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NCCAM manipulates spinal manipulation

“Complementary and alternative medicine,” as pediatrician and fellow blogger John Snyder aptly stated in a recent journal article on CAM and children,

is a term used to describe a disparate, poorly defined set of practices and treatment modalities presumed to be distinct from so-called ‘conventional medicine’.

As we have discussed here at Science-Based Medicine, this amorphous concept facilitates a convenient fluidity in delineating the parameters of CAM. Without a clear definition, CAM (and integrative medicine) proponents are able to rebrand plausible and evidence-based practices such as diet, exercise and relaxation as CAM, a tactic we at SBM call “bait and switch.” This results in inflation in the figures of CAM use (important because CAM is all about popularity) and claims that CAM “works.”

Manipulating a term

Yet another example of CAM’s claiming “conventional” medicine as its own appeared in the form of NCCAM’s most recent Clinical Digest, which discusses CAM treatments for pain and mischaracterizes spinal manipulation as CAM.

(FYI, this edition of Clinical Digest also promotes acupuncture for pain, even though it doesn’t work, and co-opts exercise (tai chi) and relaxation as CAM, even when they aren’t.)

NCCAM’s categorization of spinal manipulation as CAM would surely come as a surprise to the orthopedic surgeons who prescribe it, the physical therapists who carry out those orders, and the M.D.s and D.O.s who themselves perform it. Spinal manipulation is a physical therapy employing a high velocity, low thrust technique whereby a joint (such as a spinal vertebra) is moved beyond its normal physiological range of motion. The primary purpose of the therapy is to create mobility in an otherwise tightened joint. While its mechanism of action is not fully understood, it is biologically plausible and has some evidence of effectiveness for certain types of back and neck pain. It is “conventional” medicine.

A likely source of NCCAM’s confusion is chiropractors’ use of the term “spinal manipulation.” Some chiropractors employ manipulation in the same way physical therapists, M.D.s and D.O.s do – as a physical therapy for patients with back or neck pain who have been conventionally diagnosed and found to be appropriate candidates for this therapy. However, chiropractors also use the term “spinal manipulation” as a synonym for “spinal adjustment” which, in their unique vocabulary, is a treatment for the ubiquitous and nonexistent subluxation. Only chiropractors use the term in this manner because only chiropractors believe the chiropractic version of the subluxation exists. There is an excellent discussion of this distinction by Sam Homola, himself a chiropractor, on SBM and NCCAM’s staff would do well to review it.

(By way of background, to a physician, nurse, physical therapist and other science-based health care providers, a subluxation is a partial dislocation, as of a joint. Chiropractors have their own vocabulary which includes terms defined differently than, or not used in, the common lexicon of other health care providers.)

The chiropractic subluxation has been addressed a number of times here at SBM, but briefly the subluxation is an ill-defined, unproven spinal pathology of no known clinical significance. It was invented out of whole cloth in 1895 by a self-styled “magnetic healer” who had no medical education or training. Despite efforts by chiropractors to backfill a scientific explanation into this preconceived notion, there is no plausible scientific evidence that the chiropractic subluxation exists.

Not surprisingly, chiropractors cannot agree on a definition for their subluxation, how to diagnose one, or its clinical significance. They can’t even agree on a name for it – it’s variously called the vertebral subluxation complex, manipulable lesion, spinal lesion, joint dysfunction, and so on. Nor can they agree on its role in chiropractic – large and unremitting intramural battles have been fought over the subject. Nevertheless, chiropractors daily tell patients that they are suffering from subluxations which must be corrected at the risk of ill health. Again, one means of correction is the chiropractic “adjustment,” which chiropractors also refer to as “manipulation.”

If chiropractors are this confused, then one can well understand how the writers and editors of NCCAM’s website could be confused, but it’s time to set the record straight. The correction of subluxations via a spinal adjustment/manipulation is not the same as the use of spinal manipulation by physical therapists and other health care providers as a means of alleviating back or neck pain. While it is true that a chiropractor might “find” a subluxation and claim it is the cause of a patient’s pain, this is not a legitimate diagnostic method nor is its correction via an adjustment/manipulation a legitimate therapy for the patient’s pain.

NCCAM does its readers a real disservice in failing to explain this critical difference. As it stands, readers may be left with the incorrect assumption that a chiropractor’s use of adjustments/manipulations to correct subluxations is a useful therapy for neck or back pain. This is especially important because some chiropractors have intentionally tried to exploit the efficacy of manipulation for back pain as proof that chiropractic “works.” They have also falsely claimed that they are more proficient at, and safer in performing, spinal manipulation than other practitioners, to the point of trying to use the political process to prohibit physical therapists from employing manipulation.

But wait, it gets worse

To confound the problem, NCCAM’s discussion of manipulation as a pain therapy refers readers to its information on chiropractic, the very practitioners who may subject them to the ineffectual adjustment/manipulation for pain. And while NCCAM’s confusion over conventional manipulation versus chiropractic manipulation for subluxations might be understandable, any sympathy should end at this reference. As David Gorski pointed out, NCCAM discusses CAM practices in a “weaselly, wishy-washy way,” and chiropractic is no exception:

Chiropractic is a health care profession that focuses on the relationship between the body’s structure—mainly the spine—and its functioning. Although practitioners may use a variety of treatment approaches, they primarily perform adjustments (manipulations) to the spine or other parts of the body with the goal of correcting alignment problems, alleviating pain, improving function, and supporting the body’s natural ability to heal itself.

For the uninitiated, let’s decode these weaselly words. “Focuses on the relationship between the body’s structure – mainly the spine – and it’s functioning” is a reference to chiropractic belief that there is a spinal pathology (the subluxation) they can detect and that it has some effect on bodily function. The putative effect of this putative pathology is sometimes described simply as a “misalignment” blocking “nerve flow” and at other times more elaborately (and equally nonsensically) as “a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health . . . .” The reference to “adjustments (manipulations)” is an unintentional acknowledgement of my point that chiropractors use the terms interchangeably and describes their unproven therapy for their unproven condition, which “correct[s] alignment problems, i.e., subluxations. “Supporting the body’s natural ability to heal itself” is a reference to the chiropractic belief in vitalism, their version of which is “Innate Intelligence.”

The quoted description – indeed the whole of NCCAM’s page on chiropractic – doesn’t mention by name what even chiropractors themselves describe as its core concept: the subluxation. A consumer reading this page would have absolutely no clue that going to a chiropractor might subject him to a phony diagnosis of “subluxations” and phony treatments to “correct” them. There is also a mention that chiropractors use x-rays as a diagnostic tool, without telling the reader that a chiropractor may well use x-rays to detect the nonexistent subluxation.

Criticism of this sort of thing was raised by Steve Novella, David Gorski and Kimball Atwood at their visit with NCCAM’s director over two years ago. As Dr. Novella said then, “the pattern of information is consistent – NCCAM staff talk about a strict adherence to evidence-based medicine and science being neutral, but interspersed with this is an uncritical presentation of ancient superstition as if it were science . . .” There he was discussing acupuncture. The only difference here is that NCCAM is uncritically presenting a superstition of more recent origin, in the form of belief in “Innate Intelligence” and resulting pseudoscientific diagnostic methods and treatments.

NCCAM also advises readers to

Tell the chiropractor about any medications (prescription or over-the-counter) you take. If the chiropractor suggests a dietary supplement, ask about potential interactions with your medications or other supplements.

“If the chiropractor suggests a dietary supplement” the patient would be well advised to ask exactly why it is being prescribed, given the paucity of evidence for the safety or benefit of dietary supplements, and to be especially suspicious if the chiropractor sells the supplement, an inherent conflict of interest. And the patient should not rely on a chiropractor to know about “potential interactions with . . . medications or other supplements.” The patient should ask someone with sufficient training in pharmacology for that advice, such as a pharmacist or M.D.

As well, NCCAM advises,

Mention any medical conditions you have, and ask whether the chiropractor has specialized training or experience in the condition for which you are seeking care.

NCCAM is apparently unaware of the dubious system of chiropractic “specialization” which results in “specialties” like chiropractic neurology, chiropractic pediatrics,  and chiropractic family practice.  At least I hope the writer was unaware and would not knowingly recommend these “specialists.”

Perhaps the most egregious failure, however, is the failure to warn consumers about the risk of stroke following cervical manipulation. Here is what NCCAM says:

A 2009 study that drew on 9 years of hospitalization records for the population of Ontario, Canada analyzed 818 cases of vertebrobasilar artery (VBA) stroke (involving the arteries that supply blood to the back of the brain). The study found an association between visits to a health care practitioner and subsequent VBA stroke, but there was no evidence that visiting a chiropractor put people at greater risk than visiting a primary care physician. The researchers attributed the association between health care visits and VBA stroke to the likelihood that people with VBA dissection (torn arteries) seek care for related headache and neck pain before their stroke.

Yes, it’s the infamous Cassidy study, a subject we’ve addressed before at SBM. Now, I suppose it is correct that the study showed that “visiting a chiropractor” did not put people at greater risk than “visiting a primary care physician” if by “visiting” you mean walking in the door and having a seat in the waiting room. The study did not look at what treatment (if any) the patients received so it cannot legitimately claim to answer the question whether actually being treated by a chiropractor puts one at greater risk than being treated by a primary care physician. And it certainly does not answer the question whether cervical manipulation puts one at risk of stroke. As Mark Crislip pointed out in his analysis of the study, that last sentence is a hypothesis created by the authors of the study, it is not a statement supported by the study’s data.

Of course, the layperson might well be left with the impression, completely false, that cervical manipulation does not put one at risk of stroke. In fact, vertebral artery dissection and stroke following chiropractic cervical manipulation continues to be reported in the medical literature and no one besides chiropractors seems to think the Cassidy study settled the question.  As a recent article in the Journal of Neurosurgery plainly states

Chiropractic manipulation of the cervical spine can injure the vessels of the head and neck and produce stroke and other debilitating symptoms.

Why is this not part of the “evidence-based information” NCCAM says it is committed to?

In sum, where’s the science?

NCCAM’s supposed dedication to “rigorous science” is not in evidence in its advice to consumers about chiropractic and spinal manipulation. NCCAM’s presentation fails to live up to its promise to “maintain a strong commitment to providing objective and authoritative evidence-based information to the public and health care professionals.”

Posted in: Chiropractic, Politics and Regulation

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69 thoughts on “NCCAM manipulates spinal manipulation

  1. Blue Wode says:

    Jann Bellamy wrote: “While it is true that a chiropractor might “find” a subluxation and claim it is the cause of a patient’s pain, this is not a legitimate diagnostic method nor is its correction via an adjustment/manipulation a legitimate therapy for the patient’s pain. NCCAM does its readers a real disservice in failing to explain this critical difference.”

    That point cannot be highlighted enough. Similar confusion exists here in the UK because the regulatory body, the General Chiropractic Council (GCC), doesn’t address the chiropractic ‘bait and switch’. For example, it commissioned the Bronfort Report (2010) on the effectiveness of manual therapies, but failed to take into account the following:

    Quote
    “Double standards – Chiropractors can’t have it both ways: chiropractors can’t claim to be unique amongst the manual therapists because of their techniques, yet claim any evidence for their particular ‘art’ from the studies that were not about chiropractic manipulations. The GCC has made this perfectly clear…[they] can’t maintain [as they had done previously] that Hancock is irrelevant because it’s not about chiropractic manipulations, yet allow their prized Bronfort Report off the hook when it cites trials mainly *not* about chiropractic. Once all those non-chiropractic manipulations have been removed from the Bronfort Report, what’s left? Not a jot.”

    Ref: http://www.zenosblog.com/2010/11/where-the-evidence-leads/

    Perhaps even worse than that, the GCC, in the space of a few months, changed its mind from declaring that there was “no evidence to support chiropractic subluxation claims” to allowing subluxation claims to be linked to “health concerns” – all without providing any evidence in support of its actions. See here: http://tinyurl.com/d74ogje

    It seems to me that there are only two answers for the above state of affairs. Either NCCAM and the GCC (and other bodies entrusted with the welfare of consumers) are knowingly publishing misleading information, or they’re not up to the job.

  2. There’s just so many negative things that can be said about chiropractic. Jann wrote about those quacks pushing useless supplements onto people. These are the same chiropractors that will say “Doctors just push pills on people! They only treat your symptoms!” So what do they do? They *lie*, and tell their patient they have a non-existent deficiency and then SELL them a useless and potentially dangerous supplement. Can you imagine the outrage if legitimate doctors sold medications directly to their patients?

    In our city, there’s a new gigantic billboard, with a stupid looking girl on it that says “Auto accident? We’ve got your back! Dr. Ima Stupididiot, D.C.” (I guess they don’t know what the D in DC stands for?) They’re just scum.

    Haha, I’m so full of rage about these quacks that I have nothing more to add. Chiropractic is 99% quackery, and 1% physical therapy. :)

  3. nybgrus says:

    Sorry I don’t have time to make a more in depth comment, but when Jann said:

    The only difference here is that NCCAM is uncritically presenting a superstition of more recent origin, in the form of belief in “Innate Intelligence” and resulting pseudoscientific diagnostic methods and treatments.

    I think Ben Kavoussi and myself would disagree… the modern construct of acupuncture – which is the only form of it that would really be recognized as acupuncture these days – is an invention of the early 20th century. Palmer was late 19th century, so no matter how you slice it the NCCAM is being highly uncritical while supposedly being “science and evidence based.”

  4. Adam Rufa says:

    Jann,

    Nice post.

    My only problem with it is “the orthopedic surgeons who prescribe it, the physical therapists who carry out those orders”. I have never once had an orthopedic surgeon “prescribe” manipulation. I have had plenty of orthopedic surgeons refer patients to me (a physical therapist) and I have evaluated them to determine whether a manipulation is appropriate.

    PTs are highly trained professionals who evaluate, diagnose and treat patients. We are not technicians who take “orders”.

    That aside you made some great points about thrust manipulation and CAM.

  5. tgobbi says:

    SkepticalHealth: Haha, I’m so full of rage about these quacks that I have nothing more to add. Chiropractic is 99% quackery, and 1% physical therapy.

    Not to pick nits, but SkepticalHealth has the percentage wrong. “Mixer” chiropractic is 49% chiropractic quackery and 49% naturopathic quackery; the other 2% is P.T. “Straight” chiropractic is 100% quackery. But it’s getting harder and harder to find straights.

    I’ve contended for years that the typical D.C. is as much naturopath as he/she is chiropractor. Go to just about any chiro office or website and you’ll find that the armamentarium includes equal parts chiropractic and naturopathy.

  6. marcus welby says:

    Adam Rufa: some orthopedic surgeons perform spinal manipulation, particularly, it would seem, in parts of Europe. There was a recent accounting of a large number of strokes due to neck manipulation in Germany from a neurologic journal with about half of them due to neck cracking by orthopedic surgeons, I am sorry to report. Why medical authorities have not strongly encouraged discontinuation of this dangerous and ineffective practice among European MDs is unclear. Agree the Cassidy study, lead by a chiropractor, is fatally flawed.

  7. Jann Bellamy says:

    @ Adam Rufa:

    “We are not technicians who take ‘orders.’”

    No offense intended. I meant “orders” as a synonym for prescription. It is my understanding that some orthopedic surgeons do specifically prescribe spinal manipulation, but also understand that the PT can make the choice of appropriate treatment and carry it out, and should have made that more clear.

    I do which your profession would complain to NCCAM about their misleading information on spinal manipulation — or maybe they have?

  8. Blue Wode says:

    Tgobbi wrote on 26 Jul 2012 at 8:08 am:. “Straight” chiropractic is 100% quackery. But it’s getting harder and harder to find straights.

    That may be true for the U.S., but it’s not getting harder to find straights elsewhere in the world. For example, Scottish chiropractors, who make up at least 10% of the UK chiropractor population are apparently ‘straight’ (vitalistic). See http://www.thetwentyfirstfloor.com/?p=3534

    And a 2007 survey of UK chiropractors gave a figure of 63% re those who consider the (mythical) subluxation to be central to chiropractic intervention:
    http://wansbeckchiropractors.co.uk/pdf/Nov02.pdf

    I understand that there are also a large percentage of ‘straights’ in Spain, Australia, and New Zealand.

  9. jt says:

    So, what it is exactly that PTs and MDs are manipulating anyway; what is the scientifically approved term for a local spinal structural problem called? I suppose that you would call it an area of limited mobility. For all intents and purposes, it doesn’t matter whether these problems are called areas of limited mobility, restricted segments, manipulatable lesions, or subluxations. What matters is that these problem areas are identified and corrected, adjusted, manipulated, or moved–take your pick from the terms! These semantic differences are mostly politically charged in nature.

    Chiropractors have the most rigorous education and hands-on training when it comes to spinal manipulation or adjusting or high-velocity low-amplitude thrusting or whatever you want to call it. This experience is what sets us apart from PTs and MDs regarding this practice. The argument that “PTs and MDs perform spinal manipulation so Chiropractors are unnecessary” is based on the assumption that these practitioners are as well qualified to perform these corrective procedures–which is entirely false because of the relative lack of functional hands-on practice and experience in performing these procedures.

    The following excerpt from pg. 35 Of the Council on Chiropractic Education’s “Standards for Doctor of Chiropractic Programs and Requirements for Institutional Status” states:

    “250 chiropractic adjustments or manipulations, at least 200 of which must be spinal adjustments, provided during 250 separate encounters (200 must be non-student* patients), of which at least 75 must be assessed through direct observation”

    http://www.cce-usa.org/uploads/2007_January_STANDARDS.pdf

    You will not find any more stringent requirements for spinal manipulation education than these for PTs and especially not for MDs, who have virtually nonexistent training in these procedures.

    As for your hatred, SkepticalHealth… “Holding on to anger is like grasping a hot coal with the intent of throwing it at someone else; you are the one getting burned.” -Buddha

  10. DevoutCatalyst says:

    “The greatest impurity is ignorance.
    Free yourself from it.
    Be pure.” – Buddha

    SkepticalHealth is on a freer path than that of most any chiropractor.

  11. tgobbi says:

    jt:”Chiropractors have the most rigorous education and hands-on training when it comes to spinal manipulation or adjusting or high-velocity low-amplitude thrusting or whatever you want to call it. This experience is what sets us apart from PTs and MDs regarding this practice. The argument that “PTs and MDs perform spinal manipulation so Chiropractors are unnecessary” is based on the assumption that these practitioners are as well qualified to perform these corrective procedures–which is entirely false because of the relative lack of functional hands-on practice and experience in performing these procedures.”

    ***

    But this doesn’t invalidate the fact that the majority of you are still looking for nonexistent subluxations. It doesn’t matter what you call these chimeras from one day to the next (for a while it was “vertebral subluxation complex”). They don’t exist: teaching them in your schools is tantamount to teaching that the world is flat and 6000 years old, and you’re wasting your time as well as your customers’ time (and money) diagnosing and treating them.

    My feeling, based on more than 30 years of fascination with the bad accident of chiropractic, is that you and your customers would be better off if DCs would eschew the pseudoscience of chiropractic and concentrate on the reality of physical therapy. But that, of course, would rob you of your questionable “otherness” that you cling to in order to flimflam the public into believing that chiropractic is a valid philosophy. As far as I’ve been able to ascertain you have no clinical experience, no hands-on experience working with sick people and no hospital experience. (OK, so a few maverick hospitals are hiring staff DCs but I’d bet that they don’t employ them in any roles other than manipulation for simple musculoskeletal pain).

    An anecdote: not long ago I responded to an ethically questionable advertisement that was obviously chiropractic in origin even though it wasn’t so stated in either the ad or the pertinent website. They were passing themselves off as a physical therapy clinic. I phoned their office and my suspicion was confirmed.

    Since the ad offered a free consultation I decided to make the appointment. Having filled out the forms in their waiting room I was approached by a woman who took me to an examination room. She neither told me her name nor her title before beginning the consultation – a strange circumstance I thought. So I interrupted and asked her who she was and she introduced herself as “Doctor von Schnecken.” I asked her what kind of doctor. It was only then that she revealed that she was a DC to which I responded that I questioned her ethics. She was stunned and asked what the problem is. I pointed out that I’ve been encountering more and more chiropractors who are obfuscating their identity as DCs. (It happened again a few weeks ago at a marketing scam I attended. The presenter introduced himself as “Doctor Pflaumenbaum” and stated that he had be a practicing physician for 15 years. Of the 50 – 60 people in the audience I wouldn’t be surprised to discover that I was the only one who knew that he was a chiropractor and not a doctor).

    Chiropractic is irrelevant.

    Chiropractic is an exercise in mysticism and the occult.

    Chiropractic, as has been pointed out by many with more scientific knowledge than I, has never made a single contribution to healthcare.

  12. joebrence9 says:

    jt “Chiropractors have the most rigorous education and hands-on training when it comes to spinal manipulation or adjusting or high-velocity low-amplitude thrusting or whatever you want to call it. This experience is what sets us apart from PTs and MDs regarding this practice. The argument that “PTs and MDs perform spinal manipulation so Chiropractors are unnecessary” is based on the assumption that these practitioners are as well qualified to perform these corrective procedures–which is entirely false because of the relative lack of functional hands-on practice and experience in performing these procedures.”

    As a physical therapist (fellowship and manually trained), the claim that one must go through rigorous training to learn manipulation is prepsterous. Manipulation takes little skill and is relatively non-specific (indicated by the loads of RCTs that has been performed looking at the reliability of segmental isolation as well as imaging following the technique). This author did a great job of at identifying the different between PTs/MDs/DOs and chiros, and despite literature being “unsure” of how manipulations work (current theories being a combination of biomechanical and neurophysiological effects), we do know they can help create mobility/movement in a very select subgroup of individuals. It appears that an “expectation” for positive gain must be held prior to manipulation and a RCT, in which I recently participated, found that within/between session + changes to manual therapy determined who would have + long-term gains. All of this stated, the same RCT found that low grade mobilizations (simply pushing gently over the provocative segement) had the same result as a HVLAT. Sorry chiros, the thrust is likely unnecessary.

    I have some more science-based information about what we know about PT/Manual Therapy on my blog http://www.forwardthinkingpt.com .

  13. Jimmylegs says:

    We have at least one “straight” D.C down here in South FL, I only know of it because he had a fancy ad in the Sunday paper! He touts about his spinal decompression table that is a safe and effective (lol) alternative to surgery that has been studied in the American Journal of Pain Management, which doesn’t have a site apparently.

    Like all CAM sites, there is absolutely NO links or reference to the studies they claim have been done, but boy oh boy do they have testimonials out the ass.

    I wonder what they would say if I call and ask for references? It would be awesome if they stumble and hang up.

  14. tgobbi says:

    # Jimmylegson 26 Jul 2012 at 2:32 pm
    “…

    “I wonder what they would say if I call and ask for references? It would be awesome if they stumble and hang up.”

    ***

    A typical response, at least in my experience, would be for the guy to tell you that the studies are out there and that it’s your responsibilities to find them. Which, of course, is exactly the opposite of the way it should be.

    Another response that I’ve gotten is ad hominem attacks on you just for having the nerve to question what they “know” is the “truth.”

    I’ve saved many email exchanges from “doctors” of chiropractic and am thinking about compiling them for an article.

  15. Harriet Hall says:

    Oh, they have “evidence.” It’s laughable:

    http://www.sciencebasedmedicine.org/index.php/misleading-ads-for-back-pain-treatment/

    If they are making claims that the machine can treat a disease (ruptured discs?), that’s illegal and you can report them to the FDA and FTC.

  16. It’s always amusing when a chiropractor comes here and defends their education. >99% of chiropractic schools don’t require a college degree and only require a 2.5 GPA. Let’s be honest, it’s doubtful that few intelligent people willingly go to chiropractic school as their first choice. Likely they (academically) didn’t stand a chance of getting into medical or physical therapy school, or they are just a complete quack that believes chiropractic is some magical “natural” way of “healing.”

    It’s also funny reading how they describe their schooling as “rigorous.” Isn’t it a bit nonsensicle to have someone observe you fix a subluxation? There’s so many double negatives or oxymorons or whatever you want to call it. How can someone see something that doesn’t exist? How can you fix something that isn’t broken? How can you define something that is undefinable?

  17. BTW, I don’t think any doctors do “manipulations.” Maybe PM&R docs? (I’ve never really interacted with one.) We prescribe (haha @ Adam, just ribbing you) physical therapy. Heck, to be honest, I don’t know what I believe any more about the efficacy of PT in pain relief. That ridiculous chiropractic study that was published about neck pain a while back “demonstrated” that the cadillac treatment of neck pain (passive/active motion, heat, cold, massage, cheerleading “get better fast!”, etc) was no better than simply showing someone an exercise video and asking them to do exercises, and both of those only yielded a supposed 0.5 improvement on a subjective pain scale when compared with giving some people pain medications (and some didn’t receive medications, there was almost no record keeping) – and anybody who has asked a patient to rate their pain on a scale of 1 to 10 knows how clinically useless .5 is.

  18. Jimmylegs says:

    The site is http://www.zfwc.com. He does make claims for specific diseases, but states “manage” and not cure or treat, is this weasel wording? Oh and he uses a “Insight Millenium Surface EMG” which is for subluxations, which is hilarious.

    Feel free to read, I will make a list of questions and call the clinic tomorrow. If anyone has time to read, I’d like some help / insight just in case I miss anything important or even illegal (I probably don’t known even 1/10 of the laws in health care).

    I see quite a few fallacies, like personal experience and using an athlete as a reason to trust it (not sure which fallacy it could be).

  19. Blue Wode says:

    Jt wrote on 26 Jul 2012 at 11:21am: “Chiropractors have the most rigorous education and hands-on training when it comes to spinal manipulation or adjusting or high-velocity low-amplitude thrusting or whatever you want to call it. This experience is what sets us apart from PTs and MDs regarding this practice. The argument that “PTs and MDs perform spinal manipulation so Chiropractors are unnecessary” is based on the assumption that these practitioners are as well qualified to perform these corrective procedures–which is entirely false because of the relative lack of functional hands-on practice and experience in performing these procedures.”

    Apparently it doesn’t matter that MDs and PTs aren’t as well qualified. A systematic review of spinal manipulation concluded that there is no evidence that high-velocity spinal manipulation is more effective than low-velocity spinal mobilisation, *or that the profession of the manipulator affects the effectiveness of treatment*.

    See ref [20] here: http://www.acatoday.org/pdf/Lancet_Acute_Back_Pain_Nov.07.pdf

  20. tgobbi says:

    Jimmylegs: ” he uses a “Insight Millenium Surface EMG” which is for subluxations, which is hilarious.”

    I was unable to find reference to this on his site but I believe I know what it is: a small, laptop-sized, electronic device that has electrodes on wires. The electrodes are attached to the customer’s neck (or possibly back) and the “doctor” is able to read color-coded graphs that indicate where and how severe the subluxations are.

    A chiropractic “doctor” in my area shows up at all local art fairs and “health” fairs with his version of this little black box. I subjected myself to it a few years ago and was handed a printout of my “trouble spots” along with an offer for a free (or maybe reduced price) consultation. I sent the printout to Doctor Hall who put the lie to the device in a few well chosen words.

    It occurs to me that this may be the modern, high-tech version of ol’ B.J.’s “neurocalometer.” see

  21. Jimmylegs says:

    @tgobbi:

    That is actually very accurate description, assuming the picture is the exact machine they use. The link for the machine is: http://zfwc.com/custom_content/c_248935_first_visit.html.

    @jt:

    Yes it’s unfortunate that MDs and PT don’t learn more about spinal manipulation, I guess all this damn studying real medicine is getting in the way (sarcasm). When you use the word “us” I assume you are a chiropractor. Do you buy into the idea of “subluxations” which your linked document does support or at least mentions. If so, how do you detect it? Is there a standard way of doing so? What is it? How do you treat it? Why do you treat it? If they come into existence that causes illness, can you create them? If you can how so? If not, why?

    So many questions I want to ask every single chrio, and I’m sure I will rarely get consistent answers.

    Because you might be fond of quoting people I have one too

    “Extraordinary claims require extraordinary evidence.” – Carl Sagan.

    Note: If you are not a chiropractor, please disregard my post.

  22. Quill says:

    “NCCAM’s supposed dedication to ‘rigorous science’ is not in evidence in its advice to consumers about chiropractic and spinal manipulation.”

    After reading this article I find this conclusion to be an epic understatement, which is sort of an oxymoron in the same way rigorous science and chiropractic go together.

    @jt, apparent chiro: Buddha taught about the perils of hatred to be sure, but his core teaching was on the fatal nature of ignorance, ignorance of causality in particular. Before you advise against an alleged personal reaction to your own unconcealed ignorance, how about answering Jimmylegs’ fair and reasonable questions?

  23. tgobbi says:

    Jimmylegs: “That is actually very accurate description, assuming the picture is the exact machine they use. The link for the machine is: http://zfwc.com/custom_content/c_248935_first_visit.html.”

    The box itself is in the background of the photo but it does indeed look like what I’ve seen. Our local “doctor” attaches the electrodes to his potential customer’s neck but I’m sure it can be used for detecting all subluxations…

    Slight change of topic: Several years ago a high-profile D.C. spent some time participating on the Healthfraud list in attempting to convince us skeptics that there’s a “reform movement” sweeping over chiropractic like a brush fire. I spend a lot of time in the trenches, attending chiropractic lectures, dropping in at area D.C. offices and attempting to establish dialogs with D.C.s. Believe me when I tell you that I see zero evidence that there’s even a soupcon of a reform movement. Other than the occasional chiropractor who has abrogated the pseudoscience and sticks to PT the business is as virulently quackish as it has ever been.

    With that in mind I call attention to the Boynton Beach D.C.’s website which promises treatment for, among other things, such chiropractic treatable (note sarcasm) conditions as Crohn’s and thyroid problems.

  24. How dare you guys laugh at that magical chiropractic subluxation detection machine? Do you know how many hours of rigorous chiropractic school those non-college degree having, low GPA students had to attend to become proficient in it? It’s no wonder that us simpletons cannot understand it’s magic-like ability to detect otherwise undetectable back problems.

    /sarcam!

    Jann – how are machines like that legal? Despite the fact that they may skirt the false advertising/medical claim laws by hinting at things without making concrete claims, how is it not a crime to downright defraud people of money? Those shitheads are using fake machines on people to diagnose them with non-existent problems and then selling them useless “treatments” for them. How is that not illegal? Why doesn’t the media cover this more often?

  25. @ Jimmylegs: “…using an athlete as a reason to trust it (not sure which fallacy it could be).”

    Argumentum ad Athleta?


    Samuel Homola is a key figure in the chiropractic/science battle. One of his earliest publications in the ’60s talked about cultism in chiropractic. He was skeptical and eventually described himself as only treating musculoskeletal conditions. His influential/notorious Inside Chiropractic, published in the 1990s, is the most prominent book by a chiropractor criticizing the history and practice in his field. I also have his “A Chiropractor’s Treasury of Health Secrets” which talks about nutrition, breathing, and other “drugless” health advice. Other books he wrote were on weight loss and back pain. He never got a different degree or totally left the field, even though he’s been virulently attacked by many other chiropractors. He’s been a contributor here on SBM. In Amazon.com comments on Inside Chiropractic, he has helped some prospective chiropractic students to choose other careers, and probably helped numerous chiropractic patients avoid vertebral artery dissection. In that sense he has done more to reform the public perception of chiropractic than any other author I can think of (as most alties distrust what MDs like Stephen Barrett have to say about Chiro, TCM, NDs, etc.). Yet if Dr. Homola, DC posted on SBM under another name, it’s likely he would be denigrated as soon as he self-identified as a chiropractor.
    I point this out to encourage reflection on the goals and tactics of the Science-Based Medicine “community.” Since many Googles for terms like “acupuncture science” bring up SBM posts on page 1, I would hope that acupuncturists, their patients, and TCM students will find and read the posts and comments. If they see that acupuncturists, chiropractors, or naturopaths who comment in support of moving towards a science-based practice and rejecting pseudoscientific superstition are insulted, chased away, and incorrectly overgeneralized as totally hopeless frauds, it will probably just polarize factions and close minds to SBM/EBM. Certainly a chiropractor or acupuncturist who limits their practice to treating musculoskeletal problems with a combinations of massage, stretching, electrotherapy, etc. and doesn’t constantly badmouth MDs and prescription drugs is preferrable to the “straights” of the CAM world. Not many CAM practitioners who come to accept the validity of Cochrane Summaries are going to abandon their profession overnight, but many of them will change how they practice, tone down the claims that they make, and develop a better opinion of science-based medical providers.

  26. ConspicuousCarl says:

    jt on 26 Jul 2012 at 11:21 am

    For all intents and purposes, it doesn’t matter whether these problems are called areas of limited mobility, restricted segments, manipulatable lesions, or subluxations.

    If one doesn’t want to look like a quack, one should be careful not to sound as though one might not know the difference between partially dislocated bones vs. merely having limited flexibility due to some soft tissue condition.

  27. Janet Camp says:

    @Skeptical Acupucturist

    I will continue to hope you come to your senses and enroll in some kind of medical training asap. If you take people’s money for what you do, it is wrong–and you seem to know this (that there really is no validity to acupuncture and the rest of the woo that often accompanies it), but feel it is enough to “tone down” your claims and reduce the vitriol toward doctors and pharmaceuticals. I see your point, but it is much like the problem with the “shruggies”. Put shruggie in the search box to read more about that problem if you are new(ish) here. I appreciate that you are seeking some common ground, but you are not likely to find anyone here sanctioning your continued practice of woo in any way, shape, or form.

    ——–

    @SkepticalHealth

    I love popsicles, but haven’t tried a nonsensicle–sounds interesting! :-)
    (nonsensical is what you meant, of course)

  28. How dare you guys laugh at that magical chiropractic subluxation detection machine? Do you know how many hours of rigorous chiropractic school those non-college degree having, low GPA students had to attend to become proficient in it? It’s no wonder that us simpletons cannot understand it’s magic-like ability to detect otherwise undetectable back problems.

    /sarcam!

    Jann – how are machines like that legal? Despite the fact that they may skirt the false advertising/medical claim laws by hinting at things without making concrete claims, how is it not a crime to downright defraud people of money? Those a-holes are using fake machines on people to diagnose them with non-existent problems and then selling them useless “treatments” for them. How is that not illegal? Why doesn’t the media cover this more often?

    (Hahaha!)

  29. @acupuncturist,

    But do you realize there is NO EVIDENCE BASE to acupuncture? There is no scientific base. The whole of the “science” behind acupuncture is no more sophisticated than randomly poking someone with toothpicks. You are no more a health care administrator than a checkout lady at WalMart. If you want to be “science based” then you would, as Janet said, get legitimate medical training. You can NOT molest acupuncture into a science based practice because it is inherently unscientific. Sorry I have to be somewhere early today adios

  30. Jann Bellamy says:

    @SkepticalHealth: ” . . . how is it not a crime to downright defraud people of money?”

    It may well be, depending on whether the prosecutor could prove intent to defraud. It is certainly a candidate for the tort of fraud. I’ve written about this before:
    http://www.sciencebasedmedicine.org/index.php/is-cam-fraud/. The plaintiffs are using this same principle in their class action suit against Boiron, the homeopathic products manufacturer. http://www.sciencebasedmedicine.org/index.php/the-cam-docket-boiron-i/.

    BTW, with regard to the entrance requirements for chiropractic college, you might be interested in knowing there is no admissions test either. http://www.sciencebasedmedicine.org/index.php/dept-of-education-to-council-on-chiropractic-education-straighten-up/.

  31. jhawk says:

    Jann,

    good article overall but a few things I would like to nitpick about.

    “For the uninitiated, let’s decode these weaselly words. “Focuses on the relationship between the body’s structure – mainly the spine – and it’s functioning” is a reference to chiropractic belief that there is a spinal pathology (the subluxation) they can detect and that it has some effect on bodily function.”

    This is a rather large extrapolation on your part. These words are only weaselly when you add in your inherent bias towards chiropractic. Is it possible this just means we should have a structurally sound and well functioning spine? yes. This is what is taught at many chiro schools.

    “The reference to “adjustments (manipulations)” is an unintentional acknowledgement of my point that chiropractors use the terms interchangeably and describes their unproven therapy for their unproven condition, which “correct[s] alignment problems, i.e., subluxations.”

    The terms are used interchangably but are not mutually exclusive. Chiropractic was founded on spinal manipulation/adjsutment not on the philosophy of subluxation.

    “Supporting the body’s natural ability to heal itself” is a reference to the chiropractic belief in vitalism, their version of which is “Innate Intelligence.”

    or it just means the body has the capabitlity under many circumstances to heal itself and nothing more. Once again your trying to read between the lines draws you to a biased conclusion.

  32. tgobbi says:

    # jhawkon 27 Jul 2012 at 12:25 pm

    “This is a rather large extrapolation on your part. These words are only weaselly when you add in your inherent bias towards chiropractic. Is it possible this just means we should have a structurally sound and well functioning spine? yes. This is what is taught at many chiro schools.”

    Obviously words written by a chiropractor or a defender thereof. To accuse Jann of a bias toward chiropractic is to confuse “bias” with diligent study. As a 30-year opponent of the pseudoscience that constitutes chiropractic I can’t count the number of times I’ve been called biased or closed-minded. This is the feeble way that D.C.s have of throwing red herrings into the works. If Jann and I and others had been shown any inkling of chiropractic efficacy we wouldn’t be as vehemently in the anti-chiro camp that we occupy. As always it’s up to the claimants to offer proof. You don’t have proof; you have name-calling and indignation at our refusal to accept your flimsy claims on their surfaces.

    “or it just means the body has the capabitlity under many circumstances to heal itself and nothing more. Once again your trying to read between the lines draws you to a biased conclusion.”

    I don’t believe any rational being denies that the body is capable of healing itself. What we don’t believe is that anything you do as chiropractors contributes to this process!

  33. jhawk says:

    as to entrance requirements….

    Are med school entrance requirements more stringent? yes. Should they be, I think so. DC’s are not MD’s and are in most instances not dealing with as serious/urgent conditions. The 2.5 gpa SH quoted is only for some schools and is a minimum requirement. Many med school’s do not require a degree either only ceratin pre-req’s. Anyway, this comparison seems childish (apples and oranges). And I think we can all agree that stellar grades in school and on standardized tests does not equate to a competent doctor?

  34. WilliamLawrenceUtridge says:

    Is it possible this just means we should have a structurally sound and well functioning spine? yes. This is what is taught at many chiro schools.

    The issue isn’t whether we should have well-functioning spines. The issue is what that means.

    Most doctors would probably say that means having a spine that moves, bends and supports without pain. Isn’t it taught in many chiro schools that adjusting the spine can treat non-musculoskeletal conditions? The reason most docs (and contributors here) criticize chiropractors is because at least a substantial minority (possibly a majority) believe a well-functioning spine has implications for systemic conditions beyond mere musculoskeletal complaints. At least some chiropractors believe adjusting the spine can treat allergies, cancer, acute infections and more. As Jann points out in her article – the issue is bait-and-switch, definitions that change meaning without notification.

    You yourself do this jhawk, by pretending that all chiropractors are straights (or mixers? I forget which ones are crazy and which ones are more reasonable) who restrict themselves to just musculoskeletal pain. They don’t. You ignore the nutters like this guy that oppose vaccination, pretend vitamins are magic and claim they can cure cancer (or prevent cancer, or whatever nonsense is asserted without proof and completely contradicting what real medicine has to say). There’s no reason to think that adjusting the spine can help the body attack cancerous or precancerous cells. Though SBM shouldn’t portray all chiropractors as dangerous lunatics (a minor beef I have with the site), you shouldn’t whitewash the fact that some of your peers make outrageously wrong claims and pretend they’re doctors rather than physiotherapists (my main beef with you).

  35. I love the complete lack of defense chiropractic has: almost zero evidence base, bottom of the barrel students, rank quackery, complete rip off. jhawk is certainlly correct that it’s “apples and oranges”: doctors treat real disease, chiropractors treat made up diseases.

  36. jhawk says:

    tgobbi,

    “If Jann and I and others had been shown any inkling of chiropractic efficacy we wouldn’t be as vehemently in the anti-chiro camp that we occupy. As always it’s up to the claimants to offer proof. You don’t have proof; you have name-calling and indignation at our refusal to accept your flimsy claims on their surfaces.”

    I will direct you to the article that Jann has written in regards to efficacy…..”Spinal manipulation is a physical therapy employing a high velocity, low thrust technique whereby a joint (such as a spinal vertebra) is moved beyond its normal physiological range of motion. The primary purpose of the therapy is to create mobility in an otherwise tightened joint. While its mechanism of action is not fully understood, it is biologically plausible and has some evidence of effectiveness for certain types of back and neck pain. It is “conventional” medicine”

    “I don’t believe any rational being denies that the body is capable of healing itself. What we don’t believe is that anything you do as chiropractors contributes to this process!”

    If a reduction of pain, increase in ROM or restoration of proper biomechanics are considered healing than I disagree with you!

  37. jhawk says:

    WLU,

    “Most doctors would probably say that means having a spine that moves, bends and supports without pain.”
    Agreed.

    “Isn’t it taught in many chiro schools that adjusting the spine can treat non-musculoskeletal conditions?”

    I can only say with absolute certainty that my school did not. I think some/many still are and is not good.

    “The reason most docs (and contributors here) criticize chiropractors is because at least a substantial minority (possibly a majority) believe a well-functioning spine has implications for systemic conditions beyond mere musculoskeletal complaints. At least some chiropractors believe adjusting the spine can treat allergies, cancer, acute infections and more.”

    I agree with you that this is total BS. I just don’t think it is as widespread as this as many here are lead to believe. Maybe I am wrong but I just don’t see it in talking with my colleagues.

    “You yourself do this jhawk, by pretending that all chiropractors are straights (or mixers? I forget which ones are crazy and which ones are more reasonable) who restrict themselves to just musculoskeletal pain. They don’t.You ignore the nutters like this guy that oppose vaccination, pretend vitamins are magic and claim they can cure cancer (or prevent cancer, or whatever nonsense is asserted without proof and completely contradicting what real medicine has to say). There’s no reason to think that adjusting the spine can help the body attack cancerous or precancerous cells.”

    I did not mean to imply that. There are definitely nutters out there but I think and am hopeful they are at least dwindling.

    “Though SBM shouldn’t portray all chiropractors as dangerous lunatics (a minor beef I have with the site), you shouldn’t whitewash the fact that some of your peers make outrageously wrong claims and pretend they’re doctors rather than physiotherapists (my main beef with you).”

    Agreed.

  38. Harriet Hall says:

    “If a reduction of pain, increase in ROM or restoration of proper biomechanics are considered healing than I disagree with you!”

    The point is that the effective things chiropractors do is not “chiropractic,” not something unique offered only by chiropractors. The same effective modalities are available in non-chiropractic settings.

  39. tgobbi says:

    # jhawkon 27 Jul 2012 at 1:06 pm
    WLU,

    “Isn’t it taught in many chiro schools that adjusting the spine can treat non-musculoskeletal conditions?”
    I can only say with absolute certainty that my school did not. I think some/many still are and is not good.

    As I stated yesterday I spend a lot of time in the trenches, meaning that I attend chiropractic lectures, attempt to establish dialogs with D.C.s and stop in at D.C. offices to pick up the latest tracts promising treatment options for just about every disease known to man. It’s been my observation than the overwhelming majority of chiropractors claim bona fides in treating at least some disease conditions. Around here we have chiropractic “pediatricians” who treat otitis media, in some cases claiming that they have had kids referred to them by actual doctors. At one time I corresponded with a D.C. who claimed that chiropractic could prevent SIDS! Many cite success with bedwetting, ADD & ADHD and even autism! For quite a while there was a huge push to convince a naive public that D.C.s are qualified to be considered primary care, entry level physicians, a claim that is so preposterous that an entire book could be written to refute it.

    jhawk states that believers and practitioners of such nonsense are in the minority but I contend that they represent the mainstream of the business. I encounter D.C.s who consistently make virulently anti-medical comments, tell their customers that their M.D.s are overmedicating them and adhere to the red herring of “cut, burn & poison.”

    “The reason most docs (and contributors here) criticize chiropractors is because at least a substantial minority (possibly a majority) believe a well-functioning spine has implications for systemic conditions beyond mere musculoskeletal complaints. At least some chiropractors believe adjusting the spine can treat allergies, cancer, acute infections and more.”
    I agree with you that this is total BS. I just don’t think it is as widespread as this as many here are lead to believe. Maybe I am wrong but I just don’t see it in talking with my colleagues.

    As stated above and in my previous posts I contend that this represents the chiropractic mainstream. I suggest that jhawk might consider looking beyond his immediate colleagues and expand his base. I don’t doubt jhawk’s sincerity but I question his familiarity with the overall chiropractic picture.

  40. Scott says:

    I did not mean to imply that. There are definitely nutters out there but I think and am hopeful they are at least dwindling.

    Based on searching through chiropractic websites, the overwhelming majority are absolute nutters, quacks, and frauds.

    Heck, even if it’s only 25% – or 10% – that’s enough to completely obliterate the entire profession as credible. When you have no way to ensure that a particular chiropractor is not an outright fraud, the only safe course of action is to avoid them all.

  41. jhawk says:

    WLU,
    one last bit on the doctor thing. I think being called doctor is fine along as the person calling you doctor knows which type of doc you are. Just as I always call my dentist and my optemetrist by Dr.. XYZ. In my office, I usually introduce myself with just my name….. my preference I guess.

  42. jhawk says:

    HH,

    “The point is that the effective things chiropractors do is not “chiropractic,” not something unique offered only by chiropractors. The same effective modalities are available in non-chiropractic settings.”

    I agree but it could be argued we are the best trained in some of these modalities.

  43. jhawk says:

    scott,

    “Based on searching through chiropractic websites, the overwhelming majority are absolute nutters, quacks, and frauds.”

    A lot of crazy stuff I agree. Many who have to market are nutty. The good more evidence based ones don’t have to market because their business is referral based. My office doesn’t have a website. I have no idea of the ratio though.

    “Heck, even if it’s only 25% – or 10% – that’s enough to completely obliterate the entire profession as credible. When you have no way to ensure that a particular chiropractor is not an outright fraud, the only safe course of action is to avoid them all.”

    yep, even 10% is to great a number. I have said this here before and am not sure if you are a med professional yourself but you will be able to tell the more evidence base chiro’s as they will write letters and refer to you.

  44. joebrence9 says:

    WLU,
    I have to disagree with the statement:

    ” Though SBM shouldn’t portray all chiropractors as dangerous lunatics (a minor beef I have with the site), you shouldn’t whitewash the fact that some of your peers make outrageously wrong claims and pretend they’re doctors rather than physiotherapists (my main beef with you).”

    Chiropractors are not Medical Doctors nor Physiotherapists (I am a PT). Medicine and Physical Therapy are both scientifically based, plausible and supported by well-constructed literature. Each have their respective roles in patient care. Chiropractics is its own, separate (“magical”) entity and should not be compared to either.

  45. jhawk says:

    tgobbi,

    “As stated above and in my previous posts I contend that this represents the chiropractic mainstream. I suggest that jhawk might consider looking beyond his immediate colleagues and expand his base. I don’t doubt jhawk’s sincerity but I question his familiarity with the overall chiropractic picture”

    I shall try. The last seminar I attended had new grads (within past 5 years) from all different schools. After talking with them I reached these conclusions, There are actually many schools that seem to be on the same page as mine (as evidence based as MSK medicine can be!). Also, there were about 3 DC’s who attended Palmer (a school noted for more crazy stuff) and each of them seperately told me that about 1/3 actually fell into woo that some of the higher ups (now being removed/retired) preached. Aneccdotal, I know and still to a high a percentage but I think much more promising than 10 years ago.

  46. Scott says:

    The frauds get referrals too. That’s no kind of filter.

  47. @jhawk, I’d love to see your argument that chiropractors are better trained than physical therapists at doing things that may actually benefit the patient. We have to remember that chiropractic schools are way less competitive and get poorer quality students. We also have to remember that chiropractic school wastes time on teaching you how to take x-rays and teaching you how to invent new X-ray findings. (And you can’t deny that you spend a lot of time on this, after all it takes a real X-ray technmanynyears of school to get these skills!). And the chiropractic schools waste time on other crap like how to run a practice, and some waste time on the history of chiropractic, supplements, subluxations, etc. So how exactly do you get better training when so much of your education is wasted on things that are only a detriment to you?

  48. @jhawk, re: your claim that some chiropractors are trying to be SBM, the only solution is to get a real education and get a real degree. Even if you’re “science based”, you’re still a low quality student with a zero-to-low quality education. Just because someone accepts science doesn’t make up for a lack of brains and education. You still need to learn the right way to practice physical therapy… you know, at physical therapy school.

  49. Harriet Hall says:

    @jhawk,

    ” it could be argued we are the best trained in some of these modalities.”

    Yes, and that makes it doubly unfortunate that the title of chiropractor has become so entangled with quackery. If only that expertise could be put to good use under a new job description, with treatment based on science. Then physicians would know where to send patients without fearing they would be exposed to CAM nonsense, doctor-bashing, and anti-vaccine propaganda.

  50. Scott says:

    Even if you’re “science based”, you’re still a low quality student with a zero-to-low quality education.

    Just because the bar is low, doesn’t mean that all the students barely clear it. IOW, the “low quality student” is an generalization of dubious applicability to any individual case.

    Unfortunately, “zero-to-low quality education” rather overstates the value; when so much of the curriculum required by the licensing exams is outright falsehood, the actual value of the education probably comes out a net negative.

  51. BillyJoe says:

    skeptical_acupuncturist,

    “If they see that acupuncturists, chiropractors, or naturopaths who comment in support of moving towards a science-based practice and rejecting pseudoscientific superstition are insulted, chased away, and incorrectly overgeneralized as totally hopeless frauds, it will probably just polarize factions and close minds to SBM/EBM.”

    I cal this the Accommodationists Fallacy.
    There is no evidence that this approach works.
    There is also no chance that it can work because acupuncture/chiropractic and science have nothing in common and therefore accommodation is impossible.

    “Not many CAM practitioners…are going to abandon their profession overnight, but many of them will change how they practice, tone down the claims that they make, and develop a better opinion of science-based medical providers.”

    As I said, there is no evidence that the accommodationist approach (telling lies to change people’s minds) works as opposed to telling the truth.

  52. tgobbi says:

    # Scotton 27 Jul 2012 at 4:16 pm
    Even if you’re “science based”, you’re still a low quality student with a zero-to-low quality education.
    Just because the bar is low, doesn’t mean that all the students barely clear it. IOW, the “low quality student” is an generalization of dubious applicability to any individual case.
    Unfortunately, “zero-to-low quality education” rather overstates the value; when so much of the curriculum required by the licensing exams is outright falsehood, the actual value of the education probably comes out a net negative.

    ***

    OK, I’m going to go out on a limb here and make a few comments that, perhaps, might be better left unsaid. But my low opinion of chiropractic and, by extension, its practitioners compels me to ignore my better judgement.

    As I keep repeating, my experience with chiropractic extends back more than 30 years. In addition to examining the business as an outsider I’ve also seen a number of D.C.s professionally beginning with one appointment, although I knew it was a bad idea, at the recommendation of a neighbor who insisted that the guy could help me with chronic back pain. (He didn’t and after the second visit I couldn’t even straighten up for several days). All my other face-to-face encounters have been as an investigator, generally having aviailed myself of offers for free exams and consultations. I went to one of them with a hidden tape recorder and surreptitiously recorded both hours (exam & consult). I subsequently wrote a 2-part article based on the recordings. This article has appeared on several websites. In addition I have had correspondence with many (numbering in the dozens) by mail and, once I became a computer user, by email. In my estimation their intellects have run the gamut from one “reform” D.C. who obviously has a considerably higher than average IQ to several who impressed me as cretinous semi-literates. In between, I’d venture a guess that none would have qualified for acceptance to medical school. Their orientations ranged from dismissive of science-based medicine to virulently anti M.D. Just about all pretended to take a medical history but I seriously doubt if any of them had the slightest notion of what my medications were for. Some asked me if I wanted to be on pills for the rest of my life. (Not directly affecting me, there was one example of a friend with MS who was told be a chiropractor that her neurologist was dosing her incorrectly with medications which I believe might have been a criminal breech of ethics. Certainly it approached practicing medicine without a license). Most of those I visited mentioned subluxations by name and just about all claimed they could help me “get better” although no specifics were mentioned. Surprisingly not all of them wanted to take x-rays. Other than the one I recorded I didn’t let any take pictures. One wouldn’t proceed without x-rays so I just up and left.

    As for the chiropractors I’ve corresponded with, most of them reacted with great negativity when I asked even simple, legitimate questions about what they do and claim. Two or three said that they were “going to pray to Jesus to help take the hatred from my heart.” Several admitted to incorporating religion into their practices, Christianity in all cases. Direct questions are generally met with insults (many aimed at Stephen Barrett who is their favorite whipping boy. I think they have a special circle in hell reserved for him)!

    In conclusion (to cut this long post short) I’d estimate that the average D.C. I’ve encountered isn’t particularly bright. Most are deeply mired in superstition and just about all of them are woefully ignorant of science and the scientific method. Facts are irrelevant to the typical D.C. I’ve encountered and most cling to chiropractic nonsense even when exposed to legitimate studies that run counter to their established belief systems. They take great pride in having the “doctor” title and are offended when I question their qualifications as healthcare professionals.

  53. Jann Bellamy says:

    @jhawk

    To say I am “biased” against chiropractors is to say that my conclusions are based on some preconceived notions about chiropractic, not objective facts. I think in this and other posts on the subject I have cited sufficient evidence to support my conclusions. Simply disagreeing with the conclusions I draw from the evidence is not an adequate basis upon which to say I am “biased.”

    “Is it possible this just means we should have a structurally sound and well functioning spine?”

    No, it is a statement, as I said, of belief in the subluxation. The quoted phrase is taken from the Association of American Chiropractic Colleges “consensus statement:”

    “The practice of chiropractic focuses on the relationship between structure (primarily the spine) and function (as coordinated by the nervous system) and how that relationship affects the preservation and restoration of health . . .
    The body’s innate recuperative power is affected by and integrated through the nervous system . . .
    Chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on the subluxation . . . [which is] a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health . . . “

    Which is a bunch of nonsense.

    Which brings me to your point about the “nutters.” All of the major chiropractic organizations agree that the subluxation is a diagnosable, clinically significant condition, treatable by chiropractic adjustment/manipulation. The Council on Chiropractic Education, the accrediting agency for U.S. chiropractic colleges, requires competency in subluxation diagnosis and treatment as part of accredited Doctor of Chiropractic programs. http://www.cce-usa.org/uploads/2012_CCE_Manual_of_Policies.pdf
    A 2010 report from the National Board of Chiropractic Examiners (NBCE) states that “the specific focus of chiropractic practice is known as the chiropractic subluxation or joint dysfunction.” http://www.nbce.org/publication/practice-analysis.html#download The NBCE clinical examination includes detection and correction of a subluxation. Both the American Chiropractic Association and the International Association of Chiropractors agree with this position.

    According to a 2003 survey of North American chiropractors, 88% thought that the term vertebral subluxation complex should be retained by the chiropractic profession. They also thought that the subluxation is a significant contributing factor in 62% of visceral ailments. Almost 90% thought that the adjustment should not be limited to musculoskeletal conditions. (McDonald W: How Chiropractors Think and Practice: The Survey of North American Chiropractors. ADA, OH: Institute for Social Research, Ohio Northern University; 2003.)

    As far as I can tell, neither the chiropractic schools nor chiropractic organizations are doing anything about the fact that chiropractors are “diagnosing” and “treating” “subluxations” for a wide variety of conditions. Far from it. If this behavior were consigned to the realm of the “nutters” then you’d think the major chiropractic organizations and the schools would be doing something about it, like warning the public. They aren’t. Nor do I see any effort to remove subluxation detection and correction from the state chiropractic practice acts.

    “Anyway, this comparison seems childish (apples and oranges). And I think we can all agree that stellar grades in school and on standardized tests does not equate to a competent doctor?”

    No, but being an M.D. does not require only “stellar grades in school and on standardized tests.” In any event, the minimal entrance requirements for chiropractic school are not insignificant unless you are willing to argue that GPAs and entrance exams have no meaning. The purpose of minimum GPAs and entrance exams is to weed out those students who are unlikely to be able to perform up to the standards required for a graduate program. What the chiropractic schools standards mean is that any student with a 2.5 average in 90 undergraduate hours can likely do the work. That does not indicate that a high level of ability is needed and does not reflect well on the quality of education. It is incongruous with the right to use the honorific “doctor,” especially in the healthcare field.

    “I agree but it could be argued we are the best trained in some of these modalities.”

    Assuming this is true, there is no evidence that this translates into better outcomes.

  54. jhawk says:

    Jann,

    “No, it is a statement, as I said, of belief in the subluxation. The quoted phrase is taken from the Association of American Chiropractic Colleges “consensus statement:”

    ACA’s definiton of subluxation:
    A motion segment, in which alignment, movement integrity, and/or physiological function are altered although contact between joint surfaces remains intact.

    There are many definitions it seems. Politics I guess. To many chiro’s, and as was taught at my school, the term subluxation basically means a hypomobile joint and nothing more. Is the term subluxation confusing, IMO yes. Should it be changed to joint dysfunction or any other term that doesn’t already have a medical definition, IMO yes.

    “They also thought that the subluxation is a significant contributing factor in 62% of visceral ailments. Almost 90% thought that the adjustment should not be limited to musculoskeletal conditions. (McDonald W: How Chiropractors Think and Practice: The Survey of North American Chiropractors. ADA, OH: Institute for Social Research, Ohio Northern University; 2003.)’

    Not good. Not sure I had seen this before. Do you know specifics (age, region, school they attended, etc.) of the respondents?

    “In any event, the minimal entrance requirements for chiropractic school are not insignificant unless you are willing to argue that GPAs and entrance exams have no meaning.”

    I wouldn’t argue no meaning but am not sure they are as meaningful as some portray.

    “What the chiropractic schools standards mean is that any student with a 2.5 average in 90 undergraduate hours can likely do the work”

    This is not completely true. The minimum at UWS is a 3.0 average. The 90 hours is true but is also true for some med school minimum entrance requirements as well.

  55. jhawk says:

    scott,

    “Unfortunately, “zero-to-low quality education” rather overstates the value; when so much of the curriculum required by the licensing exams is outright falsehood, the actual value of the education probably comes out a net negative”

    I have talked about this before and when it comes down to it, the licensing exam is about ~3% BS. Still to much IMO.

  56. jhawk says:

    HH,

    “Yes, and that makes it doubly unfortunate that the title of chiropractor has become so entangled with quackery. If only that expertise could be put to good use under a new job description, with treatment based on science. Then physicians would know where to send patients without fearing they would be exposed to CAM nonsense, doctor-bashing, and anti-vaccine propaganda.”

    I hear ya, try being on my side of the fence :)

    And sorry for the multiple posts but there were a lot of questions/respones I did not answer.

  57. jhawk says:

    SH,

    “We also have to remember that chiropractic school wastes time on teaching you how to take x-rays”

    About 9 class/lab hours out of 418. (this does not include clinic hours)

    “and teaching you how to invent new X-ray findings.”

    I assume you are talking about chiropractic subluxation…. we spent zero hours as you can not see them via xray.

    “And the chiropractic schools waste time on other crap like how to run a practice”

    Maybe 3 hours out of 418.

    “So how exactly do you get better training when so much of your education is wasted on things that are only a detriment to you?”

    I was specifically talking about HVLA, of which chiropractors have superior training to the majority of PT’s.

  58. Jimmylegs says:

    @jhawk:

    Perhaps you could clear somethings up for me, it’s probably the wording that has me confused.

    “To many chiro’s, and as was taught at my school, the term subluxation…”

    You say it means hypermobile joint, but suggest a new term. The term hypermobile joints already exist, why create a completely new term just to talk about the spine. At most you could say “hypermobility of the spine” which is just a wordy version.

    Also med schools in the US require the MCAT (along with pre-reqs, GPA, extra curricular stuff) which is a very rigorous exam to say the least. To my knowledge there is no entrance exam for Chiro schools, some may require some kind of exam for their school but no standard exists.

    “I assume you are talking about chiropractic subluxation…. we spent zero hours as you can not see them via xray.”

    The wording for me seems that you are not refuting the existence of subluxations, you are simply stating you cannot see them on an x-ray scan. You specifically assume the “chiropractic subluxation” which by adjusting this you allow the “Innate Intelligence” to heal our selves.

    So what do you accept? They exist and cause disease (or at least interferes “self healing”) or it’s mombo-jumbo. I cannot find any reference to teaching subluxations at UWS, so I will take your word that you were not lectured in it. However, when looking at the services of the centers, the acupuncture blows a hole in the credibility of the other services http://www.uws.edu/Clinics/Acupuncture_Services.aspx. But the chiro services also claim to help treat “… allergies, digestive disorders and otitis media.” Which is not true, even if it was there are no links to any research that I can find on the site to back up these claims.

    From what you are saying I cannot say you are a woo-pusher but after doing a bit of digging I cannot take your word too seriously.

  59. jhawk says:

    Jimmylegs,

    “You say it means hypermobile joint, but suggest a new term. The term hypermobile joints already exist, why create a completely new term just to talk about the spine. At most you could say “hypermobility of the spine” which is just a wordy version.”

    I believe I said hypo-mobile joint but this term already exists as well. There are a multitude of different terms that are used across professions to describe joint dysfunction.

    “Also med schools in the US require the MCAT (along with pre-reqs, GPA, extra curricular stuff) which is a very rigorous exam to say the least. To my knowledge there is no entrance exam for Chiro schools, some may require some kind of exam for their school but no standard exists”

    MCAt falls under the entrance exams umbrella. Chiro school does not have one. There is talk but hasn’t come to fruition.

    “The wording for me seems that you are not refuting the existence of subluxations, you are simply stating you cannot see them on an x-ray scan. You specifically assume the “chiropractic subluxation” which by adjusting this you allow the “Innate Intelligence” to heal our selves.”

    I do refute the existence of subluxation if it is used as a term with meanings of innate intelligence and nerve flow or other BS but my point was that it is used by many as another term for joint dysfunction.

    “So what do you accept? They exist and cause disease (or at least interferes “self healing”) or it’s mombo-jumbo.”

    hypomobile/hypermoblie joints can lead to soft tissue compensation creating excessive loading patterns on other soft tissue structures and joints possibly leading to pain.

    “However, when looking at the services of the centers, the acupuncture blows a hole in the credibility of the other services http://www.uws.edu/Clinics/Acupuncture_Services.aspx.”

    Does acupuncture being offered in hospitals blow a hole in the credibility of the whole hospital?

  60. Haha, I would think that a chiropractic entrance exam would be nothing more than a test that evaluates the potential-student’s ethics. The lower the score the better!

    ***

    Potential Exam Questions for the Chiropractic Q.U.A.C.K. (Questions Uniting All Chiropractic Knowledge) Exam:

    1. “Do you have feelings of guilt after you knowingly rip off an elderly patient?”

    2. “Do you feel bad defrauding Medicaid by charging patients for worthless treatments?”

    3. “Do you believe that vaccinations are the Devil’s work?”

    4. “Have you ever paralyzed a kid by pushing on his neck or back? If not, would you feel bad if this happened?”

    5. “Are you ignorant enough to believe that you can have minimal training in taking X-rays and perform them safely?”

    6. “Do you feel bad about exposing innocent people to ionizing radiation, despite not being able to treat anything that is diagnosed on X-rays?”

    7. “Are you able to look into a sick person’s eyes and lie to them?”

  61. BillyJoe says:

    WARNING: THIS IS COMPLETELY OFF TOPIC.

    SkepticalHealth,

    This is just for your information as a follow up of a previous discussion.
    (ie I’m not intending to restart the discussion. I just thought you might be interested.)

    http://www.theage.com.au/national/cancer-specialist-slams-prostate-spin-for-cash-20120731-23d6y.html

    The evidence-based opinion of this cancer specialist pretty well coincides with my evidence-based opinion about PSA testing and the use of robotic surgery as a result of following the outcome of clinical trials of prostate cancer screening and treatment over the past few years. On the other hand, it seems pretty clear to me that the opinion of the urologist mentioned is anecdotal rather than evidence-based.
    (Again, I’m not intending to rehash the discussion)

  62. Jann Bellamy says:

    @ jhawk
    “The 90 hours is true but is also true for some med school minimum entrance requirements as well.”

    Could you please supply a citation for your statement that there are med schools which require only 90 undergraduate hours to get in?

  63. Cowy1 says:

    @jhawk/Jann Bellamy,

    You can easily dig this up via the MSAR or any other reputable med-school admissions website but many (maybe most) only technically require 90 credit hours, any MCAT score and 2.5 GPA.

    However, to compare minimum entrance requirements is pretty ridiculous given that a student with a 2.5 GPA, 22 MCAT and a bunch of community college credits would easily gain admission to any chiropractic school (either directly or through their bogus “remediation” courses). Our slacker student would have no trouble getting through the 3-and-change year program either because, no matter how dumb, the school needs his tuition money to keep the doors open.

    By contrast, my own “average” midwest MD school has similar minimum entrance requirements but the average stats last year were a 3.7 GPA and 32 MCAT. We also apparently got nearly 12,000 applications, interviewed maybe 350, and accepted about 220 for our ~140 seats. Our admitted chiropractic student, while technically attaining the minimum entrance requirements, wouldn’t even have his application make it past the initial screen.

    Additionally, the academic rigor of medical school is unquestionable and is the standard by which all other programs are compared.

  64. Scott says:

    That argument does, however, indicate that citing chiropractic school entrance requirements as saying anything about chiropractors is inappropriate. Citing the stats about which students actually attend would be meaningful, but harder to obtain.

    There are plenty of other reasons to conclude that chiropractic is so completely controlled by quacks that it should be abolished wholesale; entrance requirements are not one of them.

  65. jhawk says:

    Scott,

    “That argument does, however, indicate that citing chiropractic school entrance requirements as saying anything about chiropractors is inappropriate. Citing the stats about which students actually attend would be meaningful, but harder to obtain.”

    Exactly my point with the childish argument comment I posted earlier.

  66. jhawk says:

    Cowy1,

    “Our slacker student would have no trouble getting through the 3-and-change year program either because, no matter how dumb, the school needs his tuition money to keep the doors open.”

    Probably true to some extent but we definitely had a percentage (unkown) of students that couldn’t hack it and were booted.

    Jann,

    Cowy1 answered your question to me quite nicely. I will ask my question to you again….. Do you know specifics (age, region, school they attended, etc.) of the respondents to the Mcdonald survey? Is this an accurate representation of the totality of the chiropractic community? Sampling bias?

  67. Mark says:

    Very timely to see this. I just rounded on a patient yesterday that is observing his 50th anniversary of being a quad as a result of chiropractic manipulation. He told me the story of the day he became paralyzed with tears in his eyes as if it were yesterday. Bad things can always happen even with treatments that have a chance of working. Spending 50 years paralyzed because of quack medicine is tragic and wrong. Nevertheless, the practice continues, and I just read an article last week of yet another permanent neuro injury from cervical manipulation. We have learned nothing it seems.

  68. Jann Bellamy says:

    @jhawk

    “I will ask my question to you again….. Do you know specifics (age, region, school they attended, etc.) of the respondents to the Mcdonald survey? Is this an accurate representation of the totality of the chiropractic community? Sampling bias?”

    Sorry for the late response. I didn’t realize there was a question pending.

    From the McDonald survey’s description of it’s sampling methods:

    “[The survey] began with a systematic random sample of 1102 active chiropractors drawn from Dynamic Chiropractic’s 60,409 names in Canada, Mexico and the United States. An overall response rate of 63.3% suggests that the 687 respondents are representative of chiropractors of North America. The survey was conducted under the aegis of the Insttiute for Social Research, Ohio Northern University. The Institute performed the statistical analysis. . . . A plurality (46.4%) of the North American respondents rate themselves as middle scope chiropractors — between the broad scope (mixer) and focused scope (straight) designations. The latter two labels garner 34.3% and 19.3% respectively.”

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