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The Council on Chiropractic Education Straightens Up?

Three years ago, we reported that the Council on Chiropractic Education (CCE) was deeply embroiled in a heated dispute among various chiropractic factions over its new accreditation standards for chiropractic colleges. In a June, 2012 update of that post, we found the CCE still deeply embroiled in a heated dispute among various chiropractic factions over new accreditation standards for chiropractic colleges. Current events, however, require that we now report that the CCE remains deeply embroiled in a heated dispute among various chiropractic factions over new accreditation standards for chiropractic colleges. And it has come to this:

CCE does not represent me

Ostensibly, the debate is about whether chiropractic students should be taught to detect and correct the putative subluxation and CCE’s commitment to chiropractic’s remaining a drug and surgery-free practice. As we have discussed several times here at SBM, a faction of chiropractors fancy themselves as primary care physicians who are competent to diagnose and treat patients with a wide variety of diseases and conditions, such as diabetes and cardiovascular disease, with various methods, such as “Functional Endocrinology.” This is, in fact, the position of the largest and most mainstream of the chiropractic trade associations, the American Chiropractic Association (ACA). (The ACA is actively promoting reimbursement of chiropractors for required primary care benefits under the Affordable Care Act.)

At the other end of the spectrum, the chiropractic purists (or “straights”) believe chiropractors should limit themselves to the detection and correction of the (non-existent) chiropractic subluxation. And they are adamant about chiropractic remaining “without drugs or surgery.”

Protestations to the contrary notwithstanding, chiropractic belief in the subluxation is widespread among chiropractors in North America and in Australia. And as far as I can tell, chiropractors who eschew belief in the subluxation have merely renamed it and redefined it in terms so vague as to be meaningless. Those who want to expand chiropractic to include a broader range of treatments do not exclude the subluxation as a relevant clinical entity. They’ve simply tarted it up in an attempt to obscure its lack of scientific viability.

The CCE on probation

The Council on Chiropractic Education, which accredits all 15 U.S. chiropractic colleges, has become a surrogate battlefield on which these skirmishes are fought. Usually chiropractors manage to stay on group message in their public persona. This unified front is facilitated by their isolation – their schools operate outside the mainstream American higher education system and their practices generally operate outside the mainstream healthcare system. No one really knows what they are up to. But because the CCE must renew its recognition as an accrediting agency with the U.S. Department of Education (Education) every three years, the public gets a peek inside.

The National Advisory Committee on Institutional Quality and Integrity (NACIQI) conducts the recognition process for Education. Its staff looks into whether an accrediting agency under review is meeting Education’s standards. The staff issues a report to the NACIQI, which, after a public hearing, makes a recommendation to Education. The straight chiropractic faction perennially uses CCE’s re-recognition by Education as an opportunity to harp on the CCE’s move (as seen by the straights) away from traditional chiropractic toward the “medicalization” of the practice. Because, in the straight’s view, the more liberal end of the chiropractic spectrum controls the CCE for its own purposes, the CCE is unrepresentative of the entire profession and the schools teaching traditional chiropractic philosophy. And this view has received some sympathy from at least one NACIQI member, who said in a 2006 hearing on the CCE’s continued recognition:

[S]ome of this, maybe most of it, is a consequence of, at least as I see it, a monopoly control of a profession which has led to the establishment of a virtual cartel.”

This led the dissidents henceforth to refer to the chiropractic powers that be as “The Cartel.” When CCE came up for recognition renewal again, in 2011, battle lines were drawn.

NACIQI received about 4,000 letters on the subject, only 30 of which were positive. At a December, 2011, hearing, in addition to staff and CCE representatives, 25 others who represented the broad range of chiropractic practice testified (e.g., the ICA, ACA and Association of Chiropractic Colleges). Of these, representatives of 2 spoke in favor of the CCE and 23 against.

The staff report was unflattering too. It found over 40 deficiencies in applicable standards for re-recognition, which garnered CCE the dubious distinction of being in the top tier of accrediting agencies in violation of Education’s standards. According to The Chronicle of Chiropractic (“The Source for News on Traditional, Conservative Chiropractic”):

Arthur J. Rothkopf, president emeritus of Lafayette College and vice chairman of NACIQI told CCE, “You’ve hit the jackpot on deficiencies,” noting that the problems enumerated by the department suggest a “sloppiness” in CCEs actions as an accreditor.

(To give you an idea of where The Chronicle is coming from, it carries an ad seeking support for the “National Vaccine Information [Mis] Information Center.” So, if you ever need proof that chiropractors are anti-vaccination, here’s your citation.)

The NACIQI recommended a one-year extension of the CCE’s recognition so they could clean up their act. In addition, the NACIQI imposed a requirement that the CCE become more representative of the entire profession. This delighted the protesters. While the Undersecretary of Education agreed with NACIQI on all other points, it said the Department had no authority to impose this additional requirement. The CCE was to issue a full report in one year, at which time there would be another staff evaluation and hearing. The Undersecretary warned the CCE that further extensions were rare and that it could lose accreditation if CCE didn’t straighten up. Later, another hearing before the NACIQI was set for December 12-13, 2013. (That is, starting today.)

The dissenters circle their prey

The CCE thus weakened in the eyes of the straights, they set to work. They formed their own coalition of organizations named the “Da Vinci Group,” ironic in light of Leonardo Da Vinci’s meticulous study of anatomy. According to one member, the International Chiropractic Pediatrics Association (ICPA), the Group is a coalition of “at least” 70 chiropractic organizations. The most robust of these is the International Chiropractors Association (ICA), the official trade association for the straight faction, which provided funding to form the Group and emerged as a natural leader for the organization, an involvement that led to later disappointments, as we shall see.

The Group is now circulating a petition:

To be meaningful, CCE reform must include, but not be limited to the following elements:

1) Vertebral subluxation detection and reduction, stated in unambiguous terms, in both symptomatic and asymptomatic patients must be included in the CCE Standards as the essential element in a curriculum leading to the Doctor of Chiropractic degree.

2) Chiropractic must be defined as “without drugs and surgery” in the Standards. [“Drugs” means OTC as well as prescription drugs.]

3) Governance reform of the CCE including: [briefly, reforms in elections and an expansion of site teams which inspect schools for the CCE].

Note the “in both symptomatic and asymptomatic patients” language. In other words, the Group is demanding that students be taught “maintenance care,” sometimes referred to as “wellness care.” This is based on the chiropractic philosophy that all patients, including newborns, suffer from subluxations throughout their lives. If not reduced by adjustments (or manipulation, a term they use interchangeably with adjustment) these subluxations interfere with the nervous system’s regulation of the body, resulting in health problems, including heart disease, sudden infant death syndrome, allergies, asthma – you name it.

While the Da Vinci Group didn’t want to see the CCE killed as the recognized accrediting agency, it did want to put it on life support for one more year while Education decided whether to pull the plug for good. The Da Vinci Group members would argue to the NACIQI that if CCE were re-accredited, it should only be for another year, either by extension of its probation or a shortened recognition time. During that time, the Group could use CCE’s tenuous grip on life to leverage its own position.

A defection to the Cartel

Things were going along swimmingly when, in November of this year, ICA broke ranks as a result of an offer during the November meeting of yet another chiropractic group, The Summit. The Summit apparently consists of some groups (the CCE, the ACA, etc.) the dissidents would refer to as the Cartel, but the ICA is also a member. (Other professions have subgroups based on specialty, e.g., the American Academy of Pediatrics, the America Bar Association Section of Anti-Trust Law. Chiropractic apparently groups itself according to factions.)

At that meeting, the Summit decided it would endorse continued recognition of the CCE and issued a statement saying so. In what appears to be an attempt to soothe, or at least quiet, the dissenters, the statement said:

After multiple focus groups, the following marketing language was passed: The Summit acknowledges the concepts of spinal health and well-being as credible marketing messages and we encourage further efforts to refine and test such efforts.

Which is an interesting thing to say smack dab in the middle of a document explaining a group’s position on the governance of the chiropractic educational system. Perhaps it inadvertently reveals something about the focus of chiropractic education.

Relevant to charges that the CCE and other chiropractic organizations were being wishy-washy about drugs:

no chiropractic organization in the Summit promotes the inclusion of prescription drug rights and all chiropractic organizations in the Summit support the drug-free approach to health care.

So now we have yet another subdivision of chiropractic. A sub-faction of the mixers, the DC as PCP group, wants the privilege of prescribing drugs, although they are not generally the type of drugs any medical doctor would ever think about using on patients. They’ve achieved some success in New Mexico but were rebuffed in Colorado. And now they’ve been rejected by the Summit, although maybe “multiple focus groups” could change the Summit’s mind if prescription drugs become a “credible marketing message.”

The CCE, in front of all the other Summit members at the meeting, offered to engage in good-faith discussions addressing the ICA’s (as well as some other Summit member’s) concerns about CCE’s governance. The ICA president also “spoke with” the CCE leadership about including the Da Vinci Group in these conversations. In exchange, the ICA would temper its testimony against CCE at the December NACIQI hearing, not oppose re-recognition, and not limit its support of recognition to one year.

The Group regroups

The rest of the DaVinci Group was not amused. (One headline in the chiropractic press read: “ICA Endorses CCE . . . Move Shocks DaVinci.”) Accusations went flying. Chiropractic had managed to split into yet another set of factions. The Group viewed ICA’s action as joining The Cartel for sure. Claims and counter-claims were made about the effect of the CCE’s loss of accreditation status on federal student loans (a big cash cow for chiropractic colleges) and state licensing (many states defer to the CCE accreditation in deciding whether to accept a degree from a particular chiropractic college in determining eligibility to practice).

The ICPA sent out a urgent “Call to Action” e-mail to members bemoaning the CCE Standards’ “ambiguous” language on the subluxation and lack of a clear stance against drugs and surgery. It asks, rhetorically:

Do you want the freedom to effectively care for your patients, to proficiently adjust spines of all ages and offer the best possible chiropractic care too all: symptomatic or not? Do you desire research that substantiates the role of the adjustment in wellness and improved quality of life?

Yes, after all, what is the goal of research other than to tell you you’re doing everything exactly right?

In the midst of all this, the DaVinci Group suffered another blow when the NACIQI staff report was released in advance of the current hearing. Staff found that CCE had indeed straightened up. Staff recommends renewal of CCE’s recognition for a period of three years. All parties appear to be in agreement that NACIQI will adopt the recommendation and CCE’s recognition is assured.

If you are looking for some insight into chiropractic education from this 45-page report, forget it. To me, it reaffirms the notion that schools teaching black magic could form the Council on Black Magic Education accrediting agency and get that agency approved by the U.S. Department of Education as long it complied with financial, conflict of interest and like standards. It doesn’t matter WHAT you teach. Once again, the staff blew off complaints about the subluxation’s supposedly dwindling role and the “medicalization” of chiropractic education. But the dissidents remain undeterred.

So what? Who cares?

If you want to judge chiropractic education, look at chiropractic practice. As noted at the beginning of this post, practice is still mired in the subluxation, whether the original or new, murkier, multi-name version. Best I can tell, what has been added to practice in the name of “progress” are silly tests for “nutritional deficiencies,” homeopathy, claims that chiropractors are primary care physicians, acupuncture, and other treatments which lack a grounding in science. Frankly, I don’t care who wins this fight, or all the sub-fights within the main event. For me, their value is in providing a rare public glimpse into what transpires in the world of chiropractic.

What I do care about is the fact that millions of patients are spending millions of dollars on worthless diagnoses and treatments at the hands of chiropractors. The federal government’s approval of the CCE only serves to facilitate this unconscionable state of affairs. And it makes the taxpayer foot part of the bill, in the form of student loans. All in all, a terrible waste of money that could be going to improve healthcare in a meaningful way.

Posted in: Chiropractic, Legal, Politics and Regulation

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87 thoughts on “The Council on Chiropractic Education Straightens Up?

  1. Blue Wode says:

    Great post.

    Re: “…chiropractic belief in the subluxation is widespread among chiropractors in North America and in Australia”, I think it’s important to point out that belief in the subluxation is also widespread amongst chiropractors in the UK. The Alliance of UK Chiropractors (AUKC), which claims to be the largest chiropractic association in the UK, recently adopted the International Chiropractors Association (ICA) Best Practices documentation [ https://www.facebook.com/pages/Alliance-of-UK-Chiropractors/151897244826008?v=info ] which, among other policies, supports 27 indications for chiropractic radiography including

    spinal subluxation
    birth trauma (forceps)
    facial pain
    skin diseases
    organ dysfunction
    eye and vision problems
    hearing disorders

    and recommends a basic care plan for simple uncomplicated axial pain (neck pain, back pain, etc) consisting of 25 visits over 8 weeks – with the presence of ‘complicating factors’ (including family/relationship stress, lower wage employment, and wearing high-heeled shoes) warranting a recommended additional 12-visit blocks of care. Here is the link to the ICA Best Practices documentation: http://www.icabestpractices.org/chapter-docs.html

    When the AUKC surveyed its membership in 2010, the results revealed that of over half of its members who took the time to complete this online survey, 82.9% felt that the vertebral subluxation was not an historical concept, 95.4% thought that chiropractic philosophy should be taught in the chiropractic colleges, and 90.5% found that, in their experience, chiropractic was effective for conditions outside those mentioned in the Bronfort Report. Ref:
    http://www.ebm-first.com/chiropractic/uk-chiropractic-issues/1827-alliance-of-uk-chiropractors-october-2010-newsletter.html

    So, chiropractic in the UK remains remains riddled with pseudoscience even although many countries outside the UK view it as being respectable. Unfortunately, this veneer of respectability prevails because of a widespread lack of awareness that the General Chiropractic Council’s original guideline on the chiropractic vertebral subluxation complex was quietly altered in favour of chiropractors:
    http://www.ebm-first.com/chiropractic/uk-chiropractic-issues/1825-subluxations-still-no-evidence.html

  2. windriven says:

    I find the notion of chiropractors distancing themselves from subluxation unsettling. The subluxation theory, discredited as it is, defines the raison d’etre for chiropractic, delusional as it is. Absent subluxation, what precisely is the mission of chiropractic? What is its theoretical foundation? What are its practice objectives and based on what guidance?

    It seems to me that those advocating moving away from subluxation recognize it to be fantasy yet they want to pursue chiropractic – an empty jar once subluxation is removed. What is the motivation to pursue study in a field they recognize to be based on fantasy?

    Ultimately they may wish to follow the path pioneered by osteopathy leading, somewhere in the future to DCs earning the title ‘doctor’ without the irony that attends it now. But what does that add to the practice of medicine, the advancement of science, or the interests of the patient population? Medicine and medical education already exist. Adding a brand of chiropractic that pretty much looks like medicine is entirely pointless and gives comfort to the shruggie mantra that medicine should be an inclusive practice embracing every kind of barnyard dropping that some weasel manages to find a following for.

    1. catwhoorg says:

      The motivation is simple, insurance carriers will happily pay for chiropractic care, whilst heavily limiting regular PT/OT visits.

      Crazy as that seems to anyone who believes in science based approaches.

      1. irenegoodnight says:

        Exactly!

        I had to pay for over half of my PT for my rotator cuff recovery because of insurance limitations, but had I gone to a chiro for same, they would have paid completely!

        Insurance also (years ago) pretty much quit paying for light treatments for psoriasis and many eliminated allergy shot administration as well–yet they continue with chiro “care”.

        It is outrageous and cannot be justified except by political corruption.

        1. mousethatroared says:

          @goodnightirene – Wow, that’s crazy. IME, here in MI all my PT has been fully paid for by our insurance (outside of the standard deductible or co-pay that I would pay for any visit) up to a certain number of visits as long as it’s prescribed by my doctor and I use a participating PT group.

          Last I know chiros were only covered about 50%. Haven’t checked into it recently, though.

          1. William says:

            @MTR
            You’re right. She’s not.

            1. mousethatroared says:

              Well, I know we live in different states and have different insurance, so it’s very possible that both of us are correct.

      2. William says:

        It’s really the other way around. Give one example of PT/OT limitation
        vs carta blanche status for chiropractors. Why not start with Medicare?

  3. tgobbi says:

    Windriven queries: “Absent subluxation, what precisely is the mission of chiropractic? What is its theoretical foundation? What are its practice objectives and based on what guidance?”

    This is the $64,000 question, one that I’ve asked over and over. The “doctors” of chiropractic, themselves, don’t appear to have the answer – or at least are too embarrassed (or realistic) to be willing to answer it.

    For me, the answer is simple: without the subluxation there is no chiropractic. It’s the only thing that sets them apart for all other healthcare delivery disciplines, legitimate or not. Didn’t someone on this forum once say that without subluxations, D.C.s are nothing more than physical therapists with delusions of grandeur? (It occurs to me that this comment may cast aspersions on physical therapy, an honorable profession). OK, so the “mixers,” having realized that strictly chiropractic hocus-pocus is futile, adopted naturopathy into their armamentarium. Naturopathy, as we all know, is a free-for-all melange of just about every other kind of quackery (excluding chiropractic) know to man. So mixers are part chiropractors & part naturopaths.

    Windriven also asks “What is the motivation [for D.C.s] to pursue study in a field they recognize to be based on fantasy?”

    Simplified answer: they get to call themselves “doctor” and/or “physician” without actually being with of those things. (Side note: in California, last time I checked, they couldn’t call themselves physicians. I believe they can in most other states. In fact, I’ve been to lectures at which the D.C.s introduce themselves as Dr. So-and-so, referring to themselves as physicians without stating that they are chiropractors. I call this a gross violation of ethics)!

  4. rork says:

    Thanks so much for well-written and informative article. Laughed pretty hard a few times, but maybe this snippet deserved some humorous spin too: “Vertebral subluxation detection and reduction, stated in unambiguous terms…….”. With irony in abundance, perhaps you have to limit how many targets get your arrow.

    catwhoorg made me realize: I could use a insight/review about how insurance carriers really feel. Wish I knew or could read opinions from an insider with serious grasp. I will search but good pointers welcome. Of the things I’ve learned here, maybe I’ve forgotten more than I still recall.

  5. Michael says:

    I’m a chiropractor and all of my children are vaccinated so if your going to say chiropractors are anti vaccine then at least say some or most because obviously we aren’t all. My practice is exercise based, graded exposure to feared stimuli etc. etc. I’ve never said the word subluxation in my practice and I have to tell people all the time that their bones are not out of place. Being as far into school and as much debt as I was in, for me to leave school and go accrue more debt pursuing and “honorable” profession like PT would have been ridiculous. People come to me with chronic back and neck pain knee pain, and their general physicians have their heads so far up their asses that they actually tell these patients that their herniated discs and osteoarthritic changes seen on imaging are responsible for their pain they’ve had for years further ingraining fear avoidance behaviors for these patients and it’s makes it that much harder for me to explain that the more chronic your pain the less likely “damaged tissue” is the cause. So who is doing the patients the disservice in these instances? Me the chiro or the honorable MD? So you can poke holes in the rest of my profession, good for you. You can kick rocks and so can they. I’m a chiropractor, I have no allegiance to chiropractic though only to my patients and getting them out of pain as fast as possible which I used evidence based “practices” I won’t say evidence based medicine cause I’m sure based on the comments on here a lot of people would get their feelings hurt. So what I don’t adopt subluxation I still get people better fast and that’s all I care about.

    1. windriven says:

      “So what I don’t adopt subluxation I still get people better fast and that’s all I care about.”

      How? If your practice isn’t based on subluxation, what is the paradigm that you use to diagnose and treat?

      1. William says:

        @WD
        The paradigm is Manual Medicine.

        1. WilliamLawrenceUtridge says:

          How are you different from a physiotherapist?

          1. william says:

            @WLU
            “How are you different from a physiotherapist?”
            In general,
            You could come to see me as soon as I could see you after you felt you need intervention. No sitting in an MD or DOs office waiting for a referral then calling around to find a physio. Then scheduling an appt. with the PT who fits your schedule. That’s anywhere from one to three days ( maybe) till someone actually did some physical work on you. If your ” physician” gives you meds and you feel better there’s a good chance you wont even make that appt. Everybody’s busy.
            Even though PTs have direct access in all but two US states, not all
            insurance companies are onboard. And the PT can only treat you for one month then they need an order from an MD,DO,DPM or I hate to tell you this, a DC. This is Indiana law. You want exercises,we’ll both give them to you ( in theory). Except I won’t make you do the hard ones until you’re not in pain. By the way, if you choose the medication only route and many do, you might very well become addicted and never want physical treatment. What else do you want to know?
            I like PTs,DOs,MDs,Physiatrists,Orthopods and DCs who practice manual medicine. We can all learn from each other. Many therapeutic interventions are interdisciplinary. I don’t like people who base their strong opinions on what they see in internet ads,blogs or on their one trip to a DC.
            And there is overlap as to similar services provided.But remember some of those practitioners in all disciplines mentioned above are just better than others. It’s up to you to pick the best one.

            1. windriven says:

              William,
              Where might I find solid information on the theoretical and empirical foundations of manual medicine? A quick perusal of Pubmed didn’t yield anything useful.

            2. mousethatroared says:

              You sound as if you believe the only pharmacutical intervention that can relieve pain is some sort of opiod. If that’s the case, there is a major gap in your knowledge. A gap that is probably depriving some of your patients of pain relief.

    2. WilliamLawrenceUtridge says:

      Michael, how are you different from a physiotherapist?

      What would you think of spearheading an effort to redefine your profession as a variation of physiotherapy specializing in back pain?

      And of course, the failings of other branches of medicine in no way justifies chiropractors pretending to be anything but physiotherapists with a twist (a twist that is rapidly being integrated into physiotherapy training).

      1. windriven says:

        William,

        This is why I’m asking about the conceptual foundation of his diagnosis and treatment. Michael avers that his practice employs “evidence based “practices”.” It would be clarifying to understand the provenance of the evidence on which he relies.

        You characterize chiropractors as physiotherapists with a twist. We understand the twist and its clinical usefulness. It is the physiotherapy apart from the twist that is of interest to me. Is this physiotherapy that a physiotherapist would recognize or some other manipulation masquerading as physiotherapy?

        1. WilliamLawrenceUtridge says:

          I always write my comments before I read yours Windy, ’cause otherwise I would be reduced to “what windriven said” or “+1″ :)

          Yeah, I’m giving a fair bit of credit to any chiropractor who doesn’t think of himself of a physician. Any conceptual foundation other than “muscles move bones, muscles can knot and bones can displace” is nonsense that needs testing to verify that it exists, not assertions that the dogma is accurate.

          1. Michael says:

            Exactly, were taught in my school that bones displace slightly and even how to try and visualize it on plain film. It was awful and disproven by dynamic xray. I’m not saying the schooling is great, far from it. I just hate being lumped in with every other chiro.

            1. Andrey Pavlov says:

              I just hate being lumped in with every other chiro.

              Certainly understandable. Both ways. The reality is that what is your profession is quackery. There simply is no legitimate question about that. The fact that you don’t practice it is laudable, but doesn’t change the facts of what is undeniably your profession. It’s like an egalitarian KKK member who is only in the Klan because he likes the comfy white robes and agrees with their conservative fiscal policy ideas and then complaining that you “don’t like getting lumped in with every other Klansman.”

          2. windriven says:

            :-) Funny, I’m the same way. I hate reading your responses before I answer. You always say it nicer than I would and then I have to rethink my assholishness. But sadly, it doesn’t last.

    3. Calli Arcale says:

      “the more chronic your pain the less likely “damaged tissue” is the cause.”

      Could you explain this in more detail? I’m just a software engineer, but to me I don’t see any reason why the “chronicness” of pain would correlate negatively to damaged tissue. While I could understand chronic pain that isn’t due to tissue damage, wouldn’t damaged tissue continue to hurt until the damage is healed or repaired? That makes no sense to me, so can you explain?

      Anecdote: I had developed chronic pain in my foot that turned out to be due to a ruptured joint capsule. After the capsule was repaired and the post-surgical pain gone, the chronic pain was completely gone, and has remained gone. That makes sense to me; if a part of the body is damaged in a way that cannot heal itself, logically the pain isn’t going to go away and will be chronic without some sort of treatment or repair.

      1. windriven says:

        @Calli Arcale

        I was moving in a similar direction with my questions above. I too was struck by Michael’s dismissal of tissue damage as a cause of pain.

        Pain can be broadly separated into nociceptive and neuropathic types (and a variety of types that are, more or less, in one’s head*, i.e. phantom limb). Damaged tissue is a classic example of nociceptive pain.

        I hope to understand the theoretical underpinnings of Michael’s approach to diagnosis and treatment and from there tease out his appreciation of the causes of pain associated with herniated discs and arthritic joints and his strategies to treat that pain.

        *”In one’s head” is not intended to be dismissive in this instance. Psychogenic and phantom limb pain is absolutely real to the sufferer.

        1. mousethatroared says:

          Windriven – As far as I know phantom limb pain isn’t “in one’s head” in the sense that it has a cognitive/psycho/social basis. I believe that, at this point, it’s thought to be a sensory/nervous system issue having to do with sensory remapping. The phenomenon sounds somewhat similar to Charles Bonnet syndrome in folks with macular degeneration.

          The book Hallucinations by Oliver Sacks has a better explaination than I can give.

          1. windriven says:

            Interesting. I may have been spouting old school nonsense that has been supplanted by newer, better information. I love science!

      2. nmsk says:

        “wouldn’t damaged tissue continue to hurt until the damage is healed or repaired?”

        A person can be in pain after the damaged tissues have healed via central sensitization. Your nerves have a resting level of electricity running through them and have to reach a certain threshold to fire and send a message to your brain for processing. In some people this resting level gets “stuck” close to the firing threshold, which means the nerve sends more messages to your brain with less stimulus. The brain could then decide to process these messages as pain with or without tissue damage. Hopefully this helps.

    4. Jann Bellamy says:

      If you are one of the (apparently few) evidence-based chiropractors then congratulations for bucking the system. I wish you would all join together and try to reform chiropractic education and practice because right now, as best I can tell, it’s a mess. And good for you for vaccinating your children!

      I’m curious — how does one educational system produce everything from the “DC as PCP with prescription authority” to the super-straights? And what did they teach you about vaccination at your school? Do you know what other schools teach? It’s hard to get good information because the whole thing operates in its own world and I don’t trust the public information the chiropractic system gives out.

      1. CG says:

        Check out which institutions produce evidence based chiropractors. I practice in Canada so CMCC is one school that prides itself on being evidence based, and this is where I went. CMCC graduates 180-190 chiros a year, so this “apparently few” will grow. Just like with old school principles in other disciplines, old school chiropractic will be phased out. Just have to be patient I guess.

  6. CG says:

    I am a licensed chiropractor who utilizes principles from all evidence-based realms. The word subluxation means nothing to me (so I guess I am a vigilante or a “mixer” DC, in the opinion of this article), and don’t use the word personally. If someone’s cervical, thoracic, lumbar, or sacro-iliac joints are causing pain, I address it with treatments that have been shown in scientific papers/articles proving a chiropractic adjustment/manipulation/joint thrust makes it feel better/function better. It’s discussions like this that make my profession seem like it isn’t scientific, and why other professions can jump on and criticize us.

    I went to an evidence-based chiropractic college where the word subluxation was only used in chiropractic history classes, and therefore was not preached to us as a principal tenet of what we do. I treat musculoskeletal conditions with evidence based principles. I utilize many treatment strategies, and don’t rely on adjustments as the only treatment approach to use for any condition I see. Yes, I am a doctor. I studied anatomy, physiology, biomechanics, biology, neuroanatomy, etc. just like any other medical doctor. I’ve worked hand in hand with other manual practitioners – PTs/OTs, and medical doctors as well. Evidence-based chiropractic has a place in the health care system we live in. The higher ups who wish to use the word subluxation frustrates me as well, but doesn’t affect how I practice. The only way it affects me is that other professions think I use the word subluxation with all my patients and preach it when discussing treatment plans.

    If you want to bash the word subluxation, straight chiropractic, and chiropractors that don’t utilize evidence based principles, so be it. But leave me out of the bashing because that is not how I practice, or will continue to practice.

    1. Jann Bellamy says:

      I appreciate your answer, but I am interested that you use the term “adjustment” and it confuses me a bit. I thought the purpose of the adjustment was the reduction of the subluxation — to my knowledge, other manual practitioners (PTs/OTs) do not use the term. So how do you use the term? What is its purpose and how is it different from spinal manipulation?

      It’s not just the subluxation I am “bashing.” Chiropractors can reject the traditional view of the subluxation and still have adopted one of its newer, but equally unproven, iterations. For example, the Federation of Chiropractic Licensing Boards is (or at least was recently) pushing the following as an amendment to the state chiropractic practice acts, in which “chiropractic” is defined as “a primary care health discipline that recognizes the inherent recuperative power of the body, whose practitioners promote and facilitate health through the evaluation, diagnosis and management of structural conditions or other disorders of the body that interfere with physiological function or neural integrity.” To me, this just sounds like the subluxation put in fancier, but essentially meaningless, language. Is that the case?

      Also, I’d still love to hear what your school taught about vaccination.

      1. Jann Bellamy says:

        Oops! Thought you were Michael replying to all of our comments. Sorry, CG. But I’d still love to hear your answers to the questions I raise.

        1. CG says:

          1) in Ontario our scope of practice states we can discuss our view but state that the best discussion. Is to have it with someone who has vaccinations within their scope.

          2) doesn’t all manual practitioners utilize this definition of using the body to heal itself? Isn’t active release technique or other soft tissue protocols allow peripheral nerves to function better if they are entrapped? This doesn’t just apply to chiropractors, PT’s use modalities and rehab to aid the body in its recovery, as do I

          3) adjustment is just nomenclature in my opinion. Getting the joint to move be it with an HVLA thrust vs a lower graded MOB have the same goal, to get the joint to move better. If the joint moves better, if there is pain in that area, it usually makes the area feel better and move better. This principle doesn’t just apply to the spine, but any peripheral joint as well. Finding a term that patients understand is the most important concept – I find adjustment the one they can grasp the most as it implies getting motion through the area.

          1. WilliamLawrenceUtridge says:

            doesn’t all manual practitioners utilize this definition of using the body to heal itself?

            Bar perhaps surgery, this is pretty much how all medical professions should work; allowing the body to heal itself. I view the statement as a completely meaningless appeal to nature, far more marketing than science.

            1. CG says:

              Far more marketing than science? Some people prefer less invasive approaches to MSK injuries, and using manual therapy to aid in pain and/or function is a choice that some people make. If people wish to let natural history to run its course, then they can make that choice too.

      2. mousethatroared says:

        Regarding the word “adjustment”. As a patient, I’ve had PT use this word during therapy, not in terms of subluxation. As I recall it’s been when we are working on mobilization and and the joint will pop/crack or shift they might remark “a little adjustment there.” or similar. I’ve also been given exercise that “adjust” an area, meaning stretching or pushing on a limb or part of the spine so as to allow space into a joint and temporarily relieve pressure on inflamed area or in the hopes of shifting tissues into a more functional position (such as with impingements).

    2. Michael says:

      exactly my sentiment

    3. WilliamLawrenceUtridge says:

      No offence, but I don’t think you studied those disciplines “like a doctor”. Unless you’ve been to medical school, how would you know? And how do you apply this knowledge, considering you don’t treat patients for naught but muscle, bone and joint pain? Why do you even learn it?

      Also, calling yourself a “doctor” is perhaps something you do, but you certainly aren’t a physician. At best, you’re a doctor the same way a doctor of philosophy is a doctor.

      How are you different from a physiotherapist by the way?

      1. CG says:

        1) we are able to diagnose our patients, one difference from physios. Our program is 4 years, not 2. This allows us to develop our manual skills under supervision that much more.

        2) we learn these subjects just like dentists learn full body anatomy – it is a part of our board examinations and most classes give us knowledge so we can identify red flags and refer out if needed. Sometimes non MSK problems can masquerade as MSK, so we need to have this knowledge so that we keep our liscences.

        Its okay William, you can reserve your opinion as to who deserves the title of doctor. I am one of few professions that is allowed this Designation, so I choose to use it. If you feel that I haven’t earned it, by all means I will allow you to have your own opinion. My patients appreciate my evidence based care, and at the end of the day, thats all that matters.

        1. Michael says:

          Agree with CG again on this

        2. Badly Shaved Monkey says:

          1) we are able to diagnose our patients,

          A homeopath would make the same assertion. Asserting it does not make your diagnoses accurately based on a correct understanding of medicne.

          The homeopath will diagnose a patient as Bryonia
          The chiropractor will diagnose a patient as subluxated at Ce5-6. Or the non-users of the term ‘subluxation’ will refrain from use of that actual word, but still crack the patient’s neck based on some ill-specified inference about the Ce5-6 location.

          In connection with that latter point, whether an individual chiro claims ownership of the word ‘subluxation’ appears to make no difference, the patient still gets their back or neck cracked.

          1. CG says:

            Mechanical neck dysfunction, just like mechanical low back dysfunction, just like lateral epicondylosis, etc are all diagnoses that I would use. If someone presents with a reduce ROM, trigger points in their levator scapulae, suboiccipital mm group, have a positive Kemps test, with pain localized to the C5-6 joint, then they would have a diagnosis of “mechanical neck dysfunction”. What would I do? Soft tissue to address the trigger points, SMT or MOB the neck, depending on patient preference or if any risk factors are found on hx and phys exam, modalities for short term pain control, and rehab to stretch and strengthen the tissues. I’m not clearing up any interferences, just getting the area to feel better, move better, and get stronger. Not addressing a y subluxations or interferences.

            If you see any fault in this style of treatment, please let me know why and what differently you would do.

  7. Michael says:

    @windriven I missed the point in my post where a said damaged tissue is not a source of pain, ever?? Copy and paste where I said that. If you’re going to counter my argument at least represent what I say with some accuracy. The point I’m making is how many people are walking around with herniated discs that are asymptomatic? Many. How many people are walking around with degenerative OA in their knees with no pain? Many. How may people do you see with debilitating chronic back pain with lesser abnormalities on imaging than someone who has more profound abnormalities on imaging and no pain? Many. The correlation between chronic pain and tissue damage is often weak. Read Lorimer Mosely’s work. He says the the relationship between pain and the state of the tissues gets weaker as time goes on. Pain level doesn’t correlate well with amount of tissue damage. That was my point and even though I am a lowly chiropractor understanding these things and being able to explain them to my patient makes getting my patient out of pain, easier. If you’d like to mangle my words to fuel your keyboard warrior mentality a little then by all means. I have no more time for it, sorry.

    @Jann We have immunology classes and pathology classes but they by no means put us in a postition to make calls on the efficacy of vaccination and most DC’s like to be contrarian for the sake of being contrarian unfortunately, at least that’s how it seems to me

    1. windriven says:

      Michael,
      Please don’t be defensive. At least not yet ;-) I am trying to be respectful as I try to ferret out what your approach actually is. Look, we don’t characterize all chiros the same here. Our own Sam Homola is a perfect example of a chiropractor of many years standing doing his level best to deliver quality, evidence and science based care to his patients. At the same time please understand that we have all manner of kooks and loonies who appear in these pages. We’re going to ask pointed questions and you are free to answer or not or respond with pointed questions of your own.

      “I missed the point in my post where a said damaged tissue is not a source of pain, ever?? Copy and paste where I said that. If you’re going to counter my argument at least represent what I say with some accuracy.”

      [Some physicians] ” have their heads so far up their asses that they actually tell these patients that their herniated discs and osteoarthritic changes seen on imaging are responsible for their pain they’ve had for years…”

      To my understanding both herniated discs and arthritic joints are accurately characterized as damaged tissues.

      “being able to explain [pain levels and correlations to tissue damage] to my patient makes getting my patient out of pain, easier.”

      How? This brings me back to my initial point. If your practice is not based on subluxation theory, what informs your diagnostic and therapeutic practice?

      1. FacelessMan says:

        I was taught at orthopedics that radiologic findings correlate very porly with patients pain (an arthritis that looks very bad on an x-ray can cause litle pain and vice versa). A doctor can make the mistake of seeing arthritis, which might cause very litle or even no pain and forget about other possible causes for the pain.

        I think this is the point Michael is trying to make.

        1. Michael says:

          Yes, it is. You just articulated it better than I.

  8. Hoss says:

    I suspect there is some concern among current chiros that they’ll be required to go get an MD if the practice begins to incorporate prescription pharma. Its a poison pill. See what I did there? They don’t want to go back to school. They’d to get a proper education or walk away from practicing.

    I really don’t blame anyone from starting chiropractic school. You’re un-educated. Ignorant. It’s staying until your done that astonishes me. Or maybe, “I was well past half way done with my glass of kool aid so I thought…I paid for it…might as well finish it.”

    Cheers.

    1. CG says:

      Hoss, I don’t think that is the case at all. Mechanical problem, mechanical solution. Non mechanical problem, refer out for a non mechanical solution.

      Glass of Kool Aid? I guess you can say I’m guilty of that if looking at scientific literature on manual therapies and their benefits is Kool Aid. Make your way to CMCC and sit in on a class – you will see what education we receive and how propure it is. And to call my decision to enroll in a chiropractic program as ignorant and uneducated is absolutely false – I see a need for manual therapy in our health care system.

      There are a number of DC/MD’s out there, I doubt they would discredit their chiropractic education as you have implied.

  9. Michael says:

    My apologies. It’s frustrating to get lumped into a group of people with the same name but vastly different approaches. Damaged tissues heal and we still have pain. My other points are clear that as pain persists the correlation of that pain and tissue damage becomes weaker. There are other factors at play potentially other than just damaged tissue i.e. psychosocial factors, fear-avoidance central sensitization etc. My methods are informed by my assessment, exam, hx, subjective, imaging, testing whatever I feel like we need to figure out a cause. That doesn’t have to be based around a “subluxation”

    1. Badly Shaved Monkey says:

      Damaged tissues heal and we still have pain

      You make various assertions about the tissues of the body, but you are limited to what you can feel with your hands and see on radiography. You really have no basis on which to infer the nature of tissue pathology or it’s absence in your individual patients.

      The best you can claim is that you whack patients and at subsequent times you record them as feeling better based on your own assessment and/or thei report. You have no idea what is going on in that black box that you “adjust” and you have no basis on which to assert that your subsequent reports of your patients’ states are causally related to your intervention.

      The question has been asked in several ways in this thread already and not been answered. What is it that you ‘adjust’? How does that target differ from the chiropractic so-called subluxation?

      1. Michael says:

        Im limited to what I can feel or see on radiography? I didn’t know I wasn’t allowed to take a hx, perform orthopedic tests or order an MRI if I please. I ordered an MRI last week for an achilles injury? Is that not a basis to infer the nature of this persons tissue pathology? It was confirmatory for what I found on exam. And no I didn’t adjust his achilles. Idiot, next.

  10. Albert Macfarlane says:

    CG states that education in the Canadian Memorial College of Chiropractic (CMCC) is evidence based, and “old school chiropractic will be phased out.”
    I quote from the 2013-2014 CMCC Academic Calendar – available at
    http://www.cmcc.ca/document.doc?id=859
    “….Chiropractic Techniques Taught at CMCC
    The chiropractic adjustment is the treatment modality upon which the chiropractic profession was founded. While there is a diversity of approaches utilized by chiropractors around the world, the curriculum at CMCC centres around diversified technique……..”
    Sounds like old school chiropractic will still be around in 2014.

    1. CG says:

      Diversifed technique is the form of adjusting that we learn, and is one of the modalities that we learn, along with auxilary modalities, etc. Getting a joint to move better has been shown to make the patient feel better and make positive orthopedic tests become a negative finding. PT’s use adjustments or “diversified” techniques as well, and see the benefit of using such treatment strategy, when the given patient presentation warrants it. Spinal manipulation has been shown time and time again in the literature to help with a number of common MSK complaints, to refute that is being ignorant to the science.

      1. Albert Macfarlane says:

        Thank you for your comment.
        As I said above, sounds like old school chiropractic will still be around in 2014.

        1. CG says:

          It will be, but not being taught at CMCC. Yes, we learn adjusting, but we learn evidence based ways to apply it. That isn’t old school, old school is learning it and applying it to all conditions or making it a part of every tx plan. It is one of my “tools” (adjustments that is), along with other items like soft tissue techniques, modalities to aid in healing or pain control, kinesiotaping, rehab, etc. And most CMCC grads are taught this way, so yes old school Chiro will be around in 2014 with prior grads, but not new grads, your reference of the technique class doesn’t prove they are teaching us old school Chiro theories, because they are not.

  11. Killcurve says:

    Ms. Bellamy hit on a fatal flaw of the DOE’s oversight philosophy of both regional and professional accrediting agencies under its purview. That is, “It doesn’t matter WHAT you teach.” It only matters HOW you teach. They are concerned only with bast practices from an education perspective (e.g. how syllabi that nobody reads are formatted, what types of assessments are used in courses, how curricular maps are used, etc.).

    There needs to be some basic quality control regarding WHAT gets taught, because it is quite easy for any type of nonsense-based curriculum to fulfill these superficial criteria and get a school awarded full accreditation. Full accreditation is in turn broadcast by schools as some sort of quality control stamp of approval, but it ignores the substance of a curriculum entirely. In this way, the process of accreditation seems to mirror the flawed approach of practicing EBP while completely ignoring prior probability (the fundamental science behind it all).

    1. Jann Bellamy says:

      “Full accreditation is in turn broadcast by schools as some sort of quality control stamp of approval, but it ignores the substance of a curriculum entirely.”

      Absolutely! The fact that naturopathic “medical” schools are accredited by an agency recognized by the USDE is always mentioned in attempts to get naturopathic practice acts passed in the states. It’s, “OK, end of story. No more inquiry about their education necessary to license them as health care practitioners.”

  12. windriven says:

    Michael, William, and CG all seem like rational, caring people interested in helping people with health and pain issues. It leaves me conflicted because, while I’ve asked the question several times in several ways I struggle to understand the theoretical bases that inform their clinical practice. This is, in part, general ignorance on my part of the details of chiropractic curricula.

    Ms. Bellamy has wondered aloud if there might be some effort made or makable by chiros who eschew subluxation and use evidence based practice to publicly differentiate themselves. But then I come back to the fundamental question of what would this chiropractic specialty bring to the health care table that isn’t already handled by others?

  13. tgobbi says:

    Jann states: “I wish you would all join together and try to reform chiropractic education and practice because right now, as best I can tell, it’s a mess.”

    It’s been done. And done. And done. In 1987 there was a movement by some breakaway chiropractors who tried to establish a group called the National Association for Chiropractic Medicine. It was met with venomous opposition by the entrenched chiropractic community and disappeared rather quickly. I believe that at most only about 2% of D.C.s joined. You can read about it at http://www.ncahf.org/articles/c-d/chiro.html

    2 – 3 years ago a high-profile “reform” chiropractor & professor of chiropractic attempted to convince the participants on the Healthfraud discussion group that a large and viable reform movement exists. None of us regulars believed him at the time and, despite his arguments, his claim was met with increasing incredulity. I have asked him the same question I posit to other D.C.s I correspond with: what is chiropractic without the subluxation. Not a single chiropractor has come up with a satisfactory response. In fact, most don’t even address the question, simply ignoring it. As I said yesterday, it’s naturopathy combined with quasi physical therapy. My investigations of chiropractic offices and chiropractic websites show that the field remains steeped in quackery. OK, admittedly my research doesn’t meet the standards of scientific investigation, but one would expect that I’d find at least a few legitimate practitioners from time to time.

    I’ve met and/or corresponded with 2 non-subluxations D.C.s over the years, guys who recognize their limitations (they treat only musculoskeletal conditions and don’t claim to be primary care physicians, pediatricians, neurologists, etc.) but they retain much of their chiropractic orientation. Two examples: overuse of x-rays (I don’t believe that any D.C.s should be allowed to take x-rays in the first place – even if they’re not looking for subluxations) and an aversion to “taking pills for the rest of your life” even when nothing else helps to relieve pain.

    1. CG says:

      You are talking to the wrong bunch then. Find chiros who treat evidence based chiropractic.

      I for one only order xrays if needed (mechanism of injury, rule out red flags, etc), and if they are no getting pain relief, encouraging them to use other ways to help with pain control, be it with pharmaceuticals.

      Just like with most of my responses, you can judge some chiros with how they practice, and that is fair, but don’t lump me in with the rest of them.

      It could be based on location – I practice in Canada and went to CMCC, but other chiropractic educational institutions may have a varried curriculum to the one I received. I am only telling you my experience and hope you can see my side of the coin and see what value of what I do in helping our patients get better.

    2. William says:

      TGobbi says
      “OK, admittedly my research doesn’t meet the standards of scientific investigation, ”

      Then why are you opining on this facts only science blog?

      but one would expect that I’d find at least a few legitimate practitioners from time to time.

      Ridiculous!

      And why should chiros not be allowed to use Xrays in the first place ?

      1. WilliamLawrenceUtridge says:

        Then why are you opining on this facts only science blog?

        Well, at least one answer can be found in the fact that this blog itself documents a multitude of irrational chiropractic practices. Second, it illustrates that chiropractors selling quackery do exist. And I might ask William – do you deny that at least some chiropractic school teaches fundamental irrationalities like subluxations? Third, Tgobbi’s anecdotes buttress a rather fundamental issue revealed in the Sense about Science lawsuit in the UK, where chiropractors were willing to go to libel court and lose in the easiest jurisdiction to win such a case, over the scientific nature of chiropractic practice. To deny the fact that many chiropractors, and much of chiropractic education in at least some schools, have almost no proof of efficacy for the treatments (or worse, are disproven in some cases), seems like willful blindness. Perhaps you are different, but if that’s the case – don’t you wish you could signal this by having some title other than “chiropractor”? Don’t you wish you could have some way of letting your patients know that you’re not one of the crazies who thinks spinal manipulation can cure cancer and asthma?

        And why should chiros not be allowed to use Xrays in the first place ?

        Given the fact that chiropractors don’t set broken bones, and that subluxations don’t exist, and that there doesn’t seem to be any proof that x-rays improve outcomes for chiropractic patients, why should they be allowed to use a machine whose rather significant risk is the creation of tumors?

  14. Pmoran says:

    “Find chiros who treat evidence based chiropractic.”

    Meaning what? What has chiropractic contributed to medical knowledge so as to justify viewing it as a distinct medical discipline?

    That reads as more aggressive than I intend. Others will tell you that I am more sympathetic to the psychosocial, placebo-based manifestations of medicine than most here on SBM. I think any kind of “treatment” can be of limited help to people, though not necessarily in a cost-effective or totally benign way, and very commonly not in the way that practitioners imagine in their understanding of “the science” .

    So, within limits, good for you and the other chiros here who have been able to make a “go” of chiropractic without buying into some of the absurdities surrounding its roots and marketed by many of your fellows.

    But I think you should have no illusions that what you are doing qualifies as “evidence-based medicine” by the standards often demanded by EBM/SBM and other forms of medical scepticism — i.e. is it certainly efficacious? Nor is it likely to in the near future.

    Why? Well, being able to run a successful, apparently patient-satisfying practice, even one aligned with expressed patient preferences, is, sadly, a far cry from being proof of an efficacious treatment. The most ridiculous of quacks can do that. Clinical studies also very often show a disconnect between patient satisfaction and objective outcomes with a variety of successfully marketed physical modalities, including spinal manipulation.

    The second problem is that physical therapy of the types that the professedly more evidence-based chiropractors are being drawn to are themselves not convincingly shown better than sham treatment, even if often also employed by conventional doctors and physiotherapists.

    We accept, for the sake of peace, that spinal manipulation may help a few patients with low back pain but by golly it is a close run thing in the studies! Similar uncertainties apply to most other types of physical therapy, for fairly obvious reasons, commonly to do with the difficulties of blinding in the studies.

    So, well done, if you have been able to make “chiropractic” work for you, but have no illusions that you are as close to being as TRULY “evidence-based” as you think. If purse-strings tighten further many aspects of physical therapy including yours will find themselves under review within health care systems. There is a warning from the respected Australian University that is now hiving off its chiropractic program because it regards it as “insufficiently evidence based”.

    The best advice is that prospective chiropractors take up medicine or physiotherapy instead. Bluntly, I cannot see anything uniquely “chiropractic” ever holding its own as a fully integrated branch of medicine. I expect it to hang around indefinitely, though, in its present fragmented state.

  15. Mark says:

    I am a “doctor” of chiropratic. I have completely changed my model as I evolve as a practitioner and continue to understand the embarrassing state of “my” profession.

    I have hired a medical practitioner that aids my practice by co-managing our patients while providing additional procedures that allow our patients musculoskeletal conditions to resolve, to improve function and balance, and improve quality of life (trigger point injections, palliative prescriptions, managing complicating factors of co-morbidities in recovery, ect.) We actually discharge patients and the end of care, can you believe that? I will not adjust an asymptomatic patient simply because “that’s what my other chiropractor did.” Chiropractors, in my opinion, should be required to have a referral by a medical practitioner that is skilled in clearing patients for care with manual mobilization/manipulation, soft tissue techniques, and exercise rehabilitation that they may require for recovery.

    The school I attended taught physical therapy in terms of correcting muscle imbalance that has led to abnormal movement patterns resulting in chronic overuse syndromes that cause excessive tissue demands. The teacher that implemented this program used the info they gained by taking a vast number of hours in post-graduate course work in physical therapy and its relation to altered joint mechanics in relation to musculoskeletal conditions. This teacher was, in my opinion, an excellent diagnostician. But guess what? This same person was still a chiropractor. While making fun of the large group of students heading down the subluxaton based quackery road, some of the dogma and unproven techniques like Network analysis (one of the worst) still remained in their practice. Many other instructors were good. My teacher in biochemistry opened discussions on why being anti-vaccine was so ridiculous and dismissed conspiracy based students. My teachers in anatomy, physiology, microbiology, and other classes were mostly non-chiropractors and kept the material to proven medical facts. Their were bad teachers as well. I remember challenging the president of our institution on some of the things being taught in “philosophy” class. The mechanisms to explain how chiropractors effected visceral functions did not make sense and werent consistent with the current body of scientific knowledge. Then you have the chiroquacktor sect that were actively recruiting the not-so-skeptical students and leading them down a path to believe the same old dogma of the past.

    How am I different from a physiotherapist? I am not. The only difference is that I exist in a profession that contains a large amount of quackery. Even some of the smartest of us hold onto aspects of quackery. I only wish there was a path out of this misery. I owe over 200,000 in student loans and I am not sure if I should continue to just be “one of the good ones” or somehow transition to a new profession in spite of the monetary strain it would put on me and my family.

    I respect a large number of the voices on this site as I have been a silent observer for the last few months. I would like to know if this article has been discussed and if you fine people think that taking these steps would begin to legitimize the profession.

    http://www.chirobase.org/01General/respect.html

    Could we ever seperate the quacks from the more evidence based chiropractors by tiering or creating 2 distinct professions? Could I ever be viewed like a podiatrist is, with the public and medical community being able to differentiate me and podiatrists from chiroquacktors and foot reflexologists?

    please help. I will understand if your comments lead me down the road to depression resulting from uninformed career choices at a young age. Thank you in advance for your thoughts

    1. Harriet Hall says:

      I would love to see that happen, but I’m not very hopeful. Could you try to guess what percentage of chiropractors think like you do? Are there enough of you to band together in a reform movement? Change will have to come from within, and I fear you are badly outnumbered.

      1. Mark says:

        The numbers are certainly small. I don’t see the number of mega quacks changing any time soon because they recruit and clone their ideology each generation. The mostly to mildy quack group could be shown that some of their practices are unfounded and/or ineffective over time.

        Opinion: I do think the numbers our growing. I choose to correlate this with evolution. Agnostic/athiest/non-religious types are growing at an extremely fast rate according to research I have read. These are the types of trends that encourage me that more science based logical minds will get duped into this profession. It may take too long though. Just as hopeful movie stars end up selling coffee in los angeles, the type of mind that ends up a chiropractor is usually non-scientific in nature

        The FCPAA has been testing these waters since they started in FL and have seen their numbers growing to about 2000 members since 2011. While the FCPAA is misguided in many ways it MAY be the beginning of something. CEO Roderick Lacy MD DC is lobbying for prescriptive rights for chiropractors that have undergone some sort of pharmacological training (yet to be defined) and he has even started a psuedo-residency program in his Dominican hospital. (means nothing, just for experience). My only hope is that this organizes the people that are looking to separate from the chiroquacks. At that point some smart leadership needs to emerge and all dogmatic principles need to be denounced.

        Its all a long shot but I am trying to be hopeful about all of this.

          1. CG says:

            Well said Mark, I applaud you and the other like-minded practitioners who see how things are, and where they can go, if the right individuals were the ones in power positions . Couldnt agree more with all the points you have discussed.

    2. windriven says:

      Mark,
      I read “How Can Chiropractic Become a Respected Mainstream Profession? The Example of Podiatry” and it delineates a reasonable path for chiropractic to move from fringe quackery to a valued place in mainstream medicine. The authors recognize that chiropractic must drop its pseudo-religious and metaphysical underpinnings and replace them with science and evidence based theory and practice. In the course of this transition, subluxation and the conceit that chiropractic is useful in the treatment of conditions beyond the spine are to be abandoned. The future, as the authors see it, would be chiropractic as the go-to specialty for non-surgical treatment of the spine and pain related to it.

      Murphy, et al argue that chiropractic education should more closely resemble medical education and should include a one year internship and an additional one year residency. Faculty of chiropractic programs should be expected to do research and to publish in professional journals. Throughout, the authors recommend podiatry’s climb to the mainstream as a model for chiropractic.

      From the perspective of chiropractic this is indeed a reasonable and desirable course. Continuing reliance on subluxation imagery will further isolate chiropractic and increasingly reveal its otherness from medical practice.

      But from the perspective on mainstream medicine, what does chiropractic bring to the table that isn’t adequately addressed through the physical therapy profession? As I understand it most PT programs are Masters level programs; two years of study following a baccalaureate degree whereas chiropractic as envisioned by the authors would be a six year program following a baccalaureate. This would argue that chiropractors would be better educated than physical therapists and moreover would have more hands-on experience. But it remains to be seen whether that would result in better outcomes for patients.

      One can also question whether a clinical practice dedicated to the non-surgical treatment of spinal conditions needs to be addressed by a group of doctors rather than by appropriately trained and supervised paraprofessionals. Another way of asking this is whether there is six years of education and training necessary for the non-surgical treatment of the spine. If the answer is yes then chiropractors as constituted under the authors’ new model of chiropractic could be embraced and, among other privileges, should probably be able to prescribe drugs associated with their clinical specialty. If not, non-surgical spinal care should probably be performed by physical therapists under the direction of medical doctors.

      Is there a set of spinal conditions and treatments that are unmet by physical therapists and/or medical doctors? Are chiropractors best positioned to fill that space? Moreover, are there enough chiros who embrace something like the Murphy plan to make it viable?

  16. Marcus Welby says:

    As a possible exit strategy for this tortured morass regarding the soul of chiropractic, I propose a variation on Koch’s Postulates for chiropractic:
    Suppose we subjected chiropractic to the following tests:
    1. A diagnosis of a chiropractic lesion, be it subluxation, manipulable lesion, or imbalance of the spinoneural environment should have some reasonable possibility of being reproduced by other chiropractors unaware of the diagnosis of the previous examiner. In other words, the diagnosis should be reasonably reproducible. Some significant inter observer consistency should be present.
    2. If an “adjustment” has been completed, there should be double blind inter observer ability to determine and confirm that the lesion has been corrected.
    3. In radiologic studies by chiropractors, there should be inter observer agreement as to which lesions are present and then following treatment, which lesions have been corrected.
    These seem reasonably straight forward criteria which should shed light on whether the subluxation or chiropractic lesion is imaginary or organic, and on whether radiologic imaging studies by chiropractors are of value. Given the fact that NCCAM at NIH has been funding studies of CAM for years, studying the core beliefs of chiropractic after over 115 years of existence, seems an appropriate undertaking.

    1. Mark says:

      I actually had a guest instructor try to teach us inter-examiner reliability in regards to motion palpation to determine decreased joint mobility. It did’t go well with students that are inexperienced but I would love to see your suggestion happen.

  17. marcus welby says:

    Windriven compares chiropractic and physical therapy but the comparison is remarkably deficient. Having taught orthopedics to PT students and worked with them for 40 years, I can aver that they have a science-based education and are skilled in multiple ways chiropractors are not. Consider rehabilitation of postoperrative or posttraumatic patients, transfer education, gait training, hospital interaction with patients, home adaptation for disabled people, wheelchair prescription and training in use, the list goes on.

    1. windriven says:

      @marcus welby

      “Windriven compares chiropractic and physical therapy but the comparison is remarkably deficient.”

      Actually, windriven compared physical therapy with chiropractic as it might be taught in some future reality as imagined by Murphy, et al in the paper Mark cited. Further, I questioned whether the proffered approach to chiropractic addressed a niche already adequately addressed by PT.

      1. Mark says:

        I have seen this response brought up in multiple topics on this site. It would be two professions addressing the same public health need: conservative management of musculoskeletal conditions. My question is, why does that matter? Isnt it a rather large need to fill? Are there ever situations in which a slightly different focus or approach is more successful for the same problem?

        “Low back problems affect virtually everyone at some time during their life. Surveys indicate a yearly prevalence of symptoms in 50% of working age adults; 15-20% seek medical care. Low back problems rank high among the reasons for physician office visits and are costly in terms of medical treatment, lost productivity, and nonmonetary costs such as diminished ability to perform or enjoy usual activities. In fact, for persons under age 45, low back problems are the most common cause of disability.”

        It is a VERY large need. It seems to me that if a discussion about reforming a profession with quackery is brought up that this forum would encourage it. A transition to science based chiropractic with more of a focus on PT would help the public even if they already have an option now. Furthermore, they would be similar professions but not the same. One with slightly more training in manipulation and one with more of a focus on exercise rehabilitation. Over time, more (quality) research would be done research would be done on manipulation and its role in increasing the effectiveness of PT while getting the public back to work faster, minimizing unnecessary surgeries, improving quality of lives, ect. The public and referring medical practitioners would ultimately be faced with a better decision leading to better outcomes and less quackery in health care.

        I responded to the question “how would you be different than a PT?”. My mere response does not validate the usefulness of that question in this forum. It merely deflects and tries to create a new problem that, in my opinion, is a much better dilemma to have on our hands.

        Whether you like it or not, chiropractors have very high patient satisfaction rates even with the rampant quackery:
        http://consumerreports.org/cro/2013/01/relief-for-your-aching-back/index.htm

        Are these higher rates due to some of the ways they operate: “scare tactic set-up—-> now im your hero!”. Probably. Is there a lowering of these rates by the more common sense oriented patients left unsatisfied by the “your back hurts? Well, I need to adjust your neck too because of those dirty little subluxations on the 9 xrays we took. Oh yeah! Here are some supplements and a two year treatment plan because you totally need it!” How are the satisfaction rates so high with nonsense like that involved?

        I do believe the higher rates have something to do with the effectiveness of manipulation when correctly applied to the right problem. While I know that there are PTs doing some manipulation, I dont think it is the majority and Im not sure that they have studied the different methods of manipulation and their appropriate application to different types of clinical presentations. I have had many patients only come in one or two times, see their pain drop to zero, and I only find out about how quick and effective the treatment was when they refer a friend or loved one with what they think is a similar problem.

        Wow, I can’t believe I just defended my profession

        1. windriven says:

          “It would be two professions addressing the same public health need: conservative management of musculoskeletal conditions. My question is, why does that matter? Isnt it a rather large need to fill?

          “Are there ever situations in which a slightly different focus or approach is more successful for the same problem?”

          Yup. But my specific interest is the intersection of medicine and pubic policy. For me the question is not whether “a slightly different focus or approach” might be more successful, but whether any incremental success would justify the additional expense. I don’t claim to know the answer. But it is an important question for a nation that spends 18% of GDP on health care. As I’m fond of pointing out, if we spent proportionately what Sweden spends and invested 10% of the savings in medical research we would be giving NIH roughly $125 BILLION dollars in new funding. Per year.

  18. Mark says:

    oops! I violated rule #7 in “answering our critics” with the rant on patient satisfaction rates and the end part about patient experiences (purely anecdotal and doesnt add any meaningful content). I was trying to elude to the fact that a PT model may be more effective with the aid of certain types of manipulation (no research to this claim, ill defined). This was a simply a misguided follow up to my point that the “same as a PT” question is not valid in regards to chiroquacks reforming and becoming research/scienced based.
    I am new to this blog so cut me some slack. After all, I am a chiropractor

  19. marcus welby says:

    Mark: I appreciate your candor and approach. You do make some good points. My answer regarding P.T. vs. chiropractic would be that P.T. follows a generally science–based education approach and does not have what seems to be overwhelming emphasis on marketing / mystical beliefs like applied kinesiology and functional endocrinology/ anti-vaccination bias/ drop tables and activators/ cranio-sacral nonsense/ advocacy of “adjustments” for asymptomatic individuals/ dangerous neck cracking, along with denial of obvious danger, etc.
    In summary, I am more comfortable trusting someone who seems based in science rather than mysticism and marketing. You seem to be an exception in your profession. Your chiropractic leadership needs an attitude adjustment if they are to join the 21st century.

    1. William says:

      @ MW
      PTs are part of the medical system. They don’t have to advertise.They have guaranteed jobs .If they open on their own they advertise. Chiropractors who don’t work with MDs or within medical clinics do have to advertise. Which is mostly all chiros. It’s the schools’ fault. BTW there are plenty of PTs doing Craniosacral ,Reiki, “structural integration”,Myofascial release,etc. Things you wouldn’t approve of. Why would they do that if PT alone was all they needed???

      1. windriven says:

        “BTW there are plenty of PTs doing Craniosacral ,Reiki, “structural integration”,Myofascial release,etc.”

        Citation?

    2. WilliamLawrenceUtridge says:

      One must also always keep in mind that there are straights, who are lunatics who think they can cure cancer, and mixers, who are basically PTs with a bit of a twist. While I have no doubt that both integrate some SCAMs into their practices, straights are more likely to include woo, nonsense, and scientifically disproven modalities as part of their day-to-day activities.

      1. Mark says:

        This was all meant to be a response to the point made by Windriven about whether the reform article that I referenced above would turn a more science based chiropractic profession into something that fills a need that isn’t already being met by PTs.

        He said:
        “But from the perspective on mainstream medicine, what does chiropractic bring to the table that isn’t adequately addressed through the physical therapy profession? ”

        This seems to be a false dilemma due to the fact that the reform steps in the article lead to a profession that would gain the approval of medical profession and champions of SBM. Research would be a focus of chiropractic academia and your questions about this model leading to better patient outcomes would ultimately be answered. Are you worried that these steps would cause less to enroll in the profession, ultimately eliminating it? Do you consider this a bad thing? Could we see the profession shrink by losing the straights and rebuild with educated science based minds?

        My previous response to the false dilemma was what I think would be a slightly different model from PT that is more focused on efficacious use of manipulation than the current PT model. My response also eluded to the rather large public health need for more, not less, science based approaches to conservative management of musculoskeletal conditions. It may also lead to better patient outcomes and cost savings if the research leads to a better understanding of which model is better for each condition when properly diagnosed.

        As for the other point about trained and supervised paraprofessionals, I believe a tiered profession would solve this. Are there not PTs and DPTs? The straights would have to take the manipulation based model and apply it only with a referral and under the supervision and direction of a doctor. They would not be trusted to diagnose any condition whatsoever and would be hit on the head with a tack hammer if found to be discussing “the danger of vaccinations “or telling people to throw away their BP meds and feel the flow of life. The doctor of chiropractic (or hopefully a newly titled profession) would be able to diagnose, prescribe, manage, and supervise this model of rehabilitation.

        Why do we have DOs? Didn’t they, in general, fill a need already addressed by medical doctors?

        1. windriven says:

          @Mark

          “This seems to be a false dilemma…”

          No, because you are really talking about a chiropractic that doesn’t exist yet or that exists in theory but not in fact. The root of my question is simply this: is there anything significant to be gained by having a doctor level specialty for non-surgical treatment of spinal conditions? I don’t claim to know the answer to that. But it seems to me a valid question.

          “Why do we have DOs? Didn’t they, in general, fill a need already addressed by medical doctors?”

          I though about the DO situation when I was reading the Murphy paper. As you know DOs started off far from the mainstream and I believe DOs in many countries other than the US still practice on the fringes. In the US osteopathy went through a series of reforms and today the differences between MDs and DOs seem to be more cosmetic than real.

          Perhaps chiropractic could follow a similar path. But why? Medicine is. There is no particular reason other than an historical one that we have MDs and DOs. Is there really anything to be gained by adding more flavors of MD analogues? Why not simply have MDs and, if necessary, increase the number of subspecialties? I know this doesn’t address the issue of currently practicing chiropractors who want to move their profession into a more science based practice. I am simply trying to look at this from a broad public policy standpoint.

          1. William says:

            @ windriven
            You ask
            The root of my question is simply this: is there anything significant to be gained by having a doctor level specialty for non-surgical treatment of spinal conditions?

            Yes, because no other profession offers /manual medicine /skilled manipulation only.
            In thefuture perhaps PTs. There is overlap between other specialties but when you have drugs,available you tend to use them first. It’s too easy. That’s why few DOs are skilled at OMT. You can be a jack of all trades but a master of none.

            1. windriven says:

              “Yes, because no other profession offers /manual medicine /skilled manipulation only.
              In thefuture perhaps PTs. ”

              William, I’m not sure that actually answers the question. Perhaps I have not articulated it well. I can accept the value of specialist non-surgical treatment of spinal conditions. I am questioning whether that specialty has such depth as to require a doctor level specialist or whether an appropriately trained and supervised physical therapist could deliver equivalent care. I’m not suggesting that I know the answer, by the way.

              “There is overlap between other specialties but when you have drugs,available you tend to use them first. It’s too easy.”

              But as I understand it, the proposed new breed of chiropractor would have prescription privileges with the specialty. Doesn’t this takes us back to where we are now?

              1. William says:

                @ windriven
                ” I am questioning whether that specialty has such depth as to require a doctor level specialist or whether an appropriately trained and supervised physical therapist could deliver equivalent care”.

                I think that could happen. MDs can get training in Osteopathic Manipulative Therapy in the US ( Michigan) and
                the UK at least. They can even go to a chiropractic school where the MD gets advanced standing. It’s usually not the other way around.
                The DC with RX privileges is unlikely soon. Too much infighting and the SBM medics would fight it as well. The argument is that if DCs had limited Rx rights then the first thing they would do would be to prescribe and abandon manual therapy. It’s too east to do when you have a large caseload.

    3. windriven says:

      @marcus welby

      “I am more comfortable trusting someone who seems based in science rather than mysticism and marketing.”

      Mark is arguing in favor of a future chiropractic that is science based. He isn’t saying that this chiropractic exists in an organized form today. This is the subject of the Murphy paper that Mark referenced above. So when you say that you are more comfortable trusting someone who is science based, that is exactly what Mark and his like-minded colleagues would like to deliver.

      “Your chiropractic leadership needs an attitude adjustment if they are to join the 21st century.”

      Again, this is precisely Marks point. But it is certainly questionable whether chiropractic leadership agrees with that prescription.

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