Two chiropractors conducted a retrospective review of publicly available data from the California Board of Chiropractic Examiners. Their aim was to determine categories of offense, experience, and gender of disciplined doctors of chiropractic (DC) in California and compare them with disciplined medical physicians in California.
Retrospective reviews of publicly available data from the California Board of Chiropractic Examiners.
The DC disciplinary categories, in descending order, were
- fraud (44%),
- sexual boundary issues (22%),
- other offences (13%),
- abuse of alcohol or drugs (10%),
- negligence or incompetence (6%),
- poor supervision (2%),
- mental impairment (.3%).
The authors concluded that the professions differ in the major reasons for disciplinary actions. Two thirds (67%) of the doctors of chiropractic were disciplined for fraud and sexual boundary issues, compared with 59% for negligence and substance misuse for medical physicians. Additional study in each profession may reveal methods to identify causes and possible intervention for those who are at high risk.
The two authors of this paper should be congratulated for their courage to publish such a review. These figures seem shocking. But I think that in reality some of them might be far higher. Take the important matter of competence, for instance. If you consider it competent that chiropractors treat conditions other than back pain, you might arrive at the above-mentioned figure of 6%. If you consider this as incompetent, as I do, the figure might be one order of magnitude higher (for more on unprofessional conduct by chiropractors see here).
The abstract of the paper does not provide comparisons to the data related to the medical profession. Here they are; relative to doctors, chiropractors are:
- 2x more likely to be involved in malpractice,
- 9x more likely to be practising fraud,
- 2x more likely to transgress sexual boundaries.
The frequency of fraud is particularly striking. Come to think of it, however, it is not all that amazing. I have said it before: chiropractic is in my view mostly about money.
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I would like to look at the full article but since its from 2004 its not available on my library links… please explain how do you determine:
Chiropractors are …
2x more likely to be involved in malpractice,
9x more likely to be practising fraud,
2x more likely to transgress sexual boundaries.
Link. https://www.researchgate.net/publication/8326290_Chiropractors_Disciplined_by_a_State_Chiropractic_Board_and_a_Comparison_with_Disciplined_Medical_Physicians
Of course for the rest there are several factors to consider. Ernst seems to ignore them.
Why would it not be reasonable to consider that a well trained chiropracter is competent to treat musculo-skeletal soft tissue disorders as well as back pain?
show me the evidence
i believe it was you who made these claims so it is you who should show the evidance…
please explain how do you determine:
Chiropractors are …
2x more likely to be involved in malpractice,
9x more likely to be practising fraud,
2x more likely to transgress sexual boundaries.
Re fraud…perhaps start with this.
” In this cross-sectional study assessing all physician exclusions from 2007 to 2017, the number of physician exclusions grew by 20% per year (equivalent to 48 additional exclusions per year) to encompass approximately 0.3% of US physicians in 2017.”
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2718092
From the paper…
“During the 52-month retrospective study, 216 California
chiropractors received formal disciplinary action from the
CBCE.” That is out of 11,095 chiropractors, and thats for all offenses. For fraud it was 96 offenses.
So show me how one gets 9x more likely. Thanks.
Show us the evidence that chiropractors are “9x more likely to be practising fraud,”
Fuzzy math?
Edzard- chiropracters often use similar techniques of ‘manipulation. and massage as osteopaths, orthopedics, physiotherapists and other practitioners of physical medicine. You may not like the type of evidence used to demonstrate efficacy since the whole subject is fraught with difficulties of experimentation where the many variables are difficult or impossible to control. There are many valuable textbooks on the subject, which of course you know, where much of the best evidence, clinical practice and relevant anatomy and physiology is recounted. I can provide a list if you really want it. I suspect you wish to jettison the baby with the bathwater until double blind trials are possible- which will be never! None of this is in any way a defense of the many malpractices of any of the practitioners
double-blind may be difficult; just show me a decent RCT
Edzard- there are thousands of references of massively varying quality and types in the many textbooks I will gladly list for you. You may peruse them at your leisure. What use is say one trial reference on one particular region of the human anatomy. It will demonstrate nothing with regards the value of whole gamut of treatments utilized in physical medicine of which chiropracters and other associated practitioners share. If you believe that none of the treatments are of value because a trial cannot be conducted that meets your criteria then so be it. It was known before Captain Lind’s explorations that certain plants or their juices could prevent or cure scurvy; it was known even before Jenner that scrapings from a cowpox pustule, transferred to humans had a preventive effect for smallpox. Many more examples of the value of certain treatments were known long before clinical trials. Naturally if this were the sole approach there would be severe restrictions on medical advancement. With physical therapy there is inevitable poor treatments along with those very beneficial. Even the results of a positive trial cannot guarantee that exactly those procedures will apply to another patient and different therapist. Until more strict protocols can be established for trials we are left with a very hit and miss area of medicine- but still I maintain of some value, often very great in relief of painful joints, for the right patient in the right hands.
just send me a few of the studies that you find convincing.
thanks
Edzard- none of my conviction about the potential benefits of the matters previously discussed rests with any RCT, to which I have briefly alluded to, mentioning some difficulties in performing such a trial. For instance imagine a trial of manipulative or other physical therapy treatment for acute lower back pain. The subjects would all have to have had comparable diagnosis of the cause and consequences of that pain: there are many possible causes of low back pain. For me it seems impossible to obtain at one trial enough patients with exactly the same cause of their back pain- assuming even that a correct diagnosis was possible. So as I originally suggested I could provide a few ( or many) titles of excellent textbooks on the subject that have impressed me over the years some of which are now listed below.
Physical Treatment by Movement, Manipulation and Massage by James Mennell, J&A Churchill, 1940
The Science and Art of Joint Manipulation vol1 (1949) vol2(1952) J&A Churchill
Textbook of Orthopaedic Medicine, James Cyriax, vol1, Diagnosis of Soft Tissue lesions, 8th edit. 1983
vol2,Treatmant by Manipulation, Massage and
Injection, 10th edit. 1980, Bailliere Tindall
Cyriax’s Illustrated Manual of Orthopedic Medicine, J H Cyriax and P J Cyriax, 2nd edit.,1993, Butterworth-Heinemann
Manual of Osteopathic Practice, Alan Stoddard, 2nd edit. 1983, Hutchinson Medical Publications
Manual of Osteopathic Technique, Alan Stoddard,3rd edit. 1980, HMP
Common Vertebral Joint Problems, Gregory Grieve,2nd edit. 1988, Churchill Livingstone
Grieve’s Modern Manual Therapy-The Vertebral Column, edited Boyling and Jull, 3rd edit., 2004, Churchill Livingstone
Grieve’s Modern Musculoskeletal Physiotherapy( 6 editors), 4th edit.,Elsevier
Manual Physical Therapy of the Spine, K Olsen, Saunders 2009
I could add many dozens more to the list but perusal of the above will provide sufficient information for an understanding of what I have proposed.
I will remind you of my original question; ‘why would it not be reasonable to consider that a well trained chiropracter is competent to treat muscul-skeletal soft tissue disorders as well as back pain’. I make no defense of their ‘subluxations’ or the many unscientific claims for a variety effects other than relief of pain and increased mobility and function of the synovial joints.
I hope this all helps.
“imagine a trial of manipulative or other physical therapy treatment for acute lower back pain. The subjects would all have to have had comparable diagnosis of the cause and consequences of that pain: there are many possible causes of low back pain. For me it seems impossible to obtain at one trial enough patients with exactly the same cause of their back pain- assuming even that a correct diagnosis was possible”
I see that you do not understand much of trial design
Edzard,
Here is a small list of authoritative books in the so-called SCAM (SCSCAM) modalities that you gleefully trash on your blog. I could provide hundreds if not thousands of titles of authoritative textbooks on these subjects, but I won’t. However, I will mention my favorite book from each of the lists that will make a great bedtime reading for you EE!
Energy healing: https://www.amazon.com/Best-Sellers-Books-Energy-Healing/zgbs/books/282880.
Absolute favorite of mine “Crystals for Beginners: The Guide to Get Started with the Healing Power of Crystals”. Here is an absolutely brilliant quote from this author sums it all up “Because crystals generally have higher vibrations than the human body, they tend to raise your vibration. Vibrating at a higher rate is helpful for humans because it allows us to advance spiritually and move in more positive directions mentally, physically, and emotionally.”
Homeopathy: https://bookauthority.org/books/best-homeopathy-books
Given the current pandemic, “Homeopathy for Epidemics “is my favorite here. What is not to like about this book? Like cures like is the guiding philosophy of homeopathy. Vaccines are made based on the same philosophy. A piece of RNA from the virus that causes the diseases is used to make the vaccine, in other words like cures like!! BOOM! That is the sound of every homeo-skeptics head exploding!!
Acupuncture: https://bookauthority.org/books/best-acupuncture-books
“Laser–Quantum Acupuncture and Therapy” one of my favorites because the words “Laser” and “Quantum” are in the book’s title! With the use of lasers and quantum, acupuncture leap-frogged into the future leaving western medicine in the dust. I cannot insert gifs in this post but imagine Road Runner leaving Wile E. Coyote in the dust.
Ayurveda: https://bookauthority.org/books/best-ayurveda-books
“Evolutionary Herbalism: Science, Spirituality, and Medicine from the Heart of Nature” This 520-page compendium of thousands of years of ayruvedic medicine is all you need to heal thy self. Allow me to quote from the text on the back page of this book “Evolutionary Herbalism provides a holistic context for how plants can be used for transformational levels of healing for the body, spirit, and soul”
Chiropracty – Dr. Sugarman already covered this in his post above.
Finally, if I may borrow a question that Dr. Sugarman posed to you (that you haven’t answered yet!) regarding Chiropracty and apply to all other SCSCAM modalities – Why would it not be reasonable to consider a person well trained in {insert your favorite SCSCAM modality here} is competent to treat {insert here the list of ailments that the SCSCAM modality is intended to treat}?
Honest-Ape- with respect, I have no affinity , in fact much antipathy to the subject matter of your text book listing. I do not equate the modern evidence and techniques of which I have written with that of your subjects.
Also I am no doctor( Dr). I was a secondary school science teacher for 37 years, having a degree in physiology and biochemistry ( long outdated).
It should not need saying but a textbook in itself is no evidence of therapeutic efficacy. Who is the author, what’s in the book? With regards chiropractic there is much in their philosophy that cannot withstand scientific, rational scrutiny, as is the case with osteopathy. Nevertheless I have seen some and read of more of these practitioners , many who have great acumen and delicious manipulative skills.
Mr. Sugarman,
After reading your earlier posts on chiropractic I thought you had a very strong grasp of the subject and automatically assumed you to be a doctor. I apologize for making such assumptions.
“I have no affinity, in fact much antipathy to the subject matter of your text book listing. I do not equate the modern evidence and techniques of which I have written with that of your subjects.”
Of course, I understand your point. You just haven’t read those textbooks yet. I have and I think the modalities I am referring to are based on good evidence.
“It should not need saying but a textbook in itself is no evidence of therapeutic efficacy. Who is the author, what’s in the book? “
“With regards chiropractic there is much in their philosophy that cannot withstand scientific, rational scrutiny, as is the case with osteopathy. Nevertheless I have seen some and read of more of these practitioners , many who have great acumen and delicious manipulative skills.”
Absolutely agree with you on your above statements, and I have read various textbooks on Homeopathy, energy healing and such and was blown away by techniques and expertise presented, much like how you were impressed by the skills of certain practitioners of chiropractic after reading about them. I think you will certainly agree with me if I were to say that the strongest evidence of a modality’s efficacy is presented in the textbooks pertaining to that modality, be it chiropractic, homeopathy, Ayurveda etc.
“With regards chiropractic there is much in their philosophy that cannot withstand scientific, rational scrutiny, as is the case with osteopathy.”
Of course, most modalities come from an unscientific past. If we keep waiting for scientific evidence to emerge out of studies, we will be waiting forever. Instead, we should start using them and evidence will automatically come out of that usage. I don’t know much about chiropractic and osteopathy but it seems like they were initially based on hocus-pocus (like other alt-med modalities) and according to you, now there are excellent textbooks summarizing the scientific evidence of the said modalities. Moreover, like you said in one of the earlier posts, RCT methodology isn’t fit to evaluate chiropractic techniques and that is so true for other alt-med modalities as well. One of my favorite modality is distance healing (DH) and in this review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4654780/ the authors concluded that high quality experiments based on conventional RCT protocols are not suited for studying DH because those studies have not consistently shown that the DH works. They call for new protocols be designed to evaluate DH because it happens to be a popular modality and that the authors believe it works. In other words, one should throw away the yard sticks they are using because they are not getting accurate results that they believe should be and design new yard sticks tailor made for each modality, that would prove to the skeptics that these treatments are efficacious.
Honest-Ape- I appreciate your efforts in responding to my earlier comments but I must say we are poles apart in so many directions. Your concepts of what constitutes evidence for a particular modality does not coincide with mine. I have read a great deal over the years about homeopathy, acupuncture and many more alternative therapies, also so-called paranormal phenomena and much more. I hope I have enough critical ability to form a reasonable opinion about many of these matters. I am mainly guided by science where it is at all possible to utilize it and I am afraid that no matter what textbook is proposed the contents will have to meet certain criteria which I do not think your subject matter does.
I was not impressed initially about manipulation techniques by reading. It was an evolving process taking some time to experience the concepts in very skilled hands. The strongest evidence of a modality’s efficacy is not necessarily in any textbook- so we disagree. Wherever possible I am guided by scientific evidence in whatever format it presents itself. There are many problems associated with ‘proximity’ healing and I have no doubt that ‘distance’ healing has no validity EXCEPT when a person knows you are say praying for them ( to get better) there may well be a transient placebo effect, and that’s it. I have much confidence in the Laws of physics and chemistry and how these may apply to living matter (biology). Our belief systems do not coincide.
Edzard-‘I see you do not understand much of trial design’ is true BUT I wager that you are in the same boat when it comes to a design of a trial for LBP treatment: not only you but many other therapists. There are too many variables in the treatment relationship that would allow genuine , valid criticism of any design. If I have to pick one book of the several listed elsewhere I choose Gregory Grieve’s ‘Common Vertebral Joint Problems’. Get it, read it, think about it and with sufficient luck you may come to realize that your warranted prejudices against many unconventional ‘medical’ treatments should not be of the same strength when it comes to judging the physical therapy of some spinal problems as described in the book.
https://www.amazon.co.uk/Understanding-Research-Complementary-Alternative-Medicine/dp/1903348099/ref=sr_1_14?dchild=1&keywords=edzard+ernst&qid=1626273324&s=books&sr=1-14
Decent: of an acceptable standard (Cambridge)
What is the acceptable standard of research in Medicine for treating nsLBP?
Based on what level of evidence? This? Is this the standard?
“Considerable uncertainty exists about the clinical efficacy and safety of muscle relaxants. Very low and low certainty evidence shows that non-benzodiazepine antispasmodics might provide small but not clinically important reductions in pain intensity at or before two weeks and might increase the risk of an adverse event in acute low back pain, respectively.”
https://www.bmj.com/content/374/bmj.n1446?fbclid=IwAR12hAEkxLXG0IJK0LOcmEytj9F7SbYWT4v6XDYS3KZEdgB9_0J2_RYEjZk
EE: I see that you do not understand much of trial design
Perhaps it’s Ernst who doesnt understand how to research back pain.
“The identification of patient subgroups that respond best to specific interventions has been set as a key priority in LBP research for the past 2 decades.2,7 In parallel, surveys of clinicians managing LBP show that there are strong views against generic treatment and an expectation that treatment should be individualized to the patient.6,22.”
Journal of Orthopaedic & Sports Physical Therapy
Published Online:January 31, 2017Volume47Issue2Pages44-48
Edzard- thank you for the reference to your book on ‘Understanding Research…..’. I will of course read it and I am sure it will enlighten me on many of the problems associated with such research. I thought my example of a problem was valid. Before I read your book do you disagree with my example?
I have just published a new post about these issues
Mr. Sugarman,
Thank you for your response. With due respect, I don’t think you have provided enough evidence to make a convincing argument that chiropractic is based on scientific evidence and other alt-med modalities are not. I haven’t read any books on chiropractic but I did read many books on other modalities and I think they presented a good amount of sound scientific evidence and I am convinced of their efficacy, just like you are with chiropractic.
“I am afraid that no matter what textbook is proposed the contents will have to meet certain criteria which I do not think your subject matter does”
Please expand on the criteria that you are talking about here and provide some concrete examples on how chiropractic meets those criteria and others don’t.
“The strongest evidence of a modality’s efficacy is not necessarily in any textbook- so we disagree”
I see, so how would one go about evaluating a modality’s efficacy? Perhaps a scientific study or two? Can you cite some studies w.r.t chiropractic that happened to convince you of its efficacy? I see that Dr. Earnst already asked you the same and you responded with a list of textbooks and if I may quote you:
“You may not like the type of evidence used to demonstrate efficacy since the whole subject is fraught with difficulties of experimentation where the many variables are difficult or impossible to control. There are many valuable textbooks on the subject, which of course you know, where much of the best evidence, clinical practice and relevant anatomy and physiology is recounted. I can provide a list if you really want it.”
The above statement from you certainly holds true for other alt-med modalities as well.
“Wherever possible I am guided by scientific evidence in whatever format it presents itself”
This is such a broad statement that it can be applicable to any and all modalities. In other words, one can drive a truck full of SCAM modalities to legitimacy using this argument. You just chose to use that argument to support your favorite SCAM.
“Our belief systems do not coincide.”
I do agree that what you and I subscribe to are indeed belief systems, but I don’t think that they are that different 😉
Honest-Ape- you will not find anywhere that I have proposed that chiropractic per se is based on scientific evidence, although along with other similar approaches of physical medicine I do suggest there is much science involved: for example anatomy, physiology, some pathology, kinesiology and more. Your view of ‘sound scientific evidence’ may differ ( does differ) from scientists. And who is the best judge?-the practitioners of the science themselves. I will not seriously attempt to dissuade you of your convictions. Don’t bang on about chiropractic though since very often their hypotheses ( theories perhaps) do not coincide with accepted sciences of physiology, pathology and more. And that is a criticism from many quarters, long held.
Dr Earnst did not ask the question you write of. Many of the newer texts, even those more than 30 years old have an abundance of scientific evidence, although not the RCT Edzard seems to think could provide some definitive answers.
Scientific evidence is the best we have regards understanding the world and how it works. Use of this knowledge is part of the discipline we might consider as critical thinking and I know from what you write that our understandings of this concept is in fact very far apart.
Ah…ok, you are walking away from chiropractic to avoid answering the questions I posed in my last post. If you think chiropractic is not based on sound scientific evidence, then your original question (quoted below) that started this whole thread is moot. Thanks for wasting everyone’s time Mr. Sugarman! Goodbye!
“Why would it not be reasonable to consider that a well trained chiropracter is competent to treat musculo-skeletal soft tissue disorders as well as back pain?”
Since you choose to ignore these valid questions please allow me to assist…
If you don’t know how many DC’s are registered with this bord,
And you don’t know how many complaints were made,
And over what period of time,
And you don’t know how many complaints were found justified.
Then you know NOTHING.
Even the 67% vs. 59% for fraud and sexual misconducts means only that within the justified complaints more fell within this category (in percentages not true numbers and not even statistically validated) among DC’s than MD’s.
That means you can have 5 justified complaints against DC’s and 5000 against MD’s and this percentage will still hold…
I do hope these are genuine mistakes you will apologies for.
Don’t expect Ernst to defend his percentage claims. It appears to be based on fuzzy math.
https://www.cbsnews.com/news/james-heaps-judge-oks-73-million-payout-6000-women-allegedly-sexually-abused-former-ucla-gynecologist/?fbclid=IwAR3IuME2_fuoRKjDo6UnKNhFn-4TB9Y1qzjF3J9zOJB1uDjgxPkY-Z2ct2k
This puts it into perspective, though.
You say professor that chiropractors are “2x more likely to transgress sexual boundaries”.
If I read table 4 correctly the rate of disciplinary action for sexual offense is about 4.4 times higher among chiropractors than physicians. 1.01/1000 vs. 0.23/1000 respectively. That is twice the ratio you quote iin your summary. I am too sleepy now to dive into the paper again at more depth, but perhaps we are not looking at the same figures in this paper?
Together with the other worrying results of this surprisingly upright paper, whether the rate of misconduct of sexual nature is twice or four times as high as that among doctors, it is still grave cause for concern. No wonder the authors discuss the problems at length and contemplate serious measures to counteract such multitude of misbehavior among their colleagues.
Regarding the remarkably revealing reactions of the congregation of concerned chiropractic champions above, I find the other ratio’s in your list of rates to be quite accurately extracted. This makes one wonder if proof of knowledge in basic mathematics is not a requirement for admission to chiropractic schools?