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Legislative Alchemy II: Chiropractic

As we learned in Legislative Alchemy I: Naturopathy, legislative alchemy is the process used by state legislatures to transform implausible and unproven diagnostic methods and treatments into legal health care practices.

Today, we review how chiropractors are faring in the 2011 state legislative sessions.

Chiropractic 101

In 1895, a self-described “magnetic healer,” Daniel David Palmer, claimed to have discovered that every person possessed an “Innate Intelligence,” defined as the body’s capacity to heal itself, which flowed from the brain out through the nerves in the spinal cord. Misaligned vertebrae impinged on nerves and interfered with the flow of Innate Intelligence, causing “95 percent of all disease.”

Palmer named these putative misalignments “subluxations,” and began teaching students how to detect and correct them based on his notion that removing this interference would return the free flow of Innate Intelligence and the body would heal itself. In other words, chiropractic was — and, as we shall see, still is — simply another form of vitalism, a long-discredited notion that illnesses are caused by a disturbance or imbalance of the body’s “vital force,” which is distinct from the body’s biochemical processes.

Palmer and his disciples were arrested for practicing medicine without a license, which led to a strategy of chiropractors lobbying state legislatures for their own chiropractic practice acts. This effort stretched from 1913, when Kansas became the first state to license chiropractors, to 1974, when Louisiana became the last.

Subluxation: it’s the law

The non-existent chiropractic subluxation remains the central tenet of the 50 state chiropractic practice acts to this day.[1]

Twenty-one state chiropractic acts mention it specifically as the basis for chiropractic practice. For example, Connecticut defines chiropractic practice as:

the science of adjustment, manipulation and treatment of the human body in which vertebral subluxations and other malpositioned articulations and structures that may interfere with the normal generation, transmission and expression of nerve impulse between the brain, organs and tissue cells of the body, which may be a cause of the disease, are adjusted, manipulated or treated.

Twenty-three states refer to its purported attributes — without actually using the “s” word. In North Carolina, chiropractic practice is defined as:

the science of adjusting the cause of the disease by realigning the spine, releasing pressure on nerves radiating from the spine to all parts of the body, and allowing the nerves to carry their full quota of health current (nerve energy) from the brain to all parts of the body.

Did they say “science”? Here’s how much science is involved in chiropractic’s core concept — there’s not even a plausible hypothesis of what a subluxation is or how it might affect human functioning.

Six states simply incorporate by reference practices and procedures taught in chiropractic schools, which remain loyal to the subluxation although some have tried to distance themselves from the word, if not the concept.

This doesn’t mean, of course, that chiropractors are permitted by law to treat any disease or condition by detecting and correcting subluxations, just most any disease or condition, as long as the problem is defined in terms of the patient’s having one or more subluxations stopping up the “flow” of “nerve energy.” Asthma, allergies, ADHD, painful periods and earaches are a few of the many conditions widely advertised as treatable by chiropractic adjustment.

You might think it would cause the chiropractic industry some alarm that legislators might wake up to the fact that subluxations don’t exist. And apparently that is the case. In a few states chiropractors are attempting to expand the chiropractic scope of practice by including authority to prescribe that former anathema to chiropractic: drugs. For years chiropractors branded themselves as doctors who treat patients “without drugs or surgery.”

With drugs but not surgery

Chiropractic lobbying in New Mexico, the state where anyone can practice medicine, provides a perfect lesson in the insidious nature of CAM practitioner licensing. A few years ago, the state legislature invented a new iteration of chiropractor, the “certified advanced practice chiropractic physician.” With minimal training, this new type can, by statute, “prescribe, administer and dispense herbal medicines, homeopathic medicine, over-the-counter drugs, vitamins, minerals, enzymes, glandular products, protomorphogens, live cell products, gerovital, amino acids, dietary supplements, foods for special dietary use, bioidentical hormones, sterile water, sterile saline, sarapin or its generic, caffeine, procaine, oxygen , epinephrine and vapocoolants.”

Then, in 2009, the New Mexico legislature granted the state chiropractic board authority to develop a formulary for the “advanced practice chiropractic physician.” The requirement that substances be “natural or naturally derived” was eliminated, but there was a catch: “Dangerous drugs or controlled substances, drugs for administration by injection and substances not listed [in the quoted section, above] shall be submitted to the board of pharmacy and the New Mexico medical board for approval.”

Apparently, approval was not forthcoming to the chiropractors’ satisfaction, so they returned to the New Mexico legislature this year, seeking to dump the pharmacists and medical doctors. A new, improved version of the “advanced practice chiropractic physician” was proposed: one with a “prescription certificate.”

And just to make the point clear, the term “chiropractic” would be discarded from the New Mexico chiropractic practice act in favor of “chiropractic medicine.” Thus, the purpose of the practice act went from “granting chiropractors the right to practice chiropractic as taught and practiced in standard colleges of chiropractic” to granting “chiropractic physicians the right to practice chiropractic medicine …” [Emphasis added.]

Gone was the requirement of a pharmacy and medical board approved formulary. Instead, those with the “prescription certificate” would be authorized by statute to “prescribe, administer and dispense dangerous drugs, including compounded preparations for topical and oral administration and injection, testosterone in all its forms and codeine in cough syrup.” [Emphasis added.]

One can read between the lines thinking that goes something like: “If the pharmacists and medical doctors won’t let us prescribe testosterone ‘in all its forms’ and cough syrup with codeine, we’ll just put it in the statute and they can’t do a damn thing about it.”

Instead of pharmacy and medical board approval, the proposed legislation provided that “the [chiropractic] board, with the New Mexico Medical Board and the Board of Pharmacy serving in an advisory capacity, and with all parties agreeing to act in good faith, shall establish by rule a formulary …” [Emphasis added.]

Yeah! That’ll show ‘em!

Except the proposed legislation didn’t pass. It was still in committee when the legislature adjourned. New Mexico’s governor recently declared a special session of the legislature to deal with certain pressing problems, such as redistricting, and that has begun. We can only hope the chiropractors don’t try to shoehorn their bill into the special session agenda.

As a cautionary tale about the dangers of mission creep in “CAM” practitioner licensing, it is instructive to look at the education and training which would have been required of the “certified advanced practice chiropractic physician” in obtaining a “prescription certificate.”

In addition to the minimal requirements for “advanced practice” certification, the applicant must complete “pharmacological training from an institution of higher education approved by the [chiropractic] board or from a provider of continuing education approved by the board.” [Emphasis added.]

The applicant must complete a program, again approved by the chiropractic board, of 200 classroom hours in pharmacology, physiology, pathophysiology, physical and lab assessment and clinical pharmacotherapeutics, which, you’ll have to admit, is a really long word. Whether this is simply descriptive of, or in addition to, the education described in the previous paragraph is not clear. What is clear is that all of this can be accomplished within the current chiropractic educational system, a subject to which we will return in a future post.

But where, you might ask, would the chiropractor get experience actually treating patients with drugs, so essential to proper training? Well, remember those pesky medical doctors who were gumming up the formulary works? The ones the legislation sought to remove from the process? From them, that’s who.

In order to get the coveted “prescription certificate,” a chiropractor would have to complete 400 hours “of clinical rotation practicum in clinical assessment and pathophysiology” and 400 hours of 100 patients “with disorders relevant to the certified advanced practice chiropractic physician’s clinical specialty.” All done “under supervision of a medical doctor.”

One must wonder where one would find a medical doctor willing to take on supervision of a chiropractor treating patients with drugs.

A bad idea metastasizes

The chiropractic faction interested in foisting chiropractors as primary care physicians on the public was obviously not going to stop with New Mexico, and it didn’t.

In South Carolina, a bill would have created the same sort of “advanced practice chiropractic physician” as presently exists in New Mexico along with the option of obtaining a “prescription certificate” as proposed in the failed New Mexico legislation. The bill never made it out of the Senate Committee on Medical Affairs.

Likewise, in Alabama, a bill was introduced to allow prescription of “natural” compounds, “bio-identical hormones,” homeopathic remedies and other woo remedies favored by “CAM” practitioners. If the chiropractor took the same sort of 90-hour course as New Mexico allows, he or she could also prescribe and inject these substances even if they were classified as legend drugs. This bill also died in committee.

More scope of practice

Prescription authority was not the only means of increasing ways to make mon … I mean, increasing the scope of chiropractic practice attempted in this year’s legislative sessions.

In Illinois, lobbying efforts took a more subtle approach and attempted only an inclusion of authority to provide advice regarding the use of non-prescription products. Translation: they can advise patients regarding dietary supplements. And, of course, having given that advice, they can sell patients the supplements they’ve recommended. This bill, which also authorized chiropractors to administer atmospheric oxygen, made it into law. A bill in Hawaii, authorizing the use of “clinical nutritional methods” (whatever that means), died in committee.

Minnesota, another state where anyone can practice medicine, saw a failed attempt to include acupuncture within chiropractic scope of practice. Perhaps wary of attempts to make chiropractors actually go to acupuncture school and learn “real” acupuncture, this proposed legislation invented an entirely new form, defined as “a modality of treating abnormal physical conditions by stimulating various points of the body or interruption of the cutaneous integrity by needle insertion to secure a reflex relief of the symptoms by nerve stimulation as used as an adjunct to chiropractic adjustment.” Maybe they should have called it “acujustment”.

 

And on it goes

Last year, the Connecticut Board of Chiropractic Examiners issued a ruling that chiropractors need not warn patients of the risk of stroke following cervical manipulation, a ruling based largely on a study which specifically states it does not rule out such a risk.

In response, Connecticut Senator Len Fasano promised to introduce legislation in 2011 mandating a warning. Sen. Fasano testified at a hearing before the Board that he and others in the legislature were under the distinct impression the Board would indeed require this type of warning. Obviously, the Board did not do that, so Sen. Fasano kept his promise and introduced a bill requiring chiropractors to obtain informed written consent prior to any treatment of the cervical spine, including information on the risk of stroke. Unfortunately, the bill did not make it to the floor for a vote.

Finally, chiropractic lobbying in Florida screwed up passage of a perfectly good bill designed to protect the public’s health, safety and welfare.

A bill introduced to educate coaches, parents and young athletes about sports-related concussions and to require that an M.D. or D.O. sign off on return to play post-injury passed the House, where an attempt to include chiropractors was rebuffed in committee. However, the bill got bogged down in the Senate because of a similar attempt to force the inclusion of chiropractors in the type of health care practitioner with authority to clear the young athlete for continued play. The implication, of course, was that chiropractors were qualified to diagnose and treat traumatic brain injury, a conclusion not universally shared in the Senate, and rightly so. That squabble ran the clock out on what would have been a laudable safety measure for school athletes. And that’s a shame.

Conclusion

It is unfortunate enough that the state legislatures have legitimized a figment of the imagination first proposed by a charlatan in 1895 — the “subluxation” — by creating a licensed health care profession known as chiropractors to “detect” and “correct” them. Giving chiropractors authority to prescribe dietary supplements, and, even worse, drugs, only exacerbates their original mistake.  Instead of expanding the scope of practice, state legislatures should remove diagnosis and treatment of the nonexistent “subluxation” from the chiropractic practice acts.

 

 

References

  1. Bellamy J., Legislative Alchemy: the US state chiropractic practice acts, Focus on Complementary and Alternative Therapies (2010)15(3): 214–222.

 

 

Posted in: Chiropractic, Legal, Politics and Regulation

Leave a Comment (71) ↓

71 thoughts on “Legislative Alchemy II: Chiropractic

  1. windriven says:

    “One must wonder where one would find a medical doctor willing to take on supervision of a chiropractor treating patients with drugs.”

    Harvard leaps to mind.

  2. 1) This is pretty transparent as chiropractors tend to denounce pharmaceutical / prescription medications as “poison” by “Big Pharma” and “the medical establishment.” Why suddenly do they want to be able to give them to patients? Given the type of diseases chiropractic attracts, I wouldn’t be shocked to see a vast majority of chiropractors becoming pain pill dispensers to people with RA and fibro who eventually become addicted.

    2) Glad that most of these bills seemed to die in committee. Shouldn’t that at least be reassuring?

    3) Do you have any background articles on this site about why chiropractic is dangerous? (other than the fact that it delays real care, provides false hope, etc.) I thought that it mostly did nothing, but if it harms, I’d like to know what has been described as the mechanism.

  3. daijiyobu says:

    Licensed falsehood marches on!!!

    Naturopathy in fact is being employed by chiropractic economic advice sources, advising / promoting specifically naturopathy’s requisite homeopathy nonsense

    – which is as quite falsely labeled ‘science’ as chiro’s subluxation –

    as a way to generate further DC practice income

    (see http://www.chiroeco.com/chiropractic/news/11753/1596/homeopathic%20first%20aid/ ).

    “Homeopathic first aid”. Perhaps the shortest one-line joke I’ve heard in years.

    Courtesy of ND Oskin, an SCNM grad.

    -r.c.

  4. pwndchemist says:

    Things aren’t much better here in Canada, either. It seems there are chiropractors on every block. They are also quite forward about their practices. I recently had to listen to a testimonial from another woman about how her chiropractor cured her baby of colic and acid reflux.

  5. WilliamLawrenceUtridge says:

    Wow, that’s terrifying. They’ll be like doctors without the training, experience, critical thinking, familiarity with physiology or diseases.

    NYK, as far as I know the biggest risk is stroke after manipulation of the cervical spine (basically the neck). A good place to start would probably be the SBM article linked to in the second-last section and the paper discussed there (thus). However, Dr. Crislip’s analysis goes into why the conclusions of the paper are questionable.

    Plus, natch, there’s a whole host of discussions in the Chiropractor category on this site.

    I’m expecting HTML screw-up, because WordPress lacks a preview button.

  6. cervantes says:

    authorized chiropractors to administer atmospheric oxygen . . .

    What the heck does that mean? I’m already breathing.

  7. windriven says:

    @cervantes

    Atmospheric oxygen is used by chiropractors to propel smoke up their patients’ backsides.

  8. Vera Montanum says:

    In fairness it is important to consider that chiropractic is usually not most patients’ first choice for pain management. If traditional medical therapies did not fail to relieve many chronic pain conditions there would be no demand for chiropractic or questionable CAM modalities. This doesn’t justify acceptance of unsubstantiated practices, but it does account for why they even exist and flourish.

  9. Harriet Hall says:

    @Vera Montanum

    “chiropractic is usually not most patients’ first choice for pain management.”

    I wonder if that is really true. It seems to me a lot of people consult chiropractors first, without having tried conventional medical care. And I would guess that the majority of chiropractic patients are seeking help with short-term back pain, not with chronic pain conditions like arthritis, cancer pain, etc. Do you know of any surveys that might shed light on this?

  10. Harriet Hall says:

    Palmer claimed that 95% of disease was from misaligned vertebrae and that the 5% was due to misalignments in other bones. A typical “one true cause of all disease” claim that left no room for anything on pathology’s list of causes, VINDICATE:
    V – Vascular
    I – Infectious/inflammatory
    N – Neoplastic
    D – Drugs/toxins
    I – Intervention/iatrogenic
    C – Congenital/developmental
    A – Autoimmune
    T – Trauma
    E – Endocrine/metabolic.

  11. nybgrus says:

    Hey I’ve seen VINDICATE before! Shockingly, I’ve had to learn it. But perhaps we should amend it – you know, health freedom and equality and all. We could call it VINDICATES with the final “S” standing for “subluxations” – thus, we would be warm caring holistic doctors and chiropractics could finally be… vindicated…

  12. Dr. Kavitky says:

    These days people want a quick fix for pain management. Sometimes it take a while for chiropractic work to stop pain. I have some interesting testimonials from clients about how chiropractic has people on my site. Check it out.

    Dr. Kavitky
    Westlake Chiropractic.com
    http://www.westlake-chiropractic.com

    1. Harriet Hall says:

      @Dr. Kavitky,
      “I have some interesting testimonials”
      Sure you do. So does every purveyor of snake oil and every quack.
      What they don’t have is valid scientific evidence. Do you?

  13. ConspicuousCarl says:

    I’m sure Dr. Oz wouldn’t mind having a chiropractic buddy in the OR.

    Harriet Hall on 22 Sep 2011 at 12:53 pm

    @Vera Montanum

    “chiropractic is usually not most patients’ first choice for pain management.”

    I wonder if that is really true. It seems to me a lot of people consult chiropractors first, without having tried conventional medical care.

    I don’t have any opinion poll data, but there are at least a few people out there (I know one personally) who think that chiropractors are essentially back specialists instead of nutjobs. Allowing someone to call themselves “Dr.” and handing them a license with a unique subject on it would normally make someone think “RealDoctor+Specialty”, not “crackpot who should be wearing a sign”.

  14. CC says:

    Conspicuous Carl:

    My (one) experience with chiropractic was that they were doctors who specialized in the spine. He gave me some good advice (but no supplements, and I don’t recall seeing any woo in the office either) on a few of my habits that made my back stop bothering me and made me not need to see him anymore. I was always surprised to see chiropractic included in lists of quackery… until I started reading about subluxations and the claims made by many chiropractors.

    There’s got to be two different groups using the same name. Right? It’s all very confusing.

  15. windriven says:

    @CC

    “There’s got to be two different groups using the same name. Right? It’s all very confusing.”

    Ahhh … no. That is a false dichotomy. Because chiropractic is demonstrably quackery does not mean that a specific chiropractor might not give some useful and accurate advice. Phrased slightly differently, just because a chiropractor offers apparently reasonable advice on one occasion does not validate chiropractic or the nonsense of subluxations on which this edifice of inanity is erected.

  16. Harriet Hall says:

    What it seems to boil down to is that the non-quacky chiropractors are not really practicing chiropractic: they are instead practicing aspects of medicine and physical therapy.

  17. Becky Murphy says:

    It is a necessary evil that medicine, i.e., the art of healing, and the law intersect and not always in ways that are necessarily ethical for ether of these specialties.

    The Law should not be determining what is and is not valid medical treatment. While this article is about chiropractors, the first line immediately brought to my mind the fact that psychiatry has also been brought forth by, “legislative alchemy is the process used by state legislatures to transform implausible and unproven diagnostic methods and treatments into legal health care practices.”

    The neuroleptic treatments offered by psychiatry were effective for 26% of adults, and 12% of children with psychosis in the much touted CATIE and TEOSS drug trials; and have very serious inherent risks, which would preclude the Standard Practice of prescribing these drugs to everyone with symptoms of psychosis. It is an outrageous Standard Practice, developed in the manner it is because the clinical trial evidence base does not support developing a prescribing protocol to treat psychosis. There is no way it could; with such a small percentage of patients benefiting from the neuroleptic drugs, and the teratogenic effects and fatal risks involved in their use.

    In psychiatry, the Practice Parameters–used in standard practice by mental health professionals, and taught to medical doctors who are generalists–being developed by committees, and based on the committee member’s subjective observations–the weakest scientific ‘data’; I am going to take a giant leap and assume subjective opinions do not in fact become more valid because more than one psychiatrist has the same opinion.

    Psychiatric diagnoses were developed the same way, by consensus, and by committee. Not the way any other field of science or medicine is practiced. Psychiatry provides no scientific evidence that the ever growing list of “diseases” or “chemical imbalances” even exist. There is no doubt that the symptoms are manifested, but as yet no proof has been found that any psychiatric symptom is the result of defect, physiological abnormality or disease in the body or brain. Why in the hell has this been accepted, why in the heck is a psychiatrist the President of the AMA?

    Psychiatry uses unproven diagnostic methods and treatments that are not supported by the Science Base, but are developed by a quasi-democratic process; validated not by Clinical evidence, but by legislation. These “necessary medical treatments”are then Court Ordered for those subjectively targeted, in the name of “medicine.” Definitely not medicine in the tradition of Hippocrates. There is a whole lot of harm being done…It is legalized something, but it sure is not medicine, i.e., the art of healing. legislative alchemy is fitting, I think.

    @Harriet
    “non-quacky” really quacked me up…

    I went to a non-quacky chiropractor decades ago, after months of going to an M..D. for a back injury; he fixed me after a few sessions.

  18. CC says:

    windriven: I know that the one chiro I saw who gave good advice does not mean all of them aren’t quacks, nor does it validate subluxations and other nonsense. I’m not quite sure how you got to that statement from my post. I specifically mentioned two different groups using the same name, and did not make any defence of the quackery in one of those groups.

    That doctor that I mention showed no evidence of quackery (that I recall – it’s been a few years), appeared to my observations to be a doctor-specialist in the spine, didn’t (to my memory) mention subluxations, whether in person or in the literature inevitably lying around a doctor’s office, if he talked about misalignment it was about the physical discomfort and its relationship with the muscles in the back, and had no problem referring people to the hospital if they needed more than he could provide. (I didn’t, but a friend of the family did.) He didn’t claim to help anything other than spinal issues.

    And yet for some reason, the office sign said “chiropractor”. This is why I was confused. If, as Harriet Hall suggested, the non-quacky chiros are actually doing medicine and physical therapy type stuff, why do they call themselves chiropractors and associate themselves with a group that has such a dismal reputation and record?

  19. windriven says:

    @CC

    “I specifically mentioned two different groups using the same name, and did not make any defence of the quackery in one of those groups.”

    Chiropractic is chiropractic. There are not two groups using that name. Subluxations are the underpinning of chiropractic theory. Whether or not the chiropractor you visited mentioned subluxations is immaterial. In the event that the chiropractor you saw has abandoned chiropractic and is dabbling in treatments that he or she has not been properly trained to administer should not leave you with a warm and fuzzy feeling regardless of the outcome of your particular case.

    I am not a physician. I can read an EKG at a relatively basic level. In some non-trivial fraction of potential cases I could read EKGs and accurately diagnose S-T elevations and PVCs and a few other common abnormalities. That does not make me a cardiologist. Your chiropractor should not be engaging in non-chiropractic treatments any more than I should be reading EKGs.

    I have a friend who started life as an OB-Gyn and later decided to switch to anesthesiology. He didn’t just change the sign on his office door. He went back to school, did a residency and got board certified. If your chiropractor has become disillusioned with chiropractic he or she should go back to school and gain proper training and accreditation for the services to be offered.

  20. Jann Bellamy says:

    @ CC:

    “This is why I was confused. If, as Harriet Hall suggested, the non-quacky chiros are actually doing medicine and physical therapy type stuff, why do they call themselves chiropractors and associate themselves with a group that has such a dismal reputation and record?”

    I don’t know this, but some “non-quacky” chiropractors may choose to become chiropractors because of the educational requirements for physical therapy and medicine. Medical school is far harder to get into than chiropractic school and far harder to complete, plus MDs must go through several years of additional training after 4 years of med school. Yet, at the end of the day, both get to call themselves “Doctor” and have a broad scope of practice under state law. I’m not as familiar with education and training for physical therapists, but it is at least a 4 year undergraduate program, plus in most states they can see patients only with a referral from an MD and the scope of practice is more limited than chiropractors, plus no “doctor” title, unless you get a Ph.D. To get a master’s degree or PhD. in physical therapy you’d have to go through the normal university vetting process to get in, including taking the GRE and having a certain GPA. Chiropractic colleges don’t require a college degree, just 90 hours in certain college subjects and there is no entrance exam. The minimum GPA is 2.5. (Some states do require a 4-year degree.) You can graduate in 3 and 1/3 years and there is no residency after graduation.

  21. CC says:

    Interesting, I may look into the differences in training required here (I’m not in the US). More than a little disturbing, even if the one I saw seemed to have his head screwed on (relatively) straight. I haven’t seen a chiro in years though.

  22. ConspicuousCarl says:

    CC said:
    And yet for some reason, the office sign said “chiropractor”. This is why I was confused. If, as Harriet Hall suggested, the non-quacky chiros are actually doing medicine and physical therapy type stuff, why do they call themselves chiropractors and associate themselves with a group that has such a dismal reputation and record?

    Two reasons:

    1. If you had no degree whatsoever, you would get in legal trouble for just reading spine-related literature and giving people advice as if you were a doctor (even if the advice is good).

    2. During an interview with a non-crazy chiropractor on the Skeptic’s Guide podcast, Steven Novella (or possibly one of the other members) asked the chiropractor the same kind of question. His answer was that he liked being a chiropractor and doing that particular therapy, and he wouldn’t want to be a doctor who does other stuff. I think it is this episode:
    http://media.libsyn.com/media/skepticsguide/skepticast2007-03-28.mp3

  23. jerry_sprom says:

    Jan Bellamy
    Chiropractic education in Australia is a 5 year degree. The type of degree varies, but it is basically a 3 year undergraduate degree and 2 years masters. It is an extremely competitive course to enter. The anatomy, physiolgy, pathology, neuroanatomy, biochemistry, immunology, psychology, clinical nutrition etc subjects are neither harder nor easier than medicine.

    It may be difficult for some to understand, but maybe people become chiropractors because they want to improve peoples health and wellbeing, and they don’t see drugs and surgery as the best method of doing that.

  24. stewiegriffin81 says:

    @Jerry_Sprom

    No, chiropractic in Australia is not an extremely competitive course to enter. For example, some of the arts degrees offered at Macquarie uni have higher ATAR score requirements than the chiro course has (86 versus 80 [ATAR is the Australian equivalent of the SAT for those from the US])

    In addition, the issue with the subjects taught in Australian chiropractic is that some of them are magic rather than science (eg. that subluxations exist, and impact on disease). Also, let us not forget that Simon Floreani, who is the president of the Chiropractor’s Association of Australia [CAA] believes in homeopathy (and homeopathic vaccination), and supports the anti vaccine stance of Nimrod Weiner, who is the NSW vice president of the CAA.

    As Orac would say, chiropractic in Australia is a wretched hive of scum and quackery.

    ps. In reply to your last point, I think people study chiropractic because they are unfortunately utterly clueless about science. If they knew anything about science, they’d know chiropractic is quackery, and they’d go study something elseinstead.

  25. jerry_sprom says:

    stewie
    A very emotional and ad hominem response, but unfortunately not accurate. Can you please tell me these subjects that you classify as magic? The bone out of place model which I assume you refer to as the ‘subluxation’ is taught from an historical perspective.

    High School scores are only part of the entrance requirements, face to face interviews and/or written essays. The course is not based soley on academic scores.

    Neither Simon Floreani nor Nimrod Weiner have anything to do with the educational standards and requirements at the university level, it was silly of you to bring that up.

    With regards to your thoughts on why people study chiropractic,, I would suggest that your comments reflect how little you understand about the course and its subjects or the students who study it.

    That is all i have to say to you.

  26. stewiegriffin81 says:

    @ Jerry_Sprom:

    My reply was neither emotional nor ad hominem. Rather, my reply is merely factually accurate. The subjects in chiropractic that discuss subluxation as being a cause/part of disease are the ones that are magic.

    For you to claim that subluxations are taught from a historical perspective is either ignorant nonsense or (more likely) deliberate lying on your behalf. For example, please peruse the following position statement from the RMIT university department of chiropractic, which CLEARLY states that subluxation is the core component of their practice:

    http://www.docstoc.com/docs/71052024/Subluxation-2010-final

    Macquarie University’s chiropractic department doesn’t appear to have a position statement on subluxations, although I do know that it is in the syllabus, and that a quick google search of chiropractors who have graduated from there teach that the subluxation is an integral component of disease. This strongly implies that subluxation is not taught from a historical perspective.

    Any and all subjects taught in chiropractic that support this view are magic. They are magic by definition, since there is no evidence to support such a view, and there is in fact, evidence refuting such a view (for example, the utter lack of any interobserver reliability on diagnoses of subluxations, and also, the lack of any correlation between subluxations and actual disease).

    Moreover, please also examine the CAA policy on subluxations:

    http://chiropractors.asn.au/Content/NavigationMenu/AbouttheCAA/Policies/default.htm

    Which again, CLEARLY states that subluxations are the core concept in modern (not historical) chiropractic practice. Given that the CAA are the largest governing body of chiropractors, it is unsuprising that the content of university chiropractic courses follow what the largest governing body believes (and yes, I know that COCA does not believe in subluxations, for which I give them some credit. However, they unfortunately appear to be a minority of chiropractors).

    I agree that the issue of Simon Floreani and Nimrod Weiner believing in outrageous quackery are not specifically related to examples of university chiropractic subjects, but they are pertinent in the fact that they reflect exactly what the majority of chiropractors either believe in, or at the very least, condone.

    So, I say to you, I have presented evidence that subluxation is taught at chiropractic university courses (as a current concept), and is also believed by the largest governing body of chiropractors in Australia. Therefore, I am being entirely accurate. If you disagree, please present your evidence (and yes, evidence, not assertions).

    ps. And yes, my statement on students of chiropractic being clueless about science still stands.

  27. nybgrus says:

    @jerry_sprom:

    I concur, there was no ad hominem in Stewie’s posts and they are factually accurate as well.

    @Stewiegriffin81:

    I have to say that I had a hearty chuckle at the fact that the NSW head of the CAA, who believes in stupidities such as homeopathy and anti-vax, is named Nimrod Weiner. I had to look it up because I thought you just had to be joking. Then I laughed again. Thanks for that.

  28. jerry_sprom says:

    Stewie,

    I said the “bone out of place” model of subluxation is no longer taught, I didn’t say subluxation was not taught. Subluxation is taught as a complex involving kinematic, neural change, muscle, connective tissue and vascular change as highlighted in your link.

    The CAA supports this view, not the bone out of place model.

  29. stewiegriffin81 says:

    @ Jerry_Sprom

    Exactly my point. Subluxation is taught, and subluxation is entirely bogus. As mentioned before, there is not only zero evidence supporting the existence of this complex, there is also evidence that this complex does not exist (no interobserver reliability, no relationship with subluxation and actual disease). Absolutely nothing has changed between the ‘bone out of place’ model and the current model. The lack of supporting evidence, and the presence of refuting evidence however, remains the same.

    Thus, getting back to our original disagreement over university subjects, the chiropractic subjects that teach subluxations are magic as opposed to science.

  30. stewiegriffin81 says:

    On the topic about subluxations not existing, here is a most entertaining (and completely bizarre) article from the Chiropractic Journal of Australia on why subluxations should be taught to chiropractic students, even though (in the words of the author) those subluxations may not exist:

    http://search.informit.com.au/documentSummary;dn=347449996665676;res=IELHEA

    For those who don’t have full access, I can assure you that the full article is even more insane than the abstract! It is the sort of thing that if I hadn’t seen it published in a sCAM journal, I would actually think that it’s a POE.

  31. jerry_sprom says:

    stewie,

    I am interested to know your thoughts. Do phyical therapist/physiotherapist diagnose/treat biomechanical joint dysfunctions or hypomobile segments or facet irritations as part of their practice? Do osteopaths diagnose/treat manipulable lesions?
    I would like to know what you think these things are and if you are comfortable with physical therapists and osteopaths treating them.

  32. stewiegriffin81 says:

    I’m not comfortable with osteopaths diagnosing or treating anything at all really, as I regard them to be quacks just like chiropractors. Additionally, whether or not osteopaths diagnose/treat manipulable lesions is completely beside the point, given that we have no evidence that manipulable lesions actually exist.

    Physiotherapists I regard as being mostly non-quacks, but unfortunately there is still a fair amount of physiotherapy related modalities that have both insufficient supporting evidence, and also insufficient plausibility (eg. therapeutic ultrasound, TENS machines, some use dry needling etc.). It is inexcusable in my mind that these unsupported modalities are being currently used.

    The strong evidence for physiotherapy that does exist mostly lies in the field of early mobilisation for hospitalised patients. Everything else has little clinical evidence, but a fair amount of it has good basic science evidence (eg. there is good basic science evidence to support joint mobilisation in burns to avoid joint contractures, there is good basic science evidence to support resistance exercises in certain conditions etc etc.).

    This is in strong contrast to chiropractic, where not only is there no supporting basic science evidence, the basic science evidence that we have is very suggestive that manipulable lesions do not exist. Moreover, the clinical evidence we have for chiropractic is of extremely poor quality.

    In short, chiros and osteos are quacks. Physios are not normally quacks given that there is good basic science evidence for a decent proportion of what they do, although there is also a (not insignificant) proportion of quackery currently promulgated by physios.

  33. stewiegriffin81 says:

    I should make it clear for others reading this that osteopaths in Australia are completely different from DOs in the US. Osteopaths in Australia have no medical training, and believe in all sorts of unsupported quackery (eg. the governing body of Australia supports craniosacral therapy).

  34. nybgrus says:

    Thanks for the clarification Stewie. I was about to comment on that.

  35. qetzal says:

    stewie,

    I just read that abstract, and wow! I agree – it’s hard to believe that’s not a poe. Alan Sokol would be proud of that effort.

    My favorite bit:

    [E]ven though the abstract object or thing may not exist I attempt to show how we can come to understand that it does exist….

    IOW, how to train ourselves to believe in fairy tales. I’m glad I don’t have access to the full article. What if it actually worked on me?!

  36. pmoran says:

    Subluxation is taught as a complex involving kinematic, neural change, muscle, connective tissue and vascular change as highlighted in your link.

    jerry_sprom, what do YOU think of this approach? You see no problems with it? Might there be clearer and more likely explanations for the clinical benefits chiropractors observe?

  37. jerry_sprom says:

    Stewie,
    I am a little confused about what you are comfortable with physiotherapist diagnosing/treating. Are you sugggesting that physio should no longer be treating patients for back pain, neck pain, joint pain etc that involves joint dysfunction/hypomobility using manipulation and or joint mobilisation techniques?

    As a matter of interest, should chiropractors be diagnosiing/treating people for uncomplicated back pain, neck pain and headaches?

    With regards, to osteo, putting aside your opinions on quackery, do the osteo’s in the US treat similar conditions and in a similar way to the osteo’s in australia? ie: people with back pain etc.

  38. nybgrus says:

    @jerry:

    Physios should not (at least not in America and I think in Australia as well, but correct me if I am wrong) be diagnosing anything. They must treat whatever condition a physician diagnoses in the manner consistent with the evidence base for said treatment.

    However, in general “joint mobilization techniques” as applied by a physio for hypomobility issues bears absolutely no resemblence and has nothing in common with “joint mobilization” or “subluxation” as practiced by a chiropractor. If a patient has a shortened tendon due to lack of use post-injury or a frozen joint for some reason, then addressing that issue via “joint mobilization techniques” is perfectly reasonable. If a patient has asthma or GI problems and a chiropractor mobilizes subluxations then that is patently absurd – which is why chiropractics is patently absurd.

    As a matter of interest, should chiropractors be diagnosiing/treating people for uncomplicated back pain, neck pain and headaches?

    Your inquiry begs the question. In short – no. They are not trained to properly diagnose any disease since the basis of their understanding pathology is fundamentally flawed. Those diagnoses that they do get right are by coincidence, not design. So in other words, yes they could in theory diagnose and treat people with uncomplicated back, neck, and head pain. But they do not have the appropriate training and understanding to ensure that the condition is indeed uncomplicated.

    With regards, to osteo, putting aside your opinions on quackery, do the osteo’s in the US treat similar conditions and in a similar way to the osteo’s in australia?

    In America, osteos are for all intents and purposes medical doctors. They are recognized by the AMA, their schools are accredited by the Commission on Osteopathic College Accreditation which is recognized by the US department of education as a valid accreditor, and trained in an almost identical way as MDs. Their basis of understanding pathology, diagnostic methods, and treatment modalities are all completely in line with evidence based medicine. They do not just treat people with back pain – they go on to complete fellowships in all specialties of medicine, including critical care and surgery. They have full rights for prescription and intervention. In other words, at least from the description given by Stewie, they bear absolutely no resemblence to the osteos of Australia.

  39. jerry_sprom says:

    nybgrus

    you seem to be arguing that joint mobilisation/manipulation by physio therapists/physical therapist is legitimate to improve function in joint whether that be spinal or peripheral, but not by a chiropractor?

    I am not sure how you are suggesting a physiotherapist (whether under the instruction of a GP or not) applying a technique to improve hypomobility (kinematic change) within a joint is different to a chiropractor (or osteo for that matter) albeit that the techniques may vary?

    In terms of your comments regarding diagnosis, perhaps you are not aware of the training that chiropractors undergo in Australia.

  40. nybgrus says:

    you seem to be arguing that joint mobilisation/manipulation by physio therapists/physical therapist is legitimate to improve function in joint whether that be spinal or peripheral, but not by a chiropractor?

    Not even remotely. If that is genuinely what you have gotten from the conversation thus far you are indeed lost.

    If a chiropractor were to restrict him/herself to the same type of mobilization/manipulation for the same reasons/indications as a physio then I would have no issues with chiropractors… except that we would have two titles for the same exact thing. The problem is that chiropractors treat much more than simple uncomplicated back pain and they do so on a flawed understanding of the basic premise of pathogenesis – namely subluxation theory. Strip away subluxation theory, leave them with just physio-style interventions, and you have a legitimate health care provider… but you do not have a chiropractor anymore. You just have a physio. And physios are not doctors. Neither are chiros.

    So my contention (and that of the others here) is quite clearly that all that extra garbage they learn to try and call themselves doctors is absurd quackery and there is no reason to keep it around when physios are much more appropriate.

    I am not sure how you are suggesting a physiotherapist (whether under the instruction of a GP or not) applying a technique to improve hypomobility (kinematic change) within a joint is different to a chiropractor (or osteo for that matter)

    I’m not saying it is different. If that is all they do just call them physios and be done with it. But it isn’t, so they are quacks.

    albeit that the techniques may vary?

    If their techniques vary, then there is a decent chance one technique may be wrong or at least not as effective. Considering that chiros base their understanding of pathogenesis in subluxation theory, I don’t think I’d give them the edge on being more evidence based.

    In terms of your comments regarding diagnosis, perhaps you are not aware of the training that chiropractors undergo in Australia.

    I know reasonably well the training chiros undergo in Australia and America. Since their training is based on subluxation theory and does not include a large portion of what physician training involves, I stand by my statement that they are not trained well enough or correctly to adequately and accurately diagnose a condition as uncomplicated. Heck, they often are not able to accurately diagnose conditions period. If your basis of understanding human pathology tells you that headaches are caused by invisible vertebral subluxations and that a cervical manipulation will remedy that, how can you possibly expect a chiro to pick up on subtle clues that might indicate a stroke or arterial dissection? Sorry Jerry – but the few redeeming aspects of chiropractic does not make up for the whole of the absurdity that is chiropractic “medicine.”

  41. Valky says:

    @ jerry_sprom:

    Since chiros are trained in magic (ie subluxation theory), then no, they are not qualified to diagnose medical conditions.

    In addition to what has been said above, I might add that the conditions treated by physiotherapists are generally ones with an established or at least plausible pathogenesis and likewise an established or plausible link between pathology and treatment. This does not exist in chiropractic – eg. spinal manipulation for lower back pain, spinal manipulation for asthma. The link between pathology and treatment in the case of chiropractic is not through some kind of plausible mechanism, but through invocation of the magic of subluxation theory.

    And instead of diverting the discussion by questioning the legitimacy of physiotherapy (which by the way has been more than adequately dealt with by Stewie and nybgrus), perhaps you’d like to comment on the magic taught by chiros as evidenced in the articles posted by Stewie (which you yourself asked him to find, by the way)…(as pmoran has already asked you to do)

  42. jerry_sprom says:

    nybgrus
    I guess we will have to disagree on the training involved in chiropractic degree, in my opinion it is clearly more detailed than your current understanding.

    Some links for you if your interested.
    http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=41498

    http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=41607

    http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=41553

  43. nybgrus says:

    @jerry:

    Perhaps you’d like to address Valky’s points. I fully agree with them.

    And your disagreement notwithstanding, chiros are not qualified to adequately nor accurately diagnose conditions. Citing the science based portion of their training does not mitigate this salient point, nor does it obviate the foundation of their practice being based in the magical thinking of subluxation theory.

  44. jerry_sprom says:

    Valky and Nybgrus,
    I think this converasation is becoming a bit nonsensical. Whether your opinion is that we can/should or can’t/shouldn’t diagnose conditions is a matter of your opinion. And i might say is a matter of debate in the chiropractic profession also.)

    The reality is however that registration bodies, government agencies, private health insurers and the legal profession REQUIRE us to diagnose. Those bodies have obviously decided that our education and training is sufficient enough (or at least is now) to make a diagnosis for certain conditions.

    With regards to the subluxation as it is taught at RMIT (as pointed out by stewie), I think there is good science to suggest that kinematic change, particularly in the form of hypomobility, (and having a variety of possible causes) alters neurological function in a way that is detrimental to a persons health ie: increased nociceptive activity and decreased mechanoreptor activity. This is discussed briefly in the link provided. I dont see that as magic, obviously you do. I guess it is another point on which we will have to disagree.

  45. …here is a most entertaining (and completely bizarre) article from the Chiropractic Journal of Australia on why subluxations should be taught to chiropractic students, even though (in the words of the author) those subluxations may not exist.

    Alan Sokol would be proud of that effort.

    Heck, that stuff is old hat here at SBM:

    http://www.sciencebasedmedicine.org/index.php/the-weekly-waluation-of-the-weasel-words-of-woo-9/

    (scroll down to “this week’s entry”)

    And, of course, the follow-up:

    http://www.sciencebasedmedicine.org/index.php/the-weekly-waluation-of-the-weasel-words-of-woo-10/

  46. rwk says:

    @jerry_sprom
    You’d be better off not trying to argue with these know-it-alls.
    It’s their site and it’s okay for them to be as insulting as it gets.
    And they are a minority,still.
    As you know,anyone can take a course in how to take a history and
    differential diagnosis even Stewie,Valky and Nybgrus.
    The writer of the article knows little about what physical therapists actually do.
    Yes, there is no evidence of the chiropractic subluxation and therefore
    of the osteopathic lesion,whether you practice in the USA or elsewhere.
    You can’t argue that. It is ridiculous to say that spinal manipulation
    is not an established intervention for low back pain as Valky does.
    Anyone who makes blanket statements that all chiropractors or non-
    US osteopaths are quacks or believe in magic are not here for a serious discussion,but only to take the mick out of you.

  47. indigo says:

    Well said jerry_sprom. I had treatment at Loyola for back trouble which was NOT successful – of course surgery was suggested. Not long after I went to a chiropractor and had more success with two visits than three months of “science-based quackery”. Sorry fellas, you are part of the slice it and dice it group and your minds are so closed you can’t think your way out of a paper bag. Alternative treatments do not make a person a magical thinker or an idiot. You wouldn’t believe anyone with a different experience and outlook anyway and that does not make you right – arrogant, yes, correct, NO.

    I’m sure you don’t want to hear about herbs, Reiki, or other alternative paths that have worked for me and magical thinking has nothing to do with it.

    You are not skeptics, you are debunkers. You fight very hard to disprove alternative treatments, that must mean you actually fear they might be real.

  48. indigo says:

    Well said jerry_sprom. I had treatment at Loyola for back trouble which was NOT successful – of course surgery was suggested. Not long after I went to a chiropractor and had more success with two visits than three months of “science-based quackery”. Sorry fellas, you are part of the slice it and dice it group and your minds are so closed you can’t think your way out of a paper bag. Alternative treatments do not make a person a magical thinker or an idiot. You wouldn’t believe anyone with a different experience and outlook anyway and that does not make you right – arrogant, yes, correct, NO.

    I’m sure you don’t want to hear about herbs, Reiki, or other alternative paths that have worked for me and magical thinking has nothing to do with it.

    You are not skeptics, you are debunkers. You fight very hard to disprove alternative treatments, that must mean you actually fear they might be real. Is it also your opinion that the world is flat?

  49. nybgrus says:

    I find it quite interesting that both jerry and now rwk are patently ignoring the points myself, Valky, and Stewie have been making. I’d make a sincere attempt at clarification, but if you can’t see it clearly by now I think that would be an exercise in futility. But I’ll give it a brief stab.

    The reality is however that registration bodies, government agencies, private health insurers and the legal profession REQUIRE us to diagnose.

    Homeopathy is on the UK NHS. They also have their own governing/registration body. And are covered by private health insurance. And are legally protected. Citing those things in no way validates their practice, nor their completely magical basis of understanding pathology and treatment. Unless you’d now like to argue that homeopathy is not quackery?

    With regards to the subluxation as it is taught at RMIT (as pointed out by stewie), I think there is good science to suggest that kinematic change, particularly in the form of hypomobility, (and having a variety of possible causes) alters neurological function in a way that is detrimental to a persons health

    Of course there is good science suggesting hypomobility can lead to neuropathology. Nobody here is arguing that with you. So please stop setting straw men ablaze. But that is not what subluxation theory is nor is it how it is applied. As I said, those parts of subluxation theory that coincidentally overlap with actual science based hypomobility issues is luck. The fundamental basis of understanding pathology, as defined by chiropractics and still on the professional charters of every major chiro association in the world, is that all disease is caused by subluxations – including things like asthma and sinusitis.

    If you choose the eschew those particular magical aspects of chiro, then that is all well and good. But you are no longer practicing chiropractics, you are pared down to a physio. However, physios are not allowed to diagnose because they don’t have adequate training to do so. The fact that chiros feel they can diagnose is predicated on their belief that the corpus their practice is valid, including subluxations and thus cannot diagnose adequately and accurately (note that I always put those qualifiers in there – yes, they can diagnose some things well enough – but not adequately or accurately or consistently for that matter) no matter how you slice it.

    Either they are glorified physios who shouldn’t be diagnosing anyways or they are magical thinking quacks who certainly shouldn’t be diagnosing.

  50. rwk says:

    @nybgrus
    I can take a history, do a physical and make a differential diagnosis
    according to my training,my experience ( although that’s a bad word on this site) and scope of practice as well as anyone.Maybe better as
    I don’t see fifty people a day like many GPs and have to make ” educated guesses in the five minute allowed time slot.
    And for the millionth time, no one ever held a gun to my head and
    made me swear allegiance to the subluxation. You’ll find many other
    chiropractors with similar thoughts as well. They’re not the ones
    whose articles you typically reference on this site.
    I’d like you to prove the following statement as of this period of time:
    The fundamental basis of understanding pathology, as defined by chiropractics and still on the professional charters of every major chiro association in the world, is that all disease is caused by subluxations – including things like asthma and sinusitis.

    You can’t judge someone solely by their website as few put their own own sites together.
    You can criticise and insult some of us for doing silly things but it’s unfair to rubber stamp all of us.

  51. Valky says:

    @ jerry_spromon:

    As Nybgrus has pointed out above, the fact that chiropractic is covered by government funding and private health insurance does not constitute evidence of its efficacy or basis in science. In fact, to continue with Nybgrus’ example of homeopathy, the Austrian government insurance fund has as a requirement for funding a treatment “scientific proof of [the treatment's] effectiveness” – a requirement which is waived for homeopathy, [i]in full recognition of that “treatment’s” lack of scientific evidence for its efficacy and effectiveness[/i].

    Also as per Nybgrus, if there is overlap between some chiropratic treatments and actual pathology, it is coincidental – it is not through an understanding of the underlying pathophysiology and pathogenesis, because chiropractic explains pathology through subluxation theory, which is magic. Jerry, if you do have any evidence to support your view that it is not magic, then please provide it.

    @rwk:

    My comment about spinal manipulation for lower back pain in the chiropractic setting related to that intervention not being based on an understanding of any actual underlying pathogenesis, but rather on the theory of subluxation – ie. an example of an intervention lacking a plausible link between pathology and treatment. As per my comment to Jerry, if you do have any evidence supporting the view that subluxation theory is not magic, please quote it.

  52. stewiegriffin81 says:

    @ Jerry_Sprom

    No, it is a matter of fact (not opinion) that chiropractors cannot diagnose chiropractic conditions, as the evidence shows that there is little to no interobserver reliability between chiropractors when diagnosing subluxation complexes. Therefore, whenever any chiropractor actually diagnoses a manipulable lesion, we know that there is no reason to believe that such a diagnosis is actually real or accurate.

    With regard to the links you provide, they don’t actually provide any evidence whatsoever that subluxations exist, or that even if they do, that manipulation of these subluxations affects them. If you have evidence supporting these assertions, please provide them, as I would love to read them.

    @ RWK

    You may well make many diagnoses during your practice, but that doesn’t make them real or accurate diagnoses.

    It is also not ridiculous at all to state that manipulation of the spine is not an established therapy for back pain. I’ll say it myself: It isn’t.

    The evidence that exists for manipulation of the spine is of atrociously poor quality, and even includes a trial showing manipulation to be equally as effective as an educational pamphlet on back pain. It’s hardly the sort of evidence we’d actually need to make it an established treatment. It’s an experimental therapy only.

  53. nybgrus says:

    @rwk:

    I can take a history, do a physical and make a differential diagnosis according to my training,my experience ( although that’s a bad word on this site) and scope of practice as well as anyone

    I never claimed you couldn’t. I stated that you could not do so both adequately and accurately. This hinges on the part above I bolded – how is your scope of practice defined?

    Let me posit this as a hypothetical: what if a patient, male, mid-40′s, slightly overweight, comes to you because of a rapid onset headache (7/10 pain), mild photophobia and phonophobia, and nausea. At this point, what would your provisional diagnosis be and what would be the top few on your differential? What are some red flags you would look for and why?

    Are you trained to make such diagnoses? How would you decide to refer? How would you decide to call an ambulance? How would you decide to be comfortable sending him home?

    And for the millionth time, no one ever held a gun to my head and made me swear allegiance to the subluxation. You’ll find many other chiropractors with similar thoughts as well.

    What if I said, “No one held a gun to my head and made me swear allegiance to the germ theory of disease”? How do you justify one the one hand claiming you are qualified and trained sufficiently to make adequate and accurate diagnoses, especially as a primary care provider, if at the same time you are actively dismissing the founding tenet of the pathological basis disease of chiropractic – one that is still taught to this day and still officially recognized by your governing body as a defining characteristic of your practice?

    So if you do eschew subluxation theory, what is it in the rest of your training that would then make you equivalent to a GP? And if you are entirely equivalent except for the added (and apparently eschewed) subluxation theory (which, BTW has been quite succesfully demonstrated on this site to be central to chiropractic) how is it that your degree takes less time to complete? And more importantly, why would that make you materially different from a GP except that you must associate yourself with a profession that still believes in magical thinking? Quite frankly, if my medical school told me that the germ theory of disease was BS and that we were going to start learning about miasms, I would not just eschew miasm theory – I would leave my medical school and go find a legitimate institution and a legitimate degree.

    I don’t see fifty people a day like many GPs and have to make ” educated guesses in the five minute allowed time slot.

    Nice pejorative there about “educated guess.” Considering that a GP has roughly twice the schooling and training a chiro has, I’ll take that educated guess over a more thought out one from a chiro. But, more to the point, comparing a scenario in which a clinical judgement is rushed versus one that has ample time is not a reasonable comparison. Your basically saying that your degree is better because you get less business so you have less opportunity to make mistakes. I’m talking about an ample time situation for both – and in that case the GP will always come out best.

    I’d like you to prove the following statement as of this period of time: The fundamental basis of understanding pathology, as defined by chiropractics and still on the professional charters of every major chiro association in the world, is that all disease is caused by subluxations – including things like asthma and sinusitis.

    Thankfully I don’t need to. The resident science-based chiropractor Sam Homola that posts here on SBM has already done it for me.

    I suggest you give that one a thorough read.

    And perhaps this one, by none other than Jan Bellamy, discussing the pushback from the chiros themselves at attempts to remove subluxation theory from the “Standards for Doctor of Chiropractic Programs.”

    You can’t judge someone solely by their website as few put their own own sites together.

    Oh but I’m not – I’m judging it by the definition of what is chiropractic. That means subluxation theory. If you include that, then indeed it is simple quackery. If you choose to remove subluxation from the training and application of chiropractic a new calculus emerges – what is chiropractic then? My argument this whole time has been that it becomes reduced to either a physician with not enough training and whom one cannot be certain doesn’t ascribe to subluxation theory, or a glorified physio who fancies him or herself on par with a primary care physician. None of those is acceptable as a health care provider.

    If chiropractic was to align itself in terms of curriculum and standard with established medical practice, much like the American osetopaths had done, then I would in fact support that. Until they do, then indeed I can and will criticise the entire lot – until you prove to me (like Sam Homola) that you are the exception.

  54. jerry_sprom says:

    nybrus

    “Of course there is good science suggesting hypomobility can lead to neuropathology. Nobody here is arguing that with you.”

    You have just stated 2 key components of the subluxation complex as taught and applied by RMIT university.

    http://www.docstoc.com/docs/71052024/Subluxation-2010-final
    (stewie’s link).

    I think that is probably enough from me.

  55. nybgrus says:

    @indigo:

    Alternative treatments do not make a person a magical thinker or an idiot.

    Well not necessarily….

    hear about herbs, Reiki, or other alternative paths that have worked for me

    D’oh! There it is.

    magical thinking has nothing to do with it.

    Channeling the “one true source” to use its “energy healing powers” and even be able to send it forward or backward in time isn’t magical thinking? Are you even cognizant of what you are saying?

    your minds are so closed you can’t think your way out of a paper bag

    Watch out – yours is so open your brain might fall out.

    You are not skeptics, you are debunkers

    Care to elucidate the difference? Or even why that should be considered a pejorative? Let’s see…

    Reiki uses the one true source for energy healing. I am skeptical of this because I understand basic science and human biology. I use said science and understanding to debunk reiki. Yep, pretty straightforward.

    You wouldn’t believe anyone with a different experience and outlook anyway

    No, I don’t believe anything told to me with absolutely no evidence to back it up. And when it violates the basic principles of what I do know I certainly don’t believe it. And when I find evidence it isn’t true… well, you can fill in the rest.

    and that does not make you right – arrogant, yes, correct, NO.

    Actually, by definition, using the scientific process to empirically demonstrate the verity or falsity of something does make me right. Making vacuous claims that you somehow “just know something worked” despite all the evidence to the contrary makes you arrogant, not me.

    Science makes me humble because it tells me I can’t “just know.” It also empowers me with the skills to actually find out. Skepticism makes me right waaaay more often than I am wrong because I don’t buy in to BS like reiki, homeopathy, and miracle cancer cures.

    On the other hand, going around claiming reiki works belies ignorance and claiming that “other alternative paths” have worked for you and that you are so damned sure about that makes you quite arrogant.

    You fight very hard to disprove alternative treatments,

    Why yes we often do.

    that must mean you actually fear they might be real

    Nope. It means we know they are wrong. In the same exact way I know the earth is not flat.

  56. nybgrus says:

    @jerry:

    I think that is probably enough from me.

    Well, glad it only takes two little tiny facts to fill up your entire brain. No wonder you haven’t a clue about the rest of the magical thinking and BS that makes up chiropractic.

  57. jerry_sprom says:

    nybgrus
    you should stop now. Your embarrasing yourself with those schoolyard comments.

  58. Valky says:

    Jerry, I thought you said earlier that you’d had enough…

    Some people are certainly embarrassing themselves, but let’s just say nybgrus is not one of them.

  59. marcus welby says:

    Readers should understand there is a huge difference between physical therapists and their training and goals and with chiropractors. As one who has worked for 40 years with physical therapists, lectured to them, taught academic courses for them, observed them in action in the hospital and rehabilitation centers, I can list some differences.
    Physical therapists may be trained in and utilize gentle spinal mobilization techniques, but to my knowledge, they never use high velocity spinal manipulation which has been repeatedly implicated in uncommon but serious vertebral artery dissection, stroke and death. See the new article in the Journal of Neurosurgery

    J Neurosurg. 2011 Sep 16. [Epub ahead of print]

    Craniocervical arterial dissections as sequelae of chiropractic manipulation:
    patterns of injury and management.

    Albuquerque FC, Hu YC, Dashti SR, Abla AA, Clark JC, Alkire B, Theodore N,
    McDougall CG.

    Physical therapists are trained extensively in rehabilitation techniques: muscle strengthening, balance, gait training, use of adaptive devices (for instance walkers, various types of wheelchairs, crutches, home modifications for disability) rehabilitation of spinal injuries, joint replacement, post-fracture, cerebral palsy and neurodegenerative disease, hospital work, and much more. Chiropractors cling desperately to their unifying concepts of subluxation and vitalism and marketing. They also tend to prey on the plaintiffs in personal injury lawsuits from slip and fall and auto accidents (as do some MDs, DOs and attorneys). For a peek at that aspect, try looking at the 1-800-AskGary empire in the St. Petersburg area.
    Chiropractors have little or none of the core training in the above listed areas in which physical therapists excel.

  60. nybgrus says:

    Thank you for the clarification Marcus. I agree with you fully, and was not intending my characterization of science-based chiros as a slight against physios. I think physios are amazingly important parts of the health team – but I also think that a self motivated science-based chiropractor could theoretically be roughly equivalent, or at least not as dangerous. The problem is that with a DC degree, you have no way of knowing whether that is the case or not – nor what their actual training or qualifications are.

    I was not advocating for making chiro science based as much as I was using it as a juxtaposition that no matter how you slice it, chiro is a pretty worthless degree to pursue. I’d rather people be trained properly as physios.

    As Ben Kavoussi has lamented about his acupuncture training, many are lured into fields such as chiro thinking they really are getting real medical training, and are then left holding the bag – and often must resort to the defensive since they just spent a few years and a lot of money training for a career which we are saying is quackery. Like a priest learning there is no god, they cling tenaciously as we have seen from jerry sprom and rwk.

  61. nybgrus says:

    clarification – not as dangerous as standard chiros – I realized after that makes it sound like I was insinuating not as dangerous as physios and that is most certainly not what I was going for.

  62. NMS-DC says:

    @ Jann

    RE: 2.5 GPA. Has been changed to a 3.0 effective Jan 2014 in the USA. Source: http://bit.ly/nnlJpf

  63. nybgrus says:

    @NMS-DC:

    Why would you necromance an old post just to make such a trite and really meaningless point? BTW, that is still below the average accepted medical student.

    And why do you continue to use shortened URL’s? The only two really valid reasons to use it are if you have a character limit in your post or if you are trying to hide the true source of your link so it appears to be referenced without having to advertise that it may not be a reliable source. And BTW, that link doesn’t work (at least in my browser).

    Perhaps, if you want to resurrect this thread, you can pick up where RWK never answered – my question about how and when to refer and the distinction I make between chiros, physios, and GPs. Feel free to field that one right here (and my apologies for the bad HTML formatting on that one, the entire last section is just the one link anyways).

  64. NMS-DC says:

    @nybrygus

    Trite and meaningless? Everything chiropractic is meaningless to you, as demonstrated elsewhere with your ignorance of SMT research and cost-effective (I don’t care, it’s all BS according to you).

    I use shortened URLs because it saves space. And, my sources have been and always will be reliable, nybgrus. EBM means we both follow the same rules. I’ve abided by them you haven’t.

    I’ll go take a look at that thread. You have a bad knack of saying in 10 words what could be said in 5. I sometimes feel like I need a Jolt Cola to wake me up from your long diatribes. It reminds me of a the following lyric “you’re talking a lot but you’re not saying anything”.

  65. NMS-DC says:

    Bring on Sam Homola. This website claims he is the authority to speak on behalf of scientific chiropractors? I disagree. I have serious doubts that he is up to date with the latest research on SMT, manual therapy, or basic sciences related to chiropractic (anatomy, neurophysiology, biomechanics, differential NMS diagnosis, orthopaedics, etc…).

    I don’t doubt his commitment to science, I doubt he understands chiropractic outside his very own, dated, perspective. I know of Sam Homolla well. I remember him from Stephen Barrett’s site and other skeptical websites. He’s referenced a lot by you guys. I read his articles. I can rebutt them with current literature. I look forward to debating any chiropractic related issue with him. I’ll come with the research. I hope he does the same. Please feel free to pass along my invitation to Dr. Homola, I’m sure the webmasters here will know how to get in touch with him.

    Very best,
    NMS

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