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Studying Chiropractic with Imaging: Another Dead Salmon?

The Activator: a spring-loaded thumper. Is this "chiropractic"? Does it really balance the alignment of the lumbar spine and sacrum?

The Activator: a spring-loaded thumper. Is this “chiropractic”? Does it really “balance the alignment of the lumbar spine and sacrum”?

Researchers in Japan have done a study evaluating the effects of chiropractic treatment using MRI and PET scans. It was published in the 2009 report of the Cyclotron and Radioisotope Center (CYRIC) of Tokohu University.

Their rationale for doing the study

Ray Hyman‘s categorical imperative is “Do not try to explain something until you are sure there is something to be explained.” These researchers believe there is something to be explained. They think chiropractic has proven clinical benefits and they are trying to find the underlying physiological mechanisms. They think they have found something with their advanced imaging procedures, but the dead salmon study and Satel and Lilienfeld’s book Brainwashed have taught us that neuroimaging studies can be misleading and must be interpreted with great caution.
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Posted in: Chiropractic

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Alternative Medicine Is Infiltrating Veterinary Continuing Education

We want the veterinarians who care for our animals to continue their education and keep up to date by learning about new developments in science. A new proposal for veterinary continuing education would encourage them to learn to use questionable treatments based on pseudoscience and fantasy.

We want the veterinarians who care for our animals to continue their education and keep up to date by learning about new developments in science. A new proposal for veterinary continuing education would encourage them to learn to use questionable treatments based on pseudoscience and fantasy.

My friend Carmen Czachor is a science-based veterinarian practicing in Port Angeles, Washington. She has alerted me to a disturbing development that she fears will “put veterinary medicine back in the dark ages.” The Washington State Department of Health is contemplating a rule change in the regulations requiring continuing education for veterinarians. Current requirements are for 30 hours of continuing education every 3 years; the only restriction is that no more than 10 hours can be earned in practice management courses. The Veterinary Board of Governors had observed an increase in the volume of continuing education courses related to CAVM (complementary and alternative veterinary medicine) and they wanted to provide some guidance. They explain:

The board originally proposed a ten hour limit on the number of veterinary CAVM CE hours that can be earned in any three year reporting period. After stakeholder feedback from multiple veterinary practitioners who practice solely in CAVM, the board decided to revisit the proposal. The board now proposes to establish a twenty hour limit on CAVM continuing education and add a ten hour minimum requirement for conventional medicine. The board finds that doing so would not result in a reduction in the quality of care provided and supports the consumer’s choices about what kind of care they seek.

Note: “stakeholder feedback from multiple veterinary practitioners who practice solely in CAVM.” I find this alarming. Veterinarians are licensed to practice veterinary medicine, not CAVM. Alternative medicine is called “alternative” because it is not supported by the kind of evidence that would earn it a place in conventional medicine. What does it mean that veterinarians are “practicing solely in CAVM”? Does that mean they have abandoned the conventional veterinary medicine that they were licensed to practice?

And how on earth did they determine that the proposal “would not result in a reduction in the quality of care provided”? They just made that up because they wanted to believe it and because they believe alternative medicine constitutes quality care. (more…)

Posted in: Politics and Regulation, Veterinary medicine

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Separating Fact from Fiction in Pediatric Medicine: Facial Nerve Palsy

An infant with a left facial nerve palsy

An infant with a left facial nerve palsy

There are numerous medical conditions that are seemingly designed to allow proponents of “irregular medicine” to proclaim their treatments to be effective. These conditions tend to be chronic and subjective in nature, or to have waxing and waning courses such that a parent or patient might easily be fooled into assigning a causal relationship between a bogus intervention and a clinical improvement. Brief, self-limited maladies are also quite convenient for people with nothing to offer but false information and false hope. After a recent encounter with a patient, I’ve added a new one to the list: idiopathic facial nerve palsy.

What is idiopathic facial nerve palsy?

Although not the first to do so, facial nerve dysfunction resulting in the sudden and unexplained weakness of all muscles on one side of the face was most famously described by Scottish neurophysiologist Sir Charles Bell in 1830. Hence it is commonly, if not always accurately, referred to as “Bell’s palsy.” Since then our understanding of the condition has progressed considerably, thanks to scientific investigation and improved diagnostic testing. In particular, we have learned that many cases are the result of infection, with ear infections, various human herpes viruses, and the spirochete responsible for Lyme disease being the most common culprits in children. (more…)

Posted in: Science and Medicine

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Legislative Alchemy 2016 Update: Acupuncturists win; naturopaths and chiropractors don’t (so far)

Legislative Alchemy

Legislative Alchemy

Legislative Alchemy is the process by which state legislatures transform pseudoscience and quackery into licensed health care practices. By legislative fiat, chiropractors can detect and correct non-existent subluxations, naturopaths can diagnose (with bogus tests) and treat (with useless dietary supplements and homeopathy) fabricated diseases like “adrenal fatigue” and “chronic yeast overgrowth,” and acupuncturists can unblock mythical impediments to the equally mythical “qi” by sticking people with needles. In sum, by passing chiropractic, naturopathic, acupuncture, and Traditional Chinese Medicine (TCM) practice acts, states license what are essentially fraudulent health care practices and give them an undeserved imprimatur of legitimacy.

Only 6 of the 50 state legislatures are in regular session now. Many have ended two-year (2015-2016) consecutive sessions in which legislation from one year carries over into the next. The Texas, Montana, and North Dakota legislatures didn’t meet at all in 2016.

During 2015-2016, over a dozen naturopathic licensing or registration bills and at least 15 naturopathic practice expansion bills were introduced. (In some states, companion bills were introduced in each house. These were counted as one bill.) At least 19 chiropractic practice expansion bills were introduced in the same period. Four acupuncture/TCM practice acts were introduced, as were 14 practice expansion bills. This count does not include bills trying to force public and private insurers to cover CAM practitioner services.

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Posted in: Acupuncture, Chiropractic, Legal, Naturopathy, Politics and Regulation

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Robotically-Assisted Acupuncture Brings Ancient Healing Technique Into the 21st Century

An acupuncturist and acupuncture anesthetist perform robotically-assisted acupuncture on a patient who has been feeling kind of tired lately

An acupuncturist and acupuncture anesthetist perform robotically-assisted acupuncture on a patient who has been feeling kind of tired lately

Developed over many thousands of years (or maybe a little less), what has come to be known as traditional Chinese acupuncture has proven capable of curing or at least ameliorating the symptoms of a variety of medical conditions. But one of its greatest strengths, the intimate connection between the practitioner and the acupuncture needle, is also one of its most significant weaknesses. Taking advantage of the robotic technology being used by surgeons to perform an increasing number of minimally-invasive procedures, cutting edge acupuncture providers are now able to provide relief for patients that were once felt to be either poor candidates or had failed to improve despite treatments with traditional acupuncture by hand. (more…)

Posted in: Acupuncture, Humor

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Chiropractic Moves into Transportation

Pictured: Not a justification for chiropractic care
I debated which of two topics to blog about this week that appeared in my feeds.

The first was “Graduate slams CQU for offering ‘pseudoscience degree’,” where an Australian is upset that her University is offering an undergraduate Bachelor of Science in Chiropractic and a postgraduate Master of Clinical Chiropractic degree because chiropractic is “complete pseudoscience”.

And the second was:
Foundation for Chiropractic Progress Publishes Landmark White Paper : Non-Pharmaceutical Pain Management is a Safer Strategy than Opioids.”

Why choose? Just keep in mind that chiropractic is “complete pseudoscience” as we look at the landmark white paper. (more…)

Posted in: Chiropractic, Humor

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Pushback on Chiropractic

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

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

From time to time we respond directly to reader comments or e-mails in an article, when it seems that doing so would be a useful teachable moment. One of the strengths of social media is that it is interactive, which can be didactic.

I feel it is very important to respond to what people actual believe and say, because otherwise we may tend to get lost in our own narrative, as legitimate as it might be. That is the essence of ivory tower syndrome, academics talking to themselves without a reasonable sense of what is happening in society. Part of our mission is to interact with society, not just our colleagues, and to engage in a serious conversation about the nature of science and medicine.

To that end, I recently received an e-mail responding to an interview I had done previously about chiropractic. The e-mail is full of pro-chiropractic propaganda and misconceptions, and so it provides an opportunity to address some of these claims. (more…)

Posted in: Chiropractic

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Australian Chiropractor Ian Rossborough Promises to Stop Treating Children…for Twenty Days

kangaroochiro

An Australian chiropractor treating a baby kangaroo makes as much sense as treating a human child

Before I begin this brief update to my recent post on Australian baby chiropractor Ian Rossborough’s “crack heard round the world,” I want to give a quick thanks to Jann Bellamy for organizing our day of Science-Based Medicine at NECSS last week. It was an amazing experience sharing the stage with the SBM crew for my first public presentation, and finally getting to meet Scott, John, and Saul. I’ve given hundreds of lectures to residents and students, and even a grand rounds or two, but this was orders of magnitude more exciting and stressful. I may be biased, but I think we nailed it.

With NECSS prep taking up a significant percentage of my time and a rough current work week making up for days off, my post today is a little shorter than usual. My overall average word count still gives Gorski a run for his money however. Well, that’s not actually true. Gorski is in another league.

Rossborough provides an undertaking?

Chiropractor Ian Rossborough, who I recently discussed in a post on the backlash against pediatric chiropractic in Australia, has received the slap on the wrist I sadly expected. According to the Australian Health Practitioner Regulation Agency website, which has jurisdiction over the Chiropractic Board of Australia when it comes to “professional conduct, performance or health of registered health practitioners,” Rossborough has promised to leave them kids alone:
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Posted in: Chiropractic, Science and Medicine

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The Crack Heard Round the World

Chiropractor Ian Rossborough mid-rationalization

Chiropractor Ian Rossborough shown here mid-rationalization

In January, Melbourne chiropractor Ian Rossborough uploaded a video to YouTube of himself treating a 4-day-old premature infant. The video, one of many that can be found on his “Chiropractic Excellence” channel, is for educational purposes only, intended to teach the world about the miraculous benefits of chiropractic care for a wide variety of conditions. Although the cynical among us may proclaim that his videos are just more examples of chiropractic practice building shenanigans, Rossborough claims that he simply wants to “enable natural healthy living, without resorting to drugs or surgery.”

Australian physicians respond

Well, there are apparently a lot of angry and cynical Australians, particularly journalists and physicians. In late April, the video, which features Rossborough manipulating the newborn’s thoracic spine hard enough to cause a loud cracking sound and a cry of pain went viral after it was featured in a story on Australian Broadcasting Corporation Radio National. Rossborough, and the treatment of children by chiropractors, has since come under intense scrutiny.

According to the Australian press, “doctors have declared war on chiropractors” in response to the realization that newborns and young infants are undergoing unnecessary spinal manipulation for problems such as colic, acid reflux, and excessive crying as well as for nebulous benefits like boosting the immune system and improved growth and development. The Royal Australian College of General Practitioners, the largest medical college in Australia with a membership of over 30,000 rural and urban primary care physicians, has even requested that members refrain from referring patients to chiropractors. They want the federal government and private insurers to stop paying for nonsense such as infant chiropractic.

Frank Jones MD, president of the RACGP, has made the media rounds, describing infant and toddler adjustments as “seemingly almost cruel” and lacking any supporting evidence. He has also called for the Chiropractic Board of Australia to shape up in order to have any chance of being accepted as a legitimate scientific discipline. Jones thinks that chiropractors like Rossborough and his ilk don’t know what they are doing and are putting patients at risk. He reminds the public that a physician’s job is to advocate for patients and to try to reduce exposure to practices where the risk far exceeds any potential benefit. I like this guy.

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Posted in: Chiropractic, Science and Medicine

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Chiropractors, Blind Pigs, and Acorns

Sometimes you need to help the blind pig.

Sometimes you need to help the blind pig.

When people are at the end of their life they like to pass on their life lessons. One thing I have never had a patient say is “Doc, I sure wish I had spent more time at work.”

I try and keep that in mind, but then there are those work commitments that are hard to avoid. I need to have a talk with Drs. Gorski and Novella. No one should have write a blog entry any week their team is in the play-offs. The Blazers were not meant to win more than 25 games, much less be the 5th seed in the West with a chance to make the conference finals. I know. Trailblazers fans are not always grounded in reality. But we are up on the Clippers 3–2 and heading home to close out the series tonight. For the record I wrote the preceding sentence during the game 5 tip-off. I really should not have to do any work this week. Basketball is simply more important.

Take this case report. Anywhere else.

Case reports are a tradition in medicine. Usually they are unique or unusual cases, diseases you are likely to see but once in a career, if that. There are all sorts of medical curiosities that need to be reported. I have a blog over at Medscape devoted to Infectious Disease case reports.

Some case reports, however, inspire eye rolls and sniggers. Why are these even reported? (more…)

Posted in: Chiropractic, Clinical Trials, Humor

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