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The DC as PCP? Revisited

There is a disturbing effort afoot to rebrand chiropractors as primary care physicians, a subject both Harriet Hall and I have discussed in previous posts. Part of this effort includes convincing state legislatures to grant prescription privileges to chiropractors, an effort that succeeded in New Mexico, as reported in a post a couple of years ago. Let’s return to New Mexico and see how that is working out for everyone.

By way of background, in 2008, the New Mexico legislature created a new iteration of chiropractor called “certified advanced practice chiropractic physicians” with the authority to

prescribe, administer and dispense herbal medicine, homeopathic medicines, vitamins, minerals, enzymes, glandular products, naturally derived substances, protomorphogens, live cell products, gerovital, amino acids, dietary supplements, foods for special dietary use, bioidentical hormones, sterile water, sterile saline, sarapin or its generic, caffeine, procaine, oxygen, epinephrine and vapocoolants.

As those familiar with primary care will no doubt be aware, these aren’t exactly the type of thing the family practice doctor, pediatrician or internist would consider essential tools of practice.

The chiropractic formulary expands

The statute directed the Board of Chiropractic Examiners to develop a formulary for these substances but it had to be approved by the NM Medical Board and Board of Pharmacy. As might be expected, however, chiropractors wanted more expansive prescriptive authority and succeeded in getting it from the legislature in a subsequent amendment to the original law. This amendment eliminated the approval requirement for the listed substances and added the authority to prescribe “dangerous drugs or controlled substances, drugs for administration by injection and substances not listed” in the statute but only with approval from the medical and pharmacy boards.

This “advanced practice” status can be achieved with only 90 hours of education with whatever additional training the chiropractic board deems necessary for new substances it might want to add to the formulary. These hours can be obtained in weekend and online continuing education courses.

It didn’t take long for the chiropractors to clash with the pharmacy and medical boards over what should be included in the newly expanded formulary. (The details of this clash are chronicled, with supporting exhibits, in this document filed in the New Mexico Court of Appeals.) In September, 2009, the chiropractic board adopted a formulary which including certain drugs to be administered by injection which had not been approved by those boards. The pharmacy board appealed the chiropractic formulary to the New Mexico Court of Appeals. Later that month, representatives of the three boards ironed out their differences and a new formulary was put into place, to be effective in July, 2010.

In spite of this agreement, the chiropractic board nevertheless voted again, in June, 2010, to include in the formulary certain drugs to be administered by injection without getting the required approval. Although the chronology of events is not entirely clear, apparently the chiropractic board was about to add even more drugs for injection and dangerous drugs to the formulary in August of 2011. It will likely come as no surprise to anyone that the proposed formulary included the decidedly fringe practices of chelation therapy and prolotherapy. It also included glucosamine, which has not been approved by the FDA for medical use in humans, by injection. As well, it included a number of vitamins and minerals by injection, muscle relaxants (including metaxalone and baclofen), and glutathione for inhalation, an unproven remedy for pulmonary diseases.

Medical Board objections

At this point the medical board stepped in with a strongly worded letter to the chiropractic board stating it had voted not to approve the proposed formulary changes and set forth the reasons why. In addition to the problems noted above, the medical board complained that

  • New drugs have been added which have not been approved by the pharmacy board.
  • Drugs have been specified for injection which are not within the scope of practice of chiropractic.
  • Drugs were added without stating their intended use.
  • Additional hours of training specified by the chiropractic board do not appear to be sufficient.

The medical board also objected that no mention was made of a restriction previously agreed upon by the medical and chiropractic boards, which provided:

The patient must first be screened, by appropriate medical and laboratory means, for existing problems and contra-indications (such as renal or other diseases). Appropriate coordination with the patient’s allopathic or osteopathic physician is strongly recommended.

In another report, the medical board (here referred to as the NMMB) also said that

In February 2010, after a thorough review of the proposed chiropractic formulary and educational criteria, the NMMB adopted the position that they could not approve either the proposed drugs, or the proposed routes and dosages of administration or their safety and effectiveness. MDs and DOs would never use many of the proposed substances, especially in the manner which the chiropractors proposed for their use. . . . The NMMB also did not approve administration of dangerous drugs or controlled substances by the Advanced Practice Chiropractors based on the lack of sufficient, appropriate education, specific clinical training, and hands-on experience . . . .

So what did the chiropractic board do? Although it did drop chelation therapy, it went ahead with most of the formulary (including prolotherapy and glucosomine injections) without medical or pharmacy board approval. And it did so even though the general counsel for the New Mexico Department of Licensing and Regulation  advised against approval. The attorney sat there at the meeting and specifically told the board they shouldn’t approve the formulary because no medical or pharmacy board approval had been obtained and that it was outside the scope of statutory authority granted the chiropractic board by the legislature.

At this point, the pharmacy board, this time with the medical board, went back to the New Mexico Court of Appeals seeking a stay of implementation of the new formulary. The International Chiropractic Association (ICA) filed its own action also seeking a stay. In February of this year, the Court of Appeals granted the ICA’s and boards’ motions, and stayed implementation of the 2011 formulary. These cases remain pending before the Court for a determination whether the chiropractic board exceeded its statutory authority in enacting these rules. It’s hard to imagine any reason why the Court wouldn’t strike down the challenged rules for good.

Meanwhile, back in the legislature . . .

Apparently New Mexico chiropractors determined that a more direct approach was necessary toward the goal of rebranding chiropractors as primary care physicians, with the full scope of practice that entails. So, in 2011, a sympathetic legislator, Ben Lujan, introduced a bill into the New Mexico House of Representatives. The bill’s aim was to increase substantially the scope of chiropractic practice, which was renamed “chiropractic medicine.” In addition to “locating and removing . . . misalignments or subluxations” the bill would expand “chiropractic medicine” to include “diagnosis and treatment of a condition for which the chiropractic physician has been educated and trained. . . .” And who would make the decision whether the chiropractor had been “educated and trained” to treat a “condition?” The New Mexico chiropractic board.

I have to ask: doesn’t this seem awfully cumbersome? How would the chiropractic board decide whether a particular chiropractor has been sufficiently educated and trained to diagnose or treat a particular condition? I’m no doctor, but it is my understanding that there are lots and lots of conditions. (Thousands, maybe?) Is the board going to keep a list of all of them along with the training necessary to diagnose and treat each one?

Under the bill, practitioners of “chiropractic medicine” would also be allowed to use invasive diagnostic procedures, and, if permitted by chiropractic board rule, perform operative surgery, prescribe or use controlled or dangerous drugs, and practice acupuncture.

The “chiropractic advanced practice” status was retained, again only requiring 90 hours of additional education and training, the adequacy of which was solely within the purview of the chiropractic board. With board approval, the advance practice chiropractor could prescribe and administer

any dangerous drug or controlled substance and perform and procedure that is accepted for use within the certified advanced practice chiropractic physician’s clinical specialty and for which the certified advanced practice chiropractic physician can demonstrate appropriate clinical education and hands-on training that has been approved by a nationally recognized credentialing agency or nationally recognized institution of higher learning.

No standards were imposed to determine exactly how a “clinical specialty” would be defined or what constituted a “nationally recognized credentialing agency” or “institution of learning,” leaving those determinations solely in the hands of the chiropractic board. And gone were the pesky medical and pharmacy boards. From now on, the formulary would be determined solely by the chiropractic board.

In short, the proposed statute would empower the New Mexico chiropractic board to decide when and under what circumstances any chiropractor could perform surgery and prescribe controlled substances or dangerous drugs. I say “any chiropractor” because, although the bill retained the “chiropractic advanced practice” status, it did not limit the board’s ability to allow surgery and drug prescribing authority to that status. It would also allow chiropractors to immediately start using invasive diagnostic procedures. And it would permit some vague “clinical specialty” designations by advanced practice chiropractors.

And here’s the really scary part – this bill came very close to passing. With some amendments upping the hours of training, it passed the New Mexico House of Representatives. It was finally stopped in the Senate Judiciary Committee, mostly due to a massive lobbying effort by the ICA and other chiropractors who didn’t want these changes. According to one chiropractic publication, a spokesperson for the New Mexico Medical Board testified before the legislature that the Board did not oppose the bill. If true, this position is at odds with a legislative committee report, which noted that the Board had several objections to the bill. Among those was the misleading nature of the terms “chiropractic physician” and “chiropractic medicine.”

A national movement?

Unfortunately, this ill-advised attempt to transform chiropractors into primary care physicians with prescriptive authority is not limited to New Mexico. That this may be a national effort is hinted at in the Council on Chiropractic Education’s (CCE) removing the standard phrase “without drugs or surgery” from its description of chiropractic practice. (The CCE is the national accrediting agency for chiropractic schools.) This effort is also reflected in recent changes to the Federation of Chiropractic Licensing Board’s new draft Model Practice Act for chiropractic and petitions to the National Board of Chiropractic Examiners to develop a “chiropractic advanced practice” exam.

There is a small national association of chiropractors, the First Chiropractic Physician Association of America (FCPAA), devoted to

expanding your rights as a primary care physician with full prescriptive rights and the ability to specialize you can increase your knowledge and your ‘bag of tools.’ It all adds up so you could offer more services to the public.

(Emphasis added.)

The FCPPA has 11 affiliated state organizations working toward its goal of passing legislation to accomplish this. Perhaps the reason for this movement is best summed up by one affiliate, the Florida Chiropractic Physician Association:

Aren’t you tired of worrying where your next patient will come from? Expansion means prosperity for you and better health for your patients.

Last year, the Alabama Board of Chiropractic Examiners proposed legislation (not yet introduced) which would allow that board to authorize prescribing of certain legend drugs without any additional education or training. It would expand the scope of practice to include any procedure or service taught in a chiropractic college or in courses sponsored by a chiropractic college, leaving the scope virtually open-ended.

Conclusion

The attempt to rebrand chiropractors as primary care physicians is bad enough, but giving them the legal authority to prescribe is beyond the pale. New Mexico’s ill-conceived legislation has turned into a debacle, with the pharmacy and medical boards having to haul the chiropractic board into court to comply with the law. And once they got limited privileges, chiropractors lobbied for increasing privileges to the point of wanting to prescribe controlled substances and dangerous drugs without any oversight and the right to practice surgery to boot. If you think this can’t happen in your state, think again. Remember that chiropractors got all 50 state legislatures to grant them the privilege of “detecting” and “correcting” the imaginary “subluxation.”

Posted in: Chiropractic, Legal, Politics and Regulation

Leave a Comment (157) ↓

157 thoughts on “The DC as PCP? Revisited

  1. ConspicuousCarl says:

    “prescribe, administer and dispense [...] epinephrine”

    LoLz! If I were a chiropractor, it would be my lifelong mission to avoid mentioning the endocrine system.

  2. marcus welby says:

    This effort to expand chiropractic practice to include prescription of drugs and performance of surgery seems at odds with the repeated complaint of chiropractors AGAINST nearly all medications and often against all vaccinations, as well as surgery. They have previously and in other states clung to the trope that they are favoring and assisting “natural” healing. Seems to be an effort to expand their scope of practice and garner more patients regardless of any “healing philosophy”.

  3. <– Head just exploded.

  4. mattyp says:

    I was just picturing your response SH.
    This beggars belief. Chiropractors, your thoughts?

  5. DevoutCatalyst says:

    Did you mean, The DC on PCP?

  6. NYUDDS says:

    As usual, a clear, concise treatment of a growing national problem. Jann does us all a service as she reminds us of this quiet menace: “And here’s the really scary part – this bill came very close to passing.” Passing? Made into law? Yes, because medical practice is not what is scientific or effective or even moral in today’s atmosphere…it’s what the state legislatures and Congress say it is and you ignore them at your peril. These near-misses give them extra incentive. As you read Jann’s chronology, the characteristic battle-plan of chiropractors is evident: constant, repetitive, relentless testing of the system with a recklessness that exhibits no shame or competency. This is usually accompanied by letters, emails, testimony, anecdotes, phone calls, meetings, newspaper articles, personal appearances and every other method of “informative intimidation” one can muster. Did I mention money? It’s expensive to run for office and getting re-elected is job#1. They are very generous.

    Chiropractors are licensed in the entire country. This is a huge advantage because the foundation of their practice, as illusory as it may be, exists. The expanded scope they envision (I can’t bring myself to type “practice”) must be confronted and exposed at every turn. It starts with the individual practitioner’s involvement and progresses to the regional and state board level and beyond. And don’t forget, folks: Lobbyists for the noble professions are very, very well paid. Use them. Make them earn those dollars! The Massachusetts Medical Society spent $1.51 million last year! Health care in Mass. is a $70 billion industry.
    http://www.boston.com/news/local/massachusetts/articles/2012/03/25/ap_mass_health_care_5_year_lobbying_topped_51m/

  7. CC says:

    Did I read that right? The international chiropractic association also tried to stop them?

    As much as I normally deplore the US’ lawsuit-happy culture, I wonder if some medical malpractice suits would help get rid of quacks – or if the folks who go with quacks instead of medicine would accept that they just didn’t think enough happy thoughts. (Or, for that matter, if somebody who isn’t actually a doctor can even be the target of a medical malpractice lawsuit.)

  8. windriven says:

    “Unfortunately, this ill-advised attempt to transform chiropractors into primary care physicians with prescriptive authority is not limited to New Mexico.”

    Unless the medical community does a better job of expanding medical school seats (they are, but not at nearly the rate required to meet demand), channeling more physicians into primary care roles and better utilizing paraprofessionals to leverage PCP time, efforts such as the one Bellamy addressed today will multiply and, to one extent or another, succeed. Unmet demand will always find supply. This is as true for primary medical care as it is for illicit drugs.

  9. Earthman says:

    “…constant, repetitive, relentless testing of the system with a recklessness that exhibits no shame or competency.”

    Seems that is what the politicians / legislators are doing as well. We need better people in charge.

  10. fledarmus1 says:

    Talk about cargo cult science – this has to be a record triumph of form over substance.

    We don’t have much of an issue with regulation of medicine being carried out almost entirely by doctors. To be licensed to practice medicine, you have to graduate from a college of medicine accredited by an organization of doctors, taught by doctors, through a curriculum determined by doctors, in many cases joining a professional organization of doctors, given a scope of practice determined almost entirely by doctors, required to maintain a standard of practice determined by doctors, and only other doctors have the expertise required to testify as expert at any trial or hearing of your professional qualifications. The same thing could be said for civil engineers, lawyers, and most other highly skilled professions.

    However, the idea that the regulation of chiropracty could be carried out entirely by chiropracters, licensed by chiropractors, requiring a degree from a college of chiropracty accredited by an organization of chiropractors, through a curriculum determined by chiropractors, required to join a professional organization of chiropractors, given a scope of practice determined by chiropractors, maintaining a standard of practice determined by chiropractors, and with only other chiropractors allowed to tender an opinion on your ability to carry out that scope of practice… well, that sort of gives me the heeby-jeebies.

    Beyond simply saying that chiropracty is a fraud and medicine, law, and engineering are not, how do you formally distinguish the definition and regulation of the practice of medicine from the definition and regulation of chiropracty?

  11. rwk says:

    Jann,
    Have you ever studied how the osteopathic profession went from being a drugless profession exactly like chiropractic, to full scope medicine of today?

  12. Scott says:

    Beyond simply saying that chiropracty is a fraud and medicine, law, and engineering are not, how do you formally distinguish the definition and regulation of the practice of medicine from the definition and regulation of chiropracty?

    Is there a need? Isn’t the observation that chiropractic is factually false sufficient?

  13. Jann Bellamy says:

    @ rwk: “Have you ever studied how the osteopathic profession went from being a drugless profession exactly like chiropractic, to full scope medicine of today?”

    Not in any depth, although it is my understanding that osteopathic doctors in the U.S. have always been taught conventional diagnostic procedures and prescribed drugs but emphasized osteopathic manipulation as a treatment over others.

  14. rwk says:

    Jann,
    Please read a thorough history of the osteopathic profession. They started out as a drugless,manipulation-only profession
    predating chiropractic by about 20 years. They had dissenters who wanted to increase the scope of practice starting with surgery in the early 1900s then gradually including drug therapeutics to full scope where it has been for at least
    30-40 years. They had credibility problems with the AMA as well. Some merged to MD in the late 50s.
    Regardless, their scope of practice is very different than how they started. I think the first chiropractor just copied them as it is known that Palmer visited the first osteopathic college back in the 1890s before Palmer invented chiropractic.

    Sounds a lot like chiropractic” philosophy” to me only with different wording:

    http://www.westernu.edu/osteopathy-omm_history

  15. Calli Arcale says:

    I’ve never understood why chiropractors who want to practice medicine don’t just become doctors. MDs or DOs. One of the main distinctions between a DC and a DO is that the DC has vastly less training. A chiropractor, with normal chiropractor training, who wants to be able to prescribe chelation therapy has absolutely no clue what he’s getting himself into, because if he did know, he wouldn’t want anything to do with that; chelation is very serious stuff, and mistakes can be fatal. I wouldn’t want to design a rocket engine to lift off a human crew, because I don’t know what I’m doing — I’d probably kill the crew. I may be an engineer, but I’m not a rocket engineer. Likewise, a chiropractor doesn’t know what he’s doing when it comes to surgery, injected drugs, hormones, etc. and is *likely* to cause harm as a result.

    This is utterly insane. A chiropractor who actually believes there’s something to chiropractic shouldn’t want to do this stuff anyway; this is just an effort to become a doctor without all of that expensive education to drain the profits. That’s the hallmark of quackery right there, and it should be shut down with extreme prejudice.

    rwk — I’ve read a little about it. As I understand it, osteopaths did the same thing MDs were doing, at pretty much the same time: responding to findings that their profession badly needed regulation and standardized training. Osteopaths cleaned up their act right alongside MDs. The legislation came very shortly after. These DCs want to skip the cleaning up the act part and jump ahead to the legislation part, which makes it superficially similar but fundamentally different from what DOs did.

  16. windriven says:

    @Calli Arcale

    “I’ve never understood why chiropractors who want to practice medicine don’t just become doctors.”

    One suspects that many are unable to clear one or more of the bars to entry: grades, MCAT scores, money. I wonder what bars entrants to schools of chiroquacktic have to clear?

  17. tgobbi says:

    Several decades ago, back during the 80s if memory serves, the ACA ran a deceptive and, in my opinion, sleazy multi-page ad (I think eight) in “Readers Digest” on this very subject in an effort to convince an unwitting public that “doctors” of chiropractic are, in fact, really doctors and that they are as qualified as proper doctors as PCPs. As I say, it was a long time ago but I remember side-by-side photos showing men with white jackets and with stethoscopes dangling from their necks. The ad stated that you can’t tell the guys apart by looking at them and you can’t tell them apart when you’re in their respective offices for a physical. What really fried my bacon about the ad (well, just about everything did!) is that the ACA spent a small fortune promoting their “doctors” as doctors – while at the same time DCs all over the map were crying that they didn’t have enough money to conduct research into the putative benefits of their so-called profession. How ironic that they could afford the ad but not research! I contacted the magazine at the time in an attempt to find out how much the ad cost but the figures weren’t available but I’m certain it was a substantial amount.

    Chiropractors are habitual offerers of free or reduced-price exams. They do this to lure customers into their offices – and their clutches. I’ve taken advantage of these offers on a number of occasions in order to do some hands-on research. Invariably they start off by taking a medical history, including a request for a list of all medications. This list provides fodder for them to warn their customers of the dangers of taking pills. “Do you want to take these drugs for the rest of your life?” Then they poke, prod and ask questions. Some present the subluxation card very quickly while others hold off. (Does this bear any resemblance to practicing medicine)? Most want to take x-rays but after my first venture I’ve consistently refused.

    Calli Arcale asks why some of these people don’t become actual doctors instead of DCs if they wish to practice medicine. It isn’t all that simple; medical schools have MUCH higher standards of admission than chiro colleges and I’d bet that most DCs couldn’t pass the entrance exams, much less grasp the complexity of actual medicine. They’re much more interested in being called “Doctor” than they are in subjecting themselves to a real medical education. Chiropractic schools offer an easy route to this end. Certainly this is a generalization but I can honestly say that I’ve encountered a few DCs whom I’d classify as cretinous semi-literates. I’ve met a few who are quite intelligent -but they’re still what they’ve been trained to do: DCs. Most of the chiropractors I’ve had contact with over the past 30 years don’t even understand the scientific method. Worse, they don’t even care about it. It’s the “new paradigm” of alternative healthcare: what we believe is at least equally as true as what scientists prove.

  18. Calli Arcale says:

    “Calli Arcale asks why some of these people don’t become actual doctors instead of DCs if they wish to practice medicine. It isn’t all that simple; medical schools have MUCH higher standards of admission than chiro colleges and I’d bet that most DCs couldn’t pass the entrance exams, much less grasp the complexity of actual medicine. ”

    I do have to confess the question was a bit rhetorical. ;-) I agree about the reason. They want the prescribing privileges without all the work. Well, that’s the snarky way to put it. Most chiropractors I’ve met are well-meaning, and are truly oblivious to their own incompetence. This was made starkly evident some years ago when there was a class-action lawsuit against several prominent chiropractic schools; the students were suing because they didn’t learn until they were in the field how inadequate their training had been. So while the vanguards of this probably just want to be doctors without the work, the average grunts seriously believe they’re equipped to be doctors. They’ve certainly been led to think that. They have absolutely no clue how dangerous these medications can be, so of course they think they should be allowed to prescribe them. How hard could it be?

  19. Davdoodles says:

    ” …unable to clear one or more of the bars to entry: grades, MCAT scores, money. I wonder what bars entrants to schools of chiroquacktic have to clear?”

    Only the last one, of the four you listed.

    Chiropractic “schools” are basically carnival barkers, only more despicable, and less charming: “Step riiight up! You too can inject dangerous chemicals into un-informed rubes, as soon as your cheque clears…!”
    .

  20. Chris says:

    windriven:

    @Calli Arcale

    “I’ve never understood why chiropractors who want to practice medicine don’t just become doctors.”

    One suspects that many are unable to clear one or more of the bars to entry: grades, MCAT scores, money. I wonder what bars entrants to schools of chiroquacktic have to clear?

    Which is why whenever there is legislation proposed to allow DCs (or naturopaths) to do real medicine, that a requirement be proposed that they must pass the US Medical Licensing Exam. I don’t see a problem with having them prove they actually know how to diagnose, prescribe and administer real drugs. Most likely because I doubt any of them could pass the exam.

  21. windriven says:

    @tgobbi

    “[S]ide-by-side photos showing men with white jackets and with stethoscopes dangling from their necks. The ad stated that you can’t tell the guys apart by looking at them and you can’t tell them apart when you’re in their respective offices for a physical.”

    Patrick Dempsey in scrubs looks just like a neurosurgeon. I’ll bet he can even determine if someone’s pupils are about the same size. I wonder how man chiroquacksters would let Dempsey drill a hole in their skulls?

  22. tgobbi says:

    # Calli Arcaleon 06 Sep 2012 at 2:29 pm

    “I do have to confess the question was a bit rhetorical. I agree about the reason. They want the prescribing privileges without all the work. Well, that’s the snarky way to put it. Most chiropractors I’ve met are well-meaning, and are truly oblivious to their own incompetence.”

    Except they wouldn’t consider it incompetence. Rather, they’d look at it as a “different truth.” No kidding: a DC actually said that to me a few months ago. I informed him that a dietary anti-cancer diet (Gerson) he touts was totally discredited decades ago. He said “Your truth is not the same as my truth.” Notwithstanding the illogic of his statement I couldn’t convince him that what I was pointing out to him was not an opinion – mine or anyone else’s. It is what the current status of scientific knowledge tells us.

    “This was made starkly evident some years ago when there was a class-action lawsuit against several prominent chiropractic schools; the students were suing because they didn’t learn until they were in the field how inadequate their training had been. So while the vanguards of this probably just want to be doctors without the work, the average grunts seriously believe they’re equipped to be doctors.”

    Well, that’s the crux of the situation. They do think that. But the simple fact is that they have no hands-on experience working with sick people. All they have in their armamentarium is that they’ve been told by their teachers in chiro school and by the trainers in their weekend classes that such-and-such works. No studies, no substantiation; just word-of-mouth, testimonials and anecdotes. And, of course, wishful thinking. The “different truth” guy cited above thinks he’s a qualified heart specialist! I asked him when he last administered an EKG and if he knows how to diagnose a-fib. He just looked at me with his mouth open…

  23. nybgrus says:

    I would also be willing to bet that a chiro student would be absolutely unable to pass the USMLE. It its genuinely a very difficult Aries of tests, with the first step considered the hardest. A passing score is 189 and the average amongst med students is around 220 with 230 being the minimum cut off for consideration of your residency application at the most competitive programs. I actually tutored lower class men and when fire a full year, did a fair bit of extra reading, and went through roughly 7000 practice questions to get my score, which I am pretty happy with and is quite competitive. I know a number of colleagues who also did a fair bit of study and failed or passed in the sub 2-teens.

    The point is that there is no way that a chiro student could even hope to pass the USMLE without studying EXTENSIVELY and specifically for it. And if they did that, I doubt they would be able to continue their DC education without enough cognitive dissonance to extrude grey matter from their ears

    Interestingly in the infrequent conversations I have had with residents and attendings regarding chiropractic, they are pretty much all shruggies with a rather tepid reference to having heard something about how there is some evidence chiros can help back pain and absolutely zero understanding of ANYTHING else they do, how they do it, or what their “training” its based on.

    Also of note, none of the usual chiro contingent has shown up here yet…

  24. lilady says:

    About D.O.s…

    Dear hubby has been under the care of cardiologists since 1999, when a partially blocked cardiac artery was found…no interventions were necessary An M.D. in the practice performed successful percutaneous right and left atria cardiac ablations, 2005 and 2008. His cardiologists had monitored that partially blocked cardiac artery and the obstruction was progressive. He was referred to a D.O. (February, 2011), in that cardiology practice for angiography and possible stent placement. Three drug eluting stents were placed in two cardiac arteries.

    Fortunately, for cardiac patients in my State, the data, in terms of morbidity and mortality outcomes, at every hospital that has cardiology surgery departments is collected and available on the internet. So too, is the data for every interventional cardiologist who performs PCI (Percutaneous Coronary Interventions), available on the internet:

    http://www.health.ny.gov/statistics/diseases/cardiovascular/docs/pci_2005-2007.pdf

    Each of the interventional cardiologists (M.D. and D.O.) that performed PCI procedures on dear hubby have extraordinarily excellent records in terms of morbidity and mortality.

    Most of our physicians are M.D.s, but we have had experiences with a few D.O.s…they are rated “tops” in their specialties.

  25. windriven says:

    @nybgrus

    “Also of note, none of the usual chiro contingent has shown up here yet…”

    And if they did, what could they say? That chiropractic education is as comprehensive as medical education? That they are competent to diagnose the range of diseases common to humans and moreover to treat them with everything from gentle words to powerful drugs?

    Even most morons know that sometimes an open mouth invites only a foot.

  26. pmoran says:

    Are doctors permitted to sell (“dispense”?) medical products to their patients in the USA? Many countries have strict legislation against that, because of the potential conflict of interest. Permitting this kind of commerce in the present setting, where there are no agreed standards at all for the legitimacy of treatments, would surely look a bit crazy even to most legislatures.

    Being required to give up that right would make PCP status less attractive to chiropractors and others.

  27. Chris says:

    Sorry, I misspoke. They prescribe and administer. And they give vaccinations.

  28. nobs says:

    # pmoranon 06 Sep 2012 at 7:05 pm

    Are doctors permitted to sell (“dispense”?) medical products to their patients in the USA? Many countries have strict legislation against that, because of the potential conflict of interest. Permitting this kind of commerce in the present setting, where there are no agreed standards at all for the legitimacy of treatments, would surely look a bit crazy even to most legislatures.

    Being required to give up that right would make PCP status less attractive to chiropractors and others.

    Peter-
    REALLY? I consider you on of the more reasoned posters here. This post is truly disappointing and IMO- uninformed.

    From that query, are we to assume that “medical doctors:” DO NOT…. “sell(“dispense”?) medical products” to their patients” ?

    If THAT is indeed your claim, …well then,… you would be VERY WRONG, and misleading.

    Just a few examples:

    -Dermatologists/plastic surgeons routinely sell their potions and cremes on site, and also on the internet. BTW- Dentists have also gotten in on this big time, with whitening and tooth bleaching products sold on site.

    ***BUT***

    What is REALLY TRUELY egregious is…..when patients are being “sold(dispensed)” products without their complete knowledge OR consent!

    EG. medical devices that …ummmm…. the “precribing doctor” owns shares of, or is being paid “consulting” fees from, or….. referral to the radiology center they own, …… or physical therapy referrals to the PT clinic they own? ….the list goes on and on.

  29. If any chiropractor pretends that they could be a PCP, it’s just ridiculous. They are no more qualifed to play doctor than a plumber could.

    I’d love any chiropractor (or BJ, bc he always likes to tell doctors how to practice) to comment on this. It’s a basic scenario that ANY PCP in the USA should be able to manage:

    A 58 yr old female with a past medical history of chronic LV systolic heart failure (echo 2 months ago EF 400#), rash on her chest wall, panniculitis, and asymmetric edema of her bilateral LEs. Please tell me what diagnoses you have, what tests you would run, what medications and at what doses you would start, and the pathophysiology connecting her chronic diseases.

    If you can’t do this, then go f*** yourselves, chiropractors (acupuncturists, homeopaths, etc). Any family doctor on day 1 of residency should be able to handle a case like this and answer every question I just asked. And don’t go Google-ing and writing down some stupid crap. Just have a real conversation with yourself and say “Wow, I really don’t know *ANYTHING* about medicine, and if I *EVER* pretended to be a PCP, I would be endangering people because I’m really just a talentless hack!”

    :) Sorry, in a rush.

  30. nwtk2007 says:

    Anybody who knows anything would recognise this as a T4/T5 subluxation. Begin daily adjustments for the rest of the patient’s life of course. Der.

  31. nwtk, haha :)

    re: my above post, it should be EF less than 20%, weight greater thn 400#. HTML tags got the best of me.

  32. rwk says:

    @sh
    are you a cardiologist? My own GP wouldn’t be able to answer all those questions. He would refer out and base
    his therapy on the little report that came back. Not a real scenario anyway. No ones going to walk in to see you for the
    first time and tell you they have Left sided heart failure with a 40% Ejection fraction without being seen by someone else anyway.
    And I’m not going back and forth with you here because you’re an a-hole.

  33. windriven says:

    @rwk

    1. ad hominems have no place here
    2. My internist would absolutely know. Perhaps you should shop around for someone more competent.
    3. SkepticalHealth did not suggest that the mythical patient just walked in and offered this presentation. But in fact that is how residents see patients during grand rounds and part of how they learn to quickly assimilate information and develop a course of action.
    4. SkepticalHealth is most certainly not an a-hole. It takes one to know one and I am one (as many here will attest). S/H can always be counted on to deliver thoughtful and thought-provoking commentary.

  34. nwtk2007 says:

    now boys, I would have to agree with rwk that most folks PCP’s wouldn’t be able to answer that one. An internist, sure, but how many of us have an internist for a PCP? Many of us have an NP for a PCP. I seriously doubt you could find one at all, who might be able to answer that, unless she were an NP with a cardiac specialty.

    Its a good case though. I’d be interested in finding out what it is. It sounds like the plight of so many of the general fat folks walking around the ghetto these days. So many of those who come here to treat for injuries in MVA’s seem so close to deaths bed.

  35. Quill says:

    While New Mexico’s legislature seems inflicted with all sorts of bad things, California’s is showing some good sense, at least for now. The state is currently working to define how the federal health reforms will be implemented and right now chiropractic care will -not- be covered under the category of “essential health benefits” that all individual and small group plans must cover. (Acupuncture will be covered in some limited circumstances, so all is not yet well.)

    http://www.mercurynews.com/health/ci_21445798/california-benefits-health-plans-under-federal-reform-defined

  36. windriven says:

    @nwtk2007

    A nurse practitioner is your PCP? Really? I believe that Kaiser uses PAs as gatekeepers; maybe NPs as well. Is the choice of an NP a personal preference or something imposed by your insurer?

    In any event, I would much prefer a well-trained NP to a chiro on the simple basis that the NP can be expected to have been educated using mainstream medical principles rather than batcrap crazy notions of subluxations and high colonics.

  37. ConspicuousCarl says:

    @ SkepticalHealth:

    Going to a plumber might actually be better than going to a chiropractor because the plumber probably knows that he isn’t a doctor, and will likely tell you to go see one.

  38. pmoran says:

    Is what Nobs says true, that US doctors can sell what they prescribe to the patient and hold directly beneficial interests in other medical facilities they employ? (That is what I was enquiring about, Nobs, because I did not know, and I would be very surprised if this applied in many other developed countries!)

    Stopping that conflict of interest for PCPs might help reduce push to afford ridiculous rubbish like “protomorphogens” enshrinement, of sorts, in law.

    If CAM practitioners are to be regulated at all it should be based more on what they can and cannot claim to treat, rather than what they use to do so. Where treatments are dangerous, it should be possible to legislate against them directly.

  39. lilady says:

    @ P. Moran: In New York State, NPs, with the exception of a few NP-specialists in midwifery who care only for pregnant women, are not primary care providers.

    Many large medical practices such as the cardiology practice I referred to above, do have PAs and NPs on staff. A close friend who is a NP-cardiology specialist, works under the supervision of the medical doctors. They do rather complicated stress tests in the in-house stress test labs. NP also “cover” for doctors, who have patient overloads, in the cardiology offices where they work. IIRC, there is a scope of practice for nurse practitioners dictated by the ANA (American Nursing Association) and their NP malpractice insurance, does not cover for lawsuits generated for seeing/treating a patient outside of their scope of practice.

    I’ve purchased an ankle support for a bad sprain, and my husband purchased an air splint for a torn ligament from orthopedists…and we were not overcharged.

    I don’t believe there is any prohibition to prevent medical doctors from selling vitamins and supplements that they prescribe to a patient, which, IMO puts the doctor in an ethical dilemma…that is just my opinion.

  40. @rwk, in no way do I mean this as an insult, but your incredulity regarding your PCP to be able to handle such a basic case is telling that you, as a chiropractor, are simply devoid of even basic medical knowledge, which further demonstrates that chiros have absolutely zero business doing anything in the medical field, let alone pretend to be PCPs.

    To be somewhat fair, in my vingette it seems her complaint of dyspnea got cut out with the HTML tag error too. @windriven, you are absolutely correct your internist could treat this, honestly within their first week of practicing during residency. I, in fact, treated this during my first week of residency. @nwtk2007, (to answer) the patient comes in with dyspnea, their morbidy obese (400#), so they can barely move. They have systolic heart failure, so they’re barely perfusing their vasculature and organs, and the asymmetrical edema in the lower extremities makes you suspicious for DVT (other clues are difficult to tell due to body habitus and comorbidities.) EKG shows sinus tach at 115. Lung auscultation is difficult due to body habitus, but bibasilar rales are heard. CXR shows bilateral pleaural effusions. PE is highly suspected, d-dimer is elevated, and a VQ scan is performed. Patient is immediately placed on full dose Lovenox BID and coumadin and admitted to telemetry. Her Cr is 1.2, a repeat ECHO shows no change in her ejection fraction from previous. She’s started on Lasix 40mg IV BID. After two days of diuresis a bump in her Cr is noted, so she is switched back to Lasix 40 PO qd. At this time a EKG shows SVT @ 190, so a bolus of Cardizem is given which converts her back to sinus tach, the following day Cardizem is discontinued, and Lopressor 25mg BID is given. She is also started on Lisinopril and Digoxin. After several days more of coumadin her INR is therapeutic, Lovenox is discontinued, and the patient is discharged on coumadin and her SHF meds.

    I hope that any of you anti-medicine goobers out there who read this realize the decision making that goes into this type of treatment. Yes, for us because we know medicine it’s a basic case, but for anyone who sits there and says “doctors just treat symptoms, MANN!”, you’re dishonest. And the goober chiropractors on Twitter or whatever who write “we’re more educated than doctors!!”, you can honestly jump off a cliff, because you don’t know s***. You are not PCPs. You never will be PCPs. Your education simply doesn’t allow for it. You cannot treat disease. You may help chronic pain patients somewhat, but to ever consider that you can actually care for a patient in a primary care setting is severely overestimating your abilities and severely underestimating the knowledge that medical doctors possess.

    @nwtk, you are right that a NP could not manage this case. I think the incorporation of NPs/PAs in medicine is a travesty. I think they are often used outside of what the profession was originally intended for. Many patients tell me how they tried to make an appointment somewhere and only could see the NP. My wife ran into this problem, and she was told by their office “our NPs are as good as the doctors!”. Yeah, right. Any family doctor could manage this case, and that is why they are qualified as a primary care doctor. I can give dozens of such cases that a medical doctor manages that a chiropractor, or any other CAM pracitioner, could never, ever, ever, ever do one positive thing for (besides tell them to goto a doctor.) The truth is, chiropractic cannot offer anything beneifical to a patient in a primary care setting. Nothing, except perhaps some help with chronic pain, but in that situation I always PRESCRIBE (haha) PT. I think that some chiropractors believe they can be PCPs because they’ve never seen any real pathology. I wouldn’t think many people would bring their loved ones who are having a heart attack, or who are septic, or who are having acute decompensated heart failure to chiropractors. Maybe they’re just ignorant to what a real PCP is capable of treating.

  41. tgobbi says:

    SkepticalHealth: “And the goober chiropractors on Twitter or whatever who write “we’re more educated than doctors!!”, you can honestly jump off a cliff, because you don’t know s***.”

    Another personal experience: frequently I respond to advertisements for free chiropractic consultations. One recent ad purported to be for a freebie at a physical therapy place but my longtime experience sniffing out disguised chiropractic come-ons gave this one away immediately. After signing in at the office, which indeed was loaded with exercise equipment, I was approached by a woman who escorted me to a room without introducing herself or telling me what her title was. She began by asking me a few questions but I interrupted to ask who/what she was. “I’m a doctor,” she responded. I asked her what kind of doctor. “I’m a chiropractor.” Point blank I questioned the ethics of luring customers by making them think they were making appointments to see a PT and remarked that I find it a disturbing trend for DCs to obfuscate their true identities. (If they’re so proud to be chiropractors one wonders why they do this so often; but that’s another subject entirely).

    So what does this have to do with SkepticalHealth’s comment? “I’m better qualified than your MD to address your problem!” (I had mentioned to her that I suffer from chronic pain). I countered by stating that my primary care doctor may not be the best healthcare professional to diagnose and treat the condition but that he most certainly would refer me to the proper specialist. As I left I pointedly informed here that neither would he examine me for those pesky, but elusive, chiropractic subluxations.

  42. tgobbi says:

    Addendum to my previous comments:

    It just happened again. I attended a health fair this morning, populated by a mix of legitimate healthcare providers and the usual nut cases. Among the three chiropractors, one gave no indication that he’s a DC. Neither his card nor his literature so stated; all it said was Dr. “Krankheit.” I was almost 100% certain that he’s a DC because of the materials he had on display and he confirmed it when I confronted him.

    Another chiro offered a 25% off coupon for an initial office visit but, like the one I mentioned a few weeks back, she insisted that the appointment be made on the spot and demanded cash up front. This always strikes me has highly unethical. She also used a computerized device to show me my subluxations. At no charge…

    Also there was an acupuncturist who informed me that 75% of the world’s population use acupuncture. I bet none of the readers of this forum knew that!

  43. DevoutCatalyst says:

    tgobbi

    With your penchant, I think you should make a documentary. Sounds like fun what you do.

  44. ^^^ Agree! tgobbi has fantastic stories about quack chiropractors. Some documentary footage would be awesome. Although, one chiropractor on YouTube or something exposed himself rather bad. It was a promotional video he made of what to expect in an encounter with him. The bastard shows himself lying to the patient, lying to the patient, trying to force them into ridiculous treatment plans, then lying to the patient, and then he finished up with lying to the patient some more. He gave these ridiculous, completely impossible explanations of how his treatments supposedly work, etc. Absolutely disturbing!

  45. tgobbi says:

    Thanks to DevoutCatalyst and SkepticalHealth for their kind remarks. Indeed it is fun – in a perverse sort of way. (Maybe I’ll elaborate on this some day).

    In fact, Dr. Sampson has suggested that I write about my experiences in one way or another and I’ve been considering doing so. One difficulty is that I no longer have all my notes, mostly because some of the earlier ones were lost when I was a naive computer user (more so than now) and I didn’t realize that Apple’s newer operating systems wouldn’t recognize my original word processing application. I do, however, have quite a bit of material on the computer and as hard copies in file folders. As anyone who reads my comments has doubtless surmised my primary interest is chiropractic and I’ve noticed a cohesive factor amongst the DCs with whom I’ve had contact: they’re consistent in their refusal to answer direct questions! Either they throw red herrings into the mix or they block my emails or, frequently, they direct ad hominem attacks against Stephen Barrett, MD, who probably knows more about chiropractic than most chiropractors. I’d guess that Dr. Barrett could be considered my main source of information about the topic.

    It’s interesting that in the roughly 35 years I’ve been bashing chiropractic that I’ve never been sued. Quacks are historically litigious as we all know (although less so in recent years due to increasing lack of success in lawsuits). Years ago threats of legal action were their strongest arguments against their detractors. The closest I’ve ever gotten to being sued is when a lawyer sent me a warning letter at the behest of a DC he represented. Someone overheard me making negative comments about chiropractic in general and the “doctor” construed my remarks as a direct slur against him. Fortified by a glass or two of alcoholic sustenance I wrote an angry letter to the lawyer. In it I hinted that he may have been at home with a case of the sniffles on the day his law professor covered the First Amendment to the United States Constitution. It will surprise no one that I never heard from the lawyer again!

  46. nybgrus says:

    I am on mobile, so I will be brief…

    But the incredulity at SH’s scenario is ridiculous. Of COURSE a family medicine doctor can handle this. Hell, I can handle this scenario! I know all the relevant path, drugs, and indications. I am about to take my exit exam for internal medicine – what do you think half my patients were? And I admitted them, did the full H&P, wrote my assessment and plan, and wrote my own orders to manage the care, rounded on them every day, and updated orders as necessary. Hell, I even placed a right IJ trialysis Cather entirely in my own (and nailed it in the first stick and didn’t drop the lung).

    The point is, yes. To pass my rotation it is EXPECTED that I know how to diagnose and manage patients like these… And a hell of a lot more. It is expressly demanded that my knowledge base be diffident to manage such common conditions. no need for a cardiologist. And damn straight no DC can handle it.

    As for the NP issue, I’ll comment more later when I am not mobile, but suffice it to say that it is a pointless argument in context even if it were true that NP .was the sole pcp that would nor validate dc as pcp, it would merely be an argument against np as pcp

  47. rwk says:

    @SH and Nybrus
    That unrealistic to think that SH’s example could be handled in an office setting. The best you’d get from
    a drugless practitioner is an H+P, maybe an ECG and simple lab work.
    The rest of SH’s case ( or probably most of it) is done at the hospital with a lot of support and maybe a little help
    from a few of those little online references you both mentioned in earlier posts.
    The reason Nybgrus and SH can handle these patients is that they have experience and have gone through
    the motions after following someone else around and watching them many times!

  48. Yes, obviously this multiple day patient was treated in a hospital setting, by a primary care provider. A DVT can actually be treated outpatient, if the symptoms are not severe and the patient has good followup. They can simply come in twice a day for their Lovenox injections and the PCP can check daily prothrombin times. The point we are making is that medical doctors know medicine. Morons like chiropractors don’t know anything, and can not in any way provide anything beneifical for patients in a primary care setting. They can’t. You couldn’t do anything for a patient with refractory depression, a sore throat (do you know your modified Centor critera?), Afib, scabies, sinusitis, a stroke, chest pain, cellulitis, a STD, migraines, a GI bleed, anemia, pneumonia, COPD, etc. Nothing. Your profession is just useless. I could go through almost the entire book of ICD9 diagnoses and just list everyone of them, and point out how that chiropractic cannot offer anything for them. You simply don’t have the education, skills, or intelligence (2.5 GPA lol) to manage someone’s healthcare.

  49. rwk says:

    SH says The point we are making is that medical doctors know medicine.

    We’ve never disputed that

    And you do have a treatment for all those conditions mentioned but you don’t always help them and often just
    screw them up more

    How about your 400 pounder. After you spent all that time, money and manpower ( pumping up the US GDP )
    here’s what you did for her weight:
    Gave her a xeroxed sheet with a diet and some exercises just like you give your neck pain patients right?
    You have a study to prove that work.

    I wonder how you’d like it if tgobbi ( or anyone) came into your office and dared to question you?

    You may be a boffin at medicine but probably couldn’t do a thing with your hands for an MS complaint.
    I pity your girlfriend or maybe boyfriend if they pull a muscle or sprain something. All you can do is give em
    a pill and hope it goes away.
    So prescribe PT for your patients ( along with NSAIDs and muscle relaxers) and in a couple of days they can be seen by your PT who’ll give them some more exercises and maybe have a PTA watch them do them.

    Finally if you, Nybgrus, tgobbi et al think our anatomy and physiology classes are high school level, why don’t you just go to your local chiropractic school and sit in on some lectures.
    And then tell them how stupid they are to their faces. That’d make a good youtube video.

  50. rwk says:

    SH,
    Again if someone like your 400 pounder walked in to see just about anyone,they’d be sent straight to the hospital.

  51. nybgrus says:

    I finally have my laptop back!!!! After 19 days of waiting for what was supposed to be a 3-5 day fix here I am!

    Anyways, yes… of course the scenario SH described is a multi day hospital admit. But you know what? The PCP, family care, whatever actual medical doctor would know to refer for admit AND would know what to do ANYWAYS.

    You do have lots of support in the hospital. No doubt. But that is so you don’t screw up… not so you don’t have to know what to do. I have been expected to assess, determine, diagnose, and manage my patients and present it ALL and then have my attending confirm or disconfirm my plan of action.

    But here is the point – if you have never once studied this stuff, how can you POSSIBLY claim to be qualified to be a PCP? The most dangerous thing in medicine is not knowing what you don’t know. So a DC doesn’t learn any of this stuff. The response? Well, duh! We are back and MSK specialists! Oh, but we can TOTALLY be PCPs at the same time! Even though we never learned ANY of this other stuff. It is mind boggling how you can completely and utterly miss something and/or think it is something else entirely if you haven’t actually SEEN and STUDIED it at some point. I good physician doesn’t necessarily need to be an expert in the pathology, but merely vaguely remember having seen or studied it once to know to look it up or refer to someone else. If you have NEVER been exposed to it in the first place, all the self cogitations about how you are an MSK specialist means NOTHING. Your basic, fundamental, and total training leaves you inadequately prepared to be a PCP. For f**ks sake! Even an actual medical specialist (say an orthopod or interventional radiologist) would never DREAM (s)he could be a PCP. Because being a generalist is HARD. REALLY. FRAKKIN. HARD. You have to have at least cursory knowledge of more than a DC could hope to ever know.

    And that is the crux of it. And I have been cooking all night, had some wine and am working of a vodka tonic and my beautiful rocket scientist fiance is yelling at me to stop telling stupid people on the internet they are stupid so… I bid you all adieu.

    Skeptical, I am confident you can pick it up from here.

    Happy saturday to all!

  52. Actually, both a dietician (R.D.) and cardiac rehab were consulted on the 400 pound patient to establish outpatient followup. The patient had myocardial steatosis. If you think that solving all of their problems about being fat would be accomplished while they were hospitalized for DVT/PE and CHF exacerbation, you are completely wrong, again exemplifying your complete lack of understanding of the process of medicine and how PCPs practice. The inpatient setting is inappropriate for that. We can get the ball rolling in the hospital, but most of that is done in follow up. Counseling someone to lose weight is not a hospitalizable condition. So once we have no medical reason to keep them hospitalized (ie, in this case the patient’s INR was therapeutic and their CHF exacerbation had improved), we ensure they have followup appointments, and dishcarge them on updated medications and follow them as outpaitents.

    It’s funny. You incorrectly assumed that I just sent her home with a xerox’ed set of diet instructions. You simply do not understand what is done in hospitals. You completely failed to notice that I saved this lady’s life. Had she gone to see any non-medical doctor, she likely would have died within 12-24 hours. (Think about this, what do you think happens when a patient throws a PE, and the DVT is left untreated? And what do you think happens when a patient has CHF exacerbation and isn’t adequately perfusing their body with oxygenated blood?)

    You are correct, for MS complaints that I feel warrant therapy, I will prescribe medication to act as a crutch while they undergo physical therapy. I send them to physical therapists, not chiropractors, because physical therapists are trained under a (mostly) science-based curriculum, because they are better students, better trained, and because they are generally not anti-medicine quacks that will lie to their patients, try to upsell them on bull**** treatments, and convince them to not get vaccinations for their children, or put them on dangerously ridiculous diets. And, because they don’t refer to themselves as “doctor.”

  53. @nybgrus just made a fantastic point, that even a specialist such as an orthopedic surgeon would not pretend to be a PCP. Medicine changes and advances constantly, and if you’re out of it for even 6-12 months you have to play catchup. An ortho that beens in practice 10+ years has likely forgotten a good portion of their general medicine, and would be hard pressed to treat non-orthopedic complaints (obviously, by this I mean complicated cases.) Likewise, I’m fine injecting some joints and casting certain fractures, but if I feel remotely uncomfortable, to the ortho they go. So how could anyone even entertain the idea that a chiropractor, or any other brand of quacktitioner (see what I did there?), could pretend to play PCP when they’ve never even learned this stuff in the first place? It’s just pure insanity.

  54. rwk says:

    SH
    You’re really not saying anything that I don’t know. I know specialists who don’t know anything or have confidence
    in treating anything beyond their specialty.

    Nybgrus,
    Does this mean we won’t be having a beer the next time you’re in Chicago?

  55. nybgrus says:

    @rwk:

    I’ll buy you one the next time you are in New Orleans. My last post was a bit too harsh, perhaps, so apologies for that. I do mean what I said, though I could have said it better.

    I have no issues, per se, with a DC as a person to share a beer with. The same way I don’t have issues per se with a theist as a person to share a beer with. But if you start espousing inanity and evince to me you have no problem bilking people out of money, then the conversation will degrade rather rapidly. But I do recognize that there are larger forces at play that lead people down the wrong path – be it chiropractic or religion – and I try not to begrudge them that out of hand.

    The only one thing I cannot stand is when someone refuses to even try and understand why they may be wrong and consequently change their mind based on evidence. Which is why I have zero theistic friends and zero CAM practitioners as friends. They tend to be the people most likely to do exactly that and I just don’t have enough time in my day to engage with them (which is to say that if I did have time I would since I learn a lot that way and hope they may eventually learn something as well). I have classmates that are like that… and I tend to steer clear of them as well, as best I can.

    So in short – sure if situations conspire I’ll be glad to discuss this more fully over a beer with most people here (NMS-DC is the only one I can think of off the top of my head with whom I wouldn’t waste my time).

  56. tgobbi says:

    RWK: “Finally if you, Nybgrus, tgobbi et al think our anatomy and physiology classes are high school level, why don’t you just go to your local chiropractic school and sit in on some lectures.”

    RWK, who appears to be a chiropractor (apologies if I’m mistaken) reinforces many of my beliefs and criticisms about chiropractic and chiropractors by misconstruing my comments and misquoting me. I don’t recall saying anything about the courses they take (and again apologies if I’m wrong). I’ve read that they’re subjected to scientifically viable classes on those subjects. No, my gripe is that whatever they’ve been taught falls by the wayside when they begin to practice.

    But here’s a question that I hope RWK or some other DC can clue me in about: since your science classes are apparently legitimate, where does the subluxation come into the picture? Certainly not in those classes! But its major role in the real world of everyday chiropractic is painfully obvious. In the past few weeks alone I’ve seen displays from at least half a dozen of your peers, at art fairs and a health fair, that show the standard charts and plastic spine models with their graphics showing which parts of the spine cause specific disease conditions.

    Here’s another point, RWK: you spout the standard chiropractic litany that accuses science-based healthcare professionals of addressing medical problems with a slapdash approach. One of the DCs I spoke with at yesterday’s health fair echoed a standard chiropractic misconception that I’ve heard and read about for 30+ years: medical practitioners apply band-aids to cover up symptoms while DCs go right to the crux of the problem. Specifically, when I agreed to submit to her electronic subluxation detector (a high-tech version of B.J.’s 1920s preposterous neurocalometer) I mentioned my chronic neck pain problem. I asked her what makes her approach to the condition superior to the epidural steroid injections that I had a few months ago. Her predictable response: the band-aid artifice! (Side note: I’m thrilled to report that the injections reduced my pain level by at least 50%).

    So let’s get back to the DC as primary care physician argument using the annual physical as an example. Each year the first thing my PCP does is to send me a little hemoccult packet, several weeks before the appointment, to check for blood in the stool. The office visit begins with a blood test to check for diabetes and other conditions that are detectable in the blood. The standard “peeing in the cup” is used to check for any conditions that are detectable in the urine. Next is an EKG. Once the technician has completed these and other procedures (and after the standard interminable wait while I sit bare-assed naked, covered only by a paper sheet, before the MD finally shows up) the doctor’s examination begins. I can’t recall all the things he asks and all the pokings and proddings but I do know that it starts with a review of my medications. “Aha!” you say. “DCs review medications as well!” Granted, but the difference is that the doctor wants to make sure that the pills are doing what they’re supposed to do and that there are no medications that clash with each other while the chiropractor wants to hear what drugs you’re taking so he can warn you how dangerous they are and ask “do you want to take pills for the rest of your life?” My prostate is palpated; my eyes, ears and nose are examined; there’s a hernia check. The list is long and everything is done for specific reasons.

    Now let’s skip to the chiropractic “physicals” I’ve subjected myself to: no check for colorectal cancer; no urinalysis; no EKG (or anything else to check for cardiac problems); no ear, eye and nose exam; no prostate or hernia check. (Come to think of it, I don’t think it’s even legal for a chiropractor to check the prostate. Aren’t bodily orifices off limits legally)? The list of omissions goes on and on. DCs go through the motions of asking about past medical history, surgeries, etc. But what do they do about these? I regard it as a red herring to make their customers think that they’re legitimate healthcare professionals. What CAN they do? Not a whole helluva lot except to pretend they know all about them… Many subject their customers to ill-advised full spine x-rays in order to locate non-existent subluxations. And, let’s face it, the overwhelming majority of chiropractors still adhere to the chimeric notion that they exist and that they’re killers! Okay, so conceding you the benefit of the doubt, let’s say that you accidentally stumble across a genuine medical problem. What do you do next? Here I have to admit that I’m stymied. I have no idea what you do – assuming you have the cajones to admit that you’re stumped. I’ve read that you’re trained to send customers to actual doctors. But which doctors? Are you authorized to refer to MDs or hospitals? Or do you just wring your hands and recommend medical intervention and leave your customer on his/her own?

    So here’s what I hope you’ll be kind enough to do, RWK: please give some specific responses to at least a few of my questions instead of saying “Nyaahh, nyaahh, nyaahh! We don’t have to answer because we know that we’re right and the mainstream medical profession only denigrates what we do because we present a challenge to their livelihood.” If you do this, it’ll be a first for me. In fact, somewhere in my files, I have a whole list of reasonable (REASONABLE!) questions I’ve submitted to DCs in the past. So far not a single one of you has responded to them. Here’s a direct challenge to you, RWK: allow me to present these questions to you and offer me a few answers! Say the word and I’ll track them down and submit them. In fact I once posted this very challenge on the Healthfraud list, where a lot of DCs lurk) and had zero response! Apparently cajones are in short supply. What say, RWK – are you up to it?

  57. mousethatroared says:

    nybgrus
    “I finally have my laptop back!!!! After 19 days of waiting for what was supposed to be a 3-5 day fix here I am!”

    Hah, I wondered if you were lying in a coma somewhere…turn out it was even worse, laptop failure. ;)

  58. Lap top failure? There’s a pill for that…

  59. nybgrus says:

    much worse than a coma indeed. I kept current on my tablet, which I absolutely LOVE for reading things and typing out short emails and responses, but without a keyboard I simply don’t have the patience for longer responses.

    Well, that and I have been genuinely busy on my medicine rotation. I have been admitting and following 4 to 5 patients at a time (interns are expected to do the same for 9 and we are expected to work our way up to 2 or perhaps 3 by the end of the rotation) so I was quite busy and at the hospital quite a lot as well.

    Next up is pediatrics, which I am not particularly interested in, so I will not be putting in quite as much extra effort and will probably be showing up around here a bit more often.

  60. mousethatroared says:

    nybgrus – You may have already had the opportunity, but if this is the first time you will be working with pediatricians and they are good one, pay special attention to how they interact and communicate with both the patients and the parents. IMO, from a patient’s perspective, our pediatricians’ and pediatric specialists’ communication skills are generally superior to most of the other doctors and specialists I’ve dealt with.

    Big generalization, of course.

  61. lilady says:

    @ nybgrus: Wait until you meet parents who have children with chronic/complex medical conditions You’re in for a treat and you’ll find you can learn a tremendous amount of medicine from them. Trust me, *I know*.

    @ mousethatroared: any *results* yet?

  62. nybgrus says:

    I have worked with children a fair bit before. In my 3 years in the ER before starting med school I often worked on the pediatrics side and the child life specialists often asked for me specifically to assist in procedures because they felt I was adept at it. I never liked it much because I hated seeing sick and hurt kids and it was always a tenuous balance when a child needed restraining – they tend to go “all out” in their struggle, and you do need to hold them steady for their own good, but you don’t want to injure them either.

    And of course I will learn immensely during this rotation – I do from every rotation. What I meant to say is that I know for certain I am not interested in a pediatrics residency so I will not be doing extra scut work or really going out of my way to impress my attendings since I won’t be attempting to garner letters of rec from this rotation. I will do my work, do a good but not great job, learn as much as I can, but not kill myself putting in 60-70 hour weeks when I technically don’t need to like I did during my medicine rotation. I want to be reasonably competent enough to manage common and simple things, understand the approach to complex things, and gain some skills and knowledge that will serve me well later in life. But since I will, more or less, never be working with kids again for my career I don’t feel the need to become extremely proficient at it. Even more so since no matter how hard I work and how much I learn it will fade since I won’t be practicing the skills and knowledge.

  63. mousethatroared says:

    Sorry – Off topic

    Lilady – I received an email from my doctor. My ct scan showed no stones or abnormalities. There is no clear explaination for my pain. I should call if It doesn’t improve.

    Leaving me with the questions. Does that mean it certainly wasn’t kidney stones or that it might have been, but there’s no objective evidence? Should I continue the antibiotic that she prescribed with a kidney stone explaination? What about the micro hematuria and the very slight abnormal kidney function tests? Was that just an obvious fluke or should it be retested? If it was a stone should I do anything different?

    The doctors there don’t do phone or email responses, so I’d just have to pay another $175 if I wanted answers. Luckily, the pain diminished markedly over the last two days and is only giving me occassional painful pokes. So I can’t complain. I think I’ll save the money.

  64. nybgrus says:

    @mouse:

    Hope you don’t mind my opining – and with the requisite caveats that this is by no means inclusive or to be construed as medical advice…

    It still may well have been a stone that you passed, or the scan could have missed the stone. It is unlikely since these days scans for stones are pretty good but nothing is perfect. But one could imagine a stone the right size in the right place to be in between slices of the scan and get missed… or just be mixed up in a mileu of other tissue and missed.

    Hematuria in a female is always tricky since there is a normal source of blood very nearby. But it could have been due to the stone, a not perfectly clean catch from a benign source, or a transient glomerulonephritis even.

    The kidney function tests could also have been incidental. Generally when one is in pain one tends to drink/eat less and a touch of dehydration could easily give a small bump to KFTs. It also could be from a stone that was obstructing and now isn’t.

    Without having actually examined you I can’t possibly say, but considering nothing showed up on the scan it is highly unlikely to be a sinister cause.

    This is one of those cases where treating the patient makes the most sense. If you are getting better then scanning again is essentially useless since no matter what the outcome it won’t likely change what you do – same with the kidney function. Unless they were very abnormal they are most likely nothing to worry about (and you said they were only slightly so).

    Sounds like you were given an antibiotic to cover for a potential UTI as well. Since you have already started taking it you may as well complete the course, at a minimum to help do your bit to decrease likelihood of resistance.

    And of course, if your symptoms come back, worsen, you develop a fever, shakes, chills that you can’t readily ascribe to having just caught the flu or something, then you should go back to seek further medical care and assessment.

    Sorry to hear you had what may have been a kidney stone. I have never had one but have seen many patients with it and they are indeed miserable, but not commonly more troublesome than that.

    (I’m killing time right now waiting for some colleagues to show up who are running late. I don’t have enough time to get some real work or reading done since they should be here *any minute* {rolls eyes} and then we have a lot of work to get done)

  65. lilady says:

    @ mousethatroared: You’ve gotten some great advice from nybgrus. I would suggest you finish the regimen of antibiotics, try to increase fluid intake, check to see if you have any evidence of blood in your urine and just assume that the possibility exists that you passed a (very) small stone. Fever and shivering, should these symptoms appear, should warrant a trip to your physician…you don’t want to risk an ascending urinary tract infection.

    Years ago when dear hubby was doing a lot of jogging, he passed blood in his urine. He ended up in the hospital undergoing an IVP and cystoscopy under sedation, with negative findings, although a very small cyst was seen on one of his kidneys.

    http://www.webmd.com/kidney-stones/retrograde-pyelogram-for-kidney-stones

    He never had hematuria ever again, although apparently the cyst is still on one of his kidneys (located with an abdominal CT scan ~ 8 years ago).

  66. BillyJoe says:

    SH,

    “I’d love any chiropractor (or BJ, bc he always likes to tell doctors how to practice) to comment on this.”

    There you go again mischaracterising my posts :(
    I don’t tell doctors what to do, I interpret the evidence for some of them because some of them seem incapable of doing that for themselves and, even when they do interpret the evidence correctly, they often give advice that is either contrary to the evidence or not based on that evidence. Not to mention those who base their treatment on their personal experience rather than the evidence base.

    “A 58 yr old female with a past medical history of chronic LV systolic heart failure (echo 2 months ago EF 400#), rash on her chest wall, panniculitis, and asymmetric edema of her bilateral LEs. Please tell me what diagnoses you have, what tests you would run, what medications and at what doses you would start, and the pathophysiology connecting her chronic diseases.”

    If you do a PSA on her, I’m calling you on it :D

  67. nybgrus says:

    @lilday:

    You can get blood in the urine from excessive exercise, especially jogging, due to mechanical forces actually destroying red blood cells in the blood vessels. There is also a proposed mechanism for decreased kidney perfusion from the exercise causing minor reversible damage to the kidney that lets a little bit of blood through. The test for blood just checks for the reactivity of the iron in the heme moeity, so the heme passes through the kidney – or comes directly from some small bleeds in the bladder as it jiggles during the run – and voila it shows up as hematuria

    http://jama.jamanetwork.com/article.aspx?articleid=363309

    I have heard of people who go for (personal) record setting runs and getting massive hematuria – like frankly reddish brown urine. Usually this is a combination of causes wherein the shear stress on the RBCs is enough to lyse quite a lot of them, combined with a touch of G6PD deficiency which makes the RBCs more easy to break in hypoxic and acidic conditions (and since you get both of those on extended exercises), a little bit of kidney hypoxia, and/or perhaps a small vessel break in the bladder. In pretty much all cases this resolves spontaneously with little ill effect besides being freaked out that you just peed out blood.

    http://46.4.230.144/web/UpToDate.v19.2/contents/f29/1/29736.htm?source=see_link#H3

    And yes, thanks for including the stay well hydrated bit – that is very good advice for mouse.

  68. lilady says:

    @ nybgrus:

    “I have heard of people who go for (personal) record setting runs and getting massive hematuria – like frankly reddish brown urine.” You must *know* my dear hubby then. :-)

    He did his “personal best” on his 30th birthday!

  69. nybgrus says:

    @lilady:

    We may well have found the culprit then :-D

    I did my personal best during my first year of med – 14 miles at a 7m30s pace – and thankfully suffered no hematuria. Sadly, I am nowhere near in as good a shape these days. Such is the price paid for doing a lot of reading, studying for (and taking) board exams, and having significant clinical and research committments. I didn’t have blood in my urine, but I felt like it was coming out of my eyes after running 4 miles a few days ago!

  70. mousethatroared says:

    @nybrgus and lilady – Thanks so much for the direction. Very reassuring and I am indeed drinking more water. I tend to not drink enough. Although I feel a little bad, because I realized I put you in the position of feeling like you should answer my questions. Sorry about that.

    I mostly was just venting about my doctor, who, I’m beginning to realize is not my style. Sometimes she is very genial and informative, other times I can barely get a few words out of her (other than little comments about her staff). Although I’ve been going to her for 10 years, hate to start out with someone new. But, I think I need to look for someone more even keel.

    *nybgrus, I’m going to start a list of decriptive words that doctors use that you seldom hear in common language. “Sinister” a words that one usually only finds in paperback thrillers.

  71. nybgrus says:

    not at all! Thanks for not taking offense at my butting in. And I am glad you found it useful :-D

    As for my word usage… that may be informed slightly by the fact that I did part of my medical training in Australia and they use more colorful language there than we may be used to around these parts. “Fits, faints, and funny turns” was an interesting term to refer to vague but acute neurological status changes. LOL.

  72. lilady says:

    @mousethatroared: I love the Cleveland Clinic website for reader-friendly accurate information about diseases, disorders and procedures….alphabetically listed:

    http://my.clevelandclinic.org/health/diseases_conditions.aspx?topic=Disorders+and+Conditions&letter=K&page=1

    “Sinister”??? Can’t say that I ever heard that word used to refer to a diagnosis: although I have heard “ominous”.

    Nybgrus: It was a (very) long time ago when dear hubby marked his 30th birthday by overdoing the jogging. He *tends* to go full bore with his interests. Every time he goes to the tip of Montauk Point for surf-fishing in November, I extract promises that he will not climb the rocks on the jetty, garbed in his full waders. I’d like to keep him around for a few more years.

  73. BillyJoe says:

    nybgrus,

    “I did my personal best during my first year of med – 14 miles at a 7m30s pace ”

    I did my PB marathon distance of 42.2 km in 3:18:28.
    That converts to about 7:36 pace
    You’re a better man than I am Gunga Din.

  74. nybgrus says:

    @lilady:

    My fiance oft says similar things to me and requests I not die in the process of doing some of the things I love to do (like topping out at almost 70mph on my Cannondale bicycle or cliff diving).

    @BJ:

    Hardly. You did a full marathon and I did barely over a half. I would not have been able to sustain that pace for another 13 miles.

    However, my true claim to fame, as it were, is my PB cycling record. I covered 100 miles, with 7,300 feet of total vertical ascent in 5h34m which translates to an average pace of 18mph (160km, 2,225m, and 28.8kph). Ugh, now I miss my bike which is languishing in Aus right now.

    Hey BJ – you interested in buying a Cannondale Synapse SL full carbon with Dura-ace and Ultegra components? I’ll give you a great deal on it!

  75. BillyJoe says:

    nybgrus,

    “my true claim to fame, as it were, is my PB cycling record. I covered 100 miles, with 7,300 feet of total vertical ascent in 5h34m which translates to an average pace of 18mph (160km, 2,225m, and 28.8kph).”

    I am always amazed by coincidences such as this.

    Just today my race number arrived for the Melbourne Half Marathon, after last night putting in my appication for the Round The Bay 210km/130mile cycling race – after reading yesterday about your running exploits and today about your cycling exploits.

    Unfortunately, I cannot run the half marathon because of anterior ankle tendonitis which set in about six weeks ago and has improved only 30%. But I found that cycling did not affect the injury and vice versa, so for the past six weeks I have been cycling, using my old mountain bike pulled out of the back shed and to which I fitted road tyres. During the week, I ride on trainers and, on Sunday mornings, on the road over the Dandenong Ranges which rises only about 600m/220feet. Last Sunday I covered 89km/55mile in 4:32. That’s round about 20kph/13mph pace.

    So, on a cycle, I’m less than half the man you are. :(

    “topping out at almost 70mph/110kph”

    I’m truly impressed. My top speed so far is 35mph/55kph. After that, I apply the brakes!!!

  76. nybgrus says:

    I was quite fit when I set the century time. I couldn’t do it now. I actually haven’t cycled in – ugh – 10 or 11 months. Long story but my bike is still in Oz and I haven’t been able to afford a new one yet.

    Also, my 70mph max was coming downhill. On flat, my PB was 42mph for a very short burst.

    I have been trying to sell my bike in Oz, since it is worth more there than it is here, but have been running into the stangest issues with it. I have had many interested buyers and then after arranging everything they suddenly tell me they have bought a different bike – pretty much all of them before seeing mine (though I do have some HQ photos of it here).

    Now I am debating whether to continue trying to sell it or figure out a way to ship it back out to here.

  77. mousethatroared says:

    nybrgus has “a Cannondale Synapse SL full carbon with Dura-ace and Ultegra components”

    I have a 1970 Raleigh Sport like this http://lovelybike.blogspot.com/search?q=Raleigh+sport
    3 speed with all original parts including the Sturmey Archer Hub. I don’t go very fast, because the brake on those old steel rims aren’t great, but what a joy to ride.

    My personal best is riding to the coffee shop with a berserk dog in my basket, two kids and brakes that suddenly started squealing like a couple of angry pigs.

    I love my bike.

    Just thought I’d share. :)

  78. nybgrus says:

    That is a pretty sweet ride mouse! I would actually love to get something like that and restore it up for cruising. In fact, that is one of my projects that I want to work on over my winter holiday :-D Thanks for sharing

  79. BillyJoe says:

    Michelle: “I have a 1970 Raleigh Sport like this http://lovelybike.blogspot.com/search?q=Raleigh+sport

    My wife has a bike like that.
    She can’t ride either. :D

    “My personal best is riding to the coffee shop with a berserk dog in my basket, two kids and brakes that suddenly started squealing like a couple of angry pigs.”

    Having seen my wife ride her bike over the years, I can actually appreciate what you are saying. :)

  80. mousethatroared says:

    @BillyJoe – ha! No, I fixed the break squeal and I actually do ride it. I love how it rides. There is something about the balance of the bike that just seems more gratifying than the modern bikes. I had a rather expensive Univega mountain bike that I finally got rid of because I dreaded riding it. Those low bars are killers when you have a funny shoulder. But it is definitely more about the journey than a race to the finish with this bike. :)

    Why your wife doesn’t ride her’s? There are various things that can be done, like getting the gear sized changed out if hills are a problem, fixing the brake squeal, ect.

  81. nybgrus says:

    mouse: This reminded me of you from our chat earlier in the thread

  82. mousethatroared says:

    nybrgus, good one! I did finish the antibiotics, so no vigilante bacteria for me.

  83. Frank Lanzisera says:

    I’ve been a licensed full time practicing chiropractor for 30 years. I have no desire to attempt to practice as a primary care provider. I don’t have the necessary training. But what I do have is the training and experience over 30 years to recognize those conditions that I need to refer out of my office with all haste. Many cases come to mind. The 68 year old obese, smoker who developed acute low back pain after sanding the bottom of his boat. A lumbar plain film lateral revealed an 11 cm AAA. I call my vascular surgeon friend and the patient is transported to the hospital and is in surgery that evening. He was already leaking blood. The surgeon calls me and tells me the patient wants to drive back home to Ohio to have his doctor treat him. I call the patient in the hosptial and tell him, you won’t make a drive anywhere, you will die if you don’t get this done right now. The procedure is done. Then there was the established patient who presented with a new complaint of a swollen, warm left calf who is sent over to the GP next door who diagnoses a DVT and gets her started on the appropriate medical therapy. Then there is the 29 year old female who developed acute painless left foot drop two weeks earlier who was seen in the ER twice and by her neurologist twice. I figure I’m certainly not smarter than they are and maybe we should run an MRI of the brain considering she has painless weakness in a limb; an ice cold leg; hyperreflexia, and an upward plantar response on the left side. She is referred out after her MR came back showing a parietal lobe mass on the right side suspicious for tumefactive MS, which was later confirmed. Then there is the patient who comes into the office as a new patient with a work comp injury dx as a thoracic sprain, who was taking Lodine. She has additional complaints of acute abdominal pain and she is very pale. Off to the ER, she goes and she has an ulceration of her stomach with a Hgb of 4. Then there is the 25 year old Haitan male with chronic left leg pain and numbness, and thoracolumbar spine pain. He has a strange pattern of patchy baldness and was seen at a walk-in clinic 6 months prior for a respiratory infection. I am suspicous for HIV, with left side peripheral neuropathy which was confirmed by the infectious disease doc I referred him to. Just the life of an ordinary quack chiropractor I guess. Call me crazy but I’m happy in my role as a general chiropractor. Like a good internist friend said to me once, ‘I don’t know why people think being an internist is so glamorous. All day long I have my finger up people’s behinds and the other patients are coughing in my face all day long’ I’ll willingly leave that work to the MDs. Thank you.

  84. Harriet Hall says:

    @Frank Lanzisera,

    Good for you! But I have some questions:
    1. Is it possible that the very existence of the chiropractic option is delaying diagnosis and treatment of serious illnesses?
    2. Do you perform neck manipulations? If so, for what indications and supported by what evidence?
    3. Do you reject the subluxation concept? What do you think is happening when you manipulate a spine?
    4. Do you treat patients for non-musculoskeletal conditions?
    5. Are you a chiropractor just because it’s easier and more pleasant than being a doctor, or because you think chiropractic is uniquely able to help patients and improve their objective outcomes compared to MDs with non-manipulative treatments?

  85. @Frank, your anecdotes are humorous. It’s also humorous how you had to expose people to radiation to make some of these relatively simple diagnoses, all of which you were completely unable to contribute anything positive to in terms of treatment. Do you see what the common theme is in your stories? Hint, it’s that you could offer nothing to the patient.

    So basically, in every single case, if you didn’t exist, the patient would have seen a legitimate medical practitioner before hand and received prompt medical treatment. What’s it like to know that the world would be a better place if you simply vanished?

  86. Frank Lanzisera says:

    SH, you’re a cheeky little fellow aren’t you? How do you explain the ER missing the upper motor neuron diagnosis in the MS case upon two vists? How do you explain the neurologist missing it also upon two visits? Lets see the patient had to come to a chiropractic teaching clinic to be properly worked up for her condition to be diagnosed. I think you would agree that the ER and the neurologist are legitimate medical practioner portals? Did I provide the patient with the AAA a service? Yes my actions saved his life. Did I provide the patient with an acute stomach bleed a service by getting her to the ER. Probably saved her life also. What about a 75 year old female who had fallen at home and hit the side of her neck on an armchair and developed neck pain who goes to her legitimate medical practitioner who did not order cervical films. Did she receive prompt tx from him? No. Why you ask? Well she is referred to my office two weeks after the injury and a cervical spine x-ray reveals a fractured odontoid. How well did that legitimate medical practioner do in this case SH. Did I possibly save her life getting her transported immediately to the ER and alert them ahead of time. You sir are irrational, you sir are someone I would never refer a patient to. You sir are an embarrasment to your profession. Now go climb back under that rock from whence you came.

  87. See, what you have to understand is that you are presenting a chiropractic interpretation of the issues. Like most simple minded people, you have limited understanding of disease pathology or how medicine works. Simple, your accounting of the story is likey unreliable, and is nothing more than a few instances in 30 years of your quack practice that you may or may not have done what any reasonable person would do.

    Just think of the hundreds of thousands of dollars you’ve stolen from sick people with your rampant quackery.

  88. tgobbi says:

    Frank — Dr. Hall and SkepticalHealth ask some good questions and make some good points. Since my negative views of chiropractic and chiropractors are no secret, it may come as a surprise that I offer the following with respect – respect because you have obviously eschewed many, if not most, of the dubious aspects of the field. But please bear with me and respond to what I say.

    Dr. Hall asks if you adhere to the subluxation concept. Based on what you state vis-a-vis your practice I’d say there’s a pretty good chance that you don’t. If I’m right, good for you.

    I reiterate Dr. Hall’s concern about your stand on neck manipulations.

    Do you recommend and/or sell nutritional supplements? Do you give nutrition advice/counseling?

    Do you treat children? Do you feel that there is ever any excuse for DCs to treat them?

    What is your stand on immunization?

    Assuming your responses to my points are in keeping with what I’ve inferred from your post, I’d have to say that you’re not really a chiropractor. You may have a chiropractic degree but you don’t appear to practice in the manner that I’ve observed in the majority of your colleagues who are deeply mired in all the worst aspects of chiropractic. All but a very few of the DCs I’ve had contact with over the past 35 years (and there are MANY) adhere to the importance of the chiropractic sine qua non – the subluxation. Without that nonexistent entity a chiropractor, in my opinion, isn’t a chiropractor at all. I don’t know what he is, but subluxation defines chiropractic and you can’t have the latter without the former!

  89. BTW, you don’t have patients. You have clients that you systematically rip off.

  90. Hi, I’m an acupuncturist. One time someone got hit by a car, and their arm was bent 90′ in the wrong way and they were bleeding. A horrible doctor thought it was just a sprain, so I brought them to the ER. Therefore, acupuncture works.

  91. Frank Lanzisera says:

    Dr. Hall asked: 1. Is it possible that the very existence of the chiropractic option is delaying diagnosis and treatment of serious illnesses?

    Let me rephrase your loaded question Dr. Hall. Lets change it to: Is it possible that chiropractic treatment could delay the diagnosis and treatment of serious illness? Yes, this can happen. I have no idea to what extent. Now, I’m not being critical of MDs. I’ve worked side by side with MDs for the 30 years I’ve been in practice. That being said, I’ve seen MDs delay a proper dx in cases of a serious illness as noted above with the lady who fractured her odontoid and was left to walk around for two weeks before it was diagnosed. I’ve seen ER depts miss 8 cm AAAs. I’ve seen cases of sciatica treated by an orthopedic surgeon for over a month miss malignant spinal cord tumors. Then there was the 7 year old learning disabled girl who never had her thyroid labs tested. Did he miss a serious illness? Well, when I ran her TSH it was 150. Once she was placed on the appropriate dose of thyroid mx her learning scores improved etc. I am not faulting these docs, so please don’t take it that way. The point is there is plenty of blame to go around if we want to talk about delaying care. I hope you see my point. I’ll gladly answer another question if you answer one of mine. First I’d like you to knowI have no problem with the judicious use of medications. I never have told a patient to not take a mx. However since this site is all about evidence based medicine, could you please provide me with the indications for the pracitce of polypharmacy in a patient and the evidence based studies to support that practice? I’ve asked this question before of other medical practitioners, specifically pharmacists and have never been provided the evidence.

  92. Harriet Hall says:

    @Frank,

    ” indications for the pracitce of polypharmacy in a patient and the evidence based studies to support that practice”

    I already answered that question at http://www.sciencebasedmedicine.org/index.php/polypharmacyis-it-evidence-based/

  93. fxmed says:

    I can not believe how prejudiced and narrow-minded most of you people are—there is nothing wrong for some chiros wanting to be Primary physicians–I say some because some do not want to be PCP’s and some are not qualified either, but the same holds true for some MD’s and some Dentists etc.–but to say all are not qualified is pure horse shit—I am an MD and DC and I can tell you both camps are full of cretins–more is not better–quality is what counts and the old MD’s and old DC’s are guilty of extreme prejudice—-things that are vehemently opposed and contested go through a series of arguments and debates only to reach a stage of agreement and then that which is vehemently opposed is accepted.. You should heed what a great scientist once said—GREAT MINDS have always encountered GREAT OPPOSITION from MEDIOCRE MINDS!!! America and the world always opposed women’s rights as well as those of blacks and even other ethnic groups—but look at them now!

    R. Muccillo, MD, DC

    1. Harriet Hall says:

      @fxmed,

      Of course there is nothing wrong with chiros “wanting” to be PCPs. The question is whether they are “qualified” to be PCPs. They lack the practical education that MDs get in caring for sick patients in the hospital, not to speak of pharmacology and other matters. Regulators recognize this by not licensing MDs to practice without first undergoing a year of rigorous hands-on training in a hospital-based residency program.

      I have had many discussions with chiropractors over the years, and have not yet encountered a GREAT MIND among them. If you have, please name him or her so we can have a serious debate. I’m sure a GREAT MIND would not simply attack us as prejudiced and narrow-minded or bring up inappropriate comparisons with women’s rights and racial equality. He would instead present convincing evidence and rational arguments to support his position.

  94. nybgrus says:

    Besides the fact that I am highly skeptical that you hold both an MD and a DC, taking you are your word means you must have done mental gymnastics that would make Circque du Soleil look like a high school cheer squad.

    There is simply no possible way that the education a DC receives could train him/her for a role as PCP. Though you are right – there are some genuinely bad MD’s out there as well, and if your credentials are to be believed you might not be in the camp you wish to think yourself in.

  95. nybgrus says:

    Also, any chance you are located in Carlsbad, CA?

  96. Chris Repetsky says:

    Even if a Chiropractor decides they don’t believe in their profession’s central dogma, the subluxation, it’s my opinion that there truly isn’t anything Chiropractic can provide a patient that isn’t already offered by either a Physical Therapist or an MD/DO.

    Slightly on topic, SkepticalHealth: If you can get through more than 20 seconds of this Chiropractic video without your blood pressure spiking 40 points, then you’re a much stronger man than I! http://www.youtube.com/watch?v=R7vrGNaxIe0&feature=plcp

  97. tgobbi says:

    # fxmedon 19 Sep 2012 at 12:43 am
    “I can not believe how prejudiced and narrow-minded most of you people are…”

    Chiropractor Frank addressed us a few days ago in what I consider to be a polite, reasonable manor and I, for one, responded in kind.

    You, sir, have opted to take the opposite approach, clambering into our midst to tell us that we science oriented folk are full of shit. I shall utilize your own tactic in my response to you.

    Unlike nybgrus I’m not all that skeptical about the possibility that you hold a medical degree. Rather, my question is where that degree may have been obtained. Not, I imagine, at a first class medical school. Although it’s not totally beyond the realm of credibility I can’t believe that a graduate of a really good school could abandon whatever scientific healthcare views he may have been exposed to and replace them with belief in subluxation theory. Or do you maintain science alongside subluxation? That possibility boggles the mind! How can they both be right? This reminds me of a great scene in “Fiddler on the Roof” in which Tevye overhears two guys arguing. He agrees with both of them. Another chap pipes up with (paraphrased): “Tevye, Irv is right and Sid is right? How can they both be right?” “You know,” says Tevye. “You’re also right!”

    Citing the possibility of quacks among the ranks of physicians and dentists utilizes a logical fallacy (tu quoque, I believe). Of course there are quacks who hold MD and DDS degrees – but they’re the exception. At least they’ve been taught tenable theories of healthcare in their schools. But the entire field of chiropractic is based upon an UNtenable postulate. Not that any reasonable person believed in them before, but subluxations were conclusively demonstrated as false by Edmund Crelin in 1973. And besides, no credible evidence exists within chiropractic itself that there’s such a thing. I don’t claim that DCs aren’t taught other theories but the fact remains that your entire business is based on subluxations. It’s the chiropractic sine qua non! Without it there’s no such thing as chiropractic. Without it straights are totally negated and mixers are reduced to being naturopaths – which already constitutes more that half of what mixers do in the first place. Certainly selling vitamin pills and other supplements would strike ol’ D. D. Palmer as heresy. And maybe B. J. (the P. T. Barnum of woo) as well.

    Over the years I’ve (we’ve) been called narrow minded by legions of alternative providers. Do you not see the irony here? We’re the ones who’ve been challenging you to offer substantiation for your miscreant notions. I’ve had running battles with DCs who accuse me of narrow mindedness because I refuse to accept their claims on the basis of their beliefs. My mind is open; cite some valid studies that afford credence to any of the things you do as chiropractors. That’s all I ask. And when I ask it I’m reminded again and again that my mind is closed. It’s called circular arguing.

    Interesting that you use the word “cretin.” It’s one I’ve used many times myself, on this forum and the HF list. And doubtless elsewhere as well. But I’ve encountered many more cretins amongst the deizens of Mondo Chiropractico than I have in proper medical disciplines. In fact I’ve corresponded with, and met, a number I’ve referred to as cretinous semi-literates.

    That’s pretty much the end of my rant. For now, anyway. But before I sign off I’d request a justification for your bringing civil rights into the mix. If that ain’t a straw man argument I dunno what is…

  98. Scott says:

    Ironically, under the list of “MDs who are almost certainly quacks” are those who are also DCs. fxmed is his own best example.

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