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double post
Actually, yes, I do discuss the risk, benefits, and alternatives to treatment with all of my patients. When there exists decent evidence, I explain that to them, if the treatment is anecdota, I explain that as well. The problem is that, for chiropractic, there exists no good evidence that the modality works for anything. It is unfair to compare one or two possibile treatments a cardiologist may offer to chiropractic. On the whole, cardiology works.
Risks, benefits and alternatives including traditional medicine?
Absolutely! In fact, I am somewhat against MD/DOs providing sCAM modalities. If they believe the therapy works, then set the patient up with a qualified provider...
- H
I agree and share the same concerns. -----How many patients presenting to a GP with low back pain, or neck pain are "provided" this information @ "level of education/training" of the provider, relative to NMSK?
J Bone Joint Surg Am. 2005 Feb;87(2):310-4. Links
Adequacy of education in musculoskeletal medicine.Matzkin E, Smith EL, Freccero D, Richardson AB.
University of Hawaii and Tripler Army Medical Center, Honolulu 96859, USA. [email protected]
I practice emergency medicine. I have seen many patients worse off because of chiropractic. And while the literature is practically silent on the benefits of chiropractic, even the chiropractic literature is rife with descriptions of the risks. So no proven benefit versus mild documented risk. No brainer - no chiropractic.
- H
Interestingly.......exactly how were these patients "worse off". Did they complain of more pain or did they suggest "structural damage". I am curious because this is not my experience and my n is near 3000 patients per year. Please enlighten and edify..........
millie should reply, but i took his/her reply to mean he/shes a chiropractor with n=3000, and not an doctor.
I am a practicing interventional pain physician....I have seen many patients who were helped by chiropractors and I have seen many patients who thought that it was a big waste of time and money
Let's see, off the top of my head, there was a 25 yo male you had been treated by a DC for almost one year (unsuccessfully) for LBP, finally presented to the ED with hematuria and ESRD secondary to the renal cell CA. There was the elderly man incontinent of urine with dramatic pain on the DC's table. The DC sent him home, then his grandson, a paramedic, insisted he be seen in the ED: cauda equina. Then there was the 33 year old newly minted vascular surgeon who began chiropractic treatment for neck pain he related to mechanical pain from bad OR ergonomics three weeks prior to his death from a vertebral artery dissection (no previous known risk factors). Last, but not least in my experience, the 10 yo boy who died of HiB meningitis. No vaccinated because dad's chiropractor had convinced him it was "too risky". These were each my patients and I am only one resident in one EM program (albeit at a large facility). But hey, the plural of anecdote is not fact, let's look at the literature shall we (after all, you are claiming to be a physician, let's keep up the facade). I'll grant you it is a collection of reposts, but I provide the original links as well as links to the studies where available...
OP: http://forums.studentdoctor.net/showpost.php?p=2687469&postcount=49
"Archives of Pediatrics & Adolescent Medicine
----------------------------------------------
Volume 151(5) May 1997 pp 527-528"
OP: http://forums.studentdoctor.net/showpost.php?p=2687469&postcount=48
"For example, there is a study which I have posted many times that suggested that 17% of chiropractors who identified themselves as treating children would treat a case of neonatal fever without referral to an MD/DO or more appropriately to an ED. (see: http://www.ncbi.nlm.nih.gov/entrez/...d&dopt=Abstract&list_uids=10768681&query_hl=8 ) Neonatal fever is a defacto emergency. No attempt should be made to treat as an outpatient yet 17% of chiropractors who treat children would try."
OP: http://forums.studentdoctor.net/showpost.php?p=2561300&postcount=1
"Even SCARIER..."
http://www.jcca-online.org/client/cca/JCCA.nsf/objects/V49-1-46/$file/jcca-v49-1-046.pdf" - A chiropractic journal no less!
OP: http://forums.studentdoctor.net/showpost.php?p=2573803&postcount=19
"Now chiropractic and stroke."
from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12743225
from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12692699
from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=15513007
from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12466778 - Your favorite journal; JMPT (that fun lovin' group of chiro-bashers!)
"I thought there were "no side effects" to chiropractic? Yep it never happens, but the chiropractic journals describe when and how. I guess they are used to reporting on fictional things (like subluxations) anyway..."
from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=14586598
"To be fair, there is an article describing why there is such a different opinion of the level of risk chiropractic manipulation represents."
from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=14589464
OP: http://forums.studentdoctor.net/showpost.php?p=2135577&postcount=95
"Now as an (I assume) educated person, what is your opinion/reaction to these studies?"
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7884327&dopt=Abstract
http://www.cmaj.ca/cgi/content/full/166/12/1531
http://www.cmaj.ca/cgi/content/full/166/12/1544
http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=11340209
Now, show me one solid paper that shows chiropractic works...
BTW - your n is 3000 patient per year? You, as an MD/DO pain management specialist, residency trained in anesthesiology, refer 3000 patients a year to chiropractic? Wow, how many patients do you treat yourself? And besides the paper quoted above (http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=14589464) that may explain why you do not perceive a problem, keep in mind that it is the ED and the neurologists, not the pain specialist, that will see the effects of iatrogenic chiropractic injury.
- H
First, of all it is not nice to personally attack someone just because they do not agree with you. I have not personally attacked you or anyone else on this forum. I must point out, however, that as a resident you have much less CLINICAL EXPERIENCE when compared to someone who has been in practice for several years.
If you wanted to know about my training and my referral patterns, all you had to do was ask instead of making erroneuous assumptions. I am a fellowship trained interventional pain management physician. I obtained an MD at Baylor College of Medicine. I completed a 4 yr anesthesiology residency and a one year fellowship in pain management. I have been in private practice for over three years.
For clarification when I have been discussing chiropractic therapy, I am applying it to musculoskeletal disorders in adults (that may have been unclear). I am opposed to chiropractic therapy for the treatment of neonatal fever, asthma, cancer and other non-musculoskeletal ailments. You may have seen my earlier post in this thread opposing chiropractors performing sports physicals.
As far as my practice goes, I average roughly 100 patients per week and 5000 patients per year. Of these 5000 patients 60% have seen a chiropractor (hence n=3000). Most were referred to the chiropractor by a PCP or had a self referral.
I have probably directly refer less than 5 patients per year myself to the chiropractor. Lets face it, by the time they see me, most patients have already seen a chiropractor if they were going to.
I have discussed their experiences in detail and very few have had serious side effects.
Some felt that it was wonderful and some felt that it was a waste of time. Of the 9000 or so patients in my practice who have seen a chiropractor, one reported a serious adverse effect. He reported worsening cervical radiculopathy and was later found to have serious spinal stenosis.
If you polled those same patients and ask about side effects from a medication provided for pain, you would have a far greater number of adverse effects (I did not directly ask this however).
I still believe that chiropractic therapy for musculoskeletal ailments is very safe. I know many of the local chiropractors in my area. They all do very detailed physical exams and will refer patients if the pain is unremitting after their treatments. None of these local practioners would ever think of performing manipulation on patients with severe cervical stenosis or cauda equina syndrome.
I must admit that I did not look at all of the case reports that you quoted. I did notice that a few patients who worsened were later diagnosed with cancer. I would definitely fault the chiropractor for not referring those patients earlier. However, you cannot infer that chiropractic manipulation made their case worse. A few others named very high incidences of adverse effects (one study said that 1 in 2 patients had adverse effects). Upon further reading you will find that the vast majority of these "adverse effects" were local discomfort, fatigue, or headaches that remitted in 24 hours. These are hardly adverse effects. Patients that have a shoulder or knee injection would have similar complaints if you asked them about it. Vertebral dissection is a rare exception and not the rule.
Good luck in your residency.
Actually you infer. I have many years as a paramedic and have seen many chiropractic disasters there as well.
I am sorry about my inferences. Your practice pattern is an aberrancy in my experience.
Ahh, so your n of 3,000 has been selected out for you. The problem is that you are seeing patients who come to you after going to a chiropractor. The fact that they are seeking outpatient care sort of selects them out for the most severe of side effects. Additionally, when you refer patients to chiropractors, you, as an MD, have assessed their condition. I assume that you would not send a urolithiasis patient to a chiropractor for treatment of the stone...
So this is the retrospectoscope at work...
O.k., so now does it work or doesn't it? 3,000 patients a year seek your services after the chiropractor's.
But aren't they self-selected by that point? The serious stroke, the missed non-NMS pathology, etc. wouldn't continue to present with chronic pain management issues...
One out of 9,000 measured against no scientifically validated benefit. Seems like a skewed risk benefit ratio to me.
But was there scientifically valid evidence that those medications had at least a chance of benefit.
BUt they can cause iatrogenic injury. If you practice in a state with joint and several liability you may be held liable if you make the referral. Are you that sure that chiropractic is the "standard of care" to defend the referral against such a claim?
Again, even if rare, the liability for the disaster and the lack of scientific evidence of efficacy moves chiropractic far enough out of the standard of care to make the liability of referral too high for my taste.
Thanks!
Happy Holidays!
- H
I think that we will have to agree to disagree. I am going to graciously bow out of this discussion because I no longer feel like debating with a resident who is at the very beginning of his career. Come talk with me again after you finish your residency and pass your boards.
FWIW, there are several chiros at my medical school.
I wonder if there are any MD's at chiro school.
Actually you infer. I have many years as a paramedic and have seen many chiropractic disasters there as well.
....
Ahh, so your n of 3,000 has been selected out for you. The problem is that you are seeing patients who come to you after going to a chiropractor. The fact that they are seeking outpatient care sort of selects them out for the most severe of side effects. Additionally, when you refer patients to chiropractors, you, as an MD, have assessed their condition. I assume that you would not send a urolithiasis patient to a chiropractor for treatment of the stone...
So this is the retrospectoscope at work...
But aren't they self-selected by that point? The serious stroke, the missed non-NMS pathology, etc. wouldn't continue to present with chronic pain management issues...
One out of 9,000 measured against no scientifically validated benefit. Seems like a skewed risk benefit ratio to me.
- H
I'm not a big fan of chiropractors, but I have to point out that you are actually the one seeing a more skewed patient population as a paramedic and an ER doc. You are seeing the sickest of the sick. Many of them will have seen chiropractors at some point, this doesn't necessarily demonstrate cause and effect.
There are no convincing studies to show causation between chiropractic manipulation and stroke. You link to 3 anecdotal reports and one small retrospective analysis that relied on a questionaire (!) to gather its information. (No flaws with that design... ). Even if this were a reliable method for estimating risk or causation (which, clearly, it isn't) the sample size is embarassingly small and one would expect you to have a similar fervent agenda against the alcohol industry since 76% of those with significant CVA were current consumers of alcohol.
I have no real interest in defending chiropractors, but I do have a hard time getting past the intellectual dishonesty of critics who preach from the bible of evidence based medicine but then put forth such flimsy data to bolster their own agendas. Give me a break.
Yes Mac-
And one of the most vocal here, has been less than honest------he has a familial/personal axe to grind that distorts his objectivity.
I'm not a big fan of chiropractors, but I have to point out that you are actually the one seeing a more skewed patient population as a paramedic and an ER doc. You are seeing the sickest of the sick. Many of them will have seen chiropractors at some point, this doesn't necessarily demonstrate cause and effect.
There are no convincing studies to show causation between chiropractic manipulation and stroke. You link to 3 anecdotal reports and one small retrospective analysis that relied on a questionaire (!) to gather its information. (No flaws with that design... ). Even if this were a reliable method for estimating risk or causation (which, clearly, it isn't) the sample size is embarassingly small and one would expect you to have a similar fervent agenda against the alcohol industry since 76% of those with significant CVA were current consumers of alcohol.
I have no real interest in defending chiropractors, but I do have a hard time getting past the intellectual dishonesty of critics who preach from the bible of evidence based medicine but then put forth such flimsy data to bolster their own agendas. Give me a break.
yes, Dr. Burly is a cardiologist from Mayo Clinic. He was teaching clinical scirence and doing his chiropractic degree at Northwestern Health Sciences University in 2000.
That's was kind of a cheap shot he took at you.
Here is an article that I referenced above, which does describe the "referral bias" you describe. And I fully acknowledge this exists. My point is not that chiropractic is extremely unsafe. I believe that the overwhelming majority of chiropractic patients are safely manipulated and that VAD after manipulation is very, very rare. But it does occur. That is accepted in both the chiropractic and allopathic literature.
Referral bias:
http://www.ncbi.nlm.nih.gov/entrez/...Retrieve&dopt=abstractplus&list_uids=14589464
Risk of VAD:
Most recent:
http://www.ncbi.nlm.nih.gov/entrez/..._uids=16511634&query_hl=1&itool=pubmed_docsum
A case-controlled study as you didn't like the other studies:
http://www.ncbi.nlm.nih.gov/entrez/..._uids=12743225&query_hl=6&itool=pubmed_docsum
Chiropractic literature that acknowledges some, but minor risk (lit. review):
http://www.ncbi.nlm.nih.gov/entrez/...Retrieve&dopt=abstractplus&list_uids=16226631
Another chiropractic lit. review, probably the best JMPT review article I've read with regard to methodolgy (it looks at CES and heriation, not stroke):
http://www.ncbi.nlm.nih.gov/entrez/...uids=15129202&query_hl=21&itool=pubmed_docsum
Another lit. review assigning an ORadj of 3.8; 95% CI, 1.3 to 11 to manipulation:
http://www.ncbi.nlm.nih.gov/entrez/...Retrieve&dopt=abstractplus&list_uids=15933263
A less strong case series:
http://www.ncbi.nlm.nih.gov/entrez/...Retrieve&dopt=abstractplus&list_uids=10460445
Standardized interview retrospective study:
http://www.ncbi.nlm.nih.gov/entrez/...Retrieve&dopt=abstractplus&list_uids=14586598
And again chiropractic literature trying to identify the risk pattern:
http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12466778
And last but not least, the position of The National Center for Complementary and Alternative Medicine (NCCAM) is (from: http://nccam.nih.gov/health/chiropractic/#6a): "The rate of serious complications from chiropractic has been debated. There have been no organized prospective studies on the number of serious complications. From what is now known, the risk appears to be very low. It appears to be higher for cervical-spine, or neck, manipulation (e.g., cases of stroke have been reported). The rare complication of concern from low-back adjustment is cauda equina syndrome, estimated to occur once per millions of treatments (the number of millions varies; one study placed it at 100 million)."
There is at least one study that suggests other, minor chiropractic side effects:
http://www.jcca-online.org/client/cca/JCCA.nsf/objects/V49-1-46/$file/jcca-v49-1-046.pdf
In my, completely anecdotal, experience, there is also a risk, not explored in the literature, of chiropractic misdiagnosis leading to delays in actual care. I only mention this because many sCAM providers love to quote the IOM study of "medical deaths", which included error catagories such as "Error or delay in diagnosis", "Failure to employ indicated tests", "Use of outmoded tests or therapy", and "Avoidable delay in treatment or in responding to an abnormal test". With no measure to examine if chiropractors and other sCAM providers are making the same errors, there is no way to tell if they are "better". My guess is that they are not.
Actually, there are good studies, including case controlled studies, look above.
You miss my point. I do not believe that the risk of serious injury from chiropractic therapy is large, or even mild. I fully acknowledge that direct iatrogenic chiropractic injury is very rare. But, any measure of risk, balanced against no demonstrable benefit equals the wrong end of a risk:benefit ratio.
I also believe that many chiropractors hold themselves out as primary care physicians and impart a false sense of security to their patients in that these patients believe that their conditions, whatever they may be, have been assessed by and are being treated by, a provider of equal acumen to an MD/DO. But I can not provide any evidence for that opinion.
- H
If there are no demonstratable benifits to chiropractic C-spine adjustments, then why do so many people continue to seek this trx out for their neck pain or headaches??
I personally know that if i try a pill and over a period of time, if no results are observed, i move on to a new pill or a new trx all together. Obviosly chiropractic has benifts...it wouldn't be the 3rd largest form of health-care after medicine and dentistry if it didn't
I personaly know and speak with many DC's and i'm yet to meet one that assumes the role of a patients GP. DC's are NMSK specalists and are trained as such. Even the OCA (ontario chiro association) mailed out a province-wide statment saying that DC's are NOT to impart their personal beliefs regarding vaccination....it's not in their sciope to do so and i fully agree with that! I will however not say that there are no DC's with delusions of grandur who like to assume primary care over a pt. It's deplorable that it occurs, but it's not as wide spread of an issue as you seem to think it is. 'But I can not provide any evidence for that opinion.'
Here is an article that I referenced above, which does describe the "referral bias" you describe. And I fully acknowledge this exists. My point is not that chiropractic is extremely unsafe. I believe that the overwhelming majority of chiropractic patients are safely manipulated and that VAD after manipulation is very, very rare. But it does occur. That is accepted in both the chiropractic and allopathic literature.
Referral bias:
http://www.ncbi.nlm.nih.gov/entrez/...Retrieve&dopt=abstractplus&list_uids=14589464
Risk of VAD:
Most recent:
http://www.ncbi.nlm.nih.gov/entrez/..._uids=16511634&query_hl=1&itool=pubmed_docsum
A case-controlled study as you didn't like the other studies:
http://www.ncbi.nlm.nih.gov/entrez/..._uids=12743225&query_hl=6&itool=pubmed_docsum
Chiropractic literature that acknowledges some, but minor risk (lit. review):
http://www.ncbi.nlm.nih.gov/entrez/...Retrieve&dopt=abstractplus&list_uids=16226631
Another chiropractic lit. review, probably the best JMPT review article I've read with regard to methodolgy (it looks at CES and heriation, not stroke):
http://www.ncbi.nlm.nih.gov/entrez/...uids=15129202&query_hl=21&itool=pubmed_docsum
Another lit. review assigning an ORadj of 3.8; 95% CI, 1.3 to 11 to manipulation:
http://www.ncbi.nlm.nih.gov/entrez/...Retrieve&dopt=abstractplus&list_uids=15933263
A less strong case series:
http://www.ncbi.nlm.nih.gov/entrez/...Retrieve&dopt=abstractplus&list_uids=10460445
Standardized interview retrospective study:
http://www.ncbi.nlm.nih.gov/entrez/...Retrieve&dopt=abstractplus&list_uids=14586598
And again chiropractic literature trying to identify the risk pattern:
http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12466778
And last but not least, the position of The National Center for Complementary and Alternative Medicine (NCCAM) is (from: http://nccam.nih.gov/health/chiropractic/#6a): "The rate of serious complications from chiropractic has been debated. There have been no organized prospective studies on the number of serious complications. From what is now known, the risk appears to be very low. It appears to be higher for cervical-spine, or neck, manipulation (e.g., cases of stroke have been reported). The rare complication of concern from low-back adjustment is cauda equina syndrome, estimated to occur once per millions of treatments (the number of millions varies; one study placed it at 100 million)."
There is at least one study that suggests other, minor chiropractic side effects:
http://www.jcca-online.org/client/cca/JCCA.nsf/objects/V49-1-46/$file/jcca-v49-1-046.pdf
In my, completely anecdotal, experience, there is also a risk, not explored in the literature, of chiropractic misdiagnosis leading to delays in actual care. I only mention this because many sCAM providers love to quote the IOM study of "medical deaths", which included error catagories such as "Error or delay in diagnosis", "Failure to employ indicated tests", "Use of outmoded tests or therapy", and "Avoidable delay in treatment or in responding to an abnormal test". With no measure to examine if chiropractors and other sCAM providers are making the same errors, there is no way to tell if they are "better". My guess is that they are not.
Actually, there are good studies, including case controlled studies, look above.
You miss my point. I do not believe that the risk of serious injury from chiropractic therapy is large, or even mild. I fully acknowledge that direct iatrogenic chiropractic injury is very rare. But, any measure of risk, balanced against no demonstrable benefit equals the wrong end of a risk:benefit ratio.
I also believe that many chiropractors hold themselves out as primary care physicians and impart a false sense of security to their patients in that these patients believe that their conditions, whatever they may be, have been assessed by and are being treated by, a provider of equal acumen to an MD/DO. But I can not provide any evidence for that opinion.
- H
What I can't figure out is why CAM and chiropractic care is not a similar hornet's nest of malpractice liability that mainstream medicine has become. I mean, with all the probable harm that is being done, why aren't lawyers cashing in?
What school?I went to Chiropractic College for a few terms. I quit for a million different reasons.
I highly doubt someone is still in debt $100K after 10 years. If so they weren't making very good money.The market is going downhill fast. It is overloaded. I have met many chiropractors that have wished they'd gone to D.O. school so they weren't still $100,000 in debt 10 years down the road.
I highly doubt someone is still in debt $100K after 10 years. If so they weren't making very good money.
647 out of 70,000. Yeah HUGE percentage.
647 out of 70,000. Yeah HUGE percentage.
I understand that but you, as do I, have a preconcieved notion, which could cloud your judgement. Would you not agree with that?Again, I'm not "bashing" chiropractic, I'm just pointing out facts.
- H
I understand that but you, as do I, have a preconcieved notion, which could cloud your judgement. Would you not agree with that?
Now with that being said are not most DCs small business owners? Are they not a greater percentage SBO than DOs and MDs? Is it not true that something like 30% of small businesses fail within the first? I don't remember the exact percentage but the number is staggeringly high.
I am not saying anything as fact but my logic, it may be wrong, would indicate that the additional risk in loan defaulting among DCs may have something to do with their small business or practice failing. Could you not draw the same conclusion?
The DCs role as SBO is in no more conflict than the drug manufacture's conflict between drug research and production. Both invest into a particular method and both charge for it, same with any practitioner owned practice. Or for that matter any hospital organization.Well, if you have data to support these suppositions, please post. And even if you are right, doesn't the chiropractor's role as an SBO possibly bring their motivations into conflict with the needs of the patient?
No, I don't agree. I find it hard to believe that as posted a person is still $100k in debt for school loans after 10 years since most DC programs are well under $200k, even if you take out full loan amounts. Unless the person is including their student loans from an undergrad insitution or they don't know how to manage their money, which apparently applies to many within our society reguardless of profession.Actually, I posted in response to your disagreement with the poster who claimed many chiropractors were still in debt long after their training. So now you agree that they are?
- H
No, I don't agree. I find it hard to believe that as posted a person is still $100k in debt for school loans after 10 years since most DC programs are well under $200k, even if you take out full loan amounts.
No, I don't agree. I find it hard to believe that as posted a person is still $100k in debt for school loans after 10 years since most DC programs are well under $200k, even if you take out full loan amounts. Unless the person is including their student loans from an undergrad insitution or they don't know how to manage their money, which apparently applies to many within our society reguardless of profession.
The DCs role as SBO is in no more conflict than the drug manufacture's conflict between drug research and production. Both invest into a particular method and both charge for it, same with any practitioner owned practice. Or for that matter any hospital organization.
WRONG! The drug company doesn't prescribe it's own product.
- H
No, they just give doctors kickbacks to do it instead...
Wow, really?!? I've been licensed for two years now. Never got a drug company check yet. But then again, I don't accept their lunches or their pens either. Guess that is why they have moved on to trying to fool the public directly. They've taken a page right out of the chiropractic playbook. Make outrageous claims and promises and take them to the masses!
http://www.annfammed.org/cgi/reprint/5/1/6
But really, is there a way to get some of the "kickback money" you refer to? I could use a new TV for the super bowl. GO BEARS!
- H
That's funny.. i have 2 anecdotal cases of pharm companies giving kickbacks:
1
) I went into my GP for a physical and while i was there, this dude from Lamisil (nail fungus drug) was offering my GP a free dinner so they could sit down and discuss how the drug works blah blah blah
2) My fathers good friend is an MD who plays squash w/ him weekely. Roughly a month ago he couldn' make the game because he went on a "continuing education" trip to a resort in mexico sponsored by a drug company..basically they recruited doctors for free trips if they agreed to prescribe their drug... that to me doesn't sit right. Now, i don't know if any contracts were signed or if they were verbal agreements but non the less, docs are getting free trips to prescribe drugs AKA a kickback.
No, they just give doctors kickbacks to do it instead...
That's funny.. i have 2 anecdotal cases of pharm companies giving kickbacks:
1
) I went into my GP for a physical and while i was there, this dude from Lamisil (nail fungus drug) was offering my GP a free dinner so they could sit down and discuss how the drug works blah blah blah
2) My fathers good friend is an MD who plays squash w/ him weekely. Roughly a month ago he couldn' make the game because he went on a "continuing education" trip to a resort in mexico sponsored by a drug company..basically they recruited doctors for free trips if they agreed to prescribe their drug... that to me doesn't sit right. Now, i don't know if any contracts were signed or if they were verbal agreements but non the less, docs are getting free trips to prescribe drugs AKA a kickback.
How can DOs not believe in OMM? Isn't it a major part of their training?
If you aren't anti chiropractic then you don't know enough about it. Read some skeptical sites.