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Science-based Chiropractic: An Oxymoron?

I spent 43 years in private practice as a “science-based” chiropractor and a critic of the chiropractic vertebral subluxation theory. I am often asked how I justified practicing as a chiropractor while renouncing the basic tenets of chiropractic. My answer has always been: I was able to offer manipulation in combination with physical therapy modalities as a treatment for mechanical-type back pain—a service that was not readily available in physiotherapy or in any other sub-specialty of medicine.

If I had it to do over again, however, I would study physical therapy rather than chiropractic. Considering the controversy that continues to surround the practice of chiropractic, I would not recommend that anyone spend the time, effort, and money required to earn a degree in chiropractic. Physical therapy, which is now beginning to include spinal manipulation in its treatment armamentarium, may offer better opportunity for those interested in manual therapy. Properly-limited, science-based chiropractors are now essentially competing with physical therapists who use manual therapy. Unfortunately, only a few chiropractors have renounced the vertebral subluxation theory, making it difficult to find a “good chiropractor.” I consider physical therapy to be more progressive and more evidence based. For this reason, I generally recommend the manipulative services of a physical therapist rather than a chiropractor.

There are some science-based chiropractors who use manipulation appropriately, but until the chiropractic profession abandons the implausible vertebral subluxation theory and is defined according to standards dictated by anatomy, physiology, and neurology, I would not describe it as a science-based profession.

Heretics and Science-Based Chiropractors

After my second year in chiropractic college, I came to the conclusion that the chiropractic subluxation theory was not a credible construct. In an effort to separate the good from the bad in the use of manipulation by chiropractors, I published my book Bonesetting, Chiropractic, and Cultism in 1963, renouncing the chiropractic vertebral subluxation theory and suggesting that chiropractors should limit their use of spinal manipulation to treatment of back pain. Over the years, I wrote many articles critical of chiropractic, always suggesting that the definition of chiropractic be changed in chiropractic colleges and state laws so that the next generation of chiropractors would be properly limited. Science-based chiropractors could be separated from their subluxation-based counterparts under a new degree, such as a “Doctor of Chiropractic Therapy” (DCT) or a “Chiropractic Manual Therapist” (CMT). I suggested that it would not be necessary for chiropractors to practice as “doctors”—they could practice as therapists offering non-surgical, drug-free treatment for back pain and related musculoskeletal problems, a new specialty combining use of manipulation with physical therapy modalities. Needless to say, this change never occurred and I was labeled a “chiropractic heretic”—or worse—by my colleagues.

Today, the educational requirements for obtaining a degree in chiropractic have improved. Most chiropractic college applicants now have undergraduate degrees. But the basic definition of chiropractic has not changed. As currently defined by the North American Association of Chiropractic Colleges, “Chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on the subluxation,” indicating that the majority of chiropractors may still adhere to a basic version of the subluxation theory. Few chiropractic college graduates may be able or willing to abandon a belief system they must depend upon for an income.

Filling a Need for Manual Therapy

At the present time, spinal manipulation is still not as readily available in medical practice as it should be, leaving an opening for the services of a good─albeit rare─science-based chiropractor who combines manipulation with physical therapy modalities. But it would be necessary for such a chiropractor to openly renounce the chiropractic vertebral subluxation theory (more of a belief than a theory) and publicly state that his or her practice is limited to care of musculoskeletal problems. Unfortunately, as indicated by the paradigm of the North American Association of Chiropractic Colleges, such chiropractors may be in the minority, even among recent graduates─at least in the United States.

High-velocity, low-amplitude (thrust type) spinal manipulation is not yet commonly used by physical therapists. For this reason, orthopedists and neurologists who are familiar with manual medicine are often willing to refer back-pain patients to a good chiropractor for manipulation as well as to steer patients away from subluxation-based chiropractors. Physicians can often locate good chiropractors by reading their office notes and by talking with their patients.

Most cases of back pain are self limiting, and spinal manipulation is not often more effective than other physical treatment modalities in affecting the final outcome. But in many cases, appropriate spinal manipulation may provide more immediate symptomatic relief than other forms of therapy. And in special cases, thrust-type manipulation may be the best way to restore mobility in spines stiffened by post-traumatic adhesions or locked by muscle spasm and binding vertebral joints. For this reason, benefit may outweigh risk when manipulation is used appropriately in the treatment of carefully selected cases of mechanical-type back pain. But there is no evidence to indicate that upper neck manipulation provides more benefit than risk, considering the risk of damage to vertebrobasilar arteries.

Use of manipulation combined with instruction, massage, physical therapy, and rehabilitation may be the best way to relieve mechanical back pain and keep the patient mobile until recovery is complete—provided, of course, that treatment is based on a correct diagnosis. A science-based chiropractor who works in concert with a patient’s physician can often provide such a treatment regimen—as opposed to solo subluxation-based chiropractors whose primary concerns are locating and correcting vertebral subluxations.

Separating the Good from the Bad

Since the vertebral subluxation theory continues to form the foundation of chiropractic, it seems unlikely that the chiropractic profession will ever abandon the belief that adjusting spinal joints will restore and maintain health. Many chiropractors who say that they reject D.D. Palmer’s subluxation theory simply come up with new terminology that identifies some kind of vertebral joint “dysfunction” that allegedly affects the nervous system, thus interfering with the body’s ability to heal itself. Failure of chiropractic colleges to reject such views and make the changes needed to develop chiropractic into a musculoskeletal back-pain specialty (with commensurate changes in state laws) may simply allow chiropractic to continue as an alternative healing method, such as homeopathy or acupuncture, permitting its practitioners to treat the gamut of human ailments as “primary care providers.” It may then be necessary to depend primarily upon physical therapists for appropriate use of manipulation based on credible research. Chiropractors who can no longer tolerate the controversy associated with chiropractic can retrain as physical therapists, making good use of their training in the use of manipulation. Forty-three states now grant physical therapists direct access to patients; that is, referral from a physician is not needed.

Although I am a critic of chiropractic, I would not hesitate to offer support to a good science-based chiropractor who has separated himself or herself from the herd by expressing views that oppose the implausible treatment methods that are so prevalent among chiropractors. When I was in practice as a chiropractor, I felt an obligation to speak out so that friends, patients, and health-care professionals would not assume that my approach represented chiropractic in general. I worried that a patient who was pleased with my services might assume that treatment by any other chiropractor would be the same. Unfortunately, chiropractic treatment based on the implausible vertebral subluxation theory may be so inconsistent that treatment for any condition may range from an atlas adjustment to a sacral adjustment, all purported to be effective in improving health by removing “nerve interference.” So far, apparently reluctant to bite the hand that feeds them, chiropractic associations in the United States have failed to publicly renounce the vertebral subluxation theory or to condemn the multitude of dubious treatment methods based on subluxation theory.

Today, chiropractic treatment in America is like Forrest Gump’s box of chocolates: “You never know what you’re gonna get.”

Why the Chiropractic Vertebral Subluxation Theory Is Implausible

Scientific consensus does not support the theory that nerve interference caused by vertebral misalignment is a cause of organic disease. Spinal nerves primarily supply musculoskeletal structures. Organ function is governed by the autonomic nervous system in concert with psychic, chemical, hormonal, and circulatory factors.

The vagus nerve is an autonomic (parasympathetic) cranial nerve that originates in the brain stem and passes down through the neck and thorax to the abdomen to supply organs along its path. Preganglionic autonomic fibers, which pass through spinal segments from T1 thru L2, terminate in sympathetic trunk and splanchnic ganglia located outside the spinal column. Autonomic cranial and sacral nerves pass through solid bony openings.

The vagus nerve along with autonomic ganglia and nerve plexuses provide overlapping sympathetic and parasympathetic nerve supply from many directions to assure continued function of the body’s organs, independent of spinal nerves. This is why a transverse spinal cord injury at the C4 or C5 level can paralyze musculoskeletal structures from the neck down while involuntary functions of organs continue. With this fail-safe mechanism in place, I don’t know of any reason to believe that slight misalignment of a single vertebra or an undetectable “vertebral subluxation complex” can be a cause of organic disease as suggested by the chiropractic vertebral subluxation theory.

Spinal nerves are commonly compressed by bony spurs and herniated discs. Even the most severe compression of a spinal nerve, which may cripple the supplied musculoskeletal structures, does not cause organic disease. The sphincter muscles involved in voluntary control of bladder and bowel functions are supplied primarily by spinal nerves and sympathetic fibers that are well protected in their passage through the solid bony openings that form the sacral foramina.

When there is disc protrusion into the spinal canal, or when there is a space-occupying mass in the spinal canal compressing cauda equina spinal nerves that travel down (from the conus medullaris at the lower border of the 2nd lumbar vertebra where the spinal cord ends) to exit lumbar and sacral foramina, loss of voluntary control of bladder and bowel muscles (most commonly urinary retention) signals a medical emergency that requires the immediate attention of a neurosurgeon.

Implausible Theory Fosters Implausible Treatment Methods

The implausibility of the chiropractic vertebral subluxation theory does not provide a foundation for a consistent, replicable treatment method. As a result, vertebral subluxation theory has fostered the development of a great variety of antithetical chiropractic treatment methods designed to “remove nerve interference,” many of which do not involve use of hands-on manipulation—such as healing touch or use of a spring-loaded stylus to tap vertebrae into alignment. Such treatment methods are unrelated to legitimate use of manual manipulation in the treatment of back pain and related musculoskeletal problems.

The chiropractic (undetectable) “vertebral subluxation complex” is not the same as a true vertebral misalignment, a true vertebral subluxation, or any one of a number of joint problems that cause mechanical-type symptoms (which can often be relieved by manipulating the spine) but are not alleged to be a cause of visceral disease.

Proper treatment hinges on a proper diagnosis, which, in my opinion, is never a “vertebral subluxation complex.”

Posted in: Chiropractic

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102 thoughts on “Science-based Chiropractic: An Oxymoron?

  1. BillyJoe says:

    Sam,

    “Science-based chiropractors could be separated from their subluxation-based counterparts under a new degree, such as a “Doctor of Chiropractic Therapy” (DCT) or a “Chiropractic Manual Therapist” (CMT). ”

    It seems to me you would need to purge the word “chiropractic” from the degree title in order for the misunderstanding not to continue. In fact, but not meaning to be rude because I can see you took an extremely tough stand with your colleagues, I wonder why you didn’t purge the word “chiropractic” from your own job description.

    regards,
    BillyJoe

  2. TimMills says:

    Overall an interesting article. One comment jumped out at me as odd:

    “Organ function is governed by the autonomic nervous system in concert with psychic, chemical, hormonal, and circulatory factors.”

    Is the “psychic” in there a typo? Does it mean something different in a medical context from the everyday meaning of the term? Please clarify.

  3. DevoutCatalyst says:

    Chiropractic could have been a great name for a legitimate therapy. Even as it is, I have noticed a number of current popular references to chiropractic in a positive sense, and from a variety of sources, for example, motorcycle journalism — ” The suspension was set so stiff you’d need a month of chiropractic after riding this thing…”, etc., etc.

    But my limited experience with chiropractic as a customer was never positive, my now distant “career” as a patient was limited to a handful of visits with three compromised individual practitioners. Then never again. Naiveté cured.

    Getting x-rays from machinery that belonged in a museum of early industrial design did not inspire much confidence. Applied kinesiology seemed straight out of Barnum and Bailey. Apple cider vinegar for all that ails you? And that little actuator gun — man, at least manipulation actually felt good and productive. Say it’s not true! Oh, and you’ve got to get yourself to that electrical gizmo that affixes to the back of your neck and pulls your muscles rhythmically. Great thing that thing.

    But chiropractic is a system that does not learn. They could have owned a legitimate kingdom, maybe. Could have been a contender. I want my money back.

  4. Sam Homola says:

    Billy Joe,

    Back in the days I was referring to, manipulation was used almost exclusively by chiropractors (mostly inappropriately). I had hoped that the profession could be salvaged by changing its definition and the curriculum of its schools in order to place proper limitations on the scope of chiropractic and make science-based manipulation more available. Since I was licensed as a chiropractor, I could not change my job description.

    Today, 90% of all spinal manipulation is still being done by chiropractors, much of which is still inappropriate. Chiropractors can choose to limit their treatment to musculoskeletal problems or they can remain devoted to the subluxation theory. Since physical therapy is now including use of spinal manipulation in its treatment armamentarium, chiropractors have the option of retraining as physical therapists to get away from the stigma or the controversy associated with chiropractic subluxation theory.

    Tim Mills,

    I used the word “psychic” as an adjective for the noun “psyche” to note the affect of the mind on the body. As we all know, mental aberrations can have an adverse affect on health and body function. Perhaps I used the word incorrectly.

  5. Thanks for this very informative posting. For years the odd visit to a chiropractor has been my skeptic’s “dirty little secret”. Three or four times a year I get terrible pain in my back from an old football injury. Physiotherapy didn’t help and drugs left me stoned and still unable to move. As a last resort before surgery I was dragged to a chiropractor by a friend who insisted that “this guy isn’t a quack like the rest” and found almost instant relief. He recommended some stretching and strengthening exercises which helped me and now I’m down to once or twice a year visits. This chiropractor has never offered me anything woo-ful and I feel like I have gotten a lot of value from his treatmenst. So I guess I was lucky to find this one.

    Is it completely unrealisitc to expect a revolution from within? Is there any formal or informal organization of chiropractors who use science-based methods?

  6. Thanks for this very informative posting. For years the odd visit to a chiropractor has been my skeptic’s “dirty little secret”. Three or four times a year I get terrible pain in my back from an old football injury. Physiotherapy didn’t help and drugs left me stoned and still unable to move. As a last resort before surgery I was dragged to a chiropractor by a friend who insisted that “this guy isn’t a quack like the rest” and found almost instant relief. He recommended some stretching and strengthening exercises which helped me and now I’m down to once or twice a year visits. This chiropractor has never offered me anything woo-ful and I feel like I have gotten a lot of value from his treatmenst. So I guess I was lucky to find this one.

    Is it completely unrealisitc to expect a revolution from within? Is there any formal or informal organization of chiropractors who use science-based methods?

  7. Galadriel says:

    I’ve had, now, 7 courses of PT in several cities at multiple different PT groups (for a number of spine problems). I’ve gotten different amounts of attention and focus with varying PT groups: everything from a single PT overseeing three or four patients at a time, to a single PT who blocked out an hour just for me twice a week. None of these physical therapists has been interested in putting their hands on me for any longer than absolutely necessary; they’ll do some traction (never enough!) and they’ll do ultrasound with a machine, but nothing remotely resembling adjustment.

    I don’t know why they don’t seem to want to touch their patients; they’re certainly willing to recommend massage and even chiropractic adjustment. The PT’s themselves just haven’t seemed to want to do any manual …anything… on me–or any other patient that I’ve observed, either. Lack of training or experience in that particular field? Concerns about liability? No *time* to adjust, with all the other things they’re doing? I have no idea.

    So I’m perplexed by the assertion I keep seeing here on SBM that chiropractors are more or less obsolete, that physical therapists can do anything a chiropractor can. Perhaps they *can*, but I’ve never seen them do.

    Are there really PT’s out there who incorporate adjustment as well as stretches, exercises, traction, ultrasound/heat or ice, iontophoresis, and so on? Have I just managed to completely miss all the physical therapists who are doing adjustment, despite 7 different tries at it?

  8. jmilan says:

    Well for starters, isn’t it out of a chiropractors scope of practice to perform physical therapy? Certainly in Texas, we (licensed PT professionals) need to report any of these such activities to the licensing board. You cannot simply practice physical therapy because you want to, you need the education and the license.

    @ Galadriel:
    You describe one of the problems with the health profession, “I need you to fix me.” In physical therapy, we can teach patients to “fix” themselves. In an orthopedic setting, we do much more for a patient when we are able to teach them self-management strategies than simply going in there and doing “adjustments.” And just for the record, there are many, many PTs practicing manual therapy, that doesn’t make it any more efficacious.

    Perhaps your results were poor, that doesn’t mean anything. As much as we want to think that we can, we cannot “fix” everyone. Sometimes, time and nature do a much better job than we can do. Or maybe, you had a less than stellar therapist. There are bad PTs the same as there are bad MDs, DCs, DOs, etc.

    There is good research that demonstrates that good patient education on back pain (postural stresses, correction of these, and prophylaxis) are as effective as going through treatment. In addition, creating patient dependency is a drain on health care and not any better with results.

    So can PTs do what a chiropractor can, I suppose, but that doesn’t make it effective. Are you looking for someone to fix you, or are you seeking information that can help you prevent your back from recurring? We do much more than just watch a patient work-out. We teach effective exercises, we do “hands-on” only when appropriate, and then back off and guide and progress the patient as they improve.

    You should find Dr. Homola’s opening statement telling, “I was able to offer manipulation in combination with physical therapy modalities as a treatment for mechanical-type back pain”, I’m reading between the lines but I think I can get a glimpse of his view of physical therapy.

    I’m not sure what he included in “modalities”, but ultrasound and iontophoresis are certainly a waste of time and money for low back pain. There needs to be more research on traction but it doesn’t seem to be any better.

  9. micheleinmichigan says:

    Galadriel, When I worked with a physical therapist for lower back and leg pain (SI joint inflammation due to “twisted pelvis”, I’m told) she did both deep tissue massage and taught me to do manipulation like exercises for myself when I have pain. She was very hands on. The orthopedic doctor I was referred to confirmed those exercises and added an additional one. They are very effective.

    I do not want to invalidate your experience. I think I got really lucky with my PT person.

    Curiously, I had seen a chiropractor for the same pain years earlier. He did manipulations that were the opposite (pushed the same hip forward rather than back) which only acerbated the pain.

  10. Sam Homola says:

    Galadriel,

    It’s true that spinal manipulation is not yet commonly used by physical therapists. Since more schools of physical therapy are now teaching spinal manipulation, it will be more commonly used by physical therapists in the future.

    In the meantime, not every patient needs manipulation, which should be done only when specifically indicated. Manipulation is useful only occasionally when there is a need to increase mobility in the spine, as opposed to a “chiropractic adjustment” which is used on every patient to correct a “vertebral subluxation.”

    There are many good chiropractors who use manipulation appropriately. You just have to look for them. Many of them work along with physical therapists and physicians who are unable to provide appropriate manipulation for their patients. Chiropractors who are properly specialized can fill this niche.

  11. scottf says:

    There is a joke that goes “What do you call alternative medicine that has been proven to work? – Medicine!”

    There is a legitimate science-based profession that does physical manipulation of patients to treat them, and it is called Physiotherapy. It seems to me that any of the practices that have been proven to work through science-based methods that happen to have been discovered by chiropractors should just be incorporated into the modalities used by physiotherapists, just like the joke says.

    There is no need for a separate, legitimized chiropractor profession. It is impossible for laymen to tell the difference between the “good” chiropractors and the “bad” ones. The title of chiropractor should be abandoned entirely and the profession de-legitimized for the safety of the public.

  12. James Fox says:

    Could we see some credible scientific research that shows spinal manipulation is more effective than or as effective as no intervention at all where the test subjects are followed for a number of months after the initial complaint?

    If the practice of spinal manipulation grew out of the theories of subluxation, which are understood to be without any merit and have no credibility, then how has spinal manipulation become an accepted practice or is now considered therapeutic simply because some PT’s and non subluxation believing chiro’s still engage in the practice? It seems to me that spinal manipulation remains firmly in the arena of self reporting efficacy and anecdotal evidence absent studies that show it to be more effective than simply allowing time to pass, placebo or relying on subjective reports by patients, as well as being weighed against potential harms that are not present in other methods of treatment.

  13. jmilan says:

    James,

    There is credible research that the supports the use of some spinal manipulation. JM Fritz, A Delitto, JA Cleland, and RS Wainner to list a few authors. However, not all manipulations are effective and certainly not alone.

    LBP is multi-dimensional and not one single factor is associated with LBP. It is an accumulation of stress/forces over time (predominately, but not exclusively, from bad posture). So for this and many other reasons, the framework of subluxation is the flaw not the movement of the spine. Essentially that is what a manipulation is, movement toward the anatomical limit. Mechanical loads on a spine are effective treatments, manipulation falls in this category, but the real question should be, “Does the force always need to be at this extreme?” Force progression is important and there is no research that claims that patient-generated forces are less effective than a clinician-generated forces.

    Are clinician-generated forces sometimes necessary, absolutely, but not before attempting patient-generated forces first.

  14. Sam Homola says:

    I have always thought of “physical therapy modalities” as a generic name for a variety of physical treatment methods and not a synonym for physical therapy which encompasses a vast field of physical medicine and rehabilitation. Use of physical therapy modalities by chiropractors who identify their specialty as a method of treating visceral disease by “adjusting vertebral subluxations” is certainly an encroachment upon physical therapy.

    Some chiropractic colleges are now teaching use of physical therapy modalities along with spinal adjustments while trying to prevent use of spinal manipulation by physical therapists. Very hypocritical.

    Spinal manipulation for back problems has been around since Hippocrates. Chiropractic adjustments to correct “vertebral subluxations” began with D.D. Palmer in 1895.

  15. micheleinmichigan says:

    James – well, generally I don’t assume that my doctor is using a non-evidence based approach, especially when they have a plausible explanation and it works. Perhaps, I’m not skeptical enough. I wonder how my doc would have reacted if I demanded extensive sourcing for every treatment they recommended. I suppose it would be within my right.

    I can say that doing three exercises and taking a couple of Aleve when I have pain, has much lower side effects than the months of higher doses of NSAIDs that I was prescribed before before PT.

    jmilan – excellent point about patient generated vs clinician generated.

  16. Galadriel says:

    Hey, jmilan, you seem to think that I was complaining in some way about PT. (“poor results”? Where did I say that? Or “I need you to fix me”? Very strange what you inferred there.) I have had quite a few courses of PT for a number of different reasons; a rear-ending resulting in low back pain, a rear-ending resulting in neck pain/headaches, post-fusion PT, etc. Every time I go through PT they give me stretches, exercises for strengthening and supporting the injured area, offer me a TENS unit, and so on–not just something that can help at the moment, but things I continue after the course is over in order to hopefully never have the same problem again. These are all highly appropriate and helpful.

    A combination of statistically unlikely factors (ie, rotten luck) just keeps meaning that I’m in pain yet AGAIN and I need more help.

    So I’m not saying there’s anything wrong with the PT I’ve gotten. The PT I’ve gotten has been very helpful both in short and long term. I’m just confused that I keep seeing the statement “Chiropractors don’t do anything PT doesn’t do”–but I’ve been in *seven* courses of PT, and never had a therapist do anything remotely like adjusting my spine. Some have recommended adjustment and massage, but none have touched my back beyond ultrasound and traction.

  17. James Fox says:

    “Spinal manipulation for back problems has been around since Hippocrates. ”

    The artifacts of medical history are interisting.

    “Chiropractic adjustments to correct “vertebral subluxations” began with D.D. Palmer in 1895″

    Some artifacts of medical history are less interesting, more regrettable and not historical enough. Better to cut ties with the witch doctors and not be associated with the harms they still cause in my opinion.

  18. BillyJoe says:

    I have often read the statement:
    “Chiropractic is no better than a good massage for back pain”.
    Is this not a legitimate summary of chiropractic? Or is there something extra to be obtained from “spinal manipulation”?

    (I have never attended either a chiropractor or a physiotherapist. I had severe incapacitating lower thoracic back pain a couple of decades ago that responded completely within two weeks to initial rest (two days) followed by some stretching exercises that I’d already been using routinely in my warm-ups and warm downs before and after my mornings runs. I had obtained information of stretches from running magazines.)

  19. BillyJoe says:

    I’m going to repeat my post because it’s caught up in moderation and no one will read it otherwise:

    I have often read the statement:
    “Chiropractic is no better than a good massage for back pain”.
    Is this not a legitimate summary of chiropractic? Or is there something extra to be obtained from “spinal manipulation”?

    (I have never attended either a chiropractor or a physiotherapist. I had severe incapacitating lower thoracic back pain a couple of decades ago that responded completely within two weeks to initial rest (two days) followed by some stretching exercises that I’d already been using routinely in my warm-ups and warm downs before and after my mornings runs. I had obtained information of stretches from running magazines.)

  20. BillyJoe says:

    Okay, that didn’t work, both are caught up in moderation as I suppose willl this one.

  21. daijiyobu says:

    Per: “but it would be necessary for such a chiropractor to openly renounce the chiropractic vertebral subluxation theory (more of a belief than a theory) [...such an] implausible theory fosters implausible treatment methods.”

    I’d like to co-opt the above excerpt to portray naturopathy:

    “but it would be necessary for such a naturopath to openly renounce the Vis [a vitalistic, supernatural, teleological theory of disease (completely a SECTARIAN belief, not a theory)...such an] implausible theory fosters implausible treatment methods.”

    National University of Health Sciences is interesting, their DC and ND degrees are labeled “health science”.

    Naturopathy’s board exam labels homeopathy “clinical science.”

    And the silence from the naturopathy Sith lords regarding the recent UK homeopathy ‘it is rubbish’ decision is deafening.

    -r.c.

  22. zimney3pt says:

    Just a personal thing that I don’t like the term physical therapy modalities. As a practicing Physical Therapist I realize I don’t own using electrical or physcial modalities such as e-stim, heat, ultrasound and etc, just as you stated @Sam that manipulation or Manual Therapy should not be owned by Chiropractors. We don’t call it a nursing blood pressure.

    I know it is just semantics, but PT’s aren’t just ultrasound and e-stim – even though if you watch some practice you might argue as such. It’s unfortunate not every therapist uses the full level of the their clinical skill to fully evaluate and treat patients. I understand your concern @Galadriel that some PT’s don’t do justice to what we have been trained in school, as practicing PT I apologize that you are 0 for 7 with your care from a PT if they did not put their hands on you. @jmilan yes half of every PT or MD or Chiro graduated in the bottom of their class…. and yes modalities are at best a good placebo for low back care (but 30% of the population will improve with placebo care).

    Thanks for the excellent post on spreading the word on what is really happening with Manipulation. We need to gradually deconstruct so many past poor scientific reasons on what is truly happening. I will admit it is hard to sometime to convince some patients that something isn’t “out”. As therapist I wonder if some find it easier to say things like things are “out” or “rotated” as that is what most patients expect to here, or if they truly don’t know what is happening. This is unfortunate because it just makes it more difficult to deconstruct these non-scientific theories, when there is actual true science that helps explain what is happening from a neurological change not a subluxation change.

  23. skepticat says:

    ‘Chiropractic’ is a terrible name, IMO. It so happens I wrote about this yesterday:

    “…Ignoring the rules of declension of Greek nouns, D.D. Palmer slammed these two words together to forge a name he felt accurately represented his therapy and, as a bonus, gave it an aura of ancient wisdom and culture. Nice idea, D.D., but as a name it sucks. ‘Hand action’ could just as easily apply to reiki, reflexology or any other um…manual activity.”

    Thank you so much, Sam, for this very informative article. I recently visited a chiropractor ‘undercover’ and I was dismayed at just how full of all this ‘subluxuation’ stuff he was. He’s an American chiro but resides in London, though I’ve no reason to think British chiros are typically any closer to the sceince-based chiropractors you describe.

    I blogged about my experience here:

    http://www.skepticat.org/2010/03/inside-the-spine-wizards-den/

  24. Oroboros says:

    There’s a good article this week in The Guardian about the backlash that Chiropractors in the U.K. are facing for making false claims.

  25. One of the reasons I stopped seeing my chiropractor regularly was due to scientific concerns about the efficacy of regular ‘maintenance’ therapy for ensuring good spinal health. Had my posture and stance improved while I was seeing him once per month? Perhaps, it’s hard to evaluate that qualitatively.

    He was always very upfront that the subluxation theory had been disproven (or so I recall), but the rapid neck manipulation aspect was a concern. Not one that I voiced in front of him, however – it was simply easier to stop going.

  26. JMB says:

    Although I don’t have a reference, I would also say that the manual therapy offered by chiropractors has advantages over the common strategy of bed rest, pain relief, and muscle relaxant for treatment of acute mechanical low back pain. Could you explain the differences between chiropractic methods and osteopathic methods of spinal manipulation?

  27. PTsickofBS says:

    Sam, you must be a man of prodigious testicular fortitude, you have my upmost respect for standing against your profession. As a non-argumentative PT I am aware I don’t speak out enough against some of the more marginal activities within my profession. I guess I just have faith that SBM will bring us all to the same place eventually (faith and SBM in the same sentence??).

    @ Galadriel – the lack of manipulative PTs you have experienced could be related to geography. There seems to be pockets of PTs that tend towards particular approaches, either because that is the post grad courses the local university offers, or possibly a hangover from pre SBM days where one PT would say to another “I tried this and it worked for me – you should try it”.
    Having said that, patients of mine could feel that I don’t manipulate because I work through force progressions of patient generated mvt, patient mvt with over pressure, before moving onto therapist input of over pressure => mobilisations => manips.
    Much better to help the patient help themselves than to foster dependence on a therapist. I feel I have failed to provide the best treatment if a patient associates their recovery solely with my hands on input.

  28. rwk says:

    Dr.Homola has given you some incorrect information,as there is no North American
    Association for Chiropractic colleges it is simply called Association of Chiropractic Colleges.
    Read it yourself. The word subluxation is NOT mentioned.

    What is chiropractic?

    http://www.chirocolleges.org/whatis.html

    American Chiropractic Association ( largest prof. assn. of chiropractors).

    http://www.acatoday.org/level2_css.cfm?T1ID=13&T2ID=61

    From National University of Health Sciences:

    http://www.nuhs.edu/show.asp?durki=43

    And concerning NUHS and Evidence -Based Practice:
    http://www.nuhs.edu/show.asp?durki=676

    Not one mention of the word Subluxation

    What is Osteopathic Medicine from the governing body equivalent of the Association of Chropractic Colleges:

    http://www.aacom.org/about/osteomed/Pages/default.aspx

    Here’s an excerpt where the word Innate is used:

    Another integral tenet of osteopathic medicine is the body’s innate ability to heal itself. Many of osteopathic medicine’s manipulative techniques are aimed at reducing or eliminating the impediments to proper structure and function so the self-healing mechanism can assume its role in restoring a person to health.

    And what about the definition of Osteopathic Manipulative Medicine
    from the Abstract:
    http://journals.lww.com/academicmedicine/Abstract/2009/06000/The_National_Osteopathic_Research_Center_at_the.22.aspx

    Osteopathic physicians have a particular obligation to carry out research in areas, such as osteopathic manipulative medicine (OMM), that are unique to osteopathic medicine. OMM is similar to manual therapy that is performed by other types of practitioners, but it has some distinctive characteristics. Osteopathic doctors also use OMM to treat infectious disease-not just musculoskeletal disorders.
    Want more?

    And by the way Skepticat, Osteopathy is a much worse word describing what
    a profession ( it literally means disease of bone) does than Chiropractic ( practical hands).
    And in case you didn’t know this Skepticat,or only derived your information from the
    biased Singh/Ernst book, Chiropractic was probably copied from Osteopathy anyway.
    Chiropractic comes 20 years later from the same part of the country, same initial tenets
    just substitute vascular ( Osteopathic) for Nerve( Chiropractic) interference as the cause of most diseases. Those theories at that time weren’t much crazier than what medicine was doing: leeches,mass amputations, high dose radiation X-rays and nineteenth century pharmacology as well as guessing.

    It is also known that DD Palmer attended some classes at the Osteopathic School in Kirksville,MO so if anything you could probably only accuse him of plagiarism.

    Obviously I’m a chiropractor and I don’t use or subscribe to the word Subluxation.
    It has taken away from our legitimacy. I know many who feel the same way but many
    patients still relate to the bone out of place, back-cracking,nerve pinching explanation.
    Does your GP ever give you a technical explanation straight from his medical school books?

    How do you decide, which DC to go to? You educate yourself, then pick up the phone and then decide if you’re being duped.
    It’s the treatment that counts and the relative expense. Every practitioner has his own theory as to what is really going on based on clinical experience.
    I’ll bet many of your GP’s believe in God and go to church the day before they practice scientific evidence based medicine on you.
    That’s an oxymoron as well.

  29. Jason Silvernail says:

    Lots of good comments.
    Dr Homola, great to see you posting again!

    Certainly it’s hard to find a good provider of any service – be it a plumber, electrician, car mechanic, physician, nurse, or physical therapist.

    Luckily there are ways to find good physical therapists out there:
    http://www.apta.org
    This is the American Physical Therapy Association’s website. Click “Find a PT” at the top.
    Look for a physical therapist with a clinical doctorate (DPT) who may be board certified in Orthopedic Physical Therapy (OCS) and who has manual therapy training.

    You can find great consumer information, as well as examples of major medical studies on the effectiveness of physical therapy at this link for the American Academy of Orthopedic Manual Physical Therapists.
    http://www.aaompt.org/consumer/index.cfm

    The highest quality studies about not only the effectiveness of spinal manual therapy, but the appropriateness of the treatment and the mechanisms of effect have been designed, performed, and reported by Physical Therapists.
    Widely publicized, some of the best data for spinal manipulation in low back pain consists of two multicenter randomized controlled trials here, with more trials in the works. Also the preponderance of evidence suggests a neurophysiological mechanism of effect, and that manipulation may not work for everyone.
    Physical Therapists are at the forefront of using manipulation and manual therapy (which includes much more gentle techniques also) in a science-based context in modern medicine. No mysticism, no energy, no woo. Neuroscience and the best evidence for rehabilitation management guides the way.

    Try going to PubMed: http://www.ncbi.nlm.nih.gov/sites/entrez

    Then enter the ID numbers for these studies which answer some of the questions posed upstream.
    Effectiveness:
    PMID: 12486357
    PMID: 15611489
    PMID: 16018809
    Risk/Benefit:
    PMID: 16839800
    Mechanism of Effect:
    PMID: 12881834
    PMID: 19027342

    Physical Therapists not only have converted to the Doctor of Physical Therapy degree, but are working hard to secure access to patients without medical referral as we often can provide safe effective care for a wide variety of musculoskeletal problems without the risks of long term medications and invasive procedures.
    For more on physical therapy, go here:
    http://www.moveforwardpt.com/

    Great article Dr Homola!

    Jason Silvernail DPT
    Board-Certified in Orthopedic Physical Therapy

  30. Geekoid says:

    “spinal manipulation is still not as readily available in medical practice as it should be,”

    On what do you base tat it should be part of medical practice?

    “Spinal manipulation for back problems has been around since Hippocrates”

    And people have been using rhino horn to solve impotence for 100′s of years.

    You are coming from a bad place. Chiropractic practice is full of woo. Since you are starting this discussion with so much baggage, I would like to see some actual studies backing up you statements.

    Personally, if someone is going to manipulate my spine, I want them the be a medical Doctor, using proven science based techniques.

  31. EricG says:

    a more appropriate repost of an article that may be of interest…

    http://www.guardian.co.uk/science/2010/mar/01/simon-singh-libel-case-chiropractors

    1 in 4 are under investigation? crazy. some here may just get their wish…in the UK.

  32. Sam Homola says:

    JMB, I do believe that appropriate manual therapy offered by chiropractors who are not simply trying to correct vertebral subluxations does have advantage over bed rest and use of medication in the care of uncomplicated back pain.

    Regarding the difference between chiropractors and osteopaths:

    The percentage of practicing osteopaths who use manipulative therapy for any reason is low; most are occupied with the practice of medicine. I have no problem with evidence-based osteopaths who include use of manipulative therapy in their treatment armamentarium. Osteopaths can be dependable specialists and primary care providers.

    In 1929, osteopaths were granted the same privileges exercised by the medical doctors. Today, osteopathy cannot be compared with the practice of chiropractic. When the theory of chiropractic was formulated in 1895, it was almost identical to 1874 osteopathic theory. Chiropractors claimed that adjusting the spine to remove nerve interference (“rule of the nerve”)would cure most diseases. Osteopaths were claiming that manipulating the jojnts to improve blood flow (“rule of the artery”) would cure most diseases.

    While osteopaths no longer adhere to the basic tenets of the founder of osteopathy and now have access to all forms of treatment, chiropractic continues to define itself according to vertebral subluxation theory—producing a limited treatment method covering a broad scope of ailments.

    Although most osteopaths use manipulation to treat musculoskeletal problems, a few may use such questionable treatment methods as “cranial osteopathy” —methods rejected by mainstream osteopathic and medical practitioners.

  33. lizditz says:

    Dear Dr. Homola,

    I wish that you, or you in concert with Dr. Novella (or another neurologist) would take on the foolishness that is “Chiropractic Neurology”. There are 57 active in California alone.

    Chiropractic Neurology is defined as the field of functional neurology that engages the internal and external environment of the individual in a structured and targeted approach to affect positive changes in the neuraxis and consequent physiology and behavior.

    Ted Carrick is a person of particular interest (from a 1999 interview, posted at the Carrick Institute

    http://www.carrickinstitute.org/CIAbout.asp

    Gail Harris: What kinds of things can be treated through chiropractic?

    Ted Carrick: Well, we’re finding every day that more and more things that we didn’t think were associated with chiropractic treatment can be affected very nicely. There are testimonials from people who have had their eyesight and hearing back, and people waking up from comas.

    It would seem that the level of one’s existence, the ability to participate at a high level of society — to laugh, to cry, to enjoy activities, to not perceive painful stimulation if it’s not necessary — are things that chiropractic definitely does affect. The level to which some treatment will affect these is unknown from individual to individual.

    GH: What about chronic conditions like arthritis, or life-threatening illnesses like cancer?

    TC: There are many cancer patients who see chiropractors for treatment — certainly not for the cancer. We don’t do anything for that disorder. But we can do things to make patients more comfortable, to be able to live with the disorder. To decrease the degree of pain, to bless them with a little bit of a smile or other consequences that are associated with the brain.

    It’s important to realize that chiropractic treatment is not a treatment that is specific for a shoulder or a knee, but is a global body treatment.

    GH: What is the difference between a regular chiropractor, and a chiropractic neurologist, which is what you are?

    TC: Well, the difference is in training in the discipline. The neurologists in the chiropractic profession have an additional three years of training, specific to the neurological system. And they serve their communities as referral services to a variety of physicians — medical and chiropractic, dentists, podiatrists — on neurological problems.

  34. Harriet Hall says:

    rwk would have us believe that many chiropractors no longer subscribe to the subluxation concept. The evidence indicates that many chiropractors still do.

    The ICA website says

    “SUBLUXATION AS AN ACCEPTABLE PRIMARY DIAGNOSIS
    Subluxation is a responsible and credible diagnosis for the doctor of chiropractic and this condition should be recognized and reimbursed as a primary diagnosis by all third‑party payment organizations, both public and private.
    The analytical/diagnostic determination of a subluxation indicates the need for chiropractic care.” http://www.chiropractic.org/index.php?p=ica/policies#subluxation

    A 2003 survey of North American chiropractors found that 88% wanted to retain the term vertebral subluxation complex, and that when asked to estimate the percent of disorders of internal organs (such as the heart, the lungs, or the stomach) that subluxation significantly contributes to, the mean response was 62%.

    In 2005, the chiropractic subluxation was defined by the World Health Organization as “a lesion or dysfunction in a joint or motion segment in which alignment, movement integrity and/or physiological function are altered, although contact between joint surfaces remains intact. It is essentially a functional entity, which may influence biomechanical and neural integrity.”

    A recent study by chiropractors took the subluxation seriously enough to debunk it with a review of all the published literature. http://www.sciencebasedmedicine.org/?p=3022

    rwk, do you know of any recent surveys that clearly show what percentage of practicing chiropractors use the word subluxation? And/or how many believe subluxations cause somatovisceral conditions by nerve interference? My impression is that most of them still do, but I would be delighted if you could prove me wrong and show that there is really a significant reform movement going on.

  35. Sam Homola says:

    “Dr.Homola has given you some incorrect information,as there is no North American
    Association for Chiropractic colleges it is simply called Association of Chiropractic Colleges.
    Read it yourself. The word subluxation is NOT mentioned.”

    The Association of Chiropractic Colleges (ACC) is an organization representing North American Chiropractic Colleges. The ACC paradigm, formulated by the presidents of these colleges, states:

    4.0 The Subluxation

    Chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on the subluxation.

    A subluxation 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.

    A subluxation is evaluated, diagnosed, and managed through the use of chiropractic procedures based on the best available rational and empirical evidence.

    (Job Analysis of Chiropractic 2005. National Board of Chiropractic Examiners)

  36. coryblick says:

    Dr. Homola,

    Thanks for the great article.

    I just want to chime in and say that I would love to see the term “physical therapy modalities” expire as well.

    I think the your alternative phrasing of “physical treatment methods” is much more appropriate as we (PTs) don’t own any particular technique or modality.

    As demonstrated by the “chiropractic neurologist” example offered above, there seems to be a lot of coat tail riding attempted to be made in chiropractic as it attempts to be the primary care provider of the CAM world. It functions to say “we do physical therapy too” and thereby also frames another profession for its patients. And as most chiropractors are describing ultrasound and estim when they use the term, they are framing PT in a poor light.

    I’ve had this conversation several times before with chiropractors and I always ask, “How would feel if physical therapists called spinal manipulation a ‘chiropractic modality’?”

    Just something I can never let go by. Thanks again for the article and discussion.

    Cory Blickenstaff PT

  37. rwk says:

    Dr.Hall,
    No,but I’ll start looking.I take those surveys with a grain of salt as neither I nor any of my friends have ever participated in them.
    Regarding the word Subluxation you can thank our Medicare system
    for at least helping perpetuate that word. That is the only diagnosis they will reimburse DCs for. We can supply supporting ICD-9 codes but we must be treating a subluxation,primarily.
    By the way( and Dr. Homola should know this) this was established
    by MDs in about 1973. At that time there was a debate on whether
    subluxations could be seen on X-ray. So when chiropractic was included in Medicare, it was required that Chiropractors take an X-ray
    to demonstrate a subluxation ( if audited ) once a year!How many
    people were x-rayed unnecessarily because MDs wanted to trip up DCs.
    The X-ray rule was lifted recently, but not the subluxation rule.
    Would you want the US government to run healthcare?
    I can’t say how many chiropractors,osteopaths and medical doctors believe subluxations (or can we use terms like segmental or articular dysfunction) cause somatovisceral conditions. But I’d say that most manual therapists are interested in how they might effect the body beyond just musculoskeletal conditions.
    I stand behind this report:
    http://www.chiroandosteo.com/content/pdf/1746-1340-18-3.pdf
    until the researchers prove otherwise

  38. Mark P says:

    I have often read the statement:
    “Chiropractic is no better than a good massage for back pain”.
    Is this not a legitimate summary of chiropractic?

    I have used chiropractors a couple of times. They worked far better than any massage could have. In my case the damage was caused by rugby and a car accident, and were pretty obvious dislocations in the spine.

    I tend to think that violent injuries cannot be massaged away. How would that work? It’s not like chiropractic manipulation is anything like a massage.

    A caveat though. I live in NZ and the first two chiropractors I saw were at the non-woo end of the spectrum. Lots of medical books on the shelves, and no mention of any subluxations or “nerve flow”.

    In a moment of weakness I once visited one who was heavy on the woo. He was useless. Purely anecdotal, of course, but it was hard not to think the effectiveness was related to the scientific thinking involved.

  39. Plonit says:

    Agree with scott, upthread:

    “There is a legitimate science-based profession that does physical manipulation of patients to treat them, and it is called Physiotherapy.”

    Is the aim of this article to somehow rehabilitate, reinvent or rescue chiropractice? Why? The only reason seems to be because it is expensive to retrain as a physiotherapist – which seems a pretty self-serving and not very scientific reason.

    I have the same issues with your curious “Doctor of Osteopathy” phenomenon. If they are basically just doctors, why not drop the osteopathy bollocks? If they don’t wish to drop the osteopathy tag, what’s that about?

  40. JMB says:

    Thank you for answering my question about the differences between osteopathy and chiropractic. I see no distinctions between MDs and DOs in medical practice, other than greater percentages of DOs select primary care. Not very many DOs use manipulative therapy in their practice.

  41. BillyJoe says:

    In Australia it is rare to find a chiropractor who treats anything other than back pain – except for an American import who recently reported the editors of The Skeptic for reprinting Simon Singh’s article about chiropractic.

    Also, Osteopaths are not medically trained and practice only their particular brand of physical therapy.

    Physiotherpist seem to be the preferred options for most doctors, but there is insurance coverage (medical, transport accident, work injury and veterans affairs) for both chiropractic and osteopathy.

  42. Joe says:

    @Sam Homola on 04 Mar 2010 at 1:31 pm “… Some chiropractic colleges are now teaching use of physical therapy modalities …”

    Are they competent at it? I rather doubt …

  43. Joe says:

    BillyJoe on 05 Mar 2010 at 3:49 am”… Also, Osteopaths are not medically trained …”

    In the USA osteopaths are equivalent to MDs. Outside the USA they are quacks just like chiros.

  44. BillyJoe says:

    Joe,

    Yes, I was talking about the situation in Australia after reading what Sam had to say about osteopaths in America.

  45. Plonit says:

    Joe

    “In the USA osteopaths are equivalent to MDs. Outside the USA they are quacks just like chiros.”

    But why don’t they just drop the osteo bit then?

  46. micheleinmichigan says:

    plonit – I can only imagine it would be a bureaucratic nightmare. My view is if the main problem is largely semantic and that semantic is going to take a whole boatload of money to fix, leave the semantics problem.

  47. Joe says:

    rwk on 04 Mar 2010 at 11:43 pm “… I stand behind this report:
    http://www.chiroandosteo.com/content/pdf/1746-1340-18-3.pdf
    until the researchers prove otherwise”

    That’s interesting- it favors PT more than chiro. Also, the authors seem to have trouble with reading comprehension. Reports that found chiro useless for nocturnal enuresis and for carpal tunnel syndrome are reported (in the review) as being “favorable” to the use of chiro.

  48. Tim Kreider says:

    rwk says “I take those surveys [about chiropractors' beliefs regarding subluxations] with a grain of salt as neither I nor any of my friends have ever participated in them.”

    Interesting criticism. I’d shudder if similar logic were used to discount evidence about a treatment complication that is serious but rare enough not to be personally observed by all practitioners…

  49. Harriet Hall says:

    “I’d shudder if similar logic were used to discount evidence about a treatment complication that is serious but rare enough not to be personally observed by all practitioners…”

    Yes, that’s exactly the logic that is used to dismiss reports of stroke due to neck manipulation. I know of at least one case where the patient never went back to tell the chiropractor what had happened after he left the office.

  50. rwk says:

    “I’d shudder if similar logic were used to discount evidence about a treatment complication that is serious but rare enough not to be personally observed by all practitioners…”

    I fail to make the connection between taking a survey on one’s
    practice location,technics,etc. as solicited by a professional publication,
    and reporting a serious adverse treatment outcome. ????

  51. Calli Arcale says:

    Plonit:

    “In the USA osteopaths are equivalent to MDs. Outside the USA they are quacks just like chiros.”

    But why don’t they just drop the osteo bit then?

    In the US, the two degrees (DO and MD) are broadly equivalent, though not identical. I tend to think of it as a bit like the difference between a BA and a BS. They’re not the same, so there is something actually being expressed in the different titles, but they both will generally meet the same postgraduate requirements.

    I have found that quackery seems to be more welcome among DOs than MDs, but I don’t have numbers to back up this perception. Mostly just an observation that I seem to notice more DOs than MDs sited on dubious advertisements. There are certainly MDs who practice quackery as well; it’s not an absolute protection against sloppy thinking. Or even fraud, for that matter. It would be interesting to know the actual trends.

  52. Basiorana says:

    In my experience a bad chiropractor is a quack, but a good chiropractor is basically an exceptionally talented masseuse who will provide sufficient manipulation to relieve pain and stress on my back without causing injury. Many of my elderly friends go to one local chiropractor, who actively opposes subluxation “theory.” They do because a massage therapist leaves them covered in bruises for days and doesn’t do anything for arthritis, but they get significant relief from the chiropractor without the injuries– significant enough that none of this group routinely take painkillers or anti-inflammatories for their arthritis any more. Maybe it is placebo, but honestly, this particular guy isn’t hurting them, he isn’t advocating anything truly bogus, he doesn’t touch their necks, and he’s helping them live without needing extra medications. And yes, going to him three times a year is definitely cheaper than popping painkillers.

    The thing is, I would advocate that we just retrain the good, science-based ones as physiologists, except that this guy’s fees aren’t that much more than a spa day. Chiropractors who behave ethically and don’t have their patients come in all the time are actually affordable for the middle-class, whose insurance would not cover a physiotherapist without a specific reason. I know my insurance requires a doctor’s referral for either, and my doctor doesn’t believe that carrying a 40 lb bag on my back for 10 hours a day should justify a referral– she tends to say that I should just get my fiance to rub my back or get a massage, which usually results in more and longer-lasting pain. I wouldn’t be able to afford a physiotherapist out of pocket, and I don’t really need one. I can afford a chiropractor visit.

    I hope someday chiropractors are to physiotherapists what CNPs are to internists– a cheaper alternative for simple and uncomplicated cases of back or joint pain, fully trained in the medical model but simply without the depth. Alas, it seems more likely right now that they will either stay just as wooey as they are, or will disappear to be replaced by a more expensive alternative.

  53. kcory1 says:

    Great article. I do have a related question though: what is the consensus of using MedX equipment to rehabilitate lumbar injuries and to strengthen the musculature?

    I’ve read quite a bit about MedX and their testing procedures and even about their testing at the University of Florida (I believe that’s the right school).

    Do many science-based chiropractors or physical therapists use this type of equipment? Also what is the general opinion of using MedX for spinal rehab? Or…are the benefits of using MedX equipment over-hyped?

  54. yeahsurewhatever says:

    The percentage of practicing osteopaths who use manipulative therapy for any reason is low; most are occupied with the practice of medicine.

    I believe you mean the percentage of practicing osteopaths who ADMIT to using OMT for any reason is low, because they’re most likely embarrassed by their inability to justify such usage.

    Also, this is a great argument for the elimination of osteopathic medical schools entirely: the very characteristic that differentiates them from real medicine is a therapy that their graduates prefer not to be caught dead using, and which is largely viewed as an embarrassing senile uncle.

    Aside from that, the major difference between osteopathic medical school matriculants and real medical school matriculants is 10 points on the MCAT (even though it’s not a requirement for them), and a much greater tendency to embrace CAM, probably because their education in the basic sciences is substandard (which also explains the poorer MCAT performance).

    About the only thing they have going for them is that patients often consider them “nicer” than MDs. That, however, could just be an artifact of the representativeness heuristic. Because there are vastly more MDs than DOs, a “nice” practitioner is probably still much more likely to be an MD than a DO.

  55. Fiat says:

    Yeahsurewhatever,
    That’s a pretty brutal assessment of the DOs. Do you really
    think it makes that much difference when someone visits their
    GP that they’re a DO or a John Hopkins graduate ? I think not.
    They both use Monthly Prescribing Reference and rely on
    “pharmaceutical sales representatives.” Most of it’s all there.
    Remind us not to visit you, know-it-all.

  56. Mark Crislip says:

    Anecdotes:

    A large number of our residents are DO’s. DO’s, in the context of our internal medicine program, are interchangeable with MD’s. One of our graduates, a DO, was my primary until he moved on to run the hospitalist program at one of our hospitals. As best I can tell, the DO in the legacy system are no better nor no worse than the MD’s

    I have no idea if they use manipulation; what many have told me is that learning manipulation is the price they paid to get a medical education, there are far more good pre-meds than positions in medical school.

    My sense is that the woo is left behind when the opportunity allows.

  57. Chris says:

    One of the first webpages I encountered that showed the lies of anti-vax folks was The Anti-Immunization Activists: A Pattern of Deception. Turns out he teaches at a DO college, it takes a bit of looking but he teaches here (he has been on the web a long time, I assume he is not big on editing content):
    http://www.kcumb.edu/visitors/default.asp

  58. Plonit says:

    Calli Arcale “In the US, the two degrees (DO and MD) are broadly equivalent, though not identical. I tend to think of it as a bit like the difference between a BA and a BS.”

    It’s not really like the difference between a BA and a BSc though. There is nothing disreputable inherent in the word “Arts” and if someone has a Bachelor of Arts, that’s just fine.

    (Indeed, at the University of Cambridge everyone graduates with a BA, even if it’s in a science subject).

    Whereas, there is something inherently disreputable in using ‘osteopathy’ in combination with “Doctor [which it is implied is of the medical variety, since it is not a doctoral level degree]“. Everytime someone says “MDs and DOs are basically the same thing” it legitimizes osteopathy.

    If DOs who do not endorse osteopathy cared about this problem, they would drop the DO label and take on the bureaucratic nightmare of transforming themselves into something else.

  59. Chris says:

    Plonit:

    (Indeed, at the University of Cambridge everyone graduates with a BA, even if it’s in a science subject).

    In many universities there is a vast difference between a BA and a BS in a subject, even if it is in science. This can have consequences in employment.

    I used to work for a very technical heavy company, that actually took the difference between a “BA” and a “BS” into consideration.

    My area was near a group that mostly hired chemists (it was officially “materials engineering”). One of the new hires was very upset she was only hired as a tech aide, which was at about half the pay of of an engineer/scientist.

    Since we were women who were working in what was then not typical female jobs (engineers, chemists, physicists), we lent her a sympathetic ear to her complaints. We asked her why she was upset and she told us that since she only had a BA in chemistry she could only be a technician!

    We then asked her why she only had a BA and not a BS, and her reply was that ts was easier!

    Since the women trying to understand her “plight” all had a BS degrees and done the harder work, her plea of sympathy was lost. We all turned around and left.

    By the way, in the USA the DO is actually more equivalent to an MD is than an BA versus BS in chemistry. A DO still has to got through residency, and then pass though medical board tests. This is not at comparable to the difference in getting a BA versus BS degree in science as an undergraduate.

  60. Joe says:

    @ Plonit on 11 Mar 2010 at 2:18 am “Calli Arcale “In the US, the two degrees (DO and MD) are broadly equivalent, though not identical. I tend to think of it as a bit like the difference between a BA and a BS.”

    It’s not really like the difference between a BA and a BSc though. There is nothing disreputable inherent in the word “Arts” and if someone has a Bachelor of Arts, that’s just fine.”

    Let me get this straight, in the USA a DO is equivalent to an MD. Here, there is nothing disreputable about a DO. Outside the US, DOs are quacks, like chiros.

  61. LindaRosaRN says:

    Dr. Homola,

    Do you have any comment about these books?:

    “Doctor Homola’s Fat Disintegrator Diet”

    “Chiropractor’s Treasury of Health Secrets”

    “Doctor Homola’s Life Extender Health Guide: Secrets That Help You Live Longer”

    “Dr. Homola’s Macro-Nutrient Diet for Quick Permanent Weight Loss”

    “Secrets of Naturally Youthful Health and Vitality”

    “Doctor Homola’s Natural Health Remedies”

    http://www.amazon.com/Samuel-Homola/e/B001HPIVZI/ref=ntt_athr_dp_pel_pop_1

  62. Joe says:

    @Basiorana on 08 Mar 2010 at 12:07 pm

    I can’t find any corroboration for your testimonial in the reliable, basic literature. Perhaps it stems, mostly, from convenient memory or a select group of customers, or just luck.

  63. Sam Homola says:

    Dr. Homola,

    LindaRosaRN asked:

    Do you have any comment about these books?:

    “Doctor Homola’s Fat Disintegrator Diet”

    “Chiropractor’s Treasury of Health Secrets”

    “Doctor Homola’s Life Extender Health Guide: Secrets That Help You Live Longer”

    “Dr. Homola’s Macro-Nutrient Diet for Quick Permanent Weight Loss”

    “Secrets of Naturally Youthful Health and Vitality”

    “Doctor Homola’s Natural Health Remedies”

    http://www.amazon.com/Samuel-Homola/e/B001HPIVZI/ref=ntt_athr_dp_pel_pop_1

    My reply: Over the years, I have written many self-help books on general health care. None of the books based my health-care advice on chiropractic or the vertebral subluxation theory.

    Notwithstanding the sensational titles of the above selected books, all of my books were based on the best information available at that time and were not deliberately misleading in any way. Other books I have written are not so crude in their titles.

    My 1963 book “Bonesetting, Chiropractic, and Cultism” was a powerful critique of chiropractic. My 1968 book titled “Backache: Home Treatment and Prevention” did not even mention chiropractic in its text. “Muscle Training for Athletes,” published in 1968 by Prentice-Hall for use by coaches and physical education teachers, did not discuss chiropractic.

    My 1999 book “Inside Chiropractic” exposed the pseudoscience and the nonsense associated with chiropractic care based on the vertebral subluxation theory. My 2002 book “The Chiropractor’s Self Help Back and Body Book” contained a chapter titled “Sense and Nonsense in Chiropractic Care of Back Pain.”

    A review of the text of books and articles I have published since 1963 will show that I have always been a critic of chiropractic subluxation theory and that I have always been careful not to allow my writing to advance the cause of subluxation-based chiropractic.

    My articles critical of chiropractic have been published in such journals as “Archives of Family Medicine” and “Clinical Orthopaedics and Related Research.”

    I hope no one will assume that my hobby writing self-help health books is at odds with my career as a chiropractor who strived to follow the rules of science.

  64. LindaRosaRN says:

    Thanks. I’ll keep what you say in mind what you say when I look at your books.

    MORE QUESTIONS:

    How can a so-called “reformed chiropractor,” who has received nothing but a *chiropractic education,* justify engaging in diagnosis, treatment, and referral?

    In describing your practice, you have written that you used “modified” neck manipulation because you found it effective in your experience. Can you explain how this is consistent with science-based practice?

    You claim the best place for the public to locate a reformed chiropractor is on the Chirobase list. (I noted that most states don’t have even one “reformed” chiropractor.) I checked out a half-dozen or so of these names and found that none of them have websites that would allow the public to know more about their practices. One claims to also offer acupuncture. Does any investigation go into the chiropractors who put their names on this list? What assurances are there that this list isn’t used by some chiropractors as just another practice-building ploy that dupes the public?

    Any idea why NACM closed shop recently? Why was it an “invitation only” organization?

    How many “reformed” chiropractors would starve if chiropractic were de-licensed?

    Why haven’t the “reformed” chiropractors sued chiropractic schools in a class action suit?

    I’m glad to see your criticism of the chiropractic subluxation. I just wish you would have done so dropping the “DC” and pursuing a legitimate profession with a legitimate education.

    Thanks, Linda

  65. Plonit says:

    “in the USA the DO is actually more equivalent to an MD is than an BA versus BS in chemistry”

    “Let me get this straight, in the USA a DO is equivalent to an MD. Here, there is nothing disreputable about a DO. Outside the US, DOs are quacks, like chiros.”

    Yes, people keep saying this. But what I don’t understand is: if DOs walk like MDs and quack like MDs why not organize to call themselves MDs? If a really good doctor (by any conventional measures) is a qualified Doctor of Osteopathy, doesn’t that also lend osteopathy some credibility? Isn’t that credibility undeserved, given lack scientific evidence (and plausibility) of osteopathy? Catch 22: does a good doctor boost a bad treatment?

  66. Joe says:

    @Plonit on 12 Mar 2010 at 12:53 am “But what I don’t understand is: if DOs walk like MDs and quack like MDs why not organize to call themselves MDs?”

    You must ask them that. Keep in mind that school traditions tend to be strong and that sometimes students choose a school based on PR about tradition.

    @LindaRosaRN on 11 Mar 2010 at 11:38 pm

    I have been posing similar questions for years (as, no doubt, have you) and I don’t recall anyone even trying to answer, let alone providing a good answer.

  67. squirrelelite says:

    @Plonit and @Joe,

    In the U.S., fortunately, the distinction between MD’s on DO’s is not especially important and they often work side by side along with PA’s and NP’s, etc.

    Since this is an international forum, it is important for all readers and writers to be aware that this is not the case in most other countries.

    I suspect the distinction between MD’s and DO’s will continue indefinitely, mostly because of tradition, stylistic preference, and simple brand loyalty.

    I would like to point out one example of how plain old politics and perhaps a little bit of influence from MD’s has played a role in nurturing and continuing the distinction.

    In the late 60′s when I was an undergraduate student at Michigan State University, Michigan was a growing, booming state. The car business was thriving, the influx of foreign cars was barely beginning to dent domestic sales, the baby boomers were growing up and there were a lot more people for the medical system to support. But, the state only had one major medical school, the University of Michigan.

    It was pretty obvious that the state needed to open a second school to train doctors and the other major university in the state (MSU) was the obvious place to do so. But, there were arguments not to diminish the quality, reputation, and prestige of the University of Michigan medical school. So, the political decision of the state legislature was to open a college of osteopathic medicine at MSU.

    When this topic came up a few months ago, I got curious and did a little poking around the school’s website and downloaded a few public talks to listen to. It was a little more woo-friendly than I would have liked, but I didn’t find enough specifics to really raise the red flags.

  68. Sam Homola says:

    Questions for Sam Homola from Linda Rosa, RN. My answers in parentheses:

    How can a so-called “reformed chiropractor,” who has received nothing but a *chiropractic education,* justify engaging in diagnosis, treatment, and referral?

    (I feel that a “reformed chiropractor” who is well informed enough to voluntarily limit his practice to care of musculoskeletal problems in concert with medical care is capable of recognizing his limitations.)

    In describing your practice, you have written that you used “modified” neck manipulation because you found it effective in your experience. Can you explain how this is consistent with science-based practice?

    (I don’t recall ever writing that I used “modified” neck manipulation in my practice because I found it “effective.” See my SBM article “Neck Manipulation: Risk vs Benefit,” posted Aug 27-10.)

    You claim the best place for the public to locate a reformed chiropractor is on the Chirobase list. (I noted that most states don’t have even one “reformed” chiropractor.) I checked out a half-dozen or so of these names and found that none of them have websites that would allow the public to know more about their practices. One claims to also offer acupuncture. Does any investigation go into the chiropractors who put their names on this list? What assurances are there that this list isn’t used by some chiropractors as just another practice-building ploy that dupes the public?

    (Stephen Barrett, M.D., the co-author of your 1998 JAMA article on TT and the host of Chirobase, handles the “Chiropractic Referral Directory Guidelines.” He can answer these questions for you.)

    Any idea why NACM closed shop recently? Why was it an “invitation only” organization?

    (The NACM closed shop because there were too few chiropractors willing to renounce the vertebral subluxation in writing as a requirement for membership. The “invitation only” stipulation was designed to prevent intrusion by known subluxation-based chiropractors.)

    How many “reformed” chiropractors would starve if chiropractic were de-licensed?

    (If all chiropractors were suddenly “ de-licensed,” a few good chiropractors along with many bad chiropractors would certainly suffer. Since there is little or no opportunity for employment of chiropractors outside of private practice, most chiropractors would have to seek other forms of work in order to survive.)

    Why haven’t the “reformed” chiropractors sued chiropractic schools in a class action suit?

    (There is no basis for a suit. Chiropractic colleges state up front what they are teaching. Most of us who enter a chiropractic college are simply not well informed enough to evaluate the situation. As I said in my article “Science-Based Chiropractic: An Oxymoron,” posted on March 4, 2010, on SBM, I do not recommend that anyone attend a chiropractic college. I recommend physical therapy instead.)

    I’m glad to see your criticism of the chiropractic subluxation. I just wish you would have done so dropping the “DC” and pursuing a legitimate profession with a legitimate education.

    (I did try to leave the chiropractic profession (see my book “Inside Chiropractic”) in order to train in another field but was unable to so. If I did not think that I was able to offer a service of value in my use of spinal manipulation in the treatment of back pain, I would not have stayed in practice. This link to one of my articles published in a journal for physical therapists pretty well describes my dilemma: http://jmmtonline.com/documnts/HomolaV14N2E.pdf)

    (Incidentally, if you read any of my books, read “Inside Chiropractic” and “The Chiropractor’s Self-Help Back and Body Book” for updated versions of my opinions.)

    Good luck in your battle against quackery.

    Sam

  69. Sam Homola says:

    In my article “Science-Based Chiropractic: An Oxymoron?” I stated that:

    I spent 43 years in private practice as a “science-based” chiropractor and a critic of the chiropractic vertebral subluxation theory. I am often asked how I justified practicing as a chiropractor while renouncing the basic tenets of chiropractic. My answer has always been: I was able to offer manipulation in combination with physical therapy modalities as a treatment for mechanical-type back pain—a service that was not readily available in physiotherapy or in any other sub-specialty of medicine.

    The Mercer Report published October 12, 2009, concluded:

    A vast scientific literature has evaluated the effectiveness of chiropractic treatment for patients with common types of back and neck pain and the comparative effectiveness of these modalities with other widely-used treatments. While this literature is complex and has methodological limitations, it supports several conclusions:

    ● chiropractic care is at least as effective as other widely used therapies for low back pain;

    ● chiropractic care when combined with other modalities, such as exercise, appears to be more effective than other treatments for patients with neck pain.

    Source: Do chiropractic physician services for treatment of low back and neck pain improve the value of health benefit plans? By Niteesh Choudhry, MD, PhD and Arnold Milstein, MD, MPH, Harvard Medical School, Boston, October 12, 2009.

    _____________
    Just wanted to show that there is some justification for the practices of science-based chiropractors who use manipulation appropriately. It simply is not fair to say that all chiropractors are “quacks.”

    Sam

  70. Joe says:

    @Sam Homola on 12 Mar 2010 at 10:26 am “Questions for Sam Homola from Linda Rosa, RN. My answers in parentheses:

    How can a so-called “reformed chiropractor,” who has received nothing but a *chiropractic education,* justify engaging in diagnosis, treatment, and referral?

    (I feel that a “reformed chiropractor” who is well informed enough to voluntarily limit his practice to care of musculoskeletal problems in concert with medical care is capable of recognizing his limitations.)”

    This is one of my questions, too, and you have side-stepped it. All chiros graduate thinking they are capable of recognizing their limitations. Where is the evidence of that? Moreover, they believe they are competent to diagnose and treat, independent of medical supervision; and they are licensed to do so. That ability is fictional and you have not addressed it. Renouncing subluxations does not enhance competence in other areas.

    Then there is the question of “What musculoskeletal conditions (outside of spinal subluxations) are chiros competent to treat?” If one examines the recent review http://www.chiroandosteo.com/content/18/1/3 there are few recommendations for chiro (many of the treatments cited are PT, and chiros are not trained in that) in any area. Moreover, the authors exhibit irrational exuberance for “positive” reports. Even research that is negative is listed as “promising.”

    In short, renouncing subluxations and restricting oneself to musculoskeletal therapies does not make a chiro competent. I trust Drs. Barrett and Hall in their evaluations of you- but I don’t think you are representative of a significant percentage of chiros. And one must always look at the bottom line.

  71. Sam Homola says:

    You’re right, Joe. All things considered, I always recommend that a person seek manual therapy from a physical therapist rather than from a chiropractor.

    In areas where such treatment is not yet readily available, its best to look for a chiropractor who has publicly renounced the vertebral subluxation theory and who accepts the limitations needed to work closely with the medical community. Some orthopedists refer patients to such chiropractors. Unfortunately, such chiropractors are few in number.

    For this reason, as you say, it’s the bottom line that counts.

    Sam

  72. Fiat says:

    Sam,
    Are you pleased you started this apologetic exercise to these
    lions? Now, you’ve got a nurse with a 2-year degree talking
    down to you ( Stick to talking orders from doctors-Linda!).
    Not to mention medical students who ought to be studying instead
    of writing voluminous pieces on this blog. But then they act like they already know everything.
    Too bad some of you are condescending to US and UK DOs as if
    the person with the best grades really does make the best doctor.
    At least DO’s can treat with their hands. They have more potential
    options and certainly better manual skills generally.
    Could the MDs ( non-surgeons) survive without laptops,PDA’s and prescription pads?

  73. Sam Homola says:

    Joe,

    I think it’s important to understand that the education of a chiropractor is not totally deficient. Most chiropractic college applicants now have 2 to 4 years of undergraduate work followed by 4 years of chiropractic college. The curriculum of chiropractic colleges includes courses in anatomy, physiology, and other basic sciences, along with courses in chiropractic philosophy and principles. Those chiropractic students who are able to remain uninfluenced by the brainwashing of chiropractic philosophy may end up with enough knowledge to function fairly well as musculoskeletal specialists if they work in concert with medical care. Some who know better will simply take advantage of chiropractic theory in order to earn a living. Those who succumb to brainwashing promote their beliefs with religious fervor. This is why I say that unless a manual therapist is a graduate of an accredited school of physical therapy, it is less likely that manipulation will be used appropriately.

    It is a mystery to me how a chiropractic student could take courses in anatomy and physiology without rejecting the vertebral subluxation theory as I did. I think it might be explained in the inherent ability of the individual to reason independently. When we see highly educated people with advanced degrees talk religious nonsense, I think we see an example of easy it is to brainwash persons who simply do not understand what they have learned.

    Sam

  74. LindaRosaRN says:

    To: Samuel Homola

    You curiously refer to your published “self-help” books as “my hobby.” Aren’t they more than that?

    The “Chiropractic Referral Directory Guidelines” on Chirobase, which 60-some “reformed chiropractors” have signed onto includes this statement:
    “I may also counsel patients about lifestyle improvements and give practical science-based tips about the management of common ailments.” (http://www.chirobase.org/13RD/chiroguidelines.html)

    So it would appear that those books deal with what is considered within “reform” chiropractic scope of practice, according to your website.

    —–

    You wrote: “I feel that a ‘reformed chiropractor’ who is well informed enough…”

    “Well informed enough”? That’s a bit vague, no? Since there are no “reformed” chiropractic schools, it sounds pretty risky for the public to trust their care to a chiropractor who has the diploma from a chiropractic school on his wall and a DC after his name, yet claims to be “well informed enough.” I see little in the way of professional standards here.

    —–

    Regarding the list of “reformed chiropractors” on Chirobase, you refer me to Dr. Barrett to learn if the signers are vetted. But it appears both you and Dr. Barrett share responsibility for the materials on the Chirobase website:

    “Your Skeptical Guide to Chiropractic History, Theories, and Practices Operated by Stephen Barrett, MD, and Samuel Homola, DC” http://www.chirobase.org

    —–

    You wrote: “There is no basis for a suit [against chiropractic schools].”

    Unless chiropractic schools alert potential students that there is no scientific basis for the “chiropractic subluxation,” it is my opinion that they are defrauding students.

    —–

    I asked: “How many ‘reformed’ chiropractors would starve if chiropractic were de-licensed?” You answered: “…a few good chiropractors along with many bad chiropractors would certainly suffer.”

    Sorry. You’re wrong. This was a trick question. You, like many people, assume that de-licensure would strip people of their licenses to practice and therefore would create hardships and increase unemployment. That’s not the case. De-licensure only means that states would stop licensing chiropractors. No *new* chiropractors. The courts have been very clear that any and all practitioners of a de-licensed profession who are already licensed must be grandfathered in for life.

    At this point, I would hope that critics of chiropractic would start to see de-licensure as a viable option. Consider this: Regular ol’ chiropractors might see de-licensure as the ultimate practice-building strategy. De-licensure would mean fewer and fewer chiropractors each year, i.e. less and less competition for their services.

    Thanks for your responses. I think your criticisms of chiropractic are valuable. I also think your allowances for “reformed” chiropractors as valid health care professionals is misguided.

    Thank you for your time.
    Linda Rosa, RN, BA, BS

  75. Dacks says:

    @Mark Crislip. re anecdotes: My dad (orthopedic surgeon) used to say DOs are the ones who couldn’t get into med school. Hubristic, yes, and maybe not relevant.

  76. Sam Homola says:

    Linda,

    I do not know how to respond to your argumentative stance and your “trick question.”

    As a critic of chiropractic, my participation on the Chirobase web site is limited to contribution of articles and to answering questions about chiropractic. This site belongs to Dr. Barrett.

    While I make an effort to inform the public about the nonsense and the dangers of chiropractic care, I do not deny that some aspects of chiropractic care have value. I certainly am not supportive of the suggestion that “regular ol’ chiropractors might see de-licensure of chiropractic as the ultimate practice-building strategy.”

    I may be “misguided” as you have suggested. But I am willing to let readers judge me by the content of articles of mine that have been published here on the SBM site.

    I wish you success in your fight against the quackery in chiropractic. I have been fighting this fight since publication of my Bonesetting book in 1963.

    Sam

  77. Plonit says:

    “Too bad some of you are condescending to US and UK DOs as if
    the person with the best grades really does make the best doctor”

    There are no UK “DOs”. There are osteopaths, who have the advantage of being less likely to cause you damage than chiropractors, but apart from that not much else going for them.

    Osteopaths in the US appear to have transformed themselves into medical doctors (are all career paths in medicine as open to DOs as to MDs?). In which case, why still call themselves osteopathic doctors? Unless osteopathy is somehow important to them?

    Also, how many years and how much does it cost to qualify as a physiotherapist (physical therapist) in the US?

  78. Fiat says:

    Plonit,
    You wouldn’t be British,would you? If you were,you’d know that
    in the UK, DO stands for diploma in osteopathy. If you have your
    UK physiotherapy qualifications and want to practice in the US, you
    only need a state license:
    http://www.visalaw.com/IMG/ptchart.pdf

    “There are no UK “DOs”. There are osteopaths, who have the advantage of being less likely to cause you damage than chiropractors, but apart from that not much else going for them”.

    I’m sure many DCs and DOs feel the same way about PTs.

  79. Plonit says:

    Is this existence of a diploma of osteopathy (not the same as the US “doctor of osteopathy”, which is what most people in this thread mean when they say “DO”) some kind of defense of UK osteopathy?

    Physiotherapists (or physical therapists) have a huge amount going for them. Much of their work has been tested by trial evidence and none of it is based on implausible philosophical constructs such as subluxions or somatic dysfunction. Instead, they share an understanding of basic anatomy, physiology and pathophysiology with the other healthcare professionals with whom they work. The same cannot be said for believers in chiropractic or osteopathy.

  80. Joe says:

    Sam,

    Saying that chiropractic education is “not totally deficient” damns it with faint praise, as it should. The fact that two years of undergraduate work can get one into chiro college is not impressive; we require four years for entry into a masters program in chemistry.

    The curriculum may go through the motions of teaching anatomy, etc.; but the result is a massive failure of education and educators. An anat professor must know that “chiropractic subluxations” are the core of the program and the students should be told that no such thing, or anything like it, exists. Since the faculty don’t tell the students that they are studying a fairy-tale, I consider that a totally deficient education.

    Then, chiros claim their education qualifies them as primary care physicians (despite the fact that so many ailments have no musculoskeletal component). They think they are qualified to diagnose and treat or refer. Doctors tell me one really learns that in the clinic, in the final years of med school and then in multi-year residences. What is the clinical experience of a newly licensed chiro? Next to nothing- in school they practice on each other and on healthy young friends and family that they cajole to show up at the school pretending to be customers. I believe you have documented this at Chirobase, including the students who sued because the clinical experience was inadequate. The school won the case- not because they provided a good clinic; rather, because they had not promised to provide adequate experience.

    I particularly appreciate this quote from one of the chiropractic luminaries http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=53681&MERCURYSID=9ac341fe894c032f3c98ee00405aa420 “Since I was just out of school and without any meaningful experience, this seemed perfectly reasonable.” How about that- charging customers despite lack of experience or, more generally, lack of education.

    Overall, “chiropractic education” is an oxymoron.

    As for someone who is apparently, successfully self-taught (such as yourself). In my experience it is better to consult a professional rather than hope for the best from an amateur.

  81. Sam Homola says:

    Joe,

    You have summed up the situation nicely. I cannot argue with anything you have said. “Science-based” chiropractic, where anatomy is taught in one room and the subluxation theory in the next room, graduating “primary care chiropractic physicians,” is certainly an oxymoron. This is why I said in my article that I do not recommend that anyone attend a chiropractic college and why I suggest that it is safer to seek the manipulative services of a physical therapist rather than a chiropractor.

    Thank you for your astute observations.

    Sam

  82. LindaRosaRN says:

    Sam Homola: “I certainly am not supportive of the suggestion that ‘regular ol’ chiropractors might see de-licensure of chiropractic as the ultimate practice-building strategy.’”

    Alas, this was an attempt at humor.

  83. Sam Homola says:

    Linda,

    Sorry if I misunderstood. I know from reading your 1998 JAMA article, “A close look at therapeutic touch,” that you are objective and scientific in your approach to analyzing quackery.

    Sam

  84. Sam Homola says:

    Question from Brian Big Coyote (04 Mar message):

    “Is it completely unrealisitc to expect a revolution from within? Is there any formal or informal organization of chiropractors who use science-based methods?”

    Brian, see http://westhartfordgroup.com

    Sam

  85. Plonit says:

    Hmmms, progressive reform chiropractice! That makes it sound more like a sub-sect of a religion.

    Let me ask the question straight. You published your iconoclastic book in 1963. You recommend that people interested in physical therapies – either as consumers or potential practitioners – go for physical therapy in preference to chiropractice. It can’t cost so very much in time and money to train as a physiotherapist (crikey, maybe they would even give you crredit for the anatomy classes your already took). But in the more than 40 years since the scales fell from your eyes, you didn’t. Why not?

  86. Fiat says:

    Plonit,
    Hearing or seeing someone use the word ” chiropractice”
    which doesn’t exist or that doesn’t know the different meanings
    of ” DO” as they apply to different countries, tells me they really
    don’t know much about what they’re talking about.
    Why don’t you go to the web sites of various chiropractic,
    osteopathic colleges and national associations and see what they say and what they teach?
    Most have course listings.
    http://www.midwestern.edu/
    http://www.nuhs.edu
    So why don’t you read a little bit first as to what these professions say in 2010.
    Why would you think you’d get up to date relevant information
    from someone who graduated in 1963 about anything?
    Especially someone who’s jaded, disliked by his own profession and
    laughed at by the medics anyway!
    Anyone of you can talk a good game including physios and physicial
    therapists. It’s the results that count.
    Any of your technical books from 1963 relevant?

  87. Plonit says:

    Fiat,

    Chiropractic/chiropractice – does it really matter if it is bunk?

    My question was addressed to Sam Homola, who published his book in 1963. If, as he says, he would encourage anyone to train as a physio rather than a chiropractor (is that the correct term?) – why did he not retrain as one? That is all.

    What is your dog in this race anyway?

  88. Joe says:

    Sam Homola on 13 Mar 2010 at 6:36 pm “… Is there any formal or informal organization of chiropractors who use science-based methods?”

    Brian, see http://westhartfordgroup.com

    Sam, that is clearly just another PR group to promote chiro quackery.

  89. ps says:

    It isn’t just a question of listing a syllabus. For example, one needs to consider the content and the depth of the material, the experience and ability of the teaching, the rigor of examinations, if students are failed for poor grades and so on.

    Trying to suggest that you can compare a lecture on anatomy or biology from a professor at Harvard to one from someone who believes that the body can heal itself through “innate intelligence” isn’t just apples and oranges, it’s apples to sawdust.

    Looking at the information pointed to by previous posters, it seems that one can be accepted for entrance into a chiropractic college with an 2.5 GPA associates degree, or less. As far as I could see, a 2.5 GPA was common across all the colleges.

    http://www.nuhs.edu/show.asp?durki=33
    “We start with the highest entrance requirements: National offers the only chiropractic program that requires a baccalaureate degree for admission to the program”.

    Note that, National touts itself the ONLY (US) program that has an admission requirement of having obtained an undergraduate degree. Again, this is for entry into a program that its practitioners claim has as high, if not higher, standard of education than for a medical doctor.

    Additionally, we learn that for those that fall short of the entrance requirements, NUHS has a perquisite science class “…in an accelerated format during two eight-week mini-terms prior to starting their doctoral program…” the preceding consisting primarily of a series of evening classes.

    Everyone welcome; bad science grades? not got an undergraduate degree? No problem, we can teach you all that pesky science nonsense in just a few evenings a week. Trust us, we’re doctors.

    http://www.palmer.edu/prospective2.aspx?id=88
    From the above, at Palmer using the latest data that was listed (2008), of the students enrolling at Davenport, Florida, and West campuses, 76%, 80%, and 82% respectively were unlikely to meet the academic standards generally accepted for consideration into medical school. (Based on a 3.5 GPA)

    What I take away from that is that it requires a higher academic standard for entry into, say, a masters in a science discipline than it does to become a “doctor” of chiropractic. Sure beats community college, doesn’t it?

    So, to the question of “is science-based chiropractic an oxymoron”, I’d say that it is.

  90. LindaRosaRN says:

    Sam,

    Joe is quite right about the West Harford Group (WHG).

    Unlike the referral service on Chirobase, WHG also gives the occasional website of the 45-some chiropractors recommended in “Find a Doctor.”

    Almost without exception, these business websites promote assorted quackery: e.g. supplements, use of activators, soft laser tx, acupuncture, etc. One of the chiropractors claims proudly to have work in cooperation with Palmer Chiro College. Several promote outright the old chiropractic subluxation beliefs.

    And egads, this chiropractor, included on the WHG referral list, looks a lot like he’s trying to give kids strokes. He even demonstrates this in videos:

    http://www.drgillman.com/drgillman/pages/services.htm#
    “Chiropractic Treatment with Children Video 1 | Video 2″

    I also note that WHG speaks well of the World Federation of Chiropractic.

    It only took a few minutes to scan these chiro websites. With your long-time interest in reforming chiropractic, it would be hard to believe you never scrutinized WHG.

    – Linda

  91. Fiat says:

    PS,
    What evidence did you have that a DC has less of an anatomy experience than an MD? Or that DCs have subluxation dogma woven in
    to those lectures as well?
    Or ,that admitting some enrollees with a GPA of 2.5 is that much
    different than let’s say the school that Michael Jackson’s cardiologist
    went to.
    I found many medical schools with a 3.2 GPA and 90 hours
    ( Not a BA or BS) requirement.

    Here you go:
    http://money.howstuffworks.com/becoming-a-doctor4.htm

    “If you do poorly on one of the required courses it is probably a good idea to take another course in that field to improve your grades and show that you can handle that subject. It is also important to do well in college from the beginning. After all, if you only get a 2.0 in your first year and then get a 4.0 the next 2 years your GPA will still be under 3.5. However, medical schools do consider the fact that you are improving”.

    Here’s another:
    http://www.studentdoctor.net/2009/04/gpa-and-mcat/

    “The 3.0 GPA is a cutoff for most medical schools. However, some applicants are accepted every year that have a lower GPA, so this value is by no means absolute. Again, it all depends on the strength of the overall application…and the MCAT score.
    For example, for the 2005 school year, 155 applicants were accepted to allopathic medical schools (out of 17,978 total accepted that year) with a GPA that was lower than a 2.75. (Undergraduate Grade Point Average, Medical School Admission Requirements, 2007-2008, page 29) So, it is possible to gain admission with a low GPA, but you can see from these numbers that this is very rare. Also, these individuals most likely had stellar applications otherwise.
    For most of the allopathic (MD) medical schools, an average GPA of 3.0 is the minimum they will consider for extending interview invitations, regardless of what the rest of your application looks like, but there are a few exceptions”.

    Is the smartest doctor the best doctor?
    Do MDs fare any better than DCs with Low Back Pain?

    Check before you post.

  92. Joe says:

    Fiat on 16 Mar 2010 at 1:22 am “What evidence did you have that a DC has less of an anatomy experience than an MD?”

    We covered that, DCs cannot understand anatomy and physiology ans still believe in chiropractic subluxations and Innate Intelligence.

    Fiat “Do MDs fare any better than DCs with Low Back Pain?”

    Why don’t you tell us, with literature citations.

  93. Fiat says:

    @joe
    “We covered that, DCs cannot understand anatomy and physiology ans still believe in chiropractic subluxations and Innate Intelligence”.

    If you or anyone else believes the above statement, there’s no
    point spending time presenting articles on who treats Low back pain
    better.

    And by the way PS, they’ll let you in this US medical school with a 2.0
    GPA:

    http://www.mmc.edu/admissions/applymedical.html

  94. ps says:

    @Fiat — you asked me to check before I posted. Thank you for your kind offer, here’s what I see using the information that yu asked me to consider.

    You posted a link to http://money.howstuffworks.com/becoming-a-doctor4.htm – Here’s your excerpt in context:

    “…Needless to say, getting good grades in college is absolutely necessary. Your GPA (grade point average) is probably the most important factor in being accepted into medical school. Most medical students have GPA’s of 3.5 to 4.0 (on the standard 4.0 scale used in the U.S.). When you apply to medical school, the standard application requests your GPA for your science courses, your GPA for non-science courses and your overall GPA. For those students who entered medical school in 1998, the average science GPA was 3.52, the average non-science GPA was 3.64, and the average overall GPA was 3.57. If you do poorly on one of the required courses it is probably a good idea to take another course in that field to improve your grades and show that you can handle that subject. It is also important to do well in college from the beginning. After all, if you only get a 2.0 in your first year and then get a 4.0 the next 2 years your GPA will still be under 3.5. However, medical schools do consider the fact that you are improving. Doing well at a college with an outstanding reputation goes a long way. Try not to fall behind in your class work. This leads to cramming, poor grades and, more importantly, poor learning….

    The sciences courses, in particular Organic Chemistry, are traditionally the “weed out” courses that eliminate students who will not make it into medical school. I remember my first major exam in Chemistry. Many students failed. As a result, a large percentage of students dropped the course, stopped their pursuit of a medical career and changed majors. All this occurred in the first few weeks of college…”

    What was that? Oh right, science is important for medical school and that in 1998 the average GPA for entry in med school was 3.57. The reason I used more current figures than you did, was that I didn’t want to be accused of cherry picking or using old data. In fact, doing so cast DCs grades in a better light than they were in 1998. Don’t worry, I’ll get to that in a moment.

    You asked me to check: http://www.studentdoctor.net/2009/04/gpa-and-mcat/ – OK, that article does offer hope to under-achievers that all is not lost. I agree that encouraging people to try harder is a good thing.

    To your article, you missed this part though and it’s important to the question posed by Sam. “…The GPA really reflects how seriously an applicant has taken his or her undergraduate studies. A high GPA is a reflection of strong study habits and work ethics. Medical schools look at an applicant’s GPA for that reason – to evaluate if the applicant is likely to work hard in medical school. A high GPA has been found to be a very good predictor of success and the likelihood that someone will NOT drop out of medical school…”.

    The same article listed average the average GPA for entry into “allopathic” schools betweeen 3.60 and 3.63 for the years between 2000 and 2005.

    Well, there’s a fine thing, Fiat is right. I should have said a 3.6 GPA instead of 3.5 as being a better predictor for likely entry into medical school. Thank you for that correction.

    Now the hard part, the bit that involves mathematics. Here, I confess, I got a bit lost. You asked us to consider that “.. in 2005 155 applicants were accepted to allopathic medical schools (out of 17,978)…”. I will admit that I didn’t actually use a calculator, but in my head that comes as out as less than 1% (0.86% if my synapses have been adjusted correctly)

    So, that’s where I am lost.

    Isn’t the result of that calculation that around 80% of entrants into chiropractic college had a GPA less than 3.5, whereas that figure drops to less than 1% for the people accepted to medical school? Doesn’t that say that higher achievers, and better students of science, are more likely to be accepted into medical school, and the lower echelons go to chiropractic college to learn about the “true” nature of modern disease?

    From one of Sam’s science-based chiropractors, http://www.deflame.com/ – we learn:

    “Scientific research has demonstrated that most diseases that plague modern man are caused by diet-induced chronic inflammation.

    Here is a partial list of conditions that are driven by diet-induced inflammation: aches and pain, osteoarthritis, rheumatoid arthritis, osteoporosis, acne, aging, syndrome X, diabetes, cancer, heart disease, peripheral vascular disease, stroke, Alzhemier’s disease, Parkinson’s disease, psoriasis, eczema, and multiple sclerosis. Even feeling tired and unwell is promoted by inflammation. The main lifestyle factors that cause chronic inflammation include a poor diet, stress, and sedentary living”.

    I know, I know, please miss, pick me! Chiropractic education is like homeopathy, where more diluted scores and lower educational attainments are better. Silly me, thanks for the fact check.

    Finally, just to see how well I’m doing in my remedial “DC maths and cherry-picking quotes class”, let me point out that only one solitary student of the July 2007 intake for Palmer West had a GPA above 3.5; which is the average GPA that you established yourself for entry into medical school.

  95. ps says:

    @fiat “And by the way PS, they’ll let you in this US medical school with a 2.0 GPA” – http://www.mmc.edu/admissions/applymedical.html

    Really? Could you please provide a link to the statement that you are guaranteed admission with a 2.0 GPA?

    Anyway, we haven’t even got to the question of MCATs. Help me here, sunshine, what’s the dc equivalent of the MCAT?

    It’s not clear what your point is, so I’ll agree with you that the standards for entry to a less-competitive private medical school are still higher than that required for the majority of dc colleges. If that’s a win for you, by all means take it.

    Now, let me ask you this, dear fiat.

    Do you, or do you not agree with the following?

    (1) Disciplines that build upon previous knowledge and experience are generally best served by selecting from the most capable candidates?

    (2) The majority (all but one) of dc colleges do not require an undergraduate degree for entrance?

    (3) The majority of medical schools have standards considerably higher than that required for entrance into a dc college?

    (4) The average GPA for students attending medical schools is much higher than that at dc colleges?

    (5) Real science is hard, really hard. Modern medicine is a scientific discipline, and that rigorous academic achievement is generally accepted as a prerequisite for success in scientific endeavors such as medicine?

    (6) Medical school is usually followed by several years of growth, education and experience as a resident possibly followed by a fellowship, whereas dcs treat “patients” (aka friends and colleges) from their last year at dc college onwards?

    (6) When in a hole, it’s generally a good idea to stop digging?

    (7) We have no idea what your point is?

    p.s. I quite liked the way you told Joe that you weren’t interesting in backing up your statements with citations. You sure showed him the power of a cogent CAM (dc?) argument.

  96. ps says:

    (9) I can’t count. Oh well, back to community college for me.

  97. EvidenceBasedDC says:

    To be clear, chiropractic has it’s problems. Most of these stem from greed on the part of chiropractors and chiropractic colleges. The biggest problem in chiropractic has always been other chiropractors, and a lack of funding for it’s educational institutions (tuition driven education).
    That being said, I do not believe that the entire profession can be summarily dismissed as a fraud. The body of scientific literature regarding spinal manipulation is growing. Most of the quality research that is being done indicates that manipulation is beneficial in the treatment of low back pain, neck pain and headache as well as a number of extremity conditions. Go figure. The same research says that manipulation is no more effective than sham treatment for things like athsma, enuresis, etc. (Bronfort et al. The UK evidence report) These things are not earth-shattering news to chiropractors who pay attention to why their patients come to them in the first place. I have never had a patient come to me for the treatment of a non-musculoskeletal condition, and if I did, I’d send them to their primary care MD or DO. The number of “chiropractic heretics” is growing because it has to. The funds for research (from the NIH) have allowed us to begin to understand what we do and how it works for the first time in a century. The chiropractic care now in place within the Veterans Administration has done wonders for the advancement of evidence-based chiropractic care, because they keep tight control on what goes on in their facilitites.
    Please refrain from chiropractic bashing as it does nothing to further dialouge on the topic. Concise germaine debate is constructive whereas angry rants do little more than remove credibility from a valid point.
    BTW: This chiropractor had excellent grades and a BS in biology prior to attending chiropractic college.

  98. Harriet Hall says:

    EvidenceBasedDC said:

    “I do not believe that the entire profession can be summarily dismissed as a fraud….Please refrain from chiropractic bashing ”

    The author, Sam Homola, is a chiropractor. He is not a chiropractor-basher and neither am I. We don’t bash chiropractors; we only bash some of the things that most chiropractors do. We bash false claims, irrational practices and quackery.

    If you see this article as an “angry rant” you are reading something into it that’s not there.

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