MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

The ‘CHRONICLE OF CHIROPRACTIC’ recently reported on the relentless battle within the chiropractic profession about the issue of ‘subluxation’. Here is (slightly abbreviated) what this publication had to say:

START OF QUOTE

Calling subluxation based chiropractors “unacceptable creatures” chiropractic researcher Keith H Charlton DC, MPhil, MPainMed, PhD, FICC, recently stated “. . . that it is no longer scientifically acceptable for any responsible chiropractic clinician to ever use the word subluxation except as theory . . .” Charlton made the comment to members of the Chiropractic Research Alliance a group of subluxation deniers who routinely disparage the concept of subluxation.

Charlton is a well known “Subluxation Denier” and frequently attacks subluxation based chiropractors in his peer reviewed research papers and on Facebook groups. According to Charlton in a paper published in the journal Chiropractic and Osteopathy: “The dogma of subluxation is perhaps the greatest single barrier to professional development for chiropractors. It skews the practice of the art in directions that bring ridicule from the scientific community and uncertainty among the public.”

On January 5, 2017 Charlton further stated: “We need NOW in 2017 and beyond to get rid of the quacks that do us so much harm. They need to be treated personally and professionally as utterly unacceptable creatures to be shunned and opposed at every turn. Time to get going on cleaning out the trash. And that includes all signs, websites, literature, handouts and speech of staff and chiropractors.”

…Charlton has testified against subluxation based chiropractors in regulatory board actions and appears to revel in it.

In his most recent pronouncement Charlton states that he is okay with subluxation as a “regional spine shape distortion” and asserts that this is a CBP subluxation. This contention is common with subluxation deniers who are willing to accept an orthopedic definition of subluxation absent the neurological component.

…Charlton states he uses the following techniques on his website:

  • Applied Kinesiology
  • Diversified
  • Motion Palpation
  • Sacro-Occipital Technique
  • Activator
  • Logan Basic

When this self-declared scientist was confronted with his use of Applied Kinesiology and these other techniques his response was essentially that he is engaging in a “bait and switch” and that he just has those on his website to get patients who are looking for those things. Charlton lists 21 “research papers” on his curriculum vitae though they are all simply commentaries or reviews not original clinical research. The majority of these opinion pieces are attacks on subluxation and the chiropractors who focus on it.

END OF QUOTE

What does this tell us?

  • It seems to me that the ‘anti-subluxation’ movement with in the chiropractic profession is by no means winning the battle against the ‘hard-core subluxationists’.
  • Chiropractors cannot resist the temptation to use ad hominem attacks instead of factual arguments. I suppose this is because the latter are in short supply.
  • The ‘anti-subluxationists’ present themselves as the evidence-based side of the chiropractic spectrum. This impression might well be erroneous. Giving up the myth of subluxation obviously does not necessarily mean abandoning other forms of quackery.

31 Responses to Chiros fighting chiros

  • To what extent is the ‘bait and switch’ technique allowed before it becomes scurrilous and illegal?
    Why not offer free jam sandwiches and porno mags to bring the punters in?

    • @Barrie

      Good question regarding “bait and switch.” Perhaps you should direct the question to bariatric surgeons who prey upon the insecurities of overweight (but otherwise healthy) people in their quests, via advertising, to augment their bank accounts? Perhaps their ads would read something like “Reduce Weight and Discover The Real You.” Of course a disclaimer in fine print might read, “only a 4.6% post-one-year mortality rate.”

      Be well

      • Yes. Morbidly obese people live happy and healthy lives don’t they? If only they werent conned into seeking a surgical solution by those wicked surgeons.

        • This tiresome troll obviously thinks repeating incorrect data often enough makes them right. I already pointed L-B to reliable, non-commercial, no-US data reports on the morbidity and mortality in bariatric surgery.
          But L-B seems completely uneducable and evidently prefers to “parrot faux realities” (if I may use L-B’s own terminology) that fit its pathetic agenda.

          Let’s have a look at some non-faux realities…
          Below is a quote from the relevant part of the 2014 SOReg report, which is the latest available in English. Later reports will become available as they are translated. Our service is one of the largest single contributors to these data.

          The following excerpt is from Part 1 page 31

          Mortality
          The registry has links with the befolkningsregistret [Census Bureau] to obtain data on the number of patients who died during the period from the date of the operation up until 31 December 2014. That means that the follow-up rate is 100% with regard to data on mortality. We also have a link with the registry on the cause of death, which is presented one year after the fact, that is to say that we have data on the cause of death for all deceased persons through 2013. In some uncertain cases of death, we have asked the treating clinic for additional information in order to further strengthen the analyses. We have made an assessment, both of which a diagnosis is the primary cause of death and whether the death is due to a complication of the surgery or not. Both of these assessments are in some cases uncertain because the information in the registry on cause of death is incomplete.

          Of the over 46,000 patients who had surgery before December 2014, 399 died. Table 18 shows mortality by year for the last five years together with combined figures for earlier years. During the first 30 days, 17 patients died and 32 died during the first 90 days. This gives a total for 30 days’ mortality of 0.039% and a total for 90 days’ mortality of 0.069%. Mortality lies at a very low level and
          has possibly diminished somewhat over the years.

          These figures are for all-cause mortality in a population that is already at increased risk of premature death. Remember when reading such reports that bariatric surgery is not complication free – no surgery is. Morbidly obese people are sick, high-risk patients. The trick is to know how to avoid complications and how to deal promptly and effectively with them.

          This is as reliable as data can get in the real world of healthcare. The reports are based on real-time registration of data. In our service (Aleris Skåne), nurses and secretaries register data directly into the online registry as events happen. We surgeons have no way of manipulating the books and controllers from the registry even make visits and control that the data are valid and reliable.

          American data is also easy to find and they are as reliable as it can get.

          Safety and Risks

          Agency for Healthcare Research and Quality (AHRQ) and recent clinical studies report significant improvements in metabolic and bariatric surgery safety 10

          Primary reasons for improved safety include the increased use of laparoscopy, advancements in surgical techniques,11 and ASMBS and American College of Surgeons (ACS) accreditation program
          Laparoscopic bariatric operations increased from 20.1% in 2003 to 90.2% in 2008 12
          Overall mortality rate is about 0.1%13 — less than gallbladder (0.7%)14 and hip replacement (0.93%) surgery15 — and overall likelihood of major complications is about 4.3% 16

          Clinical evidence shows risks of morbid obesity outweigh risks of metabolic and bariatric surgery 17,18

          Individuals with morbid obesity or BMI≥30 have a 50-100% increased risk of premature death compared to individuals of healthy weight19
          Studies show metabolic and bariatric surgery increases lifespan 20,21
          Gastric bypass patients may improve life expectancy by 89%
          Patients may reduce risk of premature death by 30-40%

      • Good question regarding “bait and switch.” Perhaps you should direct the question to bariatric surgeons who…”

        If the article was about bariatric surgeons this comment would be appropriate. As it’s not this is just a distraction.

  • Interprofessional(masquerading as intraprofessional), and vice-versa, feuds are nothing new. Take medicine and osteopathy in the early part of the last millenium and into the 1960’s, for example. MD’s in the late 50’s and in 1960 referred to DO’s as quacks, quacksters, rabid dogs, uneducated zealots, and killers; of course they claimed that such descriptors were based on science. Interestingly, the true political nature of organized medicine’s “turf protection” was exposed when the medical profession acquired the COP&S to benefit itself financially and, as a quid pro quo, offered DO’s the opportunity to simply exchange their DO degrees for MD degrees. Of course this blatantly expedient action exposed medicine as hypocritical, political, and self-serving. Think of it: medicine stated that osteopaths were quacks in 1960 but then conferred to osteopaths MD degrees in 1961 simply to advantage itself. Surely “modern medicine” must always be viewed as altruistic! lol

    Medical and osteopathic docs were ostensibly part of the same profession but political motivations and individual prejudices by so-called objective medical physicians prevented practitioners of the professions from co-practicing, or even associating with each other. Conversely, chiro docs who are subluxation-based are quite dissimilar to those of us who are not. I have long thought that the two groups should split, with one of the groups renaming its profession. Alas, such an occurrence would require political and financial motivation; and such doesn’t exist currently what with the imploding of the Obamacare scheme’s having negatively impacted doctors’ incomes.

    • Post traumatic and post operative musculoskeletal rehabilitation is admirably performed by Physical Therapists. Please explain how Chiropractors treat any form of disease beyond massage and stretching of muscles.

      • The protocol for treating the broad categories of disorders you mentioned is no different in a chiropractic office than it would be in a PT’s; SMT is generally not a part of treating post-op disorders, however. I do not receive referrals from MD’s for post-op rehab; I do receive referrals for traumatic injuries which are deemed appropriate for rehabilitation. The rehab algorithms used for such rehab are, of course, in line with “best practice” physiotherapy standards. Patients who are considered to likely benefit from SMT will receive it. In the USA, however, 3rd-party payors don’t always adhere to the standards, thereby truncating a treatment plan prior to the patient’s having achieved MMI. This is true for independent doctors/clinicians and for hospital-based PT’s(e.g. my wife).

        Why did you ask how chiros treat any form of disease? Chiros don’t treat organic disease, but they are required by law to work up and diagnose patients. Prostrate, breast, testicular, blood, urine, integumentary examinations, as well as comprehensive case histories are used to assess patients’ conditions. SMT is utilized with rehab, modalities, meds, paraspinal injections, etc. to treat a variety of NMS, not organic, disorders.

        • to L-B: so your NMS disorders are not organic? Please define them. If they are functional should they be seem by a Psychiatrist or other physicians and mental health specialists who are trained to evaluate and treat such “functional, non organic diseases?”

      • The topic of Edzard’s post regarded intraprofessional discord. I note that your response regarding specific chiro treatment portocol was a bit askew to the thesis of Edzard’s comments. How do you justify the hypocrisy of medicine in its relationship with osteopathy as I have referenced it? Perhaps you don’t consider medicine’s actions to have been hypocritical? Please do give your thoughts on this matter because there definitely are analogues within it when compared to the intra-chiropractic argument.

        Be well

        • nobody, I think, want to justify the hypocrisy in any profession; hence this post.

        • In the UK, a practitioner who wants to practice as an MD (using US terminology – it would be MB BS in UK), has to be registered by the GMC. Osteopaths do not meet the criteria required, unless they get an MD, which they are welcome to do.

          Simple.

          There should be only one standard of ‘doctor’ (MD, MB BS, MB BCh…).

          Those who do not meet the criteria, do not meet the criteria.
          That is how standards are maintained. How else?

          • US osteopathic doctors have different educational backgrounds than UK osteopaths, I believe. This fact is something I actually learned from Edzard several weeks ago.

          • “osteopathic doctors” is as meaningless a term as is “chiropractic physicians” — statements that qualify as being: not even wrong.
            http://rationalwiki.org/wiki/Not_even_wrong

          • @Pete

            US osteopathic doctors are fully qualified as physicans and surgeons. Your statement is erroneous.

          • Logos-Bios,

            I do not reside in the US therefore, as has been pointed out to you several times, your statements on this blog are indeed, not even wrong.

            I shudder to contemplate the sort of treatment that I would receive from you in person. The last time I checked, neither your arrogance nor your belligerence is recommended by the UK NHS.

            “Chiropractic is the correct term for the collection of deceptions DD Palmer invented.” — Björn Geir Leifsson, MD.

          • @Pete

            Quoting Geir at the end of your post was humorous. If he is your source of information on virtually any chiropractic topic, I’d…….well, just find a more rational, unbiased source.

      • In the UK chiropractors do nothing beyond what is already offered by physiotherapy. However physiotherapy is integrated into the healthcare system but chiropractic is not. What is the point of chiropractors?

    • If a chiropractor isn’t subluxation-based then what is it they do, how do they differ from other manipulation-type therapies like physiotherapy, massage and so on?

      • good question! a limited physio with lots of blinkers?

      • @Niall

        Chiropractic doctors are required to diagnose the “entire patient” and are required by law to do so. PT’s in the US don’t have such a requirement. Massotherapists certainly have value in treating some musculoskeletal disorders but they have zero diagnostic education, and often zero college save for their masso training.

        Just as MD’s are more than street-corner pill-pushers, DC’s ideally provide(or decide NOT to provide) their services to patients based on viable diagnostic criteria.

  • It seems to me that the ‘anti-subluxation’ movement with in the chiropractic profession is by no means winning the battle against the ‘hard-core subluxationists’.

    Why am I reminded of Gulliver’s Travels. Oh yes the big-endians’ campaign against the heretical little-endians. Or was it the other way around?

  • Quoting “McCoy Press”? McCoy is a subluxationist who has just been fired from subluxation Headquarters Life College!

    • Critical_Chiro on Sunday 15 January 2017 at 13:40

      Quoting “McCoy Press”?

      YUP!!

      Good call CC!

      MUCH akin to quoting ‘FACT” !

      NEITHER is pubmed indexed or reflective of the mainstream ….. both being nothing more than pathetic attempts of their editors to disguise their op/eds/personal bias as …ahem…..”journals”

  • To make good for my recent breach of conduct, which consisted of failing to ignore L-B’s repetitive off-topic parroting, I hereby humbly submit a work of humour that I believe the management will find fully relevant to the topic of this discussion.

    Chiropractors fighting chiropractors, the Homer Simpson experience:

    https://youtu.be/31Vr9TYYNoY

  • @ Geir

    You are a Homer Simpson fan? Why am I not surprised?

    Be well

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