MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

The Telegraph published an article entitled ‘Crack or quack: what is the truth about chiropractic treatment?’ and is motivated by the story of Mr Lawler, the 80-year-old former bank manager who died after a chiropractic therapy. Here are 10 short quotes from this article which, in the context of this blog and the previous discussions on the Lawler case, are worthy further comment:

1. … [chiropractic] was established in the late 19th century by D.D. Palmer, an American magnetic healer.
“A lot of people don’t realise it’s a form of alternative medicine with some pretty strange beliefs at heart,” says Michael Marshall, project director at the ‘anti-quack’ charity the Good Thinking Society. “Palmer came to believe he was able to cure deafness through the spine, by adjusting it. The theory behind chiropractic is that all disease and ill health is caused by blockages in the flow of energy through the spine, and by adjusting the spine with these grotesque popping sounds, you can remove blockages, allowing the innate energy to flow freely.” Marshall says this doesn’t really chime with much of what we know about human biology…“There is no reason to believe there’s any possible benefit from twisting vertebra. There is no connection between the spine and conditions such as deafness and measles.”…

Michael Marshall is right, chiropractic was built on sand by Palmer who was little more than a charlatan. The problem with this fact is that today’s chiros have utterly failed to leave Palmer’s heritage behind.

2. According to the British Chiropractic Association (BCA), the industry body, “chiropractors are well placed to deliver high quality evidence-based care for back and neck pain.” …

They would say so, wouldn’t they? The BCA has a long history of problems with knowing what high quality evidence-based care is.

3. But it [chiropractic] isn’t always harmless – as with almost any medical treatment, there are possible side effects. The NHS lists these as aches and pains, stiffness, and tiredness; and then mentions the “risk of more serious problems, such as stroke”….

Considering that 50% of patients suffer adverse effects after chiropractic spinal manipulations, this seems somewhat of an understatement.

4. According to one systematic review, spinal manipulation, “particularly when performed on the upper body, is frequently associated with mild to moderate adverse effects. It can also result in serious complications such as vertebral artery dissection followed by stroke.” …

Arterial dissection followed by a stroke probably is the most frequent serious complication. But there are many other risks, as the tragic case of Mr Lawler demonstrates. He had his neck broken by the chiropractor which resulted in paraplegia and death.

5. “There have been virtually hundreds of published cases where neck manipulations have led to vascular accidents, stroke and sometimes death,” says Prof Ernst. “As there is no monitoring system, this is merely the tip of a much bigger iceberg. According to our own UK survey, under-reporting is close to 100 per cent.” …

The call for an effective monitoring system has been loud and clear since many years. It is nothing short of a scandal that chiros have managed to resist it against the best interest of their patients and society at large.

6. Chiropractors are regulated by the General Chiropractic Council (GCC). Marshall says the Good Thinking Society has looked into claims made on chiropractors’ websites, and found that 82 per cent are not compliant with advertising law, for example by saying they can treat colic or by using the misleading term ‘doctor’…

Yes, and that is yet another scandal. It shows how serious chiropractors are about the ‘evidence-based care’ mentioned above.

7. According to GCC guidelines, “if you use the courtesy title ‘doctor’ you must make it clear within the text of any information you put into the public domain that you are not a registered medical practitioner but that you are a ‘Doctor of Chiropractic’.”…

True, and the fact that many chiropractors continue to ignore this demand presenting themselves as doctors and thus misleading the public is the third scandal, in my view.

8. A spokesperson for the BCA said “Chiropractic is a registered primary healthcare profession and a safe form of treatment. In the UK, chiropractors are regulated by law and required to adhere to strict codes of practice, in exactly the same ways as dentists and doctors. Chiropractors are trained to diagnose, treat, manage and prevent disorders of the musculoskeletal system, specialising in neck and back pain.”…

Chiropractors also like to confuse the public by claiming they are primary care physicians. If we understand this term as describing a clinician who is a ‘specialist in Family Medicine, Internal Medicine or Paediatrics who provides definitive care to the undifferentiated patient at the point of first contact, and takes continuing responsibility for providing the patient’s comprehensive care’, we realise that chiropractors fail to fulfil these criteria. The fact that they nevertheless try to mislead the public by calling themselves ‘primary healthcare professionals’ and ‘doctors’ is yet another scandal, in my opinion.

9. The spokesperson said, “medication, routine imaging and invasive surgeries are all commonly used to manage low back pain, despite limited evidence that these methods are effective treatments. Therefore, ensuring there are other options available for patients is paramount.”…

Here the spokesperson misrepresents mainstream medicine to make chiropractic look good. He should know that imaging is used also by chiros for diagnosing back problems (but not for managing them). And he must know that surgery is never used for the type of non-specific back pain that chiros tend to treat. Finally, he should know that exercise is a cheap, safe and effective therapy which is the main conventional option to treat and prevent back pain.

10. According to the European Chiropractors’ Union, “serious harm from chiropractic treatment is extremely rare.”

How do they know, if there is no system to capture cases of adverse effects?

_________________________________________________________

So, what needs to be done? How can we make progress? I think the following five steps would be a good start in the interest of public health:

  1.  Establish an effective monitoring system for adverse effects that is accessible to the public.
  2. Make sure all chiros are sufficiently well trained to know about the contra-indications of spinal manipulation, including those that apply to elderly patients and infants.
  3. Change the GCC from a body defending chiros and their interests to one regulating, controlling and, if necessary, reprimanding chiros.
  4. Make written informed consent compulsory for neck manipulations, and make sure it contains the information that neck manipulations can result in serious harm and are of doubtful efficacy.
  5. Prevent chiros from making therapeutic claims that are not based on sound evidence.

If these measures had been in place, Mr Lawler might still be alive today.

 

67 Responses to The death of Mr Lawler highlights the scandals of chiropractic

  • “Make written informed consent compulsory for neck manipulations, and make sure it contains the information that neck manipulations can result in serious harm and are of doubtful efficacy”

    I will agree with this 5 minutes after you will make a written consent for giving NSAID’s , Opiates, steroids, voltaren injections, traction procedures by physio and more. If you want to bring down the risk level for written consent bellow 1% by all means BUT THIS HOLDS FOR EVERYONE NOT JUST YOUR POLITICAL TARGETS

    • tractions are obsolete
      NASIDs, opiates, voltaren are given with the proviso not to be used for prolonged periods – doctors who do not insist on this proviso should be reprimanded.
      none of the drugs have a risk of death or stroke etc. when used just once. and all are routinely supplied with appropriate written warnings.

      • EE

        “none of the drugs have a risk of death or stroke etc. when used just once”

        really ? …. who does that ?

        MD’s refill the meds over and over. … no?

  • so you refuse to ask for written consent?

    opiates killed 64,000 people in the USA last year that is the official committees numbers not mine
    traction is not obsolete… tell that to hundreds of physio still doing so
    the risk for liver failure from NSAID’s and even paracetamol exists even after a single use
    and a written warning in 5 languages on a scrap of paper is not written consent.

    Written consent is not a political issue to mess with, it is to do with risk management. If you want to change risk management criteria go ahead but remember this goes all the way.

    • so you refuse to ask for written consent? NO; FOR TERM USE, I WOULD ASK IT; SHORT TERM IS NOT DANGEROUS

      traction is not obsolete… tell that to hundreds of physio still doing so IF I RAN A BLOG FRO PHYSIOS, I WOULD
      the risk for liver failure from NSAID’s and even paracetamol exists even after a single use. ANY EVIDENCE FOR THAT STATEMENT?
      and a written warning in 5 languages on a scrap of paper is not written consent. I DID NOT SAY IT WAS

  • Just came across this article about SCAM and colic.
    https://medicalxpress.com/news/2019-11-complementary-alternative-therapies-colic.html

    Apparently spinal manipulation can help treat colic. Let’s ignore the fact that colic is a self-limited thing. No blinding of studies. Parental self report… yeah. Color me not convinced.

  • Professor Ernst, Dr Almog,

    Make written informed consent compulsory for neck manipulations, and make sure it contains the information that neck manipulations can result in serious harm and are of doubtful efficacy

    I think you both may have misunderstood what consent forms are all about.

    The purpose of taking written informed consent is to protect the PRACTITIONER, not the client.

    In the case of a chiropractic treatment, consent occurs when the client lies down on the table in order to be treated. Should there be any subsequent dispute then it can help the practitioner’s defense if they can produce a signature on a form detailing details and risks of the proceedure as evidence that informed consent was given, but that is all it is, evidence.

    In the case of prescriptions for NSAIDs, opiates and other prescription drugs, there is an information sheet provided when the prescription is dispensed, with details of what the drug is, now to take it, what the risks are and how frequently these occur, potential interactions with other drugs and important side-effects to watch out for together with instructions on how to act on them. I don’t know whether pharmacists keep a record of whether this information is included for each individual prescription but it would not surprise me if it were.

    For steroids, which are dangerous drugs where suddenly stopping or reducing the dose can be hazardous, and where there can be major implications, for instance in the case of unexpected illness or injury, the patient is also issued with a blue card detailing their specific treatment regimen and with instructions to produce it whenever they see a new doctor.

    Generally speaking, health care providers require a signed consent form in situations where they feel that it will reduce the risk of finding themselves on the wrong end of a lawsuit.

    Within the NHS there are standard forms to be signed even in situations where it is impossible to obtain informed consent (e.g. where an adult is incompetent to give consent, perhaps because they are unconscious or cognitively impaired, since nobody else can legally give consent on their behalf). These are to record any discussion that has taken place with relatives, and for the practitioner to record their reasons for making the decision to treat somebody without consent (exposing themselves to the risk of a criminal assault charge in the process).

    • “The purpose of taking written informed consent is to protect the PRACTITIONER, not the client.”
      this might be one or even its main purpose, but it is not the only one.
      informed consent is based on the moral and legal premise of patient autonomy; it therefore also protects the patient giving him/her the right to make decisions about their own health and treatments.

    • Superby put, Dr J M-K, thanks for the clarification.

      I guess the real issue is there is no data-sheet equivalent for chiropractic giving an independent summary of possible adverse effects as there is with real medicine (procedures and drugs). And I’m betting that subject is not something that would be brought up during a chiro session. When I had a relatively minor surgical procedure recently I was sat down by the consultant beforehand and given chapter and verse on different possible techniques, the consequences of treating conservatively, the consequences – desirable and undesirable – of surgery and so on, until I was able to make as fully informed a decision as was possible.

      I wonder if this 80 y.o. gentleman had such a conversation with his chiro prior to his manipulation?

      Niall

  • Interesting that EE didn’t call out this error.

    “5. “There have been virtually hundreds of published cases where neck manipulations have led to vascular accidents,…”

  • @ DC

    Before that, what about chiropractors in the U.S. setting up adverse event monitoring systems to which the public and practitioners can report harms? At present, there are none due to a loophole:
    https://www.ebm-first.com/chiropractic/risks/1842-letter-from-britt-harwe-president-chiropractic-stroke-awareness-group-csag.html

    In the UK, the only system is unreliable:
    https://www.ebm-first.com/chiropractic/uk-chiropractic-issues/1888-british-chiropractic-association-members-attitudes-towards-the-chiropractic-reporting-and-learning-system-a-qualitative-study.html

    Also, what about chiropractors and their regulators coming clean about the chiropractic bait and switch (scope of practice issues):
    https://sciencebasedmedicine.org/the-bait-and-switch-of-unscientific-medicine/

    It seems to me that chiropractors stay in business by misleading the public:
    https://edzardernst.com/2019/11/we-hope-that-the-publicity-surrounding-this-event-will-highlight-the-dangers-of-chiropractic-a-statement-of-the-family-of-the-man-who-died-after-treatment-of-a-vertebral-subluxation-complex/

    Sort that out before you even think of developing other professional relationships.

  • @ DC

    Evidently you are hung up on definitions, particularly the meaning of ‘led to’ (which I addressed in a comment above via linking to a Thesaurus). We will therefore have to agree to differ on interpretation.

    However, you still cannot escape these valid points in relation to the topic of Prof. Ernst’s blog post:
    https://edzardernst.com/2019/11/the-death-of-mr-lawler-highlights-the-scandals-of-chiropractic/#comment-118417

    These were highlighted in response to your taking exception to Prof. Ernst’s comments relating to item 5 of the Telegraph article: https://edzardernst.com/2019/11/the-death-of-mr-lawler-highlights-the-scandals-of-chiropractic/#comment-118362

    • I have no comments on the Lawler case as I have not seen all the information.

      Regardless, one would think that Ernst, who spent most of his career looking into CAM, would know the difference between “led to” and “associated with”. Maybe not.

  • Meanwhile in New Zealand, whilst Prof. Ernst and his followers e.g. B.W., Bjorn and the Franks are furiously doing a “pot calling the kettle black” act, there is a fourth death due to changing an epilepsy drug,
    https://www.rnz.co.nz/news/in-depth/403391/fourth-death-linked-to-pharmac-s-epilepsy-medication-switch

    One fifth of this years Otago University medical students final year students have been found to be cheating and it is apparently endemic in the university and staff have known about it for years. The students will get a slap on the wrist with a wet bus ticket.
    https://www.newshub.co.nz/home/new-zealand/2019/11/one-in-five-otago-med-students-have-qualifications-withheld-after-rort-exposed.html

    The death of a patient under any form of care is tragic. This is a tragedy.

    As I said before, Prof. Ernst you are nothing more than a pot calling the kettle black.

    • Thanks for sharing the link

      Collateral damage is all part of scoring profits…. don’t forget that, it won’t change anytime soon.
      A few deaths along the way are expected in SBM. The problem is there are far more than many are aware.

      They hold the license to kill.

    • GibleyGibley,

      there is a fourth death due to changing an epilepsy drug

      You are very quick to draw conclusions with very limited information.

      What we do (probably) know:
      There are 11,000 people in NZ taking lamotrigine for epilepsy.
      As a result of a national decision they are having to change their brand of lamotrigine.
      According to the newspaper article you linked to, the number who have had to change brands is in excess of 8,000
      Four of these have subsequently died.
      In the case of the young man in the article, his death was preceded by an apparent increase in the frequency of his seizures (though it is difficult to know whether this apparent increase really represented a change, since there is a random element in their frequency and random numbers tend to cluster, and also in many epileptics having one seizure makes the next more likely).

      What has been suggested:
      That the new preparation of lamotrigine has different pharmacokinetic properties than the previous one(s), affecting blood levels and therefore seizure control.
      I would imagine that this is fairly easy to test as pharmacokinetic data are available for every licensed drug, and I would expect that the blood levels of lamotrigine would have been routinely measured at the post-mortem examinations of the four individuals concerned, and could be compared with the levels in their medical records taken for monitoring.

      What we don’t know:
      Whether there has been any change in seizure pattern in the other patients who have had to switch, and if so whether or not this is within what would be expected from random variation. If the data could be collected this would be straightforward to determine using standard statistical tests.

      Whether these four deaths deviate significantly from what would be expected over that period of time in 11,000 patients with epilepsy. Note that epilepsy greatly increases the risk of death, and that every year slightly more than 1 in 1,000 epileptics die in the UK from SUDEP (sudden unexplained death in epilepsy); I see no reason why the figure should be different in NZ, though a lot of year-to-year variation can be expected as the population is much smaller.

      These deaths have raised an alert and I would expect that there will be a full investigation which will answer these questions in due course. In the meantime it is unhelpful to treat speculation as fact, and it also shows a fundamental misunderstanding of how numbers behave. I can see that it might sell newspapers, but it should not form the basis of treatment protocols.

      It would not surprise me if the outcome is that the deaths will be found not to have been due to the change in brand, but nevertheless there will be political pressure to switch back to the more expensive preparation, so reducing funds available to other areas of healthcare.

      If there is an important difference between the various brands of lamotrigine, then there remains the possibility that there are people whose epilepsy control is better as a result of the switch and that there are also deaths which have been prevented by it. However, that is something which is very difficult to test.

      Finally, I don’t see that deaths from epilepsy have any bearing on the question of safety or otherwise of chiropractic neck manipulation. Isn’t that rather like saying that standards for automobile safety ishould be based on cancer statistics?

    • @ GibleyGibley on Tuesday 19 November 2019 at 18:44

      Yes, we understand all of that, Kiwi charlatan chiro. The difference is that drugs such as those actually do something about illness with a real attempt at a cure or reducing symptoms to make life liveable, unlike chiro which is useless for anything, premised on witchcraft invented by a convicted crook.

      What the second paragraph has to do with anything is a mystery? What is the point? Unlike chiro where nonsense is taught, medicine deals with reality. Some students cheated and have been punished. Happens everywhere, including the socialist utopia.

    • GibleyGibley,

      One fifth of this years Otago University medical students final year students have been found to be cheating

      Even assuming that Newshub is an accurate source of information, that isn’t quite what the article you linked to was saying. Basically they took a few weeks off from an unstructured part of their course (elective placements) and then lied about it. When the University authorities found out they took a dim view of it and showed no inclination to treat them leniently, not least because this was not the behaviour expected of future health professionals.

      The students will get a slap on the wrist with a wet bus ticket.

      They were disqualified from graduating with the rest of their year, referred to a Fitness to Practice committee, required to repay part of their student grant and required to make up the time lost from their studies with either community service or research (more-or-less what is involved in elective placements but without the adventure of travelling to an exotic location). They also had to write a reflective essay on what they had done.

      Do you actually read your links?

  • You already used this childish trope before, Gibley.

    Professor Ernst’s blog is about so called alternative medicine, not about incidents involving quality control of the production of generic anti-epileptic drugs or an isolated incident having to do with a system and culture of higher education in New Zealand.

    You seem to like talking about the situation down under. Let’s have a look at some statistics from NZ, and compare the importance of chiropractic services down there to that of medicine.

    There are about one doctor per 327 inhabitants in NZ, if I am not mistaken. How many chiropractors? A source that seems reliable says they are just short of 400 in all of NZ, right? 162 in Auckland alone. That makes about one per 9.260 in the city. I guess that is where the money is because there are only about about one chiropractor per 12.000 inhabitatnts for the whole of NZ. Outside of Auckland the figure would then be about one per almost 14.000.
    What do these statistics tell us?
    To me this means chiropractic is a fringe service, not available to or used by most of the population of NZ. If chiropractic was so great and useful, one would have thought it was in a comparatively great demand, right?
    Most people never meet a chiro in their life. Most people with backache do not go to a chiropractor. A large part of the clientelle of chiropractors are regular returning customers, right? That makes my demand estimate even less compatible with the hypothesis that chiropractic is a necessary public service.
    Pleas feel free to try to prove me wrong.

    • I don’t know about NZ. Many factors to consider re utilization and the number of providers.

      The most recent Gallup poll in the USA found that of those who sought care for back or neck pain, 53% saw a chiropractor within the past year.

      https://news.gallup.com/poll/243302/medical-doctors-chiropractors-top-choices-spine-care.aspx

    • Meanwhile in the United Kingdom, as Frank and JM-K are trying to justify endemic cheating at Otago University Medical School, that the staff knew about and implicitly condoned and Bjorns efforts to divert the topic by ranting about chiropractic in New Zealand, the following has appeared in the news in the U.K.

      https://www.theguardian.com/society/2019/nov/19/leaked-report-exposes-nhs-worst-ever-maternity-scandal-shrewsbury-and-telford-hospital-trust?CMP=Share_iOSApp_Other

      “Pots calling the kettle black”.

      • do you ever get upset trying to buy a car at a carpet sore?

      • Frank and JM-K are trying to justify endemic cheating at Otago University Medical School,

        Are you capable of even parsing a sentence, let alone reading a paragraph and extracting the meaning from it?

        1. What the Otago students did was reprehensible, but it is misleading to call it cheating, which, in the context of an academic course is generally held to have a different meaning, namely attempting to inflate exam results or gain qualifications by subterfuge.

        2. Their behaviour was clearly wrong and not justifiable.

        3. You stated in your earlier comment that they would not be punished for their wrongdoing, and I pointed out that this was not the case. In fact their punishment included public disgrace, an immediate financial penalty, a disruption of any plans they may have had for the near future, and is likely to affect their prospects of future employment and career advancement, which seems proportionate given their behaviour. How is has my correction of your misstatement metamorphosed into a justification for their behaviour?

        4. Coming on to the Shropshire scandal, it is very important that cases such as this are brought to light and investigated so that care can be improved. The inquiry has yet to be completed but already we can see from a leaked interim report what harm results from chronic underfunding and bad management in public services. The mothers put their faith in their local maternity department and were badly let down with tragic consequences. All such cases where outcomes are worse than expected should be examined and fully investigated where appropriate so that lessons can be learned and practices can be changed. Or perhaps you don’t agree?

        5. Returning to the case of Mr Lawler, we have learnt from the Coroner’s report that he was conned into submitting to treatment to which he had not consented by a practitioner who pretended that she was a doctor, was seriously injured as a result of her incompetance and may still have survived his injuries if she had not then lied to the emergency services about what had happened.

        6. By drawing attention to other examples of wrongdoing you seem to be suggesting that this course of events is somehow acceptable. Is that really what you believe?

      • Whataboutery and straw men, Gibley.

        We’re discussing chiropractic.

        And again, as ever, the fact that airplanes occasionally crash does not validate a belief in magic carpets.

  • DC wrote: “The most recent Gallup poll in the USA found that of those who sought care for back or neck pain, 53% saw a chiropractor within the past year.”

    Bearing in mind that care was sought for back or neck *pain*, with regard to ‘Chiropractic Care’ this is an interesting finding:

    QUOTE
    “Participants in this study were also asked to describe what they thought were the benefits of chiropractic care. The top answers given were pain relief (22%), an alternative to medication/surgery/traditional medicine (16%), general alignment/maintenance/manipulation (15%), and overall/holistic/long-term wellness (8%). About one in five (19%) did not feel there were any benefits of chiropractic care.”

    Ref p.16 of the report: https://www.palmer.edu/uploadedFiles/Pages/Alumni/gallup/palmer-gallup-annual-report-2018.pdf

    • yes, that 81% thought there was at least some benefit to “chiropractic care”. This is a close percentage to other surveys on patient perception of benefit to “chiropractic care”.

      • DC wrote: “81% thought there was at least some benefit to chiropractic care.”

        They ‘thought’? With chiropractic spinal manipulative therapy looking increasingly like a placebo, it could very well be that those 81% are erroneous with their reasoning. For example,see:
        https://tinyurl.com/y3rbdqjm

        Ergo, the most recent Gallup poll in the USA that “found that of those who sought care for back or neck pain, 53% saw a chiropractor within the past year”, looks like it could be pretty meaningless.

        • Actual vs perceived benefit is a complex topic.

          What services were utilized is a complex topic.

          Appropriate care approaches to acute vs subacute vs chronic is a complex topic.

          Co-morbidities is a complex topic.

          Multidisciplinary approaches is a complex topic.

          Stating SMT is looks more like a placebo and utilization rates for care approaches as being pretty meaningless is just being simplistic, IMO.

        • A poll conducted by one chiropractic establishment in my city found that 97% of their clients were satisfied. They aparently found no problem with using this fantastic (literally) result in their marketing even if the participating population consisted only of returning customers 😀

      • @ DC on Wednesday 20 November 2019 at 14:38

        As with all chiros who post here, it isn’t long before the Logical Fallacies pour out. The Argument from Popularity is as meaningless as the basis for chiro. God’s energy flowing down the spine? hahahahahahahahaha

        • Frank. Try to follow along. Bjorn made the comment…

          “Most people never meet a chiro in their life. Most people with backache do not go to a chiropractor.”

          This may be true in NZ, idk. But it doesn’t appear to be true in the USA.

          • The USA is maybe the most chiropractor dense country in the world. Still there are only about one per 7.500 inhabitants, if memory serves me right, which is many times less than primary care practitioners for example. In the US, you cannot watch TV without seeing a commercial for chiropractic and there is a chiro-parlour in almost every shopping centre. No wonder this service is frequented, but still almost half the population do not seem to find the need for it, right?

          • @Bjorn

            Bjorn said;
            ” In the US, you cannot watch TV without seeing a commercial for chiropractic and there is a chiro-parlour in almost every shopping centre.”
            “Every shopping center”…. that may not be far from the truth.

            However, Bjorn said, “you can’t watch TV without seeing a commercial for Chiropractic” IS far from the truth. The truth is you can’t watch TV with seeing a commercial for “BiG PHARMA MEDS” … this is the truth.

          • One poll, can’t recall if Canada or US, found that 70% or so have been to a chiropractor.

    • Gibley is quite preoccupied with news she thinks reflect negatively on the intellectual honesty of medical students.
      I read somewhere that the requirements for entering chiropractic school are generally quite lean and that there are few drop-outs from such schools compared to medical education.
      It would be quite interesting to compare the threshold for entering chiropractic schooling versus medical school and know the percentage that gets to the finishing line of those who start?

      Perhaps Blue has some information on this?

      • @ Björn Geir

        I’m not sure about the drop-out rate for chiropractors v. MDs, although I recall being informed recently by a U.S. chiropractor that around half of all chiropractors who completed their degrees are still working as chiropractors.

        With regard to the requirements for entering chiropractic school (in the U.S), see from ‘F’ onwards here https://www.chirobase.org/05RB/AHCPR/03.html

        Also interesting is what former chiropractor, Preston Long, has to say on p.5 of his book, ‘Chiropractic Abuse’:

        QUOTE

        “Our education is vastly inferior to that of medical doctors.

        I rarely encountered sick patients in my school clinic. Most of my ‘patients’ were friends, students, and an occasional person who presented to the student clinic for inexpensive chiropractic care. Most had nothing really wrong with them. In order to graduate, chiropractic college students are required to treat a minimum number of people. To reach their number, some resort to paying people (including prostitutes) to visit them at the college’s clinic.*

        Students also encounter a very narrow range of conditions, most related to aches and pains. Real medical education involves contact with thousands of patients with a wide variety of problems, including many severe enough to require hospitalization. Most chiropractic students see patients during two clinical years in chiropractic college. Medical students also average two clinical years, but they see many more patients and nearly all medical doctors have an additional three to five years of specialty training before they enter practice.

        Chiropractic’s minimum educational standards are quite low. In 2007, chiropractic students were required to evaluate and manage only 15 patients in order to graduate. Chiropractic’s accreditation agency ordered this number to increase to 35 by the fall of 2011. However, only 10 of the 35 must be live patients (eight of whom are not students or their family members)! For the remaining cases, students are permitted to ‘assist, observe, or participate in live, paper-based, computer-based, distance learning, or other reasonable alternative’. ** In contrast, medical students see thousands of patients.”

        * Ref. Bernet J. Affidavit, April 12, 1996. Posted to Chirobase website
        https://www.chirobase.org/08Legal/bernet.html
        ** Ref. Standard for Doctor of Chiropractic Programs and Requirements for Institutional Status. Council on Chiropractic Education, Scottsdale, Arizona, Jan 2007

        By p.15 of his ‘Chiropractic Abuse’ book, Long has exposed rampant cheating in exams and frightening standards of teaching at the chiropractic college where he studied. One small example of what he was confronted with:

        QUOTE:

        “The head of the Biology Department used the word ‘pacific’ to refer to specific microorganisms.”

      • Bjorn: I don’t have the answers to those questions.

        IMO, the most important question is…do chiropractic colleges adequately prepare students for entry into clinical practice as it relates to their field?

        • IMO, the most important question is…do chiropractic colleges adequately prepare students for entry into clinical practice as it relates to their field?

          By what standards would you measure such preparedness?
          BW’s input above indicates that there is much to be wanted. I have no reason to doubt his information.
          Chiropractors regularly claim their education is on par with medical. I have to seriously doubt that.

      • It would be quite interesting to compare the threshold for entering chiropractic schooling versus medical school and know the percentage that gets to the finishing line of those who start

        And it is important to note that, while graduation from medical school is a milestone in a doctor’s education, there are still many years to go before they complete their training.

        • there are still many years to go before they complete their training

          Education and training really never ends for doctors. I am still learning 🙂

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