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157 thoughts on “The DC as PCP? Revisited

  1. jhawk says:

    tgobbi,

    “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.”

    It seems from reading your posts that the majority of your contact with chiropractor’s is at health fairs. Is this the case? If so, I would argue this is probably a case of sampling bias on your part in that your sample (health fair chiro’s) is probably not generalizable to the chiropractic profession as a whole.

    “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!”

    This is not the case. Chiropractic was founded on manipulation and the subluxation came later as a reason to explain why manipulation worked. Also, the word subluxation suffers from many different meanings. At some schools all it means is that a joint is hypomobile and is in response to the non-existent evidence for any part of the the “subluxation complex”.

    Should a DC be able to act as a PCP? I would say no as our training is not set up for this.

  2. Harriet Hall says:

    @jhawk,

    “Chiropractic was founded on manipulation and the subluxation came later as a reason to explain why manipulation worked.”

    I beg to differ. Subluxation was not a post hoc explanation but was essential to Palmer’s very first treatment of a patient. He thought he felt a bone “out of place” in a patient’s spine and thought he had “put it back” with manipulation. From that observation of one patient he extrapolated to assert that all disease was caused by bones being out of place, 95% in the spine and 5% elsewhere. Only much later did some chiropractors try to redefine what they were doing.

  3. jhawk says:

    HH,

    I beg to differ with your differing!

    First manipulation by DD Palmer was in 1895. First use of the word subluxation was in 1906.

  4. Harriet Hall says:

    @jhawk,

    I beg to differ with your differing with my differing. Palmer may not have called it “subluxation” but he had the concept of a bone out of place when he treated his very first patient. The subluxation did not “come later as a reason.” The reason was there. The subluxation concept was there from the get-go even though the word itself may have come later. Rather than quibbling about definitions and dates, can’t we agree that the concept of the subluxation was integral to the origin and the very definition of chiropractic?

  5. tgobbi says:

    # jhawkon 19 Sep 2012 at 12:08 pm
    tgobbi,
    “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.”
    It seems from reading your posts that the majority of your contact with chiropractor’s is at health fairs. Is this the case? If so, I would argue this is probably a case of sampling bias on your part in that your sample (health fair chiro’s) is probably not generalizable to the chiropractic profession as a whole.

    Certainly not. I’ve met (personally) or encountered (via various media) a huge sampling of DCs – including a few who have abrogated the pseudoscientific baggage of your business and concentrated on simple musculoskeletal conditions. My bone of contention with them, of course, is that they’re no longer chiropractors – or practicing as such even though they claim to utilize chiropractic manipulations. (Not adjustments, as these appear to be directed at correcting subluxations). My encounters with all these DCs of diverse stripes have occurred at health fairs; via newspaper ads and newspaper and TV articles endorsing them; their websites; their letters and posts to a multitude of forums (including one who had a letter to the editor of “Skeptical Inquirer”); direct marketing (in the form of telephone and mail solicitations); references from friends to dubious claims. In addition I frequently and randomly stop my car at chiropractic offices and pick up the tracts they stock on their shelves (Koren, et al) – the ones that remind me of the religious tracts I see little old ladies lip reading on public transportation. No doubt I’ve omitted a few of the ways I meet DCs but this is a fair sampling. No sampling bias.

    “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!”
    This is not the case. Chiropractic was founded on manipulation and the subluxation came later as a reason to explain why manipulation worked. Also, the word subluxation suffers from many different meanings. At some schools all it means is that a joint is hypomobile and is in response to the non-existent evidence for any part of the the “subluxation complex”.

    NONSENSE! (And I use this polite term in lieu of the word that really crosses my mind)…

    The genesis of the subluxation can be traced back to ol’ D. D. “curing” Mr. Lillard of deafness and crying “EUREKA! I have discovered the cause of all disease!” He may not have plagiarized the term itself at the outset but subluxation it soon became.

    While I’m on the topic of the origin of chiropractic, jayhawk, perhaps you might deign to answer a question I’ve posed to myriad DCs without ever (EVER) receiving a definitive (or any other kind) of answer: has there ever been a duplication of what that first adjustment was purported to have accomplished – curing a deaf person of his affliction? Do DCs today treat or address deafness? I’ve mentioned before, possibly on this forum, an old-timer DC, who claimed he decided to go into the business himself because his “daddy” [his word] was cured of blindness by a chiropractor back in the 20s. The only other example of claims of treating vision problems I’ve ever come across was in an ad for “There’s A New Doctor (DC, of course) In Town.” Among other preposterous conditions the “New Doctor” claimed to treat was “fuzzy vision.” Oh, yes, there’s an irony in this tale. This particular doctor had just opened an office in the very location my own business had previously occupied. I had a good laugh at that…

  6. Calli Arcale says:

    fxmed:

    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.

    I know some dentists do aspire to be PCPs, but I would run a mile from any of them, and then send a letter to their licensing board. Dentists are no more qualified as PCPs than chiropractors are, even if their field is better regulated with more thorough training being required. They are qualified to work on teeth and some diseases of the mouth and jaw structures; they are not qualified to treat other conditions. Would you see them for whooping cough or a suspected bladder infection? I sincerely hope not.

    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.

    Things that are accepted are often vehemently opposed first; this is a necessary process. They must prove themselves before they are accepted. However, most things which are vehemently opposed are actually never widely accepted. Example: mainstream reproductive medicine vehemently opposes implanting eight embryos at one time, as was done with the Octomom. Occasionally, some hack goes and does it anyway. By your logic, that practice would eventually be accepted, which is a pretty ridiculous claim. Far more opposed claims are ultimately rejected than accepted.

    Or, to put it another way, as Robert Parks did, “It is not enough to wear the mantle of Galileo: that you be persecuted by an unkind establishment. You must also be right.”

    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!

    Yes, they’re still oppressed. Just not as much, and now they have legal protections. That you are unaware of that is no surprise, given that you are also unaware of how ridiculous it is to compare not being able to practice outside of your field of expertise to the systematic abuses that, for instance, blacks have suffered in the United States. Were chiropractors ever systematically lynched when a white girl claimed that she’d become pregnant and claimed a chiropractor did it? Have chiropractors ever been denied the right to own property? Have chiropractors ever *been* property? (Both blacks and women of all ethnicities have.) Have chiropractors been denied the vote at any time, purely for being chiropractors? Have chiropractors been denied jobs or the right to rent an apartment because of their profession? Have chiropractors had their children taken away from them because the law declares the children belong to either their husband or their owner?

    To even make this comparison, sir, betrays an enormous persecution complex as well as a staggeringly inflated sense of your own self-importance. I wouldn’t even want you to give me a massage; I don’t think I could trust you even that far with an ego that size. God forbid I ask you to diagnose anything trickier.

  7. nybgrus says:

    as a side note:

    I know some dentists do aspire to be PCPs, but I would run a mile from any of them, and then send a letter to their licensing board. Dentists are no more qualified as PCPs than chiropractors are, even if their field is better regulated with more thorough training being required.

    Merely to quibble a bit, but also to defend dentists, I beg to differ. I agree that their training does not allow them to be PCPs – and certainly none but the nutters would think otherwise themselves. However, they are actually trained in science based medicine including (but not limited to) anatomy, neuroanatomy, neurology, pharmacology, pathology, and histology. Ergo, I posit that they would be vastly more qualified to act as a PCP than a chiropractor would and certainly require a significantly smaller learning curve to get up to speed.

  8. @nybgrus,

    I think you are right about R. Muccillo. I did some Google-ing, and found his name as thisL

    Richard Muccillo, DC, NMD, Carlsbad, CA

    HE FORGOT THE N! He’s a NATUROPATHIC goober! Not a MD, he’s a NMD, which is some variation of the fake naturopathic people’s way of convincing the public they are some sort of medical practitioner. By the way, his name was on the “Fluoride Action Network” list – LOL.

  9. nybgrus says:

    SH: Indeed. That would explain the lack of brain melting cognitive dissonance. I also find it interesting how in the pages referencing chiros they are called and call themselves “chiropractic specialists.” It is a clear gambit to try and make people think that they are doctors with a specialty in chiropractic… which is clearly false.

  10. Chris Repetsky says:

    I always loved when they call themselves “Chiropractic Neurologists”. If subluxations are the answer to all your medical woes, what extra services does a Chiropractic Neurologist offer? SUPER subluxation removal?

    All your nerve interference issues ironed out in 30 minutes or less, or it’s free!

  11. tgobbi says:

    # Chris Repetskyon 19 Sep 2012 at 6:19 pm
    “I always loved when they call themselves “Chiropractic Neurologists”. If subluxations are the answer to all your medical woes, what extra services does a Chiropractic Neurologist offer? SUPER subluxation removal?”

    Correction of subluxations is only the answer to ALL woes if you’re a straight. For mixers, it’s a combination of getting rid of those pesky subluxations AND selling vitamin pills. Oh, and removing white flour, sugar, all refined and processed foods from the diet. Artificial sweeteners too.

  12. jhawk says:

    HH,

    “Rather than quibbling about definitions and dates, can’t we agree that the concept of the subluxation was integral to the origin and the very definition of chiropractic?”

    Yes it was improtant but not as important today. Manipulation is now more integral than the “subluxation complex”.

    tgobbi,

    ” has there ever been a duplication of what that first adjustment was purported to have accomplished – curing a deaf person of his affliction?”

    Not that I am aware of.

    “Do DCs today treat or address deafness?”

    No and if you find one that does you should report him/her to their respective board.

  13. tgobbi says:

    # jhawkon 19 Sep 2012 at 7:31 pm

    tgobbi,
    ” has there ever been a duplication of what that first adjustment was purported to have accomplished – curing a deaf person of his affliction?”
    Not that I am aware of.
    “Do DCs today treat or address deafness?”
    No and if you find one that does you should report him/her to their respective board.

    Which raises the question: then how can an entire healthcare industry which is based on this delusive event even exist 117 years ex post facto??? To borrow from Winston Churchill: “It’s an enigma, wrapped in a riddle, surrounded by mystery.”

  14. @jhawk, how can someone report a chiropractor their licensing board when the chiropractor licensing boards in fact require one to learn quackery to pass them? And I mean besides the fact that the entire practice of chiropractic is quackery. Pure, unadulterated, quackery.

  15. jhawk says:

    tgobbi,

    “Which raises the question: then how can an entire healthcare industry which is based on this delusive event even exist 117 years ex post facto???”

    It was partially based on this 117 years ago. Not so for many schools today.

    SH,

    “how can someone report a chiropractor their licensing board when the chiropractor licensing boards in fact require one to learn quackery to pass them?”

    Much of the quackery you speak of is noted in a historical context and is a small percentage (if any) of these exams.

  16. tgobbi says:

    jhawk, you state that chiropractic was partially based on subluxation originally. Perhaps you’ll be kind enough to clue me in on the other parts. If you’re right, I guess means that all the books and reports I’ve ever read on the subject are missing something.

    Could be true that “Much of the quackery [SH] speak[s] of is noted in historical context…” On the other hand, anyone who spends even a little bit of time observing the real world of chiropractic can see that the business is based almost entirely on demonstrably false concepts and practices. For you and other DCs to claim otherwise is an insult to our intelligence.

    ***

    And my thanks to Dr. Hall for calling our attention to those examples of chiropractic deafness quackery.

  17. @jhawk,

    Pretty weak attempt at defending your quack profession :)

    I honestly don’t know how you guys sleep at night. I lose sleep if I miss the smallest finding (and I do miss things, nobody is perfect), or if I feel like I kept a patient out of the loop, or even when it’s not my fault, but they are screwed over by “the system” (their insurance company, home health, etc.) I honestly can’t imagine a world where I practiced quackery 24/7 and consistently ripped sick people off by lying to them. I just don’t know how you live with yourself. I’m honestly convinced that CAM practitioners don’t have a conscious. There’s just no other way you people can live with yourself without tossing your useless body and zero-sum “skill-set” out the window.

  18. jhawk says:

    HH,

    The first and fifth link are to case studies. You have a problem with people writing up case studies/series. Many of them clearly state that causation can not be proven. The fourth link is a lay person writing about his experiences.

    I agree 2, 3 and 6 are crazy.

    tgobbi,

    “jhawk, you state that chiropractic was partially based on subluxation originally. Perhaps you’ll be kind enough to clue me in on the other parts. If you’re right, I guess means that all the books and reports I’ve ever read on the subject are missing something.”

    I already mentioned this…..manipulation.

    “On the other hand, anyone who spends even a little bit of time observing the real world of chiropractic can see that the business is based almost entirely on demonstrably false concepts and practices. For you and other DCs to claim otherwise is an insult to our intelligence.”

    I am not saying these practices do not occur but they are dwindling IMO.

    SH,

    ” I lose sleep if I miss the smallest finding (and I do miss things, nobody is perfect), or if I feel like I kept a patient out of the loop, or even when it’s not my fault, but they are screwed over by “the system” (their insurance company, home health, etc.)”

    Same here but I probably lose less sleep as the vast majority of conditions I see are not life threatening.

    “I honestly can’t imagine a world where I practiced quackery 24/7 and consistently ripped sick people off by lying to them. I just don’t know how you live with yourself.”

    That’s easy, I don’t practice quackery, rip people off or I don’t lie to patients.

  19. … or living a life in constant denial.

  20. nybgrus says:

    Much of the quackery you speak of is noted in a historical context and is a small percentage (if any) of these exams.

    I spent quite a bit of time on one of the threads here demonstrating quite clearly that the chiropractic boards do, in fact, test the concept of subluxation and this this testing is most certainly not a question of “historical context” but very much in the “subluxation-as-the-root-of-all-disease” context.

    And I also pointed out that it cannot make sense for a practice that is not quackery to have a board exam which tests on quackery, regardless of how small a percentage it is.

    And I pointed out that it is ridiculous for a board exam to test on “historical concepts” when there is (or at least should be) so much to test that there can’t possibly be room for it. Do you think I had to prepare to be tested on the story of Semmelwiess or Snow or Koch or even Pasteur for my boards? Bollocks. I needed to know the principles they discovered and apply them to much higher order levels of thinking.

    Jayhawk, I’ll be honest that you strike me as one of the “reasonable” chiros, who doesn’t actually ascribe to the quackery of your profession and limit yourself to more physical therapy and massage sort of care. But you really should stop being so obsequious to the boards you’ve passed that you refuse to realize and admit just how much quackery there is – from top to bottom and to the core. It truly is not an isolated fringe. There has been a truly ridiculous amount of evidence – both from the authors here, as well as the commenters, including my own work which honestly may as well have amounted to a few Gorski-ian posts of their own – demonstrating quite clearly that the schools, the board exams, the boards themselves, and the professional assocations all at their core espouse and in fact demand quackery remain integral to chiropractic.

    The bigger problem for you is that your denial makes you incapable of recognizing good from bad evidence on which to practice in a manner most likely to actually help people. And it also prevents you from being an activist to reform your profession – which you truly should do. Unlike some others here, I don’t say this to be mean spirited but quite sincerely wish you to realize the mire in which you are in and thus do something about it. I know it is hard to do, but if lifelong preachers can do it through the clergy project, then so can you within your “profession.” And if you do, along with many others, there may be a day when I can remove the quotation marks. The osteopaths managed to do it, but it took work and a genuine move towards science and abandoning wholesale the quackery from whence they came.

  21. Calli Arcale says:

    nybgrus:

    Merely to quibble a bit, but also to defend dentists, I beg to differ. I agree that their training does not allow them to be PCPs – and certainly none but the nutters would think otherwise themselves. However, they are actually trained in science based medicine including (but not limited to) anatomy, neuroanatomy, neurology, pharmacology, pathology, and histology.

    I did say that they’re better trained that chiros, and agree that they’re closer — but lord almighty, have you seen the *woo* that permeates dentistry? That’s what struck me about his choice of dentists in his comparison. There are dentists who seem to think they’ve got a panacea on their hands. They have a hammer, which makes every problem look like a nail, and by god, they’re gonna pound those problems. The ones who say that your chronic fatigue is caused by your mercury fillings are just the tip of the iceberg. There’s some serious crazy there, and a lot of dental boards seem powerless to put a stop to it.

  22. Calli Arcale says:

    BTW, I don’t mean to smear all dentists. It’s a fabulous profession, and I’ve actually never met a dentist I didn’t like and trust absolutely to take care of my teeth. They also tend to have a fantastic bedside manner, cultivated because of course it’s the field most likely to have to deal with terrified patients in a lot of pain. But their fine and excellent reputation really takes a beating from the weirdos.

  23. jhawk says:

    tgobbi,

    I have a couple questions about your sampling of chiro’s. What region/state/country/province is most of your sampling from? What is the average age of your sample?

    nybgrus,

    “I spent quite a bit of time on one of the threads here demonstrating quite clearly that the chiropractic boards do, in fact, test the concept of subluxation and this this testing is most certainly not a question of “historical context” but very much in the “subluxation-as-the-root-of-all-disease” context.”

    I think I was a part of this conversation. My calculation of “subluxation-as-the-root-of-all-disease” came out to be around 3%. So yes, you are correct in saying that the boards test on this matter. I was trying to point out that it is not a major portion of the exams.

    “And I also pointed out that it cannot make sense for a practice that is not quackery to have a board exam which tests on quackery, regardless of how small a percentage it is.”

    I agree that this should not be tested on at all but I disagree with your point. Some schools are teaching and placing this issue in a historical context so no matter what the test question the student is able (or should be able!) to place it in a historical context.

    “And I pointed out that it is ridiculous for a board exam to test on “historical concepts” when there is (or at least should be) so much to test that there can’t possibly be room for it. Do you think I had to prepare to be tested on the story of Semmelwiess or Snow or Koch or even Pasteur for my boards? Bollocks. I needed to know the principles they discovered and apply them to much higher order levels of thinking.”

    I agree but I don’t think we should be comparing the DC board exams to the MD board exams.

    “Jayhawk, I’ll be honest that you strike me as one of the “reasonable” chiros, who doesn’t actually ascribe to the quackery of your profession and limit yourself to more physical therapy and massage sort of care.”

    I appreciate your honesty.

    “But you really should stop being so obsequious to the boards you’ve passed that you refuse to realize and admit just how much quackery there is – from top to bottom and to the core.”

    There really is not that much quackery on the board exams. Part 1 is all basic science and includes general anatomy, spinal anatomy, physiology, chemistry, pathology and microbiology. Part 2 consists of general dx, nms dx, diagnostic imaging, principles of chiropractic (the portion of quackery you speak of), chiropractic practice and clinical sciences. Part 3 includes case hx, physical exam, nms exam, diagnostic imaging, lab and special studies, dx or clinical impression, chiro techniques (this is biomechanics, contraindications to care and adjusting technique) , supportive interventions and case management. Part 4 is a practical exam with x-ray interp and dx, chiropractic technique and case management. Out of all of this, we have one section (principles of chiropractic) that has some quackery in it which amounts to ~3% of the boards( and this is if we assume this whole section is quackery). I think this 3% is still to much but I think you are grossly overstating how much of the board exams are quackery.

    “It truly is not an isolated fringe. There has been a truly ridiculous amount of evidence – both from the authors here, as well as the commenters, including my own work which honestly may as well have amounted to a few Gorski-ian posts of their own – demonstrating quite clearly that the schools, the board exams, the boards themselves, and the professional assocations all at their core espouse and in fact demand quackery remain integral to chiropractic.”

    I agree that the boards themselves and many professional associations do espouse quackery as well as many of the schools. I disagree with you on the board exams (see above). I also disagree with you that all schools are drenched in quackery, mine most certainly was not. I have also seen changes happening at the shcools as of recently with additions of evidence based practice classes and research teams as well as some of the old school vetebral subluxation types retiring or being ousted. An anecdote, I spoke with 3 diferent recent Palmer (a school most noted for quackery) grads on seperate occasions earlier this year and each one told me that the quackery being taught was dwindling and only came from a certain subset of higher ups and that about 1/3 of the sudent body followed this mantra. 1/3 is a huge freakin number but I would imagine 10 years ago this number would have been significantly higher.

    “The bigger problem for you is that your denial makes you incapable of recognizing good from bad evidence on which to practice in a manner most likely to actually help people. And it also prevents you from being an activist to reform your profession – which you truly should do.”

    I am not in denial and understand the severity of the problems within the profession. Many of my colleagues wish we had a different title than chiropractor so as to distance ourselves from these problems. Some of my colleagues and I have managed to do this in our community but it needs to happen on a larger scale.

    “Unlike some others here, I don’t say this to be mean spirited but quite sincerely wish you to realize the mire in which you are in and thus do something about it. I know it is hard to do, but if lifelong preachers can do it through the clergy project, then so can you within your “profession.” And if you do, along with many others, there may be a day when I can remove the quotation marks. The osteopaths managed to do it, but it took work and a genuine move towards science and abandoning wholesale the quackery from whence they came.”

    I think I understand the mire the profession is in, but I probably don’t do a good job of explaining it on this site as there really is a lot of misinformation about chiropractic being spread here (not so much in the posts but in the comments). You are right, there is a lot of work needed to be done (if it can be done at all) for the profession as a whole to lose those quotation marks.

  24. tgobbi says:

    # jhawkon 20 Sep 2012 at 2:13 pm
    “tgobbi,
    I have a couple questions about your sampling of chiro’s. What region/state/country/province is most of your sampling from?”

    Most of the in-person sampling comes from my home area – Chicago’s north suburbs. As for the indirect sampling (now mostly emails rather than USPS) it’s national. I believe I mentioned yesterday how I encounter my correspondents.

    “What is the average age of your sample?”

    That’s a toughie! I have no way of determining the ages of those I don’t meet face-to-face and I don’t think I could strike an average for those I meet personally. By and large I’d say they’re on the younger side, 40s and under. Sorry I can’t be more specific. There’s one right around the corner from my home who says he’s been at it for 35 years so obviously he’s older.

    Now I hope you’ll be kind enough to answer a few questions about your own practice and philosophy. These are legitimate questions I pose to all DCs I have contact with; most refuse to respond – and I’m quite sure I know why. I reiterate, however, that I consider them appropriate and reasonable and that they should be answered (and answerable) by anyone who purports to be a healthcare professional.

    • Do you subscribe, to any extent whatsoever, to the verisimilitude of the chiropractic subluxation?

    • What is your stand vis-a-vis immunization? There are three possible answers: I believe vaccination is necessary; I am against vaccinations; I leave it up to my individual clients (with or without expressing my opinion).

    • Do you consider yourself qualified as a nutrition counsellor/practitioner? If so, do you sell or recommend supplements?

    • Are there any conditions under which it’s appropriate for children (say under the age of 16) to be subjected to chiropractic care?

    • Are any of the chiropractic specialties/subspecialties (pediatrics, neurology, NUCCA, etc.) legitimate and/or necessary?

    • Do you employ any neck adjustments and, if so, are you aware of the potential danger of chiropractic-induced stroke?

    • Do you take x-rays (specifically full-back images)?

    • How would you define your scope of practice (yours, specifically, not that of chiropractic in general)?

    • In what general area of the country do you practice? (I’m assuming that you’re located in the U.S. If not, what country are you in)?

    I thank you in advance for your answers.

  25. Jann Bellamy says:

    @ jhawk:

    I don’t know if you are aware of it or not, but subluxation detection and correction is how chiropractic is defined (in one way or another) in all the 50 state chiropractic practice acts. If chiropractic is to change, rewriting all the practice acts would be a necessary part of that change. I’m curious: If you had an opportunity to redraft the practice acts, how would you describe the scope of practice?

  26. jhawk says:

    tgobbi,

    Thank you for answering my questions. It seems you have more than I do! I think I have answered most of these questions on this SBM before but I will again.

    “Do you subscribe, to any extent whatsoever, to the verisimilitude of the chiropractic subluxation?”

    no, all that word means to me is a hypomobile/restricted joint and of course the medical definition of partial or incomplete dislocation. I try to steer clear from using said terminology.

    • What is your stand vis-a-vis immunization? There are three possible answers: I believe vaccination is necessary; I am against vaccinations; I leave it up to my individual clients (with or without expressing my opinion).

    I believe vaccination is necessary. I would never discuss vaccination with a pt as it is out of my area of expertise.

    • Do you consider yourself qualified as a nutrition counsellor/practitioner? If so, do you sell or recommend supplements?

    no I do not sell supplements but have recommended glucosamine and chondroitin sulfate on occasion. I would say with my undergrad chemistry background and nutrition courses I have taken that I more qualified than a lay person to discuss nutrition but not as qualified as an RD. With that said I hardly ever discuss nutrition unless directly asked or think it might be contibuting the patients msk issue.

    • Are there any conditions under which it’s appropriate for children (say under the age of 16) to be subjected to chiropractic care?

    Yes. any number of msk issues……….sprain/strain, shin splints, plantar fasciitis, lateral/medial epicondylitis, rotator cuff syndrome, etc.

    • Are any of the chiropractic specialties/subspecialties (pediatrics, neurology, NUCCA, etc.) legitimate and/or necessary?

    I think the radiology residency is the most highly regarded and respected. I would say a definite no to NUCCA but I honestly don’t know much about the rest of the specialty programs.

    • Do you employ any neck adjustments and, if so, are you aware of the potential danger of chiropractic-induced stroke?

    I am aware of the potential danger and we were required in school to PARQ this with each new patient as well as get signed informed consent. I rarely use neck manipulation. In the cases I do use cx manipulation the patients have been no responsive to a myriad of other treatments.

    • Do you take x-rays (specifically full-back images)?

    I send out for imaging mostly after an acute injury or non responsive to tx (obviously this is very patient specific) . No I do not order full spine imaging.

    • How would you define your scope of practice (yours, specifically, not that of chiropractic in general)?

    My scope is musculoskeletal pain and injuries.

    • In what general area of the country do you practice? (I’m assuming that you’re located in the U.S. If not, what country are you in)?

    West Coast.

  27. Jann Bellamy says:

    @jhawk:

    I think you mentioned that you got your D.C. degree at Western States. You might be interested in knowing that two chiropractic college presidents spoke in favor of the New Mexico bill I wrote about in this post, which would have greatly expanded chiropractic prescription privileges and gotten rid of medical and pharmacy board oversight of the formulary. They were, according to “Chiropractic Choice,” an ICA publication, Joseph Brimhall, of Western States, and James Winderstein of National Univ. of Health Sciences. I believe some of the subluxation removal (if you will) in chiropractic is guided by those who want chiropractors to become PCPS. I wrote about this in the original DC as PCP? post. (link in this post)

  28. Harriet Hall says:

    @jhawk,

    Would you mind sharing with us how you treat children with a couple of the conditions you mentioned, say shin splints and lateral epicondylitis? Do you think chiropractic care is equivalent or superior to medical care for those conditions?

  29. tgobbi says:

    # jhawkon 20 Sep 2012 at 5:13 pm
    “tgobbi,
    Thank you for answering my questions. It seems you have more than I do! I think I have answered most of these questions on this SBM before but I will again.”

    And I thank you for answering mine. Your candor is appreciated and unusual.

    The last time I asked a DC about his views on vaccination was at a lecture he presented a few months ago. He refused to answer which made me feel he had something to hide. By the time I confronted him, of course, he knew that I was a skeptic and made a point of letting me know that my presence was unwelcome.

    Just in case you’re interested in knowing what his presentation (the topic was “heart health”) included here are some of the major claims, all of which were easily rebutted:

    • Grain-fed meat is bad for you and grass-fed is good for you.

    • Sugar causes inflammation. (Of what? He didn’t specify).

    • Acidity causes cancer. (I contacted Dr. Sampson about this and he supplied me with a long explanation that included a detailed description of what the DC is full of)…

    • The Gerson diet is effective in treating/curing cancer and other diseases. (For anyone unfamiliar with this discipline, be assured that it was fully discredited decades ago).

    When I asked this wannabe cardiologist if he’s familiar with the scientific method he was totally in the dark about the concept. I’ve confronted other DCs with the same question and I can’t recall any of them who understood what it’s all about.

  30. tgobbi says:

    Jann mentions James Winterstein (not Winderstein) of National University of Health Sciences (formerly National Chiropractic College). A number of people have pointed out to me that National is the most scientifically oriented of the chiro schools. In response I cite the following curricula from their website: they offer classes (perhaps degrees?) in chiropractic “medicine;” naturopathic “medicine;” oriental “medicine;” and acupuncture! If this represents the most scientific school of the bunch, please spare me from learning what’s taught in the less scientific ones…

  31. Scott says:

    @ tgobbi:

    To be fair, a lot of MD programs are being infiltrated by nonsense too. “Quackademic medicine,” as Dr. Gorski puts it.

    Of course, “infiltrated by nonsense” and “based on nonsense” are different things. Nevertheless, the presence of acupuncture classes isn’t a good argument to illustrate differences between DCs and MDs.

  32. tgobbi says:

    # Scotton 21 Sep 2012 at 9:03 am
    @ tgobbi:
    “To be fair, a lot of MD programs are being infiltrated by nonsense too. “Quackademic medicine,” as Dr. Gorski puts it.
    Of course, “infiltrated by nonsense” and “based on nonsense” are different things. Nevertheless, the presence of acupuncture classes isn’t a good argument to illustrate differences between DCs and MDs.”

    Point conceded.

    But my point was accentuate the irony of describing National University of Health Sciences as the most scientific among the chiro schools.

  33. jhawk says:

    Jann,

    ” I’m curious: If you had an opportunity to redraft the practice acts, how would you describe the scope of practice?’

    portal of entry musculoskeletal provider.

    “I think you mentioned that you got your D.C. degree at Western States. You might be interested in knowing that two chiropractic college presidents spoke in favor of the New Mexico bill I wrote about in this post, which would have greatly expanded chiropractic prescription privileges and gotten rid of medical and pharmacy board oversight of the formulary. They were, according to “Chiropractic Choice,” an ICA publication, Joseph Brimhall, of Western States, and James Winderstein of National Univ. of Health Sciences. I believe some of the subluxation removal (if you will) in chiropractic is guided by those who want chiropractors to become PCPS. I wrote about this in the original DC as PCP? post. (link in this post)”

    Yes I did get my degree from Western States. I would say that is my major gripe with UWS, pushing the DC as PCP. Interestingly, only a very select few students who attend (at least when I was there) would want to act as a PCP and I would imagine once graduated realize they are not prepared for that role. The vast majority of the students want to be msk providers. With that said, UWS is a pretty rigorous program and I think could possibly be a bridge to PCP if many more hours of pharmacology were added as well as hospital rotations and a residency program. I don’t think this can happen though with UWS offering the same degree as some of “subluxation complex” schools. In 1994 UWS was trying to implement a DCM (doctor of chirorpactic medicine) degree to distance from the other schools. I don’t know the details but it never happened. I don’t think these additions (residency, etc.) are needed for the portal of entry msk provider though.

    HH,

    Would you mind sharing with us how you treat children with a couple of the conditions you mentioned, say shin splints and lateral epicondylitis?

    shin splints treatment is a tough question to answer with out history and exam. I need to know what type of load is being placed on the patients tissues and if the shin splints are a compensation for decreased ROM, a standing pronated foot, overpronation with gait, bad shoes, a hip problem, etc. With that said, a majority of the time the treatment comes to myofascial release and therapeutic exercise and joint mobilization.

    lateral epicondylitis is a little easier to answer but I still need to try and figure out why the patients tissue is being overloaded. As an example maybe the pt is flipping papers at work in way that is placing excessive load on her wrist extensors and needs to be changed. Again though, a majority of the time the treatment comes to myofascial release and therapeutic exercise and joint mobilization.

    Do you think chiropractic care is equivalent or superior to medical care for those conditions?

    That depends on the medical care and chiropractic care that is received!

    tgobbi,

    I am suprised you have not been able to get a DC to answer your questions that you posed.

    scott,

    beat me to it!

    1. Harriet Hall says:

      @jhawk,

      So it sounds like you are not providing chiropractic care to children but are providing conventional medical care under a chiropractic license. I wonder if that is even strictly legal: you are licensed to practice “chiropractic” but are doing something else. I would have no problem with what you are doing if only you stopped calling yourself a chiropractor and made it clear to your patients and everyone else that you are not practicing “chiropractic.”

      Obviously we need new laws and new names for people like you. Rather than putting all chiropractors out of a job, I would support creating a new profession that put their training and expertise to use in a new form and that was strictly regulated to eliminate all the nonsense like anti-vaccine stances and applied kinesiology.

  34. nybgrus says:

    I tend to agree with Dr. Hall here. However, I really don’t know that state of evidence for myofascial release as a therapy. In my quick search I did not come up with much, except for the notions of “rolfing” (which just sounds wrong) which is typically considered debunked. I have not vested the time in doing a detailed review myself (simply because I really don’t have the time and am procrastinating as is) so I am curious as to what the evidence for MFR actually is. JHawk – could you supply the resources you use to determine how and when to apply MFR as well as the efficacy of it?

  35. Harriet Hall says:

    Whatever myofascial release is, it isn’t chiropractic.

  36. rwk says:

    Dr Hall,
    Of course chiropractors provide conventional medical care depending on who is the DC or what they are treating.
    The scope of practice in Illinois for example, says a DC can technically do anything but prescribe drugs and surgery.
    They can recommend OTC medications to a patient. It’s been that way since at least 1987.

    Even though many of the SBM posters berate using Google to “research” medical topics, it seems that’s where most people here do their research about chiropractic. They look something up and think they can become experts on topics over people that have been involved in the profession for years and actually going through the coursework.
    How would you like it( or should I say tolerate) if lay “researchers” like kurt youngmann ( tgobbi) acted as if they knew more about medicine than yourself?

    Mennell and Cyriax came after Still and Palmer, so were they practicing chiropractic? And even though the word
    subluxation is forever tarnished it’s been around longer than Palmer and not as it appears in today’s medical dictionary.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2565620/
    SBM participants should read this for perspective.

    If chiropractors should change their name, then so should osteopaths. The former is a better description.

  37. Quill says:

    Dr. Hall wrote:

    “Rather than putting all chiropractors out of a job, I would support creating a new profession that put their training and expertise to use in a new form and that was strictly regulated to eliminate all the nonsense….”

    I understand that many well trained, heavy-with-expertise phrenologists went on to become excellent milliners and hatters.

  38. nybgrus says:

    We are not discussing the etymology of a word in a vacuum but the specific usage as a descriptor of the pathogenesis of disease, especially disease having nothing to do with disruption of joints. That is what chiropractic means by subluxation and the origin of the profession. Nobody has claimed that Palmer invented the world wholesale, but that he invented that specific usage of the word and the specific foundational context of chiropractic.

    And my research – as well as that of the author’s here – was not “google” but down to primary sources including course catalogs of DC schools, official releases of chiro board information, professional association’s official positions, and the official requirements for accreditation of said DC schools. So yes, that is actually rather authoritative when trying to describe the whole of a “profession.” If someone wished to describe MY profession, looking at statement by my professional bodies, official curricula of medical schools, content of the USMLE’s, and accreditation requirements would also be a fair way to characterize it. And save for the infilitration of CAM – which we here oppose quite vocally – there is no institutionalized quackery to be spoken of. And that is the difference – chiropractic begins with quackery as the basis and adds in some actual therapy with fringes like JHawk who are mostly science based, whereas actual medicine begins with solid foundations in science and evidence and CAM weasels its way in with fringes like Mehmet Oz and Andrew Weil who are mostly quackery based.

  39. Harriet Hall says:

    By rwk’s reasoning, no one who has not jumped out of a plane without a parachute is qualified to comment on the utility of parachutes.

  40. Janet Camp says:

    Egad! I have been reading through all this for hours! Fascinating stuff.

    @SkepticalHealth

    I have at times scolded you for some of your brashness (mostly when you get a bit “salty”), but you have had me riveted today and I will repeat my usual compliment to your honesty and plain speaking. I hope I get you if I’m ever that sick–or the budding Dr. Nybgrus (what DOES that screen name mean?).

    @jhawk

    I wonder what you had to do to get into chiropractic college (academically) and wonder if you ever considered physical therapy as a career?

    I truly think you mean well, but even if tgobbi’s surveys aren’t completely scientific, I’m with him (?). The chiropractors who are visible to the public are widely advertising all sorts of quackery in addition to whatever manipulation they perform. Around here (the midwest, no less, and not Chicago) they mostly do “wellness” which means you come every week for the rest of your life for “wellness” adjustments. I have a lot of respect for your willingness to participate in this discussion, but I have to say to you what I said to another poster, an acupuncturist who has a similar story in that he claimed to only treat a few things and make many referrals to real doctors: Why not go get that additional training and be a real health care provider?

    @CalliArcale

    I absolutely agree with you about dentists! I would sooner ask one about a bladder infection than a chiro, but you have to be careful because there are a lot of altie dentists around who want to yank out all your mercury fillings (at great expense) and the ADA doesn’t seem to be doing much about it–or any other regulatory body.

    There’s more, but it’s getting late in the game to keep posting on this topic, but thanks to you all for a great afternoon read! I am thinking about printing it out and leaving it where a certain person whose daughter just graduated from Palmer will have to see it. I know that sounds kind of mean-spirited, but this person is a nurse (LPN, actually) and is enormously proud of the daughter. I don’t have the guts to ask her if she is proud of her achieving a goal (commendable) or proud of her becoming a quack, but I’m finding it difficult now to have conversations with her or take her seriously as part of my medical provider team.

    One note to tgobbi:

    I do think grass fed meat is more healthful than grain fed–the animals are leaner, no? It is certainly better for the animals I would argue.

  41. nybgrus says:

    Well then, I suppose I am qualified to comment. Parachutes are wonderfully useful and allowed me to leap from 13,000 feet with no ill effects. Glad I wasn’t in the control arm of that experiment though.

    @Janet Camp: Thank you for the compliment, with all sincerity. I consider that to be nearly the highest compliment I can possibly be paid and it is certainly nice to hear (read) it from time to time.

    As for what my screen name means…. at the time the internet first came about and I got my first ever screen name back in 1995ish, I couldn’t figure out what to get. At the time my sister, with whom I am very close, was living in far off New York City and since I was born in Bulgaria to a Bulgarian mother and a Russian father, I concoted the abbreviated New York Bulgaria Russia or NYBgRus – though I don’t bother with the capitalization these days. I keep it because it is a ‘nym that is never taken and I always remember.

    Hopefully my HTML tags worked out….

  42. tgobbi says:

    # rwkon 21 Sep 2012 at 2:32 pm

    “How would you like it( or should I say tolerate) if lay “researchers” like kurt youngmann ( tgobbi) acted as if they knew more about medicine than yourself?”

    You can make all the deprecatory, dismissive remarks you want to but the fact remains that I know a helluva lot more about chiropractic than you think I do – or are comfortable with. Snide and superficial criticism directed at my informed disdain for your industry have been a part of my life for more than 3 decades and have not lessened my anti-chiropractic enthusiasm. I can, as they say, live with it!

    And don’t delude yourself into thinking that my research is based on Google; if you think that you’re entirely wrong. Perhaps you’re unaware of the huge amount of critical material available in print, much of it written by people much smarter than you or me…

  43. tgobbi says:

    # Janet Campon 21 Sep 2012 at 4:23 pm

    “One note to tgobbi:
    I do think grass fed meat is more healthful than grain fed–the animals are leaner, no? It is certainly better for the animals I would argue.”

    According to one of the sources I checked with (and, I’m sorry to report, I simply can’t remember who it was after all these months) “Fact: there may be fewer calories and less fat in grass-fed meat; but any actual difference to health is insignificant. In any event there are no health-related implications. ” I included this in the letter I sent to the chiropractor after his lecture.

  44. jhawk says:

    HH,

    “So it sounds like you are not providing chiropractic care to children but are providing conventional medical care under a chiropractic license. I wonder if that is even strictly legal: you are licensed to practice “chiropractic” but are doing something else. I would have no problem with what you are doing if only you stopped calling yourself a chiropractor and made it clear to your patients and everyone else that you are not practicing “chiropractic.”

    It is legal. Chiropractic training and licensure allows you to perform manual therapy techniques (97140) and therapeutic exercise (97110) as well as a host of many other treatments/procedures that are considered medical.

    “Whatever myofascial release is, it isn’t chiropractic.”

    Your statement is correct. Myofascial release is not chiropractic as it spreads many professions but chiropractors can perform myofascial release.

    nybgrus,

    “I tend to agree with Dr. Hall here. However, I really don’t know that state of evidence for myofascial release as a therapy. In my quick search I did not come up with much, except for the notions of “rolfing” (which just sounds wrong) which is typically considered debunked. I have not vested the time in doing a detailed review myself (simply because I really don’t have the time and am procrastinating as is) so I am curious as to what the evidence for MFR actually is. JHawk – could you supply the resources you use to determine how and when to apply MFR as well as the efficacy of it?”

    To my knowledge there is not a lot if any good studies on myofascial release to date. There are many inherent problems in getting a study like this done and I would imagine the results would come out to be equivocal. Lets continue with the example of shin splints, researchers would gather x number of subjects and randomise them to xyz cohorts and apply myofascial release to one of these cohorts. This would turn out to be equivocal because shin splints not only needs a multimodal treatment approach to be effective, it is also in many cases a sx of tissue overload via compensation from other biomechanical faults or msk conditions such as decreased ROM, a standing pronated foot, overpronation with gait, bad shoes, a hip problem, etc. This isn’t to say that this research should never be attempted but that it will be difficult.

    Janet,

    “I wonder what you had to do to get into chiropractic college (academically) and wonder if you ever considered physical therapy as a career? I truly think you mean well, but even if tgobbi’s surveys aren’t completely scientific, I’m with him (?). The chiropractors who are visible to the public are widely advertising all sorts of quackery in addition to whatever manipulation they perform. Around here (the midwest, no less, and not Chicago) they mostly do “wellness” which means you come every week for the rest of your life for “wellness” adjustments. I have a lot of respect for your willingness to participate in this discussion, but I have to say to you what I said to another poster, an acupuncturist who has a similar story in that he claimed to only treat a few things and make many referrals to real doctors: Why not go get that additional training and be a real health care provider?”

    I considered PT for a bit but wanted more autonomy and the chiro’s I shadowed had PT’s working in their offices. I also had multiple other professionals reccommend chiro to me. I do consider myself a real health care provider as does the medical community in my area.

  45. @jhwak

    I do consider myself a real health care provider as does the medical community in my area.

    … on the planet K-Pax-17.

  46. Harriet Hall says:

    @jhawk,
    It’s legal in that the licensing laws authorize those practicing chiropractic to use those treatments, but is it strictly legal in the sense that the laws were intended to legalize “chiropractic” and often even specifically mention the word subluxation? Couldn’t one argue that if you are not practicing “chiropractic” the intention of the law was not to authorize you to use those treatments?

  47. jhawk says:

    HH,

    I guess you could argue that but I would argue that I am practicing chiropractic.

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

    and here is how the ACA defines chiropractic, http://www.acatoday.org/level2_css.cfm?T1ID=13&T2ID=61

  48. tgobbi says:

    # jhawkon 23 Sep 2012 at 11:57 am
    “HH,
    I guess you could argue that but I would argue that I am practicing chiropractic.
    ACA’s definiton of subluxation:
    A motion segment, in which alignment, movement integrity, and/or physiological function are altered although contact between joint surfaces remains intact.
    and here is how the ACA defines chiropractic, http://www.acatoday.org/level2_css.cfm?T1ID=13&T2ID=61

    In my opinion both ACA quotes are disingenuous and obfuscatory! I believe that most would agree on what DD Palmer originally meant when he discovered/described the chiropractic subluxation – whether he actually coined the term or not. It’s the “sine qua non” of chiropractic even though a tiny minority of DCs don’t incorporate it into their practices. ACA deliberately and purposefully (again my opinion) avoids the word in a feeble attempt to divert attention from it. But we all know that if you have even a minimal understanding of what chiropractic is all about the word is there whether it appears or not. It’s an “eminence grise,” lurking in the background.

  49. Harriet Hall says:

    @jhawk,

    Please explain how “A motion segment, in which alignment, movement integrity, and/or physiological function are altered although contact between joint surfaces remains intact.” has anything to do with shin splints or epicondylitis.

    And if you go by the definition “Chiropractic is a health care profession that focuses on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on general health. ” how does that differ from a medical specialty that focuses on those things? In other words, what makes “chiropractic” “chiropractic”?

  50. jhawk says:

    HH,

    “Please explain how “A motion segment, in which alignment, movement integrity, and/or physiological function are altered although contact between joint surfaces remains intact.” has anything to do with shin splints or epicondylitis.”

    It doesn’t. That is the whole point, chiropractic is not all subluxation.

    “And if you go by the definition “Chiropractic is a health care profession that focuses on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on general health. ” how does that differ from a medical specialty that focuses on those things? In other words, what makes “chiropractic” “chiropractic”?”

    I don’t necessarily see why it has to be different from a medical specialty but I would say a portal of entry non-surgical msk practicioner that focuses on the spine.

    tgobbi,

    “In my opinion both ACA quotes are disingenuous and obfuscatory! I believe that most would agree on what DD Palmer originally meant when he discovered/described the chiropractic subluxation – whether he actually coined the term or not. It’s the “sine qua non” of chiropractic even though a tiny minority of DCs don’t incorporate it into their practices. ACA deliberately and purposefully (again my opinion) avoids the word in a feeble attempt to divert attention from it. But we all know that if you have even a minimal understanding of what chiropractic is all about the word is there whether it appears or not. It’s an “eminence grise,” lurking in the background.”

    or the profession is growing and trying to move away from it.

  51. @jhwak,

    Do you consider chiropractic a “medical specialty”?

    Do you consider your scope of practice to be the same, or greater, than that of a PT?

    Do you think, in school, you were better educated to function in physical therapy than a PT?

  52. jhawk says:

    SH,

    Do you consider chiropractic a “medical specialty”? Not technically.

    Do you consider your scope of practice to be the same, or greater, than that of a PT? To my knowledge it is greater.

    Do you think, in school, you were better educated to function in physical therapy than a PT? Better educated in certain areas and less in others.

  53. tgobbi says:

    # jhawkon 23 Sep 2012 at 8:04 pm

    tgobbi,
    “In my opinion both ACA quotes are disingenuous and obfuscatory! I believe that most would agree on what DD Palmer originally meant when he discovered/described the chiropractic subluxation – whether he actually coined the term or not. It’s the “sine qua non” of chiropractic even though a tiny minority of DCs don’t incorporate it into their practices. ACA deliberately and purposefully (again my opinion) avoids the word in a feeble attempt to divert attention from it. But we all know that if you have even a minimal understanding of what chiropractic is all about the word is there whether it appears or not. It’s an “eminence grise,” lurking in the background.”

    jhawk
    “or the profession is growing and trying to move away from it.”

    No, I’ll stick with disingenuous as the operative word.

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