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Learning quackery for Continuing Medical Education credit

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The Integrative Addiction Conference 2015 (“A New Era in Natural Treatment”) starts tomorrow in Myrtle Beach, SC. Medical doctors, doctors of osteopathy, naturopaths and other health care providers will hear lectures on such subjects as “IV Therapies and Addiction Solutions,” given by Kenneth Proefrock, a naturopath whose Arizona Stem Cell Center specializes in autologous stem cell transplants derived from adipose tissue. Proefrock, who was disciplined for using prolotherapy in the cervical spine without proper credentialing in 2008, claims that stem cells treatments are an “incredibly versatile therapy” and uses them for variety of conditions, such as MS and viral diseases. At the same time, he admits that they are not FDA approved and he is not claiming they are effective for anything (and he’s right), which leads one to wonder why he employs them.

Proefrock also offers a typical naturopathic mish-mash of services, from oncology to urology to “naturopathic endocrinology,” and claims he specializes in treating influenza, high blood pressure and kidney stones, as well as addiction. In other words, he doesn’t seem to be the sort of expert you’d find speaking at a science-based conference on addiction medicine.

You’ll find similarly troubling bios of some of the other speakers, as well as dubious treatments for addiction, on the conference website. Here, for example, are speaker Giordano’s and Eidelman’s websites.

Dalal Akoury, MD, is the “Title Sponsor” of the conference and appears to be running the show. Although she is listed by the S.C. Board of Medicine as board certified in pediatrics, she is the founder of the “Integrative Addiction Institute” and runs the “AwareMed Health and Wellness Resource Center” in Myrtle Beach. Like the Arizona Stem Cell Center, it offers a range of treatments that defy categorization as any particular specialty: addiction recovery, “adrenal fatigue” treatment, stem cells, “anti-aging,” weight loss, “functional medicine” and “integrative cancer care“. Yet, only Akoury and one licensed practical nurse are on the staff of the Center. Again, it is questionable whether she is has sufficient qualifications in addiction medicine to run a conference on the subject. (more…)

Posted in: Acupuncture, Cancer, Chiropractic, Dentistry, Diagnostic tests & procedures, Energy Medicine, Homeopathy, Medical Academia, Medical Ethics, Naturopathy

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Do You Believe in Magic? Oregon Does.

Pictured: OHP and HERB picking "evidence-based treatment options"

Pictured: OHP and HERB picking “evidence-based treatment options”

Do You Believe in Magic?

Do you believe in magic for a back pains fix

How the needles can free her, where ever it pricks

And it’s magic, if the chi is groovy

It makes you feel happy like an old-time movie

I’ll tell you about the magic, and it’ll free your soul

But it’s like trying to tell a CAM ’bout randomized control

If you believe in magic don’t bother to choose

Although subluxation is simply a ruse

Just go and get adjusted on the table

It won’t wipe off the pain no matter how hard you try

Your wallet is empty and you can’t seem to find

How you got there, so just blow your mind

If you believe in magic, come along with me

We’ll CAM until morning paid for by the OHP

And maybe, if the CAM is right

I’ll meet you tomorrow, sort of late at night

And we’ll go dancing, baby, then you’ll see

How the magic’s in the CAM and the CAM’s in me

Yeah, do you believe in magic

Yeah, believe in the magic of a back pains fix

Believe in the magic of CAM

Believe in the magic that can set you free

Oh, talking ’bout magic

Do you believe like I believe… Do you believe in magic

Do you believe like I believe… Do you believe, believer

Do you believe like I believe… Do you believe in magic

The Lovin’ Spoonful. Sort-of.

Maybe not my best lyrics.

More Oregon magic

It continues.

Oregon has a problem with prescription pain pills. Oregon leads the nation in the abuse of such drugs, federal statistics show, with Oregon’s rate of prescription drug abuse 39 percent higher than the national average. Go us.

Why that is, I do not know. As an Infectious Disease doctor I prescribe a narcotic about once a year. There are real problems with the treatment of chronic pain and while I am aware of the issues and the changes over the last 25 years, it does not impact my practice, so my knowledge of the issues is basic.

I am also well aware of the Oregon Health Plan (OHP). The OHP was intended to make health care more available to the working poor, while rationing benefits. They were fairly transparent that resources were fixed and not everything would be covered.

Given limited resources, part of the plan has always included a prioritization of treatments and diagnostics, paying for care that give the most bang for the buck. Not a perfect way to ration care and as is always the case, no good deed goes unpunished. (more…)

Posted in: Acupuncture, Chiropractic, Legal, Medical Academia, Naturopathy

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Neck Adjustment for Newborn Supraventricular Tachycardia: More Chiropractic Manipulation of Reality…..

[Editor’s note: Not enough Clay for one day? Check out this post on homeopathy over at The Scientific Parent!]

SVT

It was recently brought to my attention that a chiropractor was promoting his profession on Facebook by claiming to have treated and cured a potentially life-threatening cardiac arrhythmia. The condition in question, supraventricular tachycardia (SVT), can be very serious and even deadly in patients of all ages. Needless to say, the thought of anyone but a well-trained medical professional with access to appropriate medication and equipment to control the heart rate if necessary was unsettling to say the least.

After a deep breath, I followed the link and was sadly not surprised to find that it was true. In fact, after taking a minute for the rage to subside, and a few more to delve deeper into the case, I found that it was in reality much worse that I had initially imagined. The intervention, a stealthy adjustment of the child’s first cervical vertebrae, was performed by her father while she was being treated in a neonatal intensive care unit just hours after being born.

The events in question were posted by the chiropractor on a public account for his practice. Still, I feel hesitant to link to them directly as they reveal not only the name of the child but the identity of the cardiologist and intensive care doctor involved in her care (who naturally cannot respond because of privacy laws). If readers want to go to the trouble of locating the source of my outrage, they certainly can.

I will provide details of the child’s care as described by her father, but first a brief primer on SVT to set the stage a bit.
(more…)

Posted in: Chiropractic, Science and Medicine

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Chiropractic and Stroke: The question is not answered

Extreme rotation of the atlas on the axis (at the atlantoaxial joint) stretches the vertebral artery.  In layman's terms, 40% of a hanging.

Extreme rotation of the atlas on the axis (at the atlantoaxial joint) stretches the vertebral artery. In layman’s terms, 40% of a hanging.

I am off to Chicago for 5 days to wow the SMACC crowd with my ID/SBM acumen. I hope. Given that most of my multiple-personalities do not seem to be able to get any work done, I am forced to write a brief post this week, limited by the battery life on my MacBook Air. Whatever I get down on paper? pixels? RAM? before the battery dies as I fly over the Rockies will be the post. It is times like this I wish I had Gorskian typing skills.

SBM has discussed the many limitations of chiropractic: the low grades for entry into chiropractic school, the inadequate training, their reason d’être, subluxations and their adjustments being divorced from reality, the lack of efficacy of chiropractic for any process beyond low back pain (and even that is no better than safer interventions), the fondness of chiropractors for other useless pseudo-medicines, and their opposition to vaccines.

Hm. When I put it like that chiropractic does appear a little sketchy. But is chiropractic safe? It is a hands-on intervention, for a brief period of time applying the same force to the neck as about 40% of hanging from the neck until dead. So there is certainly the potential for chiropractic to cause harm. (more…)

Posted in: Chiropractic, Clinical Trials

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Functional Disc Rehydration for Chronic Back Pain

A chiropractor in Illinois named Jeff Winternheimer claims to have discovered an effective way to heal herniated discs by rehydrating them. He calls it Functional Disc Rehydration and he offers it through a network of four offices in the Chicago area called the Illinois Back Clinic. He has lots of testimonials and one sorry amateurish attempt at a scientific study that claimed to show 100% improvement; but there is no published evidence, no controlled observations, and no comparison of his methods with other methods.

Degenerative disc disease

Between the spinal vertebrae there are soft, jelly-like compressible discs that act as shock absorbers. They are “corralled” by a fibrous annulus. As we get older, the disc material loses water and becomes less flexible; the disc thins, and the space between the vertebrae narrows, so in old age we are not quite as tall as we once were. Cracks in the annulus develop with age or with trauma, allowing the disc material to bulge out or rupture. Herniated discs don’t necessarily cause pain; disc degeneration can be seen on MRI in 37% of asymptomatic people over the age of 60.

by “debivort,” licensed under CC BY-SA 3.0 via Wikimedia Commons

by “debivort,” licensed under CC BY-SA 3.0 via Wikimedia Commons

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Posted in: Chiropractic

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Dubious MTHFR genetic mutation testing

Naturopathic catnip for patients.

Naturopathic catnip for patients.

Naturopaths, along with some chiropractors, acupuncturists and a few “integrative” physicians, are advising patients that they should be tested for MTHFR genetic mutations. Typically, the naturopath will start with the pitch that “conventional” medical doctors are ignoring your genes as a possible source of your health problems. (And it is mostly naturopaths who are doing this – just Google “naturopath MTHFR genetic mutation” and see what comes up.) NDs know better, of course – it could be a MTHFR genetic mutation causing your maladies.

Just what is the MTHFR gene? Allow me to introduce some actual scientific information here. According to Genetics Home Reference, a service of the National Library of Medicine,

the MTHFR gene provides instructions for making an enzyme that plays a role in processing amino acids, the building blocks of proteins. This particular enzyme is important for a chemical reaction involving forms of the vitamin folate (also called vitamin B9), a reaction required for the multistep process that converts the amino acid homocysteine to another amino acid, methionine. The body uses methionine to make proteins and other important compounds.

Back to pseudoscience. Next comes the scare tactic: telling you how a MTHFR mutation might affect your health: anxiousness, adrenal fatigue, brain fog, cervical dysplasia, increased risk of many cancers (including breast and prostate), low thyroid, leaky gut, high blood pressure, heart attacks, stroke, Alzheimer’s disease, diabetes, and miscarriages. (more…)

Posted in: Chiropractic, Diagnostic tests & procedures, Health Fraud, Herbs & Supplements, Naturopathy, Nutrition, Obstetrics & gynecology, Vaccines

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Chiropractic Manipulation of the Neck Linked to Stroke in a 6-Year-Old Child…

neckjer

The risk of suffering a stroke when undergoing aggressive chiropractic manipulation of the neck is not a new concern. We’ve discussed it several times on the pages of Science-Based Medicine over the years, most recently in November of 2014 when Steven Novella covered the death by chiropractor of 30-year-old Jeremy Youngblood, whose fatal brain injury occurred while seeking treatment for a sore neck. For a nice review of cervical manipulation in general, the evidence against its inappropriate use, and an assessment of the literature on this subject, check out prior posts by Dr. Hall and chiropractor Samuel Homola.

I believe that my take on the issue is in line with my fellow SBM authors. There is no role for high velocity, low amplitude (HVLA) thrust-type maneuvers that cause sudden and intense rotation of the neck in any patient, for any reason. It is not effective for neck pain, headache or any other complaint, and it is a proven risk factor for injury to the vertebral arteries and subsequent stroke. Some patients are at higher risk, such as the elderly or those with atherosclerosis or connective tissue disorders, but this type of injury can occur at any age and even in a perfectly healthy individual. (more…)

Posted in: Chiropractic, Science and Medicine

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Chiropractic Nose Balloons

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Pictured: Hobbit condom. Yup, it’s gonna get weird again.

You can pick your friends. You can pick your nose. But you can’t pick your friends nose.

Unless you practice Nasal Cranial Release.

There are so many pseudo-medicines, it is hard to keep track. New variations appear, new combinations of old SCAMs occur, old pseudo-medicines wax and wane, although no pseudo-medicine ever dies. Except phenology? Maybe? I find a few phrenology sites on the web, but I cannot tell if they are real or satire.

There is an ongoing discussion in my family as to the greatest band of all time. The Who is THE correct answer, but really, bands do not have to follow the Pauli exclusion principle. There can be multiple greatest bands of all time, all existing simultaneously at the same place. Except that The Who is a little bit more greater than the others. Yes. More greater.

The same concept applies to SCAMs. Whose goofiness reigns supreme? Homeopathy? Reiki? Epigenetic Birth Control? They are all equally goofy, each in their own special way.

In my feeds I saw the announcement that “Anderson Chiropractic Announces Nasal Cranial Release Therapy“. I had never heard of Nasal Cranial Release Therapy. It sounds bad, turning humans into a PEZ dispenser, popping off the skull by way of the nose, a particularly horrific form of rhinotillexomania. It’s not that goofy. But close. (more…)

Posted in: Chiropractic

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ACA: Six Key Elements of A Modern Chiropractic Practice Act

Screenshot 2015-05-13 22.46.07

In February, 2015, the American Chiropractic Association House of Delegates ratified “Six Key Elements of A Modern Chiropractic Practice Act.” For what it’s worth, this means that the “Six Elements” are part of the official “Public Policy” of the ACA.

1. “Chiropractic Physician” and “Chiropractic Medicine” as the Regulatory Terms of Licensure.

2. Scope of Practice Determined by Doctoral and Post-Doctoral Education, Training and Experience Obtained Through Appropriately Accredited Institutions.

3. Full Management, Referral and Prescription Authority commensurate with contemporary chiropractic education for Patient Examination, Diagnosis, Differential Diagnosis and Health Assessment.

4. Full Management, Referral and Prescription Authority commensurate with contemporary chiropractic education for the Care and Treatment of Neuromusculoskeletal and Other Health Conditions or Issues.

5. Full Authority for the Delivery of Information, Advice, Recommendations and Counseling Regarding General Health Matters, Wellness and Health Optimization.

6. Full Authority and Adaptable Requirements for the Management and Training of Health Care Teams and the Participation in Collaborative or Integrative Health Care Groups.

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Posted in: Chiropractic, Legal, Politics and Regulation

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“Finally…The Low Back Pain Solution”: A Chiropractor Makes Questionable Claims

Pictured: Railgun patient launcher Magnetic resonance imaging machine

Pictured: Railgun patient launcher Magnetic resonance imaging machine, not a useful tool in identifying the cause of back pain

The ads in my local newspaper are a never-ending source of questionable health claims, most often from diet supplement manufacturers and chiropractors. There’s no single spokesman like Dr. Oz, but as a group they remind me of Oz’s unending series of weight loss miracles, each one the perfect solution until the next one comes along. The proliferation of chiropractic ads is bad advertising for the efficacy of chiropractic itself, since chiropractors are increasingly turning to adjunctive treatments like lasers and decompression machines.

The latest ad that annoyed me was from the Objective Diagnostics Research and Rehabilitation Institute (ODRRI). What an impressive name! On their website, not only do they advertise “the low back pain solution,” but they offer to fix herniated discs without surgery. They say they treat the underlying cause and say their approach is “based on solid and leading edge diagnostics, scientific research, and experience.” While not a complete lie, that statement is certainly misleading. (more…)

Posted in: Chiropractic, Diagnostic tests & procedures

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