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  1. Gypsy Jazz is offline
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    Posted On:
    10/30/2013 9:43pm


     Style: Does exercise count?

    1
    Hell yeah! Hell no!
    This argument is a matter of semantics, though perhaps a worthy one. Chiropractic's foundations are by their very nature under the umbrella of CAM. That's not really up for debate, since the Palmers attribute all sorts of erroneous claims due to something in the spine only people who follow their way can find.

    However, there are many chiropractors who actively dismiss these claims as the abject nonsense they are. There are a handful of Chiropractic Colleges that refuse to teach a thing about subluxations as proposed by Palmer. These people tend to be trained more or less as Physios or PTs with more emphasis on HVLA mobilizations. This does raise the question of why bothering with the Chiro label at all, and it's a damn good question. Additionally, if there is dedication to being science based, then the emphasis on HVLA mobilization is also questionable. Add some of the modality empires to the mix and Chiros are about as guilty as any other in the MSK field as jumping onto some very dubious and/or aggressive treatment tools.

    Maybe it depends how you define CAM, but in my view if someone is practicing science based medicine with good clinical reasoning skills, that is no longer the realm of CAM.

    No title in MSK medicine or health care can identify ones actual knowledge or research literacy and as I've mentioned before I find these things to be greatly lacking far too often. I happen to know a few people with the DC designation who I would trust myself or my family with. I know more PTs and MTs who I feel the same way about. All of the above tend to be the exceptions rather than the rule.
  2. Keej613 is offline

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    Posted On:
    10/31/2013 12:49pm


     Style: It's complicated.

    --
    Hell yeah! Hell no!
    For whatever it's worth, most health insurance companies in Canada list chiropractic as a paramedical expense alongside other services such naturopathy.

    And, for whatever it's worth:

    Chiropractic is a complementary and alternative medicine (...)
    Chapman-Smith DA, Cleveland CS III (2005). "International status, standards, and education of the chiropractic profession". In Haldeman S, Dagenais S, Budgell B et al. (eds.). Principles and Practice of Chiropractic (3rd ed.). McGraw-Hill. pp. 111–34. ISBN 0-07-137534-1.

    This is pretty interesting, too:

    http://en.wikipedia.org/wiki/Chiropractic#Straights_and_mixers
  3. ChenPengFi is online now
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    Posted On:
    10/31/2013 2:11pm

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    Hell yeah! Hell no!
    Quote Originally Posted by Gypsy Jazz View Post
    This argument is a matter of semantics, though perhaps a worthy one. Chiropractic's foundations are by their very nature under the umbrella of CAM. That's not really up for debate, since the Palmers attribute all sorts of erroneous claims due to something in the spine only people who follow their way can find.
    Yes, but the point is that the C and the A in "CAM" are different things.

    However, there are many chiropractors who actively dismiss these claims as the abject nonsense they are. There are a handful of Chiropractic Colleges that refuse to teach a thing about subluxations as proposed by Palmer. These people tend to be trained more or less as Physios or PTs with more emphasis on HVLA mobilizations. This does raise the question of why bothering with the Chiro label at all, and it's a damn good question.
    Yes, and that group would likely fall under the "complementary" label, yet not the "alternative" one.
    "Chiropractor" is (in the US) a particular license, and really not much more can be assumed about a given practitioner.
    Much like "MD".


    Additionally, if there is dedication to being science based, then the emphasis on HVLA mobilization is also questionable. Add some of the modality empires to the mix and Chiros are about as guilty as any other in the MSK field as jumping onto some very dubious and/or aggressive treatment tools.

    It's not just the modality empires.
    Regular doctors do stuff all the time, that isn't supported by science.
    Hell, our country's most prolific and visible slinger of snake oil bullshit, is a damn cardiologist. (Dr Oz.)
    As far as adjustments etc go, MDs, DOs, and PTs do them too, but apparently some people think only the Chiro version is suspect.



    Maybe it depends how you define CAM, but in my view if someone is practicing science based medicine with good clinical reasoning skills, that is no longer the realm of CAM.
    Perhaps, with "CAM", but i strongly disagree with "complementary."
    One can receive complementary care in the form of say massage for LBP, and that intervention does have science backing, moreso than a lot of other more serious medical interventions i might add.

    This also highlights the enormous gap between research and clinic.
    You're not even considering medical ethics it would seem.
    Are you familiar with "DNR" bracelets?
    In our society, patient autonomy generally trumps non-beneficience and even malfecience, unless there are larger public health concerns.

    You're also ignoring the other pillars of "clinical experience" and "patient values".

    No title in MSK medicine or health care can identify ones actual knowledge or research literacy and as I've mentioned before I find these things to be greatly lacking far too often. I happen to know a few people with the DC designation who I would trust myself or my family with. I know more PTs and MTs who I feel the same way about. All of the above tend to be the exceptions rather than the rule.
    Sadly true.
    Last edited by ChenPengFi; 10/31/2013 2:32pm at .
  4. ChenPengFi is online now
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    Posted On:
    10/31/2013 2:29pm

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    Hell yeah! Hell no!
    Quote Originally Posted by Kave View Post
    If you want to be treated by witch-doctors I am not going to discourage you, I don't even care if you want to believe in leprechauns. Personally I believe in medical treatments that have been proven to be more effective than placebos in double-blind medical trials published in reputable journals, but I don't expect you to share my viewpoint.
    LOL, while that may be so, you're still a drooling idiot.
    You are now going to fallacy land, on the express route.
    Please note that while you cherry-pick Websters, i'm quoting the NIH, Mr Research.
    I've also yet to take an actual stance on Chiro, so your reading comprehension leaves a bit to be desired.


    I am not too sure what you are saying about Dr Oz. From googling him I can see that he is a guy with his own TV show (apparently some spin-off from Oprah), and that he directs the Complementary Medicine Program at New York Presbyterian Hospital. I am not really a connoisseur of daytime TV, so if you are trying to make a point you probably need to be more specific.
    Yes, idiots don't often get subtlety.
    The most popular snake oil salesman in the US, is a Cardiologist, not a Chiro.
    Chew on that for a moment or two, and please reflect on how that affects your implications.
    (Hint: You're a dumbass.)



    Looking at your profile I can see that you are an acupuncture student, so I guess you have a vested interest in magical thinking.
    Actually it makes me uniquely qualified to comment on CAM, but you would do well to not look too far into something i typed off the cuff nearly 10 years ago.

    With a little digging you might realize that i run a small clinic (not acupuncture) and have treated members of this site.
  5. Gypsy Jazz is offline
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    Posted On:
    10/31/2013 4:36pm


     Style: Does exercise count?

    1
    Hell yeah! Hell no!
    Quote Originally Posted by ChenPengFi View Post
    Yes, but the point is that the C and the A in "CAM" are different things.
    In terms of attitude, I would say so. In terms of evidence, I would disagree, but I think that's a philosophical difference. I don't believe that there is such a thing as complimentary medicine. If something has good evidence for its use and/or a strong explanatory model, then it's just plain medicine. I am quite aware of the massage research on LBP, so I would define massage for LBP as medicine. It might not be primary care, but I wouldn't go to the dentist for chest pain or the eye doctor for an ingrown toenail. Not all medical care is relevant for all situations. I don't think there's any disagreement except perhaps one of perspective here.


    Quote Originally Posted by ChenPengFi View Post
    "Chiropractor" is (in the US) a particular license, and really not much more can be assumed about a given practitioner.
    Much like "MD".
    I know there are a lot of quack MD's too, but at very least their training was in something that consistently and measurably exists. Dr. Oz is one of the worst things on the planet, but he acts in defiance of his medical training. Chiros who believe they can cure asthma from a crack of the back often do it because of their training. I think this is a poor comparison

    Quote Originally Posted by ChenPengFi View Post
    As far as adjustments etc go, MDs, DOs, and PTs do them too, but apparently some people think only the Chiro version is suspect.
    I defer to my research savvy PT friends who have fairly unanimously said grade V mobilization rarely if ever is anything more than a more theatrical lower grade mobilization with more risk. This is entirely consistent with the body of research I've read. You can call it manipulation or you can call it Susan. It's all the same to me.

    Quote Originally Posted by ChenPengFi View Post
    This also highlights the enormous gap between research and clinic.
    You're not even considering medical ethics it would seem.
    Are you familiar with "DNR" bracelets?
    In our society, patient autonomy generally trumps non-beneficience and even malfecience, unless there are larger public health concerns.

    You're also ignoring the other pillars of "clinical experience" and "patient values".
    I'm ignoring those insofar as I'm discussing what informs practice, not how practitioners should treat. You're right to point this out, but I'm quite familiar with Sackett's standards for EBM.

    I hope that clears things up. I don't think we really disagree.
  6. ChenPengFi is online now
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    Posted On:
    10/31/2013 5:41pm

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    --
    Hell yeah! Hell no!
    Quote Originally Posted by Gypsy Jazz View Post
    In terms of attitude, I would say so. In terms of evidence, I would disagree, but I think that's a philosophical difference. I don't believe that there is such a thing as complimentary medicine.
    The NIH disagrees with you, as do i.
    They actually take the opposite stance, that true alternative medicine is actually a rarity.

    If something has good evidence for its use and/or a strong explanatory model, then it's just plain medicine. I am quite aware of the massage research on LBP, so I would define massage for LBP as medicine. It might not be primary care, but I wouldn't go to the dentist for chest pain or the eye doctor for an ingrown toenail. Not all medical care is relevant for all situations. I don't think there's any disagreement except perhaps one of perspective here.
    More of semantics...
    For example, the explanatory models and evidence for massage are all over the place, and most of what is taught in schools is bullshit; toxins, bloodflow etc.
    You are well aware of this.
    That would seem to disqualify massage as medicine, by your reasoning, and put MTs in the same boat as the Chiros.




    I know there are a lot of quack MD's too, but at very least their training was in something that consistently and measurably exists. Dr. Oz is one of the worst things on the planet, but he acts in defiance of his medical training. Chiros who believe they can cure asthma from a crack of the back often do it because of their training. I think this is a poor comparison
    I'm challenging the implication that MDs behave with science and research foremost in their minds, on several levels.
    Dr Oz is a black swan, yes.
    But take all the points together, and you can clearly see the earlier implication is demonstrably false.
    You have quackery, ego and bravado, financial motivations, ignorance and even legal/ethical obligations that might compel a clinician to proceed with an intervention that has little or no scientific merit.
    Many interventions have poor support.
    Cardiovascular disease treatments are rife with them.


    I defer to my research savvy PT friends who have fairly unanimously said grade V mobilization rarely if ever is anything more than a more theatrical lower grade mobilization with more risk. This is entirely consistent with the body of research I've read. You can call it manipulation or you can call it Susan. It's all the same to me.
    Yet we agree that they are not the sole territory of Chiros, my actual point.
    I also refer you back to your "exception rather than the rule" with regards to research, and extend that to interventions.
    The majority of PTs appear to still be using outdated models and interventions, so the comparison is valid.
    Somasimple wouldn't be such a contentious place if not.


    I'm ignoring those insofar as I'm discussing what informs practice, not how practitioners should treat. You're right to point this out, but I'm quite familiar with Sackett's standards for EBM.

    I hope that clears things up. I don't think we really disagree.
    Not really, but i'm picking nits.
    And since you're aware of these things, you must also be aware that not all clinicians use the S/EBM models.
    Clinical experience informs practice, heck, it is practice, and often there is no, or even contradictory evidence in the literature.
    Patient values may directly contradict science.
    Both of those inform, and shape practice in a S/EBM model.
    I'm not talking how one should, but how one does treat when using a science or evidence based model.
    Them's the facts.
  7. ChenPengFi is online now
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    Posted On:
    10/31/2013 6:45pm

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    --
    Hell yeah! Hell no!
    Here's a good read on spinal fusions and rampant financial corruption:


    Excerpts:
    More than 465,000 spinal fusions were performed in the United States in 2011, according to government data, and some experts say that a portion of them — perhaps as many as half — were performed without good reason.
    The Medicare agency every year audits a sample of the claims it has paid and determines how many of those have “medical necessity” errors. The agency estimated the amount of money spent improperly on spinal fusions was more than $200 million in 2011, for example, and most of that was because the treatment was deemed unnecessary, often because a more conservative course hadn’t been tried, officials said.

    How could this happen?

    The answer, in part, is that the Medicare system is not designed to discourage doctors from performing it, according to past and present Medicare officials.

    At a very practical level, the bureaucracy offers little incentive to weed out unnecessary treatment: Medicare hires contractors to issue payments to doctors, and those contractors are paid based not on how many claims they reject but on how many they approve.

    “The contractors are incentivized to efficiently process claims and not to accurately evaluate clinical effectiveness” of treatment, according to a paper by three former senior officials at the Medicare agency and one current one.
    (my bold)
    http://www.washingtonpost.com/busine...cd6_story.html
  8. ChenPengFi is online now
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    Posted On:
    10/31/2013 6:52pm

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    Hell yeah! Hell no!
    ...and while

    Patient Spending for Spinal Care in U.S. Has Nearly Doubled Over Past Decade
    yet

    ...Spending for spinal care provided by chiropractors also remained stable. Care provided by physical therapists was the most costly service throughout the study decade, but spending for physical therapy appeared to decrease over time...
    http://www.sciencedaily.com/releases...0905110857.htm
  9. ChenPengFi is online now
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    Posted On:
    10/31/2013 8:00pm

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    --
    Hell yeah! Hell no!
    And lest i get labeled an apologist:
    The following is a guest post by Preston H. Long. It is an excerpt from his new book entitled ‘Chiropractic Abuse—A Chiropractor’s Lament’. Preston H. Long is a licensed chiropractor from Arizona. His professional career has spanned nearly 30 years. In addition to treating patients, he has testified at about 200 trials, performed more than 10,000 chiropractic case evaluations, and served as a consultant to several law enforcement agencies. He is also an associate professor at Bryan University, where he teaches in the master’s program in applied health informatics. His new book is one of the very few that provides an inside criticism of chiropractic. It is well worth reading, in my view.
    Most chiropractors believe that spinal problems, which they call “subluxations,” cause ill health and that fixing them by “adjusting” the spine will promote and restore health. The extent of this belief varies from chiropractor to chiropractor. Some believe that subluxations are the primary cause of ill health; others consider them an underlying cause. Only a small percentage (including me) reject these notions and align their beliefs and practices with those of the science-based medical community. The ramifications and consequences of subluxation theory will be discussed in detail throughout this book.

    http://edzardernst.com/2013/10/twent...wont-tell-you/
  10. Shawarma is offline

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    Posted On:
    11/01/2013 1:20pm


     

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    Hell yeah! Hell no!
    Quote Originally Posted by Vieux Normand View Post
    This directly contradicts why you wrote in the very first sentence of post # 8. Yes, it does.
    I was actually being tongue-in-cheek, didn't really intend to spark any kind of major debate about what is and what is not alternative practice.

    Chiropractic is indeed usually considered to be alternative medicine. I just don't really practice in what could be called an especially alternative manner, don't deal with anything that cannot be addressed through Applied biomechanics, wouldn't know spiritual energy if it kicked me in the face and am very content to work within the scope of mainstream Health care and get referrals from local doctors, many of whom acknowledge that chiropractors simply see more patients with joint problems than they do and that they might have something to offer in the ways of both diagnosis and treatment.

    So if you'd like your asthma checked, I'd have to ask you to look elsewhere. Nobody I know in these parts practices like that.
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