Chiropractic medicine.

[JJM]

not what i'm saying. let me clarify: {snip}

Very good. A lot of chiros continue to argue that they actually change spinal alignment. I find it humorous that they argue the Crelin paper is too old, as if research had an expiration date. (Which is ironic because they continue to cite DD Palmer, and he died way before 1973.)

 

[Blue Wode]

well you tried hard to lead me to whatever conclusion you were trying to lead me to, sorry if i never arrived.

Actually, you did:

definitely looks like one can't go too far wrong by avoiding ALL chiros in the UK. and most elsewhere.

your line of argument seems a bit odd. what are you really arguing here? i don't think that we're in disagreement that some chiros are good but most are bad. if i'm wrong, it seems odd you'd cite chirobase, for starters. are you arguing that chiro should be outlawed? (disagree) or regulated? (agree)

I don’t think there’s a need for chiropractors when physiotherapists can provide the same type of service with much less likelihood that their patients will be ensnared by quackery.

With regard to regulation, chiropractic has been regulated by statute in the UK since 2001 and it hasn’t made much difference to the way in which the chiropractic 'profession' conducts itself since the four main professional chiropractic organisations all continue to buy into chiropractic subluxation theory, and several of these organisations' members now serve on the regulatory body's committees.

why should it matter if Joe sixpack, who can access google same as i do, does his homework?

Because the public should be able to trust the information that health professionals give them without having to resort to Google.

Interestingly, here’s what the UK regulatory body, the General Chiropractic Council, has to say on the subject…

The trust that the public places in chiropractors can be abused in a variety of ways.

It may be through marketing activities that exploit the public even before they become patients.

Or it may be by using strategies designed to lock patients into treatment plans that are excessive in both frequency and duration. Such treatment plans are exploitative, leading patients to believe they are more seriously ill than they are and thereby promoting undue dependence on chiropractic care.

Any abuse of trust or exploitation of lack of knowledge undermines the foundation of respect for the profession. It is particularly damaging when a conduct hearing exposes a complete lack of clinical justification for recommended treatment.

When a patient consents to treatment/care, it is essential that the plan of care is developed in discussion with the patient to ensure that

• it helps the patient to improve her/his own health and actively participate in her/his own care
• it has aims that are consistent with the patient’s identified health and health needs, and anticipated changes in those health needs
• it is kept under continuous review by the chiropractor and modified appropriately, in line with the patient’s changing health and health needs

All chiropractors must ensure that all the information they provide, or authorise others to provide on their behalf

• is factual and verifiable
• is not to be misleading or inaccurate in any way
• does not, in any way, abuse the trust of members of the public nor exploit their lack of experience or knowledge about either health or chiropractic matters
• does not put pressure on people to use chiropractic, for example by arousing ill-founded fear for their future health or suggesting that chiropractic can cure serious disease

See page 5 here:
http://www.gcc-uk.org/files/link_file/F2P2005_6.pdf

Unfortunately, they seem to be little more than pretty words.

 

[JJM]

{snip} *if* no claims other than the obvious musculoskeletal ones any physio might make are made, then i fail to see how a back rub is tactitly "woo-tainted" solely by virtue of taking place in a chiropractor's office.

The problem with chiros who eschew the nonsense is- you still don't know what they are really competent at. Some people call them "PTs with delusions of grandeur;" but the standard chiro education focuses so much on quackery that I doubt they are technically as capable as PTs. Some are, however they behave just like the ones who are not.

A chiro can graduate and get a license to practice without ever seeing a sick person! Not so for PTs. And PTs learn when to refer back to a doctor, chiros may not. Furthermore, chiros can graduate without learning to take usable xrays, or to read good xrays, or when to take xrays. Sometimes, the first symptom of a cancer is joint pain, which can be missed by a chiro even though it is visible on a good xray read by a competent radiologist.

in fact, having been to MDs, physios and chiros for the same problem, i can say with some conviction (still just opinion, obviously) that a good back rub is a good back rub, regardless of whether you get it in an MD's office or a chiro's office. {snip}

That is my point- generally, there is no reason to go to someone who's training is suspect (DC). If you have found a competent DC for your purposes, you are are beating the odds; their own surveys suggest they only represent around 5% of the business.

BTW- Lack of appropriate capitalization of words in posts is strongly associated with chiros. You seem like a rational person, if you are going to write more on the topic you should probably be more careful.

 

[zeusbheld]

Actually, you did:

oh. well then. problem solved. for the UK anyway.

I don’t think there’s a need for chiropractors when physiotherapists can provide the same type of service with much less likelihood that their patients will be ensnared by quackery.

fair enough, but you're in the UK. i'm not nor have i ever been. the situations are not comparable. for one, as i pointed out, neither the US nor Thailand have an NHS at this point.

i don't think, in either case, banning chiropractors would be the way to go. although perhaps the good ones could pass a test and be re-labeled "spinal manipulation physio" or something like that.

can't speak to the UK but banning them in the rest of the world would throw out a few babies with the bathwater--for my particular problem, most physios don't know what to do and are too much the generalists. i couldn't endorse banning them without chiros being replaced by physiotherapists who specialize in spinal manipulation.

With regard to regulation, chiropractic has been regulated by statute in the UK since 2001 and it hasn’t made much difference to the way in which the chiropractic 'profession' conducts itself since the four main professional chiropractic organisations all continue to buy into chiropractic subluxation theory, and several of these organisation’s members now serve on the regulatory body's committees.

in other words the inmates are minding the asylum. regulation of their claims would have to come from outside chiropractic in order to work.

Because the public should be able to trust the information that health professionals give them without having to resort to Google.

forgetting chiro and just looking at medicine for a minute: that'd be great in a perfect world but in practice one can go very, very wrong with an MD. and MDs are tightly regulated. among other ill-advised behaviors, many people plunge into major surgical interventions without benefit of even a second opinion.

in short, regardless of how good the info that health professionals give them is, Joe sixpack NEEDS to resort to Google and NEEDS to be involved in his own healthcare (arguably Josephine does even more).

Interestingly, here’s what the UK regulatory body, the General Chiropractic Council, has to say on the subject…

Unfortunately, they seem to be little more than pretty words.

perhaps rather than banning outright or repurposing them, make it so that chiro can't take on a new patient without a referral from an MD or at least a phsyio.

 

[zeusbheld]

The problem with chiros who eschew the nonsense is- you still don't know what they are really competent at. Some people call them "PTs with delusions of grandeur;" but the standard chiro education focuses so much on quackery that I doubt they are technically as capable as PTs. Some are, however they behave just like the ones who are not.

A chiro can graduate and get a license to practice without ever seeing a sick person! Not so for PTs. And PTs learn when to refer back to a doctor, chiros may not. Furthermore, chiros can graduate without learning to take usable xrays, or to read good xrays, or when to take xrays. Sometimes, the first symptom of a cancer is joint pain, which can be missed by a chiro even though it is visible on a good xray read by a competent radiologist.

That is my point- generally, there is no reason to go to someone who's training is suspect (DC). If you have found a competent DC for your purposes, you are are beating the odds; their own surveys suggest they only represent around 5% of the business.

the problem with that is most physios that i've been to do not specialize, and i've been to some very reputable physios who just plain aren't very good at any sort of upper back work. if i had found a physio in new york who could have done the trick, i would have stuck to physios. as it was, an MD referred me to a physio who referred me to a (rational) chiro.

on further reflection i definitely be in favor of banning chiro if and only if in its place a clearly differentiated spinal manipulation specialization in physiotherapy were created.

BTW- Lack of appropriate capitalization of words in posts is strongly associated with chiros. You seem like a rational person, if you are going to write more on the topic you should probably be more careful.

BTW- pedantry is strongly associated with dogma. don't give up your day job for comedy any time soon.

 

[Blue Wode]

in short, regardless of how good the info that health professionals give them is, Joe sixpack NEEDS to resort to Google and NEEDS to be involved in his own healthcare (arguably Josephine does even more).

But how will they know that the information they find via Google is reliable?

perhaps rather than banning outright or repurposing them, make it so that chiro can't take on a new patient without a referral from an MD or at least a phsyio.

It would be nice to see that being made compulsory.

 

[zeusbheld]

But how will they know that the information they find via Google is reliable?

how does one know that ANY information is reliable? no matter how trustworthy the source one must approach with caution, and check sources against each other wherever possible.

in some major US cities (New York, definitely) there are databases of doctor ratings one can subscribe to. also with MDs checking their credentials, number and type of specialtizations, what they've published, and their malpractice record are also worthwhile.

It would be nice to see that being made compulsory.

incidentally my insurers would not pay for chiro if no referral from an MD. (referral chains like mine were OK). do people in the UK have to pay for chiro out of pocket or is there some sort of insurance reimbursement?

anyway, long-term, i'd rather they be made to either quit or train properly as physios.

 

[Rolfe]

Most people in Britain have no health insurance as it isn't necessary - the NHS takes care of us. So, as there's no chiropracitic on the NHS, if you want that, pay up.

There are policies avaliable, mostly for people who want the option to go private if they find themselves with a wait for treatment, but I have seen one advertised recently that seemed to be promoting itself as covering extras - like private physiotherapy, but I woudn't swear it didn't mention woo stuff.

Rolfe.

 

[zeusbheld]

Most people in Britain have no health insurance as it isn't necessary - the NHS takes care of us. So, as there's no chiropracitic on the NHS, if you want that, pay up.

just checking if i'm understanding this correctly: phsyios are covered by NHS, but chiros are not? and does NHS allow you to choose your MDs and physios? in other words, if your'e not satisfied with your physio, you can go to a different one? if indeed one can, i don't understand how chiros survive in the UK.

 

[Blue Wode]

i don't understand how chiros survive in the UK.

From post #93:

Those endless repeat visits which are recommended by many chiropractors usually amount to little more than the financial exploitation of their patients.

If chiropractors didn’t (deliberately) create patient dependency, their ability to earn a good living would rapidly diminish. That’s why the vast majority of them treat infants and young children despite there seldom being any medical reason for them to do so, and despite the non-existence of chiropractic paediatric safety data. This exploitation also extends to their pushing of bogus concepts like “family wellness care” where whole (usually asymptomatic) families are encouraged to adopt the ‘chiropractic lifestyle’.

 

[JJM]

{snip} BTW- pedantry is strongly associated with dogma. don't give up your day job for comedy any time soon.

I am serious. I have debated this with many chiros online, and some of them claim to be neutral, or, even, MDs; but the lack of capitalization gives them away. I don't sense that you are a chiro. In fact, it does not matter- we deal in facts and the source does not matter. However, if someone is inclined to be prejudiced, you might be summarily dismissed.

You wrote "pedantry is strongly associated with dogma." I have no idea what that means.

 

[Blue Wode]

just checking if i'm understanding this correctly: phsyios are covered by NHS, but chiros are not? and does NHS allow you to choose your MDs and physios? in other words, if your'e not satisfied with your physio, you can go to a different one?

Yes to all three questions.

on further reflection i definitely be in favor of banning chiro if and only if in its place a clearly differentiated spinal manipulation specialization in physiotherapy were created.

As Samual Homola said, that will probably be in place in the US by 2020. Hopefully, by then, the treatments offered by chiropractors in the UK will have been properly defined and limited to evidence-based manual therapy. Indeed, I believe that one or two reformist (rational) chiropractors would like to get rid of the name 'chiropractor' and be known as 'musculoskeletal specialists'.

 

[zeusbheld]

I am serious. I have debated this with many chiros online, and some of them claim to be neutral, or, even, MDs; but the lack of capitalization gives them away. I don't sense that you are a chiro.

i am most definitely not a chiro. or an MD.

In fact, it does not matter- we deal in facts and the source does not matter. However, if someone is inclined to be prejudiced, you might be summarily dismissed.

if someone is inclined to be prejudiced, i'm inclined to summarily dismiss *them.*

You wrote "pedantry is strongly associated with dogma." I have no idea what that means.

people inclined to read pedantically are generally not reading at all, as they are "inclined to be prejudiced" and tend to be merely looking for the opportunity to demonstrate that they already know everything. and very, very few of them have anywhere near the command of the English language they imagine themselves to.

 

[robinson]

So true.

 

[JJM]

{snip} people inclined to read pedantically are generally not reading at all, as they are "inclined to be prejudiced" and tend to be merely looking for the opportunity to demonstrate that they already know everything. and very, very few of them have anywhere near the command of the English language they imagine themselves to.

I have been following chiro-quackery for 30 years. I may be biased; but you certainly can't call it prejudice any longer.

of course, i may not have anywhere near the command of the english language ...

 

[zeusbheld]

I have been following chiro-quackery for 30 years. I may be biased; but you certainly can't call it prejudice any longer.

of course, i may not have anywhere near the command of the english language ...

or the memory, apaparently. predjudice was *your* word.

given your commitment to reason, you are no doubt aware that while all cats are mammals, it does not imply all mammals are cats. shall we get back on topic now, or split more hairs over my nasty irreverence toward capital letters?

 

[JJM]

or the memory {snip}

Quite. You've run rings round my logic ... it's time for the penguin atop your TV-set to explode ...

 

[Rolfe]

just checking if i'm understanding this correctly: phsyios are covered by NHS, but chiros are not? and does NHS allow you to choose your MDs and physios? in other words, if your'e not satisfied with your physio, you can go to a different one? if indeed one can, i don't understand how chiros survive in the UK.

Basically yes. Chiropactors are very firmly part of "alternative medicine" here. They have no pseudo-medical qualifications and nobody is likely to call them "Dr." Alternative medicine has very very limited penetration into the NHS (see separate thread), and chiropractic not at all.

People go to them for much the same reasons as they go to any alternative quack. Either their conventional treatment isn't really doing it for them and they think they'll try unconventional, or the NHS system has imposed a wait on them, which they decide to circumvent by going private. At that point, when you're out of the system, the distinction between kosher and not can get a bit blurred.

Personal example. In December my mother fell and injured her shoulder. I took her to the GP at once. GP confirmed nothing apparently broken, probably just bruised, prescription for painkillers. But she also said, if it's not getting better in a week, go to Casualty. That means, show up at the Accident and Emergency department of the hospital, where x-rays are available. (All that is totally free.)

Well, it wasn't getting better, but we happen to live in a rural village some distance from the nearest hospital. I didn't fancy carting an elderly lady all that way to sit in a waiting room for an couple of hours possibly, only to go away with a sling and more painkillers (as I was pretty certain it wasn't broken). So we waited more like six weeks, and still it wasn't better.

By this time we could hardly show up at A&E, yes it's an emergency she fell back before Christmas.... So I'd have had to take her back to the GP, who would have had to get a referral appointment for her with an orthopaedic consultant, again a trip to the city and the hospital, all for probably something which wouldn't show up on x-ray. Then what? Probably physiotherapy at this stage. Which might all have entailed a wait for treatment, and again probably driving her to the hospital multiple times.

It's just the way the system works. Great for a major injury, but a pest for a minor one which isn't resolving. And physiotherapy is notoriously badly served in the NHS, they just don't have enough staff, they need more funding. If we'd been broke then we'd just have jumped through the hoops and she'd have been treated in the end, but we're not.

So I decided to cut out the middle-man. I knew it was a physiotherapy case, so I looked through the local phone book and picked out a properly qualified physiotherapist who advertised house calls. I wondered if she'd see her without an x-ray but fortunately she did. She agreed that an x-ray was probably unnecessary, and decided it was supraspinous tendonitis. She's been coming every two weeks, doing some infra-red treatment and giving Mum a series of exercises, which are gradually doing the trick. £35 a pop. Fine by me, especially for the house calls part, never mind the instant availability.

But this is where people can get suckered into woo. There were two or three "massage therapists" in that book, including one doing the infamous cranial osteopathy, and they looked quite dodgy to me. I also pass a chiropractor's establishment on the way into the city so I know they exist. I knew what to look for and got the proper physio. She came to see Mum on her way home from her part-time work in the city for the NHS. But if I hadn't known, Mum could just as easily ended up with the woo massage or the chiro, or heaven help us, an acupuncturist.

There's a fair bit of scope scratching round the edges like this. Especially when there is a wait time to get proper physiotherapy on the NHS. But really, chiropractors in Britain are in the Outer Darkness.

Rolfe.

 

[arthwollipot]

Those endless repeat visits which are recommended by many chiropractors usually amount to little more than the financial exploitation of their patients.

The best description of this was from Michael Shermer's book Why People Believe Weird Things. He said that the more he saw the chiropractor, the more his back would go "out" and the more he'd have to go and see the chiropractor. Once he stopped seeing the chiropractor, his back stopped going "out", and he didn't need them any more.

 

[zeusbheld]

The best description of this was from Michael Shermer's book Why People Believe Weird Things. He said that the more he saw the chiropractor, the more his back would go "out" and the more he'd have to go and see the chiropractor. Once he stopped seeing the chiropractor, his back stopped going "out", and he didn't need them any more.

i should be so lucky. for me, the more i exercise properly the less likely my back is to go 'out,' that's about THE only treatment long term. exercise is about the ONLY thing that i've noticed to actually have the kind of positive knock-on effects often attributed to new-agey crap. (for example, is tai chi adjusting your chi flow? no. it's a good safe low-impact workout).

a question about the NHS: can you go outside the plan and get a proper MD if your'e in a hurry and in the mood to burn a stack of cash? if so are MDs working outside the NHS better, on average, or worse, or do they also work for the NHS?

a question about physios in the US: do they specialize? i'm used to going into an MDs office and seeing degree and certificates for specialties on the wall; i don't recall seeing anything like this in a physio's office (which doesn't mean it wasn't there). for me, and people like me who have used chiros for the only thing they're good for, it would be useful to know how to spot a physio who'd be good at legit spinal manipulation.