and here) manufactured by other companies. Like the III application, the V didn’t cite any studies of clinical effectiveness, nor could it piggyback onto studies cited by the manufacturers of the two other devices, as they don’t cite any in their applications. There is now an Activator V-E, also approved, but unfortunately its summary does not appear on the FDA’s website. (V-E is not sold on AMI’s website.)

Thus, it appears that the evidence of clinical effectiveness of the Activators submitted by AMI to the FDA is less than convincing, even though the FDA requires it for approval. (21 CFR Sec. 807.92) Interestingly, by the time V was submitted for approval in 2007, there was a 2005 article in the JMPT reviewing the studies of clinical effectiveness of the Activator Method and validity of leg-length analysis. The authors concluded that studies of AMCT diagnostic measures “did not permit assertions concerning the validity of AMCT assessment procedures for the detection of supposed joint lesions [one of the many names chiropractors have invented for the invented subluxation] or targets for adjustive intervention.” Clinical trials of the Activator method itself led them to the conclusion that it “may be a clinically useful tool” although they admit that the handful of studies they rely on have insufficient controls (e.g., lack of a placebo, not blinded) and not enough participants to demonstrate much of anything. And the funny thing is one of the authors of this article is Arlen W. Fuhr, D.C., co-creator of the Activator Method, President of Activator Methods International and the contact person on each of the pre-market approval applications filed with the FDA. Why wasn’t his article cited to the FDA?

The Tooth Fairy visits the Journal of the American Dental Association

Of course, all of this is simply Tooth Fairy Science in the first place, that wonderful term coined by SBM’s own Harriet Hall. “Tooth Fairy science seeks explanations for things before establishing that those things actually exist,” according to the Skeptic’s Dictionary. Dr. Hall offers this example:

You could measure how much money the Tooth Fairy leaves under the pillow, whether she leaves more cash for the first or last tooth, whether the payoff is greater if you leave the tooth in a plastic baggie versus wrapped in Kleenex. You can get all kinds of good data that is reproducible and statistically significant. Yes, you have learned something. But you haven’t learned what you think you’ve learned, because you haven’t bothered to establish whether the Tooth Fairy really exists.

Speaking of tooth fairy science, let’s turn to the JADA article. The rationale for the study will sound familiar:

TMD can become a chronic problem lasting several years, and patients receive little help from traditional forms of treatment. Consequently, some patients may seek complementary and alternative (CAM) approaches to manage their TMD-related pain.

So, what to do? Should we expose chiropractors for ripping people off by telling them they have subluxations which may be causing their TMD pain and proceeding to “correct” those subluxations with little spring-loaded mallets? No, we study it because CAM is popular. (Actually, it isn’t.) And we study it with taxpayer money, in this case provided by NCCAM. No surprise there.

Do the authors cite any evidence that the Activator method is nevertheless effective for TMD in an attempt to justify this study, despite the lack of plausibility (which they never admit, of course)? Well, they cite a single case report and a prospective case series of 8 patients who were assessed at 6 weeks with no further follow-up. There was no blinding and no placebo control. I don’t know if this would normally justify a “prospective randomized controlled pilot trial” (as this study is described) of a medical or dental intervention, but perhaps some of you could comment.

Fifty-two (out of an original 80) completed the JADA study. Participants were divided into 4 groups which numbered between 11 and 14 in each group. They compared self-care and self-care plus either AMCT, sham AMCT or reversible interocclusal splint therapy (RIST). Self-care consisted of someone talking to the patient about TMD and suggesting such things as using OTC pain medications, jaw relaxation stretches, and reducing their stress levels.

Before I get into how AMCT was described, let me repeat Sam Homola’s explanation, because it should be fresh in your mind when you read what follows:

The AM system is based on a concept of “pelvic deficiency (P.D.)”—also called “functional short leg”—which proponents define as an “apparent” difference in length, not an anatomical difference. To determine where the alleged problem is located, the practitioner holds the patient’s feet [perhaps shod in AMI shoes] in various prescribed ways while the patient lies facedown on an examining table. Other parts of the body may be tested in various other ways. . . . If any inequality or “imbalance” is found, the practitioner taps various points along the spine, pelvis, and/or elsewhere with a handheld, spring-loaded mallet until the legs appear to be equal in length . . .

Of course, anyone with a background in medicine or dentistry would have his or her suspicions instantly aroused by such an explanation and likely seek further information. Or perhaps even toss the proposed article into the wastebasket. But let’s look at how the authors describe AMCT:

The AMCT protocol is a structured method of chiropractic treatment that involves the use of a series of biomechanical tests in determining how, where and when (or when not) to perform a mechanically assisted manipulation. These biomechanical tests involve well-defined joint or joint complex (motor unit) movements involving the area of examination. Each specific manipulation—called an “adjustment”— is given with a hand-held, springloaded instrument (Activator IV, Activator Methods International) that delivers a quick, shallow thrust. The AMCT protocol can include the entire spine and extremities, as well as the temporomandibular joint. The entire AMCT protocol has been described in detail elsewhere.

A “series of biomechanical tests?” Where is the description of functional leg-length analysis? Or the subluxations it supposedly uncovers? How about an explanation of the subluxations’ putative effect on TMD? Or what it is that this “quick, shallow thrust” is supposed to do?

And that description “in detail elsewhere?” The authors cite a chiropractic textbook written by the aforementioned Arlen W. Fuhr, a text which I expect resides exclusively in chiropractic school libraries and practitioner offices. A less obfuscatory explanation of ACMT can in fact be found in a source more readily available via medical libraries – the same 2005 article in the Journal of Manipulative and Physiological Therapeutics not cited to the FDA by AMI. (JMPT is indexed in PubMed.) Also not cited was a 2012 systematic review in the Journal of the Canadian Chiropractic Association (also indexed in PubMed), which found no difference in results between the Activator Method and manual therapy. Since none of the 8 studies were randomized clinical trials, all lacked a no-treatment or sham treatment group and were unblinded, no results could reliably be attributed to either treatment.

Had the JMPT article been cited, the peer reviewers would not only have discovered the obvious: the lack of validity, not to mention the underlying pseudoscience, of functional leg length analysis and lack of evidence of effectiveness (and, again, the pseudoscience) of the Activator Method. They would also have found a refreshingly honest admission by its authors: there is no evidence that the chiropractic subluxation exists in the first place.

Let’s imagine two scenarios here. First, the peer reviewers were misled by what was made to sound like a fairly innocuous procedure by using vague terms like “structured method of chiropractic treatment” and “biomechanical tests.” Part of me hopes this is the case, although I do think someone should have asked for more detail. And part of me doesn’t want to contemplate a second scenario: that more information was requested by the reviewers and a more straightforward explanation provided by the authors and that it informed them exactly what AMPT is.

And the results of the JADA study?

After going through an impressive amount of verbiage about subject selection, control groups, confidence intervals, baseline characteristics, and all the other accoutrements typical of Tooth Fairy Science, we learn there was no statistically significant difference between results in each group. But that’s ok because the study was simply looking at the “feasibility of conducting a full-scale RCT to evaluate the effectiveness of AMCT” although the next study, according to the authors, should be a comparative effectiveness study. An odd suggestion, as such studies are generally done to compare treatments that are effective. Otherwise, why would you do it?

However, I can’t say nothing useful was learned, although likely not what the researchers intended. First, for all of the hoopla we hear about patients preferring CAM practitioners for their more “holistic” approach, mean satisfaction with care was actually greater for the RIST and self-care-only groups than with the AMCT and sham-AMCT groups. Second, they report “subtle differences” between the chiropractor’s interaction with participants in the AMCT and sham AMCT groups. Actually, some of the differences (more fully explicated in a poster presentation by the authors) weren’t so subtle. The chiropractor talked more to one group than another, but which was which is not reported. And in the active AMCT group the median number of Activator device “clicks” was almost twice as many as in the sham group (42 clicks v. 22 clicks).

But what about the idea that CAM practices must be studied because, as the authors suggest, “some people may seek complementary and alternative approaches to manage their TMD-related pain.” True enough, “some people” do exactly that. “Some people” may seek crystal therapies or use biomats, or tape magnets to their jaws. Should we study those too? After all, they have no less plausibility than AMCT. Must we study every treatment anyone makes up? And does it matter why “some people” try these therapies? Does it matter that they seek them out because chiropractors are misleading them about AMCT’s effectiveness and taking their good money for a worthless treatment? Wouldn’t it be more useful to tell them this rather than spending money on implausible treatments that we know can’t possibly work? Do we think for one second that chiropractors will stop using AMCT because the studies don’t support its use? (Answer: they won’t.)

Which brings me to other troubling aspects of this study.

Why was this study approved by the University of Iowa’s Institutional Review Board (IRB)? I am certainly not an expert in bioethics, but it is my understanding that no trial should be approved that does not conform to the “World Medical Association Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Subjects,” which states:

21. Medical research involving human subjects must conform to generally accepted scientific principles, be based on a thorough knowledge of the scientific literature, other relevant sources of information, and adequate laboratory and, as appropriate, animal experimentation.

As well, ethical and legal principals require informed consent before a human subject agrees to participate in a trial. As Steve Novella said yesterday in his post on informed consent:

This principle is, in turn, based largely upon the principle of autonomy – people have the right to control their own lives, and one cannot have control without information.

The same is true for informed consent in the legal context, which is based historically on the tort of battery: no one can intentionally touch you without your consent. And to consent you have to know what you are consenting to.

So let’s review what we know about AMCT.

  1. It is based on the “theory” that subluxations (chiropractic version) of the spine affect human functioning and can cause ill health. As chiropractors themselves admit, there is no real support for this “theory.” And whatever chiropractors think, as any responsible scientist will tell you (and as one neuroscientist in fact told me) the whole idea is nonsense.
  2. These subluxations can be discovered by something called “functional leg length analysis,” which even a casual observer can see makes no sense (anatomical or otherwise) whatsoever.
  3. That thumping the vertebrae or other articulation with a small, spring-loaded mallet will reduce the subluxation by moving it back into its proper location, an obviously dubious concept.
  4. This “correction” of the subluxation will have a beneficial effect on the patient’s condition.

And how do we know this? Through information readily available via a search of literature indexed on PubMed. There are plenty of other journal articles with similar information, but articles on AMCT alone will tell you everything you need to know. As will Science-Based Medicine, for that matter.

Did the University of Iowa IRB have this information? I don’t know, but it was certainly easily available. Would this information be relevant to a person making a decision on whether to participate? Of course. Were the subjects told this? I doubt it. (And if anyone out there has the informed consent documents used in this trial, I would certainly love to see them.)

If I can figure all of this out with my 10th grade biology science education and an internet connection, why couldn’t the editors of JADA? Why couldn’t the University of Iowa IRB? Good questions.

Posted in: Chiropractic, Clinical Trials, Dentistry, Legal, Politics and Regulation

Leave a Comment (57) ↓

57 thoughts on “Journal of the American Dental Association Falls for Tooth Fairy Science

  1. devo-T says:

    What in the actual hell?

    The AM system is based on a concept of “pelvic deficiency (P.D.)”—also called “functional short leg”—which proponents define as an “apparent” difference in length, not an anatomical difference.

    This has to be one of the nuttiest claims I’ve ever read. By that account, I can now claim with certainty that antineoplastons are not the answer — but my newly-discovered diagnostic device, the AlmondJoy-9000-Z, is. By measuring not actual, but apparent, differences in gullibility, I can cure cancer and relieve the patient of about $100,000 quickly, easily, and with only a few major side effects.

    1. windriven says:

      Maybe this chiro article in JADA is supposed to be like the cartoon in a New Yorker – something to be smiled at but not taken seriously or given much thought.

  2. Thank you for bringing to light this joke of a research article. I blogged about this a couple of weeks ago (http://www.prismpodcast.com/2013/11/01/the-jada-drops-the-ball-big-time/) and followed up with a letter to the editor of the JADA. We’ll see if it gets published.

    Jann did a fantastic job of outlining was AMCT is and why it is ludicrous to think that it could be use for the treatment of Temporomandibular Disorders (TMD). Of course, the authors of the study did not describe how the Activator was used, whether it was utilized to “correct” a vertebral “subluxation” or if it was applied directly to the TMJ, as has been described. One would think that this methodology would be described, but the authors were vague in that area. If leg length was indeed employed to ascertain the efficacy of TMD treatment, it would only add to the ridiculousness of the project.

    What jumped out to me was that what seemed to start out as a study of various potential treatment methods for TMD morphed into a study to study the feasibility of a future study after things didn’t go their way. The exclusion/drop out rate was extremely high, leaving a small sample to study. Complete blinding was impossible, and the results, as Jann mentioned, were basically equivilant and probably no different than placebo and/or no treatment at all.

    The JADA should have passed on this paper. Not because they should censor possible alternative treatments, but because this was a meaningless study, period. Funded by the NCCAM (surprise!!), this is an example of their pointless, “more studies are needed” hand waving that just serves to kick the woo can further down the road without providing any useful information or furthering our body of scientific knowledge.

    Grant Ritchey

    1. Jann Bellamy says:

      Thanks. The way I read the article, AMCT is a combination of the leg-length test and use of the Activator, which would indicate that study participants were subjected to the test. Unless all “subluxations” “discovered” by the test were of the TMJ, it seems the vertebral subluxations discovered would be “adjusted” with the Activator as AMCT protocol would dictate. (According to chiropractic “theory” subluxations can occur in any articulation.) In addition, I doubt the 42 clicks (mean number) of the Activator used in the active treatment group (as described in the poster presentation by these authors) would have all been directed to the TMJ — ouch!

  3. Mielczarek says:

    Jann , Thanks for your expose of CAM “tooth fairy” mythology at all levels; e.g. editorial boards of peer reviewed medical journals and FDA certified clearances of medical devices. My own complaint about the ‘Physical Therapists’ use of an FDA “approved laser? light which could heal? broken bones’ wound through many FDA offices. The bottom line was: a device easily receives FDA approval if it does not require surgical insertion.
    Eugenie Mielczarek

  4. nyudds says:

    The JADA should be ashamed of itself. This is terrible work masquerading under cover of a scientific journal. I personally can hear the cry of disappointment from the Dawson Center for Advanced Dental Studies. I have treated many chiropractic patients successfully because chiropractors don’t know the first thing about dentistry or TMJ dysfunction and start from some strange places (compressed air blown on skin anterior to the ear is a treatment!) And let’s not qibble about a proper diagnostic progression: I used MD’s, including psychiatrists, pharmacists, oral surgeons and PT’s to great advantage. I did my own radiography and read my own films, which in itself, is pretty different. I don’t know it all, like most chiropractors do, but I do know that publication of such a specious article emanating from a chiropractic school (Palmer) with chiropractors citing themselves in the literature (almost all from lower-tier journals) to make their case, is misleading at best. Pity the JADA doesn’t. Nonsense is nonsense, whether it is published or not.

  5. TiredFather says:

    Who were the reviewers and the editor I wonder? I am not a medic of any description but I assume there is some sort of peer review process on this journal. ‘Apparent leg length’ – it would be very funny indeed… if we weren’t talking about sick people.

  6. Dan says:

    Is all chiropractic quackery? Or is some chiropractic practice (“chiropractice”?) less than pure chicanery, i.e. evidence-based? And if so, is that merely the rehab or PT oriented chiropractic, as practiced already by PT’s and others in allied industries?

    1. WilliamLawrenceUtridge says:

      There are two broad divisions of chiropractic – straights and mixers. Straights are basically the nutters – they think chiropractic care can cure straight-up diseases, including asthma, cancer, allergies, and pretty much everything else. They’re strongly antivaccination. They’re also the branch that lost their lawsuit against Simon Singh in the UK last year.

      Mixers are basically “physiotherapists with a twist”. The twist being their approach to spinal manipulation – high-velocity, low-amplitude thrusts (snapping the neck or back around sufficient to pop it). Much like physiotherapists, a lot of their practice is experience-based, and the good ones will give you stretches and exercises.

      Physiotherapists and chiropractors now overlap in at least one area – since spinal manipulation now has an evidence base to support its safety and efficacy for acute low back pain, it is being trained and added to the physiotherapy curriculum and continuing education (see for instance here).

      An unfortunate matter in the discussion of chiropractic is the mixing of the two – lots of chiropractors say “I’m not crazy, I don’t believe in spinal manipulation fixing cancer”. And they’re right. But there are other chiropractors who believe exactly this. It’s unfortunate, and an issue that leads to mixer-chiropractors getting a lot of undeserved shit on this website. But you can’t just tell them apart until you probe deeper into their beliefs – because they both call themselves chiropractors.

      My continued thoughts on the matter are that chiropractors should resolve this themselves by mixers voluntarily folding themselves into physiotherapy colleges and strengthening their evidence-base for musculoskeletal conditions. Straights should stick to being called “chiropractors” and should be marginalized.

      1. Edward, a DC says:

        WLU, Rather than two broad divisions, the evidence suggests that in the USA chiropractic is rampant with quackery that the vast majority are subluxation-based, “mixer” or “straight.” I am not aware of survey data; my anecdotal take is that 99% are subluxation-based and most deserved every bit of criticism by SBM, Chirotalk, etc.

        http://www.chiromt.com/content/19/1/4

        http://www.chiromt.com/content/21/1/33

      2. Edward, a DC says:

        WLU, Rather than two broad divisions, the evidence suggests that in the USA chiropractic is rampant with pseudoscience that the vast majority are subluxation-based, “mixer” or “straight.” I am not aware of survey data; my anecdotal take is that 99% are subluxation-based and most deserved every bit of criticism by SBM, Chirotalk, etc.

        http://www.chiromt.com/content/19/1/4

        http://www.chiromt.com/content/21/1/33

    2. Jann Bellamy says:

      Re: WLU’s response: Beware that many mixers will still manipulate your spine based on their finding non-existent subluxations — you can’t be sure that a chiropractors’ spinal manipulation is for the same reasons as a physical therapist. Mixers also use acupuncture, cranial sacral therapy, homeopathy and other “alternative” treatments. Some of them use bogus tests for “nutritional deficiencies” to sell vitamins and dietary supplements and are anti-vaccination. Surveys show that the majority of chiropractors still believe in the subluxation “theory” and that subluxations cause visceral disease. At least in the U.S., I think it is difficult to find a chiropractor who practice like a physical therapist. They all go to the same schools, where they are all exposed to a certain amount of alternative medicine nonsense (at some schools more than others). See: http://www.scienceinmedicine.org/policy/papers/Chiropractic.pdf

      1. WilliamLawrenceUtridge says:

        To be fair, some physios, some doctors commit these sins as well. I have no figures, but I would be surprised in the least if the SCAMs listed were more common among mixer-chiros than docs, and straight chiros than mixers.

        I talked to my physio about this, she called what chiros use the “Million Dollar Roll”, because they do the whole spine at once, and do it quickly (so, charging $40 per treatment, seeing 40 patients per day, you can make a million bucks in a little over a year and a half). In contrast, her training was in single-vertebra adjustments, a minimalist intervention, and she won’t be considered “certified” for another two years or so. And despite me having considerable acute back pain, gave me two weeks of exercises to work at before even considering trying a manipulation. And in that two weeks, my back got much better. Placebo? Tincture of time? Exercises? I’ll never know, we would need to conduct a controlled trial…

      2. Chase Rupprecht says:

        Jann Bellamy,

        In response to your article on bashing Chiropractic Physicians and their eligibility to prescribe medications. Do you have any idea what type of training we go through? To see people like you make such ignorant comments is abhorrent to us all. Have you been to chiropractic school? Are you a Doctor? Have you been through the misery? Do you know that chiropractic physicians take three times that of an MD and DO in Diagnosis and Diagnostic imaging, and twice as many hours in Anatomy, Physiology, Embryology, Neurology and Orthopedics? On top of that we take an equal number of hours in Pathology, Pediatrics, Endocrinology, Microbiology, Rheumotology and Biochemistry. Chiropractic school is a full 4 years of school, after a bachelors degree has been completed with a minimum of a 3.0 gpa (higher in science gpa is required). These four years are spent in the classroom and in clinical rotation all months of the year (no we do not get the leisure of taking off summers like MDs, DOs, dentists etc). There are several specialties in chiropractic that require residency including those in Radiology, Neurology, Orthopedics/Sports Medicine to name a few. The acceptance process is an extremely selective one for each. Contrary to most MDs and DOs we take double there course load (7-8 classes at once), and must balance all of these courses while still managing to maintain an appropriate GPA to sit for board exams. In actuality, because we attend school all year around for 4 years with twice an MD’s courseload, it is a total of 7 years of chiropractic school if we had taken summers off like they do. To even compare chiropractic physicians to nurses is disgusting. They are not even close to the caliber of a chiropractic physician in training or knowledge. That would be like comparing a highschool football coach with that of an NFL coach. There is no comparison. They are not even on the same level, hence why they were not given the name “Doctor” or “Physician” for their training. If you are going to bash a profession, don’t make ignorant comments on a profession in which you know nothing about or have experience. Go to chiropractic school for 4 years and come back and comment.

        1. windriven says:

          “Do you know that chiropractic physicians take three times that of an MD and DO in Diagnosis and Diagnostic imaging, and twice as many hours in Anatomy, Physiology, Embryology, Neurology and Orthopedics? On top of that we take an equal number of hours in Pathology, Pediatrics, Endocrinology, Microbiology, Rheumotology and Biochemistry. Chiropractic school is a full 4 years of school, after a bachelors degree has been completed with a minimum of a 3.0 gpa (higher in science gpa is required).”

          What a waste of time. Have you read Palmer et fils? You cannot build a grand edifice on a foundation of bullshit.

          That said, exactly what has chiropractic done for the world? What are the top ten disease entities that chiropractic has crushed? Appendicitis? Zoonotic leishmaniasis? No, those are both treated by actual physicians; medical doctors. Smallpox? Polio? Measels? Help me out here. What exactly has your brand of quackery done to transform the human condition beyond treating low back pain?

          Nothing. Nada. Zip.

        2. Jann Bellamy says:

          This post is not about chiropractors prescribing medications so I am not sure why you made this comment. In any event, I think it is hard to argue,as you do, that chiropractors have an education equal to or more rigorous than medical doctors when we know that chiropractors believe in the subluxation and the use of leg-length analysis and an Activator to detect and correct these subluxations. One concept pretty much excludes the other. I and others who post on this site have refuted all of your assertions many times. I recommend you review the Chiropractic section under the References tab.

        3. windriven says:

          @Jann

          When the going gets tough, the weak-kneed flounce. It looks like Chase has left the building.

  7. Chase Rupprecht says:

    To add to my comment above. In the past, chiropractic school has received a bad name because it’s entrance is easier than MD school, yet many fail to explain how the fail-out rate for chiropractic school is 50% because of the rigors and demands it places on the student. It is not cut-out for everyone. Classes will start out with 150 students and about 50 of them will become doctors. Many people fail to realize that those that were fortunate enough to make it through and become a chiropractic physician deserve to be called a Doctor and to be able to make the life/death clinical decisions they make.

    1. Harriet Hall says:

      “many fail to explain how the fail-out rate for chiropractic school is 50%”

      I think your figures are for “drop-out” rates, not “fail-out” rates, and I have an alternate explanation: maybe a lot of students have the same experience Preston Long did and realize they are being taught things that don’t make sense, but are luckier than he was and have more options and are able to quit?
      http://www.sciencebasedmedicine.org/chiropractic-abuse-an-insiders-lament-2/

      Do you have any data on students’ stated reasons for dropping out? Can you document that those who drop out have lower grades? Do you have any numbers on graduated chiropractors who quit practicing, and what their reasons are? References, please.

  8. Chase Rupprecht says:

    Not drop out, they fail out. About 20% of my class has failed out already because they had failed too many classes. They were either not smart enough, or couldn’t balance the course load. Also, are you a doctor? Did you go to chiropractic school? Where are your accusations and opinions coming from?

  9. Chase Rupprecht says:

    Why are you using blogs as resources. Ask a Chiropractic physician not a blog. Please use your head. not “drop out” rates, its failure rates (the school asked them to leave). I know I am friends with the President at Logan where I attend chiropractic school and have knowledge and valuable resource on the subject.

    1. Harriet Hall says:

      So you admit that you don’t have any actual evidence that half of chiropractic students “fail out.” You don’t offer any references, just anecdotes.

      1. windriven says:

        “You don’t offer any references, just anecdotes.”

        I’m fairly convinced that he cannot differentiate the two.

        I’m just amazed that he goes on and on about none of us having gone to chiropractic ‘school.’ I haven’t been to astrology ‘school’ but I still know it to be nonsense. I have not been to alchemy ‘school’ but I might change my mind if they master that lead to gold thing.

  10. Chase Rupprecht says:

    about 99% of people that bash chiropractic medicine just use hear-say and stereotypes as reference and haven’t actually BEEN to chiropractic medical school it is an outrage.

    regarding education:
    http://www.yourmedicaldetective.com/drgrisanti/mddc.htm

    1. Harriet Hall says:

      “about 99% of people that bash chiropractic medicine just use hear-say and stereotypes as reference and haven’t actually BEEN to chiropractic medical school it is an outrage.”

      And chiropractors who praise chiropractic medicine just use hear-say and stereotypes as reference and haven’t actually BEEN to medical school, so they have no basis of comparison. That’s an outrage.

  11. Chase Rupprecht says:

    The curriculum I blueprinted for you above in the hyperlink is a response to your comment “taught things that do not make sense”. That is a medical curriculum. Chiropractic school is medical school case and point.

    1. windriven says:

      ” That is a medical curriculum. Chiropractic school is medical school case and point.”

      You are kidding, right? A list of course titles and you are ready to call that a medical curriculum? In your n=1 world with no real medical classes to compare against, you’re ready to claim, if not superiority, equivalence. Delusional is the word that comes to mind.

      I ask again: what has chiropractic done to transform the human condition? Where are the great chiropractic advances in leukemia, cholecystitis, coronary artery disease, fertility, advanced imaging technologies, neurosurgery, neonatology? They’re nowhere. Because there are none. Chiropractic has been around for better than a century. There are chiropractic quack shacks on more corners than Starbucks. Performance talks and bullcrap walks. Where’s the impact?

    2. windriven says:

      And, Mr. high-GPA, the phrase is ‘case in point’ not ‘case and point.’

  12. Chase Rupprecht says:

    Preston Long: Probably cheated through chiropractic school or went to one of the straight institutions that teach Chiropractic subluxation theory as the end all be all to diagnosing disease (Life, Palmer, Sherman are examples of these). They should all three be shut down and lose creditation. Most chiro schools are extremely medically based as I stated above. You need to choose your chiro physician wisely. Many MDs went to subpar medical training in grenada or the carribean and still practice here in the states with a license but you call them legitimate doctors. Patients need to do more research dont just go to any doctor. Please research him or her. Just because they have the initials DCM MD DMD beside their name doesn’t mean they are good or went to the best schools.

    1. windriven says:

      “Preston Long: Probably cheated through chiropractic school…”

      ad hominem attack bordering on slander. Pathetic.

    2. windriven says:

      “Classes will start out with 150 students and about 50 of them will become doctors.”

      No. None of them will be doctors. 50 of them will be chiropractors.

      “[O]ne of the straight institutions that teach Chiropractic subluxation theory as the end all be all to diagnosing disease (Life, Palmer, Sherman are examples of these). They should all three be shut down and lose creditation”

      Subluxation is the foundational concept on which chiropractic is based. If you don’t want to study chiropractic why didn’t you go to medical school and become an MD or DO?

  13. Chase Rupprecht says:

    *accreditation

  14. LRosa says:

    I thought these thumpers were insanely expensive at several hundred dollars, but I see the Activator V goes for $1,500!

  15. Chase Rupprecht says:

    Hey Winddriven have you attended chiropractic school? no you haven’t so where is your argument. Go through chiropractic school and then I will take your points seriously. None of your arguments have substance or matter because you haven’t been to chiropractic school. And yes a list of course titles absolutely shows that it is medical school and we spend the same amount of time on each area of medicine that medical school does. Yes this is a fact. I live it. The people who bash chiropractic haven’t lived it they just latch on to the misconceptions society places on the profession. Get knowledgeable from experience don’t just reiterate what you hear from people, that is ignorance. I am gladly providing you with a link to the curriculum at National School of Chiropractic as well as one from a U.S. medical institution so you can see.

    1. Chris says:

      “Hey Winddriven have you attended chiropractic school? no you haven’t so where is your argument. Go through chiropractic school and then I will take your points seriously.”

      If that is your criteria, then perhaps you would be interested in these SBM articles:
      http://www.sciencebasedmedicine.org/author/sam-homola/

      Sam Homola is a chiropractor.

    2. windriven says:

      No, I’ve attended physics school where I learned a few things about science.

      I’m reading lots of attitude here but I’m not seeing any answers to my very basic question: what the hell has chiropractic actually accomplished. Let’s compare chiro’s contribution over the last century with medicine’s. I’ve already laid out a bunch of major accomplishments by medicine. Whatcha got there bigmouth? Are you all talk or do you and your co-delusionals have something solid to offer? I’d love to see it.

  16. Chase Rupprecht says:

    National School of Chiropractic-https://portal.nuhs.edu/documents/DC.pdf

    University of Texas at Houston School of Medicine-http://med.uth.tmc.edu/administration/edu_programs/Assets/documents/medical-education/coursedir-coords.pdf

    1. windriven says:

      “National School of Chiropractic-https://portal.nuhs.edu/documents/DC.pdf

      University of Texas at Houston School of Medicine-http://med.uth.tmc.edu/administration/edu_programs/Assets/documents/medical-education/coursedir-coords.pdf”

      I’ve explained that course titles and coursework are two entirely different things. Introduction to String Theory taught at an institution with a serious physics program is an entirely different animal than Introduction to String Theory taught at Delgado Community College.

      If you believe that acceptance and coursework in medical school and chiropractic are equivalent, why didn’t you go to medical school and become a real doctor?

  17. Chase Rupprecht says:

    Faculty at most chiropractic schools have MD’s and DC’s teaching clinical classes by the way. The legitimacy of chiropractic school compared to medical school is unquestionably equivalent

    1. windriven says:

      The teaching of real physics in real universities has taken our knowledge of the universe from earth, wind, water and fire to deep understanding of the foundations of matter and energy.

      The teaching of real chemistry in real universities has taken us from efforts to turn lead into gold to a stunning ability to understand and manipulate the fundamental units of matter.

      The teaching of real engineering in real universities has taken us from a spark gap transmitter (Marconi) to the iPad I’m typing on and the wireless network connecting me to the Internet.

      The teaching of real medicine at real universities has taken us from humors and miasmas and blood lettings to eradicating whole diseases, positron emission tomography, surgery to correct defects in fetal hearts, replacing entire diseased organs with healthy ones harvested from cadavers…

      Teaching real chiropractic at chiropractic colleges has taken us from a quasi-spiritual belief in human anatomy to … What? What has chiropractic education delivered besides authentic sounding course names?

  18. windriven says:

    “The legitimacy of chiropractic school compared to medical school is unquestionably equivalent”

    Keep repeating that over and over. You might convince yourself. You aren’t going to convince anyone with even a smattering of scientific sophistication. Chiropractic is based on silliness. Like homeopathy and reiki. Swearing up and down that it is real doesn’t make it so. WHERE’S THE PROOF? WHAT HAS CHIRO OFFERED THE WORLD? Medicine has changed the face of the planet. Prancing around with a white coat and a stethoscope is theatre. Eliminating smallpox, replacing diseased kidneys, saving 2kg premies … those things are medicine. Play on but do it quietly. Others have serious work to do.

  19. Chase Rupprecht says:

    http://www.chiroweb.com/mpacms/dc_ca/article.php?id=9127

    one of many, and proof from harvard MDs. that is just one small way we have and are impacting the world. Once we have prescription rights in every state, the sky is the limit (and we will soon). We have already been recognized as legal physicians by the Joint Commission. Click on the link below:
    http://webcache.googleusercontent.com/search?q=cache:5BYzIejDgGQJ:www.jcrinc.com/common/PDFs/fpdfs/pubs/pdfs/JCReqs/JCP-06-09-S6.pdf+chiropractic+physicians+joint+commission&cd=3&hl=en&ct=clnk&gl=us&client=safari

    the point of my argument is the legitimacy of a chiropractic physician. I can hit you with evidence all day for how chiropractic medicine has changed the world. You bash the profession yet you all fail to recognize the rigor of the education and the equivalency of chiropractic school to medical school. I am lobbying for prescription rights so we can help more people that is all. The legitimacy of the profession is there we are right there with medical doctors. A dentist can go to school for less time than us and prescribe medication in every state yet we cant? nonsense. They go to school for 4 years and have summers off. We go to school for 4 years all year around and must balance twice the hours as them (8 classes at once not 4).

    1. windriven says:

      @Chase

      ” I can hit you with evidence all day for how chiropractic medicine has changed the world. ”

      OK, do it. Don’t talk about it. Pick your top ten and let’s go toe-to-toe. Quit whining about chiros being “real doctors” and prove that they have a seat at even the kiddies’ table of medicine.

  20. Chase Rupprecht says:

    if we had summers off our program would be 7 years and our curriculums are identical as shown in past posts.

  21. windriven says:

    Chase, old boy, how about answering my challenge? Here it is if you missed it the first time:

    ” What are the top ten disease entities that chiropractic has crushed? Appendicitis? Zoonotic leishmaniasis? No, those are both treated by actual physicians; medical doctors. Smallpox? Polio? Measels? Help me out here. What exactly has your brand of quackery done to transform the human condition beyond treating low back pain?”

    Then we’ll compare and contrast with medicine’s contribution since the dawn of the 20th century.

    Time to ante up, Chiroman.

    1. Chase Rupprecht says:

      You are changing the subject i see from my initial argument haha…I was simply debating the legitimacy of our education not what we have done for medicine. I don’t believe in the “old” model of chiropractic. Subluxations do not exist whatsoever. They are not the cause of all disease. There is no scientific evidence that backs that a subluxation exists nor that it can be used to explain disease. Besides chiropractic neurology, sports medicine, and radiology, general chiropractic needs to go. The use of chiropractic modalities to treat disease is ridiculous. What we need to do is receive prescription rights so we can help more people, and our training deserves respect as a physician who should be able to prescribe along with dentists, optometrists, DPMs and so on.

      1. windriven says:

        You are all talk. Where’s the proof? If chiropractic was anything more than bogus bilge water there would be an impressive record of major accomplishment such as diseases vanquished and technologies advanced. Medicine has that record. But then medical curricula are more than words on a website and physicians are more than men and women in white jackets and storefront ‘clinics’.

        Chiro has had well over 100 years. So let’s compare lists, slick.

      2. Harriet Hall says:

        An MD studies pharmacology and writes prescription orders (which then must be co-signed) for inpatients and outpatients during a couple of years of clinical rotations in medical school, then spends 3 or more years as a medical resident during which he writes thousands of prescriptions. He has learned how to prescribe. Have you learned anything comparable? Have you had comparable practical experience under supervision? How can you possibly think chiropractic school gives you the right to prescribe?

      3. WilliamLawrenceUtridge says:

        Chase, how are chiropractors different from physiotherapists?

        How are you equivalent to MDs? MDs spend years in internships, see thousands of patients, understand the biochemistry of pharmaceuticals as they enter the body, are processed by the liver, and excreted by the kidneys and colon. How equivalent is that?

        For that matter, you claim chiropractors are equivalent in training to MDs. How do you know? Have you been through med school? Do you have an MD? Do you have equivalent experience to even a physician’s assistant, or nurse practitioner? How much of your current training involved actually dealing with pharmaceuticals? What’s the current proposed training, a couple weekend courses? You really think that a couple weekends of training on drugs is enough to give you the experience and understanding to prescribe them? That’s pretty arrogant of you. How many patients did you see in chiropractic school who came in for musculoskeletal complaints versus complaints that could be managed medically? I’m guessing the majority, by far, if not everybody, came in for a manipulation, and not a damned one came in looking for prescriptions.

      4. Andrey Pavlov says:

        It is wonderful that you realize the “old” model is quackery, but what is the “new” model? On what basis do you identify, diagnose, treat, and measure outcomes? And, as Dr. Hall pointed out, what on earth in your training gives you the ability to prescribe medications? The teaching of pharmacology in chiro school is extremely sparse, if any at all, and you don’t do any post-graduate training. You don’t have someone with more knowledge telling you that you shouldn’t prescribe that particular drug in that particular patient and making you look up why and give a quick 2 minute presentation on it for 5 years straight.

        Dentists, optometrists, and DPMs prescribe within a limited scope based specifically on their practice needs which in turn reflects their education. In other words, they actually have training in pharmacology and a valid basis by which to discern indications and contraindications for drug therapy. There is simply nothing in chiropractic education or practice that warrants this.

      5. WilliamLawrenceUtridge says:

        What we need to do is receive prescription rights so we can help more people, and our training deserves respect as a physician who should be able to prescribe along with dentists, optometrists, DPMs and so on.

        A question that hasn’t been asked yet – since we have dentists, optometrists, DPMs, nurse practitioners, physicians assistants, and since as you say, “The use of chiropractic modalities to treat disease is ridiculous”, why do we need chiropractors? Given your own criticisms of the profession, Chase, why bother having a new profession if you basically seem to be redundant to several others?

        What do you offer that is unique?

  22. Chase Rupprecht says:

    And regarding your community college analogy…
    http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=36267
    “On the other hand, there’s no question that they are getting an extremely solid foundation. I actually think chiropractic school is significantly harder than medical school. You have to take in all those factors, and the fact that I’m older, but one thing I am absolutely certain about is that Northwestern gives absolutely nothing away in terms of quality of education. I’m extremely impressed. I think it speaks well for the profession in general.” -Dr. Robert Bruley MD, DC

    http://www.bruleycenter.com/about/bios

    1. windriven says:

      Lots of chiroquacksters slapping each other on the back and reassuring each other that they aren’t just saps playing doctor. Yeah. Solid stuff there.

      Man up and take the challenge. Show us chiropractic a ten greatest contributions in the last hundred years.

      Better still, pull the plug before you’ve invested your life in an illusion. Go to medical school. Become a doctor. A real doctor. Add to the sum of human knowledge and the improvement in the human condition.

    2. Harriet Hall says:

      You offer no evidence, only one person’s “opinion” that chiropractic school is harder than medical school. Whatever the rigor of individual classes, chiropractic schools can’t begin to compare with medical schools in providing inpatient and outpatient experience evaluating and treating all kinds of sick people with every imaginable disease in the clinical rotations, with increasing responsibilities as the student progresses.

  23. windriven says:

    Let’s bring this right down to fundamentals, Chase. Your claim is that chiropractic education is equivalent to medical education. I have countered that if this were true, chiropractic would have a track record similar to that of medicine to demonstrate that equivalence. It doesn’t. Res ipsa loquitur.

    We can even take a generous view and say that chiropractic has historically been quackery but that chiropractic wants to change its ways and teach medicine. The question then becomes: why? We already have medical schools. What does chiropractic bring to the table?

    If you want to be a doctor go to medical school. If you want to be an electrical engineer, study electrical engineering. What is the rationale for going to chiropractic school? Why should chiropractic be accepted as medicine? Medicine already is. It doesn’t need chiropractic. Chiropractic brings nothing to the table.

  24. Dave says:

    Just curious:

    Workload hours have been legislated downwards for medical residents (and by default third and fourth year medical students on clinical rotations) to no more than 80 hours a week and I believe no more than 30 hours a shift. This was in response to the Libby Zion case, which raised the question of medical errors occurring from the old workload system, which typically was about 100+ hours in hospital a week and shifts up to or longer than 36 hours. (One of the reasons I didn’t go into surgery was that at the time the usual residency entailed every other night call duty for 6 straight years. Basically that meant going to the hospital at 0600 hours one day, getting home after 7 PM the following night, and repeating that for many years. After doing it for a few months in medical school I didn’t want to be a surgeon that desperately. I do remember thinking during my Internal Medicine training that if you could be guaranteed 2 hours of sleep a night, life would be golden.)) There’s some concern that the current workload is not enough. I’m not trying to argue the wisdom of this one way or the other. Less hospital time means more book time at home and there’s certainly more information to pack in, but you don’t learn how to be a physician by just reading a book.

    What workload restrictions have had to be put been in place for chiropractic training? Do chiropractors ever serve night shifts or work around the clock? Do the students have clinical rotations on holidays and weekends?

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