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The CAM Docket: Texas MDs v. DCs

In April, the Texas District Court of Appeals (Third District) affirmed a lower court ruling that chiropractors are prohibited from performing manipulation under anesthesia and needle electromyography[EMG]. The lower court also ruled that the Texas Board of Chiropractic Examiners exceeded its authority in defining the chiropractic scope of practice to include “diagnosis.” This part of the ruling was overturned by the Court of Appeals, but with some interesting language in the opinion which could turn their one win into a Pyrrhic victory for Texas chiropractors.  In a separate ruling, not on appeal, a lower court held that vestibular testing is outside the scope of chiropractic practice.

First, some background. Back in 1949, the Texas Legislature defined the scope of chiropractic practice as, among other things, “the practice of adjusting the vertebrae to correct any subluxation or misalignment thereof . . .” Over the ensuing years, the legislature amended the chiropractic practice act with an eye toward modernization, resulting in the current scope of practice being “nonsurgical, nonincisive procedures, including, but not limited to, adjustment and manipulation, in order to improve the subluxation complex or the biomechanics of the musculoskeletal system.” Now that’s progress!

Playing by the rules

Texas chiropractors are regulated by the Texas Board of Chiropractic Examiners [TBCE]. Normally, a regulatory body like the TBCE issues rules through a formalized procedure which gives stakeholders a voice in the rulemaking process. Once a rule is enacted, those adversely affected by it can challenge the rule in an administrative proceeding or in court. However, the TBCE for years avoided this process by relying instead on informal “statements” or “memoranda.” The effect of this was to prevent anyone from challenging the TBCE’s interpretation of chiropractic scope of practice.

In 2005, the Texas Legislature forced the TBCE’s hand by requiring it to adopt rules clarifying what is, and what is not, within the scope of chiropractic practice. In doing so, the TBCE would be limited by the Legislature’s definition of chiropractic but there was wiggle room to interpret the practice act as it saw fit. Requiring the TBCE to go through the normal rulemaking procedures would give any opponents of TBCE’s scope-of-practice delineations the chance to test the rules in court. Thus, the TBCE came to issue rules broadly defining chiropractic scope of practice, including authorizing chiropractors to perform needle electromyography, manipulation under anesthesia and vestibular-ocular-nystagmus testing. The rules also appeared to allow chiropractors expansive authority to “diagnose.”

A little too expansive, according to the Texas Medical Association [TMA] and the Texas Medical Board [TMB]. Because they now had specific rules they could challenge in court, the TMA and TMB (which I will collectively refer to, as the appellate court did, as the “physician parties” or “physicians”) sued the TBCE, along with its Executive Director and the Texas Chiropractic Association (referred to collectively as the “chiropractic parties” or the “chiropractors”). The physicians alleged that the TBCE’s rules were too broad and therefore went beyond the authority granted TBCE by the Texas Legislature. They also argued the rules were unconstitutional, a challenge yet to be ruled upon by the trial court and therefore not a subject of the appellate court’s opinion.

Vestibular testing

In a separate ruling, a Texas district (trial) court struck down the TBCE rule allowing vestibular-ocular-nystagmus testing as beyond chiropractic scope of practice. That decision was not part of this appellate opinion, but we’ll briefly look at it. According to the TMA website, its successful challenge was based on the contention that state law did not allow chiropractors to perform vestibular testing, because:

The vestibular system is a component of the inner ear and communicates with the central nervous system. Tests of vestibular function are diagnostic tests designed to evaluate the function and structure of the inner ear and/or brain, and they include hearing evaluations because the hearing and balance functions of the inner ear are closely related.    . . . The vestibular apparatus is not part of the musculoskeletal system because the muscles that connect the eyes to the skull do not ‘move the body’ or ‘maintain its form.’ . . . Chiropractors are not authorized to diagnose medical conditions, including defects in the vestibular apparatus, because the Chiropractic Act does not include the diagnosis of diseases within the definition of chiropractic. Even if chiropractors can use the word ‘diagnosis’ in a rule, any such diagnosis must be limited to the biomechanical condition of the spine and musculoskeletal system.

The court agreed.

Manipulation under anesthesia

Manipulation under anesthesia (“MUA”or “S[pinal]MUA”) is, according to Quackwatch, a

procedure in which a chiropractor performs manipulation while an anesthesiologist keeps the patient asleep. MUA has little appropriate use and is potentially dangerous. Because the normal protective reflexes are abolished, the manipulated joint can be overstretched.

Here is how the health insurance company Aetna describes chiropractic use of MUA,

Within the realm of chiropractic, SMUA is generally performed daily for 1 to 5 consecutive days on an outpatient basis, and is followed by a post-SMUA rehabilitation regimen, which entails 1 week of daily manipulation to maintain joint mobility and avoid re-adhesion of fibrotic tissue. Anesthesia is usually induced by intravenous Pentothal (sodium thiopental), and manipulation of the affected joints takes about 7 to 10 minutes.

Except in narrowly defined circumstances, Aetna considers MUA investigational and experimental, which translates as “we won’t pay for it.” Of course, in cases where the patient’s health insurer won’t pay, the patient pays the full freight, without discounts normally negotiated by the insurer or mandated by Medicare.

I don’t know how much a full course of chiropractic MUA would set a patient back, but add up the cost of the MUA itself, an anesthesiologist, an outpatient procedure facility equipped and licensed to handle administration of anesthesiology, multiply that by 5, then add 5 more days of in-office chiropractic manipulation, and I can imagine we’re getting into thousands of dollars.

Neither the trial nor the appellate court had much trouble deciding that MUA was outside the scope of chiropractic practice as defined by the Legislature. This is because the Legislature had specifically defined (by incorporating Medicare coding as a guide) MUA as a “surgical” procedure. Because chiropractors are statutorily forbidden from performing surgery, the rule permitting MUA fell.

Needle EMG

Needle electromyography measures the electrical activity of muscles. (This should not be confused with surface electromyography, a bogus diagnostic procedure sometimes used by chiropractors to detect “subluxations.”) A needle electrode attached by wires to a recording machine is inserted into a muscle to record the electrical activity. Needle electromyography is used to determine the cause of weakness, paralysis or muscle twitching and to diagnose diseases that damage muscle tissue or nerves, such as ALS or myasthenia gravis.

The trial court found, and the appellate court agreed, that insertion of certain types of needles used in the EMG met the definition of an “incision.” As chiropractors are prevented by state law from performing “incisive” procedures, the rule permitting their use of needle EMG was declared invalid.

To diagnose, or not to diagnose

The physicians also challenged TBCE rules allowing chiropractors to “diagnose,” a privilege is not specifically included in their practice act, which limits chiropractors to “us[ing] objective or subjective means to analyze, examine, or evaluate the biomechanical condition of the spine and musculoskeletal system of the human body” and “perform[ing] nonsurgical, nonincisive procedures . . . to improve the subluxation complex or the biomechanics of the musculoskeletal system.” One has to wonder how performing surgical or incisive procedures, should chiropractors be allowed them, could “improve the subluxation complex,” as the “subluxation complex” is a figment of the chiropractic imagination. The very thought raises the horrible specter of a chiropractor chopping away in an effort to redact a “subluxation” of, say, the second cervical vertebra.

The physicians won on this issue in the trial court, but lost on appeal. As I suggested earlier, this may be a hollow victory for Texas chiropractors.

TBCE rules challenged by the physician parties included:

Rule 75.17(d) Analysis, Diagnosis, and Other Opinions

(1) In the practice of chiropractic, licensees may render an analysis, diagnosis, or other opinion regarding the findings of examinations and evaluations. Such opinions could include, but are not limited to, the following,

(A) An analysis, diagnosis or other opinion regarding the biomechanical condition of the spine or musculoskeletal system including, but not limited to, the following . . . .

The rule then goes on to list pretty much everything one could possibly think of in the way of looking into “the biomechnical condition of the spine or musculoskeletal system,” including:

(i) the health and integrity of the structures of the system;

(ii) the coordination, balance, efficiency, strength, conditioning and functional health and integrity of the system;

(iii) the existence of structural pathology, functional pathology or other abnormality of the system;

(iv) the nature, severity, complicating factors and effects of said structural pathology, functional pathology, or other abnormality of the system;

(v) the etiology of said structural pathology, functional pathology or other abnormality of the system; and

(vi) the effect of said structural pathology, functional pathology or other abnormality of the system on the health of an individual patient or population of patients.

These references to “structural pathology, functional pathology or other abnormality of the system” are apparently designed to encompass the latest iteration of the “subluxation,” known variously as the spinal lesion, joint dysfunction, manipulable lesion, and many other names. This formulation holds that the chiropractor can feel or otherwise detect something significant in the spine and then proceed to correct this significant something, although they’ve never been quite able to explain how what they say they feel or otherwise detect has anything to do with the patient’s problem. Nor have they been able to explain how what they do to this significant something, such as an “adjustment,” makes any difference to the patient’s health. At least that is what I have gathered from explanations of what they do posted in commentary on SBM. If I’m wrong about this, I’m sure I’ll hear about it.

Diagnose, but with limits

Two factors saved this rule from exceeding the scope of chiropractic practice in the appellate court’s view. First, the TBCE has interpreted the word “diagnosis” as synonymous with “analyze,” “examine,” and “evaluate,” which are within the statutory scope of chiropractic practice. Apparently the court thought this put some sort of limitation on their authority to “diagnose.” In other words, the court appears to be saying that “diagnosis” may have a meaning beyond “analyze,” “examine” or “evaluate” to a physician, but whatever that expanded meaning might entail, as long as chiropractors interpret “diagnosis” in this limited fashion, they are within their rights. This may be a distinction without a difference, but it is one the court makes.

Second, the court dismissed the physicians’ concerns that chiropractors defined terms in the rules so broadly that they could include virtually any disease or condition of any part of the body. Apparently unaware of the full extent of chiropractic claims of the near universal effect of spinal “structural” or “functional” pathology on the human body, the court found, over and over, that the physicians’ concerns should be allayed by the limitation to “biomechanical condition of the spine or musculoskeletal system.” To each argument of the physicians that the rules included an impermissible expansion of chiropractic scope of practice, the court replied, in effect: “No, no, chiropractors are limited to ‘biomechanical condition of the spine or musculoskeletal system.’” In other words, the court seemed to think this term meant the same thing to chiropractors as it means to physicians and other health care professionals.

This may prove problematic for Texas chiropractors attempting to extend their diagnoses beyond the “biomechanical condition of the spine or musculoskeletal system” – as these terms are used in medicine — by employing the chiropractic concept of the “biomedical condition of the spine or musculoskeletal system,” that is, to the subluxation or any of its current iterations.

In arguing that the rules permitted an overly broad scope of practice, the physicians pointed to the definition of the “subluxation complex” contained therein:

[A] neuromusculosketal condition that involves an aberrant relationship between two adjacent articular structures that may have functional or pathological sequelae, causing an alteration in the biomechanical and/or neuro-physiological relations of the articular structures, their proximal structures, and/or other body systems that may be directly or indirectly affected by them.

Of course, this is gibberish and most chiropractors well know it is gibberish but refuse to do anything about it, such as, say, letting the state legislatures in on this open secret. That would mean the states would have to redefine chiropractic practice to exclude the “detection” and “correction” of the non-existent “subluxation.”

In any event, the physician’s concern was that in using words like “pathology” and “etiology” the rules employed terminology that referenced the disease process. Because the diagnosis of disease was legally beyond the scope of chiropractic practice, they argued, the rules were invalid. The court disagreed, saying that their argument

presumes that ‘disease’ would extend beyond the biomechanical condition of the spine or musculoskeletal system of the body. This construction, as previously suggested, ignores the plain language of the rule restricting any such diagnosis to the biomechanical condition of the spine or musculoskeletal system. . . .

[R]egardless of whether diagnosis, pathology, or etiology invoke concepts of disease as the Physician Parties suggest, the bottom line is that [the rule] limits chiropractors to diagnoses regarding ‘the biomechanical condition of the spine and musculoskeletal system’ as required by the statutory scope of chiropractic.

The physicians also worried that the rule allowed chiropractors to

diagnose any diseases (pathology) that relate to the biomechanical condition of the spine and musculoskeletal system (redefined [by chiropractors] to include nerves and other tissues), determine their origins (etiology) and provide a prognosis on the disease’s effect.

The court specifically rejected this interpretation as too broad, once again citing the limitation of chiropractic practice to the biomechanical condition of the spine and musculoskeletal system.

Did the Court of Appeals adjust the subluxation?

This apparent limitation becomes even more clear in the court’s discussion of the “subluxation complex,” for which it accepted the TBCE’s definition, repeated here:

[A] neuromusculosketal condition that involves an aberrant relationship between two adjacent articular structures that may have functional or pathological sequelae, causing an alteration in the biomechanical and/or neuro-physiological reflections of the articular structures, their proximal structures, and/or other body systems that may be directly or indirectly affected by them.

[BTW, if anyone can tell me what this means, I would appreciate it. I once asked a friend who is a Ph.D neuroscientist specializing in the spine. He said it was “nonsense” but perhaps there are other views out there.]

The physicians argued that the rule’s subluxation definition would allow chiropractors to diagnose a broad range of “neurological conditions, pathological and neuro-physiological consequences that affect the spine and musculoskeletal system and ‘other body systems’ affected by subluxation.”

In what I view as an interesting limitation on the broad sweep of the chiropractic “subluxation,” the court disagreed that the inclusion of this definition of “subluxation” somehow expanded the scope of practice.

Although the definition of the ‘subluxation complex’ indicates that its existence may have functional or pathological consequences or that it may affect essentially every part of the body, the rule itself only allows chiropractors to render an analysis, diagnosis, or other opinion regarding a subluxation complex of the spine or musculoskeletal system.

To me, this says that a Texas chiropractor diagnosing the existence of a “subluxation” and then rendering an opinion that an “adjustment” of the “subluxation” may have consequences beyond the (once again) “biomechanical condition of the spine or musculoskeletal system” would be outside of his scope of practice. This would prohibit, in my view, a number of current chiropractic practices, such as opining that “adjustments” can be beneficial to asthma, allergies, painful periods, infant colic, bedwetting, otitis media, and any of the myriad other diseases and conditions chiropractors claim to treat. (Oh, wait, they don’t “treat” anything. They simply unleash the body’s self-healing ability.) It would also prohibit “maintenance” care, that is, regular “spinal checkups” and “adjustments” for general health, to the extent these claims extended beyond benefit to the “biomechanical condition of the spine or musculoskeletal system.”

The physicians and chiropractors have not announced whether they will appeal to the Texas Supreme Court. The physicians will have another shot when the district court decides whether the rules allowing chiropractic diagnosis are unconstitutional. Stay tuned.

Posted in: Chiropractic, Legal, Politics and Regulation

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24 thoughts on “The CAM Docket: Texas MDs v. DCs

  1. tgobbi says:

    Quoted from Ms Bellamy’s article: Manipulation under anesthesia (“MUA”or “S[pinal]MUA”) is, according to Quackwatch, a procedure in which a chiropractor performs manipulation while an anesthesiologist keeps the patient asleep. MUA has little appropriate use and is potentially dangerous. Because the normal protective reflexes are abolished, the manipulated joint can be overstretched.

    ***

    The idea of anesthetizing a chiropractic customer raises some issues with me (not unusual for me when the topic is chiropractic). Unless I’ve missed something, I don’t believe there’s such an animal as a chiropractic anesthesiologist. (There most certainly shouldn’t be)! This would mean that an actual doctor (MD or DO) needs to administer the anesthesia, right? Wouldn’t it be unethical for a doctor to work in cahoots with a DC – especially for such a dicey reason? And, in those states that do allow SMUA, is the procedure done in a hospital or in an outpatient environment? I believe that there are a few hospitals that have DCs on staff – for performing PT related treatment, not for correcting subluxations. Would any of them allow an MD to anesthetize a patient for chiropractic treatment?

    A final question: how common is SPMU – assuming it’s being done anywhere?

  2. Jann Bellamy says:

    @ togobbi:

    You are correct that an MD or DO, or someone acting under his direct supervision (a nurse anesthetist) would have to administer the drug(s). I am not a physician, but I think it would (or at least it should) raise ethical questions for a physician when he knows (or should know) that a procedure is unnecessary. Maybe Dr. Atwood (an anesthesiologist) could chime in here. I don’t know how common MUA is — but chiropractors must do enough of the procedure to make them very unhappy when a court finds it not within their scope of practice.

  3. During medical school, I was scrubbed in with an ob/gyn resident and the attending doing a gynecological surgery on a patient who was intubated and under anesthesia. The resident pulled down on the patient in an attempt to move her on the table (this was so long ago I don’t recall exactly why.) I have *never* heard an a medical doctor be so absolutely pissed and (rightfully) condescending as I did that day. The anesthesiologist absolutely freaked, because of the resident pulling on a patient who is intubated, along with all of the under stuff they are hooked up to. The ob/gyn attending just stood there and let the resident take the verbal beating, because, well, it was necessary.

    I can’t imagine a remotely ethical anesthesiologist, nurse-anesthetist, or anyone else allowing a quack to come in and manipulate a patient. That’s absolute insanity. It’s also not standard of care, it’s not a proven treatment, and it’s absolutely inappropriate use of anesthesia. Anyone who supplies anesthesia for these quacks should have their license reviewed.

  4. DugganSC says:

    Given as we’ve had sufficient evidence that there are actual doctors out there who are willing to refer their patients out to chiropractors, I suspect there are also anesthesiologists willing to work with them. Even past belief systems, the money may well be worth it.

    Somehow, the idea of chiropractic anesthesiologists sounds like something you’d see in a martial arts parody film… “The patient needs to feel no pain.” “The patient feels no pain”.

  5. DugganSC says:

    *grr* The system ate my *neck snap* bit between the dialogue above.

  6. daedalus2u says:

    I think it would also be a violation of prescribing regulations for anesthetics. I would think that no manufacturer of anesthetic drugs would want/allow chiropractors to use them in this manner. When people get injured and killed from MUA, the patients’ are going to sue everyone, including the manufacturer of the anesthetic agents.

    A manufacturer of propofol recently lost a gigantic judgment because the propofol they sold in large multi-use containers was misused by the anesthesiologists and people got hepatitis as a result.

    Since virtually all types of anesthesia require (or at least warrant for safety purposes) an IV line, doesn’t inserting an IV exceed the chiropractic scope of practice?

    I would think that insurers of anesthesiologist malpractice would not willingly cover MUA.

  7. lilady says:

    I located “Section 157.058 Medical Practices” in the Texas Occupations Code:

    http://law.onecle.com/texas/occupations/157.058.00.html

    Ҥ 157.058. DELEGATION TO CERTIFIED REGISTERED NURSE
    ANESTHETIST. (a) In a licensed hospital or ambulatory surgical
    center, a physician may delegate to a certified registered nurse
    anesthetist the ordering of drugs and devices necessary for the
    nurse anesthetist to administer an anesthetic or an
    anesthesia-related service ordered by the physician.
    (b) The physician’s order for anesthesia or
    anesthesia-related services is not required to specify a drug,
    dose, or administration technique.
    (c) Pursuant to the physician’s order and in accordance with
    facility policies or medical staff bylaws, the nurse anesthetist
    may select, obtain, and administer those drugs and apply the
    medical devices appropriate to accomplish the order and maintain
    the patient within a sound physiological status.
    (d) This section shall be liberally construed to permit the
    full use of safe and effective medication orders to use the skills
    and services of certified registered nurse anesthetists.

    My interpretation of this Code is that a nurse-anesthetist’s practice is limited to a licensed hospital or licensed ambulatory surgical center. I also believe that a licensed anesthesiologist must be available (in person), within the licensed hospital/licensed ambulatory surgical center.

    So, how would a licensed anesthesiologist…or a licensed nurse-anesthetist ever get malpractice insurance for administering anesthesia during a MUA?

  8. tgobbi says:

    # daedalus2uon 03 May 2012 at 12:13 pm

    Since virtually all types of anesthesia require (or at least warrant for safety purposes) an IV line, doesn’t inserting an IV exceed the chiropractic scope of practice?

    ***

    But that’s exactly the problem as I see it. The chiropractic “scope of practice” has been defined (jokingly perhaps – but on the mark) as anything anything that chiropractors do! As we all know it began as strictly limited to spinal adjustments. But over the years, likely because the “doctors” weren’t curing anyone of illnesses or preventing new ones, they started adding ancillary techniques and modalities to their arsenals – nutrition, etc. It’s gotten to the point that today, other than the few “straights” who remain, most DCs are as much naturopath as chiropractor. Quackery, I’ve always maintained, begets quackery.

    At the risk of turning this into a rant, I’ll just mention one more point: a few weeks ago I attended a lecture on “heart health” given by a “doctor” of chiropractic. (Talk about straying from scope of practice)… I asked the guy the same question I ask every time I listen to a DC give a presentation: “Do you have any idea what the scientific method is?” None of them have the slightest idea what I’m talking about! Yet they consider themselves healthcare professionals, some even insisting that they’re primary care, portal of entry doctors. The irony is that they don’t even perform the basic tests of a physical examination.

  9. @tgobbi, the reason that chiropractors do not even know the fundamentals of the scientific method is because they are not required to complete a college degree. Their admission requirements is a 2.5 GPA and $100,000 for tuition. They do not have to have a degree, any certain pre-requisites, or take any standardized tests. This explains why their understanding of the human body is so juvenile and they believe that they are capable of doing these magical (but ridiculously impossible) things by merely pressing on the back. In short, their idiots.

  10. tgobbi says:

    Today seems to be the day for chiropractic lunacy. In the past few hours I’ve encountered two goofy examples:

    1. A “chiropractic neurologist” who operates out of Kenosha WI. I’ve emailed the guy and asked if he can explain just what this means.

    2. A chiropractic diabetes “expert” on whose 16 1/2 minute video appear certain claims that I find questionable: http://diabetessacramento.com/

    I’ve been fascinated by quackery in general and chiropractic in particular for more than 30 years and I still can’t believe that these guys don’t realize that they’re jeopardizing the lives of the misguided souls who place their health needs in hands of quacks.

  11. @tgobbi, oh my god, that video. I barely made it past the first 5 seconds where this quack piece of garbage refers to himself as “Dr. Martin” and states that he will only accept patients that will follow his absolute quack advice to a “T”. Following that, his mohawk almost made me puke. Then I see his white coat, labeled “Dr. Martin.” NEVER IN MY LIFE have I seen a medical professional with “Dr. Xxx” labeled on their white coat! It’s *ALWAYS* “XxXX, M.D.” This underlines the root of the problem with these scummy pieces of crap chiropractors. They think they are DOCTORS and they are, in reality, garbage.

    Oh god, his explanation of diabetes and related morbidities is absolutely atrocious. It exemplifies why chiropractors are absolute idiots. Your financial stress is causing diabetes, get screwed you cartoon character-looking idiot. Oh and food coloring is causing diabetes, oh my god. And he basically admits that he is just an idiot that will charge you a lot of money, checking numerous unnecessary labs to “treat diabetes.”

    Dear @nwtk2007, jt, jhawk, this epitomizes the QUACKERY in your worthless, garbage profession. This stupid idiot is saying he treats DM2. PLEASE EXPLAIN HOW CHIROPRACTIC TREATS DM2! Man, this guy is an idiot.

  12. rwk says:

    @SepticHealth

    ” They do not have to have a degree,”

    Really, all colleges or just some?

    “any certain pre-requisites,”

    Really?

    http://www.nuhs.edu/admissions/chiropractic-medicine/applying/prerequisites/

    You’re wrong! And if you’re wrong about that what else are you wrong about?

    That’s why we sometimes enter into these anti-chiropractic rants that go back and forth nowhere

    because newcomers read your crap and might think you know what you’re talking about.

    If you want to be the champion quack buster here. Prove your statement

    ” They do not have to have a degree, any certain pre-requisites, or take any standardized tests

  13. Oh please, even that doesn’t list any exact classes and allows for multiple substitutions, doesn’t require a degree, doesnt require standrdized testing, and needs a 2.5 GPA. That is utterly pathetic. A 2.5 is a “C”, meaning “average.” Parker chiropractic and WIS didn’t even have remotely specific pre-requisites. Absolutely deplorable for a “doctorate” program. Did you have any point to make?

  14. Lol. The quack institution you linked also gives out degrees in acupuncture, “oriental medicine”, naturopathy, etc. how can you not see your profession is complete quackery? You should be ashamed of yourself, Mr.

  15. * excuse me, that quack place prides itself as being the *only* chiropractic quack school that requires a college degree – LOL. Setting the bar real high.

  16. nybgrus says:

    @skepticalhealth:

    To be fair, the requirements for medical school are actually equally as vague when looking at a prerequisites page:

    Tulane SoM as an example.

    However, you are correct – all MD/DO programs require a bachelor’s degree. As NUHS states:

    National University is the only chiropractic institution that requires a baccalaureate degree for admission. In addition, in Fall 2012, applicants will be required to have a cumulative undergraduate GPA of 2.75. We will be the only DC program to require a bachelor’s degree in addition to a raised GPA requirement.

    Which is rather pitiful.

    And not only do they offer the other quack degrees but:

    National University is one of only two schools in the country to provide chiropractic, naturopathic and acupuncture/oriental medicine degree programs on one campus. Chiropractic students are trained in an integrative medicine setting, alongside first professional students from our naturopathic and acupuncture and oriental medicine programs.

    And the DC licensing exam has an optional part devoted to acupuncture, in addition to the acupuncture questions on the required exam.

    So while you weren’t exactlyr right in your statements, you were indeed pretty close – I’d reckon to rwk’s chagrin.

    As for the whole anesthesia thing – I do not know where Texas stands, but there is currently a big issue re: anesthesia that is being battled out. Namely, 17 states allow for nurse anesthetists to administer anesthesia completely without physician supervision.

    Also, daedalus, not all anesthesia requires a IV – ketamine, for example, is routinely given intramuscularaly for anesthesia of children during orthopedic reductions (fracture or dislocation). Of course, I do not think this was the limit of what was used in MUA, especially since SMUA apparently exists as well.

    I’d comment further, but I need to actually get going and round on my patients before assisting in a trans metatarsal amputation. You know, real medicine.

  17. @nybgrus,

    Thank you for pasting that information. It’s pretty depressing that @rwk’s best example of chiropractic education is still a pitiful school. How disgusting is it that they advertise it as “integrative medicine” when they work with acupuncturists and naturopaths? Yikes. Acupuncture is just 100% pure quackery, not a single redeeming quality, and naturopathy is actually destructive quackery.

    Below is a quote from Emily Kane, who is the senior editor of the Journal of Naturopathic Medicine, which is the official publication of the American Association of Naturopathic Physicians:

    Another useful Physical Medicine technique is that of Hydrotherapy, discussed at length in the Introduction to Modalities section. Placing a hot, wrung out towel over the chest can relax the breathing muscles and restore normal breathing. For an acute asthma attack try a steam inhalation (draping a towel over your head and a bowl of hot water) with a few drops of eucalyptus oil in the water. Be careful that the water is not so hot that the steam burns your face. Some doctors recommend taking baths with a cup or so of 3% hydrogen peroxide in the water to bring extra oxygen to the entire surface of the skin, thus making the lungs somewhat less oxygen hungry. This method can be performed preventively. Another technique for an acute attack is to drink some hot water with the juice of one clove of garlic.

    It may be useful to assess the alignment of your spine. Often the upper thoracic vertebrae will be out of alignment after an asthma attack, which will ultimately put pressure on the lungs and possibly precipitate another attack. Getting regular maintenance soft-tissue work (massage), specifically between the shoulder blades, followed by a Chiropractic adjustment to the thoracic vertebrae, can reduce the frequency of attacks in chronic asthma, and the severity of attacks in acute asthma.

    If anybody feels like elevating their blood pressure and causing an aneurysm, just read this website:

    http://www.healthy.net/Health/Article/Asthma/783

    Harry Spitler, in the textbook Basic Naturopathy writes:

    A good case of smallpox may rid the system of more scrofulous, tubercular, syphilitic and other poisons than could otherwise be eliminated in a lifetime. Therefore, smallpox is certainly to be preferred to vaccination.

    Thankfully these lethal quacks are only licensable in a few states. But this is the kind of information they learn in their “integrative medicine” institutes, and this exemplifies why none of these people should have *any* contact with patients.

    Have fun at that amputation. The worst one I was in on was a diabetic who suffered a spider bite. The patient finally came in because their rotten foot smelled so bad that they couldn’t sleep at night.

  18. @nybgrus,

    Thank you for pasting that information. It’s pretty depressing that @rwk’s best example of chiropractic education is still a pitiful school. How disgusting is it that they advertise it as “integrative medicine” when they work with acupuncturists and naturopaths? Yikes. Acupuncture is just 100% pure quackery, not a single redeeming quality, and naturopathy is actually destructive quackery.

    Below is a quote from Emily Kane, who is the senior editor of the Journal of Naturopathic Medicine, which is the official publication of the American Association of Naturopathic Physicians:

    Another useful Physical Medicine technique is that of Hydrotherapy, discussed at length in the Introduction to Modalities section. Placing a hot, wrung out towel over the chest can relax the breathing muscles and restore normal breathing. For an acute asthma attack try a steam inhalation (draping a towel over your head and a bowl of hot water) with a few drops of eucalyptus oil in the water. Be careful that the water is not so hot that the steam burns your face. Some doctors recommend taking baths with a cup or so of 3% hydrogen peroxide in the water to bring extra oxygen to the entire surface of the skin, thus making the lungs somewhat less oxygen hungry. This method can be performed preventively. Another technique for an acute attack is to drink some hot water with the juice of one clove of garlic.

    It may be useful to assess the alignment of your spine. Often the upper thoracic vertebrae will be out of alignment after an asthma attack, which will ultimately put pressure on the lungs and possibly precipitate another attack. Getting regular maintenance soft-tissue work (massage), specifically between the shoulder blades, followed by a Chiropractic adjustment to the thoracic vertebrae, can reduce the frequency of attacks in chronic asthma, and the severity of attacks in acute asthma.

    Harry Spitler, in the textbook Basic Naturopathy writes:

    A good case of smallpox may rid the system of more scrofulous, tubercular, syphilitic and other poisons than could otherwise be eliminated in a lifetime. Therefore, smallpox is certainly to be preferred to vaccination.
    Thankfully these lethal quacks are only licensable in a few states. But this is the kind of information they learn in their “integrative medicine” institutes, and this exemplifies why none of these people should have *any* contact with patients.

    Have fun at that amputation. The worst one I was in on was a diabetic who suffered a spider bite. The patient finally came in because their rotten foot smelled so bad that they couldn’t sleep at night.

  19. DevoutCatalyst says:

    Chiropractic vs. US Patent Office

    “…What is also known but not generally appreciated is that individuals who regularly visit a chiropractor for care live longer than those who do not…”

    http://www.google.com/patents/US6850890?printsec=description&dq=6850890

    Take that, SkepticalHealth. Put on your rubber boots, this stuff is d-e-e-p.

  20. Dawn says:

    @Jann Bellamy and others: MUA is a VERY popular chiropractic thing. It’s very hard to prevent billing for it (there is no specific CPT code) so either you look at a lot of claims as an insurance company, or you anger a lot of anesthesiologists and physicians by denying legitimate claims.

    MUA has very specific uses in the medical world. It generally is a “last resort” procedure for something like frozen shoulder, when other modalities like PT have failed, before resorting to surgery.

    I haven’t read a lot of the operative reports, so I am not certain as to what extent anesthesiologists/CRNAs/etc are involved. I do know that as an insurance company, we have a lot of provider claims flagged for inappropriate use of MUA.

  21. Josh Berndt says:

    @Dawn
    As an insurance company, I would make it easy and deny all MUA performed by a chiro. Please research the effects of spinal manipulation. Nothing needs to be put back in place. This would be like paying to put someone under for a massage (that they won’t feel or remember). Exposing a patient to the risks of the procedure is bad enough, but when I think how expensive this must be, I get a little frustrated thinking my premiums go up to pay for this stuff.

    The two specific uses I can think of would be an arthrofibrotic TKA and frozen shoulder, both performed by an orthopedist.

  22. nmkirk says:

    @# SkepticalHealthon 03 May 2012 at 3:19 pm

    “In short, their idiots.”

    And what was your GPA for English? lol. Imagine composing a comment on lack of educational standards and not having a fundamental grasp of English. Credibility = 0.

  23. DevoutCatalyst says:

    A single spelling error equals not having a fundamental grasp of English? Haha, how old are you?

  24. mattyp says:

    “[A] neuromusculosketal condition that involves an aberrant relationship between two adjacent articular structures that may have functional or pathological sequelae, causing an alteration in the biomechanical and/or neuro-physiological reflections of the articular structures, their proximal structures, and/or other body systems that may be directly or indirectly affected by them.”

    As a (student) chiropractor, this is such a broad definition that it means nothing.

    Does this include an osteoarthritic knee? The femur and tibia are adjacent and have an aberrant relationship with one another – usually an altered joint space with osteophyte formation, occasionally subchondral cyst formation.

    I’m confused…

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