Mar 07 2014

Health of Vaccinated vs Unvaccinated

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270 responses so far

270 Responses to “Health of Vaccinated vs Unvaccinated”

  1. NNMon 07 Mar 2014 at 1:51 pm

    I’m glad you put chiropractors in the same category as homeopaths…
    Almost everyone I know sees chiropractors, and there is NOTHING I can say to make them understand they’re being tricked into immediate relief (probably psychological)… And they get angry when I tell them I think the chiropractor is the main reason their backs never heal. Please write an article about chiropractors; give me some “ammo”. (PLEASE!!)
    Sorry, off topic…

  2. zorrobanditoon 07 Mar 2014 at 2:45 pm

    @NNM

    I have many friends who swear by chiropractors, and even more who swear by homeopathic remedies. (I don’t know much about chiropractors, but what I know about homeopathy makes it look like complete nonsense to me.)

    But no one can be “tricked” into getting well (or, if they can, sign me up, that’s fine too) and if people with ailments which are out of the reach of conventional medicine find relief from pain, get well, feel better, I can’t see for the life of me what is wrong with that. Pain in particular always has a strong psychological component; many main-line pain clinics rely on this fact in formulating remedies, and this very often works for them and for their patients. Not enough attention, in my opinion, is paid to the therapeutic effects and the very real benefits of care, attention and other intangibles in the treatment of pain.

    Your post sounds like you would like to take someone who actually feels relief from pain and talk them out of feeling better. That can’t be what you mean, since I gather that you are a physician.

  3. NNMon 07 Mar 2014 at 3:34 pm

    Zorro,
    I said they feel immediate relief; but my main point is that I strongly believe that “the chiropractor is the main reason their backs never heal”…
    If they would just follow my advice, and stop seeing the chiro for a few weeks, and move more, as simply going for walks. But they insist on seeing their chiro at least once a week. After the session, they laugh about how much pain he subjects them too.
    It saddens me to see them destroy their health, and waste money on charlatans.

  4. BillyJoe7on 07 Mar 2014 at 3:51 pm

    zorrobandito,

    I think you have an unrealistic view of the placebo effect.

    When patients report that they feel better, it may be because….
    - they may not actually feel better but simply report that that feel better in order to please the attentive practitioner who has gone to all the trouble of trying to help them.
    - they may think they feel better without actually being better.
    (There is an asthma study where patients said they felt better but objective measurements indicated they their asthma had not improved.)
    - they may simply be returning to the mean.
    (Patients tend to seek treatment when they are at their worst, meaning that they are likely to improve whatever they do)

    Also the placebo effect, whatever the mechanism, is generally short lasting and generally disminishes with repeat treatments.

    As for what the harm…
    - the asthma study above shows that there is a potential for harm.
    (If you think your asthma has improved but it hasn’t you may neglect to take your ventolin)
    - there is the harm of using ineffective treatments in place of proven effective treatments.
    - there is the harm of being potentially drawn into the world of alternative medicne world for the management of more serious conditions for which effective treatment is available
    - there is the general harm of believing something to be true when it isn’t.

    In summary, if all you have is the placebo effect, this means that the treatment doesn’t work.
    Find yourself a scientifically based effective treatment.

  5. BillyJoe7on 07 Mar 2014 at 4:34 pm

    NNM,

    There are plenty of articles on chiropractic at the science based medicine blog.
    Search the categories section on the right.

  6. zorrobanditoon 07 Mar 2014 at 4:52 pm

    “- they may think they feel better without actually being better.”

    If I feel better I feel better, and no one is going to talk me out of it. (Just as when I am in pain no doctor is going to talk me into the idea that I am not.)

    I understand the anxiety that a patient may neglect effective treatments in favor of ineffective ones. But what about conditions (and so much back pain falls into this category) about which conventional medicine can do little or nothing? When there is no scientifically established effective treatment at all?

    If I had such a condition (which I am grateful that do not) and I found something that made me feel better without doing any demonstrable harm (I imagine most homeopathic treatments would fall into this category, since as I understand them they are chemically inert) you will have a very hard time talking me out of the idea that I feel better, doctor, or that I shouldn’t feel better for some reason which is important to you (“believing something to be true when it isn’t”) but which may not be important to me.

    Most of my friends who visit chiropractors have been advised by their doctors that nothing much can be done about their pain. If the chiropractor makes them feel better that is good for all concerned so far as I can see.

  7. Bruceon 07 Mar 2014 at 7:06 pm

    Zorro,

    Simon Singh sums up just about everything to do with the “What’s the harm” gambit:

    http://www.1023.org.uk/whats-the-harm-in-homeopathy.php

    In short, you think Homeopathy helped you once when you have something that is manageable without medical intervention, so when you do actually get sick, you go see them first and it delays or even substitutes real treatment resulting in a lot of harm or even death (considered to be the maximum harm).

    As for Chiros, the risk to reward ratio is just not worth it. They can do real harm with very little evidence for any kind of cure for most, if not all, of their claims. That, for me is much worse than Homeopathy.

  8. DrJoeinCAon 08 Mar 2014 at 12:13 am

    Bruce: I think you are missing Zorro’s point. He is talking about relief of symptoms, not curing or prevention of disease. The Singh article pointed out the danger of substituting homeopathy for traditional medicine in the treatment or prevention of diseases. That has nothing to do with symptom relief.

    Real harm from chiros? I guess, apart from the occasional “chiro-caused-a-stroke” anecdote, I haven’t seen that. I think the problem with chiropractic is that they seem to tend to hang onto their patients for many treatments and tend to sell preventive adjustments and such. But there is not much doubt that many patients experience significant relief of symptoms such as back pain from judicious use of chiropractic.

    BillyJoe: When patients report they feel better, it may be because…they actually do feel better.

  9. BillyJoe7on 08 Mar 2014 at 1:03 am

    zorrobandito & DrJoe,

    Neither of you have addressed the points I made in my post.
    In that post, I have already answered the objections both of you have raised in your follow up posts, so all I am prepared to do at this stage is to suggest you go back and read my post again.
    If, after you have considered all of these points, you still have an objection, please let me know, because I believe I have covered all bases.

  10. BillyJoe7on 08 Mar 2014 at 1:16 am

    DrJoe,

    “But there is not much doubt that many patients experience significant relief of symptoms such as back pain from judicious use of chiropractic”

    This is incorrect.

    Patients often feel less pain after chiropractic treatment, but this does not mean that the chiropractic treatment provided that relief. That is your fallacy – after this, therefore because of this.

    Chiropractors often employ massage and physiotherapeutic techniques as an adjunct to their chiropractic manipulations. These have been shown to provide some benefit. Chiropractic manipulation has not.
    The harm is that you pay out a lot in time and money for no benefit and potentially subject yourself to other forms of useless altmed practices promoted by the chiropractor, including anti-vaccination advice.

  11. weingon 08 Mar 2014 at 1:17 am

    “If I feel better I feel better, and no one is going to talk me out of it. (Just as when I am in pain no doctor is going to talk me into the idea that I am not.)”
    Maybe not. Maybe a chiropractor or a witch-doctor with some mumbo-jumbo may make you forget. If that is the case, you merely received was entertainment and distraction. Watch the 3 Stooges or some such. It’s cheaper and safer.

  12. Bruceon 08 Mar 2014 at 4:53 am

    DrJoe:

    “He is talking about relief of symptoms, not curing or prevention of disease.”

    I did not deny that the patient did not feel relief from symptoms. The danger in them thinking it was magic woo that cured them as opposed to regression to the mean or any other placebo effect gives them a false sense of security when it comes to treating something more serious.

    “Real harm from chiros? I guess, apart from the occasional “chiro-caused-a-stroke” anecdote, I haven’t seen that.”

    The evidence is not anecdotal, here is a good starting point:

    http://www.quackwatch.com/01QuackeryRelatedTopics/chirostroke.html

    “When patients report they feel better, it may be because…they actually do feel better.”

    There is a very big difference between feeling better and actually being better. Sufferers of major trauma often report feeling quite good despite very obvious evidence to the contrary. Even if they were better, you still miss the point mentioned many times above.

  13. zorrobanditoon 08 Mar 2014 at 11:00 am

    “Chiropractors often employ massage and physiotherapeutic techniques as an adjunct to their chiropractic manipulations. These have been shown to provide some benefit.”

    I’ve never been to a chiropractor, so I know all this only second hand.

    But if, as you are suggesting, massage and physiotherapeutic techniques can provide some measure of pain relief, perhaps more could be done to incorporate these techniques into main-stream medicine. This would keep patients like this out of the hands of chiropractors, if that is an anxiety.

  14. NNMon 08 Mar 2014 at 11:01 am

    BillyJoe7, can’t find the link you refer to…
    Only finding mostly 10 year old studies.
    HOW do I prove to the common people, that they should avoid the chiropractor. Many will even answer that their DOCTOR recommended it!?
    Is there any easy to read page I can send them to? One that doesn’t look like a mickey mouse website with words such as “quack”, pictures of ducks, or filled with “donation” links such as http://www.sfsbm.org/. These websites look so amateurish and fake I just shake my head and close them within 5 minutes.

  15. Steven Novellaon 08 Mar 2014 at 12:12 pm

    zorro – they already are. Physical therapists, physiatrists, and sports medicine doctors use these modalities. There is nothing that is legitimate and evidence-based that is unique to chiropractic. When chiropractors are strictly evidence-based, in my opinion, they are basically physical therapists.

  16. DrJoeinCAon 08 Mar 2014 at 12:40 pm

    BillyJoe: Your point is that when patients report they feel better it is because of one of three reasons: to please the practitioner; their incorrect perception of feeling better; or they were going to get better anyway. There is a fourth reason that you did not include, i.e., that the patient actually did feel better. Again we are talking about symptoms. If the patient once had pain and now they don’t have pain, that is “better.”

    If a patient walks into a chiro’s office with back pain all hunched over and in spasm and in pain, undergoes “treatment” whether manipulation or physiotherapy or massage in the chiro’s office, and comes out walking upright and without pain, my conclusion is that the treatment in the office had something to do with it. There was no other intervention, no sudden regression to the mean.

    Bruce: We’re not talking about “major trauma.” We’re talking about simple stuff like back pain. The document you reference states that the incidence of side effects is unknown, and it relates to neck manipulation. I wouldn’t send my 90 year old mom to a chiropractor for neck manipulation because there is the possibility of harm. But for the average not-very-elderly person with back pain, sure.

    As Steve says, chiros use many modalities.

  17. NNMon 08 Mar 2014 at 12:53 pm

    About vaccination topic, I have an anonymous confession… I know they work, I know how they work, why they work…
    But, I have an extreme phobia of them… Injecting the virus into my blood just instinctively feels wrong. I’d recommend it to others, but I can’t bring myself to do it.
    https://en.wikipedia.org/wiki/Hepatitis_A_vaccine
    https://en.wikipedia.org/wiki/Hepatitis_B_vaccine
    I’m supposed to get those in relation with my work. But I can’t. I just want to run away whenever it becomes reality.
    It’s probably stupid, but I can’t do it I can’t do it I can’t do it I can’t do it….

  18. ChrisHon 08 Mar 2014 at 1:29 pm

    “Injecting the virus into my blood just instinctively feels wrong.”

    First vaccines are not injected into your blood.

    And second, the virus for HepA has been inactivated. It will not reproduce:
    http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/hepa.pdf

    And thirdly, the HepB vaccine is not even a virus, but some proteins grown in yeast:
    http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/hepb.pdf

    The last few times I have been vaccinated for influenza, I have been amazed about how tiny the needles are. You really don’t feel.

    Go, get vaccinated. Bring a big strong friend to hold on to. It is better than immune globulin injections. Something my husband had to get when someone in a sandwich shop he had had lunch turned out to have Hepatitis A.

  19. weingon 08 Mar 2014 at 1:48 pm

    “If a patient walks into a chiro’s office with back pain all hunched over and in spasm and in pain, undergoes “treatment” whether manipulation or physiotherapy or massage in the chiro’s office, and comes out walking upright and without pain, my conclusion is that the treatment in the office had something to do with it. There was no other intervention, no sudden regression to the mean.”
    That reminds of the poor woman, hunched over her cane, walked into a hardware store and saw Joe the hardware store doctor. She walked out a few minutes later, straight as an arrow. He had given her a longer cane.

  20. BillyJoe7on 08 Mar 2014 at 2:09 pm

    DrJoe,

    “There is a fourth reason that you did not include, i.e., that the patient actually did feel better”

    What I’ve said twice now and can only repeat a third time, is that they will not have felt better because of chiropractic. They might have felt better for the other three reasons you mentioned, or because of physiotherapy or massage employed by the chiropractor, or for the psychological reason of having someone pay attention to them and doing something. But the chiropractic manipulation, itself, has no beneficial effect. That is what the evidence shows. That person needs to see a physiotherapist or a massage therapist and get a real physical effect along with the psychological effect. Or a counsellor or psychologist for a directed psychological effect. That will also avoid the potential harm of believing something that is not true, being given other treatments which have been proven not to work (ie homoeopathic and herbal remedies), and given information that is untrue (ie anti-vaccination advice).

    I really do hope I’ve made my point clear now…

    Placebo = does not work.
    Chiropractic manipulation = placebo = does not work.
    Find something that DOES work.

  21. Bruceon 08 Mar 2014 at 2:15 pm

    DrJoe,

    My reference to people with major trauma was illustrating the point that even people with obvious injuries can report feeling very good. Feeling good does not mean being good.

    I don’t really mind if it is proven physical therapy, as Steve said, if all they do is that, then they are basically physical therapists… the problem is while they might be able to cure with some of the modalities they use, they have quite a range of non-science based medical techniques that cause much more harm than good.

  22. NNMon 08 Mar 2014 at 2:25 pm

    ChrisH, for the A variant, “contains a live but attenuated virus”…
    Anyway, if you’ve ever see an “extreme phobia”…. I could get violent. Last time I tried, I just had to abort when I saw it get within 20cm of me… Followed by months of nightmares. I don’t think I can ever get vaccinated again. :(

  23. DrJoeinCAon 08 Mar 2014 at 2:38 pm

    BillyJoe: You seem to have trouble with the definition of “work.” They feel better following their treatment by a chiropractor. Whether it is because of the attention or massage or physiotherapy or “manipulation” or all of the above that they get with visiting one provider. Having no pain after treatment = feeling better after treatment = hmmm, maybe what just happened to me helped my back pain.

    References to homeopathy, herbal remedies, and anti-vaccination advice have nothing to do with their treatment by a chiropractor for their back pain.

    Bruce: And my point is that the setting of “major trauma” has nothing at all to do with the scenario of a patient seeking chiropractic treatment for musculoskeletal low back pain. The patient is seeking treatment for their symptoms. Feeling good to them is having less or no pain. Feeling good = being good.

    Weing: Irrelevant.

  24. BillyJoe7on 08 Mar 2014 at 2:47 pm

    NNM,

    “BillyJoe7, can’t find the link you refer to…”

    http://www.sciencebasedmedcine.org
    To the right of the text there is a scroll down menu labelled “categories”.
    Click on “chiropractic”.

    “Only finding mostly 10 year old studies”

    Chiropractic hasnt changed much.
    They should be fine.

    “HOW do I prove to the common people, that they should avoid the chiropractor. Many will even answer that their DOCTOR recommended it!?”

    You will have an uphill battle, especially if their non-evidence based, non science trained doctor recommends it. Many doctors have no idea how to evaluate a clincal trial. Altmed has infiltrated academia, medical schools, and medical practices (BTW, that is why sfsbm is asking for donations – to help combat this infiltration of non evidence based treatments into these institutions).

  25. BillyJoe7on 08 Mar 2014 at 2:55 pm

    DrJoe,

    ” You seem to have trouble with the definition of “work.””

    You seem to have trouble with the defintion of “chiropractic”.
    Once you have that definition right, you will see what I mean by “chiropractic does not work”.
    And, yes, apart from chiropractic not working, chiropractors do recommnend homoeopathy, herbal treatments, and anti-vaccination advice.
    You seem to be at pains to avoid acknowledging the harm that chiropractors do.

  26. ChrisHon 08 Mar 2014 at 3:33 pm

    NNM, I am so sorry.

  27. NNMon 08 Mar 2014 at 3:36 pm

    BillyJoe7, Link not working…

  28. weingon 08 Mar 2014 at 3:52 pm

    “Weing: Irrelevant.”
    Dang it. I was trying for irreverent.

  29. BillyJoe7on 09 Mar 2014 at 12:34 am

    NNM,

    Theres an ‘i’ missing in medicine.
    Here, try this: http://www.sciencebasedmedicine.org/

    Not sure why you still need to be hand fed though, or at you at the other end of the life cycle? (:

  30. NNMon 09 Mar 2014 at 6:48 am

    Category selection not working…
    “donate” – “buy”…
    Bad website.

  31. BillyJoe7on 09 Mar 2014 at 8:31 am

    NNM,

    Yeah, so you didn’t see the search function at the top right?
    Just type “chiropractic” in the space provided. (;

  32. Steven Novellaon 09 Mar 2014 at 12:21 pm

    Dr.Joe. In medicine we have a very specific meaning of the word “work” – it means there is a specific effect above and beyond non-specific placebo effects. If you redefine “work” to include placebo effects, then everything works, and the term losing all meaning.

  33. DrJoeinCAon 09 Mar 2014 at 12:48 pm

    Steven: Symptom relief is defined by the person experiencing the symptom. If the patient goes to a chiropractor and comes out with symptom relief, they consider that the chiropractic experience “worked.” Whether it’s the manipulation or attention or massage or some placebo effect added on, the experience and the care they got at the chiropractor contributed to their improvement. They know that. I don’t think it’s necessary to break it down into the components of the experience, like massage works and heat works and attention works but manipulation doesn’t work. It’s all a package and an experience that many patients find beneficial.

  34. Steven Novellaon 09 Mar 2014 at 1:11 pm

    I could not disagree more. It is very important to break down what components of an intervention are working, and which are window dressing. That is core to the science of medicine. Otherwise we waste resources doing things that do not add to efficacy, may contain unnecessary risk, and confuse future research.

  35. DrJoeinCAon 09 Mar 2014 at 1:54 pm

    Steven: Well, I guess we disagree. I think patients generally like the chiropractic experience because of everything that goes into it. The personal attention, the conversation, the demonstration of interest from the chiropractor, the massage, the ice/heat, the manipulation, the unnecessary x-rays. I suppose one could study each of the components that make up an hour session and see which could be eliminated and still have the patient experience symptom relief. But, if patient satisfaction is already fairly high and if patients report symptom relief from a chiro visit, then why would you want to do that except for academic interest?

    (If you got into an expensive treatment that was introduced that the insurance companies balked at, that’s a different thing.)

    I think there’s a lot of art that goes into the “science of medicine.” If medicine discounts the art aspect, the patient schmoozing, the physician knowledge and experience, the gut feeling, etc., it’s not really clear to me that this would be a better thing.

  36. Bruceon 09 Mar 2014 at 2:04 pm

    I find it funny that one of CAM biggest claims is that it addresses the cause and not just the symptoms, but then apologists fall back on arguments like DrJoe ie if it fixes the symptoms then why not!?

  37. NNMon 09 Mar 2014 at 2:48 pm

    So if you trick the patient into thinking he’s better, you’ve done a good job?
    I’m sure people could be convinced a good bleeding works; but that does not justify the practice.
    Chiropractors cause damage. They maintain the injuries, and prevent the body from healing. They are charlatans and should be treated as such.

  38. weingon 09 Mar 2014 at 2:52 pm

    “I suppose one could study each of the components that make up an hour session and see which could be eliminated and still have the patient experience symptom relief. But, if patient satisfaction is already fairly high and if patients report symptom relief from a chiro visit, then why would you want to do that except for academic interest?”

    Why bother with chiropractic? Just watch a Louis de Funès comedy or 3 Stooges. You may find you get the same, without the risks and the costs. Hey, they feel better so it works. What do you care if it’s pure placebo of distraction or entertainment and not bone crunching?

  39. BillyJoe7on 09 Mar 2014 at 6:11 pm

    DrJoe,

    “Steven: Well, I guess we disagree”

    That is a cop out.
    It’s not a matter of agreeing to disagree.
    Steven is right. You are wrong. Sorry.
    I invite you to read this whole exchange again and see if you don’t agree that you’ve been clutching at straws all along and ignoring important points that all of us have made that don’t read into your favoured narrative about chiropractic?

    “I think patients generally like the chiropractic experience because of everything that goes into it. The personal attention, the conversation, the demonstration of interest from the chiropractor, the massage, the ice/heat, the manipulation, the unnecessary x-rays”

    The point is that the actual “manipulation” – the actual chiropractic part of the variety of treatments that chiropractors use, and the reason chiropractic exists – does not work. Chiropractic manipulation can also occasionally do harm. Even if it does so rarely, this risk is unjustiable if the treatment has been shown not to work.
    Again you seen to be at pains to avoid acknowledging the harm of chiropractic, although I do see that you’ve plugged the x-rays as unnecessary. Is that not a harm?

    “I suppose one could study each of the components that make up an hour session and see which could be eliminated and still have the patient experience symptom relief”

    It’s been done for the actual chiropractic manipulation and it does not work.

    “But, if patient satisfaction is already fairly high and if patients report symptom relief from a chiro visit, then why would you want to do that except for academic interest?”

    A number of reasons…
    Time, cost, introduction to other unproven and disproven altmed treatments, anti-vaccination propaganda, believing something to be true when it is false, a false world view that makes you vulnerable to con artists and scammers.
    But I’ve said all this before, so no doubt it will continue to have no effect on you.

    “I think there’s a lot of art that goes into the “science of medicine.” If medicine discounts the art aspect, the patient schmoozing, the physician knowledge and experience”

    So why not use that with treatments that have actually been shown to work?

    “the gut feeling”

    Perhaps I’m exaggerating a little when I say this, but intuition is almost always wrong. At best – and provided it is based on what we already know – it can form the basis of an hypothesis to be tested. And it needs to be tested – through the rigors of the scientific method. This is how we know what it true and what is false.

  40. DrJoeinCAon 09 Mar 2014 at 6:46 pm

    NNM: Seriously? Chiros maintain injuries and prevent the body from healing?

    BillyJoe: You will notice, if you read more carefully, that I mentioned the “chiropractic experience,” not specifically the manipulation. It’s the whole experience that patients seem to like and find benefit from. Many patients do feel better symptom-wise after attending a chiropractic session or two or six. Regarding “harm,” we already addressed the unknown incidence regarding specifically cervical manipulation. I suspect there is less harm from chiropractic treatment of low back pain. Though I guess you think that their harm is that some of them espouse alternative opinions regarding things like homeopathy and non-vaccination. It’s up to the patient to follow that advice or not. Presumably, if they get propagandized by the chiropractor, their own family doc will provide the opposite viewpoint. Or do you think it’s up to someone to keep the patient out of hearing range of this propaganda?

    Regarding time and cost, I would bet it’s a wash between six sessions of chiropractic and six sessions of physical therapy. And it’s not the physician responsibility to shield the patients from propaganda or prevent them from whatever “world view” they want to have.

    Regarding the art aspect, the physician has to listen to the patient. If the patient reports success with chiropractic in the past and requests it again, the experienced clinician will recognize that the patient’s expectations have a lot to do with their healing. In the same vein, if the patient has tried multiple other modalities and found them to be of no benefit and suggests chiropractic because they have heard good things or whatever, perhaps the family doc will admit that it’s worth a try.

    Regarding gut feelings, the experienced physician will be able to see and hear what the patient is saying and where they’re coming from healthcare-wise. If the physician understands that the patient is sort of on the alternative medicine side of the line and requests chiropractic rather than physical therapy, here again the physician will recognize the patient’s expectations and perhaps go with them. That’s what makes it artful rather than robotic.

    The experienced physician will involve the patient in their own care. And again, we are not talking about treatment of disease. We’re talking about simple treatment of common symptoms.

  41. Bronze Dogon 09 Mar 2014 at 8:20 pm

    Why bother with chiropractic? Just watch a Louis de Funès comedy or 3 Stooges. You may find you get the same, without the risks and the costs. Hey, they feel better so it works. What do you care if it’s pure placebo of distraction or entertainment and not bone crunching?

    Curly: “I don’t know anything about chiropracty!”
    Moe: “Everyone just grab a spine and get crackin’!”
    Homer: “Hehe! Moe is their leader.”

  42. BillyJoe7on 09 Mar 2014 at 8:35 pm

    DrJoe,

    In my opinion, you don’t have any reasonable arguments so you’re scraping the bottom of the barrell and coming up empty.
    Your posts are loaded with empty arguments but I’ll give you just one example…

    “If the physician understands that the patient is sort of on the alternative medicine side of the line and requests chiropractic rather than physical therapy, here again the physician will recognize the patient’s expectations and perhaps go with them. That’s what makes it artful rather than robotic”

    That’s artful?
    For a doctor to refer a patient to a chiropractor because he knows the patient prefers alternative medicine would be what you have called “robotic”. Not artful! How is there any art or difficulty in that. Doctor could you please refer me to a chiropractor. Sure here you go. An artful approach would be for the doctor to find ways of correcting the patient’s misconceptions about treatments they think might have helped them in the past whilst, at the same time, keeping them onside. It would just easy to go along with whatever the patient wants. To persuade them to use what will actually help them can, on the other hand, prove extremely difficult and require all the resources at the doctor’s disposal.
    Okay, another empty bottom of the barrel argument….

    “if they get propagandized by the chiropractor, their own family doc will provide the opposite viewpoint. Or do you think it’s up to someone to keep the patient out of hearing range of this propaganda?”

    It’s not a matter of keeping the patient out of hearing range of propaganda, it’s a matter of them not even recognising it as propaganda.
    And they may not even have a family doctor. Some use chiropractors as their only port of call for their health. Some chiropractors even encourage that view. But the point is that most patients will not even see it as propaganda. Going on their “chiropractic experience” with a friendly attentive practitioner, they are unlikely to even question his advice. If they do have a family doctor, they are not likley even to mention treatments or advice offered by the chiropractor.
    And yet another empty bottom of the barrel argument….

    “And it’s not the physician responsibility to shield the patients from propaganda or prevent them from whatever “world view” they want to have. ”

    Responsibility or not, why wouldn’t a physician want to correct their patients’ misconceived “world view”? And it’s not a matter of “shielding” their patients from propaganda, it’s a matter of avoiding the undue influence of the charismatic practitioner. For an “artful” doctor with all the resources at his disposal, it will also be a matter of explaining that what the chiropractor is suggesting IS propaganda – that what he is suggesting has no evidential support.

    “The experienced physician will involve the patient in their own care.”

    Yes…by explaining to them the evidence, lack of evidence, or evidence against various proposed treatments and guiding them to an evidence based choice. Patients do not have experience and expertise. They need guidance from the experience and expertise of a evidence based physician. Otherwise what are you there for Joe? To pander to the patients wishes? Or to actually help them?

  43. DrJoeinCAon 09 Mar 2014 at 10:29 pm

    BillyJoe: You really don’t understand, do you? The “art” is recognizing that “correcting the patient’s misconceptions” is perhaps not something that the patient wants. The patient has developed their view of medicine and alternative medicine and believes that altmed is what they want to help them get better. The experienced physician will realize that “what will really help them” is perhaps what they want. The robotic response would be, “I know what is best for you because I have read the studies and this is what I will prescribe whether you like it or not.”

    Wow. “Avoiding the undue influence of the charismatic practitioner.” Sounds sinister. But it really isn’t. Perhaps you would also like to keep the patient away from certain books that hold alternative views of medical care?

    The artful, experienced, knowledgeable doctor will hold certain views of medicine and alt medicine. But he has to realize that he is there to help the patient. He gains the trust of the patient by doing what is in their best interests.

    Obviously — and this is the key point — it makes NO difference at all in the health of the particular patient whether they get chiropractic care for their low back pain or 6 weeks of physical therapy or yoga or a combination of all three. The patient is going to get better regardless of the treatment they get. The relationship of the doctor and patient, however, is important. If the doctor realizes — there’s that gut feeling — that the paternalistic, I-know-all-and-certainly-more-than-you approach to a particular patient is going to damage their relationship, then he will not adopt that attitude. He will be open to and accepting of what the patient is asking for and will discuss it in an open accepting manner because he knows IT MAKES NO DIFFERENCE. Either treatment will work.

    Certainly, if the patient were to broach the idea of using chiropractic for a condition the physician realizes might REQUIRE surgery or other modality or for treatment of a disease, this would be the time for education and convincing because it would be in the best interests of the patient to have the non-chiropractic treatment. But when it makes no difference, it makes no difference.

  44. grabulaon 09 Mar 2014 at 10:30 pm

    “An artful approach would be for the doctor to find ways of correcting the patient’s misconceptions about treatments they think might have helped them in the past whilst, at the same time, keeping them onside. ”

    Important enough to repeat. there’s a misconception that the patient might know best. I feel a good doctor does the right thing, and not the thing the patient thinks is right.

    @DrJoeinCA – by your reasoning if I suffer extreme back pain, but drink enough alcohol to take the pain away, I’ve found something that works?

  45. BillyJoe7on 09 Mar 2014 at 10:59 pm

    DrJoe,

    Your comments have now become completely content free.
    Thanks for the conversation, but that will be all for now.
    (I truly hope that you are not actually a doctor of medicine)

  46. BillyJoe7on 09 Mar 2014 at 11:07 pm

    DJ: “when it makes no difference, it makes no difference”

    Well, I’m going to leave you to figure this one out for yourself.
    Good luck!

    Okay, a couple of hints:
    Hint 1: This whole conversation has been about why there IS a difference.
    Hint 2: Read it again.

  47. zorrobanditoon 09 Mar 2014 at 11:16 pm

    “I feel a good doctor does the right thing, and not the thing the patient thinks is right.”

    Wow. That’s pretty arrogant, and in addition it is impossible.

    Doctors do not override the opinions of patients in this country, unless the patient has been declared incompetent in a court of law, and then he has to deal with the conservator. What are you suggesting? That a physician prevent an adult patient from consulting a chiropractor? How exactly do you suggest this be done?

    If a physician feels strongly that physical therapy would bring better results than a chiropractor in a case of, say, low back pain (and I believe that data is not all that clear on this point) the physician had better be prepared to do a sales job on the patient, and must also be prepared to lose.

  48. weingon 09 Mar 2014 at 11:36 pm

    “Doctors do not override the opinions of patients in this country, unless the patient has been declared incompetent in a court of law, and then he has to deal with the conservator. What are you suggesting? That a physician prevent an adult patient from consulting a chiropractor? How exactly do you suggest this be done?”
    Same as when a patient says that Vicodin will help him with his backache. That’s the patient’s opinion. I am overriding it and won’t prescribe it for him. How arrogant of me!

  49. grabulaon 09 Mar 2014 at 11:43 pm

    @zorrobandito

    “Doctors do not override the opinions of patients in this country”

    Doctors are highly trained professionals. A professional does not mislead a patient and suggest remedies for which there is no supporting science. A good doctor wouldn’t recommend homeopathic remedies for the same reasons.

    While a patient has some say in how he or she is treated, ultimately it’s the responsibility of the Doctor to determine the proper course of treatment. While some of this should be tailored to the patient, it shouldn’t’ go beyond unscientific treatments.

    It’s similar to a responsible financial advisor not recommending a client practice feng shui in order to bring in financial prosperity.

  50. DrJoeinCAon 09 Mar 2014 at 11:50 pm

    BillyJoe: And I guess you have not figured it out yet that some things just don’t make a difference, huh? When a doctor finds himself in conflict with his patient about something that doesn’t make a difference, it’s time to step back and determine whether the doctor/patient relationship or “being right” comes first. You obviously don’t get that part. The objective is to help the patient recover. Some people never get that, and they would rather “be right” than do the right thing for the patient.

    Weing: Vicodin? It depends on the patient, on the exam, on the general circumstances. Pain is a subjective thing. It may be that arrogance is preventing the physician from giving the patient Vicodin because he considers pain a part of life and adopts the “suck it up” philosophy of treating back pain. Perhaps the patient doesn’t feel the same way. Gee, maybe compromise is worthwhile.

  51. DrJoeinCAon 09 Mar 2014 at 11:53 pm

    Grabula: But what does the doctor do when the patient requests chiropractic as “the only thing that has helped in the past?” Argue with the patient that it really didn’t help them in the past because the studies show…?

    More like the client wanting to buy GE and the advisor recommending AMZN. Both are gonna work.

  52. grabulaon 09 Mar 2014 at 11:59 pm

    ” Argue with the patient that it really didn’t help them in the past because the studies show…?”

    Why argue at all. As a responsible doctor you explain to the patient where their perception has gone wrong. The patient has the option of going elsewhere to get his referral or to find another doctor who might be willing to kowtow to his misconceptions.

    Both AREN’T going to work, that’s what these guys are trying to explain to you and zorrobandito. You’re misconception is believing that 1 – the patient knows best and 2 – that co-operating with the patience ignorance is also best for the patient.

  53. DrJoeinCAon 10 Mar 2014 at 1:30 am

    Grabula: The patient comes to see the doc and says that chiropractic DID work in the past and he wants to try it again. Same back pain he gets every spring when he starts working in his garden, and chiropractic works every time. You expect the doc to tell him that it didn’t work? You want the doc to communicate to him that he is ignorant and has misconceptions?

    Here’s a better idea. Say ok to the chiropractic. The patient will feel better because, based on his prior experiences, chiropractic will help relieve his symptoms. The patient will feel better about the doc because he will see that the doc is listening to him and respects his opinion about how his body reacts to stuff. Win win. And when there is another interaction in the future when the doc really needs to communicate with the patient about making a difficult choice, the patient will listen.

    It is most assuredly NOT a misconception that patients frequently know what works for them and what doesn’t. How many times have you gone to a doc and you know what is wrong and what treatment has worked in the past? How pissed are you when the doctor doesn’t listen to you, and how bad do you feel about the encounter with the doctor?

    This is not brain surgery or diabetes treatment. This is a self-limited symptom of low back pain that will get better no matter which treatment is used. And it will get better faster if the patient is allowed to have a say in their care and treatment rather than being pissed at the doc who wouldn’t listen to them.

  54. grabulaon 10 Mar 2014 at 1:44 am

    “Here’s a better idea. Say ok to the chiropractic.”

    Yes, and continue to feed an industry that’s making a lot of claims about a lot of things science has shown doesn’t work.

    Chiropractors do so well because they offer a brief sense of relief that keeps you coming back, not to get the issues fixed, but to get it temporarily relieved.

  55. Bruceon 10 Mar 2014 at 3:53 am

    Wake up to 20 more comments and DrJoe is still rattling out the same argument and does not seem to understand the basics of what we are arguing. The What’s the Harm argument simply does not hold up in the long term