Calling All Evidence Based Chiropractors

If YOU are a chiropractor, or KNOW a chiropractor, who feels they use science and evidence based chiropractic, PLEASE pass this request along to them. If you know a chiropractor who DOESN’T practice evidence based chiropractic, pass this along to them as well!

I’ve spent the last month on general internal medicine in a rural community. Driving around this particular community what strikes me is just how many chiropractors there are! I’ve seen 4 offices for primary care doctors – either DO or MD, and 10 for chiropractors. Many people appear to be using chiropractors as their PCPs. Needless to say I have a problem with this. Below, I have some questions for these or any other chiropractors who would be willing to take some time to answer.

Over the course of the month, I’ve seen 3 patients who said their previous PCP was their chiropractor. In all 3 cases, the patients had blood pressures over 160/100 (that’s what we call “bad”). In all cases, the patient said their chiropractor suggested no medications, and did not recommend that the patient see an MD or DO for their blood pressure. None of the patients (2 men, 1 woman) had had the basic screening and health maintenance procedures or exams that we would call very important – pap smears, mammograms, digital rectal exams, colonoscopies, repeated blood pressure measurements for example.

One of the patients said they had been receiveing chiropractic manipulation for their allergic rhinitis. They claimed that the manipulation in question involved their low back and hips, and that the chiropractor said that their allergies were related to the curvature of their spine. I understand that patients often misunderstand explanations given to them, so I’m assuming something got lost in translation there.

If you are a chiropractor, can you explain your brethern’s clinical practice in these situations? Answer as many or as few as you feel comfortable doing so, this is not a trick and I will be VERY forgiving in my comments of any chiropractor who ventures into this potentially hostile territory. Below is a list of specific questions.

  1. Do you think chiropractors are prepared to be primary care providers? If so, why?
  2. What is the scope of practice of a chiropractor? That is, what conditions can you treat? What procedures and other actions are you comfortable, and licensed to provide? What special training do you require to provide these services?
  3. What kind of process does your profession use to decide if a new action or procedure is worthwhile, and discard those actions that are unacceptable, while promoting those that are good? That is to say, how do you separate the wheat from the chaff?
  4. Outside of treatment for low back pain, what conditions do you feel there is scientific evidence that chiropractic is useful?
  5. What is the chiropractic basis of spinal manipulation as a treatment for allergic rhinitis? If there is no such basis,  is there a procedure to censure a chiropractor falsely claiming that there is such a basis, and charging patients for such manipulation.

And finally

    6.    What is the basis of chiropractic, is there still a vague belief in “innate intelligence”, or is there now a theory that is consistent with our knowledge of anatomy and physiology? If there is any such theory, is there any basic science study that backs this up?

I welcome your responses in the comments, or if you’re uncomfortable with that, via email, my email can be obtained from the contact page on the sidebar.

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14 Comments on “Calling All Evidence Based Chiropractors”

  1. MXH Says:

    Good questions. I looked up the “scientific” evidence for using chiro to treat otitis media (heard a patient talking about it recently) and here’s what I found. The studies are either not studies, case studies of a single patient, or have no controls.


    • I’m familiar with that page, I was considering debunking it a while ago, but there are adequate corrections elsewhere.

      They also cherrypicked the positive evidence only, and ignored larger studies on chiropractic for AOM that were negative.

      Incidentally, hows third year man? I’ve been checking your blog for updates!

      • MXH Says:

        yeah, i just assumed chiro.org would have the best “evidence” for their methods. 3rd yr is going pretty well, i’ll have an update up soon.

  2. Katherine Says:

    Ooh Whitecoat Tales, you’ve given me a sign that everything is going horribly wrong to watch for in my country. When I see more of any single alternative medicine practitioner than GP’s offices, I’ll start to worry 🙂

    Now I’ve got to figure out whether my friend still needs to visit her chiropractor (she goes once every 2 weeks, and could well use the money for something else, but it is for her back pain…)


  3. Obviously, none of you live in California, the center of the woo-universe. You can’t throw a rock in LA and not hit a woo office front.


  4. What are you trying to say about chiropractor? Chiropractic treatment is a professional job. It treats people who feel pain.


    • The evidence is limited at best that chiropractic helps for anything. However I’m not averse to chiropractors sticking to their actual training areas of attempting to help low back pain.

      I DO object to chiropractors acting as primary care physicians, because they do not have the training to do so.


  5. an attractive question that can normally see who is truly a chiropractors practitioners and those who are fake just to have money in it.

  6. Emily Says:

    I am not a chiropractor. I have been a patient and this is a response to try to help you gain a better understanding of some of the fields of medicine you do not seem to know much about.

    I went to a chiropractor that served as my primary care doctor a couple years after I was in an accident. I had fallen off a cliff a couple years before. I broke my back, broke a couple ribs, broke my coccyx, broke my collarbone, fractured my skull and took a chunk out of one of my legs. I very much appreciate the surgery that was performed on my back.
    However, I was exceedingly disappointed with my medical care outside of my surgery. I went to a wide array of specialists and primary care doctors that were of absolutely no help to me. They kept giving more medications when I was looking for medical care and not to be poisoned. I spent two years of my life not sleeping more than eight hours a week, losing weight, vomiting, having shortness of breath, having severe headaches almost constantly, feeling like my vaginal area was constantly being cut by razor blades, feeling like I had to pee constantly and having a number of other medical issues. I wasn’t able to read because my vision would blur tell all I could see was gray.
    I asked for logical advice from my doctors, but was always met with prescriptions instead. I expressed multiple times to my doctor that I thought my medications were hurting me. He would up my dosage every time I said that and one day he told me, “I don’t think you could live without your medications.”
    I had to take myself off my medications against his advice. It is the best thing I ever did. All the medical issues I had been told I would have for the rest of my life went away after I stopped my medications and stopped going to see MDs. I don’t go to see MDs anymore. I am absolutely disgusted with the state of medical care in our country.
    I had a chiropractor I would go to. I got logical advice that contributed to my current state of good health.
    A strong understanding of the physiology and structure of the human body is extraordinarily important. My current chiropractor adjusted my coccyx. My skin used to wear away due to the position of my tailbone. My tailbone was at a 90-degree angle from where it should have been. My urinary and vaginal muscles were constantly contracting. It was very painful. I had asked MDs what I could do about it. They told me I could get surgery on my tailbone, but that it probably wouldn’t help.
    Not one doctor suggested that I go to a chiropractor. My current chiropractor adjusted my tailbone. I can no longer feel a hard lump intersecting into my vaginal canal. I no longer have to live with the pain and discomfort.
    I had rectal bleeding because I had been on a large dosage of opiates for so long. I would not have bowel movements more that once or twice a week. I could not use the suppositories that my MD doctors suggested that I use, because it burned too much. I had to manually remove fecal matter out of desperation, but my MD doctors thought it was in my best interest to continue taking the medication that was doing this to me or at the very best just wouldn’t help me reduce the medication at a safe rate.
    Anyway, my chiropractor suggested that I go to see a naturopathic doctor that specialized in the GI track. He was so helpful. He told me how I should adjust my diet; told me how I should treat the 5 hemorrhoids and 1 fissure I had; and made sure I was fully aware of my medical situation.
    I had tried to go to see an MD about the issue after I was not on medications anymore. He examined the area without proper precautions and caused further damage. He didn’t instruct me on how to attend to the injuries and suggested I have a medical procedure preformed that he should have know was inappropriate based on my injuries.
    I am a healthy twenty-five year old woman. I owe this to the surgeons, chiropractors, naturopathic doctors, physical therapists and nurses that helped me. I have spent the last year taking a load of credits comparable to any medical school at colleges, because of the help I received.
    I just started going to school to be a naturopathic doctor, because after what I went through I can’t ethically decide to go to school to be an MD because I know that our country has more than enough MDs and not enough NDs. If someone really wants to be healthy and is willing to do what it takes to regain their health or keep it, chiropractors and naturopathic doctors can help.
    I know what matters is what works. We are physical bodies and I am disappointed in the short sightedness I have observed on the part of conventional medicine. No doctor can ethically give patients something that they know will give patients a false sense of comfort while wearing down their bodies. I hope you will make sure to come out of school determined to be a good doctor and not a drug dealer. I’m sorry this comparison might seems harsh, but when I think of the care I have seen given by so many doctors I can’t help but think of many of them this way. It is sad, because people go to medical school so they can help other people. Naturopathic medicine is important. A strong knowledge of nutrition, physiotherapy, noninvasive care, physiology, anatomy, pathology, immunology, orthopedics, gynecology, gastroenterology, proctology, and so much more should be prerequisite to being a doctor. I’m not going to list out every organ system, but naturopathic doctors learn about all of them.
    Not only should a doctor have to have a very strong knowledge in all these areas, but also a doctor should be trained to discuss all of these topics with patients in an easy to understand manner. Naturopathic doctors are trained to do this. I don’t know about homeopathic remedies, because I haven’t taken a class on it and I’ve never had a naturopathic doctor prescribe one for me. In addition to the topics I’ve listened, naturopathic doctors do undergo more training on how to discuss people’s lives with them. This is so they can help them manage their personal lives in a manor that supports them in being healthy. This is very important. Often, people are surrounded by people with bad habits. These habits may be as simple as a bad diet or as horrible as a methamphetamine addiction. It is not as easy for the actual patient to deal with a real life situation when they have no one to turn to for advice that they can feel has a real understanding of their physical and environmental state. You can tell a patient to do something, but if due to you not knowing their limitations they can’t do what you say what good is it?
    In addition, naturopathic doctors do take more classes that deal with their own emotional maturation than MDs do. There are plenty of young things that are able enough to get out of medical school with all the information their curriculum promised them, but if they aren’t mature enough to handle situations with real people they can do a lot of damage. I know a lot of people have ideas on what naturopathic doctors or chiropractors do that is not based on facts. I hope you strive to be aware of all the types of doctors that are out their that could help your patients in one way or another. What is important is that your patients either stay healthy or get better. Don’t put blinders on just because it’s socially acceptable. I’m glad you took the time to right some questions to try to explore chiropractic medicine. However, in your disclaimer you say, “ Always check with your doctor (your MD or DO doctor, not your naturopath, your accupuncturist, your chiropractor, or your PhD) before taking advice from someone on how to manage your health”. You are entitled to your own opinion, but your not exactly inviting the professionals you are down playing to take a further look into your blog. I don’t understand how you would reason that chiropractors would take the time to go to your postings about their profession when you judge their careers without knowing anything about what they do. If I based my opinion of MDs solely on what I have seen I would say that most MDs are quacks. Don’t think, that since some of your patients that have gone to see chiropractors are not in optimal health, that chiropractors are unnecessary. Take the time to examine what really happens. Remember what really happens isn’t what is written in articles in medical journals when the data was cherry picked and financially backed by corporations that stand to get large quantities of money if doctors decide to prescribe the medications they are selling. There are not nearly as many studies done on naturopathic, chiropractic and acupuncturist techniques because no one stands to make large quantities of money from these types of treatments. There is some data though. I am going into naturopathic medicine, as opposed to allopathic medicine, because I know naturopathic medicine works. I’m unlikely to ever make as much money as a MD. I’m going to be in as much debt when I get out of medical school as a MD would be in. There is a lot you could learn if you broadened your scope of thinking. I just want to give you just a tidbit about acupuncture. It is just logical to think that if you surround an area, that needs attention from white blood cells, with sterile needles that it will increase blood flow to the area and therefore the quantity of white blood cells that could move into the tissues that need attention. There is a lot more to know about acupuncture. I wish you knowledge in your career and the medical professions that surround you.


  7. Calling all evidence based MD’s
    Are you truly ready to cast that first stone? Your profession gives out antidepressants that have been shown to be no more effective than sugar pills, MD’s perform arthroscopic knee surgeries that have worse results than sham procedures and I could go on about toxic chemotherapy drugs that destroy quality of life for a 2% increased rate in survival and many other medical procedures.
    Conservative estimates say that medical malpractice kills over 150,000 people a year making medical doctors the 3rd leading cause of deaths in this country.
    In 2008 the CDC announced that the infant mortality rate is better in 28 other countries.
    As a chiropractor I see many patients who have been injured in auto accidents. If they have been to hospital before seeing me I ask them about the exam they received by the MD and it is usually described as being cursory at best if not a complete joke. I have a patient who was sent away from the hospital with a broken back. His MD then missed it in-spite of taking X-rays. It was only when he went to his chiropractor that he properly diagnosed.

    So I guess I am saying maybe you should ask some question about your own own profession before questioning ours. One only needs to look at the malpractice premiums to see where the damage is being done. (or maybe compare the chiropractic bill to the hospital bill if you are wondering where people might be getting ripped off)


    • I’d have replied sooner but I wrote this post almost a year ago…

      Calling all evidence based MD’s

      Tu quoque

      Whether or not MDs are evidence based has nothing to do with whether or not chiropractors are evidence based, and more importantly, whether or not chiropractors are at all prepared to be primary care practioners.

      That being said, MDs are far more evidence based than chiropractors. We abandon practices as evidence mounts that they don’t work. You’ve failed to abandon a guiding principle upon which you’ve based practice after practice, despite the utter lack of evidence at the foundation of your ideology. Please note, ideology.

      Whereas medicine is an ever changing body of applied science, chiropractic is an ideology, and/or an article of faith.

      Your profession gives out antidepressants that have been shown to be no more effective than sugar pills

      False. There are SOME studies that have shown antidepressants aren’t useful in SOME populations. Put another way, antidepressants aren’t a cure all. If you have severe depression, you should have an SSRI, no study of good methodology and large numbers disputes this. If you have mild depression, it may not help – the jury is still out, large trials have weighed in both ways.

      MD’s perform arthroscopic knee surgeries that have worse results than sham procedures

      Citation needed. You can find a study that has shown SOME arthroscopic knee surgeries are unnecessary. Oddly enough, that’s a good thing. We show these practices aren’t useful, and then we phase them out! What practice can you chiropractors say you have shown to be useless and removed from your practice? Anything?

      and I could go on about toxic chemotherapy drugs that destroy quality of life for a 2% increased rate in survival and many other medical procedures.

      You COULD go on. But you’d be wrong. Lots of people are alive, and have lived fulfilling lives because of cures from chemotherapy. Because of chemo, many diseases that were once death sentences are now manageable diseases. Your random number of 2% is infact BS. I can find no such number in the literature. It’s not even a misattribution. It appears to be an entirely made up number.

      Conservative estimates say that medical malpractice kills over 150,000 people a year making medical doctors the 3rd leading cause of deaths in this country.

      Incorrect. “Conservative estimates” is wrong, this is the wildest estimate. Also, it’s not about malpractice, it’s about nosocomial and iatrogenic causes of death. This is a number we strive to reduce every day.

      However using this as an argument against medicine is simply silly. Consider how many of these patients would have been alive at all without modern medical care. Consider how many of them would have been alive if they’d just have had chiropractic care.

      In 2008 the CDC announced that the infant mortality rate is better in 28 other countries.

      I agree! This is the first statistic that you have properly quoted. However, you’ve failed to interpret this statistic. WHICH infants are dying? Infant mortality is highest among those children without access to medical care. Among the uninsured, the underinsured. Among the poor.

      Most sources generally agree this statistic can be attributed to inequalities in access to medical care – an artifact of our current insurance system.

      As a chiropractor I see many patients who have been injured in auto accidents. If they have been to hospital before seeing me I ask them about the exam they received by the MD and it is usually described as being cursory at best if not a complete joke.

      Ah, and your patients have some way of evaluating the medical exam they’ve received do they? And you have a way of evaluating by report the exam a patient received without seeing it? Are you also psychic?

      I have a patient who was sent away from the hospital with a broken back. His MD then missed it in-spite of taking X-rays. It was only when he went to his chiropractor that he properly diagnosed.

      Who diagnosed this broken back? A chiropractor? I’ve never seen a study showing that a chiropractor is capable of diagnosing a broken veretebrae on X-ray. Infact, I’ve seen multiple studies showing that chiropractors cannot agree on what a given x-ray shows, no inter-rater reliability. It’s very difficult to catch broken veretebrae on plain film x-rays, one of the many reasons CT scans are ordered so often in cases of back pain.

      So I guess I am saying maybe you should ask some question about your own own profession before questioning ours.

      I do! Every day! All over this blog! I’ll question any bad medical practice, regardless of who is practicing it. I don’t discriminate.

      One only needs to look at the malpractice premiums to see where the damage is being done.

      Ha! That’s a funny one. So malpractice premiums mean doctors do a bad job do they? Or do they mean that we live in a litigious country and that juries maybe aren’t capable of judging complex medical decisions.

      (or maybe compare the chiropractic bill to the hospital bill if you are wondering where people might be getting ripped off)

      I’m going into emergency medicine. I’d love to have you come to work with me and see how many of my patient’s you could treat. Because if pressing on the backs of gunshot victims, cancer patients, septic patients, and people having heart attacks worked, I’d do it! If pressing on someones back would bring their blood sugars under control, I’d do that too!

      Sadly, that doesn’t work. Since a large portion of the cost of medical care comes from chronic disease management, and care at the end of life, your chiropractic bill tells us nothing about how to solve the problem of healthcare costs.


      • You accused me of being vitriolic (in an email), but please note that I did make personal attacks such as “are you psychotic?” or inane remarks like “I’d love to have you come to work with me and see how many of my patient’s you could treat. Because if pressing on the backs of gunshot victims, cancer patients, septic patients, and people having heart attacks worked, I’d do it!” I am not, nor do I want to be trained in emergency medicine. And no sane chiropractor would be “pressing on the backs of gunshot victims, cancer patients, septic patients, and people having heart attacks worked”

        In any case here are sources and citations for the statements that you incorrectly shot down.

        A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee
        J. Bruce Moseley, M.D., Kimberly O’Malley, Ph.D., Nancy J. Petersen, Ph.D., Terri J. Menke, Ph.D., Baruch A. Brody, Ph.D., David H. Kuykendall, Ph.D., John C. Hollingsworth, Dr.P.H., Carol M. Ashton, M.D., M.P.H., and Nelda P. Wray, M.D., M.P.H.
        http://content.nejm.org/cgi/content/short/347/2/81

        Here are studies for “Your random number of 2% is infact BS”
        http://www.ncbi.nlm.nih.gov/pubmed/11869577?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

        and yes for some groups the absolute increase in survival was as high as 11% but for others it was 2%

        This study shows that new drugs can add a few % to the 2%
        http://www.biij.org/2007/1/e12/abstract.asp?ID=144

        You wrote “Incorrect. “Conservative estimates” is wrong, this is the wildest estimate.”
        I do stand corrected just because the cause is iatrogenic (induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedures) does not make it malpractice. However: Starfield B. Is US health care really the best in the world? JAMA
        2000;284(4):483-5.
        estimated the number at 225,000 deaths a year.

        And I have seen MUCH wilder estimates out there.

        You said “I’ve never seen a study showing that a chiropractor is capable of diagnosing a broken veretebrae on X-ray.”
        I am sorry you feel you need a study for that. Chiropractors do get 360 hours of radiology in our core curriculum.

        And by the way those jurors who aren’t so capable are you, me, your readers, and our patients.

        I may be incorrect but based on our correspondence so far you seem to be only interested in winning this argument and proving your already made up mind so I see no point in continuing on.

        Cheers


  8. Not sure why your comment was initially moderated. Will attempt to respond more productively later this week.

  9. John Wernz Says:

    I appreciate the “beyond the short coat” author’s genuine concern and desire to help all of us achieve whatever goals that you have that have taken us to where ever we are as a nation today in terms of health, happiness, and our current political / economic situation. I appreciate your literary efforts to continue things as they have been in spite of efforts by those not of your persuasion to modify them. Overwhelmingly as a Chiropractor I have found all the patients that have previously been to Medical Doctors,… I’ve then had to try to fix…to have been been (by their Medical Doctors) to only have gotten the very best medical examinations, evaluations, tests, treatments, etc. …and always only for reasons for the good of the patient, nation, and humanity… and never for financial, insurance, or legal expectations. Medical Doctors, on average, have reduced their fees, extended their office visit times with each patient, and have driven smaller cars, bought inexpensive houses, and taken fewer exotic vacations … than Chiropractors or other alternative practitioners, because they are inherently more ethical, intelligent, harder working, and altruistic; than the generally unappreciative and ignorant masses of humanity that might want to express a misguide freedom of choice in what practitioner they want to go to.


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