Thoughts on Chiropractors?

[~TEO.]

total hours: MD has 2756 hours and a DC has 2887
grand total of classroom hours: MD has 4485 and a DC has 4248.

the hours listed are comparing med school to chiro school. now if you go into speciality those hours are goign to be significantly higher for both MD and DC

One of the most prevalent beliefs circulating among residents of Chiroland is that a chiropractic education is about the same as -- which is to say, comparable with -- one received at a medical school. Believing their own advertising, it's not uncommon to hear chiro-folk humming lines to themselves like, "Chiropractors study the same things as MDs," "Chiropractic school is four academic years (just like medical school)" --each verse of their chiropractic song punctuated with a reminder that: "Hey, we're doctors, too, ya know (ya know (ya know))" -- wee wee wee, all the way home.

For example, we see these DC/MD education course-work lists published as side-by-side comparisons whenever competitive push comes to compensatory chiropractic shove. And, while these sorts of comparisons are just part of chiropractic's oobleck, generally --forever oozing its way through the health care cracks in an effort to convince consumers, legislators, and third-party payors of a DC's training and expertise -- we really shouldn't overlook the role of these promotions in having students buy into their own chiropractic advertising. After all, it's all part of the reassuring and patting-oneself on-the-back process of becoming a chiropractor. First, you "educate" the chiropractor ... THEN all else follows.

Here's something I wrote to USENET in the mid-nineties in response to a chiropractor who published a side-by-side DC/MD course-work comparison -- as if to convince others and reassure himself that chiropractors are doctors, too -- just like other doctors are doctors.

*************************************************************

MY FAMILY PHYSICIAN SAYS THAT CHIROPRACTIC SCHOOL IS A JOKE AND THAT THOSE "QUACKS" HAVE NO BUSINESS IN THE HEALTH PROFESSION.

Andrew White, Chiropractor, responds:
The MD is mistaken...Here are the stats on education. He is probably concerned because DC's pose a significant financial threat to him. He ought not to be concerned about a littel economic competition. These values are taken from a survey of med school graduation reqs.

See for yourself.

One of my admonitions in SOME GUIDELINES FOR CHOOSING A CHIROPRACTOR was to avoid one who in any way competitively suggests that "chiropractic" is better than medicine. It appears I should have said "greater than or equal to" so to include those who would argue the equivalence of a DC and MD as though they were both merely flavors of ice cream with essentially the same ingredients. While the impact of picking chocolate over vanilla on any given day is clearly harmless, I suggest that treating your chiropractor as an entry level physician when you have a complaint is a much more serious choice -- one that would be inappropriate since chiropractors are not qualified to be primary care providers.

Please be clear. I'm not saying that certain procedures that may sometimes be done in some chiropractic offices are not occasionally useful for some musculoskeletal conditions, some of the time. Nor am I saying that there aren't some chiropractors who are extremely bright, articulate, accomplished, and/or very talented. There are exceptions in EVERY profession. I am saying that, among other things, the training of chiropractors is inadequate to the task of diagnosing and treating most conditions for which people go to the doctor and rare conditions, which (rarely) underlie a patient's entering complaint, but nonetheless do occur. Most chiropractors should not even be considered competent musculoskeletal doctors or back specialists since almost all their so-called clinical training, including diagnosis and management, is dedicated to "finding and fixing the [Chiropractic] Subluxation," which I have said before is a fictitious diagnosis invented by chiropractors.

I am writing this in response to a recent post that lists the basic and medical science courses which must be completed by chiropractors presented side-by-side some of the academic requirements of MDs. The suggestion, of course, is that because chiropractors have a similar education to MDs, they can be considered to be medically competent practitioners. While I certainly can understand the motivation of a given chiropractor or the profession promoting this pseudo-equivalent medical simulacrum by calling each other "Doctor," wearing white coats in school, and publishing these comparisons and claims, I wouldn't confuse this imagery with the enthusiasm of patients who "REALLY like their chiropractor" and who "know people who have benefited" when choosing a primary physician. But MOST of all, I wouldn't cite chiropractic education and the education of a chiropractor as a justification for my chiropractic proclivity and pyschoaesthetic.

(continued in part II)

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[~TEO.]

(Part II)

You see, the chiropractic profession is fundamentally conflicted about education. On the one hand, they come from, and often prefer to be identified with a "Healer" tradition. On the other, they want to participate in the health care and insurance industry, and so are forced to rationalize their arbitrary therapies in the eyes of the scientific community and account for their diagnoses and treatments in medical terms. And so, chiropractic's relationship to the medical model, like any educational requirement your heart's not-in, is handled poorly, is unsupported, often resented, and most frequently "put-up-with" by those students who have no real intent of ever applying the material professionally. "Adjust the spine..and all is fine." Many chiropractors, in fact, are anti-intellectual, believing that being educated gets-in-the-way of healing.

This schizoid attitude toward the western heteropathic tradition crystallizes in the chiropractic student's clinic experience, which generally starts somewhere between midway and two-thirds-way through their academic curriculum. In the clinic, they must reconcile the basic and clinical sciences with their chiropractic philosophy and methodologies. It is, as I've mentioned before, a conflict between whether there really IS such a thing as pathology as defined by anatomic and physiologic abnormalities on the one hand, and a Conceptual Pathology (The Chiropractic Subluxation) based on the need for the chiropractor to sell themselves as The Solution to this Pseudo-Problem, on the other. In other words, "tissue has become an issue." Notably, it was B.J. Palmer (the son of D.D., the "father" of The Chiropractic), who denied the existence of the cranial nerves (anatomy) because they didn't fit-in with his Subluxation Paradigm (Fictitious Pathology). This kind of denial underlies chiropractic education and practice today. So-much for the chiropractic anatomy and neurology classes :-|

While I don't think you can get any deeper than fundamental differences (by definition), the posted comparison-list leaves out several important facts pertinent to evaluating its implied assertion, which is that you can rely on a chiropractor for diagnosis and treatment of things medical, from glaucoma to neck pain since chiros, like MDs, have the same course-work in basic and clinical sciences. Leaving aside the naive assumption that the title of a course with the number of units applied to it indicates _anything_ about the organizational content of the curriculum (how the task of training an MD and DC is allocated) or the quality of the course-work, let me say a few things about what's NOT on the list.

1) Compared to getting into medical school, matriculating to chiropractic school is a breeze. Only two years of undergraduate pre-requisites are needed with passing grades in the required courses. Many chiropractors have taken their basic science pre-reqs at schools that offer special 6-weekend courses in each. There is no equivalent in "chiropractic" of the MCAT (Medical College Admissions Test), which considered alone is not a good predictor of what KIND of doctor you will be, but IS an indicator of a certain level of intellectual function (disturbingly absent in the chiropractic profession). I was accepted to a "good [chiropractic] school" with only a phone call since I already met the requirements and had the tuition money. I was the one to suggest that they actually meet me personally (like an interview) to make sure I wasn't a mass-murderer.

A persons' character and especially their intellectual interests and motivation are not carefully considered in the application process. Chiropractic schools are essentially trade schools, tuition dependent, and can not afford to be picky about choosing who's admitted. And because the schools require the tuition to remain open, they also can't afford to LOSE anyone, who, even at a chiropractic school, is demonstrably stupid, incompetent, and/or dishonest. I think the quality of the entering student has some bearing on the ultimate product. I didn't see anything about this on the comparison list.

2) The faculty at chiropractic schools generally do not have real expertise in the areas they teach. Quite often, they are DCs who have done their best to put together a course in pathology or diagnosis, but have no experience (as a medical doctor) beyond the textbooks they used and the DCs who taught them. Basic sciences: My biochemistry and physics teacher maintained that you weighed less when you picked one foot off the ground and that there was no gravity on the moon. Microbiology: When asked about the size of a virus, the professor maintained it was "very small," but wasn't quite sure if it was bigger than an atom, or not. A fungus was defined as the "green stuff" that appears on cheese left too long in the refrigerator. Clinical sciences: The OBGYN course is currently taught by a DC who believes that new-borns need to be Adjusted to treat the neck trauma incurred at birth. I didn't see anything about this on the list when comparing the `units' of basic and clinical sciences.

3) Being at clinic is like having a free ticket to "Ripley's, Believe It or Not." The stunning things that go on daily in the name of "The Chiropractic" are too many to enumerate: using non-medically diagnostic x-rays to locate the (conceptual) Chiropractic Subluxation; "Adjusting" the first cervical vertebra on a patient who has fainted (as an emergency measure); faculty DCs, who when asked to confirm an arrhythmia on a patient, telling a student not to worry about it (since the instructor has no idea what to listen for) and that "Thuh" Adjustment will take care of The Problem anyway; and on.. and on. This kind of data is conspicuously absent from the comparison list.

Chiropractic outpatient clinics, where the so-called clinical training takes place are not affiliated with any hospital. Students do NOT see the patients they've only read about, so that their clinical judgement and opinion about a rash, a bump, or even a pain is almost worthless. The faculty DCs are generally Adherents of a particular Chiropractic Technique; so frequently they only know a portion of their already narrow chiropractic approach. For example, a teacher who practices NUCCA Technique only analyzes and treats "malpositions" of the first cervical vertebra. Any patient complaint is presumed to be a misalignment of the first cervical vertebra and is "corrected" with what's called a "Triceps-Pull," a robotically tense, slow and convoluted maneuver so byzantine in concept and application that, well, you'd have to "See it, to Believe it!" If a student spends their entire clinic life "mastering" such an irrelevant medicine, how does this speak to the issue of training for primary care, or even a back specialist? Where is this information represented on the comparison list?

Finally, I am not aware of any required clinical internship or residency (as with MDs) for chiropractors above and beyond their relatively minor clinic exposure and the irrelevant clinical antics to which I referred earlier. Leaving out this three to five years training that most MDs undertake AFTER graduating four years of medical school is perhaps the most grotesque, but no less naive, misrepresentation of the lists comparing MD and DC medical educations. But there's a qualitative subtlety which may be missed if we only focus on this obvious quantitative difference. This relates to the relationship of the chiropractor and the MD _to_ the course-work that's listed.

Remember, that the Vitalism that informs much of Chiropraxis both historically and hysterically, is virtually unrelated to scientific medicine. Hence, the medical and science courses that ARE listed for chiropractors represent little more than a theatrical prop, like the white jacket and stethoscope needed to "Play a doctor in real (insurance-reimbursable) life." Medical education, OTOH, represents the fundamental and basic underpinning of the diagnostic and therapeutic strategies and skills MDs will develop and apply throughout their practice career. Chiropractic students *STILL* argue about why they have to take all this "medical stuff" knowing very well how easy it is to trade-in the complexities of biochemistry, nerve trespass, and patient management for the more lucrative world of Body Chemistry, Nerve Interference, and Practice Management once they graduate.

From The Chiropractic Byzantium.

~TEO.

******************************
John Badanes, DC, PharmD
LCCW '84, UCSF '97

 

[Mike MacKinnon]

TEO

Thank you for the truth and honesty.

Arent you the fellow from the video?

 

[Lugnut]

That is the definition of a blanket statement. Unlike medical schools in the U.S, chiro schools are not created equally. I am a chiro who is planning on going to med school. I agree for the most part with your assessment of the clinical education and the subluxation junk, however I felt my basic science education was very strong at NUHS, maybe not as strong as med school, but we'll see. It looks like you went to Life college, and from what I hear know, that was a mistake. I know several chiros from reputable chiro schools who went back to med school(UVM,GW, OU, UIllinios, Unecom) and personally told me med school was a breeze(Honors) having the chiro education under their belt. Everyone, at the end of the day, no matter what field you are in, there are going to be plenty of bad, good and disgruntled. Although I do not subscribe to most of the chiro subluxation mumbo jumbo, I do believe there is a lot of good that gets done by a select group of chiros who wish to work within there scope concentrating on the NMS system and working closely with the medical and PT profession.

Thats what I do and have been very successful. I have accepted my place in the healthcare system, and it is the very limitations in my scope that has sparked me to further my education.

 

[611]

That is the definition of a blanket statement. Unlike medical schools in the U.S, chiro schools are not created equally. I am a chiro who is planning on going to med school. I agree for the most part with your assessment of the clinical education and the subluxation junk, however I felt my basic science education was very strong at NUHS, maybe not as strong as med school, but we'll see. It looks like you went to Life college, and from what I hear know, that was a mistake. I know several chiros from reputable chiro schools who went back to med school(UVM,GW, OU, UIllinios, Unecom) and personally told me med school was a breeze(Honors) having the chiro education under their belt. Everyone, at the end of the day, no matter what field you are in, there are going to be plenty of bad, good and disgruntled. Although I do not subscribe to most of the chiro subluxation mumbo jumbo, I do believe there is a lot of good that gets done by a select group of chiros who wish to work within there scope concentrating on the NMS system and working closely with the medical and PT profession.

Thats what I do and have been very successful. I have accepted my place in the healthcare system, and it is the very limitations in my scope that has sparked me to further my education.

The problem is you are talking about National and most of the other chiropractic schools just don't measure up.

 

[~TEO.]

Arent you the fellow from the video?

If you're talking about the PBS "Scientific American Frontiers" episode that aired nationally in June, 2002 called, A Different Way To Heal? ... that was me in the segment, "Adjusting the joints."

You can watch the darned thing online and read some of my replies to viewer mail at the two following links, respectively:

http://www.pbs.org/saf/1210/video/watchonline.htm

http://www.pbs.org/saf/1210/hotline/hbedanes.htm

I actually posted these links in another SDN thread about "chiropractic," but didn't realize that the discussion had ended sometime last May, I think it was

Thanks for your interest.

~TEO.

John Badanes, DC, PharmD
LCCW '84, UCSF '97

 

[611]

Hey, you guys found a hero!

 

[Lugnut]

Hey TEO,

You still put DC in your signature. Why? You obviously have a lot of pent up feelings about chiros. Did you practice? How long? Did you ever make an effort to work in a mainstream setting, evidence based rehab, etc.

 

[Mike MacKinnon]

Thanks.

It is nice to have someone who stands up and talks about reality instead of quoting propoganda and spouting the drivel "high pressure sales" that chiro is known for. I appreciate your bravery and honesty

If you're talking about the PBS "Scientific American Frontiers" episode that aired nationally in June, 2002 called, A Different Way To Heal? ... that was me in the segment, "Adjusting the joints."

You can watch the darned thing online and read some of my replies to viewer mail at the two following links, respectively:

http://www.pbs.org/saf/1210/hotline/hbedanes.htm

http://www.pbs.org/saf/1210/video/watchonline.htm

I actually posted these link in another SDN thread about "chiropractic," but didn't realize that the discussion had ended sometime last May, I think it was

Thanks for your interest.

~TEO.

John Badanes, DC, PharmD
LCCW '84, UCSF '97

 

[Lugnut]

Yeah! TEO somehow found a way to live with himself and his unsubstantiated treatment for eight years in practice. For some of us, Adjusting spines for subluxations is not all there is in the chiropractic world. How about getting further training in orthopedics, rehab, sports medicine and actually treat that muscle strain by reducing the inflammation and spasm and utlilizing other techniques such as myofascial release, propriocetive and stabilization training. Believe it or not, I only use manipulation on a third of my patients, and all this is completely within my scope.

 

[Squad51]

The problem is you are talking about National and most of the other chiropractic schools just don't measure up.

Wow, so we should only deal with chiropractors from National? Should we write to our legislators and have the standards to practice chiropractic changed so that only National graduates can practice? Hmm, doesn't seem fair. Maybe we should have a national accrediting body to see to it that all chiropractic colleges live up to some standard. Oh wait, that's right, we do. The CCE. And that organization preaches what? Say it with me: "subluxation!"

From: http://www.cce-usa.org/2006 COA Self Study and Report Guide.pdf

Under the heading "Requirements for Accreditation"
"The DCP incorporates the understanding of chiropractic as a profession practicing primary health care, provides curricular and clinical evidence of that through outcome measures, and consists of education and training to prepare graduates to:
A. Practice direct contact health care as a portal-of-entry provider for patients of all ages and genders; The DCP graduates are prepared to practice direct contact health care as a portal-of-entry provider for patients of all ages and genders.
B. Assess the patient's general health status, complaints and problems leading to a diagnosis. Specific elements of patient assessment minimally include complete health history; review of systems; physical, biomechanical, and neurological examination; the analysis of spinal subluxation; and, when clinically indicated, diagnostic imaging, clinical laboratory, and/or specialized diagnostic procedures"

Now, I know that you claim that National students do as well as Loyola University CoM students on physiology tests, but having taken medical physiology (and passing it quite well), I must have been absent on the day they taught about subluxation analysis. I still have a year of medical school to go. Do you think they'll let me go back and make that chapter up? BTW - keep in mind that the CCE is over ALL chiropractic colleges in the US. Including National.

Look, no one is saying that all chiropractors are idiots. But you yourself suggest that there are very extreme differences in training. And the organization that was created to eliminate those differences is beholden to subluxations in the very preface to their accreditation manual! How is chiropractic safe for the public? How are they to know if they are getting help from a qualified practitioner, aware of their limits or a subluxation freak like wayttk?

 

[Lugnut]

You making my point for me. It will never happen as long as there are wacky chiros preaching subluxation in the ACA and in the colleges. The lack of consistent philosophy will spell the demise of chiros, IMO. This is why I have chosen to get out.

 

[611]

You making my point for me. It will never happen as long as there are wacky chiros preaching subluxation in the ACA and in the colleges. The lack of consistent philosophy will spell the demise of chiros, IMO. This is why I have chosen to get out.

Best of luck to you.

 

[awdc]

I'm a former DC and I agree with a lot of TEO's post but I also disagree with a lot of it. I thought my basic science education at SCUHS/LACC was actually quite good. We had PhD's, MD's, and some dual-degree MD, PhD's as profs in each of our basic sci classes. Most classes were not on par with med school but they didn't need to be considering that neuromusculoskeletal was the emphasis. And I didn't encounter any of the things TEO described about the college clinics at my school. If a patient had a medical problem, they were referred to a MD. However, I do agree that in medical school, I've already seen many of the things that I've only read about in chiropractic school.

 

[seanjohn]

I heard chiropractors give adjustments to the TMJ.

Most dentists I've spoken to have said that adjusting the TMJ is about the worst thing you can do for the joint, and is extremely harmful since it's such a delicate joint.

So now these chiroquackters cause strokes when they adjust necks, and dislocations when they adjust the TMJ. What a great track record these quacks have.

 

[quack2be]

I was sent this link a tonight from a friend of mine who is desperately trying to get into medical school, however, in reality he doesn't have the marks to ever get in. Since i am currently attending a chiropractic college i thought it would be interesting to clearify a few points that have been brought up by the one side.

Obviously allopathic medical students are going to shoot down any claims that are posted in defence of chiropractic in general, but there's no harm in trying. I could send you thousands of articles that show a correlation between spinal manipulation therapies and alleviation of various types of musckuloskeletal ailments. But again most are from chiropractic journals and thus all of you dr's to be will say there biased.

As for the non-evidence based schooling that you all seem to believe that DC attend...yes there are some schools that would be lower on the evidence-based learning and bring a more philosophic approach to healing. I don't attent one of those, and a number of my lecturers are not only MD's but Ph.D's as well and you can't sit there and tell me that someone that has a PhD in neuroanatomy or in biomechanics or in epidemiology or in neurophysiology is coming from a lower IQ level then you guys. Did i mention all of these lectures happen to be DC's, weird i thought that there was a lower GPA in chiro colleges? Must be some sort of mistake?

On to the quakary that exists. I'll be the first to admit that chiropractic as a whole is flawed with biased studies and a lot of flaws within the studies that have been performed. but chiropractic has been formally around for only 100 years, allopathic medicine with hipporactes... thats a long time ago and i seem to remember blood letting and and other archaic forms of medice to last a little longer then just 11 years. You also have to admit that allopathic medicine is not perfect. Do me a favour when you actually get your MD title and your patient comes into your office with a musckuloskeletal complaint dont just perscribe a bunch of anti-inflammatories, becuase we both know you've done nothing to treat the underlying problem: is there ligament damage? muscular damage? hemarthrosis? osteoarthritis? dont go by the multiple cause = one cure approach, becuase thats just as bad the original chiro philosophy of "one cause, one cure". and i'll do you a favour and wont "crack" every patients back i see. I'll be doing everything a Phyio can do and then some.

I think one of the thing that really bugged me when i read the responces was that nothing concrete is learned in chiro colleges. I find that annoying as i take the time to write this responce as i take a break from studying for my cranial nerves exams. Alright, relax, i'm not trying to show off that i know ALL 12 nerve names, its more the fact that on my board exams i'm going to have to know what supplies the taste to the anterior 2/3 of the tongue what nerve does it hitch hike in and where does it synapse (for the doctors that dont know its the corda tympani, with lingual nerve and it synapses in the geniculate ganglion on the way to the brain). My point is...I'LL NEVER NEED TO KNOW THIS IN PRACTICE...yet i sit here and learn it because it shows chiro's actually do know their anatomy, maybe even better then MD's (though i believe MD's understand the pathology of the internal organs to a much greater degree)

Sorry for the long responce but this is what i'm going to be doing for a living and i i'd rather get along with the MD who practices down the street then have arguements about the problems with "back cracking" and the arguements about paralysis or causing a VBA (if you dont know what that is look it up) here are some stats...because you MD's love your "evidence". the literature shows that 165 VBA's have occured with spinal manipulation in the 100 years of chiropractic. In contrast 1998 US report reports 98,000 accidental deaths due to medical malpractice (surgical or drug related. And here's a funny one since august 2000 there have been 150 cases of patients having the opposite limb being operated on to the one that is suppose to be.

As i expect dozens of you will come back with articles of your own or various comments about how i'm crazy to say the things that i have or that chiropractic is just nonsence. With which i reply this, maybe the reason people are gravitating to chiropractic and chiropractors as health care providers is because their sick of the egotistical, almost God like personality of their MD. Which i am already seeing on thie message board (and your not even MDs yet) You sit there in your comfy leather chairs in your office and you judge your patients, you show a lack of empathy and there is a group of you that probably only care if your going to be late for your tee time at the country club...take that for what its worth.

quack2be...sorry couldnt resist the name since thats all you see me as anyways

 

[BACMEDIC]

OK, I looked through this quickly and could not find the answer.

In the state on CT I've been told that a chiropractor is performing pap smears. He says he is the same as a medical doctor and is allowed to perform these procedures - any truth to this or is he practicing medicine without a license?

We start learning this stuff on standarized pts in the 2nd year of school - do they do this as well? And who cares - who would go to a chiro for a pap smear?

 

[THP]

I think one of the thing that really bugged me when i read the responces was that nothing concrete is learned in chiro colleges. I find that annoying as i take the time to write this responce as i take a break from studying for my cranial nerves exams. Alright, relax, i'm not trying to show off that i know ALL 12 nerve names, its more the fact that on my board exams i'm going to have to know what supplies the taste to the anterior 2/3 of the tongue what nerve does it hitch hike in and where does it synapse (for the doctors that dont know its the corda tympani, with lingual nerve and it synapses in the geniculate ganglion on the way to the brain). My point is...I'LL NEVER NEED TO KNOW THIS IN PRACTICE...yet i sit here and learn it because it shows chiro's actually do know their anatomy, maybe even better then MD's (though i believe MD's understand the pathology of the internal organs to a much greater degree)

Dude, learning cranial nerves is 1 or 2 lectures tops during gross anatomy. I had to learn the cranial nerves for high school anatomy and physiology. You think we don't learn that? The thing is, if you are an Ob/Gyn and haven't even thought about cranial nerves in 10+ years its easy to forget them.

 

[PublicHealth]

OK, I looked through this quickly and could not find the answer.

In the state on CT I've been told that a chiropractor is performing pap smears. He says he is the same as a medical doctor and is allowed to perform these procedures - any truth to this or is he practicing medicine without a license?

We start learning this stuff on standarized pts in the 2nd year of school - do they do this as well? And who cares - who would go to a chiro for a pap smear?

http://www.fclb.org/directory/connecticut.pdf

 

[deleted87716]

In the state on CT I've been told that a chiropractor is performing pap smears.

This link may be helpful, although it is not specific to the state of CT. In particular, Spunt v. Fowinkle (at the bottom of the page).

 

[BACMEDIC]

http://www.fclb.org/directory/connecticut.pdf

Thanks for the reply publichealth

After reading the "Scope of Practice", this guy is practicing medicine without a license - or did I miss something?

What about scope of practice rights in other states? Do chiros really have a strong lobby and are getting procedure rights that are really in the realm of physicians?

 

[awdc]

OK, I looked through this quickly and could not find the answer.

In the state on CT I've been told that a chiropractor is performing pap smears. He says he is the same as a medical doctor and is allowed to perform these procedures - any truth to this or is he practicing medicine without a license?

We start learning this stuff on standarized pts in the 2nd year of school - do they do this as well? And who cares - who would go to a chiro for a pap smear?

As crazy as it sounds, we actually learned how to perform pap smears, breast exams, and rectal exams on standardized patients in chiropractic school. I think it was supposed to fulfill some CCE requirements or something. But I don't know who in their right minds would actually continue doing this in practice considering we never saw anyone for those issues during the rest of our training beyond those standardized patients. And yeah, who would go to a chiro for pap smear in the first place?

 

[awdc]

I heard chiropractors give adjustments to the TMJ.

Most dentists I've spoken to have said that adjusting the TMJ is about the worst thing you can do for the joint, and is extremely harmful since it's such a delicate joint.

So now these chiroquackters cause strokes when they adjust necks, and dislocations when they adjust the TMJ. What a great track record these quacks have.

The "adjustments" we learned for the TMJ in chiro school were more like gentle mobilizations and working on the musculature surrounding the TMJ. Nothing like the high velocity, low amplitude adjustments that is commonly associated with chiropractic.

 

[seanjohn]

The "adjustments" we learned for the TMJ in chiro school were more like gentle mobilizations and working on the musculature surrounding the TMJ. Nothing like the high velocity, low amplitude adjustments that is commonly associated with chiropractic.

oh... well then that doesn't sound so bad then, but I don't think too many dentists or physicians would recommend a high velocity thrust on the TMJ, the joint is too delicate, and a high velocity thrust would only cause harm.

 

[box29]

I was just wondering about what other techniques DC's learn besides the obvious HVLA...

I stumbled onto National's site and found a technique they use...

"Flexion-Distraction technique uses a special precision table that makes circular and vertical movements to release disc and spinal pressures. The movement, guided by the hands of a chiropractic physician, creates a suction effect to allow a disc to return to its normal height or a joint to its normal range of motion.

The technique's founder, Dr. James Cox (a National graduate) explains Flexion-Distraction as a marriage of chiropractic principles with osteopathic principles. These principles were set forth by Alan Stoddard, DO, in his book 'Manual of Osteopathic Technique' which described the manipulative procedures developed by John McManis, DO, in the early 1900's."

http://www.nuhs.edu/show.asp?durki=539

I understand there are other techniques that may be similar to those of OMM, such as Muscle-Energy and counterstrain...but what are they called and exactly what techniques do you learn?

THanks

 

[Squad51]

...but what are they called and exactly what techniques do youn learn?

THanks

It seems to me (from reading this thread and others) that you should more properly ask "exactly what techniques do you learn and where did you learn them?" There seems to be wild variation between different chiropractic colleges.

 

[fab4fan]

As crazy as it sounds, we actually learned how to perform pap smears, breast exams, and rectal exams on standardized patients in chiropractic school. I think it was supposed to fulfill some CCE requirements or something. But I don't know who in their right minds would actually continue doing this in practice considering we never saw anyone for those issues during the rest of our training beyond those standardized patients. And yeah, who would go to a chiro for pap smear in the first place?

You'd be surprised. I live in an area with a lot of Amish/Plain people, and they go to chiros for everything. Taking an admission history is so much fun; when you ask them about meds/herbal supplements, they give you a list 10 miles long of various supplements their "doctor" (DC) has prescribed them.

 

[PublicHealth]

You'd be surprised. I live in an area with a lot of Amish/Plain people, and they go to chiros for everything. Taking an admission history is so much fun; when you ask them about meds/herbal supplements, they give you a list 10 miles long of various supplements their "doctor" (DC) has prescribed them.

If given the choice to go to an MD/DO or DC, wouldn't the Amish choose to go the 'natural' way of the DC?

 

[Squad51]

If given the choice to go to an MD/DO or DC, wouldn't the Amish choose to go the 'natural' way of the DC?

This could well be an access issue more than a cultural choice. The Amish will accept modern healthcare. Many communities even hire an "English" (non-Amish) driver for emergencies. That said, a chiropractor could make a decent living (as the Amish abhor debt and usually pay in cash) by travelling into the Amish community to provide chiropractic "care".

 

[611]

Set your Tivo's: CNN, Saturday April 8, 8:30 AM edt.

 

[DOctorJay]

what does a DC provide that a DO cannot?

 

[611]

I think manipulation is a very small part of an Osteopath's practice these days. But to specifically answer the question, there is nothing a DC can provide that a DO, or MD for that matter, cannot. The DC license is certainly a more restrictive license which it has to be due to the type of training.

 

[fab4fan]

This could well be an access issue more than a cultural choice. The Amish will accept modern healthcare. Many communities even hire an "English" (non-Amish) driver for emergencies. That said, a chiropractor could make a decent living (as the Amish abhor debt and usually pay in cash) by travelling into the Amish community to provide chiropractic "care".

It's not an access issue. We have tons of doctors here. One hospital offers them a special rate because they pay cash upfront.

We also have a lot of chiros, too. I'm not sure if it has so much to do with a preference for "natural" treatment, because quite a few Amish are into "manipulation under anesthesia."

 

[611]

Check out CNN Sunday at 8:30 AM.

 

[seanjohn]

Chiropractors seem to learn how to do breast and genital exams on patients while studying in chiropractic college... but I'm pretty sure if a chiropractor did any of these exams in their practice on real patients, they'd be facing criminal charges for sexual assault because only real doctors are allowed to perform such examinations.

 

[611]

Wrong

 

[fab4fan]

Wow...think of the potential for this type of alternative medicine.

 

[PublicHealth]

Wow...think of the potential for this type of alternative medicine.

Shoot, I'd much rather 'travel back in time' than die at the hands of some incompetent MD/DO: http://www.msnbc.msn.com/id/11355786/

 

[Squad51]

Shoot, I'd much rather 'travel back in time' than die at the hands of some incompetent MD/DO: http://www.msnbc.msn.com/id/11355786/

Wow, quoting from your article: "They reported 38,371 errors in ICUs between 2000 and 2004. These resulted in 14 deaths and included 68 "very serious errors."". 14 deaths and 68 "very serious errors", there is plenty of evidence, in the chiropractic literature no less, (for instance here: http://www.jcca-online.org/client/cca/JCCA.nsf/objects/V49-1-46/$file/jcca-v49-1-046.pdf and here: http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12466778) that would suggest more serious adverse outcomes occur at the hands of chiropractors. The other difference? At least the doctors had the possibility of helping the patients prior to the errors. Chiropractors expose their patients to these risks with no proven clinical benefit and certainly no ability to help at all in the medically complex setting of an ICU. 14 iatrogenic deaths in ICUs nationwide from medication errors? Given the utter complexity of ICU care, that is actually not a bad rate. The more complex a system, the greater chance for error. But don't worry PublicHealth, I wouldn't expect a chiropractor like you to know anything about that.

 

[PublicHealth]

Wow, quoting from your article: "They reported 38,371 errors in ICUs between 2000 and 2004. These resulted in 14 deaths and included 68 "very serious errors."". 14 deaths and 68 "very serious errors", there is plenty of evidence, in the chiropractic literature no less, (for instance here: http://www.jcca-online.org/client/cca/JCCA.nsf/objects/V49-1-46/$file/jcca-v49-1-046.pdf and here: http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12466778) that would suggest more serious adverse outcomes occur at the hands of chiropractors. The other difference? At least the doctors had the possibility of helping the patients prior to the errors. Chiropractors expose their patients to these risks with no proven clinical benefit and certainly no ability to help at all in the medically complex setting of an ICU. 14 iatrogenic deaths in ICUs nationwide from medication errors? Given the utter complexity of ICU care, that is actually not a bad rate. The more complex a system, the greater chance for error. But don't worry PublicHealth, I wouldn't expect a chiropractor like you to know anything about that.

Firstly, you are making a comparison between TRAINED medical physician errors and chiropractic STUDENT errors and a case report!? Secondly, you forgot to quote and comment on the following:

"The report helps support the logic behind a World Health Organization initiative to reduce such errors, which the U.S. Institute of Medicine estimates kill as many as 98,000 people every year in the United States alone.

The U.S. Food and Drug Administration estimates as many as 1.3 million Americans are injured by medication errors every year. The Health and Human Services Department has been working on a nationwide electronic prescribing, records and inventory control system to help reduce those errors."

I challenge you to find me an article -- popular press, scientific literature (ANYTHING) -- that shows that chiropractic kills 98,000 and injures 1.3 million Americans per year. http://darwin.nap.edu/books/0309068371/html/26.html

By the way, I'm a DO student. Oh, and ad hominem attacks do not make for good discussion.

 

[611]

Firstly, you are making a comparison between TRAINED medical physician errors and chiropractic STUDENT errors and a case report!? Secondly, you forgot to quote and comment on the following:

"The report helps support the logic behind a World Health Organization initiative to reduce such errors, which the U.S. Institute of Medicine estimates kill as many as 98,000 people every year in the United States alone.

The U.S. Food and Drug Administration estimates as many as 1.3 million Americans are injured by medication errors every year. The Health and Human Services Department has been working on a nationwide electronic prescribing, records and inventory control system to help reduce those errors."

I challenge you to find me an article -- popular press, scientific literature (ANYTHING) -- that shows that chiropractic kills 98,000 and injures 1.3 million Americans per year. http://darwin.nap.edu/books/0309068371/html/26.html

By the way, I'm a DO student. Oh, and ad hominem attacks do not make for good discussion.

 

[guetzow]

My SP is soon to be regional director for WC, as mandated by the WC commission (In our state). Many Chirs will soon no longer be privvy to doling out services to non-compliant WC types who do not follow the PLAN of their treating physician.....

 

[Squad51]

By the way, I'm a DO student. Oh, and ad hominem attacks do not make for good discussion.

O.k. slick, since FF seems to have left the board, I suppose I'll school you a bit here. First off, A (fallacious) ad hominem argument has the basic form: A makes claim B; there is something objectionable about A, therefore claim B is false. For what I said to be an ad hominem argument you must a. feel that being called a chiropractor is objectionable (which you wouldn't appear to given your posts here) and b. I would have had to provide no "backup" to my statement other than the argument that your opinion is de facto invalid. Which is not the case. If you are going to throw big words around, check the definitions.

BTW - now having looked at your previous posts, you are a second year DO student correct? So your ICU time to this date is extremely limited. In fact, for purposes of this discussion, your experience in an ICU is likely similar to that of most chiropractors...

Firstly, you are making a comparison between TRAINED medical physician errors and chiropractic STUDENT errors and a case report!?

O.k., you are right, I responded quickly. Let's do this correctly. The measures of chiropractic errors and the resulting iatrogenic injuries are notoriously poorly reported. That said, there are several studies that suggest rates:

http://www.ncbi.nlm.nih.gov/entrez/...uids=11340209&query_hl=10&itool=pubmed_docsum

Found that "for those aged <45 years showed vertebrobasilar accident (VBA) cases to be 5 times more likely than controls to have visited a chiropractor within 1 week of the VBA (95% CI from bootstrapping, 1.32 to 43.87). Additionally, in the younger age group, cases were 5 times as likely to have had >/=3 visits with a cervical diagnosis in the month before the case's VBA date (95% CI from bootstrapping, 1.34 to 18.57). No significant associations were found for those aged >/=45 years." But in fairness, the authors do state that further study is needed.

http://www.ncbi.nlm.nih.gov/entrez/..._uids=8642364&query_hl=12&itool=pubmed_docsum

Attempted a more complete review via the literature. They found "295 complications of spinal manipulations from the literature: 165 VBAs; 61 cases with disc herniation or progression to CES; 13 cerebral complications other than VBAs; and 56 other types of complications. The average age of patients with VBA was 38 years. Vertebrobasilar accidents occur mainly after a cervical manipulation with a rotatory component. Estimates of VBA range from 1 per 20,000 patients to 1 per 1 million cervical manipulations. The incidence of CES is estimated to be less that 1 per 1 million treatments." But again, more study was suggested.

http://www.ncbi.nlm.nih.gov/entrez/...uids=12015249&query_hl=12&itool=pubmed_docsum

Was not as nice. They found "Data from prospective studies suggest that minor, transient adverse events occur in approximately half of all patients receiving spinal manipulation. The most common serious adverse events are vertebrobasilar accidents, disk herniation, and cauda equina syndrome. Estimates of the incidence of serious complications range from 1 per 2 million manipulations to 1 per 400,000. Given the popularity of spinal manipulation, its safety requires rigorous investigation."

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=14589464

This is actually a review from a chiropractic insurance carrier's data. It showed that "For the 10-year period 1988 to 1997, there were 23 cases of vertebral artery dissection after cervical manipulation reported to the CCPA that represents 85% of practicing chiropractors in Canada. Based on the survey, an estimated 134,466,765 cervical manipulations were performed during this 10-year period. This gave a calculated rate of vertebral artery dissection after manipulation of 1:5,846,381 cervical manipulations. Based on the number of practicing chiropractors and neurologists during the period of this study, 1 of every 48 chiropractors and one of every two neurologists would have been made aware of a vascular complication from cervical manipulation that was reported to the CCPA during their practice lifetime." One out of two neurologists, gosh, I love those odds!

All of which leads me back to http://www.jcca-online.org/client/cca/JCCA.nsf/objects/V49-1-46/$file/jcca-v49-1-046.pdf

Which is remarkable not because it shows that chiropractic students were in harm's way but rather because it completely debunks the idea that chiropractic adjustments are "safe". Few, if any, medical students are hurt in the process of their schooling. And to quote the paper (written by chiropractors mind you), "the overall incidence of injury experienced by students during class was similar to the incidence of injuries reported by chiropractic patients under clinical care" so your "they are just students" argument goes out the window.

Secondly, you forgot to quote and comment on the following:

"The report helps support the logic behind a World Health Organization initiative to reduce such errors, which the U.S. Institute of Medicine estimates kill as many as 98,000 people every year in the United States alone."

Yeah, way to look at the actual study. Did you bother to read it or just post the link? Let's see, first, let's look at the types of errors. From your link: http://darwin.nap.edu/books/0309068371/html/36.html

"Types of Errors

Diagnostic
- Error or delay in diagnosis (BTW, this is the largest category, and one where chiropractic is undoubtedly far, far worse than medicine.)
- Failure to employ indicated tests (keeping in mind, if a test is simply not available at a rural location, failure to employ it is still an error)
- Use of outmoded tests or therapy (see, if doctors use treatments as poorly supported as chiropractic, it is an ERROR!)
- Failure to act on results of monitoring or testing

Treatment
- Error in the performance of an operation, procedure, or test
- Error in administering the treatment
- Error in the dose or method of using a drug
- Avoidable delay in treatment or in responding to an abnormal test
- Inappropriate (not indicated) care (again, all of chiropractic would be listed as an error if we would subject that profession to these standards)

Preventive
- Failure to provide prophylactic treatment
- Inadequate monitoring or follow-up of treatment

Other
- Failure of communication (even if this is related to an inability to find a patient)
- Equipment failure
- Other system failure"

Now, as for the rest of this "report", you need to realize that the number of "deaths" is extrapolated from many smaller studies. The methodology employed is extremely suspect.

http://www.ncbi.nlm.nih.gov/entrez/..._uids=11143166&query_hl=2&itool=pubmed_docsum

"The Institute of Medicine's (IOM) report on medical errors is faulty because it does not include a control group and all the patients studied were 'very sick' according to researchers at Indiana University. 'What the figures suggest is that people don't die [without an adverse event],'"

http://www.ncbi.nlm.nih.gov/entrez/..._uids=11151524&query_hl=4&itool=pubmed_docsum

"The two studies cited by the IOM committee substantiate its statement that adverse events occur in 2.9% to 3.7% of hospital admissions. Supporting data for the assertion that about half of these adverse events are preventable are less clear. In fact, the original studies cited did not define preventable adverse events, and the reliability of subjective judgments about preventability was not formally assessed. The committee's estimate of the number of preventable deaths due to medical errors is least substantiated. The methods used to estimate the upper bound of the estimate (98,000 preventable deaths) were highly subjective, and their reliability and reproducibility are unknown, as are the methods used to estimate the lower bound (44,000 deaths)... ...it is unfortunate that the IOM's estimate is not well substantiated."

http://www.ncbi.nlm.nih.gov/entrez/..._uids=11151522&query_hl=6&itool=pubmed_docsum

"We have four principal observations. First, errors have been defined in terms of failed processes without any link to subsequent harm. Second, only a few studies have actually measured errors, and these have not described the reliability of the measurement. Third, no studies directly examine the relationship between errors and adverse events. Fourth, the value of pursuing latent system errors (a concept pertaining to small, often trivial structure and process problems that interact in complex ways to produce catastrophe) using case studies or root cause analysis has not been demonstrated in either the medical or nonmedical literature."

I challenge you to find me an article -- popular press, scientific literature (ANYTHING) -- that shows that chiropractic kills 98,000 and injures 1.3 million Americans per year.

I challenge you to find me anything that suggests medical care does. But, while you are searching, look toward risk versus benefit. You have to admit that there is some risk to chiropractic care. Where is the evidence that it EVER makes anyone better? If it doesn't, and let's face it, it doesn't, then patients are being exposed to some level of risk for NO benefit. Whereas the medical patients would likely be made better by the treatments that do occasionally go awry.

 

[Squad51]

Firstly, you are making a comparison between TRAINED medical physician errors and chiropractic STUDENT errors and a case report!?

Sorry for the dual reply, ran out of space. The other little issue with the IOM report is that it is not limited to errors by "TRAINED medical physicians" as you assert. Many, some would argue most, of the "errors" described are system errors.

An example, often quoted in the ICU literature has to do with something called the VAP bundle. To quote the IHI (http://www.ihi.org/IHI/Topics/CriticalCare/IntensiveCare/Changes/ImplementtheVentilatorBundle.htm):
"The Ventilator Bundle is a series of interventions related to ventilator care that, when implemented together, will achieve significantly better outcomes than when implemented individually.

The key components of the Ventilator Bundle are:

Elevation of the Head of the Bed
Daily "Sedation Vacations" and Assessment of Readiness to Extubate
Peptic Ulcer Disease Prophylaxis
Deep Venous Thrombosis Prophylaxis "

Now, understanding the VAP bundle as the accepted standard of care, realize three things, first, some reports (http://www.ncbi.nlm.nih.gov/entrez/..._uids=16430019&query_hl=6&itool=pubmed_docsum and http://www.ihi.org/IHI/Topics/CriticalCare/IntensiveCare/ImprovementStories/NoVAPsItCanBeDone.htm) conclude that ALL pneumonias occuring in patients who are currently or recently were ventilator dependant, are medical "errors". They aren't. There is a baseline. Second, the problem with VAP Bundle "compliance" is more often than not a paperwork issue, and not "real". By that I mean that if a contraindication to a component of the bundle exists (e.g., potential spinal injury preventing elevation of the head of the bed) but it is not speficially recorded in terms of a VAP contraindication, then the "bundle" is incomplete, and an "error" has occured (from: http://www.ihi.org/IHI/Topics/CriticalCare/IntensiveCare/Measures/VentilatorBundleCompliance.htm - "This is an "all or nothing" indicator. If any of the four elements are not documented, do not count the patient in the numerator. If a bundle element is contraindicated for a particular patient and this is documented appropriately in the medical record, then the patient is considered compliant with regard to that measure."). Third, this bundle, as an example, is a "teamwork" exercise, and errors in it's implementation are not limited to physicians (http://www.ncbi.nlm.nih.gov/entrez/...ids=15960014&query_hl=10&itool=pubmed_docsum).

Wow. I'm looking at this contorted post and wondering how to edit it, but have instead decided to leave it stand. Why? Because this is a VERY small example of the complexity in determining medical error. It is also a VERY small example of the extensive oversight that physicians are subject to. These efforts (to reduce VAP) exist as efforts to help patients. Where are these types of quality measures in chiropractic? Where is the proven safety and efficacy? And coming back with "research has just started" isn't an answer, and you know it. Science doesn't consider a treatment "safe" until proven so. This is true of pharmacueticals (as you yourself have often pointed out the "phase four" removals such as Vioxx), medical treatments, or even new consumer chemicals brought to market outside of healthcare. Chiropractic shouldn't get a pass because YOU (or anyone else) likes it. If and when it is proven, then it should be used.

 

[PublicHealth]

Compare risk/benefit of chiropractic to risk/benefit of anti-inflammatory medication for low back pain. Equal efficacy, probably more risk for anti-inflammatories (http://www.ncbi.nlm.nih.gov/entrez/...ids=16354394&query_hl=15&itool=pubmed_DocSum). I'm not aware of any meta-analyses that compared the two interventions for low back pain -- what are you doing this summer?

Also keep in mind that big pharma, with its cozy relationship with the FDA and host of pharma-funded researchers who publish most of the "research" that you read, has a financial interest in touting the merits of pharmacological interventions and downplaying any purported benefits of alternative interventions (http://www.ncbi.nlm.nih.gov/entrez/...ids=16287960&query_hl=20&itool=pubmed_docsum). The "truth" is coming out, though, in the form of excessive pharma-related deaths and increasing interest among Americans in alternative treatments (tens of billions are spent out of pocket each year on such services). Further, medical folks have been denigrating chiropractic for decades. Restriction of trade lawsuits have resulted in a gag order so the AMA can no longer publicly misrepresent chiropractic. Nevertheless, medical physicians and researchers, as well as some skeptical chiropractors, have managed to publish articles on the purported dangerousness of chiropractic. Meta-analytic data generally does not support these claims. According to the NIH:

"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.14,16,17 It appears to be higher for cervical-spine, or neck, manipulation (e.g., cases of stroke have been reported18,19). 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 million16).1,20,a"

http://nccam.nih.gov/health/chiropractic/#6a

 

[611]

I don't understand why Chiropractic malpractice rates are rock bottom compared to even a family practice physician. With all these injuries from manipulation you would think they would be up there with high risk specialties, alteast that is what some of you make it sound like.

 

[guetzow]

Most suits come from the patients 'percieved' quality of care and Pt/MD relationship. i.e.- PCPs tell the patients what 'they' have to do; in terms of preventative Txs, exercise, diet, ad nauseum, where as the Chir/pain specialist/insert other specialist.... 'DOES SOMETHING for their pain immediately, in the clinic". It's simple business. The patient gets what they want/satisfaction. So in the Pt's mind, the Chir is helping, the PCP is obstructionist and demanding/irritating (And therefore, worthy of a suit).

 

[611]

Most suits come from the patients 'percieved' quality of care and Pt/MD relationship. i.e.- PCPs tell the patients what 'they' have to do; in terms of preventative Txs, exercise, diet, ad nauseum, where as the Chir/pain specialist/insert other specialist.... 'DOES SOMETHING for their pain immediately, in the clinic". It's simple business. The patient gets what they want/satisfaction. So in the Pt's mind, the Chir is helping, the PCP is obstructionist and demanding/irritating (And therefore, worthy of a suit).

Understood, but if one were to believe the statements put forth in this forum one would think Chiropractic insurance rates would be MUCH higher than they are. By the way much of the post was facetious...read and learn

 

[guetzow]

PCP guys tell folks they really don't want to hear: Lose weight, (To 60 year old) "If it hurts after 3 games of tennis, stop playing/stop playing as much", If it hurts, take your pain medicine/If your pain medicine interacts with your martinis, stop your martinis (Or chose between the two), etc, ad nauseum. The PCPs are the bad guys. They tell everybody what deep down, they already know, and don't want to hear. Whereas, the pain guys/Chir/etc, dole out immediate satisfaction. When we already know that "Satisfaction"(The business model), not necessarily "Quality of care" (i.e.-'Percieved' quality of care) is what drives lawsuits, it becomes OBVIOUS why the PCP guys get sued more.

 

[611]

Chiropractors dole out the same advice. I agree with what you say. But you are missing the point. Read what people on this forum say about the dangers of spinal manipulation. If what they say were true, there would be many more serious injuries and deaths and therefore higher insurance premiums. The answer you give is based in reality. My question is what about the OTHER posts on this forum.