In her article “Chiropractors are Bullshit” SciBabe discussed her views on the chiropractic profession. Now the chiro ‘Dr’ Michael Braccio has published a rebuttal (excerpts from it are below). Here I will provide a rebuttal of his rebuttal. For clarity, the bold quotes are by SciBabe (as quoted by the ‘Dr’), what follows is the rebuttal by the ‘Dr‘ himself and my re-rebuttal is in italics.
“There is scant medical evidence that a chiropractor is your best treatment option for…anything”
Since most people initially seek care from a chiropractor for low back pain, it seems appropriate to focus there. The most recent clinical practice guidelines recommend heat, exercise, spinal manipulation, acupuncture, and massage as first-line therapies for low back pain. All of these services (with the exception of acupuncture) are services commonly provided by chiropractors for low back pain.
The current low back pain guidelines used to advise healthcare providers on the can be found here: American College of Physicians (ACP), National Institute of Health and Care Excellence (NICE), Towards Optimized Practice (TOP), and Journal of Orthopedic and Sports Physical Therapy (JOSPT).
Guidelines are often not up-to date. NICE no longer recommends chiropractic for back pain. All the hundreds of non-back pain claims made by chiros are even less well supported by evidence.
“Medical doctors often refer patients to the proper experts, and outside of a narrow scope of experts, this rarely includes someone who is a ‘duly-licensed non-M.D.,” because that person’s views on medicine would not be aligned with their standards of care.”
Clinical practice guidelines are intended to provide healthcare professionals with information on the most effective treatment options for various conditions based on the current research. As stated above, the current standards of care for low back pain include spinal manipulation and other therapies commonly provided by chiropractors.
Guidelines are often not up-to date. It is true that proper doctors rarely refer to chiros.
“We didn’t have proper scanning equipment to identify issues in the spine”
Imaging technique has definitely improved since the 19th century, however, this statement reflects an inadequate understanding of low back pain (and pain in general). Abnormal radiographic findings in the spine are common in asymptomatic individuals and are more closely associated with age than they are pain severity. In fact, the current practice guidelines for low back pain discourages routine imaging due to the high false positive rates.
Yet far too many chiros do use imaging – not for diagnostic but for financial reasons, I suspect.
“It appears there is a link between chiropractic manipulation and risk of stroke due to potential artery dissection.”
The American Heart Association and American Stroke Association (also endorsed by the American Association of Neurological Surgeons and Congress of Neurological Surgeons) released a scientific statement stating that the association between stroke and chiropractic manipulation was not well established and probably low. These patients are likely already presenting with a stroke that is in progress, regardless of treatment provided.
I am not sure what a ‘low association’ is. The risk of stroke is, however, real. To deny it is a violation of the precautionary principle that governs all healthcare.
“Chiropractic beliefs are dangerously far removed from mainstream medicine, and the vocation’s practices have been linked to strokes, herniated discs, and even death.”
This statement is made without context. All medical interventions have an associated risk when performed, but their occurrence rates vary. The risk of death from cervical manipulation has been estimated to be 1 in greater than 3,330,000 to 3,730,000 manipulations while the risk of death from gastrointestinal bleeding from NSAIDs is estimated to be 1 in 1,200 patients.
Medical error has also been reported as the third leading cause of death in the United States and many of the commonly used medications have also been linked to adverse events such as stroke and death (ibuprofen, tramadol, and duloxetine).
Even if all of this were true (which it isn’t), it would not be a good reason to tolerate unnecessary harm by chiros (look up ‘tu quoque fallacy).
“Chiropractors can also cause damage by being used for primary care or emergency medical needs, as their training is not appropriate for such care…The chiropractor somehow missed that her son’s arm was broken, and the injury was not detected until many days later when they visited an emergency room.”
I am not privy to the case referred to above to specifically comment on it, but it is inappropriate to condemn an entire profession based on a single case. In SciBabe’s interview on the Joe Rogan Experience, she describes her experience with spinal manipulation performed by her Doctor of Osteopathy (D.O.) for an episode of low back pain. It turned out that her lower back pain was caused by a fractured rib (fractures are a contraindication for spinal manipulation) which was also somehow missed. It is biased to berate the entire chiropractic profession based on a single case and not hold other healthcare professions to a similar standard.
Yes, that would be biased! But the case was a mere example, one of many. It is undeniable that chiros want to be upgraded to primary care physicians, a role for which they are not sufficiently educated or trained.
And finally, “don’t let a chiropractor fool you by reciting the warning label from a vaccine that they’re not qualified to administer.”
Similarly, please do not take medial advice from someone who is not licensed to administer it.
I am not sure I understand the rebuttal here. Yet, avoiding chiros is sound advice, particularly when it comes to vaccination advice.
MY CONCLUSION + ADVICE:
‘Dr’ Braccio is using very tired pseudo-arguments which have all been addressed and invalidated hundreds of times.
My advice to him: book yourself urgently on a course of critical thinking.
My advice to consumers: ask yourself who has an axe to grind; perhaps ‘Dr’ Braccio is worried about his and his colleagues cash-flow? Neither SciBabe nor I have such reasons to misguide you.
36 Responses to ‘Chiropractors are Bullshit’: a rebuttal of a rebuttal
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The American College of Physicians LBP guidelines are not outdated as they were issued on 14 February 2017.
Thoracic hyperkyphosis, when confirmed by imaging, is useful in predicting decreased lifespan. Imaging can provide information on what rehabilitation(Spinal remodelling using Chiropractic Biophysics traction procedures) is best to reduce a thoracic hyperkyphosis.
Dr Michael Epstein wrote: “The American College of Physicians LBP guidelines are not outdated as they were issued on 14 February 2017.”
@ Michael Epstein
They are, however, highly dubious:
QUOTE:
“That guideline contains that great mystery of all the guidelines: how they can make strong recommendations based on low-quality evidence? Got me. It is the alchemy of guidelines, turning digested straw into spun gold. Here is the text. The effect of spinal manipulation is unimpressive:
‘Low-quality evidence showed that spinal manipulation was associated with a small effect on function compared with sham manipulation; evidence was insufficient to determine the effect on pain. Low-quality evidence showed no difference in pain relief at 1 week between spinal manipulation and inert treatment (educational booklet, detuned ultrasound, detuned or actual short-wave diathermy, antiedema gel, or bed rest), although 1 trial showed better longer-term pain relief (3 months) with spinal manipulation. Function did not differ between spinal manipulation and inert treatment at 1 week or 3 months. Moderate-quality evidence showed no difference between spinal manipulation and other active interventions for pain relief at 1 week through 1 year or function (analyses included exercise, physical therapy, or back school as the comparator). Low-quality evidence showed that a combination of spinal manipulation plus exercise or advice slightly improved function at 1 week compared with exercise or advice alone, but these differences were not present at 1 or 3 months.’
Anyone impressed? Not me. It is the usual pseudo-medical analysis, a hodgepodge of weak studies show marginal aka placebo effect.”
Continues here:
https://sciencebasedmedicine.org/afterword-chiropractic-and-the-new-york-times-is-the-newspaper-trying-to-prove-trump-right/
BTW, it’s worth noting that the guidelines also recommend acupuncture….
http://edzardernst.com/2017/05/acupuncture-for-back-pain-an-open-letter-by-a-canadian-therapist/
With regard to the NICE guidelines, they…
QUOTE:
…are something of a problem for osteopaths and chiropractors as their treatments are no longer first line choices and they are not well placed to offer a suitable [group] exercise programme. Some of them may opt to continue treating patients the way the always have and not take the NICE guidelines into account. However, that is a potentially risky strategy for two reasons:
1. It doesn’t seem to be in the best interest of their patients
2. They risk being found in breach of their “Practice Standards” which could result in formal complaints to either the GOsC or GCC.
Ref: https://complementaryandalternative.wordpress.com/2016/12/06/nice-guidelines-for-low-back-pain-and-sciatica-a-clarification/
as I stated in the post: guidelines are often not up to date; this means they are not up to the best current evidence [not as Epstein implied ‘not of recent publication-date]
I will then just have to wait for the American College of Physicians for their updated guidelines in relation to treatment for acute and chronic low back pain. In relation to group exercises, my clinic is well positioned and designed, incorporating manipulative, exercise and spinal remodelling traction all in one private facility. I follow
Chiropractic Biophysics protocol of care, an evidence based examination and treatment intervention plan.
My back is really painful
Visit an osteopath or chiro
=I feel great
End of
Period
Treatment is treatment if it’s effective , great !
What gives orthodox medicine the right to say they are right ?
They are running scared ,most doctors I see don’t know jack shit about muscleoskeletal biomechanics
have you forgotten to take your little red pills?
Prof Ernst. You forgot or even decided not to include this in your post.
http://www.health.harvard.edu/blog/heres-something-completely-different-for-low-back-pain-2017070611962?utm_campaign=shareaholic&utm_medium=facebook&utm_source=socialnetwork
It does give rather a good indication of what is appropriate for the treatment of low back pain. Also the dangers of what has been considered appropriate care, i.e. NSAIDS and Paracetemol, (strokes, heart attacks and toxicity)
https://www.ncbi.nlm.nih.gov/pubmed/23489151
http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11894763
If you were really brave and thorough, I would expect you to include an analysis into physiotherapy and the dubious and non-evidence based methods used by them. This includes exercises, TENS, Ultrasound etc.
However, I expect no more from you, than the poorly researched articles that you have written over the years.
I like your choice for an evidence-substitute; it does seem to indicate that you are THE expert on everything related to backs
Better than the “Shake, bake and fake” and “hands on homeopathy” that represents the methods of treatment provided by the physiotherapy profession today.
“My advice to consumers: ask yourself who has an axe to grind; perhaps ‘Dr’ Braccio is worried about his and his colleagues cash-flow? Neither SciBabe nor I have such reasons to misguide you.”
http://scibabe.com/business-contact-info/
You were saying?
This took about 10 seconds on her website to find.
and what do you conclude from your ‘find’?
Sensational headline guaranteed to gain attention followed by the usual carpet bombing.
Good for her business cash-flow. Wonder if her “Talent and Brand Management Company” has had increased business inquiries since the post? Do they take the usual 10% commission?
As for you not having an axe to grind. Two words “Prince Charles”.
Until you balance criticism of the BS (which is necessary for reform) with support for the chiropractic reformers and reform then you do have an axe to grind and are carpet bombing.
instead of writing nonsense, why don’t you link to some achievements by the ‘chiropractic reformers’?
Dismiss relevant criticism, avoid answering and try to shift it back onto the person asking the question. Love it.
Did you not write:
“My advice to consumers: ask yourself who has an axe to grind; perhaps ‘Dr’ Braccio is worried about his and his colleagues cash-flow? Neither SciBabe nor I have such reasons to misguide you.”
@Critical_Chiro (or more correctly bonehead non-doctor) on Thursday 27 July 2017 at 03:49
This is on EVERY page;
YVETTE D’ENTREMONT – SCIENTIST – WRITER – PUBLIC SPEAKER
So much for a major revelation.
You are a master of cheery-picking and nearly every other form of logical fallacies, and still peddling the same ‘reform’ nonsense. As always, the question is; REFORM WHAT? If you want reform, start with yourself and enrol in a physio course, if you can?
You keep espousing the same crap yet nothing changes.
My concern is and has always been the ‘where, how and why (beyond patient pain)’ a Chiropractor “knows” to ‘adjust’? Motion palpation is utter farce, leg-checks and AK nut-science and painful-to-pressure vertebral segments have been shown to be HYPER-mobile (thus not needing ‘thrusts’ to move them ‘more’). Thus treatment is always desultory and based in a religious milieu.
So what if the “wrong” segment is adjusted?? Since the “right” segment has zero inter-intra reliability or validatity yet IF adjusted has utterly imperative life changing health benefits….won’t a wrong adjustment be devastating ??
So which of the 100 techniques and who among the 60,000 DCs is doing it right????
Of course it’s bullshit.
@Michael Kenny
What percentage of all the standard orthopedic tests (used by orthopods, physio’s, chiro’s, GP’s etc) are stand alone accurate?
Recent paper put it at 4%.
“painful-to-pressure vertebral segments”
Research has also shown that feedback from the patient increases the inter and intra practitioner reliability and validity of orthopedic testing.
If its a chiropractic TORon who doesn’t take a thorough history and examination balancing the results of multiple tests and uses sound clinical judgement then I agree with much of what you say.
“So which of the 100 techniques and who among the 60,000 DCs is doing it right????”
Very good question.
Just look at the anatomy of the sinu-vertebral nerve. How important is it being “specific” to one level?
Guru’s who promote “clinical certainty” if you just sign up to their “unique” technique(TM) really pee us off as do the technique groupies.
With all the physio and chiro techniques (both are legion) what do they all have in common Michael excluding the extremes?
“You do it too” is a logical fallacy. THAT everything regarding 99% of back pain may be desultory and indeterminate doesn’t seem to stop the enrollment by Chiropractic colleges. Their enrollment is based on the very assumption that THEY in fact do possess “insight” and certainty regarding it (and of course addressing much more than just “back pain” is the shibboleth of the DC degree….If NOT, as you point out why with such limited-knowledge would the profession persist? It is a bridge to a religious causa sui regarding ‘certainty’ about the spines’ alignment and ‘function’. Of course it is…..
Dianetics posits itself in the land of science and ‘psychology’ but quickly ‘upgrades’ prospective targets straight into the land of Thetan & Scientology. Don’t pretend 75% of your colleagues don’t do the same with their patients. The 1-3 treatments back pain ‘may warrant’ (at a worth of $20.00 each) would certainly drive every DC out of business in a month if they were not ‘upgrading’ each victim to another ‘level’ of care…likely unnecessary and illegitimate.
What do they (other science-based professions) all have in common? That is also a good question…however what they don’t have in common with Chiropractic is a religious milieu, an ‘explanation’ which can’t be supported by reason and science and +80% of their fellows spewing ‘certainty’ regarding ’causes’, mechanisms and solutions.
Chiropractic appears to make sense to those either unaware of biomechanics, physics and anatomy…or those demanding certainty and seeking to avoid dissonance.
Getting a DC degree to practice ‘as an evidenced-based PT, ATC or kinesiologist’ may be an excellent path for those not able to acquire the real science-based degrees…but that the “standard chiropracTOR” has much pride (and arrogance) in their chosen field can’t be denied. As do you as an adjudicator to who isn’t playing fair i.e. gurus and their devotees “who piss us off”. What criteria do you possess for that assessment? Was it learned IN Chiropractic school? Did they have a course on what IS and what ISN’T really true??
I’d be curious if you (apparently having acrimony toward the profession) would direct your children to be DCs??
If not then prey tell why try to borrow a whole mass of science-based information and insights and pile it under a useless DC degree….and then suggest you are trying to reform the profession?
@Michael Kenny
You are making many assumptions, generalizations and sweeping statements about chiropractic and seem to be unaware of what is taught IN the universities. We are not all members of the high church of DD and BJ and have moved on from 1890. Research in Europe, USA, Canada and Australia put the religious fringe at 15-18% of the profession.
Much of the criticism from critics like yourself matches similar critical debates going on within chiropractic. I am not acrimonious towards the profession just hostile and critical of the 15-18%.
Where do you think reform and change comes from? Not from the likes of CalJam, Rubicon or the ICA. Reform comes from universities, associations and researchers which regulars on this blog carpet bomb and think are acceptable collateral damage.
Here is a good starting point:
http://vertebre.com/charte-pour-l-education-chiropratique-en-europe-8163
Several more universities have signed up to this position statement.
Are you aware that 15 of the top 60 musculoskeletal researchers in the world are chiropractors with Jan Hartvigsen ranked #1?
In clinical practice the only certainty is uncertainty and I am constantly looking at the research for better ways to help patients and changing the way I practice. For your information I keep detailed practice statistics and I see a patient on average 6.8 times. I also work in a multidisciplinary medical centre and use multiple approaches (though the critics often think that chiropractic is a single modality).
My eldest son is at university studying engineering. He considered medicine and chiropractic and spent time doing work experience and also came into my practice. 4 surgeons and 3 GP’s here all advised him not to do medicine with the common advice of “I wouldn’t go into medicine now days”. They were all pessimistic about medicine. We supported him in his choice and he could have had an established practice handed to him on a silver platter. My youngest is in final year at school and he has come in here as well with the same advice from the doctors but he seems more interested in doing a business/finance/economics degree.
Finally, do you assume that anything science based in chiropractic is “borrowed” from other professions?
Critical_Chiro wrote: “Research in Europe, USA, Canada and Australia put the religious fringe at 15-18% of the profession.”
It is not 15-18%. See here and keep scrolling to the end of the comment:
http://edzardernst.com/2015/01/my-visit-to-the-anglo-european-college-of-chiropractic/#comment-63772
Please note that your previous answers were discussed here, so you still require to produce convincing data:
http://edzardernst.com/2016/02/some-chiropractors-seem-to-believe-that-progress-is-a-malignant-disease/#comment-74804
As for chiropractic reform in Europe, it looks like it’s still a very, very long way off:
QUOTE:
“During last summer, ECU representatives (ECU Treasurer Vasileios Gkolfinopoulos and ECU Secretary-General Ian Beesley) met with Guy Riekeman and Gerry Clum of Life University to explore if there was enough common ground for the two parties to collaborate and conduct a meaningful conversation. Draft statements were then scrutinised and amended in a meeting in Geneva in August where the whole Rubicon Group was present together with the ECU Executive Council. The Executive Council believes that these statements are the first stepping-stones to a situation where the profession can act in a unified way. They are a result of negotiation and compromise. If one of the parties had written the statements themselves, they would have looked different. They reflect where we found common ground.
So far, the discussions have not covered areas like the subluxation complex, vaccination, the use of drugs and patient management, where we know there is a significant difference in opinion between the two groups.”
Ref (p. 3):
https://www.chiropractic-ecu.org/wp-content/uploads/2017/03/01-32-Backspace-Mar17-to-print.pdf
Finally, in the UK, in December 2016, the President of the British Chiropractic Association announced that “unity need not mean uniformity”:
http://www.mccoypress.net/i/bca_bennett_letter_december_2016.jpg
IOW, he’s inviting UK chiropractors to tolerate 1,000 (declared) subluxationist chiropractors – a third of those registered with the General Chiropractic Council (GCC). See 5.14 here where the GCC mentions the Alliance of UK Chiropractors (AUKC):
http://www.professionalstandards.org.uk/docs/default-source/publications/performance-review—gcc-2015-16.pdf?sfvrsn=0
Those interested can read more about the AUCK here:
http://www.zenosblog.com/wp-content/uploads/2010/11/AUKC_Oct_Newsletter.pdf
Thank you for your reply. I respect your striving for integrity as being in Chiropractic it must always be difficult. As a back-pain sufferer for many years 2 things strike me: you say your avg is 6.8 txs. Unless you are treating the majority once and the very occasional patient 20 times 6.8 suggests to me unnecessary care is dominant. DCs sell ‘treatments’ which never really work for anything but transient ‘relief’ (worth $20 perhaps). Along with the tx however is a well-orchestrated bait & switch suggesting (better: coercing) to the gullible that an ‘underlying, treatment-necessary’ condition exists. This is simply unsupportable by modern research….irrespective of the fact that some researchers happened to get a DC degree before or after getting a real degree.
DC ‘treatment’ invariably cause me more irritation than relief since the ‘alignment’ bullshit-treatment (guns, ‘drops’, manipulation etc) add nothing to the ‘modalities, which at least help the pain for a few hours. The BS ‘adjustment’ non-sense is the “upsell”. 6.8 treatments still seems like 6 too many.
I invested the cost of ONE DC treatment in Stuart McGill PhDs book ‘Back Mechanic’ and it has truly given me my life back. Can DCs instruct patients in his methods? Of course but 99% don’t. They ‘up sell” bull shit courses of ‘adjustment-based’ care. Recalcitrant conditions are NOT made responsive via ‘chiropractic’ even though chiropractic promulgates getting to the “cause”. ‘Strained’ backs invariably heal (and better without care in my experience). So who is the ideal DC patient requiring 6.8 sessions? The strained back that goes away in 2 weeks with no intervention or the recalcitrant back that is unresponsive to a 100 ‘treatments’?
Those unwilling to adopt viable lifestyle measures will become addicted to DC and PT ‘nonsense care’ and accept 20mins of relief as their ‘lot in life’. It is contrary to a DCs economic interest to tell the public the truth.
@Michael Kenny
Big fan of Stu McGill, Craig Leibenson and Gray Cook. Use their work every day, been to their seminars and read their books and research. Tx should always be about transitioning the patient to active care ASAP not creating a toxic dependency in the patient and practitioner. Acute back pain, as you say, will resolve in 80% of patients. The 20% that become chronic is what I focus on. Most patients I see have had chronic pain for years and have been through the mill. Education, advice, exercises, rehabilitation and empowering the patient is important. Chiropractic is not a single technique.
I get the chirochondriacs and physiochondriacs and I start with what they have been told then shift the conversation and educate. Demedicalizing and decatastrophising patients so they don’t think that they are broken, damaged and out of place takes up a lot of my time.
So you are in fact validating that ‘Chiropractic is bullshit’. Nothing you just described could possibly be described as ‘chiropractic’. You have simply been give liberality in scope-of-practice to adopt potentially efficacious treatment procedures and concepts developed by non-DCs. They are certainly NOT chiropractic….irrespective of whether I know what IS taught in their institutions (knowledge that would be unlikely to affect any scientists’ opinion of the profession).
As stated in many blogs here and elsewhere, the DC degree is superfluous and likely a confounder in expanding real back-care solutions. The ‘care’ you describe is probably much better dispensed by those who developed the concepts and do not intend to intermix them with invalid and desultory concepts of ‘alignment, nerve-conduction and metaphysics (absolutely replete in at least 75% of DC practices….not 15%).
I find it highly unlikely thoughtful spokesmen (and women) for science-based treatment approaches would have such animus for the profession if only 15% were involved in skeevy practices and the vast majority practice as you claim to.
IF a bio/psycho/social, multi-factorial treatment approach is beneficial to many recalcitrant patients (who are vastly susceptible to pseudoscienctific mumbo-jumbo) and a DC is a highly viable member of that team….what prey tell will they actually DO?….that isn’t being done by a better trained, science-based clinician already?
McGill certainly doesn’t suggest a DCs as a DC can ever get to the essence of back pain. So why persist in defending the indefensible excepting at a financial remuneration level….?
@MK
You are making so many assumptions.
So a few questions?
Are you aware of who the other two people are who I cited along with Stu McGill above? All three of them have presented together and I have been to their seminars.
Do you think that chiropractic is a technique/single approach and nothing more?
Do you know who developed the concepts, procedures and guidelines adopted by chiro’s, physio’s, pain medicine specialists etc who follow the evidence?
Are you aware of the seismic shifts currently taking place within “real back care solutions”?
Are you aware of the hammering “real back solutions” have taken in the literature lately? By chiro and physio researchers BTW.
Are you aware in the literature that that 15-18% that I quote matches vitalistic, fringe and anti-vaccination beliefs?
There is a close correlation. I have discussed this with Blue many times previously, not just in the comments section he quoted.
In talking about confounders are you aware of the literature discussing the medicalization and catastrophization of pain?
I spend a large part of my time de-medicalizing and de-catastrophising patients.
In talking about the BPS model are you aware of the ongoing debate as to whether its bPS, BpS, Bps etc?
Are you aware of the recent statements from several medical associations in regards to chiropractic for chronic back pain?
Are you aware of the work being done by chiropractic researchers?
Your statements like:
“They are certainly NOT chiropractic”.
“Nothing you just described could possibly be described as ‘chiropractic”.
Would say otherwise.
Your next statement here:
“what prey tell will they actually DO?….that isn’t being done by a better trained, science-based clinician already?”
Are you aware of their training?
What are the current front line treatment/first teir approaches for chronic back pain and what are those practitioners level of training when it comes to backs?
I suggest you read the literature.
“So why persist in defending the indefensible excepting at a financial remuneration level”
Are you saying that following best practice, clinical guidelines, patient focused care is indefensible?
If you then say that any evidence utilized by chiro’s has been swiped from physio’s then forgive me if I have a good laugh. I have communicated extensively with leaders in the physio profession and they are as frustrated with the dinosaurs within their own profession as we are with ours. Remarkably similar problems with similar resistance to reform from their fringe elements. As one physio once said to me “unite the professionals, not the professions”.
Blue Wode cited Rubicon and their meeting with the ECU. Gerry Clum has stated that “we don’t care about the rest but we will not budge on certain key issues”. There was no common ground and the ECU did not push them on subluxation, vaccination and practice guidelines. They should have but this is round one. The BS merchants should be forced to reform or call themselves “spinologists” and depart. The time for appeasement is long past. The ECU tried to look for common ground while Rubicon just dictated and probably took the key issues off the table right at the outset. Reform though is inevitable as national guidelines and third party payers cut the ground out from under Rubicon. Rubicon think that they can dictate/stymie the pace of reform but reform happens at the university, research and national board levels. The third party payers are also dictating what they will cover and if you are not guideline compliant then you will not be paid. This is now happening in Australia where the health insurance companies and auditing practitioners.
The answer to your questions is yes, I am aware of and studied in all of what you (inappropriately) suggest has some bearing on being a DC. (And I would fathom a guess so is Dr. Ernst and the numerous Chiro-detractors on this and other sites….)
You appear to be saying that which IS and has always been “Chiropractic” is no longer it’s descriptor and now (excepting that dubious 15% you quote) being a Chiropractor is simply practicing PT without the appropriate license. If as you say you practice deep within EBG i.e. no ‘leg check’, muscle-challenge, X-ray line drawing, AS/PI, motion palpation, thermography, bilateral scales, skin-tension, spine-springiness etc etc etc….no drop tables, no Activtor no upper-cervical, no Logan basic, no flexion-distraction and no ‘flying-seven’ diversified “adjustments”….then congratulations. The problem is how are you NOT a PT without the appropriate license?
IF you had been well-versed in McGill and Cook and innumerable other non-DCs PRIOR TO enrolling in a chiropractic school I doubt you would have…..What would have been the point of that?? A $150,000 useless, non-transferable ‘degree’ that has no inherent respect in 90% of the world especially that of substantial physical medicine to which you seem aligned(?)
So I respect your paradigm shift and trying to make lemonade out of bullshit, but your arguments are inherently illogical and you consistently side-step the obvious and apparent problem. As Harriet Hall has pointed out: adding apple pie to cow pie is a disservice to both.
“So I respect your paradigm shift and trying to make lemonade out of bullshit, but your arguments are inherently illogical and you consistently side-step the obvious and apparent problem. As Harriet Hall has pointed out: adding apple pie to cow pie is a disservice to both.” Lovely!
Critical_chiro appears regularly on this blog, forever trying to impress readers that he is a reasonable, even rational force in bringing chiropractic into mainstream medicine. Today he has made an interesting proposition: “The BS merchants should be forced to reform or call themselves “spinologists” and depart. No, no, C_C!! It’s you reformed folk who need to call yourselves ‘spinologists’ and depart from the fold. That’s surely inherent in the nature of reform?!! Compare “expecting to call skeptical christians ‘humanists’ and depart from the fold”. Oh, heck, that’s what they’ve actually done! Humanists don’t expect Christians to rechristen (sorry!) themselves!
Maybe you should abandon the drivelling title of ‘chiropractor’ and call yourself something new (as I and many others have suggested to you for several years). How about physiotherapist? (Though ‘spinologist’ sounds good too.)
MK, you appear to think, but supply no references, that the “shake, bake and fake” of modern physiotherapy/physical therapy is the panacea of all things neuro-musculo-skeletal. I suggest you delve into the research and writings of physiotherapists to see that they has a severe crisis within the profession, as science is showing that little of their core methods actually work, e.g. exercises, TENS, Ultra-sound, core stability etc. They have been trying to copy chiropractors for decades (i.e. weekend courses in manipulation) as well as taking up acupuncture/dry needling.
http://www.health.harvard.edu/blog/heres-something-completely-different-for-low-back-pain-2017070611962?utm_campaign=shareaholic&utm_medium=facebook&utm_source=socialnetwork
No other health care profession in the world has been subject to the intense scrutiny as has the chiropractic profession. It still looks better than anything else out there.
How many physiotherapists does it take to change a light bulb?
None, because physiotherapists cannot change anything.
Tu Quoque remains a well worn approach for most, if not all Chiro-apologists. That PT has not cracked the nut of MSK doesn’t change the realities that the inherent nature of medicine (and PT) is to limit dogma and limit purely financial ‘strategies’. Chiropractic has had 100+ years to get its head out of its ass…..but it can’t and continues to decry science and logic.
Chiropractic, as much as the so-called reformers wish to suggest otherwise, simply is NOT a comprehensively critical rational-based system of health care. Their threads to a religious and non-sense primordial base persist….and in fact persist because IF the subluxation/vitalistic concept were once and for all put-down, the profession is rendered moot.
That it sometimes renders temporary pain cessation in a small percent doesn’t dismiss the terrible burden to which that relief comes.
Robin McKenzie PT pointed out perhaps 70% or more of treatments (both PT and DC) are generally worthless….however he was a PT, innumerable PTs took heed and none of them appear to have sought his excommunication. Trying to ‘reform’ (or simply give reasonable criticism to a DC or the profession) is tantamount to sacrilege….which is to be expected since it is a religion not a science.
The answer to GibleyGibley’s last question is not “none” – but “infinity”.
@ GibleyGibley
The link you provided seems to be an apologist piece for The American College of Physicians’ new guidelines for the treatment of low back pain. If you scroll up the comments section here you’ll see a comment which you appear to have overlooked:
http://edzardernst.com/2017/07/chiropractors-are-bullshit-a-rebuttal-of-a-rebuttal/#comment-93054
Snippet:
“It is the usual pseudo-medical analysis, a hodgepodge of weak studies show marginal aka placebo effect.”
Continues here:
https://sciencebasedmedicine.org/afterword-chiropractic-and-the-new-york-times-is-the-newspaper-trying-to-prove-trump-right/
GibleyGibley wrote: “MK… I suggest you delve into the research and writings of physiotherapists to see that they has a severe crisis within the profession, as science is showing that little of their core methods actually work, e.g. exercises, TENS, Ultra-sound, core stability etc.”
That might be so, but, in the UK, physiotherapists are still a far better bet than chiropractors as most patients are referred to them via their GPs. Further, fixed salaries and scarce NHS funds demand that UK physiotherapists discharge their patients following adequate improvements. Chiropractors, on the other hand, usually work in private practice and depend on as many patient visits as possible to ensure a good livelihood. There are also the new UK NICE guidelines to consider which…
QUOTE:
…are something of a problem for osteopaths and chiropractors as their treatments are no longer first line choices and they are not well placed to offer a suitable [group] exercise programme. Some of them may opt to continue treating patients the way the always have and not take the NICE guidelines into account. However, that is a potentially risky strategy for two reasons:
1. It doesn’t seem to be in the best interest of their patients
2. They risk being found in breach of their “Practice Standards” which could result in formal complaints to either the GOsC or GCC.
Ref: https://complementaryandalternative.wordpress.com/2016/12/06/nice-guidelines-for-low-back-pain-and-sciatica-a-clarification/
On top of that, physiotherapists, in general, appear to use spinal manipulation far more judiciously and carefully than chiropractors:
https://web.archive [DOT] org/web/20070225062100/http://www.ptjournal.org/cgi/content/full/79/1/50#F1
GibleyGibley wrote: “They [physiotherapists] have been trying to copy chiropractors for decades (i.e. weekend courses in manipulation) as well as taking up acupuncture/dry needling.”
According to three chiropractic academics, a weekend is all that is required to learn to perform spinal manipulations/adjustments competently. Scroll to the end here:
http://web.archive [DOT] org/web/20041215180456/www.familychiropractic.co.uk/news/Articles/article3.htm
With regard to acupuncture, I understand that the membership of the UK Acupuncture Association of Chartered Physiotherapists is 6,000+ strong. As there are around 49,000 registered physiotherapists in the UK, that would mean that approximately 12 % practice acupuncture (which, of course, is 12% too many). However, according to the latest data on the scope of chiropractic practices in the UK, traditional chiropractic beliefs (chiropractic philosophy) were deemed important by 76% of the respondents, and 63% considered subluxation to be central to chiropractic intervention:
http://www.ebm-first.com/chiropractic/uk-chiropractic-issues/1188-the-scope-of-chiropractic-practice-a-survey-of-chiropractors-in-the-uk.html
@ GibleyGibley
Do you have any better data?
Ooooh ooooh, do my rebuttals next! This one got over 35k reads: https://medium.com/@chirobabe/the-science-babe-is-neither-scientist-nor-babe-shes-bullshit-89eba206cd9
And this one is at 10k. Enjoy! https://medium.com/@chirobabe/a-chiropractor-does-research-haters-gon-hate-be87bed59c88
Chirobabe:
Just curious, given your prolific verbiage FOR Chiropractic, if you might give us some insight as to WHAT Chiropractic IS, and perhaps WHAT a typical Chiropractic-patient-encounter may entail?
Let me prime the pump…
Perhaps it starts with several minutes of Rhetoric regarding the “big idea” and that Thomas Edison once said: “look well to the spine for the cause of dis-ease”? Or “as the twig is bent so grows the tree”…”and I bet your kids have mis-alignments since they run in families”…and “your immune function is dependent on proper nerve transmission” and “Chiropractic is proven effective AND without side-effects”….yada, yada, yada.
Then perhaps a few minutes of one of several (utterly spurious, but) impressive-to-the-gullible “motion-palpation” tests to determine (indeterminable) mis-alignments, ‘fixations/altered segmental motion’? (“Findings” only taught in Chiropractic college and inaccessible to those drug pushing MDs and their PT lackeys).
Then on to the Leg-length discrepancy checks with arcane “challenges” i.e. Activator nut-science….revealing a PI/AS or SI joint being “stuck”? And whether Atlas has slipped out left or right and needs a good Toggle?
Perhaps some fraudulent AK muscle-imbalance checks to reveal nerve-interference or “verity” what your spurious motion-palpation revealed??
Or to validate what orthotic, pillow and supplements (you coincidentally stock in-office) are necessary to help “support your adjustment”.
IF covered by insurance, a few x-rays can give iron-clad proof of “mis-alignment” and “degeneration”…
(always a consequence of the ubiquitous yet indeterminate “mis-alignments”) and an indication for the need of elongated care. And then check to see if that neck-curve is “off”…that could require many more months of extra-care.
How about some “muscle-texture” assessment and a check of that pesky Psoas….”to verify” those muscles are “tight” and need to be “released”….necessitating extra visits as well??
Then when the specious, pseudoscientific theatrical assessments are completed do you start-a’-whackin’ with drop-tables, Activators, Pro-adjusters, Arthro-stims, percussive-massagers, distraction-tables, Gonstead and Diversified “rolls, breaks” and chair-“adjustments”….? And dig into those tight muscles and “release” them?
All the while directing the gullible customer as to “what” is happening, how adept and well-trained you are and how important this care really is?? And how you can tell you got a “really good set” with that adjustment?
And validating all you did with motion-palpation and leg-length RE-checks?
And then say: “Voila’ YOU are now Chiropractically realigned AND free of deadly nerve-interference”!!
Neither Shakespeare nor L. Ron Hubbard could do any better!
And if NOT these things (and perhaps a bunch of other lesser known entrepreneurial-theatrics) WHAT prey-tell DO you do? And WHAT prey tell do you tell your customers? And WHAT prey tell IS Chiropractic IF not these thoroughly I’ll-conceived and dis-proven, entrepreneurial theatrics?
After painfully reading through enough lines filled with very mediocre attempts to defend Chiropractic, without actually making anything even remotely resembling a case for it, only one thing caught my attention enough to merit a comment:
Naturally, I wondered what kind of a document would provide a definition as vague as this. I had to take a look at the referenced guidelines around chiropractic. Coincidentally, the first thought that came to my mind is precisely the second part of the title of Dr. Ernst’s next post. However, they must cover their asses, just in case, so in the aforementioned definition of subluxation (p. 4), there is a related note at the end of the page:
Yes, that is perfectly right, and one of the very few things in this document that doesn’t make it look like an echo chamber. Subluxation is NOT what is stated in there. It is what chiropractors believe it is. I think we have found another fair example of proper regulation of nonsense there.
Because I find it hard to digest, allow me to reiterate the given definition as cited before:
Am I the only one who thinks this definition of subluxation is just a more complicated and fancy rewording of the phrase: “any patient complaint of pain or stiffness”? Really, I read it multiple times and tried very hard to find some meaning in it. A lesion in a joint, which alters alignment no less, cannot leave contact between joint surfaces intact. Did they confuse the meaning of the word “alignment” in their attempt to modernize the term?
James wrote: “Am I the only one who thinks this [WHO] definition of subluxation is just a more complicated and fancy rewording of the phrase: “any patient complaint of pain or stiffness”? Really, I read it multiple times and tried very hard to find some meaning in it. A lesion in a joint, which alters alignment no less, cannot leave contact between joint surfaces intact. Did they confuse the meaning of the word “alignment” in their attempt to modernize the term?”
@ James
It looks like the confusion is deliberate. The World Health Organisation (WHO) Guidelines on Chiropractic were developed at a Consultation on Chiropractic which took place in Milan, Italy, on 2-4 December 2004. If you read the resulting guidelines from page 29 onwards, you will see that of the 27 listed participants, 18 appear to be professionally involved with either chiropractic or Complementary and Alternative Medicine (CAM):
http://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf
Interestingly, on page 5, under the heading ‘Philosophy and basic theories of chiropractic’ (Section 1.2) it is stated: “A majority of practitioners within the profession *would maintain* that the philosophy of chiropractic includes, but is not limited to, holism, vitalism, naturalism…Significant neurophysiological consequences may occur as a result of mechanical spinal functional disturbances, described by chiropractors as subluxation and the Vertebral Subluxation Complex”
However, the WHO is not as chiro-friendly as chiropractors would like to believe. See here: https://skepticbarista.wordpress.com/2010/10/24/subluxations-who-said-what/
QUOTE
“The WHO don’t just limit their chiropractic subluxation comments to this document. A 2003 WHO bulletin on Lower Back Pain (something very dear to chiropractors) mentions chiropractic and the reasons people turn to it:
“People with low back pain often turn to medical consultations and drug therapies, but they also use a variety of alternative approaches. Regardless of the treatment, most cases of acute back pain improve. At the time, people in such cases may credit the improvement to the interventions some of which clearly are more popular and even seemingly more effective than others (e.g. chiropractic and other manipulative treatments in which the laying on of hands and the person-to-person interaction during the treatment may account for some of the salutary results).” “
And:
“The spread of chiropractic and other manipulative treatments worldwide has won many adherents to this treatment, who perceive that it works better than others. This hypothesis was recently put to the test (25) and, although the respondents still favoured such approaches (chiropractic adjustment, osteopathic manipulation, and physical therapy) perhaps because of the time spent and the laying on of hands meta-analysis cannot confirm the superiority of manipulative treatments (or, for that matter, of acupuncture and massage (26)) over other forms of therapy, or even time as a healer (25), which substantiates the contentions of WHO’s document (1). In most instances, manipulative treatments are more expensive than others (apart from surgery) and not more helpful to outcome (26).
All of this hardly constitutes a glowing commendation from the WHO on chiropractic as an effective treatment option.”
Yes, I noticed the glorious paragraphs about the philosophy and the fact that many of the participants have quite a fair degree of conflicts of interest on the subject… I took a fair look and really couldn’t see how this document could be used as evidence of the effectiveness of chiropractic. Chiropractors would probably not think so, though….
I know of 3 people who got permenently harmed from chyropractors all spinal injury and the doctors who refured them are the ones who got charged with Mal practice. All three of them lost their vision to some degree l, one is completely blind and has a perminant cage to hold their spine so she cant walk any langht of time and has to worry about brain fluids building up so she has a perminant straw in her skull so it drains, has constant nerve pain due to the cage she was on a high dose of fentinal daily (enough to kill two people) which just got banned here so they cut her off cold turkey. The next girl is also completely blind, she also has a brain straw due to the constant brain fluid build up.she has fluid build up him her legs and is also in pain when she walks. The third has sone vision and can see outlines of people and can see some tv when a foot away. She’s stated to the gills in drugs and she can barely move her muscles from the hips down they speraticly twitch when shes in certian positions she was taking physio therapy so she may be able to walk again but she didn’t get any better so the Dr’s gave upon trying. In all these cases the chyropractors got away scott free because it was fluid build up around the spine that was causing the pain. So the chyropractors forced on the water balloon tying to shift it and the fluid forced the spine and the nerves to break or sever so the chyroprators pointed at the doctors and said it was the “Dr’s diagnosing the patients wrong, that they should have caught that the fluid build up was causeing the pain.” while the chyropractors got away with litterally breaking people’s spines. And these are all girls I’ve met in person it makes me shudder to think how many victims there are with similar cases. These are just the ones I happened to run into and talk with. And on the other side of it my family talks chyropractors up and down as the best thing for their backs do to the point where my brother in law had back problems and he sees them 3 times a month and his 6 year old daughter began to complain about back problems, I see it for what it is she session her dad get out of having to do things by saying his back hurts as an excuse, so she’s began using it the same so my sister went past the Dr’s and started setting up chyropractors appointments for her daughter and my niece has been seeing them for years now and she’s admitted that her back has started to hurt worse but has felt much better after the chyropractor. Growing pains maybe but I think it’s doing damage slowly over time she does dance and so does her sister her sister is fine but she can’t do certain moves in dance due to back pain. So almost half my family praises chyropractors up and down an perpetuates the “safe practice”