But this time it was non-fatal. A patient came to see me. He’s middle-aged, generally quite healthy, and physically active. After a recent return to physical activity, his elbow began to hurt, so rather than call his internist, he visited a chiropractor. Not surprisingly, the back-cracker was unable to effect a cure. What did he do next? Asked his friend for the name of a “better chiropractor” (which is a bit like trying to find a better wrench to turn a screw). This one took a totally different approach to not helping the patient, but that damned elbow still hurt.
Like most cult medicine, there is little that chiropractic will not claim as their own. How tennis elbow could possibly be helped by back manipulation is beyond me. One website did, however, give some good insight:
Not always thought of as a “chiropractic” condition by patients, chiropractic’s conservative approach to elbow pain is often very effective, avoiding more invasive, risky treatment options.
An excellent example of “hurry up and do nothing”, which is not always bad advice, but is not unique to chiropractic. I guess when all you have is a hammer, and nails are notably absent, a wise chiropractor steps back and says, “abra cadabra!” I’m sure chiropractic cures the common cold as well—whereas the common cold, when left untreated, usually lasts a week to a week and a half, visit the chiropractor and your cold is gone in 7-10 days.
Anyway, I gave the guy a tennis elbow strap, told him to rest and ice it, and take ibuprofen if he needed it. If he’s patient and follows my advice, he’ll probably save a few bucks. A strap is usually covered by insurance, but cheap anyway. Ice is basically free. And a visit to me is about sixty bucks—and if he gets better, he doesn’t have to return for multiple “manipulations”.
March 15, 2008 at 2:47 pm
I had a hard time figuring out chiropractic when I had a herniated disc in my neck, which I dealt with for a few years. So many people told me to go to a chiropractor that I eventually did.
The stuff he did to my neck scared me, a lot, but it did also give me some relief, mainly not pain relief but increased range of motion that was really noticeable. I felt much better.
When I asked my actual spine doctor about it, she was loathe to tell me not to do it, but, when pressed, said that if she were in my shoes, she wouldn’t. (Well, some would say that’s not surprising, but, given the conflicting info out there, I trust doctors over chiropractors.)
Ultimately I had expensive, invasive surgery that worked great. Oddly, my surgeon was much more positive (before we made the decision to have the surgery) about chiropractic.
So I guess my question is this. I know that chiropractic is useless for colds, epilepsy, autism, or what have you, but is it useless for back troubles?
March 15, 2008 at 3:21 pm
Chiropractic manipulation for acute back pain may help one feel better. Acute back pain usually takes anywhere from 3 to 6 weeks to get better, provided one does not hurt the back again during the recovery period. Doing nothing will result in recovery in that time period, but the patient will suffer in the meantime. Drugs can help ease the suffering during this time, but is not as “touchy-feely” as chiropractic manipulation.
Manipulation may be as effective as drugs to ease the suffering during the 3 to 6 week period, however, this requires frequent visits.
In one study, patients were divided into a “drug group” and a chiropractic group. Both did about the same, but the patients who were manipulated were happier. There’s something more personal to this approach than pain meds.
The problem with chiropractic is that the hypothesis is flawed. They maintain that small (indeed sometimes undetectable) subluxations of the spine cause disease. This is not even a “theory” because there is no evidence for it. It is a failed hypothesis. Its successes depend on the placebo effect and the warm fuzzies people experience from the human touch.
March 15, 2008 at 6:22 pm
There is no doubt in my mind that chiropractic subluxation is a scam. I choose to save my money for time proven therapies like the Kinoki foot pads that suck all the bad stuff out of your body through your feet. It’s based on ancient Chinese medicine so it has to be true.
As soon as I get my $32 million deposited in my account from the widow of that Nigerian warlord, I’m going to buy some of those…
March 16, 2008 at 5:47 am
Tam,
It is well-documented that the only things chiros do, that work, are also offered by real health professionals. Browse through chirobase.org for a lot of information.
In some cases, even non-professionals can equal a chiro. For example, a chiro can be as successful as a masseur in treating acute, low-back pain. Howover, about 50% of chiro customers report short-lived discomfort after treatment; which is unlikely from a massage.
On the other hand, chiro neck manipulation can leave you seriously dead, or ‘merely’ paralyzed, from a stroke. There are articles on that at chirobase. There is also this excellent (42 minute) video http://ph-ms.ouhsc.edu/ah/rehab/kinsinger.wmv
In it, Dr. Kinsinger explains how the strokes are caused, and why physical therapists are not known to cause the same problems when they manipulate the neck.
At first, chiros all denied they cause strokes (it is said the only thing that unites chiros is opposition to criticism). As the data accumulated that they do cause strokes, the brightest of these dim bulbs said “But every procedure carries some risk.” However, there is no reason to undertake that risk when safer therapies are available. This, they cannot accept because neck manipulation is so profitable.
March 16, 2008 at 6:38 pm
This sounds definitely sketchy, but I was wondering, how would fake medicine practiced like this constitute “cult” medicine? Do you have a post explaining exactly what makes cult medicine cult-like?
March 16, 2008 at 7:04 pm
http://whitecoatunderground.com/2008/02/03/cult-medicine/
But I can elaborate if necessary
March 16, 2008 at 8:53 pm
I came up with quite a good analogy (I thought) of quackery over at Neurologica, that of the Emperor’s new clothes.
The emperor had no clothes. That a child said it doesn’t reflect the child’s superior wisdom, it reflects that the child didn’t self-sensor to appease those in power. The child didn’t go along to get along. The child didn’t pretend to preserve her ego. The child didn’t pretend so that her peers wouldn’t think she was foolish. The child didn’t pretend because all her friends were pretending too. The child didn’t pretend because she didn’t want to admit that she had been duped by quacks who had defrauded her.
The emperor did pretend. Pretending he was “wise” was more important than accepting the reality that he had been duped. He pretended because he didn’t want to admit that he had been duped and swindled by people who had massaged his ego. Duped by people who had appealed to his “special wisdom” as emperor. Duped by quacks who had appealed to his foolishness and who had shown him to be an ignorant fool. Just the way the quacks appeal to the “special wisdom” of parents. The parents of the child pretended the emperor had clothes too. The “special wisdom” of parents didn’t work for them either.
The person then responded that I was very offensive and that Dr Novella’s blog wasn’t “safe”. Right after saying her child had been diagnosed “mercury toxic” via porphyrins (pure quackery) and that there was still “substantial” thimerosal in childhood vaccines. I guess it struck too close to home. I feel badly that I am driving people away from Dr Novella’s blog.
I think it very much is like a cult, they try and suck you in by pulling all the strings that are attached to things that are important to you. When children are involved it is heart wrenching. But then the quacks don’t care.
March 16, 2008 at 10:37 pm
This is not true for everyone. I dealt with my problem (which is 99% gone now, after surgery) for four years. That said, it’s good for most people to know that neck or back pain doesn’t usually require invasive treatment.
Joe, yeah, I read about strokes. That combined with the intrinsic scariness of what the chiro did to me, and my doctor’s wariness, kept me from going back.
March 17, 2008 at 12:47 am
i may have mentioned this here or elsewhere already…
I lived next to a chiropractic college in whittier, and as such i could get free backwork, etc. Whenever i saw the people at that school, they never said anything about it being a miracle cure or anything. I had(might still have) a curvature in my spine of slightly less than what would be considered scoliosis. I often have really bad knots in my back, all over, that no well-meaning girlfriend can fix. The chiropractors that i saw in my teen years seemed to help me, overall, in my eyes.
Just recently finding out that it was a bunch of bull sort of felt weird. I do know that a kick ass massage makes me feel better than having a TENS unit and a crack go on - and i can usually get the massage for free. I dunno what the point of this is other than i was never aware of the “CAM” side of chiropractics… i just figured they fixed back issues, and when i had them work on me, it fixed my back issues.
I’ll never go to one again. I’m looking into finding out what forms of massage have the longest lasting effects - something that will eventually help my back not hurt constantly.
March 17, 2008 at 9:37 am
It is extremely disappointing to read how narrow minded your are regarding chiropractic.This form of medicine has saved my health and my life is much improved because of it.
You obviously have an ax to grind and your narrow mindedness has attracted a few. Not surprising — like attracts like. OR is this saying to controversial for you.
March 17, 2008 at 9:37 am
It is extremely disappointing to read how narrow minded you are regarding chiropractic.This form of medicine has saved my health and my life is much improved because of it.
You obviously have an ax to grind and your narrow mindedness has attracted a few. Not surprising — like attracts like. OR is this saying to controversial for you.
March 17, 2008 at 10:05 am
It’s not too controversial, but really, you only have to say it once.
March 17, 2008 at 2:38 pm
Did you know that the US Government has been closely looking at complementary and alternative medicine (CAM)? In fact there is an entire department over at the NIH ( national institutes of health) that do nothing but study CAM. The white house has a special commission that has been tasked to Study CAM as well. Chiropractic used to be a part of this conversation, but to my surprise we have been slowly leaving the CAM discussion for the past 7 years. This trend started back in 2001. See below:
Archive
WHITE HOUSE COMMISSION
on
COMPLEMENTARY and ALTERNATIVE MEDICINE POLICY
Meeting Topic I:
CAM: Understanding Coverage and Reimbursement
and
Meeting Topic II:
CAM: Research Challenges
Volume I
Monday, May 14 2001
8:00 a.m.
Excerpt
Dr Alen Korn:” I would like to clarify that the Association does not consider chiropractic services to be complementary or alternative for the purpose of this statement. I believe that chiropractic has become a stakeholder in the politically dominate health system of the United States. The NIH Office of Alternative Medicine defines complementary and alternative medicine as healing resources outside the politically dominant system.”
MR. PIZZORNO**: Dr. Korn, you made a very provocative statement that I would like you to address further. You said you do not consider chiropractic part of CAM anymore, that is part of the dominant health care system at this point. Why do you think that and what was the transition that chiropractic went through?
DR. KORN*: The chiropractors have gone through a very painful transition and one that I would wish none of you would have to do. It is obviously a very complex topic that I will try to summarize at a very, very high level.
What we have observed over the past many years, four or five really, and we have really actually come to understand quite clearly through some direct discussions with the American Chiropractic Association, is the profession has evolved in a way that we find to be quite intriguing.
They have now adopted in large measure a collaborative model of care, in which what the chiropractic community offers is merged with what the allopathic and osteopathic communities offer. And you have a unique opportunity we see here in blending all of the science often rendered by physicians, who sort of stand behind a medical record, it gets between them and the patient, and another body of physicians, and that is how chiropractors are defined in most states, who really are very expert in hands-on care, nutritional counseling, lifestyle things. What we have observed, the data would suggest that with that kind of an approach, patients are far more likely to change their behavior, to not smoke, to lose weight, to exercise, to eat properly than being told to do so by someone sitting on the other side of the desk, writing a progress note in a allopathic office.
So, we could talk a great deal more about it, but we have become impressed with the contribution that that model of care has in the global picture. Again, that is overlaid on a long history and many other things, but that is why, at this point, it probably makes sense to put them outside of the CAM circle.
** Joseph E. Pizzorno, Jr., N.D., appointed by President Clinton in December 2000 to the White House Commission on Complementary and Alternative Medicine Policy and by President Bush¹s administration to the Medicare Coverage Advisory Committee in November 2002, is one of the world¹s leading authorities on science-based natural medicine.
Allan Korn, M.D., is Chief Medical Officer and Senior Vice President for Clinical Affairs for the Blue Cross and Blue Shield Association (BCBSA), a national federation of 39 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide healthcare coverage for more than 99 million – nearly one-in-three of all Americans.
So, There you have it according t the chief medical officer of blue cross blue shiel chiropractic is no longer “alternitive” But rather part of the “mainstream.”
March 17, 2008 at 2:47 pm
Blood pressure and Chiropractic
Did you know that getting your neck adjusted and lower your blood pressure. Yes, it’s true according to a recent study that is published in the Journal of Clinical Hypertension (volume 8 number 5 May 2006) researchers found that anatomical abnormalities (subluxation if you are a chiropractor) of the cervical spine at the level of the Atlas vertebra are associated with relative ischemia of the brainstem circulation and increased blood pressure. Manual correction of this Mal alignment (subluxation) has been associated with reduced arterial pressure. This pilot study test the hypothesis that correcting Mal alignment of the Atlas vertebra reduces and maintains improved blood pressure. In the study and 50 patients that were not taking medication and suffered from stage I hypertension were evaluated using randomized, double-blind, placebo-controlled study design at a single center. Patients received no medication during the eight week study session. After baseline measurements of their blood pressure were taken they received chiropractic adjustments or a sham procedure. Considering that the technique performed was (NUCCA) it is difficult or impossible for the patient distinguish between a real chiropractic adjustment or the sham procedure. Statistical analysis performed comparing the baseline and eight week visits. The study demonstrated an 8/5 mm reduction in pressure at eight weeks over the placebo (sham adjustment) group. In other words, a patient that had a blood pressure of 147/92 at the end of the week study had a blood pressure of 130/82 and the only treatment received was chiropractic adjustments to the cervical spine.
March 17, 2008 at 3:36 pm
[...] by PalMD under Cranks and Quacks, cult medicine, health, medicine, woo A recent commenter advocated quite voceferously for chiropractic, specifically citing its supposed benefit in hyertension, one of the leading causes of morbidity [...]
March 17, 2008 at 4:27 pm
I would like you to comment on #14
March 18, 2008 at 6:31 am
@ Peter
As you are already aware, post #14 has been fully commented on here:
http://whitecoatunderground.com/2008/03/17/chiropractic-and-hypertension-uncracked-potential/#respond
March 18, 2008 at 9:43 am
Peter, your discription of the patient population is disingenuous. The patients did have anotomical abnormalities. The vast majority of patients with hypertension don’t have anotomical abnormalities. To imply that chiropractic will lower blood pressure in these patients is unwarrented extrapolation with no basis in known physiology.
March 18, 2008 at 10:48 am
“To imply that chiropractic will lower blood pressure in these patients is unwarrented extrapolation with no basis in known physiology.”
So then we should not explore anthing that is an unknown? Did you bother to read the study? Can you be certian without a shadow of any doubt that you know every physiological process? Its funny to see you guys so threatened by a study that was published in a medical journal.
March 18, 2008 at 11:05 am
OK I would like someones take on #13.
March 18, 2008 at 4:21 pm
Sure, I am all for doing research and exploring the unknown, but if you are going to experiment on humans, you need to adhere to the Declaration of Helsinki.
http://www.wma.net/e/policy/b3.htm
March 18, 2008 at 4:31 pm
How does this not adhere to the Declaration of Helsinki.
April 2, 2008 at 7:49 pm
It’s good to see doctors advertize their arrogance and stupidity online. That way, you can google your doctor (Dr. homo-fegele??) and realize what a complete ass he is, and schedule a appointment with someone who isn’t arrogant over his own outrageously limited knowledge. I’m sure you’d be just as arrogant if this was 100’s of years ago and you were practicing bloodletting, trepannation, or any of the other travesties that have been called medicine in the past.
You practice the same kind of travesty on your patients, and future developments will prove that just about everything you’re claiming as solid truths are complete lies. Just as every central truth of medicine in every era has proven to be completely wrong.
In particular, you sent a patient away with a “splint” … the reality is that this kind of joint, ligament or tendon pain, tendonitis is a HALLMARK SYMPTOM OF LYME DISEASE.
But we already know what kind of doctor you are… you’ll send away a patient with a potential infectious disease,the %1 vector based infection in the world today, and you’ll arrogantly send this patient away in a splint with a bogus “tennis elbow diagnosis”. This is for a disease that has shown to be present in 25% of the population of Sonoma County (an example area, considered non-lyme-endemic… and 1/4 people surveyed have serological evidence of borrelia….)
There’s plenty of chiropractor/naturopaths that have diagnosed lyme in their patients using an entirely valid intuitivist approach to medicine that has worked for millenia (c.f. ayurveda). Such a doctor performs a higher form of healing than your regular back cracker… and in many cases I know of personally, the infectious “diagnosis” made by a naturopath end up being valid and these patients test positive for Lyme and receive correct long-term antibiotic treatment for the disease and it’s coinfections.
I much trust intuitivist medicine over arrogant doctors like yourself. At least they direct us to the correct medical specialists, bypassing arrogant “gateway” docs like you… there just to block any potential of actual diagnosis and healing… saving insurance companies lots of money by blocking access to specialists and purposefully misdiagnosing complex diseases.
Hopefully if your tennis-elbow misdiagnosis figures out what’s actually wrong… he’ll sue your arrogant ass for causing “treatment delay”.