Posts Tagged Chiropractic

American Academy of Family Physicians Home Study Course Recommends Non-Science-Based Treatments


Strong medicine…along with a little nonsense

Since passing my board exams in family practice in 1979 I have relied heavily on the American Academy of Family Physicians for continuing medical education via the American Family Physician and the AAFP home study programs. The AAFP prides itself on its evidence-based approach to medicine. In general, it delivers. But the recent FP Essentials Number 432 on “Chronic Pain Management” fell short. It recommended treating chronic pain with acupuncture, chiropractic, touch therapy, and S-adenosyl methionine (SAM-e), presenting them in a way that misled readers into thinking that the recommendations were based on good scientific evidence. They were not.

With 6,500 peer reviewed journals and over two million papers published every year, it is easy to find a study to support pretty much any point of view. John Ioannidis taught us that most published research findings are false, with preliminary studies frequently being overturned by larger, better follow-up studies. When evaluating the evidence for a treatment, it is not enough to find one or two positive studies. It is essential to also look for negative studies and for systematic analyses that weigh all the published evidence, and to put all the available evidence into perspective. The authors failed to do that. (more…)

Posted in: Science and Medicine

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Separating Fact from Fiction in Pediatric Medicine: Ear Infections


Please don’t try chiropractic first, or at all, for any pediatric condition

As discussed numerous times on the pages of Science-Based Medicine, children are increasingly a target of chiropractors, with some even pushing for recognition as primary care practitioners. Despite a thoroughly inadequate training, and a lack of experience with ill pediatric patients, they believe that they have what it takes to recognize and manage common pediatric conditions or refer to an actual pediatric medical professional when they deem it appropriate. While a significant percentage of pediatric illness is self-limited, and thus might appear to respond to chiropractic manipulation, I have seen many deteriorate quickly and with little warning. The idea of an ill child suffering at the hands of a charlatan is terrifying.

Many chiropractors are of course more than happy to see pediatric patients without acting as their PCP. They love to claim that children are at risk of developing misalignment of the bones of the skull and spine, chiropractic subluxations, and numerous other conditions unique to alternative medical reality, particularly during the first few years of life. They tell caregivers that these insults can be subtle, or even silent for years, and that regular maintenance care is required to prevent severe problems, even going so far as to blame SIDS and “shaken baby syndrome” on these fictional entities.

Many chiropractors are also quick to claim that they can prevent or cure some of the most common conditions seen by pediatricians and family healthcare providers, such as viral infections of the upper respiratory tract, asthma, bedwetting, and ear infections to name just a few. By simply improving the function of the nervous system, chiropractors believe that they can “boost” the immune system’s ability to fight infections, improve control over bladder function, and even reduce airway inflammation and bronchoconstriction. If you think that sounds like nonsense, you’re right!


Posted in: Science and Medicine

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The DC as PCP: the battle resumes

Daniel David Palmer, creator of the nebulous subluxation and father of chiropractic.

Daniel David Palmer, creator of the nebulous subluxation and father of chiropractic.

It has been almost five years to the day since I wrote my first post in “The DC as PCP” series. These posts (listed here) chronicle the continuing battles among various factions within the chiropractic profession over the subluxation and its many iterations, educational requirements for chiropractic colleges, their legal scope of practice, and whether chiropractors are – or are not—primary care physicians (PCPs). At its heart, the controversy boils down to this essential issue: what is “chiropractic” and what is it that chiropractors do? Or, perhaps, should do.

At one end of the spectrum is the straight chiropractor, who wants to make his living detecting and correcting subluxations for all manner of problems. These are the chiropractors who claim newborns need adjustments for “birth trauma” and maintenance care is necessary to good health. At the other end are those promoting the idea that chiropractors are primary care physicians capable of seeing the undifferentiated patient, form a differential diagnosis, and either treat the patient or coordinate the patient’s care with other health care professionals.

Neither has any basis in reality. The subluxation is a chiropractic fiction. And the notion that chiropractors have the necessary education and training to act as primary care physicians is no less a fiction.

Apparently unrepresented in this battle is the chiropractor who wants to see the profession as evidence-based spine care specialists based on a model of specialty care like podiatry and dentistry. (more…)

Posted in: Chiropractic, Politics and Regulation

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The Time a Pulitzer Prize Winning Journalist Got Manipulated by a Chiropractor


You have WiFi allergy, chronic Lyme, multiple chemical sensitivity, and menopause!

Katherine Ellison won a Pulitzer Prize in 1985, not for science journalism but for coverage of the monetary mayhem perpetrated by Ferdinand and Imelda Marcos on the people of the Philippines. I was nine at the time and have little recollection of the impact of her work, but I will assume that it was meaningful in light of the award. And she went on to win numerous additional accolades for her writing on politics, economics, and human rights.

Her most recent work, “Chiropractic Care Grows, and Gains Acceptance“, will likely not be considered for any journalism awards. The article, published on the New York Times Health and Wellness blog, reveals a terribly flawed understanding of chiropractic practice and philosophy and a preternatural ability to interpret fleecing at the hands of an obvious quack as a positive experience. She displays few if any signs of an ability to think critically when it comes to medicine and gives no indication of having done more than cursory research on the subject of chiropractic.

Sometimes the apple does fall far from the tree

The inspiration for Ellison’s article was a trip to the chiropractor after having injured her tail bone during a spin class. She does this despite having grown up with a surgeon father who apparently did not think highly of “alternative healers,” particularly chiropractors. Right off the bat she brings up the history of the AMA’s stance on the chiropractic profession:

Of course, this was in the 1960s, when the American Medical Association was still waging war on the profession via its Committee on Quackery, which labeled chiropractors as an “unscientific cult.”


The A.M.A.’s Committee on Quackery is long defunct, having gone out of existence after a lawsuit by chiropractors led to a 1987 federal district judge’s ruling that the medical association had tried to destroy the chiropractic profession.

Well, not exactly. The AMA absolutely was vehemently opposed to chiropractic and its practitioners and, as Dr. Harriet Hall describes, they are far from beyond reproach in the methods they used. In fact, I think you would be hard pressed to find anyone that would defend their tactics today. But the Committee on Quackery actually disbanded in 1974, two years prior to the filing of the infamous Wilk v. AMA antitrust lawsuit and at a time when all 50 states were licensing chiropractors. Louisiana, as backwards as my home state can be when it comes to science and medicine, was the last to give in that same year.


Posted in: Science and Medicine, Science and the Media

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Chiropractors Lobby for Acceptance by the VA and TRICARE



It seems alternative medicine is infiltrating into more and more organizations that should be based on science. We have quackademia in medical schools, integrative medicine clinics in hospitals and medical centers, government funding for alternative medicine research and education, coverage of alternative medicine by government and private health insurance, and acceptance of alternative practitioners in the VA and in military hospitals. Two weeks ago I wrote about an ill-advised effort to get naturopathy into the VA. Now it seems chiropractors have been lobbying to give all veterans and TRICARE beneficiaries access to chiropractic care. On the Society for Science-Based Medicine blog, Jann Bellamy has provided the details.

There are several bills pending: S. 398 and H.R. 1170 for the VA and H.R. 802 for TRICARE. There is also a bill (H.R. 542) that would include chiropractors in the National Health Services Corps. The American Chiropractic Association has issued statements in support of those bills. In their statements, they misrepresent what chiropractic is and what it can do. (more…)

Posted in: Chiropractic, Politics and Regulation

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October is National Chiropractic Health Month!

October is National Chiropractic Health Month (NCHM) and chiropractors can’t resist the opportunity to overstate, obfuscate, and prevaricate in celebration.

They do this in the face of some unfortunate (for them) statistics revealed by a recent Gallup Poll. The Poll was paid for by Palmer College of Chiropractic as part of an effort to increase the chiropractic share of the health care pie. (There is also a secondary analysis of the poll in the Journal of Manipulative and Physiological Therapeutics.) We’ll get to those stats in a few minutes.

But first, in celebration of NCHM, the American Chiropractic Association (ACA) has produced a set of six graphics chiropractors can download and display. Four of them fudge on the facts. Let’s take a look at these graphics, compare them to the evidence cited in support of their claims, and see where the ACA went astray. (The ACA also hosted a twitter chat yesterday with the hashtag #PainFreeNation.)


The study cited as evidence for this graphic actually compared both manual thrust manipulation (MTM) and mechanical-assisted manipulation (MAM) to each other as well as manipulation versus usual medical care (UMC). Although MAM, such as the Activator Method, is the second most common manipulation technique used by American chiropractors, is increasing in popularity among them, and is touted to be a safe and effective alternative to MTM, this study found that MTM is more effective (at 4 weeks) than MAM and that MAM had no advantage over UMC. But you don’t see that in this graphic.


Posted in: Chiropractic, Clinical Trials, Critical Thinking

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The Enigma of Chiropractic: A Brief Review with a Perspective on Chiropractic as a Specialty

 Subluxation-based chiropractic care is sustained more by faith than by facts.

Subluxation-based chiropractic care is sustained more by faith than by facts

Much of what is discussed in this article has been said before in previous articles I have written for Science-Based Medicine. But since the audience for SBM has greatly increased over the past few years, some subject matter should be repeated for the new readers and researchers coming to this site for reliable information on health care.

Many consumers now search SBM for articles dealing with controversial alternative treatment methods that have been shown to be ineffective or to be loaded with fraud and quackery. Chiropractic in particular continues to be problematic for its failure to renounce the scientifically indefensible, nonfalsifiable subluxation theory that defines the profession as a whole. A review of chiropractic web sites reveals that many chiropractors continue to base their treatment methods on subluxation theory, encompassing a broad scope of health problems. Some chiropractors are now including use of “functional medicine” which uses “natural tools” to treat diabetes, thyroid disease, neuropathy, and other diseases best treated by conventional medical care. Most alarming of all is the treatment of infants and children by “pediatric chiropractors.” Chiropractors are being certified in 10 different specialties, including a diplomate in Diagnosis and Internal Disorders.

As long as chiropractic is licensed as a health-care profession based on subluxation theory or some other unscientific approach, it will continue to be subjected to scrutiny and criticism by the science-based community. It is, in fact, the moral and ethical responsibility of science-based practitioners to oppose any form of unscientific health care, wherever it might exist, separating sense from nonsense without being influenced by politics, special interest, pseudoscience, or belief systems.


Posted in: Chiropractic, Science and Medicine

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Medicine in the Magic Kingdom of Cascadia

Beautiful Cascadia, where science goes to die.

Beautiful Cascadia, where science goes to die.

When the Pacific NW secedes from the Union it is to be part of a new country, Cascadia. The capital would be Portlandia, I suppose. Somehow, I think not. But when I watch the devolution of health care in Oregon, I think back to The Onion (?) when they reported that the United Kingdom was to be sold to Disney, being renamed as “The United Magic Kingdom.”

That is health care in Oregon due the steady insinuation of naturopathy and other pseudomedicine into real health care.

Oregon Health and Pseudoscience University

Growing up my alma mater was the University of Oregon Medical School. Since then it has undergone two name changes, first to Oregon Health Sciences University and then to the current Oregon Health & Sciences University (OHSU)—with, it should be noted, an ampersand. Not an ‘and’.

Perhaps they need one more name change, since they are not always that interested in the “Science” part of their name.

Some background is needed.

Portland has a trifecta of pseudoscience schools: Naturopathic (National College of Natural Medicine), Chiropractic (University of Western States) and ‘Oriental’ (Oregon College of Oriental Medicine).

Lucky us.

As an aside my kids let me know that the word ‘Oriental’ as used to describe people from the East, the term I grew up using, is persona non grata. I understand the reasoning. The proper term, they tell me, is Asian. So I have a mental cringe every time I see the name “Oregon College of Oriental Medicine”.

All three schools are steeped in pseudoscience and pseudomedicine, removed from known reality. As examples, the naturopathic school teaches homeopathy (and more), the chiropractic school teaches the subluxation complex, and the ‘Oriental’ (cringe) school teaches acupuncture. Reading the curricula of the schools suggests that there is no pseudomedical stone left unturned. (more…)

Posted in: Naturopathy, Politics and Regulation, Public Health

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Learning quackery for Continuing Medical Education credit



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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