Apr 20 2010

The Chiropractic Conundrum

Some of the pseudoscientific “alternative medicine” modalities we deal with are easy to summarize: homeopathy is 100% nonsense – nothing but water; acupuncture (if you define it as placing needles in specific acupuncture points) has no measurable effect beyond placebo, and therapeutic touch and other forms of energy healing are nothing but magical thinking. But when people ask me, “What do you think about chiropractic?” there is no one-liner. This is partly because “chiropractic” is not a monolithic profession; it is a many-headed beast. It is a mixture of legitimate interventions and pure pseudoscience in widely varying proportions. But also, chiropractors tend not to be self-reflective as a profession, and are shy about outside scrutiny.

But the internet contains a wealth of information and is increasingly useful as a tool to survey practices and claims. Edzard Ernst has recently published a survey of English-speaking chiropractic websites and found some very informative results. Ernst is a professor of complementary and alternative medicine and has become the Energizer Bunny of holding CAM up to the light of rigorous science.

The question is this – since many chiropractors mix evidence-based and non evidence-based practices, what can we say about the percentage of chiropractors who are basically evidence-based vs pseudoscientific?  Are most chiropractors mostly scientific, or are most chiropractors peddling pseudoscience with just a patina of legitimacy?

The legitimate treatments chiropractors use is manipulation for lower back strain, for which there is some evidence of efficacy. Although there is no apparent advantage of any technique that is uniquely chiropractic – so physical therapists, sports medicine specialists, and physiatrists also use similar manipulative techniques. At their best, chiropractors are glorified physical therapists or sports medicine specialists. I am not aware of anything new or unique that they bring to the table, but some have developed a knowledge and skill base to function in this capacity.

But most chiropractors do not simply sell themselves or limit their interventions to physical medicine. They also include (again, to varying degrees) a variety of magical and pseudoscientific interventions, including the misuse of manipulative therapy. This includes high cervical manipulation for headaches and other conditions (an intervention that also carries a stroke risk), applied kinesiology, iridology, homeopathy (chiropractors are the most common prescribers of homeopathy in the US, although naturopaths are on the rise), and spinal manipulation for asthma, childhood ailments, and other conditions.

Now, really for the first time as far as I am aware, Ernst has provided at least some information about the percentage of chiropractors who engage in dubious treatments. He found:

Results: We found evidence that 190 (95%) chiropractor websites made unsubstantiated claims regarding at least one of the conditions. When colic and infant colic data were collapsed into one heading, there was evidence that 76 (38%) chiropractor websites made unsubstantiated claims about all the conditions not supported by sound evidence. 56 (28%) websites and 4 of the 9 (44%) associations made claims about lower back pain, whereas 179 (90%) websites and all 9 associations made unsubstantiated claims about headache/migraine. Unsubstantiated claims were made about asthma, ear infection/earache/otitis media, neck pain, whiplash in at least half of all chiropractor websites.

Conclusions: The majority of chiropractors and their associations in the English-speaking world seem to make therapeutic claims that are not supported by sound evidence, whilst only 28% of chiropractor websites promote lower back pain, which is supported by some evidence. We suggest the ubiquity of the unsubstantiated claims constitutes an ethical and public health issue.

As a caveat, when chiropractors advertise themselves they may be focusing on the more dubious claims because they think that will attract clients. But it is reasonable to presume that what chiropractors advertise reflects what they actually do. This study suggests that 95% of chiropractors feature dubious treatments in their practice, and that more than half made unsubstantiated claims about many treatments, suggesting this forms a major part of their practice. This study strongly contradicts those who claim that chiropractors are mostly evidence-based but a few bad apples dabble in nonsense. The reverse is true – dubious treatments appear to be the mainstay of their practice, and a very few (5%) stick to evidence-based treatments.

2010 is the 100th anniversary of the Flexner Report – essentially an expose on poor-scientific regulation of medical practices that led to a scientific revolution in mainstream medicine. Chiropractic is in major need of its own Flexner Report (an Ernst Report?). In my opinion they need to clean house if they want to become respected members of the evidence-based mainstream medical community. They are trying to achieve this through legislation, lobbying, and advertising rather than genuine quality control, and that is a shame. As Ernst writes – their failure to do so constitutes an ethical and public health issue.

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75 responses so far

75 Responses to “The Chiropractic Conundrum”

  1. bluedevilRAon 20 Apr 2010 at 9:30 am

    Dr. Novella, there is a lot of criticism levied against chiropractic (and rightfully so!), but I have yet to see osteopathic medicine tackled here on this blog or SBM.

    Any thoughts on their manipulations? I appreciate that they’re a different breed from chiropractors. Something like 95% don’t even manipulate. So I know DO’s can make fantastic doctors at top institutions, but I wonder if the osteopathic schools are more steeped in pseudoscience than their MD counterparts.

  2. DevoutCatalyston 20 Apr 2010 at 9:34 am

    Can you separate chiropractic from the back cracking? Those pops are pretty damn cool, whatever their effectiveness. It’s what a chiropractor does…

  3. bluedevilRAon 20 Apr 2010 at 10:03 am

    Personally, I love a good knuckle or back cracking. I have no idea why it feels good, it just does. The high velocity, low amplitude thrusts (HVLA) are downright scary though. I do not want someone jerking my neck around like that.

  4. SpicyCupcakeon 20 Apr 2010 at 10:17 am

    I am going to submit this to the SGU as a topic. However I will take any input. You rolled reference to acupuncture, healing touch, and chiropractic into one place. This spawned my memory of NUCCA. It is a form of chiropractic that supposedly manipulates the brain stem to perform chiropractic treatments. It sounds like the bastard of healing touch, acupuncture, and chiropractic. What are your thoughts about the plausibility of using brain stem manipulations (the reference I have only seen reference to using hands/fingers to do these manipulations) to perform already dubious treatments.

  5. eeanon 20 Apr 2010 at 10:50 am

    @bluedevilRA: I used to live in Kirksville, MO (the home of osteopathic medicine). My impression is that it is just a part of mainstream medicine. If anything the issue is that the only difference are the letters after the doctors name…

  6. Smedon 20 Apr 2010 at 11:05 am

    Is there any reason to seek out an evidence based chiropractor rather than going to a physical therapist? Are they less expensive?

  7. bluedevilRAon 20 Apr 2010 at 11:33 am

    @eean, that is or more or less my perspective as well. I think they are pretty equivalent, but I wonder if quackery still lurks in the shadows of osteopathy. Of course, the case can be easily made that quackery is pervasive throughout all of medicine. There are quack MD’s, DO’s, DDS’s, physical therapists, etc.

    While I do agree with you, I was curious to hear what Dr. N has to say about it. As a leader in the skeptical medical community, he may know more about the curriculum at osteopathic schools, for example. It is possible that I am letting recent high-profile osteopathic cranks (Rashid Buttar) tarnish their otherwise respectable peers.

  8. Gallenodon 20 Apr 2010 at 12:51 pm

    My wife sees a chiropractor once a month (on the advice of her primary care physician) to help relieve back pain after x-rays revealed that she has some vertabrae seriously out of alignment. It seems to help her.

    After reading this blog post I decided to check out her chiropractor’s Web site. While they apparently haven’t “pushed” any of this while my wife has been there, they contend that “Vertebral Subluxation Complex” is a problem and that: “Chiropractors are the ONLY health professionals trained in the detection, location, and correction of the VSC.”

    Why do I get the impression that only chiropractors use this term?

    They also have a link to a lovely little ICPA video on “Kids & Chiropractic” that seems to fall within the less reputable claims area.

    My wife will likely keep going there because she likes her chiropractor and gets relief from the treatment. It’s a little husband and wife practice and they’re nice people. But they appear to fall in the 95% that make or subscribe to fuzzy claims.

  9. ccbowerson 20 Apr 2010 at 1:02 pm

    How are we defining chiropractic? Are we defining it by whatever chiropractors out in the real world do? Or is it the defined by the theory of the study of chiropractic based upon its founding and theories behind its practice?

    The concept of subluxations being the source of many diseases has been shown to be baseless, and this is the basis for chiropractic. In order to show evidence for chiropractic we would have to expand our definition to include physical therapy techniques. If so, why is there even a separate profession?

    Maybe I’m missing something, but it appears that the profession has been in transition to evidence-based for so long, because any techniques that show evidence are no longer based in traditional chiropractic. In order to embrace evidence based chiropractic, they would have to abandon the field of chiropractic for what appears to be medicine and physical therapy. If so then how can we still call it chiropractic?

  10. lizditzon 20 Apr 2010 at 1:33 pm

    Dear Dr. Novella,

    Please take on “chiropractic neurology”. Melillo is marketing his “Brain Balance” “treatment” like crazy, and I haven’t yet found a good rebuttal to his claims.

    Here’s a sample, from a “chiropractic neurologist…
    http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=53928

    At some point there will be an autistic child in your office who needs your expertise and care. Dr. Melillo’s program provides a directed approach to these children’s brains, allowing us to deliver an effect that is specific and powerful. The concept behind functional disconnection syndrome is this: There is essentially a breakdown in the ability of the right and left brains to connect and talk to each other…..

    The right and left hemispheres, although anatomically similar in appearance, are vastly different in terms of function. We know, for example, that most people, including left-handed individuals, have the speech centers on the left side of the brain. The right brain is our social brain and the left brain is our clinical brain. The great majority of these autistic cases are right-brain disorders or deficiencies. Due to the fact that the right brain is the social brain, we can begin to understand how these children will withdraw themselves from those around them, choose not to maintain eye contact, and resist the most basic, loving touch of a parent or sibling……

    The primary premise of chiropractic neurology, and the reason I am writing these articles, is to convey the potential power that we possess through neuroplasticity. We literally have the ability to change the nervous system directly and profoundly with a great chiropractic adjustment. This is the complexity and the importance of knowledge; indeed, it is the responsibility of that knowledge. If I adjust an autistic child on their right side, this drives afferent barrage into the right cerebellum and left cortex. This then stimulates cortical cells already firing at a high level to promote greater genetic expression and greater protein replication, such that it can reinforce or create new dentritic connections in the left hemisphere. I may very well have worsened the child’s condition and made it that much harder for them to ever improve.

    If, however, I do that same adjustment on the left side, the probability of central changes are such that it may get that child’s brain to begin communication with the left brain and, lo and behold, have them utter their first words to stunned and overwhelmed parents. This has happened in my office on more that one occasion (though, of course, it is by no means a common occurrence). Such a little difference in the side of the treatment, but such a potentially huge difference in response….

    ….For now, take away this pearl for your practice: adjusting the left side of the spine (and only the left side) in a coupled manner in an autistic child may yield great benefit. We may be the answer the whole world has been looking for.

  11. Gallenodon 20 Apr 2010 at 2:17 pm

    Did he consider that maybe those few kids just started speaking to try and stop the twisting, poking, and prodding because they didn’t like being touched?

  12. Joeon 20 Apr 2010 at 2:28 pm

    Dr. Novella wrote “At their best, chiropractors are glorified physical therapists …” I disagree, they are insufficiently educated to be physical therapists of any sort; they are masseurs with delusions of grandeur.

    Turning chiropractic into some sort of allied health field would be like converting a hood ornament into a complete car. Plus, they have no impetus to clean-up their act since they are already licensed to make money any way they can.

    @ccbowers wrote “Maybe I’m missing something, but it appears that the profession has been in transition to evidence-based for so long …” No, it has not, you are seeing chiro propaganda. Evidence puts them out of business, saying they follow evidence extends their life. And it is not properly a “profession.” Historically, we distinguished between trades, merchants, artisans, professionals (who offered educated opinions) etc.; chiro is a trade. Today, where garbage collection is a “profession” (sanitation workers) maybe chiro is a profession, like garbage collection.

  13. CivilUnreston 20 Apr 2010 at 3:34 pm

    I’m seconding the question on DOs. I have a few friends getting their DO degrees and have been a little concerned about the physical manipulations and whether or not they’re evidence-based…

  14. Steven Novellaon 20 Apr 2010 at 5:05 pm

    Quicky on DOs – they started off very much like chiropractors. After Flexner, the osteopathic schools essentially agreed to “clean house” and adhere to the new higher scientific standards of MD medical schools. Essentially, while chiropractors became increasingly hostile to scientific medicine and went their own way, osteopaths were assimilated into the collective.

    However, osteopaths never fully fully got rid of their manipulative roots. Most DOs just ignore it, and it falls away during their residency training (which can be right along side MDs), but a few keep the tradition alive. I think it has made a bit of a comeback in recent years due to the growing interest in such things.

  15. Steven Novellaon 20 Apr 2010 at 5:10 pm

    Joe – I mostly agree with you, but I wrote “at their best” because a small percentage do stick to evidence-based physical and sports medicine, and seem to even be competent at it. I did not mean to imply they were the same as physical therapists or have all their training.

    But I agree – even in the best case, they bring nothing unique to the table. And, as this study shows, the vast majority incorporate unscientific treatments, and anything that can reasonably be defined as “chiropractic” (such as manipulations for subluxations) is pseudoscientific.

  16. bluedevilRAon 20 Apr 2010 at 6:37 pm

    Thanks for the brief but informative history. I didn’t realize the Flexner report had such an impact on osteopathic medical education.

    Great Borg reference too. Perhaps that should become the slogan for Science-Based Medicine. Resistance is Futile.

  17. ccbowerson 21 Apr 2010 at 12:33 am

    Joe-

    “No, it has not, you are seeing chiro propaganda.”

    I hope it is clear that I was not trying to make any claims about chiropractic becoming more evidence based, in fact I was actually attempting to make an entirely different point (which is obvious if you read the rest of my post, or maybe the second half of the sentence you cherry picked).

    I was offering the explanation of why the transition to evidence-based chiropractic has taken so long… because the more evidence-based chiropractic gets, the less chiropractic it becomes. We are not in disagreement. I realize that I was missing a key phrase in my statement:

    ‘Maybe I’m missing something, but it appears that (the reason why the) the profession has been in transition to evidence-based for so long (is) because any techniques that show evidence are no longer based in traditional chiropractic.’

    -Sorry I was typing on my phone and the words came out a bit off.

    Another point: I don’t think refering to chiropractic as a profession is misleading in any way. It is a matter-of-fact statement. Professions are determined by states (in my case NY), and is usually a legal term. This usually includes any occupation which is licenced in a given state.

    The term profession does not imply any degree of legitimacy other than the fact that it is regulated by the state. Acupunturists are even licenced in some states, which makes it a profession in those states. That doesnt mean that acupuncture works. The argument is that regulating these occupations put needed restraints on them, and is a way to control practices that would otherwise be outside of regulation.

    Of course there are many counter arguments to regulating fringe practices such as: the licensing by the state gives a false impression of legitimacy and endorsement, and there are other ways to regulate these practices without licensing them. But the real reason may have to do wit dollah billz.

    If anything I think Steve is being very careful and balanced in his comments on chiropractic. The only significant evidence for chiropractic is for lower back pain… which is largely a self limiting condition.

  18. jaranathon 21 Apr 2010 at 10:02 am

    bluedevilRA:

    Clearly you, as with the rest of the world, need more Mark Crislip. Otherwise you’d know resistance is not, in fact, futile. Resistance is inevitable! :)

  19. chaos4zapon 21 Apr 2010 at 11:35 am

    It would be great to see some statistics on what percentage of chiropractors are also trained and certified in physical therapy. I would imagine its low, why buy the cow when you can get the milk for free? Not that chiropractic schools are free, but I’m sure the additional step of physical therapy training and certification would seem unnecessary to a chiropractor that can just do physical therapy and call it chiropractic. If I had to give a single thing that upsets me most about Chiropractors, it would be that they have the ability to call themselves “Doctor”. Unfortunately, people read or hear doctor and automatically assume rigorous training and schooling. Anytime I read or see an advertisement for something that is obviously nonsense and a “doctor” is involved in the promotion in some way, it almost always turns out to be a D.C. Sometimes it takes some digging to find out that they are actually a D.C., or (in some cases) even a veterinarian making outlandish medical claims. They intentionally avoid specifying what kind of “doctor” they are. You wouldn’t let a dentist perform your open heart surgery just because he is called Doctor, would you? The title of doctor and specifying what type of doctor are important factors and should not be manipulated and used to intentionally legitimize junk medicine.

  20. Calli Arcaleon 21 Apr 2010 at 11:41 am

    Nonsense. Everyone knows resistance is voltage divided by current. :-P

    There’s a retired chiropractor named Samuel Homola who has written for Chirobase (a sister-site of Quackwatch) and recently also for Science Based Medicine. He attempted to reform chiropractic from the inside, by promoting science-based attitudes, but ultimately became convinced that this was hopeless; chiropractic will never abandon its roots in subluxation theory and manipulation of the “innate”. Now he advocates moving from chiropractic to physical therapy, with PT adopting spinal manipulation for treatment of lower back pain, as there is really nothing else chiropractic brings to the table.

  21. locutusbrgon 21 Apr 2010 at 11:51 am

    In orthopedic spinal surgery I have to deal with reintroducing people into what is actually scientifically understood about pathology and what is essentially speculative and psuedoscience. Chiropractic is frustrating. I applaud science based chiropractors however it is also non-sequitur. What makes a chiropractor a chiropractor is for the most part bunk. What is scientifically justifiable is essentially advanced physical therapy. So if you do not believe in what essentially makes you a chiropractor why not just become a Doctor of physical therapy. Still there is no supporting evidence for straight chiropractic. If I start saying that I am a Faith healer but still perform Spinal Cervical Corpectomy, Laminotomy, and Fusion on patients does that mean that faith healing is working? In my opinion is a dodge around proven training and licensure for physical therapy. If they want to be a spinal physician then do that, stop trying to justify a imaginary Subluxation Issue.

  22. Joeon 21 Apr 2010 at 1:11 pm

    @ccbowers No offense intended.

    @Calli The problem with Sam Homola is he is self-taught (and well done by all accounts). But, I don’t want to go to health-care and rely on the person having figured-it-out on his own. There is a saying in medicine “when you hear hoofbeats, don’t think zebras.” The notion is to think of the more likely causes (of hoofbeats in the USA). However, you want to see a health professional who does know, or can readily find, the rarer possibilities. Those are more likely to be the people with a formal education in the topic.

    Along the same lines @chaos4zap “… a chiropractor that can just do physical therapy and call it chiropractic.” Not if they have not had the courses that lead to a degree in PT. I recently read a statement from a chiro who claimed to have earned a PT degree as part of his DC; that is imaginary. Chiros have begun conferring many specialized diplomas on themselves, they are not worth any more than the basic DC.

  23. chaos4zapon 21 Apr 2010 at 1:36 pm

    There seems for be more and more young Chiros out there. In my experience, they love playing the “I’m a doctor” card. This “doctor” title thing has to go. One thing I have noticed is that once the Chiro (young or old) realizes that you know what they actually are and that you know the history and what chiropractic is..they no longer want to have a conversation with you. Many times, they will run away out of fear that you will reveal them as a fraud to anyone around that might hear. They are almost always genuinely shocked that you actually know the truth. Most times, they will ask me if I’m a chiropractor myself, assuming that only people within the “profession” could possibly know this stuff. It seems to me that the majority of their “success” (I’m using that term very loosely) comes from the general public just not knowing anything about them and assuming they are M.D.s that specializes on back issues. Homeopathy is very similar, 9.9 people out of 10 I ask…think Homeopathy has something to do with all natural ingredients or vitamins. I suspect if people knew what chiros and homeopathy really were, some (I dare not assume most) would see their philosophies are as ridiculous as we know they are. I suppose it’s only fitting that Chiros and Homeopathy are often found hand in hand.

  24. John Quickon 21 Apr 2010 at 5:56 pm

    this study was published in the Journal of Bone and Joint Surgery… I know not exactly relevant to the article above the comments, but suitable for the opinions below.

    In 1998, two medical doctors at the University of Pennsylvania School of Medicine in Philadelphia, contacted all 157 chairpersons of orthopedic residency programs in the United States. Together they developed and validated a basic-competency examination in musculoskeletal medicine to give to the first year residents. The results were astounding, because 82% of the eighty-five medical school graduates failed this BASIC competency exam!

    Four years later they redesigned the exam and again gave it to all the residents. Even though the passing grade was LOWERED from 74% to 70% (plus or minus 9.9 percent), 78% of them again failed the exam, with a mean test score average of 59.9 percent!

    To add insult to injury, this exact test was given to a group of 51 chiropractic students during their last semester of schooling. The results? 70% of the students passed the test. This is in contrast to an 80% failure rate for the MDs.

  25. John Quickon 21 Apr 2010 at 7:09 pm

    last point. you all realize that chiro school is 4 years long and pt school is 2 years? and that the curriculum is essentially medical school minus pharmacology and surgery?

  26. bacdocon 21 Apr 2010 at 10:42 pm

    Maybe you will post this, maybe you will not.

    I have been a doctor of chiropractic for 34 years. In all that time I have NEVER treated a patient that I believed I could not help. Many have been referred out as untreatable.

    It sickens me to see your people on the blog describe my profession as less than what it is. We go through 4 years of chiropractic college after our undergraduate degree (same as MD’s). We do not practice pharmacology or surgery, but instead study non-surgical/drugless techniques.

    Like all DOCTORS, we have anatomy, embryology, cytology, pathology, neuroanatomy, pediatrics, public health, geriatrics, physical examination, ethics, health care laws, differential diagnosis, lab work, obstetrics & gynecology, etc. Can the PT’s say this?

    I don’t mind criticism of the wackos in my profession. They deserve it, but the majority of doctors of chiropractic want to help people in a method that is not available in standard medical protocol.

    To say that there is no basis for chiropractic care is bunk. It is just a lie, and if you want to believe that, go ahead. But spend a few weeks in a busy chiropractic office and see what kind of ailments come in and are relieved. It can’t be all smoke and mirrors as your bloggers claim, and it surely is not spontaneous cure that would have happened anyway.

    Balance in discussions is fine. Your bloggers bias is very apparent.

    BTW, the Ernst papers have been degraded to nothing more than his opinion, which is obviously not good toward chiropractic care.

    Dr. Ken Martin
    Temple City, CA USA

  27. Steven Novellaon 22 Apr 2010 at 8:51 am

    John – I found the reference: http://www.ejbjs.org/cgi/content/abstract/84/4/604

    This needs to be put into context. Doctors are NOT competent to practice medicine when they graduate medical school, and states require 2 years of clinical training before they can get licensed. The purpose of this study was to assess musculoskeletal training in medical school, and they concluded it was inadequate. Their conclusions may be reasonable, but the context is this – medical schools struggle to cram in all the material they need to teach into four years. Each specialty is always fighting with the others over priority and time. This is really a turf war – orthopedists arguing that their specialty needs more time and priority in medical school.

    But MDs who specialize in the musculoskeletal system get the bulk of their training in this area after medical school. So this study says nothing about MDs in practice.

    Further, I could not find the reference on the comparison to chiropractors – can you provide it please. But I did find this reference: http://www.jaoa.org/cgi/content/abstract/106/6/350

    Which compared MDs to osteopaths (not chiropractors) and found that 70% of osteopathic students also failed the exam (70% failed, not passed). So I think you got the details twisted, unless you can provide another reference.

    Finally – it doesn’t matter that chiropractors spend four years studying, when what they are learning is not adequately science-based. If you want to learn more about the generally low standards of chiropractic schools, look here: http://www.chirobase.org/

  28. Steven Novellaon 22 Apr 2010 at 8:53 am

    bacdoc – your apologetics fails to address the core point of this paper – that 95% of chiropractors engage in unscientific claims. It’s not the exception – it’s the rule. You cannot dismiss evidence as Ernst’s “opinion”.

  29. locutusbrgon 22 Apr 2010 at 9:12 am

    Dear Dr. Martin
    I was not making statements reguarding your amount of education practice length or your intentions. According to all available quality studies I have read your most effective treatments are high level physical therapy. What distinguishes you as Chiroprators is what is in question. The effectiveness of physical therapy is not. I probably do have some biases because I have had patients with negative outcomes secondary to chiropractic care. I have also had patients with negative outcomes in my care and in my partners care. Still this irrelevant to issue. I recognize my biases. All you need to do is post the research that indicates that Chiropractic aspect of your care is effective in reasonably rigorous clinical study. I look forward to that information.

    John Quick .. Pointing out that first year interns have less knowledge than Chiropractors, even if true, fails to be a valid argument. The study does not identify them as orthopedic interns. Secondly an orthopedic spinal surgeon has 7 more years of supervised residency and fellowship before he can practice as a board certified physician. How well would a chiropractor score on the a generalized test about asthma, heart disease, neurological disorders. Medical education is broad based to provide a foundation for multiple specialities. I am unaware of such training rigors for chiropractic doctors. FYI a doctor of physical therapy has 4 years of education some times 6. A physical therapist has 2. An MBA has 6 years of school I would still not have him treat me for back pain. I will not go into the rigors of medical school education versus chiropractic since I did not attend a chiropractic school. However you obviously do not know medical school curriculum well enough as well.
    Stephen Propatier
    RI

  30. locutusbrgon 22 Apr 2010 at 9:44 am

    Sorry Steve I think we were both posting at the same time. Did not mean to be repetitive.
    I would like to clarify Nuerosurgeons have 8 years total residency. Orthopedic spinal surgeons have 5 years gen ortho 1 year spine fellowship. If numbers matter to your argument. It is 4 years undergrad, 4 years med school, 4 years residency, 1 year fellowship. Oral board certification exam.
    I propose that length of education is irrelevant to content.

  31. Joeon 22 Apr 2010 at 10:52 am

    @bacdoc on 21 Apr 2010 at 10:42 pm
    Mr. Martin, your supposed education in all the subjects you listed does not matter. See “How chiropractors think and practice” William P. McDonald et al “Seminars in Integrative Medicine” 2004 V.2 #3 92-98. Among the conclusions of this large survey of chiros, by chiros, is that 90% of chiros believe in chiro subluxations. One cannot understand anatomy and physiology and believe in that fairy tale. In other words, 90% of chiros make the rest look bad.

    You write “In all that time I have NEVER treated a patient that I believed I could not help.” Certainly; but is there good evidence for any of your ministrations, except (possibly) low back pain? The doctors who bled George Washington to death kept good records of how they did it, all the while thinking it was beneficial.

  32. Calli Arcaleon 22 Apr 2010 at 12:55 pm

    Like all DOCTORS, we have anatomy, embryology, cytology, pathology, neuroanatomy, pediatrics, public health, geriatrics, physical examination, ethics, health care laws, differential diagnosis, lab work, obstetrics & gynecology, etc. Can the PT’s say this?

    I’m aware of some of this being taught at the undergraduate level at the chiropractic college where my husband goes for occasional adjustments. But are they taught at the post-graduate level? Are they seriously equivalent to the post-grad work that MDs get?

    I decided to look at exactly what our local chiropractic college offers, as it is one of the better-known ones, with a reputation as offering one of the more complete educations available to budding young chiropractors. Indeed, many of these sorts of courses are offered as part of their Bachelor of Science in Human Biology. That degree is not obligatory; you need a bachelor’s degree, and Northwestern (to its credit) does require some basic science (up through organic chemistry, it looks like) as well as some sort of a bachelor’s degree before you can receive a Doctor of Chiropractic. They do not require that you have your BS or BA before embarking upon the DC; you can complete courses concurrently. The DC itself appears to consist of 10 trimesters, which puts it at just over 3 years. If you take it concurrently with your BA, you could theoretically graduate with a DC only four years out of high school.

    I’m not sure how that’s supposed to be equivalent to an MD. Truthfully, it does seem more like what most PTs get — essentially, a bachelor’s level education plus occupational training.

  33. wjreinon 22 Apr 2010 at 1:42 pm

    “you all realize that chiro school is 4 years long and pt school is 2 years?”

    Currently the majority of PT schools in the U.S. are a 3 year post-graduate doctoral degree

    “Like all DOCTORS, we have anatomy, embryology, cytology, pathology, neuroanatomy, pediatrics, public health, geriatrics, physical examination, ethics, health care laws, differential diagnosis, lab work, obstetrics & gynecology, etc. Can the PT’s say this? ”

    With the exception of any lab work (other than recognizing abnormal lab values) the PT curriculum addresses the majority of these areas.
    http://www.orthorehab.wisc.edu/physical-therapy/academic/2010_course_sequence.pdf

    The DPT curriculum is currently teaching spinal manipulative therapy techniques for uncomplicated lumbopelvic pain. The difference with regard to the use of SMT for LBP is that the majority of PT’s will subgroup patients with LBP based on the evaluation and use a clinical prediction rule to determine whether or not the patient will likely benefit from SMT.

    http://www.ncbi.nlm.nih.gov/pubmed/17612355

    http://www.ncbi.nlm.nih.gov/pubmed/15611489

    This maximizes the effectiveness and limits the potential adverse effects associated with SMT.

    While, in my opinion, the number of PT’s using SMT for uncomplicated LBP is still relatively low compared to Chiro’s (which may not be a bad thing). It is increasing and within the next 10-20 years the manual skill set will be very similar. Again bringing up the question of what can a Chiro do that a skilled PT can’t.

    Bill

  34. Joeon 22 Apr 2010 at 8:54 pm

    @Calli Arcale on 22 Apr 2010 at 12:55 pm wrote “I decided to look at exactly what our local chiropractic college offers, as it is one of the better-known ones …”

    Calli, it doesn’t matter how well-regarded you think your local school is- garbage is garbage. There are (were?) nationally accredited schools of astrology, they taught nonsense just like your school of chiro.

  35. vitullogon 22 Apr 2010 at 11:03 pm

    I think, before we cast stones, we endeavour to leave our glass homes….

    to wit:

    The British Medical Journal’s “Clinical Evidence” analyzed common medical treatments to evaluate which are supported by sufficient reliable evidence (BMJ, 2007). They reviewed approximately 2,500 treatments and found:

    • 13 percent were found to be beneficial

    • 23 percent were likely to be beneficial

    • Eight percent were as likely to be harmful as beneficial

    • Six percent were unlikely to be beneficial

    • Four percent were likely to be harmful or ineffective.

    • 46 percent were unknown whether they were efficacious or harmful
    In the late 1970s, the US government conducted a similar evaluation and found a strikingly similar result. They found that only 10 percent to 20 percent of medical treatment had evidence of efficacy (Office of Technology Assessment, 1978).
    Today in America, every man, woman, and child is prescribed around 13 prescription drugs per year (and this doesn’t count the many over-the-counter drugs that doctors prescribe and that patients take on their own) (Kaiser, 2006). Just 12 years earlier, Americans were on average prescribed less than eight drugs per person, a 62 percent increase! The fact of the matter is that drugs are not tested for approval in conjunction with other drugs, and the safety and efficacy of the use of multiple drugs together remains totally unknown.

    According to a 2008 nationwide survey, 29 percent of Americans used at least five prescription medications concurrently (Qato, Alexander, Conti, 2008), while just three years previously, 17 percent took three or more prescription drugs (Medscape, 2005). Even conservative publications such as Scientific American can no longer deny the increasing serious problems from pharmaceuticals. A recent article highlighted the fact that there has been a 65 percent increase in drug overdoses leading to hospitalization or death just in the past seven years (Harmon, 2010).

    A 2007 study of over 350,000 children found that a shocking 78.7 percent of children in hospitals are prescribed drugs that the FDA has not even approved for use in children (Shah, Hall, Goodman, et al, 2007). If this isn’t shocking enough, a survey in England found that 90 percent of infants were prescribed drugs that were not tested for safety or efficacy in infants (Conroy, McIntyre, Choonara, 1999).

    There is almost a 350 percent increase in adverse drug reactions in children prescribed an off-label drug than children who were prescribed a drug that had been tested for safety and efficacy (Horen, Montastruc, and Lapeyre-mestre, 2002). Doctors are committing “medical child abuse” on a regular basis.

    Ultimately, an American who was 40 years old in 1900 and an American who was 40 years old in 1960 has a similar chance of living to 80 years old today.

    Angell, M. The Truth about Drug Companies. New York: Random House, 2004. This fact is extremely startling, but the source is reputable: Marcia Angell, MD, is former editor of the New England Journal of Medicine.

    Begley, Sharon. “We Fought Cancer, and Cancer Won,” Newsweek, September 15, 2008. http://www.newsweek.com/id/157548

    BMJ, 2007. http://clinicalevidence.bmj.com/ceweb/about/index.jsp; http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp

    Conroy S, McIntyre J, Choonara I. Unlicensed and off label drug use in neonates. Archives of Disease in Childhood – Fetal and Neonatal Edition 1999;80:F142-F145. doi:10.1136/fn.80.2.F142

    Consumer Reports, “High Anxiety.” January 1993, 19-24.

    Darwin, F. (ed.). The Life and Letters of Charles Darwin. New York, D. Appleton & Co., 1903.

    Dima M. Qato; G. Caleb Alexander; Rena M. Conti; Michael Johnson; Phil Schumm; Stacy Tessler Lindau. “Use of Prescription and Over-the-counter Medications and Dietary Supplements Among Older Adults in the United States.” JAMA. 2008;300(24):2867-2878. http://jama.ama-assn.org/cgi/content/full/300/24/2867

    Horen B, Montastruc JL, and Lapeyre-mestre M. “Adverse drug reactions and off-label drug use in paediatric outpatients.” Br J Clin Pharmacol. 54(6); Dec 2002, 665-670. doi: 10.1046/j.1365-2125.2002.t01-3-01689.x.

    Harmon K. Prescription Drug Deaths Increase Dramatically, Scientific American. April 6, 2010. http://www.scientificamerican.com/article.cfm?id=prescription-drug-deaths

    Kaiser Family Foundation, Prescription Drug Trends, June 2006. http://www.kff.org/rxdrugs/upload/3057-05.pdf

    InfoPlease.com. http://www.infoplease.com/ipa/A0004393.html, 2007.

    “Levi, R. Science Is for Sale,” Skeptical Inquirer, July/August 2006, 30:4, 44-46.

    Medscape, More Americans Take Prescription Medication. May 3, 2005.
    http://www.medscape.com/viewarticle/500164

    Office of Technology Assessment, 1978. http://www.fas.org/ota/reports/7805.pdf

    “Roberts, W. H. Orthodoxy vs. homeopathy: Ironic developments following the Flexner Report at the Ohio State University,” Bulletin on the History of Medicine, Spring 1986, 60:1, 73-87.

    Shah SS, Hall M, Goodman DM, et al. “Off-label Drug Use in Hospitalized Children.” Arch Pediatr Adolesc Med. 2007;161(3):282-290.

    Walsh, J. J. History of the Medical Society of the State of New York. New York: Medical Society of the State of New York, 1907.

    Wilson, Duff. Pfizer Gets Details on Payments to Doctors, New York Times, March 31, 2010. http://www.nytimes.com/2010/04/01/business/01payments.html?partner=rss&emc=rss

    ………..with thanks to Dana Ullman.

    Gary Vitullo, DC
    South Pasadena, CA

  36. agashemon 23 Apr 2010 at 9:47 am

    I need to reiterate that physiotherapists in Canada are now all Masters of Science. In other words, an undergraduate degree in science (usually Kinesiology but certainly not exclusively) followed by two years of Master’s level education and clinical hours. In my opinion, any DC quoting Dana Ullman needs to be ignored. I favour making it the law to required DCs to be called at best “Doctor of Chiropractory” or such, preferrably Chiropractor only. Many educated people I have encountered truly believe they are medical doctors……..why have we let this situation carry on for so long????

  37. Calli Arcaleon 23 Apr 2010 at 10:16 am

    Joe:

    #
    # Joeon 22 Apr 2010 at 8:54 pm

    @Calli Arcale on 22 Apr 2010 at 12:55 pm wrote “I decided to look at exactly what our local chiropractic college offers, as it is one of the better-known ones …”

    Calli, it doesn’t matter how well-regarded you think your local school is- garbage is garbage. There are (were?) nationally accredited schools of astrology, they taught nonsense just like your school of chiro.

    Joe, you misunderstand my point. My point is that this local college is one of the better ones, nationwide. And still, its curriculum does not support Martin’s assertion. The DC itself requires three years of study, not four, and they can run concurrently with a bachelor’s program, so you can have DC, even at this relatively respectable school, within 4 years of high school graduation or GED. It also implies a GRE might be accepted instead of a BS or BA as a prerequisite for graduation, and courses are offered to assist in this, so it could be just 3.3 years.

    There are plenty of schools which are much worse, and even a lot of chiropractors know this; there have been lawsuits (even against Northwestern, which again, is one of the more respectable ones) from graduates angered by the discovery that their education hadn’t been as extensive as their professors had led them to believe.

  38. Draalon 23 Apr 2010 at 1:22 pm

    # vitullogon 22 Apr 2010 at 11:03 pm

    I think, before we cast stones, we endeavour to leave our glass homes….
    Oh, goody. We’re playing the “Name That Logical Fallacy Game”!

    Logical fallacy: Tu quoque
    Literally, you too. This is an attempt to justify wrong action because someone else also does it. “My evidence may be invalid, but so is yours.”

  39. Joeon 23 Apr 2010 at 2:50 pm

    @vitullog on 22 Apr 2010 at 11:03 pm
    http://scienceblogs.com/insolence/2010/04/the_return_of_dana_ullman_2010.php

    Dana Ullman (MPH!!) is an idiot

  40. vitullogon 23 Apr 2010 at 3:23 pm

    @ Draal
    Oh. Good.
    We’re playing that “attack the form, not the content” game.

    @Joe:
    Scholarly retort.

  41. vitullogon 23 Apr 2010 at 3:31 pm

    @agashem.
    In point of fact, the DC degree is considered a licentiate of the healing arts, just as medical doctors, podiatrists, and dentists. As such we are required to perform expected examination, history taking and treatment protocols that any doctor or licentiate of the healing arts is required and expected to by law.
    We are then required to create a diagnosis which shall be reported to any and all intersted parties, just as any doctor would do. We are legally licensed doctors in that we examine, triage, and report according to state and federal laws.

    This is what defines us differently from other professions such as RpT’s who are not licentiates and are held to different standards.

    Our scopes of practice have nothing to do with the fact that we have lawful status in all 50 states in the Union. The length of our educational programs is also not germane to the status and responsibilities we have as doctors.

    Our status and definitions and scopes of practices are all defined under federal and state law. If you have a problem with that, this is where you go to change it.

  42. weingon 23 Apr 2010 at 3:35 pm

    “The British Medical Journal’s “Clinical Evidence” analyzed common medical treatments to evaluate which are supported by sufficient reliable evidence (BMJ, 2007). They reviewed approximately 2,500 treatments and found:”

    Those were not science based treatments that you are implying. Those treatments included chiropractic, homeopathy, etc. They lumped it all with science based treatments and then gave you these meaningless statistics.

  43. Draalon 23 Apr 2010 at 3:56 pm

    @ Draal
    Oh. Good.We’re playing that “attack the form, not the content” game.

    I’m pointing out that you’re trying to derail the argument away from addressing this blog post by employing a debating tactic instead of sticking with valid arguments. Issues with pharmaceuticals does not disprove the assertion that most chiropracticors use non evidence-based practices.

  44. Draalon 23 Apr 2010 at 4:06 pm

    And copying and pasting anything from our dear friend, Dana, is the quickest way to losing any credibility for yourself.

  45. SquirrelEliteon 23 Apr 2010 at 4:49 pm

    @Joe (2:50 pm)

    Thanks for posting the link. I was going to post the same one, but got distracted.

    @vitullog,

    I see you noticed Joe’s link. Did you read it? All the way, top to bottom, blog and comments?

    It’s actually a rather interesting discussion and not just cut and pasted out of someone else’s blog. You should also check out the link to orac’s previous response on the same subject.

    When you are done, as Draal tried to suggest, try telling us what you think and give us some reasonable or at least plausible arguments to support it. If you will make that effort, some of us at least will make an effort to give you a considered response in turn.

  46. Joeon 23 Apr 2010 at 5:28 pm

    vitullog on 23 Apr 2010 at 3:31 pm “In point of fact, the DC degree is considered a licentiate of the healing arts, just as medical doctors, podiatrists, and dentists.”

    “Considered” is the important word- your license is conferred by ignorant legislators, not by competent scientists. That is because the legislators can make your many customers happy, for free, by giving you licenses. It is ironic that a trade that believes in Innate Intelligence relies on a lack of intelligence.

  47. John Quickon 24 Apr 2010 at 1:55 am

    thank you vittulog. I think for the most part people do not want to take medications- except for life saving things like anti-biotics. Talking about chiropractors making inflated claims, what about pharmacy companies rigging results or hiding adverse effects just to get the fda’s approval? I’ll have to look for that forum on this site as well.

  48. Draalon 24 Apr 2010 at 7:09 am

    @JQ
    You looking for something like this?
    http://www.sciencebasedmedicine.org/?p=4792
    http://www.sciencebasedmedicine.org/?p=3534
    http://www.sciencebasedmedicine.org/?p=3278
    http://www.sciencebasedmedicine.org/?p=1116
    http://www.sciencebasedmedicine.org/?p=461
    http://www.sciencebasedmedicine.org/?p=406
    http://www.sciencebasedmedicine.org/?p=283
    http://www.sciencebasedmedicine.org/?p=192
    http://www.sciencebasedmedicine.org/?p=173
    http://www.sciencebasedmedicine.org/?p=50

  49. Calli Arcaleon 24 Apr 2010 at 10:40 am

    vitullog:

    In point of fact, the DC degree is considered a licentiate of the healing arts, just as medical doctors, podiatrists, and dentists. As such we are required to perform expected examination, history taking and treatment protocols that any doctor or licentiate of the healing arts is required and expected to by law.

    Be careful with your terminology. A licentiate is generally a degree somewhere between a bachelor’s degree and a master’s degree which constitutes a license to practice, and it does not exist in all jurisdictions. For instance, in Minnesota, your DC does not automatically grant you a license to practice. (Neither does an MD, DDC, etc.) The degree is a prerequisite for licensure, but you can have the degree without being licensed to practice medicine.

    This is what defines us differently from other professions such as RpT’s who are not licentiates and are held to different standards.

    Again, this depends on jurisdiction. in Minnesota, physical therapists are licensed or they are not permitted to practice. Heck, we even license massage therapists.

    Our scopes of practice have nothing to do with the fact that we have lawful status in all 50 states in the Union. The length of our educational programs is also not germane to the status and responsibilities we have as doctors.

    Actually, the lawful status you may have in various states (which does differ from state to state) most certainly does have something to do with your scope of practice. This is because the law and state licensing boards impose limits, and you must honor those limits or risk losing your license. For instance, a podiatrist who performs brain surgery is acting outside the scope of his practice as defined by the law.

    The length of your educational programs is also germane to the status and responsibilities you have as a doctor; most states require certain numbers of credit hours in order to obtain a license, covering certain topics at a minimum. And I would expect your degree program to also require a certain number of degree hours. You aren’t suggesting someone can just write a letter to somebody on the Internet, pay a fee, and receive a DC, right, and that this lack of education would be irrelevant, are you?

    No, there really are standards, and you ought to know that.

    But even apart from the standards, you go to school for a reason. It’s not just to warm a seat long enough to qualify for credit hours. It’s to learn how to do your job. And the more you do, logically, the more training you will require. A neurosurgeon can be expected to need more schooling than a physical therapist, for instance. When I had my last c-section, I was happy to know that I was being operated on by a trained obstetrician and not, say, a chiropractor. This is not an indictment of chiropractors; you’re not trained in surgery, so I wouldn’t put that responsibility upon you. It’d be like asking a glider pilot to fly a helicopter; it’s just not something you’ve trained to do.

    Our status and definitions and scopes of practices are all defined under federal and state law. If you have a problem with that, this is where you go to change it.

    I hope you are not arguing that the only reason you went to chiropractic college was because the law required you to do so. By saying that the quantity and quality of education is unimportant, you seem to be denigrating your own education, by implying that it is not important to your practice. That may be unintentional on your part, in which case you may want to clarify.

  50. Calli Arcaleon 24 Apr 2010 at 10:57 am

    John Quick:

    thank you vittulog. I think for the most part people do not want to take medications- except for life saving things like anti-biotics. Talking about chiropractors making inflated claims, what about pharmacy companies rigging results or hiding adverse effects just to get the fda’s approval? I’ll have to look for that forum on this site as well.

    That sounds a lot like my young daughters saying “well, she started it!” So if pharmaceutical corporations make inflated claims, are you arguing it’s okay for chiropractors to do likewise? That’s absurd; it’s not okay for either of them. I’m cynical; I feel there is a tendency in any health care business for at least some providers (corporations, individuals, whatever) to be as dishonest as they can possibly get away with as long as it increases their cash flow. That’s why pharmaceuticals are regulated; we *know* there is a huge potential for abuse. The FDA is presently our main vehicle for doing this. It is woefully underfunded, and so it cannot provide adequate oversight. It is, however, better than nothing.

    You’re right that most people do not want to be taking medications — antibiotics or otherwise. People don’t want to need them in the first place, which is entirely reasonable. I’m on several medications, and I’d much rather not need them. Alas, it is an imperfect world, and I have an imperfect body. Just because I don’t want to have to take my medications doesn’t mean I should throw them out, so really, just because most people quite reasonably don’t want to be dependent on drugs doesn’t mean their wishes can all be fulfilled.

    I’m an advocate of taking as little medication as possible. But

    Bottom line: take as little medication as possible without compromising your condition, try lifestyle modifications first where applicable, and remember ALWAYS that most people are trying to sell you something — consciously or otherwise — so keep your critical eye open at all times.

  51. Joeon 24 Apr 2010 at 1:30 pm

    @John Quick on 24 Apr 2010 at 1:55 am “thank you vittulog. I think for the most part people do not want to take medications- except for life saving things like anti-biotics.”

    The list of life-saving drugs is far longer than you could possibly imagine. On top of that, there are drugs that, undeniably, make life easier under certain conditions. Flaunting your ignorance does not help your cause.

    @Calli You are still mistaken if you think some chiro schools are better than others. Where I live, there are dairy farms that are happy to give away their manure to anyone who will take it. I maintain that it does not matter what breed of cow they milk- it is still manure (no better, no worse). The same goes for the manure offered by chiro schools.

    But, you can prove me wrong by explicitly explaining how your quack college is better than others.

  52. bindleon 24 Apr 2010 at 4:16 pm

    Arguably a chiro school that has some courses better taught with less inaccuracies than others may be a school that by that standard is even worse, with the good parts acting as a cover to better promote the essential quackery of the larger fraudulent enterprise.

  53. webbleon 25 Apr 2010 at 6:27 am

    Interesting read, but I am yet to see an example of what is actually wrong with chiropractic education or in fact evidence that it does not work. You keep saying it like it is an established fact but do not bring anything to the plate besides your opinions.

    Below is a fairly comprehensive review of current evidence, I encourage you to read it.

    http://www.chiroandosteo.com/content/18/1/3

    Of the people that visit a chiropractor 60% have low back pain the remainder with head, neck, and extremity symptoms. Only a small number, typically fewer than 2% to 5%, seek care for other conditions

    There is good evidence for most chiropractic patients if you refer back to the the above study. With a very small minority actually presenting with complaints outside of what has been researched. Due to the relative low risk nature of chiropractic treatment a conservative trial in these patients is not totally unreasonable depending on the nature of the condition and what else has already been trialed.

    I think the same could be said about all health care professions that in a small proportion of patients that treatment is not back by evidence.

  54. Calli Arcaleon 25 Apr 2010 at 5:33 pm

    Joe: exactly what point are you trying to make here? My point was that even if we were to accept the assumption that chiropractic has any merit whatsoever, Martin is still wrong.

    Look. To me, defending science-based medicine is not simply about lambasting alternative medicine at every available opportunity. That’s easy to do, and sometimes satisfying in a vicious sort of way, but it carries the assumption that the right person is whoever can shout loudest. It’s far more interesting and effective to talk about *why* it is mistaken, and why it may not be trustworthy.

    Martin is essentially comparing his courses in human biology to what a general practitioner physician gets, when in fact what he’s probably gotten is pretty introductory, based on what one of the most respected colleges offers — bachelor’s level stuff, and I can’t vouch even for the quality of that. (I suspect I got more chemistry than he did, and I’m a software engineer.) In other words, I went with the best case scenario for his education, and it still did not measure up.

    I’m quite sure that like most graduates of these schools, he feels this is a fair comparison. This is not his fault; it’s the fault of his education. These chiropractic schools bill themselves as providing a scientific education comparable to an accredited medical school or university, and that just isn’t true, and there have been class-action lawsuits against chiropractic colleges because of that.

    How is this particular chiropractic college better than others? Mostly, just the fact that it is one of the few that actually offers a bachelor’s degree. I’m not saying it’s an especially good degree. But most of them don’t even offer that. Others are worse, ranging from the infamous Life University (which descends from DD Palmer himself, and therefore is beholden to the “theory of the innate” and teaches straight chiropractic) to thinly-veiled diploma mills. So yes, there are many far worse schools. I really did pick one of the better schools.

    And if you don’t know that, then you may not understand the full depth of quackery and fraud in the profession. I strongly recommend spending time perusing Chirobase to learn more.

    bindle: that’s certainly arguable. I tend to feel that there’s no education which is entirely wasted, and so requiring a basic science curriculum is better than requiring nothing more than a GED and a check. For one thing, they will be better equipped to later realize the problems inherent in their profession. For another, requiring only a GED and a check is a pretty near 100% sign of fraud.

  55. webbleon 25 Apr 2010 at 10:08 pm

    @Calli Arcale: Please try and refrain from using such emotive language, it does nothing to help your cause and with the complete lack of facts in your posts makes your response nothing more than an emotive attack.

    “My point was that even if we were to accept the assumption that chiropractic has any merit whatsoever”

    Bring evidence to the plate besides your opinion that it does not, please see my post before for current evidence.

    “Martin is essentially comparing his courses in human biology to what a general practitioner physician gets, when in fact what he’s probably gotten is pretty introductory, based on what one of the most respected colleges offers — bachelor’s level stuff, and I can’t vouch even for the quality of that.”

    What he’s probably gotten is pretty introductory? Lets not actually research curriculum, much better to just guess and assume. Based on an above response where chiropractic interns had a significantly higher pass rate compared to new graduate medical interns in the area of musculoskeletal disorders I would say that our education is a little more than introductory (at least in the main area in which we treat).

    I think majority of what poster’s here have against chiropractic is the non-musculoskeletal claims it sometimes makes. Given this makes up a very small minority of patients that actually seek chiropractic care. I find it interesting how people scoff at the thought of innate intelligence, as in to think that all treatments work in isolation and give no credit to the body’s natural healing ability. This is not to say that chiropractic should be at the forefront of treating organic disease, just making the point that even with no treatment the bodies natural healing ability is quite remarkable and that it seems some posters think that the concept of the body being able to heal itself (innate intelligence) is ridiculous. Wether Chiropractic can improve this ability is an area of hot debate in it’s own (even within Chiropractic).

  56. BillyJoe7on 26 Apr 2010 at 6:23 am

    webble,

    Please try and refrain from telling people how they should behave. You have no purchase on this blog to be making such demands. Furthermore, provided what posters say can be backed by evidence, I see no reason not to say it and to say it with emotion if you feel strongly enough about it. Finally, you could have no idea whether Calli Arcale was actually typing with emotion or not.

    “Bring evidence to the plate besides your opinion that it does not, please see my post before for current evidence.”

    More demands!
    Posters can simply state what they can back up with evidence. That don’t have to supply the actual evidence if they don’t feel inclined. For the record:
    There is no evidence that chiropractic is useful for non back conditions. There is almost no evidence that it is useful for musculo-skeletal conditions except back pain. There is very little evidence that chiropractic is any better than massage or physiotherapy for back pain.
    Those are the facts.
    The evidence is there if you know where to look for it and how to evaluate it.

    “I find it interesting how people scoff at the thought of innate intelligence, as in to think that all treatments work in isolation and give no credit to the body’s natural healing ability. “

    Excuse the scare quotes but they are necessary:
    (Note: scare quotes are used when refering to nonsense)

    “Innate intelligence” is said to be a “force” by which the body maintains and heals itself. Moreover it is said to work through the nervous system which is why “subluxations” are said to block it and chiropractic manipulation is said to unblock it – thereby allowing the body’s “innate intelligence” to heal itself.
    In short , the concept of “innate intelligence” is laughable nonsense.
    The body IS capable of healing itself but NOT via “innate intelligence”.

    “This is not to say that chiropractic should be at the forefront of treating organic disease”

    I should say not!

    “it seems some posters think that the concept of the body being able to heal itself (innate intelligence) is ridiculous.

    Okay, so now you know:
    The body is capable of healing itself.
    And “innate intelligence” is a ridiculous discredited idea.

    “Wether Chiropractic can improve this ability is an area of hot debate in it’s own.”

    Reality check: there is no debate regarding chiropractic:
    The mechanism of chiropractic is totally implausible and the evidence supports nothing more than a possible role for chiropractic in relieving back pain more or less on par with therapeutic massage and physiotherapy.

  57. BillyJoe7on 26 Apr 2010 at 6:25 am

    …sorry, the fourth last paragraph is a quote from webble and should have been bolded.

  58. webbleon 26 Apr 2010 at 7:50 am

    I am sorry if I upset anyone as it was not my purpose I just find emotive language to be off putting and a tool for someone to use when they don’t have a strong argument.

    Innate intelligence is the bodies own healing power. It is not something chiropractic as per say.

    I am allowed to ask for evidence just as others are, this whole debate is that chiropractic is unscientific and does not work yet there is no actual evidence presented to support this. If I was to make a claim regarding chiropractic I am sure you would hold me to the same standards and ask to see a source.

    Excuse me I am not sure how to bold quotes but anyway.

    ——————————————————————–
    For the record: There is no evidence that chiropractic is useful for non back conditions.
    ——————————————————————–

    I just posted a comprehensive review of the current literature out lining chiropractic is helpful for many other extremity conditions (outside the spine) and some weak evidence for non-musculoskeletal conditions. So for the record: There is.

    The nervous system controls everything in your body (including your immune system). I do not see how it is totally implausible that focal nerve root irritation from inflammation of facet joints in the can disturb nerve function and thus affect the end organs that the nerve innervates. There is much about the nervous system that we are only beginning to understand and there is evidence emerging to support this hypothesized mechanism. Due to the complexity of the nervous system and individual differences it is extremely hard to predict the exact non-musculoskeletal affects of a chiropractic adjustment. However there have been various affects recorded as shown in the below studies.

    {http://www.ncbi.nlm.nih.gov/pubmed/14589467
    http://www.biomedcentral.com/1471-2474/7/68
    }

    Even if you want to discount chiropractors effect on non-spinal related conditions the shear number of people with low back pain alone is enough to justify our place in the health care system. With 80% of people experiencing low back pain in their lives and Americans spending 50 billion dollars a year on it making it one of the most expensive ailments.

    {http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm }

    “…injured workers… diagnosed with low-back pain returned to work much sooner when treated by chiropractors than by (medical) physicians.”

    The Effectiveness and Cost Effectiveness of Chiropractic Management of Low-Back Pain (The Manga Report). Pran Manga and Associates (1993) – University of Ottawa, Canada.

    “It was found that those individuals who received chiropractic care for their back pain returned to work 4 times faster (6.26 days vs. 25.56 days) and had treatment that cost 4 times less ($392 vs. $1,569) than those who received treatments from medical doctors. Also, in those patients who received chiropractic care there was a significantly lower incidence of progression to a chronic low back pain status.”

    Mechanical Low-Back Pain: A Comparison of Medical and Chiropractic Management Within the Victorian Work Care Scheme. Ebrall, PS. Chiropractic Journal of Australia – 1992;22:47-53.

    Patients who suffered back pain for 2-4 weeks had a 60% reduction in pain from chiropractic manipulation after 3 days compared to a 10% reduction from mobilization. “Patients who underwent (chiropractic) manipulation achieved a 50% reduction in their pain levels more rapidly than those receiving mobilization” (therapy commonly used by Physical Therapists).

    A Benefit of Spinal Manipulation as Adjunctive Therapy for Acute Low-back pain: A Stratified Controlled Trial. Hadler NM et al. Spine – 1987;12:703-706.

    I could continue on however it is suffice to say that there is plenty of scientific evidence that chiropractic works.

  59. webbleon 26 Apr 2010 at 7:58 am

    P.S using chirobase as a source is laughable.

  60. Calli Arcaleon 26 Apr 2010 at 10:31 am

    My emotive language was directed exclusively at Joe, who seemed to have gotten upset at me for what seemed to be nothing more than not being suitably insulting towards chiropractors. That bothered me. I’m sorry it offended you. I usually try to be more restrained.

    webble:

    Innate intelligence is the bodies own healing power. It is not something chiropractic as per say.

    It is not chiropractic, per se? But chiropractic is the only profession which teaches the existence of the innate at all. It was postulated by DD Palmer. (It certainly does have a lot in common with other “life energy” systems of belief, of course, including others which also orginated in the fertile minds of the 19th Century.) That said, although innate intelligence is unique to chiropractic, not all chiropractors practice according to it. “Straight” chiropractors do, but “mixers” usually don’t.

    Chiropractic practice exists along a continuum. On one end are those who follow DD Palmer precisely. For them, it is all about the innate. Disease does not really exist; it’s just a dysfunction caused by deficient flow of innate to the affected organ, and chiropractic is about restoring the flow and allowing the body to sort itself out. (In this, it has a lot in common with reiki, acupuncture, and qigong.)

    In the middle are those who have noticed the past century of neuroscience and realize that what’s traveling along nerves is signals, not some mystical energy force, but who still feel that disease is sometimes (or even often) caused by impingement upon these signals. The stomach, for instance, is enervated; if the nerves to it are pinched, signals will be degraded or absent and the stomach may not function properly. Therefore, to them, chiropractic is about relieving those nerve pinches so that organs can function properly.

    And on the opposite end from the straightest of the straight chiropractors is those who have seen that nerves actually can’t be pinched by a chiropractic subluxation in an otherwise normal person, yet feel that chiropractic has helped their patients; for them, it is all about symptomatic relief for back pain, and perhaps restoration of a full range of movement so that the person can be comfortable. This chiropractor is probably the most likely to refer serious conditions to a medical doctor, and probably also the most likely to get referrals from medical doctors.

    There is a very big difference between the two ends of that spectrum. On the straight end, you find chiropractors who will attempt to treat a person presenting with symptoms of meningitis. From there through the middle you find chiropractors who believe they can cure asthma, and will tell their patients to throw away their albuterol and controller meds, and even some who purport to treat diabetes. On the opposite end, the practice is very restricted, but effective and, unfortunately, usually not very profitable compared to the other end.

    You sound like you’re somewhere in the middle, as you say things like “The nervous system controls everything in your body (including your immune system). ” This is not true, but I’ve heard it claimed by chiropractors often enough that I believe it’s something you’re taught. Consider this: many quadriplegics have quite good health. If a completely severed spinal chord doesn’t kill them, clearly many of their systems are able to get on with things even in the absence of conscious nervous control.

    The immune system is actually a good example of one system *not* directly controlled by nerves. Your brain can influence your immune system, but it does so through a different signaling mechanism: hormones, which travel through the blood. You can completely sever the spinal cord at the base of the neck and still have a normally functioning immune system. As long as it’s not so high as to be fatal (you do need nerves to breathe), your immune system will keep ticking along just fine.

    I could continue on however it is suffice to say that there is plenty of scientific evidence that chiropractic works.

    For the treatment of back pain, especially lower back pain, there is considerable evidence that it can provide symptom relief. That’s nothing to casually dismiss; back pain is one of the most common complaints in the human species, and it’s a direct result of our erect posture. It will be with us as long as we are still human. Drugs work, PT works, chiropractic works. It’s nice to have options. So I agree with you about this.

    What bothers me is the claims that it can help other things for which there is no evidence. Sure, it’s worth researching, as long as somebody’s willing to foot the bill, but it doesn’t seem right to represent it to patients as proven when it is not. A chiropractor who claims to be able to treat asthma is something that worries me. Asthma comes and goes; it can be very easy to get the illusion of efficacy, and if the person thinks they are cured, they run the risk of not taking their next attack seriously and suffering lung damage before they get treatment.

    (By the way, as for my criticism of the coursework a chiropractor typically gets, I looked at the course catalog for a respected chiropractic school. It’s not terrible, that’s for sure, but it’s less than what my school would have required for a degree in human biology, so while I think it’s a start, I do not think it qualifies chiropractors to be primary care practitioners. No bachelor’s degree program does, quite honestly. You need similar coursework at the postgrad level, in my opinion, because it’s only at that level where you start to get a deeper understanding of the systems instead of just memorizing facts.)

    ——————
    BTW, to bold quotes, enclose it in HTML “b” tags, and to make the cool little quote blocks, use “blockquote” tags. I’ll try and show them here in a sneaky little way that lets the code show without WordPress trying to render it as HTML.

    >b<This text will be bolded.>/b<
    This text will be bolded.

    >i<This text will be italicized.>/i<
    This text will be italicized.

    >blockquote<This text will be blockquoted.>/blockquote<

    This text will be blockquoted.

  61. Calli Arcaleon 26 Apr 2010 at 10:32 am

    Oh, it kinda worked — I put the brackets backwards, though. I’ll do it again.

    <b>This text will be bolded.</b>
    This text will be bolded.

    <i>This text will be italicized.</i>
    This text will be italicized.

    <blockquote>This text will be blockquoted.</blockquote>

    This text will be blockquoted.

  62. Joeon 26 Apr 2010 at 10:59 am

    @webble on 25 Apr 2010 at 6:27 am The Bronfort review you linked is not what you think it is. (First, it does not provide the statistics about chiro use that you mention.) Did you even look at it? Many of the studies reviewed (32%) are immediately seen not to be about chiro (there’s massage, reflexology etc.). In addition, Bronfort has a very low standard for success. For example, there were two studies concerning bed-wetting; both found chiro ineffective yet Bronfort reports they were favorable.

    Ernst et al (NZ Med. J. April 9, 2010 sorry, I don’t have page no.s) found 95% of English language chiro web sites make unsupported claims. You may think that most chiros stick to low back pain; but 95% are making the rest of you look bad.

    @webble on 26 Apr 2010 at 7:50 am wrote “The nervous system controls everything in your body (including your immune system).”

    That is wrong, I will leave it as an exercise for you (based on your knowledge of anatomy and physiology) to figure out why.

    Bronfort notwithstanding, there still is feeble evidence for any effectiveness of chiro (outside of low back pain) and it is likely to disappear if chiros ever learn how to do research.

    Chirobase (and Quackwatch) are the most comprehensive sources of accurate information on chiro. I always invite chiros to find something substantially wrong with any article there. They never manage to do so.

  63. jpdc95630on 26 Apr 2010 at 3:16 pm

    How many of you actually know what type of education chiropractors receive?

    I wrote a pretty detailed post, but it is still awaiting approval.

    There appears to be two separate arguments here: 1) chiropractic is useless and 2) chiropractors are no more educated in the biological sciences than an engineer. (Callie Arcale, 25 Apr 2010 at 5:33 pm )

    Most, if not all, of you posting your opinions on a chiropractic education have no clue what you are talking about. Just as I have no clue about the education of a software engineer. If any of you took the time to actually research the education of a chiropractor you would see that we actually do spend the same amount of time, or longer in some cases, in the classroom or lab settings. I know most, or all, of you will scoff at such a notion; but, it is true. We receive a high-quality, scientific education. Several of my classes were taught by MDs and most of our texts were written by MDs and would be recognized by many allopaths. I do not see how MDs and DOs can be taught the same information and yet ours is lacking in some way.

    Anatomy is anatomy, physiology is physiology, radiology is radiology, nutrition is nutrion, pathology is pathology, public health is public health, etc. To try and pit a chiropractic model of these subjects against a medical model is pointless because it is impossible to do. If any of you has encountered a DC who has tried to tell you otherwise I wholeheartedly disagree with their assertions.

    Please go to the following website for a comparison of didactic training between MDs and DCs. It is a chiropractic website but toward the bottom of the page are tables 9 and 10 taken from the Center for Studies in Public Health Policy, Inc., Washington, DC. It gives some good perspective and addresses the hours put forth by MDs in terms of clinical clerkships. The link is: http://chiroweb.com/archives/ahcpr/chapter3.htm

    I will admit that the website itself would indicate a biased source, but the study was independent of either profession.

    As to whether chiropractic is a beneficial part of healthcare, I could discuss it all day and you still wouldn’t change your mind. I am a proponent of it, obviously, and I also support the allopathic model. There are times when cervical or lumbar fusion, discectomy, or arthoscopy are necessary. Sometimes people are going to look for a less-invasive route first and, in many cases, we can help put off the inevitable even if for just a few months. My dad and my cousin are RTs, my stepmom and aunt are RNs, and my sister is a DO. I have adjusted all of them for musculoskeletal problems ranging from simple low back pain to upper cross syndrome and they all benefit from my treatment.

    Say what you will about the efficacy of chiropractic care, but please understand that our education regarding the anatomy and physiology of the human body, and all of the associated biology and chemistry, is most certainly up to par with that of a medical school graduate. How my colleagues choose to sustain that knowledge is up to them. Also, please do not take my statement to mean that we are also as well trained in histology, pharmacology, or laboratory diagnosis.

    Just try to be open-minded and actually research what is required of us to become DCs even if you don’t agree that what we actually do is worth anything. I honestly couldn’t care less if you think my profession doesn’t meet your clinical criteria.

    Jason A. Patterson, DC

  64. Joeon 26 Apr 2010 at 4:32 pm

    @Calli Arcale on 26 Apr 2010 at 10:31 am wrote “My emotive language was directed exclusively at Joe, who seemed to have gotten upset at me for what seemed to be nothing more than not being suitably insulting towards chiropractors.”

    I wasn’t upset at you, I was trying to show you the facts. You cannot have a good school of chiro any more than you can have a good school of astrology. As noted above, the Association of Chiro Colleges says the subluxation is central to chiropracty. They cannot teach a good program based on fiction, no matter what their catalog says.

    Also, this blog post is about the finding that 95% of chiro web sites offer bogus treatments. In addition, I linked to a survey that shows 90% of them believe there are subluxations, and 67% think they cause visceral ailments. Chiros are beginning to have a problem with that term and many are now adopting things they hope are synonymous, and obscure definitions, such that it seems they don’t follow the straights; but they still believe. There are more surveys at Q-watch and Chirobase that emphasize the point.

    Put bluntly, your notion that there can be a good chiro school is belied by the nonsense most chiros advertise and believe, and the core of their curriculum.

  65. bindleon 26 Apr 2010 at 5:24 pm

    Actually the body does have a form of “innate” intelligence, but with respect to chiropractic treatment, it functions best as a reparative system undoing as much as possible the damage being done by the chiro. Chiros may now argue that without their provocative assistance, the body would not have reacted, thus not only undoing the chiro effects but healing other ills in the bargain. Because of course, they are manipulative little buggers.

  66. webbleon 26 Apr 2010 at 9:45 pm

    @Calli

    In the middle are those who have noticed the past century of neuroscience and realize that what’s traveling along nerves is signals, not some mystical energy force

    “By correcting these displacements of osseous tissue, the tension frame of the nervous system…” D.D Palmer in his first book. Chiropractors have always thought themselves to work through the nervous system since day dot.

    On the straight end, you find chiropractors who will attempt to treat a person presenting with symptoms of meningitis.

    Please provide evidence for this statement.

    You sound like you’re somewhere in the middle, as you say things like “The nervous system controls everything in your body (including your immune system). ” This is not true, but I’ve heard it claimed by chiropractors often enough that I believe it’s something you’re taught. Consider this: many quadriplegics have quite good health. If a completely severed spinal chord doesn’t kill them, clearly many of their systems are able to get on with things even in the absence of conscious nervous control.

    The immune system is actually a good example of one system *not* directly controlled by nerves. Your brain can influence your immune system, but it does so through a different signaling mechanism: hormones, which travel through the blood. You can completely sever the spinal cord at the base of the neck and still have a normally functioning immune system. As long as it’s not so high as to be fatal (you do need nerves to breathe), your immune system will keep ticking along just fine.

    You say our brain can influence your immune system (which is correct) yet you say that it is not influenced by the nervous system. It may not be DIRECTLY controlled with nerves innervating lymphocytes but it is responsible for regulating the hormones which do control the immune system (as you say).

    You say many quadriplegics have good health, which is true in some. The brain that influences the immune system, the parasympathetic system via CN X (vagus) and the vital sympathetic nerves in the upper cervical area (Phrenic C3,4,5 as you used as an example) are still intact and functioning. In fact early chiropractic philosophy was that adjusting these upper cervical vertebrae to be the most powerful and important. That being said quadriplegics do have a lower life expectancy which is multifactorial (just being immobilised causes many of the same problems) and for instance loss of continence can cause significant increase risk of UTI and mortality. There is far too many factors to say what exactly decreases life expectancy however depression and suicide also contribute.

    For the treatment of back pain, especially lower back pain, there is considerable evidence that it can provide symptom relief.

    There is also evidence as previously referenced by myself that long term function and symptoms are improved making it more than JUST immediate symptomatic relief.

    @ Joe

    The Bronfort review you linked is not what you think it is. (First, it does not provide the statistics about chiro use that you mention.)

    It reviews spinal manipulation which is the main tool of a chiropractor, read into that as you will. Sure there are other modalities but there is plenty of reference to spinal manipulation which is as I said the modality of choice for most chiropractors.

    In addition, Bronfort has a very low standard for success. For example, there were two studies concerning bed-wetting; both found chiro ineffective yet Bronfort reports they were favorable.

    Bronfort reports there is inconclusive evidence which is favourable. The two studies (one of which is a Cochrane review) state
    “Active chiropractic adjustment had better results than sham adjustment (RR for failure or relapse after stopping treatment 0.74, 95% CI 0.60 to 0.91). However, each of these findings came from small single trials, and need to be verified in further trials.”

    With Cochrane concluding “There was weak evidence to support the use of hypnosis, psychotherapy, acupuncture and chiropractic but it was provided in each case by single small trials, some of dubious methodological rigour. Robust randomised trials are required with efficacy, cost-effectiveness and adverse effects carefully monitored.”

    This is why in the review it is inconclusive but there is favourable weak evidence for.

    Please continue to tell me what else is “wrong” with Bronfort as the two points you have raised are illegitimate.

    @webble on 26 Apr 2010 at 7:50 am wrote “The nervous system controls everything in your body (including your immune system).”

    That is wrong, I will leave it as an exercise for you (based on your knowledge of anatomy and physiology) to figure out why

    Don’t be so condescending, provide an example of why it is wrong and you would have made a much better point than slander. To clarify I do not necessarily mean that each cell is individually monitored and innervated, if this is how you read it.

    Bronfort notwithstanding, there still is feeble evidence for any effectiveness of chiro (outside of low back pain) and it is likely to disappear if chiros ever learn how to do research.

    There is plenty of evidence and there is nothing substantially flawed about Bronfort other than your own reading comprehension. Also your point on chiropractic research is to some extent valid, however you must take into account we don’t have huge pharmaceutical companies funding research (and in some cases biasing them) and with most chiropractors in private practice it is easy to see why our research may not be as of high quality as say a well funded pharmaceutical trial through a hospital in the public health system. It will get there and there is emerging evidence all the time.

    Actually the body does have a form of “innate” intelligence, but with respect to chiropractic treatment, it functions best as a reparative system undoing as much as possible the damage being done by the chiro.

    Reference please.

  67. Calli Arcaleon 26 Apr 2010 at 10:27 pm

    Joe: I give up. You are still arguing against something which I did not claim.

    “By correcting these displacements of osseous tissue, the tension frame of the nervous system…” D.D Palmer in his first book. Chiropractors have always thought themselves to work through the nervous system since day dot.

    Absolutely, but he claimed the nervous system’s purpose was to distribute a vital energy force, not merely as a signaling mechanism. He thought he cured a deaf man by manipulating his spine; that has nothing whatsoever to do with the nerves that feed the ear’s actual hearing mechanism, which pass directly through the skull.

    As far as treating meningitis there was a study (I’ll have to dig up the reference when I have more time) where chiropractors were asked how they would treat patients presenting with various symptoms. Some included patients with classic meningitis symptoms. Some recognized the imminent danger and referred to ER; others simply recommended adjustment and sending the patient on their way.

    You say our brain can influence your immune system (which is correct) yet you say that it is not influenced by the nervous system. It may not be DIRECTLY controlled with nerves innervating lymphocytes but it is responsible for regulating the hormones which do control the immune system (as you say).

    Yes, I was specifically stating that the brain does not directly control the immune system. It signals via hormones instead, which are released from within the brain itself directly into the bloodstream. This is not something that any adjustment can influence, except in the sense that if a person is experiencing pain, they are likely to be stressed, which in turn has an immune suppressant effect.

    As far as how long symptom relief lasts — out of curiosity, what do you consider long-term? My husband sees a chiropractor on an “as needed” basis, and this generally ends up being three or four times a year. I would consider that long-term symptom relief. (Short-term would be like the 4-8 hours you might get with an anti-inflammatory pill.) So yeah, I can buy that. If it only lasted a week at best, it would be short-term and probably not worth the time and money.

  68. webbleon 28 Apr 2010 at 7:24 am

    Deadly quite when confronted with evidence some of you.

  69. thurgoodon 28 Apr 2010 at 12:16 pm

    Steve,

    Acupuncture is not harmless. It killed my father. The quack he went to used a weird combination of acupuncture, magnetotherapy and homeopathy. The quack used crude sterilization, keeping the needles immersed in alcohol when not in use, claiming that autoclaving them would “diminish their potency”. Repeated puncturing of the skin first created rashes, and then open scars, finally turning them septic. By the time I wised up to what was happening my father had lost 10 kgs, was suffering from urine retention, sepsis and raging toxic shock. Call me if you would like me to talk about the evils of acupuncture. I cannot get my father back, but I can surely prevent others from losing their near and dear.

  70. bacdocon 07 May 2010 at 4:21 am

    In response to chiropractic education. I don’t see how one could get a chiropractic degree “4 years out of high school”. My daughter just graduated 2 years ago. She has her BS in Biology from San Diego State University, and spent 4 years on the “accelerated” course schedule in chiropractic college. Non-accelerated takes 8 months more.

    Would someone tell me how that makes 4 years out of HS? NO ONE in her class had less than a BS or BA degree.

    Now if you are talking about outside of the US, I guess that is possible, or someone (like me) who went to chiropractic college in the 70′s. When I got my license only 2 years of college was required before the 4 years of chiropractic college. (I got my BS anyway.)

    In regard to the comment “90% of your profession makes the rest look bad” because they speak of subluxation, your facts are wrong. 22% of the practicing DC’s in the US are subluxation based and call themselves “principled”. The rest are those who use manual therapies, drugless methods, and refer out to MD’s and others for cases that are not chiropractic related. I will post the source of this survey (I believe it was published in Chiropractic Economics) when I get exact links so all can read it.

    Again, like all professions, chiropractic has their wackos, but they are the few, not the many (at least here in the US).

    A quote from an MD (orthopedic) friend of mine. I told him how to put all chiropractors out of business. He said “You are kidding, right?” I told him nope.. just get them all well first. He let out a breath of air and then agreed with me.

    By my estimate (my office experience only), 70-80% of chiropractic patients have seen their MD first and the treatment was not successful.

  71. Joeon 07 May 2010 at 12:52 pm

    @ bacdoc on 07 May 2010 at 4:21 am

    You misunderstood the survey I cited (McDonald, above). You are right, 1/5 of chiros are “straights” (you termed it “principled”); but most of the rest (88.6% total) retain the belief in subluxations (which betrays ignorance of basic anatomy and physiology). My facts are right.

    As for your assertion that quacks are few in chiro, there is little evidence to support it. Go to http://www.quackwatch.org and its subsidiary, chirobase, and look at the surveys. Most chiros offered (useless) treatment to asymptomatic people, or bogus help for visceral illness, and failed to recognize symptoms of an emergency.

    The facts support me, not your testimonial.

  72. ccbowerson 07 May 2010 at 5:44 pm

    “By my estimate (my office experience only), 70-80% of chiropractic patients have seen their MD first and the treatment was not successful.”

    I’m not sure what this “statistic” is supposed to point out. That patients go to the chiropractor after other treatments have failed? That most people go to an MD for their health problems first? That not all physical ailments are curable?

    It still says nothing about the efficacy of your interventions, nor does it say anything about the efficacy of the physician’s interventions. This is a self selected pool, and as a result you state the obvious as if it says something profound.

  73. drericaperezon 23 Nov 2012 at 11:13 am

    Because straight chiropractors believe that nearly all diseases are caused by issues with the spine, they don’t believe they need any diagnostic tools. Traditional testing done by medical doctors and hospitals is not even considered by a straight chiropractor as being necessary. Diagnosis is done by finding the subluxations in the spine so that those can be corrected.

    http://www.drericaperez.com

  74. millandcon 21 Nov 2013 at 4:00 pm

    I graduated from chiropractic school in 2009 and have practiced in different settings. It pains me to see what many of my colleagues have done with what would otherwise be a great profession. My commitment to my patients every day is this: a) my treatments will have a definite basis on sound evidence, b) I only treat symptomatic patients (the term wellness has been abused enough), and c) the chiropractic use of the term “subluxation” belongs to the 19th century only.
    I would appreciate any feedback from the author as to which therapies under the chiropractic scope of practice have been found to be the most effective (based on evidence, not on patient testimonials).
    My short comment to all my colleagues is that chiropractors are chiropractic’s worst enemy. We need to get rid of the subluxation “complex”, we need to get rid of all those green books, and we need to embrace an evidence-based future. Instead of blaming medicine, the economy, the public, or blaming anybody else for the problems in the profession we need to blame ourselves. In other words, the disease in chiropractic does come from within.

  75. BillyJoe7on 23 Nov 2013 at 3:19 pm

    Millandc,

    Steven Novella has written about Chiropractic in the following two articles:

    http://www.sciencebasedmedicine.org/chiropractic-a-brief-overview-part-i/

    http://www.sciencebasedmedicine.org/chiropractic-a-brief-overview-part-ii/

    I assume you fall into this category:

    “A small minority of chiropractors, numbering only about 1,000, or 2% of all chiropractors (these are rough estimates because accurate figures are lacking), have been openly critical of their own field. They have called for absolute rejection of the subluxation theory of illness, disposing of pseudoscientific and unethical practices by chiropractors, and the restriction of chiropractic to treating acute musculoskeletal symptoms”

    As for evidence of effectiveness:

    “There is evidence to support the very narrow indication of spinal manipulation for the symptomatic management of acute uncomplicated lower back strain”
    “With the possible exception of back pain, chiropractic spinal manipulation has not been shown to be effective for any medical condition”

    Do you agree?
    Do you also agree with his recommendations for reform of the Chiropractic profession…

    - This means rejecting completely subluxation theory, including the notion of innate intelligence and the existence of mysterious chiropractic subluxations.

    - Along with subluxation theory, chiropractors should condemn the use of manipulative therapy to treat medical conditions and diseases, including asthma, ear infections, ulcers, migraines, and other conditions.

    - The chiropractic profession should endorse the principles of science-based medicine and dedicate themselves to high standards of science and transparency. This includes subjecting their treatments to more clinical research, changing their practice based upon the evidence, exploring the risks as well as the benefits of their own treatments, and internally policing their practitioners in order to maintain an adequate standard of care across their profession.

    - Chiropractors should seek to align themselves with other science-based professions. This includes endorsing science-based public health measures, like immunization. They should not foster hostility toward science-based practitioners, and they should refer patients to other specialists when appropriate.

    - Chiropractors should not seek to expand their scope of practice beyond their training and ability. They should not present themselves as primary care providers, nor lobby for regulations to allow them to do so.

    - Chiropractors can thrive as a health-care profession as experts in back care and physical medicine. This would provide them with a sufficiently broad scope of practice to be viable, in an area where there is a great need for expertise and symptomatic management. In fact, many science-based chiropractors do just fine within this scope, and provide a best-practice model for their profession.

    - The chiropractic profession should purge from their training and practice modalities other than spinal manipulation that are pseudoscientific – including iridology, applied kinesiology, homeopathy, and nutritional pseudoscience. Of course, the medical profession now needs to do this too, as pseudoscience has infiltrated mainstream medicine, but that is a separate article. Also, the percentage of chiropractors using such methods is far greater than within mainstream medicine, and is therefore much more of a problem.

    - Chiropractic colleges should change their curriculum so that they are more uniform and more in line with modern scientific concepts and practice.

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