MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

Chiropractors have been shown to over-use X-rays (a worry about which I cautioned almost 20 years ago) and to refer for lumbar radiography inconsistent with the current clinical guidelines for low back pain. It is unknown whether this is due to lack of adherence with, or a lack of awareness of relevant guidelines. The aim of this study was to clarify this issue; more specifically, the authors wanted to determine Australian chiropractors’ awareness of, and reported adherence to, radiographic guidelines for low back pain.

An online survey was distributed to Australian chiropractors from July to September, 2014. Survey questions assessed demographic, chiropractic practice and radiographic usage characteristics, awareness of radiographic guidelines for low back pain and the level of agreement with current guidelines. Results were analysed with descriptive statistics and logistic regression analysis.

A total of 480 surveys were completed online. Only 49.6 % of the responders reported awareness of radiographic guidelines for low back pain. Chiropractors reported a likelihood of referring for radiographs for low back pain: in new patients (47.6 %); to confirm biomechanical pathologies (69.0 %); to perform biomechanical analysis (37.5 %); or to screen for contraindications (39.4 %). Chiropractors agreed that radiographs for low back pain could be useful for: acute low back pain (54.0 %); screening for contraindications (55.8 %); or to confirm diagnosis and direct treatment (61.3 %). Poorer adherence to current guidelines was seen, if the chiropractor referred to in-house radiographic facilities, practiced a technique other than diversified technique or was unaware or unsure of current radiographic guidelines for low back pain.

The authors of this paper concluded that only 50 % of Australian chiropractors report awareness of current radiographic guidelines for low back pain. A poorer awareness of guidelines is associated with an increase in the reported likelihood of use, and the perceived usefulness of radiographs for low back pain, in clinical situations that fall outside of current guidelines. Therefore, education strategies may help to increase guideline knowledge and compliance.

I am tempted to rephrase the last sentence: EDUCATION STRATEGIES MAY HELP TO INCREASE THE KNOWLEDGE THAT RESPONSIBLE HEALTHCARE PROFESSIONALS SHOULD WORK PRIMARILY FOR THE BENEFIT OF THEIR PATIENTS RATHER THAN FOR THE BENEFIT OF THEIR BANK ACCOUNTS.

In my view, this investigation confirms that:

  • chiropractors still grossly over-use X-rays (it probably is fair to assume that the responders of this survey were relatively guideline-conform compared to non-responders; if that were true, the true figures of X-ray overuse would be even higher)
  • they use X-rays for spurious reasons;
  • they are ill-informed about the existing evidence;
  • they have not abandoned the myth of ‘subluxation’, i. e. ‘biomechanical pathologies’.

Of course, the data are from Australia, and chiros elsewhere might claim that they are more guideline-conform than their Australian colleagues. But, in their discussion section, the authors of the present paper point out that “three previous studies have quantitatively assessed the adherence of registered chiropractors to radiographic guidelines for the management of low back pain (LBP). Two surveys performed in Canada with 26 and 32 responses respectively found that 63 and 59 % would use radiography for acute LBP without indicators of potential pathology and 68 and 66 % thought that radiography was useful in the evaluation of acute LBP.”

69 Responses to Only 50 % of chiropractors are aware of current radiographic guidelines

  • The Association of Medical Royal Colleges has just drawn attention to the fact that far too many Xrays are used in LBP – by regular, orthodox doctors!
    Often ‘just to be sure’.
    Sometimes just to assuage a patient’s anxiety and propensity to complain, even claim.
    More rarely, amongst regulars, I suspect but cannot prove, to act as a ‘badge of honour’ and ‘authority magnet’, indicationg to the patient what a fine, knowledgeable, conscientious practioner they are consulting – equivalent in every way to all other conventional practitioners, and undoubedly not a quack at all.

    • It seems that Dick has implied that “regular, orthodox doctors” are either unaware of, or purposely ignore, radiographic guidelines. Agreed!

  • A new U.S. Department of Veteran Affairs and Stanford (Calif.) Health study found between 30 percent and 50 percent of lumbar spine MRIs are inappropriately ordered, according to Scope. The American Journal of Managed Care published the study.
    The researchers wrote lower back pain patients can often undergo conservative treatment, like exercise. Additionally, many patients’ back pain corrects itself.

    CMS wrote guidelines about lumbar spine MRIs, indicating conditions that require immediate scans (HIV, trauma, cancer, spinal surgery). If the patient doesn’t fit the guidelines, CMS suggests physical therapy or chiropractic care first.

    Here are five key notes:

    1. The study found inappropriate MRIs totaled $13.6 million.

    2. The researchers found 24 percent of medical providers order 74 percent of the inappropriate MRI scans.

    3. Some believe the high rate of unnecessary lumbar spine MRIs is due to the fee-for-service model. If surgeons are paid for MRI regardless of indications, they may be more likely to order them.

    4. Some surgeons order radiographic tests for medicolegal reasons; if the patient sues, they’ll have additional evidence their initial diagnosis and non-surgical treatment recommendation was correct. Because VA physicians are salaried and aren’t too concerned about malpractice issues, the researchers hoped to uncover further indications for the high rate of lumbar spine MRIs.

    5. Radiographic findings sometimes prove misleading, focusing on aspects that don’t address patients’ symptoms.

    It would seem that MD’s order many unnecessary imaging tests which, btw, are MUCH more expensive than plain film radiographs. Apparently they are unaware of, or simply ignore, guidelines for the appropriate and cost-effective use of MRI’s.

    Edzard lamented that chiros’ “referring for radiographs for low-back pain” was to “benefit their bank accounts.” Unfortunately, he is again wrong in his conclusions as even his own statement of “referring” for radiogaraphs attests. Note to Edzard: when a patient is “referred” for radiographs, the reimbursement for the study goes to the hospital and the interpreting medical radiologist, not to the referring chiropractic physician. Note also that the gross overuse by MD’s of expensive MRI’s is often driven by the medical physicians’ ownership interest in the MRI facilities.

    In his typical, hypocritical manner, Edzard insults chiropractic at large over an alleged practice which enriches hospital radiology departments(not chiros’ bank accounts); he, of course, predicatbly ignored the much more onerous and expensive utilization of MRI’s by his medical brethren…and such practice actually does enrich the MD’s. Edzard is always good for a laugh, or at least a chuckle. You simply can’t make this stuff up. Hilarious!

    Be well

    • IWhat is the possibility that chiropractors, as some regular MDs, like to order X-rays to big themselves up.
      And by so doing, falsely give out that they are the top dogs.
      And worth spending time, and money with.
      And thereby enriching them?

      What percentage of registered chiropractors accept that the only people who are satisfied there is plausible radiographic evidence of ‘subluxations’ which might reasonably benefit from ‘adjustments’ are fellow chiropractors?

      Who made up this stuff? BJ Palmer?

      • Dick,

        I agree that there are people in all professions who order unnecessary procedures, some for monetary gain and others because of malpractice concerns.

        I don’t know the % of chiros around the world who practice as B J Palmer did. B.J. died over 5 decades ago, so what is the point of your question? Do you also wonder what % of MD’s practice trepanation with non-sterile technique, or who engage in bloodletting for UTI’s as did their forebears? Who made THAT stuff up? “Modern medicine” of an earlier era?

    • Logos-Bios,

      The title of the article is: Only 50 % of chiropractors are aware of current radiographic guidelines.

      The first sentence of the article is: Chiropractors have been shown to over-use X-rays (a worry about which I cautioned almost 20 years ago) and to refer for lumbar radiography inconsistent with the current clinical guidelines for low back pain.

      On 2016-10-25 22:25 BST, you used the term “MRI” eleven times.

      You very clearly demonstrated that you did not understand the difference between radiographic imaging [the use of ionizing electromagnetic radiation, especially X-rays, to view the internal structure of objects] and MRI [the use of nuclear magnetic resonance imaging to view the internal structure of objects].

      Your response to the article, with eleven mentions of “MRI”, has created an indelible record of both your scientific ignorance and, in a ‘chiropractic physician’ with ‘patient’ setting, your level of medical incompetence.

      • @ Pete

        The moronicism of your post is consistent with what you commonly evince in your prattle on this forum. Perhaps you are incapable of reading more than one post in a thread at a time, or maybe you selectively defer from same. Had you invoked whatever nominal cognitive function you possess in reading other comments I had made in this thread, your laughably ridiculous allegation that I “clearly demonstrated that I did not understand the difference between radiographic imaging and MRI” would have been understood even by you to have been off-point and bogus, if not fully chimerical.

        You have shown yourself to be a dolt of a high order; learn to read, man! The topic of this thread did not mention even once the concern for radiation exposure. Even the title itself referred to guidelines and a reported non-adherence to same of some chiropractic doctors, and Edzard’s spin on the article obviously was directed toward potential overuse of imaging to FINANCIALLY benefit the doctors at the expense of their patients. Your conflation of financial and overexposure concerns speaks to your intellectual incoherence. Your mendacious averring that I don’t understand the difference between MRI and x-ray speaks volumes about the perils of assuming something about which you are ignorant.

        I’ll dumb it down for you, Pete, since you appear too unmotivated to read the posts of this entire thread. If you would kindly scroll toward the top of this thread, you will see that I did note that unnecessary procedures are ordered/performed by people in all professions(er….including “modern medicine”). Further, MRI and radiographic procedures are performed largely in hospital radiology departments. Moreover, the FINANCIAL burden of the overuse of imaging is more vehemently stoked by MD’s overuse of MRI than it is by x-ray studies when ordered/performed by chiropractic physicians.

        Be well, Pete

        • do you get a kick out of being offensive?

          • No, I don’t. I would rather simply discuss issues with as little bias and snark as possible. Most on this site don’t ascribe to such a desire, apparently. Vitriol will be met with vitriol.

            BTW, I sincerely wish to thank you for this professional blog and website. You have executed it very well.

          • L-B eagerly demonstrates his skills in being at the same time boringly offensive and offensively boring. 😀

          • @Geir

            Nice insult…I enjoyed your flipping of the words offensive and boring. It’s nice to see humor from you.

            There may be hope for you yet.

            Good day to you. Sir

        • There are no such things as “x-rays”, “x-ray”, and “x-ray studies” — other than in the buffoonery of ‘chiropractic physicians’.

          QED.

          • Pete states there are no such things as x-rays, x-ray, or x-ray studies!?! Who knows what that tool has been drinking today?

          • @Logos-Bios,

            My apologies. I was taught both in science and in UK Health and Safety legislation that they are always referred to using the capital letter “X” (e.g. X-rays). It seems that there is no international standard on the usage of “X” versus “x”.

          • I don’t understand your point. It seems as though you have stated there are no such things as x-rays(I didn’t comment on and couldn’t care less if you wish to use a lower case or an upper case “x.”). Your comment regarding the non-existence of x-rays makes no sense. Please clarify, Pete.

          • he has clarified it – just read his comment!

  • Logos-Bios on Tuesday 25 October 2016 at 22:25

    “chiropractic physician”

    No such thing exists.

    “Note also that the gross overuse by MD’s of expensive MRI’s is often driven by the medical physicians’ ownership interest in the MRI facilities.”

    And these things are recognised and addressed, unlike chirocraptors who go on their merry way unsubjected to scrutiny.

    “In his typical, hypocritical manner” ” he, of course, predicatbly ignored the much more onerous and expensive utilization of MRI’s by his medical brethren…and such practice actually does enrich the MD’s.”

    You may not have noticed, given you are a chirocraptor, that this a blog about alt-med (I even shudder to use med in this circumstance).

    “Edzard is always good for a laugh, or at least a chuckle. You simply can’t make this stuff up. Hilarious!”

    You make stuff up; it is called chiro but it isn’t funny.

    “Be well”

    Unless you go to a chiro who twists your neck, severing an artery in the process and you die.

    • Frankentool is at it again, childishly deconstructing posts in order to inject his dullard’s view of humor. It’s good to see that the F-tool has at least the minimal amount of grey matter to admit that his medical brethren do order unnecessary, expensive tests. BTW, “these things” are not recognized and addressed adequately(feel free to support your contrarian allegation). When “safe harbor” violations are proved, most of the MD-owned imaging centers pay a nominal fine and keep on doing what they had been doing.

      Chiros are “unsubjected to scrutiny,” states a man who is blatantly ignorant of mainstream chiropractice in the USA. His words on this matter are so laughably bogus as to call everyone’s attention to himself as dolt. It seems that F-tool is unaware of his own participation in a forum dedicated to cynically scrutinizing chiropractic.

      Cervical SMT, when performed by a chiropractic physician, is quite safe. F-tool’s suggestion to the contrary reeks of bias, sarcasm, and stupidity.

      A Canadian study, reported in the October 2, 2001 issue of the Canadian Medical Association Journal (CMAJ), puts the risk of stroke following neck adjustment at 1 in every 5.85 million adjustments. The study, which is based on patient medical files and malpractice data from the Canadian Chiropractic Protective Association, evaluated all claims of stroke following chiropractic care for a ten year period between 1988 and 1997.

      “This study is based on the most factual evidence available for determining the risk of stroke associated with neck adjustment,” said Dr. Paul Carey, one of the principal authors of the study. “There has been much recent speculation about this risk, and some neurologists have expressed concern that the risk may be higher than previously believed. This study indicates that there is no cause for undue alarm, and that the risk may, in fact, be considerably lower than previously thought.”

      The study identified 23 reported cases of stroke following neck adjustments (also known as cervical manipulation), as diagnosed by the treating physician, over the ten year period. This was compared to the estimated 134.5 million neck adjustments performed by chiropractors in Canada over the same time frame.

      Today’s publication points out that earlier surveys of neurologists who reported stroke following chiropractic treatment were not rigorous, and did not review patient charts to determine the type of adjustment that was performed, or even whether an adjustment was performed during the chiropractic visit implicated in the stroke.

      “Unnecessary alarm has been created by the release of unpublished data in the past based on flawed methodology,” explained Carey. “While it is possible that the experience of chiropractors does not reflect all strokes that occur following neck adjustment, this most recent study establishes such an extremely low degree of risk that patients can feel confident about the safety of neck manipulation performed by chiropractors.”

      Carey pointed out that other very common treatments for headache, and neck and back pain carry much higher risks of serious complications.

      He also noted that the study supports the recent research published in CMAJ by the Institute for Clinical Evaluative Studies which found that the incidence of stroke associated with neck adjustments is so rare, it was not possible for the researchers to establish a meaningful rate of occurrence despite the high number of cervical adjustments that are performed.

      The study, titled “Arterial dissections following cervical manipulation: the chiropractic experience” was authored by Scott Haldeman, DC, MD, PhD, FRCP; Paul Carey, DC; Murray Townsend, BSc, DC; and Costa Papadopoulos, MHA, CHE.

      Perhaps F-tool would like to explain why malpractice insurance for chiropractic physicians is so much lower than it is for practitioners of “modern medicine” if his opprobrius drivel regarding chiropractice is to be believed? FLUSSSHHHH! This is the sound in the back of F-tool’s mind as he attempts, and likely fails, to respond cogently relative to his comments about mainstream chiropractice.

    • Frank Collins
      Full Definition of physician
      1
      : a person skilled in the art of healing; specifically : one educated, clinically experienced, and licensed to practice medicine as usually distinguished from surgery
      2
      : one exerting a remedial or salutary influence

      You might like to check the definition of “Medicine” while you’re at it.

      • @ William

        Frank is not interested in actual definitions of words if such fail to jibe with his biased anti-chiro meta-narrative or his potential to slam a paramedical profession. You have to accept his words about chiropractic for what they’re worth: not very much! F-tool is amusing in his own way, though.

  • Good study from Hazel Jenkins (Chiro) at Macquarie Uni!
    This should lead to change, better education on the guidelines and their enforcement!
    @Logos-Bios
    You are correct as here in Australia Medicare (public health) pays for the xray report only and NOT the actual taking of the xrays be it chiro or radiographer. Its the radiologist who gets the $$$$$!

  • As a Senior House Officer in A&E 2005 (UK) the need to minimise radiation was emphasised, although I was aware before.

    I would suggest very few doctors in the UK are unaware of the need to minimise radiation. Some old doctors may be ignorant.

    I will admit to requesting X-rays that weren’t needed and I knew weren’t needed, because of a patient wanting an X-ray and there not being time to explain why it isn’t needed. In particular I feel sorry for GPs who have hardly any time.

    I’ve booked loads of cardiac monitors for obvious extrasystoles, but the choice is often:
    A) pointless (non-radiating) test you know will be normal and then discharge after test.
    B) take time explaining the mechanism of the symptom, but your clinic is already running late. Then discharge.
    C) don’t book any tests and discharge, but get complaint to deal with.

    Unfortunately tests are often a replacement for time to reassure people. My guess is that, although doctors often know the test is not needed, they are requested for other reasons. Quite how chiropractors get away with doing pointless radiating tests is beyond me. I wonder how many extra people get cancer because of chiropractors. I doubt they care.

    The MRI nonsense above is a red herring: there is no ionising radiation from an MRI.

    • The MRI comments did not represent a red herring. Edzard specifically referred to the ordering of imaging(x-rays) to enhance chiros’ bank accounts. MD-owned MRI units do a much better job of enriching them than a lumbar series(pays $35 on average) does of generating profit for a chiropractic office.

      I appreciate your comments regarding GP’s and tme constraints. In America, GP’s are being hammered by government mandates/insurance requirements for which they don’t get paid, thereby requiring them to work longer and harder..and with less satisfaction because the extra work is for the benefit of insurance companies, not their patients or their practices. Perhaps one could justify an unnecessary test to placate a very concerned patient; maybe to do so might be considered honorable and important for a particular circumstance.

      BTW, do you have any citations which would validate your prattle regarding apathetic chiros’ causing cancer due to their raditaion practices? If so, please share.

      Be well

      • Risks of a procedure always need to be balanced against the benefit. However small you believe the risks are they are completely unjustified, as there are zero benefits.

        There is plenty of evidence that increased ionizing radiation is associated with increased risk of cancer. It is not new knowledge and is not even slightly controversial. It is impossible for chiropractors to use ionizing radiation without causing a small number of cancers. That you don’t know that speaks volumes. Again, we come back to the risk:benefit relationship – as there is no benefit there is no justification of any risk, however small.

        But, well done for providing evidence that, as I would have guessed, you just don’t care about the risk of cancer. There are very few real medical professionals anywhere who wouldn’t want to be confident there was benefit to exposing a patient to ionizing radiation to justify exposing them to that ionizing radiation. You just want to stick your head on the sand and pretend the risk isn’t there.

        And it the responsibility of chiropractors to demonstrate safety, not outside groups to demonstrate danger. They presumably haven’t done so because they don’t care (and it is clearly crazy to think Chiropractor associated ionizing radiation could somehow be not associated with the same risks as doctor associated ionizing radiation, but then they do believe in magic like subluxations – maybe they have magic X-rays too…. ).

        MRI is a red herring. There is clearly a difference between exposing someone to a non-ionizing scan for money and exposing them to risky ionizing radiation for money. It is trying to compare chalk and cheese.

        • Silly EB….of course there’s evidence linking ionizing radiation to cancer. Where did I state otherwise? Your post is quite incoherent. That you haven’t provided documented anything which would prove your preposterous point that I don’t care about cancer risk speaks volumes(your words) about your sub-cogent projection of malice into my decisions to or not to image a patient.

          Risk:benefit is a priori per established guidelines, which should be followed by all ordering clinicians. Your opprobious prevarications directed toward me are unsubstantiated. Moreover, your attempt to avoid the admission that your brethren within “modern medicine” simply ignore or have not taken the time to assimilate MRI guidelines. This is expected from anti-chiro zealots who care more for protecting their own turf than they do about truth-telling.

          According to Health and Science, MD’s are quite willing to order unnecessary CT scans because of malpractice concerns or, perhaps laziness/reluctance regarding the acquiring of previous CT reports.
          Some hospitals tend to perform double scans — one with a contrast agent and a second without it. Doctors sometimes refuse to accept or are unable to access radiology studies done elsewhere and send patients for duplicate tests at a facility in which they have an ownership interest. Doctors who have a financial stake in radiology clinics or who own scanners use imaging substantially more often than those who don’t, studies have found. And increasingly, specialists are requiring that patients get a scan before they first see a patient.

          Imagine that! MD’s have been shown to care more for their own financial profit than they do for their patients’ cancer risk vis a vis unnecessary CT scans. I suspect EB is by now apoplectic.

          According to the FDA, which has launched an initiative to reduce unnecessary exposure to medical(note to
          EB:MEDICAL, not chiro) radiation, the effective doses from diagnostic CTs are “not much less than the lowest doses of 5 to 20 mSv received by some of the Japanese survivors of the atomic bombs” dropped over Hiroshima and Nagasaki in 1945. Some of these survivors have “demonstrated a small but increased radiation-related excess relative risk for cancer mortality.”

          Radiation exposure is cumulative, and children, who undergo between 5 million and 9 million CT scans annually, are much more vulnerable to its effects.

          Concerns about overuse and potential harm have prompted actions by federal health officials as well as consumer and physician groups. These include the Image Wisely and Image Gently campaigns, part of the national Choosing Wisely effort, which seeks to educate patients and doctors about unnecessary tests such as CT scans for headaches or back pain.

          A “decision support” system that creates a set of standards for doctors to follow, pioneered at Massachusetts General Hospital in Boston, reduced the rate of inappropriate imaging tests from 6 percent in 2006 to 1.5 percent in 2014, said James Brink, the hospital’s radiologist-in-chief. A similar statewide program in Minnesota cut the growth rate from 7 percent per year to about 1 percent annually. New Medicare rules will require doctors to consider appropriateness criteria developed by the American College of Radiology when ordering imaging. Beginning this year, Medicare will reduce by 5 percent reimbursement for CT scans performed on machines that fail to meet modern standards, including the ability to automatically adjust radiation doses. It’s good to learn that appropriate authorities are “cracking down” on MD’s who dismissively order ionizing radiation, CT scans for patients who don’t require them.

          Be well, EB

          • You think rather a lot of yourself to believe anyone would become apoplectic after reading your ramblings.

            Although, to be fair I got bored and didn’t read all of the volume.

            The fact remains radiation exposure is associated with increased cancer risk and Chiropractors request investigations using ionizing radiation. As there is no benefit to chiropractic treatment this risk is unjustified.

        • Of course EB retreats from substantiating his incoherent remarks; not surprising for him! It’s blatantly obvious that EB prefers to inject bogus, biased, anti-chiro allegations into this forum. His posts here are prime examples of changing the topic, which was, per Edzard, the claim that chiros were inflating their bank accounts by referring for unnecessary x-rays. EB commented nonsensically that I didn’t understand the relationship between CA and radiation; EB has been unwilling to prove his allegation. Note that EB has been silent regarding the blatant overuse of MRI by MD’s.

          I must also laugh at EB’s non-subtle deflection relative to MD’s overuse of highly irradiating CT scans. One would think that a person who feigns such support of radiation protection for patients would be “up in arms” against the overutilizing medical quacks. Alas, EB seems to be content with well reported medical overuse of MRI and CT scans, yet is deeply troubled by apparent overuse of x-ray by the chiropractic profession. Yeah, right! You simply can’t make this stuff up! Please, keep it coming, EB. Reading your tortuous literary attempts to respond to my posts, without really responding to them, is amusing. I was hoping for more from you.

          • I’m not responding to your points because I don’t respect you our your intelligence enough that I read your ramblings, apart from the start and end.

            If you want to be listened to I would suggest earning some respect.

            Simple fact; exposure to ionising radiation is associated with increased risk of cancer. That risk is not justified in chiropractic practice, as chiropractic treatment is bogus.

        • EB retreats, sans a cogent argument to address my clearly expressed concerns. Typical cynic! He resorts to ad hominem attacks because he lacks the intellectual capability to argue effectively against my points. EB apparently is quite comfortable zinging insults with his buds on this site against non-MD professions and exits abruptly when he is asked to directly address comments which shine onto “modern medicine” a less-than-bright light. When the going gets tough, EB…..capitulates. Priceless!

          • There is a quote, attributed to various people, about wrestling pigs. It applies here.

          • EB’s capitulation is on full display. There is also a quote about (my) getting into a battle of wits with an unarmed person(you), that I believe is more appropriate to your unwillingnes(inability?) to coherently discuss issues I’ve raised. Given your conspicuous failure to address them, instead deflecting our conversation to ages-old knowledge about radiation which has been ubiquitously desseminated to the public for decades, it was probably wise for you to retreat from this discussion to avoid further self-embarrassment. Perhaps you are more intelligent than you have let on in this conversation. After all, surrendering to another poster’s superior argument does evince at least nominal wisdom.

            Be well

          • It must be lovely living in your delusion.

        • EB’s retreat has become even more brisk……go figure! LMAO

          Be well, EB

      • I have seen quite a number of x-ray’s taken by chiropractors. Radiologists regularly take care of people who come from chiropractors, often scared witless by something the chiro’s think they saw in their plates, are unanimously critical of both the poor quality images taken by chiropractors and their interpretation. What is most striking is that none[sic] of them seem to know how to shield the gonads. I.e. the chiropractors seem not to bother with the self-evident safety feature of covering the testicles or ovaries with lead to minimise ionizing radiation to the cells that will become future children.

        • I don’t know of any chiropractic physicians who don’t utilize gonadal shielding. In fact, such is inspected and required by most states. Please inform yourself before you comment.

          BTW, why do you as a BS(er, bariatric surgeon) have any professional need to view spinal or extremity radiographs? You allege, likely dishonestly, that you “have seen quite a number of x-rays taken by chiropractors.” The surgeons I know are quite busy with their own patients and they work very long hours; they don’t have the time or energy to review x-rays from other providers unless such review is necessary for management. Either you are not a very busy BS, you have no personal life, or you simply are mendacious when it comes to talk of the chiropractic profession of which you know little-to-nothing. Which observation is correct, dear Geir? Please advise.

          Be well

        • Silence from Geir….he must be reviewing myriad radiographic studies by chiropractic physicians between his surgical procedures(snicker…). It is quite important for bariatric surgeons to involve themselves in quantifying the number of lumbopelvic x-rays that demonstrate gonadal shielding, I would suppose. His contributions, if real(I doubt they are), to the betterment of radiation protection of patients should be properly respected. His comments regarding the alleged lack of gonadal shielding by chiros should be viewed with suspicion. Blue Wode’s padawan certainly has no credibility whatsoever regarding the practice of mainstream chiropractic in the USA.

          Be well, dear Geir

  • @Richard Rawlins
    You make a good point and the subluxationists do use xrays as a marketing tool! In chiropractic we call it “scare care” and it really gives most of us the shits!
    Currently in Australia the referring for 3 and 4 region spinal xrays is being investigated. They are taring the whole profession on this issue when they should be doing an audit to see who is generating the excessive referrals and revoking their rights or placing restrictions on them! Similar to auditing doctors for their prescribing of certain drugs!

    Years ago the radiologists realized that chiro’s were taking xrays so they invited chiro’s to send them, they charge medicare $160 for the report and the radiologist kept $60 for the report and gave the chiro $100 to cover the cost of taking the xrays. This was stopped several years ago and the referral rates dropped. Then the radiologists started paying rent for the facilities within the chiro’s practices, sent in their radiographers and referrals went back up. The above study does note:
    “Poorer adherence to current guidelines was seen, if the chiropractor referred to in-house radiographic facilities”.
    These facilities are now run by the radiologists!!!
    @Frank Collins
    “And these things are recognized and addressed, unlike chirocraptors who go on their merry way unsubjected to scrutiny.”
    I do not know what the situation is like in your neck of the woods but here xrays come under the control of the Environmental Protection Agency (EPA) for owning a facility/taking xrays and they apply strict standardized rules across all professions (Chiro, Medical, Dental, Industrial)! As for referring for xrays that comes under the control Medicare (Public Health) and it is being scrutinized right now. The physio’s here are upset that they have only gained xray referral rights very recently yet they to are being audited and the ability to refer for 3-4 regions is probably going to be restricted for all! So scrutiny is NOT by chiro’s! I know of one vitalist chiro who had his xray licence revoked and he then told his patients that he is non-drug, non-external intervention and believes that health comes from within so he stopped using xrays as they come from without the body! Philosophy of convenience! Before that every patient of his got a full spine xray!

    • @Critical

      Thank you for your cogent thoughts. I do wonder, however, why you spend so much time schooling Frankentool in your posts. He really gives you no respect whatsoever, despite your obvious professional and ethical views of how mainstream chiropractic is and should be practiced. F-tool is essentially a zero relative to knowledge of mainstream chiropractice, yet he proffers his spurious drivel about it incessantly and ad nauseum. Your kind attempts to educate him are akin to trying to convince Putin to stop making a fool of Obama: in other words, you are wasting your time with F-tool.

      Be well, Critical

  • @Logos-Bios
    I am here to put both sides of the argument into the public record! Google never forgets! The chiropractic profession must engage with the critics as this drives reform. I look on all critics both within and without the profession as absolutely necessary for reform!
    There has been many a time I have had to pause and take a deep breath before responding, usually to sweeping statements and carpet bombing that has the reformers within the profession as unacceptable collateral damage. But to some degree this balances out the vitalist chiropractors at the other extreme.
    I may have differing opinions to Prof Ernst at times but I still have respect for his years of research and professional achievements. I have not once been blocked on this site. I have only ever been blocked by chiropractors and chiropractic forums and this speaks volumes in my book! I also thoroughly enjoy my exchanges with @Blue Wode, @Björn Geir, @Frank Odds and the other forum regulars. @Frank Collins on the other hand is a lost cause but I have stubborn Irish heritage so bring it on Frank! 😉

    • @ Critical

      Fair enough! You are a kind and educated physician. I laud you for giving F-tool more than he usually deserves.

      • errm… Critical_Chiro is NOT a physician!

        • @Odd Frank

          Is Critical a PhD, a PT, a Masters’ level researcher? I assumed by his moniker and professional writing skills that he is a chiropractic physician. You are welcome to clarify his credentials if you are aware of same.

          • @Logos-Bias

            Physician, definitions: “a person qualified to practise medicine, especially one who specializes in diagnosis and medical treatment as distinct from surgery.” (Google); “A person qualified to practise medicine, especially one who specializes in diagnosis and medical treatment as distinct from surgery.” (Oxford English dictionary); ” a medical doctor; especially : a medical doctor who is not a surgeon.” (Merriam-Webster). Much as chiros like to think of themselves as doctors, they are emphatically not.

            You and Critical Chiro prefer to hide behind pseudonyms; now it seems you’re appropriating to yourselves titles for which you’re not qualified.

          • Frank Odds,

            Considering the title and the content of the article on which they are commenting, they are also appropriating to themselves the protected title “diagnostic radiographer”.

            They have many reasons to hide behind their pseudonyms.

          • @Logos-Bios
            I am just a chiropractor with a masters at present though I am currently exploring opportunities for doing a PhD! I am NOT a doctor, Physician, neurologist, pediatrics etc and I am not a fan of chiro’s who abuse those titles to put it mildly! Never appropriated those titles @Frank Odds so you are making assumptions and my views on this subject have been made abundantly clear on this forum! As for hiding behind a pseudonym its to keep the noise down from both extremes of the spectrum, vitalist nut jobs and entrenched carpet bombing critics!

          • @Critical-Chiro

            I agree I was making assumptions about you. I apologize. I blame Logos-Bios, he’s dragged you into his arguments. You’re always far more rational than L-B; you’re right to distance yourself from this person.

        • @Odd Frank

          I note you failed to answer my question about Critical’s professional degree(s).

          In the United States, practitioners with a Doctor of Chiropractic (DC) have been added to the list of recognized physicians by the Joint Commission on Accreditation of Healthcare Organizations.

          A physician, by defintion, is a person who is skilled in the art of healing. Since chiros diagnose, discuss treatment options, and treat(when they believe specific interventions which they provide are appropritate and consented to by their patients), they clearly meet this defintion.

          Now, about the question I asked you and that you circumvented answering……….. How about producing an answer?

          • You really don’t improve, do you?

            I note you failed to answer my question about Critical’s professional degree(s).

            Because it was a rhetorical question. Why should I have had any idea about Critical Chiro’s qualifications? (He told us in a subsequent comment.)

            In the United States, practitioners with a Doctor of Chiropractic (DC) have been added to the list of recognized physicians by the Joint Commission on Accreditation of Healthcare Organizations.

            Not a great recommendation for the wisdom of the Joint Commission.

            A physician, by defintion, is a person who is skilled in the art of healing. Since chiros diagnose, discuss treatment options, and treat(when they believe specific interventions which they provide are appropritate and consented to by their patients), they clearly meet this defintion.

            I gave you three dictionary definitions of a physician. You have chosen to ignore them and substitute one of your own.

            Now, about the question I asked you and that you circumvented answering……….. How about producing an answer?

            What question is that? About C-C’s professional qualifications? Even when you asked you wrote “You are welcome to clarify his credentials if you are aware of same.” I’d have thought my silence on the subject clearly signalled I have no idea.

            I am now aware that C-C is “just a chiropractor with a masters at present”. But I’m not sure what difference a person’s qualifications make to the substance of their arguments, which is why I never refer to my own: arguments to authority are not evidence of anything.

          • @ Odd Frank

            At least Odd Frank occasionally admits when he makes assumptions, rare as those admissions are. BTW, Critical answered the question directly; it was not rhetorical.

            The definition I gave for “physician” was from the dictionary which, BTW, also included those that you posted. It’s unsurprising that you would cite the definitions which made you appear correct and omitted the one which didn’t jibe with your personal views.

            Your “silence on the subject” regarding Critical’s qualifications appeared to be more of a deflection than a tacit admission of ignorance on your part. I accept that you were ignorant of his qualifications; thanks to Critical for revealing them.

            I do agree that a person’s professional qualifications do not necessarily bring wisdom or authority to his/her viewpoints. It’s a shame that others on this site reflexively discount the views of clinicians in non-medical profesions.

            Be well

          • And maybe Frank Odds will read this standard definition:

            med·i·cine
            ˈmedəsən/
            noun
            1.
            the science or practice of the diagnosis, treatment, and prevention of disease (in technical use often taken to exclude surgery).
            2.
            a compound or preparation used for the treatment or prevention of disease, especially a drug or drugs taken by mouth.

          • @L-B
            The definitions I gave were the primary definitions from the sources cited.

            You wish to define the term ‘physician’ to include any kind of ‘healer’. Practitioners of reiki, colonic irrigation, reflexology, therapeutic touch and many more therefore join homeopaths, chiropractors and acupuncturists as ‘physicians’. This is pure floccipaucinihilipilification of the word.

            @William
            ‘Standard’ definition?! Ain’t no such thing. The term is an appeal to an (unsourced) authority. And the word being defined was physician, not medicine. Please hone your reading skills

          • Franko,

            “And the word being defined was physician, not medicine. Please hone your reading skills.”

            While it’s always good to hone your reading skills, William may have been definining ‘medicine’ because it was part of the definition you posted for ‘physician’. I’m sure he appreciates your heart felt advice, though – it’s very kind of you.

            “Much as chiros like to think of themselves as doctors, they are emphatically not.”

            Almost anyone can use the title Doctor – you can go to the Universal Life Church’s website. A “Dr of Divinity” title will run you $32.99. Maybe you meant to say “Much as chiros like to think of themselves as physicians…”.

          • @Odd Frank

            You really have the forum laughing at you, Frank. As you unsuccessfully attempted to regale us with a large, amalgamized word(floccinaucinihilipilification), you instead misused the word: priceless! Your attempt at an insult should have utilized this word to describe your thoughts about what other non-medical posters believe the defintion of “physician” was. Instead, you inappropriately used it when you should have merely stated that you believe that non-medical physicians(e.g. chiros) were using the word “physician” over-inclusively. Classic FAIL by Odd Frank…..LMAO big time!

            Perhaps Odd Frank should stick to words he actually understands how to properly incorporate into his comments! Still LMAO big time!

            Be well, Odd Frank

          • “Almost anyone can use the title Doctor”
            https://en.wikipedia.org/wiki/Doctor_(title)

          • Floccipaucinihilipilification: the act of reducing something to worthlessness. I rest my case.

          • @ Odd Frank

            The definition of floccinaucinihilipilification is as follows: “The action or habit of estimating something as worthless.” Frank “rested his case” on his error of understanding. His “rested case” has been found wanton.

          • @L-B

            Let me spell it out for you in words you just might understand. ‘flocci’ from ‘floccus’ (Latin) a hair, or having the value of a hair; ‘pauci’ (Latin) ‘few’ (some prefer ‘nauci’ from Latin ‘naucum’, a trifle); ‘nihil’ (Latin) ‘nothing’; ‘pili’ from Latin ‘pilus’, again ‘a hair’; ‘-fication’ from Latin ‘ficatio’, a making. Hence, the (silly but fun) amalgamized word (some say the longest ‘authentic’ word in the English language) floocipaucinihilipilification: the act of estimating as worthless or reducing something to worthlessness.

            Your insistence on applying the word ‘physician’ to any kind of small-time quack who is ‘skilled in the art of healing’ is indeed a floccipaucinihinipilification of the word: it reduces it to worthlessness or estimates it as worthless. For crying out loud, an astrologer or a masseur can claim to be ‘skilled in the art of healing’.

            So if, as you claim, you laughed your ass off because you figured — wrongly — I was misusing the word, you’d better swallow your pride, adjust your spine and laugh your ass back on. Your prolific posts on this and more recent threads are on a rising scale of inaccuracy, missing the point, obduracy and offensiveness. Please try to substitute quality for quantity, otherwise I will have to start referring to you as ‘Logic Bollocks’.

          • @Odd Frank

            I appreciated your “spelling it out for me.” Unfortunately, you continue to misuse the word. I suggest that you review my 11/3 post for clarification so that you don’t make the same mistake in the future; that is, if you ever dare to attempt to use the word again.

            The estimating or judging of something as worthless might represent my take on many comments on this forum, for example; such would be an example of floccinaucinihilpilification. To claim, as you have, that my alleged changing the defintion of “physician” represents such an example is erroneous. You see, Frank, to aver the latter scenario as veridical would imply that “flocci” is actionable(it’s not!). The word is of nominative, not actionable, case and is best used the way I have discussed above and in previous comments.

            BTW, I do wish to compliment you on your understanding of language. You are head-and-shoulders above just about everyone else on this site. Your education has obviously been quite complete. I respectfully disagree with your take on “flocci..” but I certainly appreciate the conversation.

            Have a fine day, Frank

  • @Critical Chiro
    I can understand the sentiment of your last post. However my problem is that Prof. Ernst and his followers (Bjorn and the Franks etc.) do not apply the same rigorous criticism to aspects of “medicine” that are seriously un-substantiated. E.G. physiotherapy relies on some very unproven methodologies in treatment, exercises, TENS, ultrasound, heat, massage, shortwave diathermy have yet to be proven to work, or have been proven to be of no benefit. Bariatric surgery has great short term results, but if the patient does not change their lifestyle, than the results are minimal. The list goes on. One only needs to look at the shonky “anti-chiropractic” research published in the NZ Medical Journal, authored by the deceitful Sean Holt, to realise how far some researchers will go to dishonestly criticise the chiropractic profession. There has been some very good research in neurophysiology done by chiropractors at Auckland University. Bernadette Murphy, Heidi Haavik and Kelly Holt are three chiropractors with PhD’s from Auckland University (In the top 100 of universities worldwide). They have published in peer reviewed literature and are well thought of.

    • @Gibley

      I agree that “the list goes on…..” Thank you for your thoughts.

    • GibleyGibley,

      I was very surprised by your statement

      E.G. physiotherapy relies on some very unproven methodologies in treatment, exercises, TENS, ultrasound, heat, massage, shortwave diathermy have yet to be proven to work, or have been proven to be of no benefit.

      because I was under the impression that (other than some forms of evidence-based therapeutic exercises) physiotherapists do *not* use the unproven methodologies that you listed.

      I know that Wikipedia neither intends to be, nor pretends to be, a definitive source of medical advice, but I found the following article enlightening:
      https://en.wikipedia.org/wiki/Physical_therapy

      Physical therapy or physiotherapy (often abbreviated to PT) is a physical medicine and rehabilitation specialty that, by using mechanical force and movements, remediates impairments and promotes mobility, function, and quality of life through examination, diagnosis, prognosis, and physical intervention. It is performed by physical therapists (known as physiotherapists in many countries).

      Effectiveness
      A 2012 systematic review found evidence to support the use of spine manipulation by physical therapists as a safe option to improve outcomes for low back pain.[52] A 2015 systematic review suggested that spine manipulation and therapeutic massage are effective interventions for neck pain; it also suggested, however, that electroacupuncture, strain-counterstrain, relaxation massage, heat therapy and ultrasound therapy are not effective and thus not recommended for the treatment of neck pain.[53]

      United States
      Definitions and licensing requirements in the United States vary among jurisdictions, as each state has enacted its own physical therapy practice act defining the profession within its jurisdiction, but the American Physical Therapy Association (APTA) has also drafted a model definition in order to limit this variation, and the APTA is also responsible for accrediting physical therapy education curricula throughout the United States of America.

      (Retrieved 2016-10-31 21:50 UTC)

      It seems to me that the therapists who provide PT to their clients, and to patients who are referred to them by the UK NHS, vary widely in terms of their indulgence in quackery.

      My apologies to Professor Ernst and to the readers for my comment being off-topic. My lower back sporadically causes me a great deal of irritation. It has been incredibly irritating today, which is Halloween, therefore it has been a sobering reminder of everything that I initially learnt from the book Trick or Treatment, and everything that I have subsequently learnt from this website — for which I am extremely grateful.

      • I wonder why Pete was surprised by Gib’s statement to the point that not all PT’s use strictly evidence-based therapies in trying to help their patients. In fact, heat, massage and other modalites can occasionally be effective adjuncts to more proven therapies. It seems that Pete might be declaring the use of ALL non-evidence-based treatments to be quackery, but perhaps I’ve misunderstood his comments. If I’m correct in my assessment of Pete’s words, however, I suspect that Pete would condemn the common use of off-label prescribing practices as a quack practice. Ergo, it would follow that Pete would be critical of MD’s who provide off-label RX’s, sans authoritative evidence-based countenance for same.

  • …my problem is that Prof. Ernst and his followers (Bjorn and the Franks etc.) do not apply the same rigorous criticism to aspects of “medicine” that are seriously un-substantiated…

    That will have to remain your problem, not mine or Frank’s or the professors. This thread is about abject shortcomings of chiropractors, not physiotherapists. If the professor decides to discuss issues with physiotherapy, then we will perhaps chime in as we see fit.
    You are absolutely right that bariatric surgery has only a limited effect unless the patient makes permanent lifestyle improvements. That is why we do not consider surgery to be the main “ingredient” in the treatment of obesity and we educate and test and reinforce the patients’ compliance and motivation before[sic] we operate. We also advise many of them to first deal with other problems that may hinder satisfactory results of surgery. Consequently, almost 90% of our patients have good results long term. Bashing bariatric surgery for the one’s who fail or for the problems of poor or unprofessional bariatric services is totally out of place in this thread and only goes to support the hypothesis that your nickname may be appropriate.

    • Bjorn, this site is about CAM, Complementary and Alternative Medicine. Chiropractic is considered to be “alternative”, but to what? Physiotherapy is considered to be “main-stream” and chiropractic alternative to it. However, if the “mainstream” treatment i.e. “physiotherapy”, has little or no scientific validity, and can be considered to be no more than pseudo-scientific “shake, bake and fake”, then it is legitimate to compare the two professions. Pete goes on to say that spinal manual therapy (the realm of chiropractors) is one of the few methods of treatment that PT’s use that works. Pete also says that PT’s focus on “rehabilitation”, without actually defining what it is. “Physical Intervention” is a waste basket term for what?, more shake, bake and fake.

  • @GibleyGibley
    This blog isn’t devoted to the shortcomings of medicine, only CAM and I take this into account when posting here (Tu Quoque arguments are so damn seductive and appealing but I resist the urge). Science Based Medicine (SBM) does devote more time to medical BS but their bias is often apparent. The recent post by Harriet Hall on the article by Neurosurgeons “Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation.” where she not once acknowledged that the authors were neurosurgeons, just called then “they” and it came across as chiro’s burying their heads in the sand. Or Mark Crislip taking a lumbar study on the forces involved in spinal manipulation and arbitrarily applying it to the cervical spine and equating it to the forces involved in hanging. (Adding an image of a noose for emotional effect). I drew this error to Marks attention and I am still waiting for a reply. If I used those types of forces through the tip of my index finger I would break every bone in my hand! But then you have Sam Homola writing articles for SBM and I agree with so much of what he says. That he wrote his book in the 1960’s is remarkable! The blog by Dr David Gorski (ORAC) on the Katie May case started with the usual carpet bombing and sweeping statements but then he carefully analyzed the timeline of events, association, causation and the likelihood of the chiropractor causing the dissection very well.
    As for Heidi Haavik I find her research interesting but unfortunately the vitalists take it and interpreting it in ways never intended. She should be actively setting the record straight and slapping them down but instead she goes to vitalist conferences as the sole subluxation researcher to give them some veneer of credibility. She could learn from Paul Hodges (Physio) who has done definitive research on Transversus abdominus and the core muscles. He now spends a lot of time debunking all the core BS from people misinterpreting it!

Leave a Reply

Your email address will not be published. Required fields are marked *

Gravityscan Badge

Recent Comments

Note that comments can be edited for up to five minutes after they are first submitted.


Click here for a comprehensive list of recent comments.

Categories