052303 Commentary, and chiropractic

[Beleth]

This is a comment about the first topic on the May 23, 2003 comentary. I know I'm a week late, but I was on vacation.

In this topic, Mr. Randi prints a letter he received from Dave Nesbitt.

(To summarize: Mr Nesbitt had chronic back pain. He went to several doctors, including some back specialists, who had no remedy beyond prescribing some anti-inflammatory drugs. On the advice of friends, he went to see a chiropractor. The chiropractor did what chiropractors do - performed an evaluation and adjusted his spine according to what the evaluation told him. A few days later, Mr. Nesbitt developed pains in his chest as well. Another trip to the real doctors showed that he had a Ankylosing Spondylitis (AS), a form of rheumatism that was made worse by the pressure applied to his body by the chiropractor.)


Now. I'm no fan of the wild claims made by chiropractors. I don't think that they can cure bed-wetting, like the story says Mr. Nesbitt's chiropractor claimed. But the conclusion that Mr. Randi draws from this story is, well, a little embarrassing.

Mr. Randi calls the chiropractic treatment Mr. Nesbitt underwent "quackery", but he has the benefit of 20/20 hindsight in this assessment. The real doctors didn't diagnose his AS until after his visit to the chiropractor. At the time he went to the chiropractor, all anyone knew about Mr. Nesbitt was that he had chronic back pain - which is within the realm of problems that chiropractic is generally accepted to be able to help with, even within the skeptical community. (Kidney failure? No. Back pain? Yes.)

If anything, I see this anecdote a condemnation of the real medical community, who had years to diagnose Mr. Nesbitt's AS and failed to do so.

Oh yeah, and denouncing chiropractic with a mere anecdote is beneath Mr. Randi. That's the really embarrassing part. He wouldn't accept an anecdote as proof of a woo-woo claim, and it pains me to see him try to use one as disproof.

I feel sorry for Mr. Nesbitt. I do. But I, as a skeptic, must put the blame on the real doctors in this case and not on the chiropractor, who was just trying to do what chiropractors really can do: fix back problems.

 

[kerfer]

Yes, I agree.

I have used Chiropractors in the past to remove back pain. For this purpose, the manipulation that they do works wonderfully for the type of back pain I have experienced.

I recently received my first massage after a relatively grueling race.

I have the same opinion of massage therapy as I do of Chiropractic:

They believe an awful lot of new-age hooey, but what they do works.

This, of course, applies only to back pain caused by skeletal misalignments, and toxins in the muscles from over-exertion (and, it feels really good, too).

Toothache? Cancer? See an MD.

Backache? Give a DC a try. They may be able to help you.

 

[rwguinn]

I also have to agree, here. Statistically, the single event is insignificant. Additionally, when the chiropractic treatment failed to aid, in fact aggrivated the condition, then and only then, did medical science diagnose the true problem. It failed to do so before.
Blaming the bone-cruncher in this case is much like blaming the shuttle failure on the chunk of foam. The real problem apparently lies elsewhere. In the case under discussion, it was a very real, known but undiagnosed disorder. In the STS case, it was brittle leading edge material. Only when the chunk of foam (of which there have been many over the years) hit exactly the right (wrong) place did the root cause come to light. In the chiropractic case, the BC found exactly the right (wrong) spot to manipulate in order to force diagnosis of the problem.

RW

 

[Zombified]

The problem with chiropracters is, do they have the training to distinguish between problems they can treat, or have any chance of treating, vs. problems that should be referred to a doctor?

For example, if you complained to a chiropracter about headaches, would he know how to decide whether you have a tension headache vs. a migraine, and does he have any business deciding? Rare back disorders are one thing, but headaches are pretty common.

Without diagnostic ability, a chiropracter should be advising most or all clients to get a medical examination and diagnosis before they treat them.

(Apologies if I'm sounding like a stuck record on this headache thing. It seems to have turned into my favorite example.)

 

[rwguinn]

The problem with chiropracters is, do they have the training to distinguish between problems they can treat, or have any chance of treating, vs. problems that should be referred to a doctor?

For example, if you complained to a chiropracter about headaches, would he know how to decide whether you have a tension headache vs. a migraine, and does he have any business deciding? Rare back disorders are one thing, but headaches are pretty common.

Without diagnostic ability, a chiropracter should be advising most or all clients to get a medical examination and diagnosis before they treat them.

(Apologies if I'm sounding like a stuck record on this headache thing. It seems to have turned into my favorite example.)

There is the real problem. I go to a chiropractor for problems only after I have been to an MD. The guy i use now won't do my neck, since I have had moderate C7 arthritis diagnosed-and I wouldn't let him manipulate my neck anyway, knowing what I know. But in the case in point, if Medical science couldn't diagnose the root cause, then howinheck is a chiropractor going to? I mean, science has prescribed anti-inflamitory drugs. More often than not, manipulation will reduce the pressure causing the inflamation.
That's why my wife prefers Osteopaths- medical training, with manipulation.

 

[Beleth]

The problem with chiropracters is, do they have the training to distinguish between problems they can treat, or have any chance of treating, vs. problems that should be referred to a doctor?

Just like the only thing I'd go to a dentist for is tooth issues, the only thing I'd go to a chiropractor for is back pain. Everything else gets looked at by my GP first.

 

[Quasi]

I agree that chiro can help a good deal in some cases, and some chiro actually work with GP/MD's and even can evaluate MRI data etc (very rare.) On the other hand, I would be astonished to find a chiro who did not find something wrong in a "healthy" patient. Further, virtually all chiro have no means of diagnosing any medical problem quantitatively, which led to the problem above. Yes, the GP did not pick up on it at first, but the chiro manipulations made the problem worse, then the proper diagnosis. The GP may have had many reasons for missing the diagnosis. A girl I know has a bone disorder which was not detected on several visits, and not finally until she went to the ER. It was a degenerative disease- if she went to a chiro she could have been seriously hurt. Not to mention my father who was almost paralyzed by a chiro and suffers permenent neck pain now. So herein lies the problem- the ACA cannot part with its religious/cult beliefs to get chiro the training they need, like osteopaths do. Why? They would have to admit that they, and other CAM people are dead wrong. God forbid that happens right?

 

[rwguinn]

I agree that chiro can help a good deal in some cases, and some chiro actually work with GP/MD's and even can evaluate MRI data etc (very rare.) On the other hand, I would be astonished to find a chiro who did not find something wrong in a "healthy" patient. Further, virtually all chiro have no means of diagnosing any medical problem quantitatively, which led to the problem above. Yes, the GP did not pick up on it at first, but the chiro manipulations made the problem worse, then the proper diagnosis. The GP may have had many reasons for missing the diagnosis. A girl I know has a bone disorder which was not detected on several visits, and not finally until she went to the ER. It was a degenerative disease- if she went to a chiro she could have been seriously hurt. Not to mention my father who was almost paralyzed by a chiro and suffers permenent neck pain now. So herein lies the problem- the ACA cannot part with its religious/cult beliefs to get chiro the training they need, like osteopaths do. Why? They would have to admit that they, and other CAM people are dead wrong. God forbid that happens right?

I feel like some folks are missing the point. The medical profession missed the problem, and prescribed medication for the wrong thing.
Lets look at it this way- suppose you feel back pain after an exercise session. You go to the doc, and after x-rays, etc, can't find a problem. So he prescribes anti-inflamatories, and sends you off to a sports therapist/trainer.
The therapist applies heat and/or massage, and shortly thereafter the pain gets worse. You had an undiagnosed condition (AS, hairline fraxture, planet-x incursion, whatever), which the treatment actually made worse-and you will have to live with it.
Is this the fault of the therapist? Remember-he is doing much of t the same stuff with a massage as the Chiro did with manipulation. he merely applied treatment that works in 9999 out of 10000 cases- but this time made it worse. To me, the treatment given the Chiropractor by Mr. Nesbit and Mr Randi is akin to blaming your kids teacher for the heart attack you have when the kid brings home an F on his report cart-and you've only been smoking since age 14 and eat 3 meat meals a day!

 

[Dr. Popalot]

Without access to the medical records and xrays I am hesitant to dish out blame in this instance. Generaly AS is quite easy to diagnose; I don't know what happened here. AS is a contraindication for manipulation.