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The DC as PCP? The battle continues

Chiropractors are trying to rebrand themselves as primary care physicians, a topic both Harriet Hall and I have addressed (here and here) on SBM.  Toward this end, they are seeking the expansion of their scope of practice, via the magic of legislative alchemy, to include the prescription and administration of drugs.  Not drugs that any self-respecting M.D. would use, but drugs nonetheless.  That effort succeeded to an extent in New Mexico.  Recently Colorado got into the act.  Other states have followed suit.

Chiropractors have claimed from the very beginning they are primary care physicians. Chiropractic was born in 1895 with the notion that virtually all diseases could be resolved with chiropractic treatment.  This was Daniel David Palmer’s original contention, that the interruption of “nerve flow” by “subluxations” caused disease which could be remedied by spinal adjustment to restore the flow, thereby allowing the body to heal itself.

State chiropractic practice acts have always given chiropractors a broad scope of practice which allows them to diagnose and treat virtually any condition as long as they can squeeze the treatment into the “chiropractic paradigm.”  If they can pretend the condition is amenable to chiropractic treatment via the detection and correction of subluxations, they can diagnose and treat it legally.  This is how they are able to claim, falsely, that asthma, allergies, colic, and many other health problems can be resolved by chiropractic care.  This is how “straight” chiropractors still practice.

Over time, to the chagrin of the “straights,” “mixer” chiropractors sought to expand their treatment options.  They’ve succeeded in all 50 states to some extent. This liberalization of their practice acts includes the right to use acupuncture and to give nutritional advice, including the sale of dietary supplements and homeopathic products.   Now some of the mixers want to dump the subluxation altogether and become, by legislative fiat, real primary care doctors who use the same diagnostic methods and treatments as primary care M.D.s and D.O.s, while at the same time skipping the education and training the latter must go through.

Colorado chiropractors attempt an end run . . .

One of the main obstacles in their way is the lack of authority to prescribe drugs.  Colorado chiropractors recently attempted an end run around the time-consuming and expensive process of lobbying the state legislature and getting their practice act amended to include prescription privileges.  Perhaps they were aware of certain snafus (which we’ll get to soon) bedeviling New Mexico chiropractors in their quest for practice expansion.  The Colorado Board of Chiropractic Examiners’ solution was to bypass the legislature altogether by simply passing a rule giving chiropractors the authority to administer and prescribe certain drugs.  Never mind the fact that this was totally beyond the authority the Colorado Legislature gave the Board.

Here’s what the Colorado chiropractic practice act says, in part, chiropractors can do, in Section 12-33-102(1.7), Colorado Statutes (emphasis added):

“Chiropractic” means that branch of the healing arts that is based on the premise that disease is attributable to the abnormal functioning of the human nervous system. It includes the diagnosing and analyzing of human ailments and seeks the elimination of the abnormal functioning of the human nervous system by the adjustment or manipulation, by hand or instrument, of the articulations and adjacent tissue of the human body, particularly the spinal column, and the use as indicated of procedures that facilitate the adjustment or manipulation . . .

Up to this point, we are in familiar straight chiropractic territory.  The statute goes on, reflecting the more recent addition of “nutritional measures:”

. . . and the use of sanitary, hygienic, nutritional, and physical remedial measures for the promotion, maintenance, and restoration of health, the prevention of disease, and the treatment of human ailments . . .

Colorado law specifically prohibits chiropractors from prescribing, compounding or administering drugs. Yet, in the phrase “nutritional remedial measures,” the Colorado Board of Chiropractic Examiners found an opening for the inclusion of real drugs in the chiropractic scope of practice. Or so it thought.

In November, 2012, the Board enacted Rule 7(C), which would have gone into effect on January 14, 2013:

Nutritional Remedial Measures as referenced in Section 12-33-102(1), C.R.S., means that a doctor of chiropractic may administer, prescribe, recommend, compound, sell and distribute homeopathic and botanical medicines, vitamins, minerals, phytonutrients, antioxidants, enzymes, glandular extracts, non-prescription drugs, durable and non-durable medical goods and devices.

Administer includes Oral, Topical, Inhalation, and Injection.

However, not just any chiropractor could administer these substances by injection.  To do that, the chiropractor must have a “Certification in Injectables,” which can be obtained by, according to the new rule,

Successfully complet[ing] a minimum of a combined total of 24 hours of theoretical study and supervised clinical instruction . . . [and] passing a nationally recognized Injectable certification examination recognized by a CCE [Council on Chiropractic Education] accredited chiropractic college.

No, that is not a typo.  It takes only 24 hours of combined instruction to use injectables, including intravenous administration of the listed substances, which are prescription drugs under federal law. (Per federal law, a substance that may be an over-the-counter dietary supplement if taken orally is a prescription drug when injected.) You do have to pass a test, but what does it say about the rigor of this examination if there is a reasonable opportunity to pass it after a 24-hour course?

. . . and get creamed

Rule 7(C) displeased just about everyone.  The straight wing of chiropractic saw this move as simply another step on the road to chiropractic ruin, as detailed in a series of articles in The Chronicle of Chiropractic, an on-line publication the Foundation for Vertebral Subluxation.  (You’ll need to hold your nose to avoid the smell of the National Vaccine Information Council plug on their website.) On December 5, the Colorado Attorney General issued an opinion that the rule exceeded the scope of authority granted the Board by the legislature.

Under the Colorado Administrative Procedure Act, new rules such as this one are reviewed by the Office of Legislative Legal Services (OLLS) to make sure they are within the Board’s rule making authority.  OLLS quickly determined that Rule 7(C) most certainly was not within the Board’s authority and voted 8-0 to ask the legislature to repeal the rule.    And on January 8, the Colorado General Assembly’s Committee on Legal Services did just that.  It is unclear to me whether this repeals the rule for good, or whether the entire legislature must vote.  What is not unclear is that the rule is, for all practical purposes, dead.

The Executive and Legislative branches having weighed in on the subject, the third branch of state government, the Judiciary, was also drawn into the controversy.  The Colorado Medical Society and 12 more state and local medical groups sued the Board of Chiropractic Examiners.  They sought an injunction against implementation of the rule, also citing the Board’s lack of authority. In addition, according to the complaint, Rule 7(C) is an intrusion into the practice of medicine as defined by statute, which gives M.D.s the authority to prescribe drugs.  (Apparently, the medical society is suddenly upset about other groups practicing medicine even though they sat on their hands when naturopaths tried to do the same thing.) The suit remains pending, although I suppose it will be dismissed as moot.

How the Board of Chiropractic Examiners ever thought it could get away with this is beyond me.  No doubt chiropractors will try the legislative route next time.

Chiropractic Cardiologists

Before we leave Colorado for its neighbor to the south, one more of the Board’s new rules bears mentioning, as it appears to be an effort at furthering the notion that chiropractors are somehow qualified to be PCPs.  Rule 7(B)(3), which is unchallenged, states that “Electrocardiography (EKG/ECG)” is included in the chiropractic scope of practice, if the chiropractor has

One hundred and twenty (120) hours of initial and related clinical with didactic training and demonstrated competency in cardiac medicine.

“A demonstrated competency in cardiac medicine?”  The very thought induces angina. No specifics are given for how said “competency” is achieved or what “initial and related clinical with didactic training” consists of.  Typical of other chiropractic “specialties,” I suppose this competency is accomplished in weekend courses.  Perhaps competency can be achieved by becoming a “Diplomate” of the American Board of Chiropractic Internists (DABCI), although it appears this course would actually over qualify its participants by a large margin.   Here’s what an ABCI functionary says about the course, courtesy of the American Chiropractic Association website:

This specialty, says its council president, Cindy Howard, DC, DABCI, FIAMA [Fellow, International Academy of Medical Acupuncture], is essentially the chiropractic version of primary care. “We look at primary care a little bit differently,” she says. “A lot of people look at it in terms of being the first doctor someone comes to. We look at it from the perspective that we want to handle everything: work up the problem, diagnose you, and treat you. Instead of referring you to the ‘proper person,’ we want to be that person.”

Dr. Howard acknowledges that not all cases can be treated by a chiropractic physician, but thanks to the extensive training provided by the DABCI . . .  certification, there are many that can. The 26 sessions of 12-hour weekends take three years to complete, followed by a three-part board exam—two written segments and one clinical competency examination.

“We do laboratory workups, blood chemistries, adrenal and hormone testing, GI function studies, EKGs,” says Dr. Howard. “We treat everything from allergies to thyroid problems to fatigue. It makes us more of a family doctor—not in the sense that we always take care of the whole family, but we can take care of all that ails them. I have people come into my office not for neck and back pain, people who don’t get adjusted, because we have other capabilities to treat naturally. If I’m adjusting somebody and not getting them better, [my training] gives me a broader range of things to look at as to what it might be.”

What family practice doctor or internist wouldn’t love to complete his training with “26 sessions of 12 hour weekends” instead of three grueling years of hospital-based residency working 80 hours a week.  Let’s see, at 80 hours per week, you could do your whole residency in less than four weeks and avoid all the messiness involved in taking care of people who are really sick. Brilliant!

New Mexico: An update

Meanwhile, in New Mexico, the battle over chiropractic prescribing continues.  As reported in a previous post, the legislature amended the chiropractic practice act to create a new iteration of chiropractor, an “advanced practice” version, which takes all of 90 hours of additional training plus passing a test.

The New Mexico Chiropractic Association describes part of this training on its website [capitalization and punctuation as in original]:

Routes of administration [for ‘naturally derived’ substances], of course, are oral, topical and rectal, which we may already do but new to us here are intravenous (IV) and intramuscular (IM) administration. Doctors completing the certification will be prepared to do: IM injections (B12, homeopathic, magnesium, trigger point, etc.), neural therapy injections Intravenous procedures (meyer’s cocktails, H2O2, chelation, ascorbates, amino acids, minerals, etc.), emergency procedures Laboratory testing and diagnosis.

In other words, a veritable pantry full of quack remedies, now conveniently available via an IV.

Not satisfied with the formulary it had stipulated to with the state’s medical and pharmacy boards, the Board of Chiropractic Examiners, like its compatriots in Colorado, tried an end run around its statutory authority by enacting a new formulary without the required approval of the other boards.  This landed the chiropractic board in court, with the medical and pharmacy boards, as well as the International Chiropractors Association, all seeking an injunction against implementation of the formulary.  The New Mexico Court of Appeals agreed with the plaintiffs and upheld a stay of the formulary.  That proceeding remains pending.

Here’s an update:  On September 13, 2012, the aforementioned American Chiropractic Association (ACA), filed an amicus curiae (friend of the court) brief. All the brief really says is that chiropractors, working through their state legislators and regulatory agencies, are best suited to determine their scope of practice.  This is an ambiguous statement – if they mean that chiropractors should be the ones to determine what their scope of practice is, that is certainly not true.  That is solely up to the legislature, which (at least ideally) takes into account all points of view, not just chiropractors.  In any event, it is totally irrelevant to the issue before the court:  whether the chiropractic board exceeded its authority, which it most certainly did.  Even its own lawyer told the board that.

But the brief does make some interesting, if irrelevant, statements further demonstrating the ACA’s dedication to reinventing D.C.s as PCPs.  The ACA actually says that chiropractors’

. . . academic and clinical training is both extensive and exhaustive and is very comparable to the level of the education and training received by medical doctors.

They go on to provide a handy chart which supposedly compares the hours required for a D.C. degree at Western States University with the hours required for a medical degree at Oregon Health Sciences University, along with the names of courses and number of hours.   It purports to show that chiropractic students actually spend a few more hours in combined classroom and clinical training (4,896 v. 4,877). Of course, the Council on Chiropractic Education recently got into hot water with the U.S. Department of Education over just how accurate the system of credit hour determinations were among chiropractic colleges. Even without getting into that issue, I don’t know where this chart got its figures as the OHSU medical school curriculum doesn’t look anything like the chart.   But you be the judge: Western States D.C. degree (click on “Program Curriculum” pdf) v. Oregon Health Sciences M.D. degree (see links under “Curriculum” in left column).  Do you think they are “very comparable?”

The ACA brief totally fails to mention the fact that graduating from medical school is only the beginning for M.D.s.  It skips the subject of residency entirely.   The brief also describes several “post-graduate” training programs in a variety of “clinical disciplines and specialties,” including Chiropractic Pediatrics, Chiropractic Clinical Neurology (post-graduate training can be had at the “Carrick Institute for Graduate Studies”), and training provided by the American Board of Chiropractic Internists, whose Cindy Howard, D. C., is quoted above.

Before we leave New Mexico, let’s see what one advanced practice chiropractor, Stephen Perlstein, D.C., who was instrumental in getting the advanced practice legislation passed, is offering patients under the formulary currently allowed by law.

Biopuncture

a technique that bioregulates the body’s immune system, meaning that it heals the injury by enabling and enhancing the mechanisms that control inflammation, pain, and tissue regeneration.  Biopuncture traditionally uses small needles to inject substances subcutaneously (just under the skin). On occasion, a deeper injection is required. In a single session, single or multiple injections may be necessary to cover the injured area. . . . Substances typically used in Biopuncture are homeopathic medicines, lidocaine or procaine (analgesics), sarapin (a natural pain reliever), and dextrose (an immune stimulant).

Now, you may be thinking this sounds awfully modest for a CAM treatment.  Where’s the ubiquitous “one true remedy” claim.  It’s right here:

Biopuncture is not only effective for sprain and strain injuries, both new and old, or pain at various joints or parts of the body of indeterminate origin, but is also remarkably effective for the following conditions:

Asthma

Eczema

Hayfever

Bronchitis

Sinusitis

Headache

Colitis

Constipation

Carpal Tunnel Syndrome

Homeopathic Flu Vaccines

After making misleadingly simplistic statements about the mutation of flu viruses and its effect on flu vaccine effectiveness, Perlstein goes on to make this absurd claim about the homeopathic “flu vaccine:”

These [homeopathic] vaccines also stimulate an immune response to a flu virus, but, unlike the conventional ones which rely on the actual virus itself which has changed, these homeopathic preparations stimulate an immune response designed to strengthen resistance to all flu viral elements, whether last year’s or any other years, making the mutating quality of flu virus irrelevant and not a factor in the effectiveness that conventional flu vaccines demonstrate.

Apparently this guy knows something that  “130 national influenza centers in 101 countries [which] conduct year-round surveillance for influenza and study influenza disease trends” as well as five World Health Organization (WHO) Collaborating Centers for Reference and Research on Influenza located in the USA, the UK, Australia, Japan and China, don’t know.

Here we go again

The Arizona Association of Chiropractic has filed an application with the state legislature for an expansion of chiropractic scope of practice to include

the use of natural substances, homeopathic medication and orthomolecular therapy as an opportunity to enhance care for their patients.

According to the petition, these “services” are currently available to chiropractic patients in Oklahoma, Utah, Alaska, Oregon and Idaho, as well as New Mexico and Colorado.  Ten other states are in the process of considering legislation.

We’ll return to these unfortunate developments in a future post.

Posted in: Chiropractic, Health Fraud, Herbs & Supplements, Homeopathy, Legal, Politics and Regulation, Vaccines

Leave a Comment (25) ↓

25 thoughts on “The DC as PCP? The battle continues

  1. tgobbi says:

    Chiropractor Perlstein is well-known to longtime participants and readers of the Healthfraud discussion list. Several years ago he spent considerable time on that forum trying to convince us that there is a sweeping “reform movement” within chiropractic and that DCs were renouncing pseudoscience in droves. I don’t remember that anyone bought his “reform movement” folly. In fact, many of us questioned his claim. But he stuck to his guns, despite our offering overwhelming arguments to the contrary. Now Jann shows us that he isn’t as science-based as he would have everyone believe. Really, chiropractor Perlstein – biopuncture???

    I, too, stick to my guns, expressing my belief that chiropractic isn’t as much a healthcare profession as as it is an elaborate marketing scheme.

  2. tgobbi says:

    Jann: ” This liberalization of their practice acts includes the right to use acupuncture and to give nutritional advice, including the sale of dietary supplements and homeopathic products. Now some of the mixers want to dump the subluxation altogether and become, by legislative fiat, real primary care doctors who use the same diagnostic methods and treatments as primary care M.D.s and D.O.s, while at the same time skipping the education and training the latter must go through.”

    The above reinforces my long-held contention that “mixers” (the majority of DCs) are really crypto naturopaths. The defining characteristic of chiropractic, its sine qua non, is the subluxation. Ol’ DD Palmer built his glass house out of them. What, I ask, do diet and homeopathy (to say nothing of the myriad other non-subluxation disciplines) have to do with chiropractic? Not much! Here’s what I think: the whole business foundered when it became apparent that those pesky subluxations don’t exist and that, in order to stay in business, most of the DCs had to glom onto whatever they could to keep from going bust.

    I find it interesting to note that many “straights” look down their noses at “mixers,” insisting that they aren’t even genuine chiropractors.

  3. tgobbi says:

    MEA CULPA!

    I have confused Stephen Perlstein, DC with Stephen Perle, DC. My sincere apologies to Stephen Perle for the error!

  4. Janet says:

    It boggles the mind to think that any state legislature would take any of these proposals seriously. Well, not really, I guess, when you think what other nonsense they’ve been up to lately in many states!

  5. Lemons says:

    You know how it is if you’re shopping for, say, lawn furniture, and you go to Home Depot, Lowe’s, and Wal-Mart only to find the same crappy stuff from China everywhere? This happens because American companies can’t compete with Chinese companies, due to safety, environmental, and fair wage standards here.

    The same thing is happening with health care. Less intelligent, less well trained people are entering the front lines. Business people with no understanding of the complexities of maintaining a physicianly culture of peer review now run hospitals and clinics. The day is coming –it might already be here– when the higher ups where I work will include naturopaths and chiropractors. How will I uphold sound, evidential standards then?

    People like me are going to go elsewhere as the New Age creeps closer. So maybe one day only the moonbats will be left to see the patients. Sad thing is, America probably won’t notice the loss.

  6. Harriet Hall says:

    Thanks, Jann, for digging into these attempts to expand the scope of chiropractic. It makes me sick just to hear what they’re doing, and investigating and writing about it must be much worse. Thanks for sacrificing yourself! :-)

  7. cervantes says:

    I had to read Lemons a couple of times to get what he/she is talking about. Our standards for training physicians haven’t slipped, but apparently you’re decrying the increasing prevalence of non-medically trained management types in hospital executive jobs. I’m not sure that’s really the problem — they’re in business to make money, so they’ll offer what insurers will pay for, or people will pay for out of pocket. Well crafted payment and accountability structures should, if anything, be more effective with provider institutions run in a businesslike way. There is a growing presence of industrial and systems engineering in medicine, at least in hospitals, which I do not think is a bad development. They aren’t medically trained, but they are trained to focus on getting results, cost effectively. That should not bode well for chiropractic or any other pseudoscience.

    Or so it seems at first blush.

  8. Jann Bellamy says:

    @ Harriet Hall

    “It makes me sick just to hear what they’re doing . . .”

    It makes me sick too — at the least, people are being ripped off and it only gets worse from there. Thanks for your nice comment. I am happy to be part of the SBM team (ok, maybe not every other Wednesday night when I’m working late to get the post up) — I think SBM is making a difference. Many times I am rewarded in my investigations with claims that are so absurd or pompous, or both, that they are laugh-out-loud funny.

  9. KBDCMV says:

    As a Chiropractor I admit to drinking the cool-aid at first. But now, there are quite a few of us who are focusing on evidence-based practices. I know, it must sound ridiculous to you. Truth is, I love getting my spine and other joints adjusted and many others do too. Maybe it is a placebo affect as recent research posted by this site suggests. Who knows? But research also suggests that a placebo can be a good thing. A few more things. In most states, Chiropractors are considered PCPs. We are therefore required to differentially diagnose and refer to the appropriate provider. That is how I practice. I don’t attempt to diagnose out of my scope of practice, but I must be aware that the differentials are possible, and then refer out. I don’t take this as actually diagnosing a condition. I only diagnose musculoskeletal conditions and that is my focus. I don’t think that Chiropractic can “cure” anything, I hate the word “subluxation” and I definitely do not want to prescribe (or un-prescribe, which is what DCs really want to do) medications. Chiropractors are fools for focusing on all this foo-fooey stuff and I don’t like being associated with them.
    Some of us think that Chiropractic has a place in the orthopedic world, why else would they be doing research on manipulation and teaching it in schools? And some of us want to see the Chiropractic profession move away from all this nonsense. But unfortunately, there are way too many Chiropractors out there preaching the subluxation.

  10. tgobbi says:

    An interesting and reasonable post from KBDCMV, but one that raises some questions from this unabashed chiro-skeptic.

    Apart from eschewing subluxations, do you practice any of the other unscientific modalities favored by most of your more traditional peers? I refer to, for example: applied kinesiology; “nutrition;” x-rays (unscientific in standard chiropractic practice); and neck manipulation.

    Do you favor immunizations and fluoridation?

    My assumption, based on your post, is that the answer to to the first group is no and to the the second, yes.

    Which leads to my conclusion that you are, in essence, a physical therapist with a chiropractic degree – which appears irrelevant to your modus operandi. It also makes me wonder why you don’t simply give up the chiropractic title (and all its negative baggage) and call yourself a physical therapist.

  11. Zetetic says:

    “These [homeopathic] vaccines also stimulate an immune response to a flu virus, but, unlike the conventional ones which rely on the actual virus itself which has changed, these homeopathic preparations stimulate an immune response designed to strengthen resistance to all flu viral elements, whether last year’s or any other years, making the mutating quality of flu virus irrelevant and not a factor in the effectiveness that conventional flu vaccines demonstrate.”

    WHAT? HOW? And no mention of “Quantum” in sight!

  12. windriven says:

    I have a modest proposal for all of the DCs and NDs and whatnot who wish to be primary care physicians. Let them sit for either the American Board of Family Practice or the American Board of Internal Medicine. Their choice! And let the test be blinded. The examiners can’t know who is an MD and who is a DC and who is an NP. The exams are written, the orals are taken and everyone who passes gets to be a primary care provider. Fair is fair, right? The NDs claim ‘the same’ training as MDs. Let them put up … or shut up.

    My health insurer isn’t going to give me a rebate for going to an Earl Scheib* primary care provider so why on earth should I settle for someone who isn’t board certified in a relevant discipline?

    *Earl Scheib(sp?) is or was a paint and body shop that back in the ’60s advertised that they would paint “any car any color for $19.95″

  13. Marc Stephens Is Insane says:

    There is an interesting thread on chiros right now at Andy Lewis’s Quackometer site. Several UK chiros have written in to passionately defend their profession. Each one denied they believe in subluxations or innate intelligence, claiming “that’s old fashioned” and “nobody believes that anymore” even though they were shown it’s all included in recent versions of chiropractic school curricula. So it’s still being taught and endorsed, but nobody believes it anymore?

    Chiros want the “alternative” veneer, as they attract many customers who either mistrust real doctors or feel that the medical profession has nothing to offer. And yet as this story and many others show, chiros also want the stamp of legitimacy from the medical profession.

    Many chrios support and sell homeopathy, supplements, cranial-sacral therapy, reflexology, BodyTalk, crystal healing and other New Age “wellness” woo. It supplements the bottom line and once you have a “believer” on the table it’s easy to suggest other products you just happen to sell or services you just happen to provide. Or a partner in your “wellness” or “holistic” clinic provides.

    Why are so many chiros supporters of quackery like Gerson cancer therapy or German New (Non) Medicine/Biologie Totale? If you look at the websites for that quackery, you see a lot of DCs listed. Any chiro who would support either of these regimes has absolutely no understanding of science or medicine.

    One of the British chiros wrote me back and said “so what if some chiros support Gerson? What’s wrong with advocating eating a healthy diet with lots of fruits and vegetables when you have cancer?” Beside showing no understanding of cancer, he also showed no knowledge of what Gerson really is. And that’s what scares me about chiros.

  14. Quill says:

    If a DC wants to be a PCP they should indeed sit for the ABFP or ABIM PDQ or simply get an MD in the first place.

    If a person wants to be a doctor then they should be a doctor and not, say, try to be an auto mechanic when all they have studied is astrology.

    And windriven? You may have tarnished the sacred memory of Earl Scheib by comparing him with chiropractors. ;-) At least he did indeed get some paint on the car and actually do more or less as claimed and advertised, if cheaply and sloppily, which is more than chiros do when they claim to treat anything other than a minor lower back ache.

  15. Narad says:

    We do laboratory workups, blood chemistries, adrenal and hormone testing, GI function studies, EKGs

    Ah, even I could “do” an EKG given a lead set and the magic box. Reading one is… a tad different.

  16. nybgrus says:

    @windriven:

    I’ve made a similar comment somewhere in the past. I’ve challenged them to sit the USMLE – not even the specialty boards. I’d be willing to bet they couldn’t pass those. Hell, I have colleagues who have actually tried studying the right material for two years and still failed the Step 1. And there is no chance they could pass the Step 2 because it is all about management of conditions… conditions they have no knowledge of how to diagnose or properly manage.

    Of course the out I see is they cry foul that the tests are designed to evalute our medical practice, not theirs. They are, after all, claiming equivalency not saying they are identical to us. This then just moves the burden to show that their outcomes are the same as ours and we fall right back into the old canard that a “complete health system” that is internally logically consistent is just as valid as any other internally consistent health system (i.e. the one you and I practice). For instance, I doubt that I could pass a chiropractic board exam. However, the pesky details about the foundational premises upon which that internally consistent logic is built is always conveniently sidestepped.

    So they could weasle out of failing the Step 2 and the ABIM for that reason – a very bad reason and certainly not a valid excuse, but they could manage it. I believe that the same cannot be said for the Step 1. It is supposed to test basic science knowledge, not management, and since they claim the school curricula are essentially the same and they learn the same anatomy, physiology, microbiology, etc as we do they should be able to technically pass it. There is some pharmacology on the Step 1, but not that much. So maybe they won’t get a great score, but barely passing should be feasible if any of their claims are true. I’d be willing to bet they can’t pass it. And I’d further bet that if they studied enough to actually pass it, they’d learn enough to likely get them to see the light and leave chiropractics entirely.

  17. nybgrus says:

    And I just read through the curricula that Jann provided. It is very strange indeed.

    If you look at the OSHU curriculum you find 600 hours of instruction in the first 2 years. Then second two years do not have fixed hours since clerkships have highly variable hours. But based on my experience so far, I’d say it is reasonably to estimate that at another 400 hours. So 1,000 hours total.

    The UWS curriculum totals it up at the bottom with 418 hours for all 4 years combined. They then somehow calculate a “clock hours” of 4598. I’m not sure what “clock hours” are or how they differ from “lecture and lab hours” but making up a ~4000 hour deficit seems highly implausible. They may not be factoring in clinical clerkships in the “lecture and labs hours” section, but I can’t fathom 4,000 hours of time being spent on the clinical clerkships the chiros go through in 2ish years. Being generous that means 50 hours of clinical work per week for two solid years, which simply does not exist in their curriculum.

    But even if you take the credit hours and add them to the “lecture and lab hours” (which I am not even sure is valid and may be double dipping) they still don’t have 1,000 hours of instruction.

    And of course, yes, this does not even touch the post graduate training we must go through. If I had to actually go out and see patients entirely on my own after I graduate this year I would be a nervous wreck and probably harm a lot of people! After internal medicine residency I would feel much more confident… because that is an extra 10,000 hours of training! (minimum)

    Mind boggling.

  18. Yep- I have been a Doctor of Chiropractic for 10 years. I have found many who are VERY opposed to chiropractic are usually the one’s who have never gone to one.

    While, I agree, there are a lot of DC’s who are not worth anything but are very good marketer’s; there are also some; like me who dare you to try.

    Spinal Manipulation has been an age old way of fixing the body. Doctors of Osteopathy know/knew it; American Indians knew it; the Greeks and Egyptians have records of it also.

    While the philosophy of chiropractic is still hotly debated within the profession itself, but it seems short sighted to say it doesn’t work. Especially when peer reviewed journals (JMPT and SPINE) as well as leading hospitals (Mayo) agree it does. (Im not citing it- you can look it up)

    As for Expansion of the Chiropractic Scope of Practice- HELL YES! But not for vitamins and crap- Pain killers and NSAIDS and Steroid shots.
    As for a safer place for these things to be administered- has anyone ever heard of nosocomial and iatrogenic infections?

    And yes, I have fixed many things in one visit. Including asthma.

    Cheers!

    - Dr. Adam Paul Thom
    chirowithresults@gmail.com

  19. Marc Stephens Is Insane says:

    Mr. Thom,

    Why does your website have a picture of you “manipulating” a baby?

  20. Marc Stephens Is Insane says:

    If I understand Adam’s website correctly, he is denying germ theory and states that subluxations are the source of disease. He also states that chiros can prevent cancer.

    And he employs a reiki saleperson at his shop. Not much science there, is there?

  21. nybgrus says:

    I didn’t need to go any further than his claim he has fixed asthma.

    Utter, total, unequivocal, quackery.

    At first I thought he may be one of those chiros that is really more like a PT, but that one bit gave out the whole show. No point in even engaging.

    Sorry Adam, you aren’t a doctor but you are a quack. And if you are convincing people you are treating their asthma (let alone cancer) you are a dangerous one at that.

  22. Marc Stephens Is Insane says:

    Yeah, Adam claims he was in (real) medical school when he realized it was all bogus so a professor suggested he switch to chiroquackery. His website is amateur, and hilarious: way too many blocks of text and incredulous “questions and answers”

    At least he offers a “money-back guarantee” if a customer isn’t satisfied after three sessions.

  23. arphysicaltherapist says:

    I can’t tell you how much it makes me cringe when I hear “physical therapy” being used in the same sentence as “chiropractic”, unless of course it’s a sentence revolving around how underqualified chiros are to be performing physical therapy. Congratulations, you don’t believe in subluxation theory anymore! Welcome to reality, where the rest of us have been for the last century. What is amazing to me is not the gall of this group of “practitioners” who claim to be a one-stop shop as pediatricians, internists, orthopods, and dieticians, but rather the amount of discourse within their group. Have you ever heard of half of any other medical profession suddenly rejecting the ENTIRE PREMISE THEY WERE FOUNDED ON?! I find it so obscenely convenient that as skepticism reaches all time highs (boosted by the fact that there is literally no science to support subluxation theory) there arises a new movement of chiros who try to pretty themselves up by agreeing with all of us–”I’m not like THOSE chiropractors, I swear!–and in the same breath “curing asthma” and claiming to be qualified as a PCP. I’m sorry, but if you can admit that there was a time that you “drank the kool aid” i.e. believed a LIE that was perpetuated by the same people you associate yourself with on a daily basis, how could you possibly justify continuing with that profession, given the assumption that it apparently takes a while after graduating to stop drinking said kool aid? What’s to be said for the army of chiropractors your non-accredited schools are pumping out? Do you not have a MORAL obligation to correct the lies being taught to your classmates and associates?! I read a fantastic article called “why I quit chiropractic” that literally says that students are exposed to contradictory chiropractic systems and are encouraged to find one that they can support even if they disbelieve the others.

    And Adam Thom, of course manipulations work! Physical therapists have been proving that in evidence based research long before you people decided that it would probably help to have some science to back you up. Manipulations to SPECIFIC JOINT LEVELS (vs.
    a gross, and I do mean gross, approach) for patients that have undergone judicious testing and are found to be appropriate for that manipulation (i.e. decreased joint mobility) benefit! The problem is that you pervert these findings as proof to “realign and adjust” thrice a week for the rest of a sucker’s life, which is just as much crap as the subluxation theory. Just because you CAN manipulate a joint doesn’t mean you SHOULD, and that’s where you lose patients. A person with instability or excessive joint mobility can absolutely experience a cavitation in a joint–What you call an “adjustment”! But consider a person who has suffered with back pain for 10 years and needs instruction on better posture and stabilizing exercises for weak core and lumbar musculature. The LAST thing they need is increased joint mobility, which is exactly what your manipulation does. That patient example, by the way, was a real patient I saw a month ago who was facing surgery but after 3 weeks of the aforementioned treatment was discharged with 100% improvement in function and pain. Of course the kicker is…he’d been going to a chiro for “adjustments” for TEN YEARS with no relief before he finally sought out an orthopod who got him to my clinic. It’s not rocket science, but it does take critical thinking, and putting the patient’s function and quality of life before your pocketbook.

    My point is this: if you love all the hard work and research various health care providers have done, why not join us? If you love correcting musculoskeletal dysfunction, become a physical therapist. Most chiros are already falsely and illegaly claiming they can perform PT. You want to become a real doctor? Go to medical school. But stop trying to demand respect when you haven’t earned it. We can’t blame you for being naive when you chose the profession, but you’ve got no excuse anymore.

    And for the love of God, stop calling yourselves doctors. PT’s are now Doctors of physical therapy–we’re just not pompous or stupid enough to put it in front of our names.

  24. phog says:

    I noticed on Adam Thom’s website that he talks about “staff” infections. Pretty bad taxonomy for someone studying as much as he can to be a better doctor. Probably why he switched.

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