chiropractic
‘Chiropractic Economics‘ focuses on “bridging the gap between what doctors of chiropractic learn about healthcare and what they need to know as entrepreneurs who command successful, thriving practices. We are the top-rated resource for chiropractic news, marketing, consulting, financial planning, attracting and retaining patients, and motivating and managing employees. We provide information for practicing chiropractors, with a focus on office management, patient relations, personal development, financial planning, legal, clinical and research data, and wellness and nutrition.”
The magazine recently published an article that is so wonderfully overflowing with BS that I cannot resist showing you a few hilarious excerpts from it:
HOMEOPATHY IS A NATURAL FOR CHIROPRACTORS — because it works with innate intelligence. Each tiny pellet of a homeopathic remedy is like a flash drive full of information that “reinstalls the software,” i.e., it reminds the body that “you know how to have a healthy nervous system” or strong and healthy bones or muscles.
A remedy for patient malady
Homeopathic remedies have much to offer your patients:
- Fast-acting: Some patients will actually feel the effects as soon as they ingest the remedy; it works faster than herbs or vitamins
- Easily available in health food stores, some drug stores and online
- Inexpensive: pennies per dose
- No rebound or withdrawal: Your patient can discontinue it without symptoms recurring
- No drug interactions: It can work well alongside meds and supplements
- Safe: Reactions are rare and serious side effects are unknown.1
Practitioners will benefit as well from recommending homeopathy as this unusual modality will set the chiropractor apart and patients will be grateful for the relief they feel. Homeopathy is available as single remedies, plus more unusual ones are also blended into combination formulas which chiropractors may choose to stock in their office, just as they stock nutritional supplement and glandular formulas.
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How does it work?
Homeopathy is totally safe because there is nothing in it — not even one molecule of its original starting substance — yet it is powerful and fast-acting. How can we make these contradictory claims? Because it is information technology.
The manufacturing process imprints the healing information onto water like recording onto a flash drive. The process takes the starting substance through many stages of dilution (making it safe) and potentizes or energizes it at each step (making it powerful). Water behaves differently at these very high dilutions, becoming coherent or structured, as explained by the newly emerging field of ultra-high dilution physics. Two Nobel laureates have testified that their studies explain how homeopathy works.2
Now let’s look at some specific remedies.
Hypericum for the nervous system
Hypericum is almost a universal remedy for nerve-related symptoms: tingling and numbness, pain shooting along a nerve, and trauma to nerve-rich areas (like hitting a finger with a hammer or slamming it in a car door):
- Arnica for soft tissue trauma: homeopathy’s best-known remedy, Arnica is good for sore muscles, pulled muscles, sports injuries, sprains and strains, and bruising.
- Symphytum for fractures: This is the well-known herbal remedy comfrey, known traditionally as “knit-bone,” used to speed the healing of fractures and reduce bone pain.
- Bryonia for joints that hurt to move. When your patient is splinting or guarding, think bryonia, for a bruised rib that makes it painful to laugh or cough or sneeze, or knees that hurt from walking that make the patient take cautious steps.
- Rhus tox for “rusty gate” joints: This is for your patient who needs to limber up when first getting out of bed, or who needs to swing their leg a few times to loosen it up before getting up from a chair.
- Ruta grav. for connective tissue, cartilage and joints in general: sprains and strains, cracking joints, torn tendons and ligaments, and fascia. It has a special affinity for the knee, like the knee that goes out from under someone and for Baker’s cysts.
Three homeopathically-energized minerals to strengthen and heal bone need to be given in a special 6x potency and are known as cell salts or tissue salts:
- Calcarea fluorica (Calc. fluor.) 6x to soften and dissolve: This remedy can help dissolve bone spurs and hardened or condensed tissues like cataracts.
- Calcarea phosphorica (Calc. phos.) 6x to deposit minerals in the bones: This provides the template to send calcium and other minerals to bones and not deposit them elsewhere in the body.
- Silicea 6x strengthens bone as well as hair, skin and nails; you know silica as a supplement, and as a homeopathic remedy it provides the instructions for silica the mineral to go where it is needed. However, Silica 30c (full strength) can push foreign objects out of the body and should not be given to patients with a rod or plate and screws.
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What could possibly go wrong?
Not much — an “overdose” in homeopathy is not harmful in the long run — in fact, too much of a remedy is pushing the patient too fast in the direction of cure and the long-term result can be positive. It can be uncomfortable in the short run, though.
The body can only process so much of the remedy’s information at once, and if the body is presented with more than it can handle, it pushes back in the form of increased symptoms, the same symptoms the remedy was intended to treat. This is called an “aggravation” in homeopathy. It’s often said that “You have to get worse before you get better” in homeopathy and this is absolutely not true as long as mild to moderate doses are used (the typical 30c dose in health food stores) and the patient is told to stop if the remedy starts to feel too intense. When in doubt, it’s always safe to stop the remedy and start again later.
The bottom line
Start by recommending these few remedies and you are likely to get good feedback from your patients. Or consider stocking combination remedies that include even more unusual remedies.
They may give even better results and keep patients coming back to you for more, since they are only available through professionals. And if you’re feeling exhausted beyond repair, try some Sepia for yourself.
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Yes, this is what a ‘top rated’ chiropractic resource mistakes for information on ‘clinical and research data, and wellness and nutrition’!
I didn’t promise too much, did I?
The case of a 91-year old male patient developing acute neuropathic pain along the sciatic nerve distribution following spinal manipulation has been reported. Manipulative treatment with an Activator Adjusting Instrument (AAI) had been performed. During this treatment, three applications of the AAI were administered. The applications were bilateral (1) over the sacroiliac joint, (2) gluteal area, and (3) paraspinal region just above the iliac crest.
Within 24 hours, the patient developed severe 10/10 pain originating from the left gluteal area at the site of one of the activator deployments with radiation all the way down his left leg to the foot. He was able to maintain distal left leg strength and sensation. Subsequently, the patient developed insomnia, confusion, and adrenal gland dysfunction in response to changes in steroids, gabapentin, and other drugs, thus highlighting some nuances of managing elderly patients with back pain.
Relief was achieved with subsequent physical therapy techniques aimed at relaxing the patient’s deep gluteal muscles, raising the hypothesis of temporary injury to the deep gluteal muscles, with painful contractions resulting in gluteal region pain as well as sciatic nerve inflammation as the nerve passed through that region.
The authors concluded that this clinical case illustrates some of the perils and risks of spinal manipulation, particularly in the elderly, and the need for careful patient selection.
The authors of this (stranely incomplete) case report discuss whether any manipulation was truly necessary or indicated as part of his initial chiropractic treatment plan. They state that, given that complications associated with similar practices are not often reported in the literature, this case highlights important considerations to be made in the elderly given the potential impact of transient/permanent neuropathic pain in that population subset.
Somehow, I doubt that we can be certain that the patient improved due to the physical therapy and not due to the drugs he received. Moreover, I question the authors’ repeated assertions that such adverse effects of chiropractic spinal manipulation are truly rare. Here is a section from our own 2002 systematic review of the subject:
A systematic review of five prospective investigations of the risks of spinal manipulation concluded that mild-to moderate transient adverse reactions occur in approximately half of patients who undergo spinal manipulation. The largest of these studies involved 1058 patients who received a total of 4712 treatments from 102 chiropractors in Norway. At least one adverse reaction was reported by 55% (n 580) of patients. About one quarter (n 1174) of treatments resulted in at least one adverse reaction. The most common reaction reported was local discomfort. Eighty-five percent (n 824) of reactions were described as “mild or moderate” and 1% (n 14) as “unbearable.” Seventy-four percent (n 1052) of reactions disappeared within 24 hours. No serious, permanent complications of spinal manipulation were reported, but follow-up was not described. These results were confirmed by a similar study in Sweden with 625 patients and a smaller one (68 patients) from the United Kingdom …
Non-life-threatening adverse effects after spinal manipulations are not rare – they are merely rarely reported!
Manual therapy is considered a safe and less painful method and has been increasingly used to alleviate chronic neck pain. However, there is controversy about the effectiveness of manipulation therapy on chronic neck pain. Therefore, this systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to determine the effectiveness of manipulative therapy for chronic neck pain.
A search of the literature was conducted on seven databases (PubMed, Cochrane Center Register of Controlled Trials, Embase, Medline, CNKI, WanFang, and SinoMed) from the establishment of the databases to May 2022. The review included RCTs on chronic neck pain managed with manipulative therapy compared with sham, exercise, and other physical therapies. The retrieved records were independently reviewed by two researchers. Further, the methodological quality was evaluated using the PEDro scale. All statistical analyses were performed using RevMan V.5.3 software. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment was used to evaluate the quality of the study results.
Seventeen RCTs, including 1190 participants, were included in this meta-analysis. Manipulative therapy showed better results regarding pain intensity and neck disability than the control group. Manipulative therapy was shown to relieve pain intensity (SMD = -0.83; 95% confidence interval [CI] = [-1.04 to -0.62]; p < 0.0001) and neck disability (MD = -3.65; 95% CI = [-5.67 to – 1.62]; p = 0.004). However, the studies had high heterogeneity, which could be explained by the type and control interventions. In addition, there were no significant differences in adverse events between the intervention and the control groups.
The authors concluded that manipulative therapy reduces the degree of chronic neck pain and neck disabilities.
Only a few days ago, we discussed another systematic review that drew quite a different conclusion: there was very low certainty evidence supporting cervical SMT as an intervention to reduce pain and improve disability in people with neck pain.
How can this be?
Systematic reviews are supposed to generate reliable evidence!
How can we explain the contradiction?
There are several differences between the two papers:
- One was published in a SCAM journal and the other one in a mainstream medical journal.
- One was authored by Chinese researchers, the other one by an international team.
- One included 17, the other one 23 RCTs.
- One assessed ‘manual/manipulative therapies’, the other one spinal manipulation/mobilization.
The most profound difference is that the review by the Chinese authors is mostly on Chimese massage [tuina], while the other paper is on chiropractic or osteopathic spinal manipulation/mobilization. A look at the Chinese authors’ affiliation is revealing:
- Department of Tuina and Spinal Diseases Research, The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, China.
- Department of Tuina and Spinal Diseases Research, The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, China; Department of Tuina, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China. Electronic address: [email protected].
- Department of Tuina and Spinal Diseases Research, The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, China; Department of Tuina, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China. Electronic address: [email protected].
What lesson can we learn from this confusion?
Perhaps that Tuina is effective for neck pain?
No!
What the abstract does not tell us is that the Tuina studies are of such poor quality that the conclusions drawn by the Chinese authors are not justified.
What we do learn – yet again – is that
- Chinese papers need to be taken with a large pintch of salt. In the present case, the searches underpinning the review and the evaluations of the included primary studies were clearly poorly conducted.
- Rubbish journals publish rubbish papers. How could the reviewers and the editors have missed the many flaws of this paper? The answer seems to be that they did not care. SCAM journals tend to publish any nonsense as long as the conclusion is positive.
This systematic review with meta-analysis of randomized clinical trials (RCTs) estimated the benefits and harms of cervical spinal manipulative therapy (SMT) for treating neck pain. The authors searched the MEDLINE, Cochrane CENTRAL, EMBASE, CINAHL, PEDro, Chiropractic Literature Index bibliographic databases, and grey literature sources, up to June 6, 2022.
RCTs evaluating SMT compared to guideline-recommended and non-recommended interventions, sham SMT, and no intervention for adults with neck pain were eligible. Pre-specified outcomes included pain, range of motion, disability, health-related quality of life.
A total of 28 RCTs could be included. There was very low to low certainty evidence that SMT was more effective than recommended interventions for improving pain at short-term (standardized mean difference [SMD] 0.66; confidence interval [CI] 0.35 to 0.97) and long-term (SMD 0.73; CI 0.31 to 1.16), and for reducing disability at short-term (SMD 0.95; CI 0.48 to 1.42) and long-term (SMD 0.65; CI 0.23 to 1.06). Only transient side effects were found (e.g., muscle soreness).
The authors concluded that there was very low certainty evidence supporting cervical SMT as an intervention to reduce pain and improve disability in people with neck pain.
Harms cannot be adequately investigated on the basis of RCT data. Firstly, because much larger sample sizes would be required for this purpose. Secondly, RCTs of spinal manipulation very often omit reporting adverse effects (as discussed repeatedly on this bolg). If we extend our searches beyond RCTs, we find many cases of serious harm caused by neck manipulations (also as discussed repeatedly on this bolg). Therefore, the conclusion of this review should be corrected:
Low certainty evidence exists supporting cervical SMT as an intervention to reduce pain and improve disability in people with neck pain. The evidence of harm is, however, substantial. It follows that the risk/benefit ratio is not positive. Cervical SMT should therefore be discouraged.
This systematic review and meta-analysis assessed the effectiveness of visceral osteopathy in improving pain intensity, disability and physical function in patients with low-back pain (LBP).
MEDLINE (Pubmed), PEDro, SCOPUS, Cochrane Library and Web of Science databases were searched from inception to February 2022. PICO search strategy was used to identify randomized clinical trials applying visceral techniques in patients with LBP. Eligible studies and data extraction were conducted independently by two reviewers. Quality of the studies was assessed with the Physiotherapy Evidence Database scale, and the risk of bias with Cochrane Collaboration tool. Meta-analyses were conducted using random effects models according to heterogeneity assessed with I2 coefficient. Data on outcomes of interest were extracted by a researcher using RevMan 5.4 software.
Five studies were included in the systematic review involving 268 patients with LBP. The methodological quality of the included ranged from high to low and the risk of bias was high. Visceral osteopathy techniques have shown no improvements in pain intensity (Standardized mean difference (SMD) = -0.53; 95% CI; -1.09, 0.03; I2: 78%), disability (SMD = -0.08; 95% CI; -0.44, 0.27; I2: 0%) and physical function (SMD = -0.26; 95% CI; -0.62, 0.10; I2: 0%) in patients with LBP.
The authors concluded that this systematic review and meta-analysis showed a lack of high-quality studies showing the effectiveness of visceral osteopathy in pain, disability, and physical function in patients with LBP.
Visceral osteopathy (or visceral manipulation) is an expansion of the general principles of osteopathy and involves the manual manipulation by a therapist of internal organs, blood vessels and nerves (the viscera) from outside the body.
Visceral osteopathy was developed by Jean-Piere Barral, a registered Osteopath and Physical Therapist who serves as Director (and faculty) of the Department of Osteopathic Manipulation in Paris, France. He stated that through his clinical work with thousands of patients, he created this modality based on organ-specific fascial mobilization. And through work in a dissection lab, he was able to experiment with visceral manipulation techniques and see the internal effects of the manipulations.[1] According to its proponents, visceral manipulation is based on the specific placement of soft manual forces looking to encourage the normal mobility, tone and motion of the viscera and their connective tissues. These gentle manipulations may potentially improve the functioning of individual organs, the systems the organs function within, and the structural integrity of the entire body.[2] Visceral osteopathy comprises of several different manual techniques firstly for diagnosing a health problem and secondly for treating it.
Several studies have assessed the diagnostic reliability of the techniques involved. The totality of this evidence fails to show that they are sufficiently reliable to be od practical use.[3] Other studies have tested whether the therapeutic techniques used in visceral osteopathy are effective in curing disease or alleviating symptoms. The totality of this evidence fails to show that visceral osteopathy works for any condition.[4]
The treatment itself seems to be safe, yet the risks of visceral osteopathy are nevertheless considerable: if a patient suffers from symptoms related to her inner organs, the therapist is likely to misdiagnose them and subsequently mistreat them. If the symptoms are due to a serious disease, this would amount to medical neglect and could, in extreme cases, cost the patient’s life.
My bottom line: if you see visceral osteopathy being employed anywhere, turn araound and seek proper healthcare whatever your illness might be.
References
[1] https://www.barralinstitute.com/about/jean-pierre-barral.php .
[2] http://www.barralinstitute.co.uk/ .
[3] Guillaud A, Darbois N, Monvoisin R, Pinsault N (2018) Reliability of diagnosis and clinical efficacy of visceral osteopathy: a systematic review. BMC Complement Altern Med 18:65
The World Federation of Chiropractic (WFC) has recently launched a new Global Patient Safety (GPS) initiative:
Unanimously approved by the WFC Board at its May meeting, the project will be overseen by the Research Committee and involve the establishment of an expert task force. Planned projects will include a scoping review, identification of best practices in incident reporting and learning, risk management in chiropractic practice and knowledge translation activities.
In recent years, patient safety has increasingly been in the spotlight as health systems strive to reduce unnecessary incidents and iatrogenic injury.
“With adverse events having the potential to impact trust and confidence in the chiropractic profession, it is important that we do as much as possible to inform ourselves in relation to the risks and benefits of chiropractic treatments and related activities,” said Prof. Richard Brown DC, LL.M, WFC Secretary- General.
“While we know that serious adverse events are rare, patients with multiple co-morbidities and known risk factors require special attention. The WFC GPS Task Force will highlight key areas of patient safety to support chiropractors, build and strengthen the existing safety culture and help to meet the expectations of patients and the public.”
Chiropractors use a package of interventions in their treatment of patients, including hands-on care, adjunct therapies, health promotion, advice and exercise prescription. The process of shared decision-making involves consideration by the chiropractor of the suitability and safety of each intervention. In addition to direct patient care, chiropractors also have a duty to consider the safety of their offices and clinics.
A WHO resolution on patient safety, passed in 2019 at the World Health Assembly, made a commitment to take global action in tackling avoidable harm.
Its subsequent publication, Global Action on Patient Safety, set out goals and targets to reduce morbidity from healthcare related incidents.
Chair of the Task Force and Research Committee vice-chair, Dr Katie Pohlman DC, PhD, said: “With the current global focus on patient safety, I’m proud to be leading this WFC Task Force, which will support the chiropractic profession but, most importantly, work to minimize adverse events and protect patients.
“The creation of an open, transparent culture of patient safety is key to maintaining trust and credibility. The Task Force is looking forward to adding to the body of knowledge and advancing safe, evidence-based, people-centered practice.”
The WFC GPS Task Force will report to Research Committee Chair, Assoc. Prof Sidney Rubinstein. It will include members of the existing Research Committee as well as external experts.
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At first, most people will think: WHAT A GOOD IDEA!
After a bit of reflection, however, some might ponder: WHY ONLY NOW AND NOT DECADES AGO?
And after reading the above text carefully, skeptics might feel that the exercise can already be classified as a PR gimmick that will not generate the needed information:
- The WFC has yet again failed to establish a monitoring system of adverse effects; without it ‘patient safety’ is not achievable.
- They claim that “we know that serious adverse events are rare”. How do they know this? And if they already are convinced of this, the new task force is bound to be a pure ‘white wash’.
- They think an “existing safety culture” exists in chiropractic. This is wishful thinking and far from reality.
- They speak of the “expectations of patients and the public” but ignore the need for a monitoring system accessible to the public.
The website of the World Federation of Chiropractic (WFC) points out that public health is defined by the WHO as follows:
“Activities to strengthen public health capacities and service aim to provide conditions under which people can maintain to be healthy, improve their health and wellbeing, or prevent the deterioration of their health. Public health focuses on the entire spectrum of health and wellbeing, not only the eradication of particular diseases.”
The WFC then continues stating this:
As primary contact health professionals, chiropractors can play an important role as public health advocates. This can range from providing support and advice on health matters such as physical activity, diet, and fitness as well as lifestyle choices such as injury prevention and avoiding tobacco use. Chiropractors can also play a role in counselling patients and communities on the benefits of public health measures, especially as this relates to immediate health needs of each region.
I think that this might merit a few comments.
- Physical activity is undoubtedly an important issue for public health; however, there are clearly healthcare professionals who are in a better-informed position to advise on it than chiropractors.
- Diet is undoubtedly an important issue for public health; however, there are clearly healthcare professionals who are in a better-informed position to advise on it than chiropractors.
- Fitness is undoubtedly an important issue for public health; however, there are clearly healthcare professionals who are in a better-informed position to advise on it than chiropractors.
- Lifestyle choice is undoubtedly an important issue for public health; however, there are clearly healthcare professionals who are in a better-informed position to advise on it than chiropractors.
- Injury prevention is undoubtedly an important issue for public health; however, there are clearly healthcare professionals who are in a better-informed position to advise on it than chiropractors.
- Avoiding tobacco use is undoubtedly an important issue for public health; however, there are clearly healthcare professionals who are in a better-informed position to advise on it than chiropractors.
- Counseling is undoubtedly an important issue for public health; however, there are clearly healthcare professionals who are in a better-informed position to advise on it than chiropractors.
So, what is the real contribution of chiropractors to public health?
- Chiropractors tend to advise their clients against vaccinations.
- Some mislead the public by claiming they boost immunity and prevent serious infections.
- Many undermine evidence-based medicine by promoting obsolete myths such as ‘the innate’ or subluxations.
- Many sell supplements that could interact with prescription drugs.
- Many make bogus health claims for profit.
I would therefore argue that, on balance, the contribution of chiropractors to public health might be considerable …
sadly, however, it goes in the wrong direction.
In a video, Mr.Darkmoore speaks from a hospital bed and says the cause behind his visit to the emergency room stemmed from a chiropractor’s work on him. Three days ago, he had a ringing in his ear due to a long-term condition he knew as tinnitus. Thus, he decided to visit a chiropractor. “I figured $100 to a chiro, let them adjust a few things, if all else fails, I’ll go to a doctor,” explains Darkmoore.
This $100 visit led to several other complications and doctor’s bills worth thousands of dollars. The day after he was treated by the chiropractor, he experienced a headache that eventually led to dizzy spells. He decided to visit the emergency room where a CT scan was ordered which showed that the chiropractor had dissected an artery in his neck.
Next, Darkmoore was put on blood thinners to avoid blood clots that could result in a stroke or worse. Darkmoore explains that he will be on two blood thinners for the next three months to prevent clotting. If the dissection heals partially, he says he will need to take aspirin every day for the rest of his life. If it doesn’t heal, he claims that he will need surgery.
Many viewers of the video claimed they have had the same “chiropractor gone wrong” experience as Darkmoore.
- “Wow. How scary. I had a similar thing happen to me. Extremely bad headache after going one time. Haven’t gone since,” one commenter wrote.
- “I’m so sorry this happened to u,” another user echoed. “My chiropractor also caused an injury which required emergency surgery & I have permanent damage. I’m glad u survived.”
Darkmore captioned his last update video, “I appreciate the thoughts and prayers. Hopefully, I’ll be okay after 3 months of recovery.”
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Let’s hope that he is correct and that he will make a speedy and full recovery.
Of course, chiros will queue up to stress that important details are missing in this case report. To them, I would merely say this:
THERE IS NO GOOD EVIDENCE THAT NECK MANIPULATIONS BRING ANY BENEFIT AND QUITE A BIT OF EVIDENCE THAT THEY CAN CAUSE SERIOUS HARM.
SO, WHY NOT JUST STOP OFFERING THE PROCEDURE?
The U.S. Department of Health and Human Services alleges that Jason James of the James Healthcare & Associates clinic in Iowa, USA — along with his wife, Deanna James, the clinic’s co-owner and office manager — filed dozens of claims with Medicare for a disposable acupuncture device, which is not covered by Medicare, as if it were a surgically implanted device for which Medicare can be billed. According to the lawsuit, more than 180 such claims were filed. Beginning in 2016, the lawsuit alleges, the clinic began offering an electro-acupuncture device referred to as a “P-Stim.” When used as designed, the P-Stim device is affixed behind a patient’s ear using an adhesive. The device delivers intermittent electrical pulses through a single-use, battery-powered attachment for several days until the battery runs out and the device is thrown away.
Because Medicare does not reimburse medical providers for the use of such devices, DHHS alleges that some doctors and clinics have billed Medicare for the P-Stim device using a code number that only applies to a surgically implanted neurostimulator. The use of an actual neurostimulator is reimbursed by Medicare at approximately $6,000 per claim, while P-Stim devices were purchased by the Keokuk clinic for just $667, DHHS alleges. The department alleges James knew his billings were fraudulent as the P-Stim device is “nowhere close to even resembling genuine implantable neurostimulators” and does not require surgery.
The lawsuit alleges that on June 15, 2016, when Jason James was contemplating the use of P-Stim devices at the Keokuk clinic, he sent a text message to P-Stim sales representative Mark Kaiser, asking, “Is there a limit on how many Neurostims can be done on one day? Don’t wanna do so many that gives Medicare a red flag on first day. Thanks.” After realizing the “large profit windfall” that could result from the billing practice, DHHS’s lawsuit alleges, James “told Mark Kaiser not to mention the Medicare reimbursement rate to his nurse practitioner or staff – only his office manager and biller needed that information.” James then pressured clinic employees to heavily market the P-Stim devices to patients, even if those patients were not agreeable or, after trying it, were reluctant to continue the treatment, the lawsuit claims.
In October 2016, the clinic’s supplier of P-Stim devices sent the clinic an email stating the company had “no position on what the proper coding might be for this device if billed to a third-party payer” such as an insurer or Medicare, according to the lawsuit. The company advised the clinic to “consult a certified biller/coder and/or attorney to ensure compliance.” According to the lawsuit, James then sent Kaiser a text message asking, “Should we be concerned?”
DHHS alleges the clinic’s initial reimbursement claims were submitted to Medicare through a nurse practitioner and were denied for payment due to the lack of a trained physician’s involvement. In response, the clinic hired Dr. Robert Schneider, an Iowa-licensed physician, to work at the clinic for the sole purpose of enabling James Healthcare & Associates to bill Medicare for the P-Stim devices, the lawsuit claims. James then informed Kaiser he had a goal of billing Medicare for 20 devices per month, which would generate roughly $125,573 of monthly income, the lawsuit alleges. The lawsuit also alleges Dr. Schneider rarely saw clinic patients in person, consulting with them instead through Facebook Live.
In April 2017, Medicare allegedly initiated a review of the clinic’s medical records, triggering additional communications between James and Kaiser. At one point, James allegedly wrote to Kaiser and said he had figured out why Medicare was auditing the clinic. “Anything over $7,500 is automatically audited for my area,” he wrote, according to the lawsuit. “We are now charging $7,450 to remove the audit.”
The clinic ultimately submitted 188 false claims to Medicare seeking reimbursement for the P-Stim devices, DHHS alleges, with Medicare paying out $4,100 and $6,300 per claim, for a total loss of $1,028,800. DHHS is suing the clinic under the federal False Claims Act and is seeking trebled damages of more than $3 million, plus a civil penalty of up to $4.2 million.
An attorney for the clinic, Michael Khouri, said Wednesday he believe the federal government’s lawsuit was filed in error because a settlement in the case had already been reached. However, the assistant U.S. attorney handling the case said no settlement in the case had been finalized and the lawsuit was not filed in error.
Previous legal cases
In 2015, the Iowa Board of Chiropractic charged Jason James with knowingly making fraudulent or untrue representations in connection with his practice, engaging in conduct that was harmful or detrimental to the public, and making untruthful statements in advertising. The board alleged James told patients they would be able to stop taking diabetes medication through the use of a diet and nutrition program, and that he had claimed to be providing extensive laboratory tests when not all of the tests for which he billed were ever conducted. The board also claimed James referred patients to a medical professional who was not licensed to practice in Iowa. The case was resolved with a settlement agreement in which James agreed to pay a $500 penalty and complete 10 hours of education in marketing and ethics.
In 2019, Schneider sued the clinic for failing to comply with the terms of his employment agreement. Court exhibits indicate the agreement stipulated that Schneider was to work no more than two days per month and would collect $2,000 for each day worked, plus $250 per month for consulting, plus “$250 per device over six per calendar month.” In March 2020, a jury ruled in favor of the clinic and found that it had not breached its employment agreement with Schneider.
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Before some chiropractors now claim that such cases represent just a few rotten apples in a big basket of essentially honest chiropractors, let me remind them of a few previous posts:
- A $2.6M Insurance Fraud by Chiropractors and Doctors?
- Fraud and sex offences by chiropractors
- Chiropractic therapy for gastrointestinal diseases. Evidence of scientific misconduct?
- Twenty Things Most Chiropractors Won’t Tell You
- The Dark Side of Chiropractic Care
- Chiropractic subluxation: the myth must be kept alive
- CHIROPRACTIC: an early and delightful critique
- Students of chiropractic condemn the ‘unacceptable behaviour’ of some chiropractors and their professional organisations
- Far too many chiropractors believe that vaccinations do not have a positive effect on public health
- Chiropractor is in the dock for not wearing a mask
- “The uncensored truth” about COVID-19 vaccines” … as told by some chiro loons
To put it bluntly: chiropractic was founded by a crook on a bunch of lies and unethical behavior, so it is hardly surprising that today the profession has a problem with ethics and honesty.
An impressive article by John Mac Ghlionn caught my attention. Allow me to quote a few passages from it:
The U.S. House of Representatives and the U.S. Senate recently reintroduced legislation to increase access to Medicare-covered services provided by chiropractors. Last year, the US chiropractic market size was worth $13.13 Billion. By the end of the decade, it will be worth over $18 billion. Each year, a whopping 35 million Americans seek chiropractic care.
But why? It’s a questionable science full of questionable characters.
Last year, a Georgia woman was left paralyzed and unable to speak after receiving a neck adjustment from a chiropractor. She’s not the first person to have had her life utterly ruined by a chiropractor, and chances are she won’t be the last. Many patients who visit chiropractors suffer severe side effects; some lose their lives…
As Dr. Steven Novella has noted, what used to be fraud is now known as holistic medicine. Dr. Edzard Ernst, a retired British-German physician and researcher, has expertly demonstrated the many ways in which chiropractic treatments are rooted not in science, but in mystical concepts…
Spinal adjustments, also known as “subluxations,” are also common. A dangerous practice that has been heavily criticized, spinal manipulations are associated with a number of adverse effects, including the risk of stroke. As Dr. Ernst has noted, the cost-effectiveness of this particular treatment “has not been demonstrated beyond reasonable doubt.”
Not content with spinal and neck manipulations, some chiropractors offer to treat other conditions — like diabetes, for example. They are not trained to treat diabetes. Other chiropractors appear to take joy in torturing infants. In August of 2018, a chiropractor made headlines for all the wrong reasons when a video emerged showing him hanging a two-week-old newborn upside down by the ankles…
Finally, as I alluded to earlier, the chiropractic community is full of fraudsters. In 2019, in the US, 15 chiropractors were charged in an insurance fraud and illegal kickback operation. More recently, in February of this year, a New York federal judge sentenced Patrick Khaziran to 30 months in prison after he pleaded guilty to being part of a widespread scheme that defrauded the NBA out of at least $5 million. In recent times, the chiropractic community has come under scrutiny for abusive care and illegal billing practices. When it comes to instances of healthcare fraud, chiropractic medicine is unrivaled.
None of this should come as a surprise. After all, the entire chiropractic community was constructed on a foundation of lies. As the aforementioned Dr. Ernst told me, we should be skeptical of what chiropractors are offering, largely because the whole practice was founded “by a deluded charlatan, who insisted that all human diseases are due to subluxations of the spine. Today, we know that chiropractic subluxations are mere figments of Palmer’s imagination. Yet, the chiropractic profession is unable to separate itself from the myth. It is easy to see why: without it, they would at best become poorly trained physiotherapists without any raison d’etre.”
… Dr. William T. Jarvis famously referred to chiropractic as “the most significant nonscientific health-care delivery system in the United States.” Comparing the chiropractic community to a cult, Dr. Jarvis wondered, somewhat incredulously, why chiropractors are licensed to practice in all 50 US states. The entire profession, he warned, “should be viewed as a societal problem, not simply as a competitor of regular health-care.”
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In my view, this is an impressive article, not least because it is refreshingly devoid of the phenomenon known as ‘false balance, e.g. a chiropractor being invited to add his self-interested views at the end of the paper claiming, for instance, “we have years of experience and cause far less harm than real doctors”.
