Thoughts on Chiropractors?

[guetzow]

Per AAOS (Amer Assoc Ortho surge) and Sports Medicine: Manipulation should not be considered/done with exreeeeeeeeeeeme caution in patients with OA (DJD). This is nothing new. Paradoxically, this demographic (People with DJD/OA) tend to have more joint pain/cause for requesting such manipulations. This is good for pain/ortho docs, however, as injections and PT are also quite helpful in the same populations.

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[Squad51]

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.

Not actually. There exists a temporal dissociation between the initial injury and the devastation in VBAs. That makes it more difficult to "prove" in legal (not scientific) terms.

Second, no chiropractor has "inpatient" patients. Thus there exists a "healthy patient" effect that has been commented on in both the chiropractic and scientific literature. So the overwhelming majority of the patients are low risk.

Med mal rates are not the measure to be used here. I will grant you that the basic rate of complications from chiropractic (in gross terms) is lower than the medical rate (where the patients are sicker). But what is the measure of benefit against this (agreeably low) risk?

 

[611]

Benefit vs risk is HUGE when there is a proper diagnostic workup.

 

[Squad51]

Benefit vs risk is HUGE when there is a proper diagnostic workup.

Prove it! Post one citation that demonstrates that chiropractic is effective for anything beside idiopathic LBP. In those cases (idiopathic LBP) placebo is almost as effective as either chiropractic or medical therapy, so given the self limited duration, one would most reasonably argue minimal treatment of any kind is best.

 

[611]

Prove it! Post one citation that demonstrates that chiropractic is effective for anything beside idiopathic LBP. In those cases (idiopathic LBP) placebo is almost as effective as either chiropractic or medical therapy, so given the self limited duration, one would most reasonably argue minimal treatment of any kind is best.

Correct, chiropractic is minimal treatment when compared to medications and surgery. Most ailments have a self limited duration but medication is still given to aid in the bodies ability to heal most illness. It is the body that does the healing, not the physician. Even if an organ is removed, the bodie healing process takes over from there. A doctor is nothing without the healing powers of the body. Don't flatter yourself.

 

[Squad51]

Correct, chiropractic is minimal treatment when compared to medications and surgery. Most ailments have a self limited duration but medication is still given to aid in the bodies ability to heal most illness. It is the body that does the healing, not the physician. Even if an organ is removed, the bodie healing process takes over from there. A doctor is nothing without the healing powers of the body. Don't flatter yourself.

Wow, you twist words better than most attorneys!

Now, what I was asking for (and what neither you nor any of the other chiropractic apologists here have provided) is scientific evidence that chiropractic is effective for anything. If it is not (and it isn't, but hey, these are entertaining discussions), then there is risk exposure sans potiential benefit. As for "chiropractic is minimal treatment when compared to medications and surgery" I suppose that is true - but the same could be said for faith healing or psychic surgery. Fact is that none of these things has been shown to work. And yes, medication is given to aid the body in healing, I won't debate that point. My question is - does chiropractic help the body heal? The answer is NO. Can chiropractic hurt the body? The answer is YES. The conclusion? Chiropractors are an unwarranted health risk.

"A doctor is nothing without the healing powers of the body." Absolutely the most true thing said on SDN in a long time. The prolouge? "A chiropractor is nothing without marketing!"

 

[jesse14]

You say chiro is basically usless so due to your theorty, such athelets as Tom Brady of the New England Patriots and Lance Armstrong (7 time Tour du France Winner) advocate a sham therapy?
As i've said before on this forum, a chiro helped with my headaches like NO MD could. I am NOT a DC or a DC student. I am NOT and MD basher at all. I volunteer at sick kids hospital in Toronto and the things those docs do is incredable. With that said, i firmly believe chiropractic helps people. If they didn't then why do SO many people go to them? Why are they the leading form of ACT? I like to give people credit so i won't say they all go back because of placebo effect therefore people go for a reason.... because they feel better afterwards. I know that was the case with me....just a chiro patient. People arn't stupid and they won't pay for a service unless they feel that service is worthwile...if you dont feel that way than that's fine. Just don't assume you're the norm (if in fact you do)

thanks!

Wow, you twist words better than most attorneys!

Now, what I was asking for (and what neither you nor any of the other chiropractic apologists here have provided) is scientific evidence that chiropractic is effective for anything. If it is not (and it isn't, but hey, these are entertaining discussions), then there is risk exposure sans potiential benefit. As for "chiropractic is minimal treatment when compared to medications and surgery" I suppose that is true - but the same could be said for faith healing or psychic surgery. Fact is that none of these things has been shown to work. And yes, medication is given to aid the body in healing, I won't debate that point. My question is - does chiropractic help the body heal? The answer is NO. Can chiropractic hurt the body? The answer is YES. The conclusion? Chiropractors are an unwarranted health risk.

"A doctor is nothing without the healing powers of the body." Absolutely the most true thing said on SDN in a long time. The prolouge? "A chiropractor is nothing without marketing!"

 

[nebrfan]

You say chiro is basically usless so due to your theorty, such athelets as Tom Brady of the New England Patriots and Lance Armstrong (7 time Tour du France Winner) advocate a sham therapy?

Tom Cruise says that audits by scientologists have helped him - so it must be true. Madonna swears by Kabbalah water - it must work!

 

[611]

Wrong a mundo. Chiropractic does help the body heel itself in the same way physical therapy helps the body heel. Prolouge? Medicine is nothing without drugs. Do they work? Yes. Do they hurt? Yes. When y'all have a musucloskeletal problem, knock yourselves out with drugs and surgery. It is good to see you believe in what you profess.

 

[Squad51]

Chiropractic does help the body heel itself in the same way physical therapy helps the body heel.

Once again - where is the scientific proof to this farcical statement?

 

[611]

Once again - where is the scientific proof to this farcical statement?

Physical therapy is a large part of Chiropractic treatment in addition to nutritional counseling. I guess proper nutrition is unscientific also. Get off the science bandwagon. Even a large part of medical practice is art and not science...surgery. Actually, other than doing surgery and the E.R., the medical professional does nothing but decide what pill to give someone. The science is accomplished by the PhD's who do the research. You are not as scientific as you think you are.

 

[Squad51]

Physical therapy is a large part of Chiropractic treatment in addition to nutritional counseling. I guess proper nutrition is unscientific also. Get off the science bandwagon. Even a large part of medical practice is art and not science...surgery. Actually, other than doing surgery and the E.R., the medical professional does nothing but decide what pill to give someone. The science is accomplished by the PhD's who do the research. You are not as scientific as you think you are.

I'm not asking which already available services chiropractors duplicate in an attempt to justify their existence. There is no question that proper nutrition works - so I'll send my patients to a RD. There is no question that PT works (in some settings) so, after a complete evaluation, I'll refer my patients to a PT. But what, in the pseudo-science that DD Palmer "discovered", has any scientific validity? The answer, as you obviously know given your attempts to deflect the discussion towards valid and accepted means of therapy, is NONE.

Now look, I will happily acknowledge that many chiropractors are intelligent, honest people who invested a great deal of time and money in becoming DCs. And I'm really, really sorry they got taken in by the hucksters that run chiropractic education. But the reality is simple; chiropractic, as a modality, is invalid. Yes, chiropractors do learn nutrition and PT, and spend a great deal of time learning basic science, but that does not actually do anything. The only area where their training is "superior" to other providers is in "chiropractic". Which is unfortunate because that robs the population of some great folks who, given different training, would likely be great MDs, DOs, PTs, RDs, etc., etc. But, the reality is that the only areas where chiropractors do demonstrable good are areas where there already exist more expert services (such as DPTs for PT or RDs for nutrition). Patients should be guided to those people, not chiropractors.

 

[ptreese]

Physical Therapy is NOT a large part of Chiropractic treatment. You may refer to modalities you use as "Physical Therapy" but that is far from true physical therapy. The limited study you have in physical therapy during chiro school is in no way equal to the training real PTs get in physical therapy. If as a chiro you try to call what you do "physical therapy" in the state of California, you are breaking the law. I have reported chiros before for claiming to patients that what they do is physical therapy. Please don't lump PTs in with the quacks who claim to cure asthma with upper cervical manipulations

 

[Squad51]

Physical Therapy is NOT a large part of Chiropractic treatment. You may refer to modalities you use as "Physical Therapy" but that is far from true physical therapy. The limited study you have in physical therapy during chiro school is in no way equal to the training real PTs get in physical therapy. If as a chiro you try to call what you do "physical therapy" in the state of California, you are breaking the law. I have reported chiros before for claiming to patients that what they do is physical therapy. Please don't lump PTs in with the quacks who claim to cure asthma with upper cervical manipulations

 

[DOctorJay]

Physical Therapy is NOT a large part of Chiropractic treatment. You may refer to modalities you use as "Physical Therapy" but that is far from true physical therapy. The limited study you have in physical therapy during chiro school is in no way equal to the training real PTs get in physical therapy. If as a chiro you try to call what you do "physical therapy" in the state of California, you are breaking the law. I have reported chiros before for claiming to patients that what they do is physical therapy. Please don't lump PTs in with the quacks who claim to cure asthma with upper cervical manipulations

from a fellow PT (now med student) who has heard people who work for chiros actually call themselves physical therapists with only a high school degree

-J

 

[ProZackMI]

Not actually. There exists a temporal dissociation between the initial injury and the devastation in VBAs. That makes it more difficult to "prove" in legal (not scientific) terms.

Second, no chiropractor has "inpatient" patients. Thus there exists a "healthy patient" effect that has been commented on in both the chiropractic and scientific literature. So the overwhelming majority of the patients are low risk.

Med mal rates are not the measure to be used here. I will grant you that the basic rate of complications from chiropractic (in gross terms) is lower than the medical rate (where the patients are sicker). But what is the measure of benefit against this (agreeably low) risk?

Well said! Are you sure one of your "Ds" isn't a JD? Your points were dead on accurate in terms of a chiros general patient demographics vs. an MDs general patient demographics.

 

[ProZackMI]

Wow, you twist words better than most attorneys!

Now, what I was asking for (and what neither you nor any of the other chiropractic apologists here have provided) is scientific evidence that chiropractic is effective for anything. If it is not (and it isn't, but hey, these are entertaining discussions), then there is risk exposure sans potiential benefit. As for "chiropractic is minimal treatment when compared to medications and surgery" I suppose that is true - but the same could be said for faith healing or psychic surgery. Fact is that none of these things has been shown to work. And yes, medication is given to aid the body in healing, I won't debate that point. My question is - does chiropractic help the body heal? The answer is NO. Can chiropractic hurt the body? The answer is YES. The conclusion? Chiropractors are an unwarranted health risk.

"A doctor is nothing without the healing powers of the body." Absolutely the most true thing said on SDN in a long time. The prolouge? "A chiropractor is nothing without marketing!"

It's prologue. Just teasing. The healing powers of the body are amazing; however, it takes a skilled physician to know how to combine various palliative, surgical, pharmacological, and technological modalities/techniques to ameliorate pain, dysfunction, and pathology. A good physician knows what things to do to assist the body's own regenerative processes. A chiropractor induces a temporary fix; he does not assist the body in repairing itself.

 

[ProZackMI]

You say chiro is basically usless so due to your theorty, such athelets as Tom Brady of the New England Patriots and Lance Armstrong (7 time Tour du France Winner) advocate a sham therapy?
As i've said before on this forum, a chiro helped with my headaches like NO MD could. I am NOT a DC or a DC student. I am NOT and MD basher at all. I volunteer at sick kids hospital in Toronto and the things those docs do is incredable. With that said, i firmly believe chiropractic helps people. If they didn't then why do SO many people go to them? Why are they the leading form of ACT? I like to give people credit so i won't say they all go back because of placebo effect therefore people go for a reason.... because they feel better afterwards. I know that was the case with me....just a chiro patient. People arn't stupid and they won't pay for a service unless they feel that service is worthwile...if you dont feel that way than that's fine. Just don't assume you're the norm (if in fact you do)

thanks!

Yeah, many of my patients tell me how ETOH, pot, and crystal meth helped cure their depression and anxiety. If you were born ugly, putting on a pretty mask won't cure your ugliness; it only covers it up. The only way to cure terminal ugly is to surgically or chemically repair the underlying damage. Chiro tx masks true neurogenic, orthogenic, or psychogenic pain in a quasi-clinical, pseudo-scientific manner that is empirically deficient in so many respects its not worth reiterating here.

Has chiro tx been effective in treating LBP or NMS pain in some folks? I'm sure it has, but how much of that improvement was mental (attitude, drive, determination, desparation, placebo) and how much of it was physical?

 

[jesse14]

Tom Cruise says that audits by scientologists have helped him - so it must be true. Madonna swears by Kabbalah water - it must work!

OK, care to comment on the rest of my post now?Why do so many people continue to go to a DC if it really has no effect? People arn't dumb and they won't pay for s service that does nothing for them.

 

[jesse14]

Tom Cruise says that audits by scientologists have helped him - so it must be true. Madonna swears by Kabbalah water - it must work!

OK, care to comment on the rest of my post now?Why do so many people continue to go to a DC if it really has no effect? People arn't dumb and they won't pay for a service that does nothing for them.

 

[611]

You will never win this one with these people so who cares and why bother.

 

[jesse14]

You will never win this one with these people so who cares and why bother.

i'm not trying to "win".. i dont know how one would win in this sort of area anyway. I'm just trying to understand/ make others aware of the positive aspects of chiropractic... because it does had quite a few

 

[611]

Unfortunately, these people are close-minded. Fortunately they are in the EXTREME minority. They don't realize it of course.

 

[jesse14]

Unfortunately, these people are close-minded. Fortunately they are in the EXTREME minority. They don't realize it of course.

611, are you a DC??

 

[611]

Yes

 

[ptreese]

Actually, we're in the majority. Try checking national stats on use of chiro services. Pretty sure it's around 15% or less.

 

[611]

No actually the post referred to the ATTITUDE of most of the people on this forum are in the minority as far as physicians in the field and the public. "F" on this test!

 

[Squad51]

No actually the post referred to the ATTITUDE of most of the people on this forum are in the minority as far as physicians in the field and the public. "F" on this test!

Actually, as EBM becomes more and more the rule, you will find that more and more physicians will hold chiropractic's "feet to the fire". There are many QI/QA initiatives out there now that extend EBM to the referrals a physician makes. In those settings (and this is set to become a JCAHO rule) chiropractic would simply not be allowed.

611, what I do not understand is how is questioning the efficacy and validity of any treatment reflective of a "bad attitude"? Prove that chiropractic is effective and safe and I (and many others) will use it. Until that time, it is scientificially an unsafe and unproven modality. (Especially since, by your own admission there are deep differences in training and National has trained only a minority of all chiropractors.)

 

[611]

I never said you had a "bad attitude". Why would you think you had a bad attitude. You just have a difference of opinion. You certainly are not nasty. You are just expressing your opinion. That's what's nice about this forum. Both professions are FAR from perfect. Both have their good and bad apples. Not everything in the universe needs to be explained to hard core science. I don't know if you are a student, resident or what but the reality is that in the field Chiropractic is well accepted by the vast majority of the medical profession. It just is, atleast in the areas with which I am familiar.

 

[jesse14]

611,i tried private messaging you just to ask you a few questions (since you actually are a trained DC) but it said that you don't accept them.. so should i ask you some questions via the public forum??

thanks

 

[611]

Sure!

 

[Squad51]

I never said you had a "bad attitude". Why would you think you had a bad attitude.

Well, the quote "No actually the post referred to the ATTITUDE of most of the people on this forum are in the minority as far as physicians in the field and the public. "F" on this test!" infers you believe I might have a "bad attitude".

You just have a difference of opinion. You certainly are not nasty. You are just expressing your opinion. That's what's nice about this forum. Both professions are FAR from perfect. Both have their good and bad apples. Not everything in the universe needs to be explained to hard core science.

It is true that "not everything in the universe needs to be explained to hard core science" but as a means of patient safety, healthcare methodology does. Safety (in terms of truly independent oversight and public QI/QA) is really where chiropractic fails its patients miserably...

I don't know if you are a student, resident or what but the reality is that in the field Chiropractic is well accepted by the vast majority of the medical profession. It just is, atleast in the areas with which I am familiar.

Well, I think you might have a bit of a bias. The physicians you interact with might accept chiropractic, but you are seeing the ones who do. It is an observer bias similar (but opposite in direction) to the one described in the chiropractic insurance company paper on VBAs. That paper pointed out that only a few chiropractors, working independantly, will cause a VBA, but that VBA will be seen by teams of neurosurgeons. So, a neurosurgeon is far more likely to see a chiro related VBA than is a chiropractor. The same bias exists for you. There are a small number of docs who will accept your care as "real" but you are likely to see lots of them (as they seek out qualified providers to work with). But the "silent minority" are silent to you. And these forums, pre-med as they are, are a good example of what is to come without an EBM backing to chiropractic. The CAM programs in medical school almost all require strong EBM to be taught (as this is a significiant thrust for national patient safety organizations).

Here is some of the data available
(check out figure 3 here): http://archfami.ama-assn.org/cgi/content/full/9/5/446

Here is a flawed (they picked the respondants) Austrailian study: http://www.ncbi.nlm.nih.gov/entrez/...t_uids=7673797&query_hl=7&itool=pubmed_docsum

Not exactly on point, but these two papers attempt to answer the question "Why/why not chiropractic?": http://www.ncbi.nlm.nih.gov/entrez/..._uids=11822617&query_hl=7&itool=pubmed_docsum

http://www.ncbi.nlm.nih.gov/entrez/...uids=11805694&query_hl=16&itool=pubmed_docsum

But there is little published in the last five years that directly answers how physicians "see" chiropractic.

To answer your other question, I am an MD/PhD student awarded my PhD in health policy last year. I am just finishing my M3 year of medical study and will finish my MD in June 2007. I will be entering the "match" for residency next year and hope to train in emergency medicine.

 

[611]

Nope, it referred to his interpretation.
I have not run into an MD in my area with any negative feelings towards atleast my chiropractic practice probably because they realize I am helping their patients. You are making unsubstantiated assumptions. Finally, I certainly hope that if I should be unfortunate enough to end up in an emergency room I am seen by a physician with your dedication. You should believe strongly in what you do. Wait until you see the cases that come through your ER that are MD screw-ups. It is not just chiropractic.

 

[611]

http://forums.studentdoctor.net/showthread.php?t=99957

 

[Squad51]

sorry duplicate

 

[Squad51]

Nope, it referred to his interpretation.
I have not run into an MD in my area with any negative feelings towards atleast my chiropractic practice probably because they realize I am helping their patients. You are making unsubstantiated assumptions. Finally, I certainly hope that if I should be unfortunate enough to end up in an emergency room I am seen by a physician with your dedication. You should believe strongly in what you do. Wait until you see the cases that come through your ER that are MD screw-ups. It is not just chiropractic.

I've got to tell you, I think that your experiences are fairly narrow (and perhaps a bit blinded by politeness?)??? I've yet to find a physician I have worked with, at home or school, who will refer to a chiropractor for any reason. Even the CAM folks at my medical school fairly "bash" chiropractic. I've worked with a wide range of faculty and residents and to a person, they distrust / dislike chiropractic. The posts here would seem to indicate this is not isolated. BUT - I can find no strong data to support either case. So I can not prove you are wrong any more than I can prove I am right - we will have to agree to disagree based on our personal experiences.

 

[611]

Academia is different from private practice. Even ER work is not private practice. The posts here represent a minute percentage of the physician population. Again, should I end up in an ER I hope to have an attending with your dedication.

 

[truthseeker]

I am a PT in a town of about 5400 in rural Minnesota. We have 7 familypractice MDs, 2 FNPs, and one general surgeon on our regular staff. None of them support chiropractic as primary care providers or gate keepers. They are polite about it and do not bash the profession but if the patient asks, they generally tell them that they prefer the approach of physical therapy.

In our town, there are 5 more or less "normal" chiros and one who most would say is on the fringe (treating energy fields by touching their auras and whatnot.

I agree with squads assessment of your vision of the traditional medical world 611. I think the MDs and DOs you work with are receptive to your ideas and treatment because your patients get better. There are more, in my estimation, that would discount you just because of the letters behind your name. That is unfortunate but I think it is a real problem for the chiropractors that do follow EBP. I am friends with one of the chiros in town and for the most part, he follows EBP.

Our philosophy of treatment is different however. I am more likely to refer on quicker than he is. If my patients are not improved in 3 visits then they need more imaging/labs etc . . . I tell people that our relationship is sort of like Wile E. Coyote and the sheepdog in the cartoons. They say hi and are evidently friendly until they punch in and then they disagree philosophically on how to go about their day.

I know that the MDs in the neighboring town of 1200 also are more or less negative on DCs, as are the MDs where I used to work in Kansas City.

The way I see it, the worst elements of chiropractic run the public relations campaign. They are the ones who have the morning radio shows where they claim to treat asthma and allergies and constipation with spinal adjustments none of which has been shown in any study to be more or even as effective as traditional medical treatment.

What say you to that?

 

[611]

Totally agree. Maybe the DC is slower to discontinue treatment since they can order the radiology and lab testing and don't have to get the primary care doctor to order them. Maybe attitudes in small towns vs metropolitan areas are different, who knows.

 

[Squad51]

Totally agree. Maybe the DC is slower to discontinue treatment since they can order the radiology and lab testing and don't have to get the primary care doctor to order them. Maybe attitudes in small towns vs metropolitan areas are different, who knows.

BUt can they accurately read the radiographs and/or lab tests? (What about if they went to Life as opposed to National?). Will the tests need to be repeated or is there a CLIA certified lab being used by the chiropractor? If the chiropractor "holds on" too long, where is the QI/QA to help prevent that in the future?

 

[611]

I said they can ORDER them...that means send it out! But by the way they can accurately read musculoskeletal xrays.

 

[PublicHealth]

Great review on chiropractic and general practice patients in North America:

http://www.ncbi.nlm.nih.gov/entrez/..._uids=16600038&query_hl=7&itool=pubmed_docsum

From the abstract:

"Canadian DC patients are more likely college educated, to have higher incomes, and dissatisfied with MD care."

"DC only patients in both countries have fewer chronic conditions, take fewer drugs, and have no regular doctor. U.S. DC only patients are more likely uninsured and dissatisfied with health care; Canadian DC only patients are more likely under 45, male, less educated, smokers, and not obese, without disabling back or neck pain, on fewer drugs, and lacking a regular doctor."

 

[lawguil]

Great review on chiropractic and general practice patients in North America:

http://www.ncbi.nlm.nih.gov/entrez/..._uids=16600038&query_hl=7&itool=pubmed_docsum

From the abstract:

"Canadian DC patients are more likely college educated, to have higher incomes, and dissatisfied with MD care."

"DC only patients in both countries have fewer chronic conditions, take fewer drugs, and have no regular doctor. U.S. DC only patients are more likely uninsured and dissatisfied with health care; Canadian DC only patients are more likely under 45, male, less educated, smokers, and not obese, without disabling back or neck pain, on fewer drugs, and lacking a regular doctor."

also, CONCLUSIONS: Chiropractic and GP patients are dissimilar in both Canada and the U.S., with key differences between countries and between DC patients who do and do not seek care from GPs. Such variation has broad and potentially far-reaching health policy and research implications.

What exactly does this great review of chiropractic and GP in North America mean to you? I'm neither a practitioner of either nor do I have an MPH so perhaps you could enlighten us all on the impact of this piece when presenting your SDN format of a journal club.

 

[Medikit]

Hmm, subluxations and "innate intelligence". I think I'll pass, fortunetly they rarely hurt people so I guess the worst thing they do is offer a convincing placebo for a significant sum of cash.