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Re: Chiropractic madness!!!!!!!!!!!!
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Re: Chiropractic madness!!!!!!!!!!!! - March 14, 2002 11:46:00 AM
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Andrew M. Ball MS MBA PT
Posts: 271
Joined: September 30, 2001
From: Chapel Hill
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Diane,
Qualitative Research and Quantum Research are the same thing, only the term Quantum Research has (until recently) generally commanded more respect among traditional Quantitative Researchers.
Traditional Quantitative Research (RCT's, multiple baseline studies, ABA studies, etc.) genrally try to find the effect of one or more independent variables upon one or more dependent variables. The idea of "cause and effect" is pivotal to Quantitative research. That's why "Quant Jocks" are so concerned with randomization of subjects and controlling variables. They want a sterile environment to examine cause and effect.
To a Quantum/Qualitative researcher, the problems with the creation of a sterile environment are many, but of greatest importance for this discussion are the facts that the sterile environment often looks nothing at all like reality (e.g. How many times have you looked at a research article and said, "That's nice, but that's not how we actually do things in the clinic?"), and furthermore, Quantum researchers recognize the "isufficiencies" (not my words folks, that's actually, I think, Einstien), of being able to control all variables in a Newtonian (Qualitative Study) . . . the ones you KNOW about are hard enough to control for, not to mention the ones you don't.
Quantum/Qualitative researchers, therefore, do attempt to test yet another hypothesis of a cause-and-effect relationship of known variables, but rather will begin with the idea that not all independent variables are known, and that they must be exposed before any meaningful quantitative analysis can occur.
A common complaint of quantitative researchers is that qualitative results cannot be generalized to larger populations. Not only is this assumption not entirely true, it misses the point, of qualitative research. Qualitative research is not concerned with generalization to larger populations as it is to different samples, settings, and situations as much as describing situations, cultures, events, and in so doing, GENERATING questions to be tested quantitatively. There is therefore no need to control and measure the effect of unknown variables through traditional tools of random sampling, large sample sizes, precision measurement, and sophisticated statistical analysis because no attempts are made to test a hypothetical cause-and-effect relationship.
This is not to say that Quantum studies have no threats to validity. The closest approximation of threats to the validity qualitative research, surround the issues of reflexivity, positioning, and triangulation of data.
Reflexivity refers to the influence that the researcher's background, bias, and line of questioning will have upon the participant during interviews. This not a limitation of qualitative research per se, rather a situational variable of which the qualitative researcher must be aware.
The only truly limiting factor of this type of research is that of position. Positioning (or more to the point, positioning mismatch) is a problem when the gender, class, ethnicity, sexual orientation, age, experience, and/or disability, of the researcherand participant are different. Upon write-up, of a good qualitative study, there should be a very detailed description of the purposeful sample including relevant demographic information, taking care to point out differences in gender, class, ethnicity, age, experience, and education of study participants, from that of the examiner.
The reliability and validity of the data will be enhanced through data triangulation, including systematic recording of interviews, physical artificts that support ideas and themes (e.g. if someone claims to be sad and crying, is there a wet and used tissue to support the claim?) and a logical consistency in interpretation, as described by DePoy and Gitlin.
In summary, quantum/qualitative research completes the circle of research by aiming to, "describe the experiences of people in particular settings and to understand their perspectives. Its purpose is also to develop hypothesis, concepts and theory." It is guided by three underlying assumptions. First, human behaviors extend beyond the observable and incorporate subjective meanings, values, and perceptions that are difficult, (if not impossible), to quantify. Second, actions and ideas can only truly be understood from within the physical, economic, and socio-cultural contexts in which they exist. Third, people (including researchers using any methodology) interpret realities differently due to past experiences. There are therefore no objective truths . . . but the culture and experiences of a group described and compared to that of another group. It's then up to the researcher to test, by subsequent quantitative study, the hypotheses generated from the qualitative study . . . or more to the point --- pave the way for someone else to do that.
Drew
P.S. NUD*IST is the Quantum equivalent of SAS, SPSS, or JMP. It is a Trademark of QSR, and stands for Non-numerical Unstructured
Data* Indexing, Searching, and Theorizing. I thought I'd clear that up for a few RehabEdge members who got excited about purchasing a "NUD*IST in a box." LOL!
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Re: Chiropractic madness!!!!!!!!!!!! - March 14, 2002 5:26:00 PM
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Diane
Posts: 1507
Joined: March 9, 2001
From: Vancouver, B.C., Canada
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Drew,
Thank you for your thorough and considerate reply.
I'm thinking that quantum or qualitative research is a lot like clinical reasoning then...
Each person is a set of variables that one can never define completely. One can only really generate more questions, in the midst of solving problems.
Each treatment encounter is a unique event, with an outcome that we might hope has something to do with us, and our intervention, but may have something to do with lots of other things as well...
And the more we study the "sample of one", the more we learn about that person, and the more we can tailor our own set of personal variables to match up with the ones needed by our patient.
Is this thought on track with what I think you are describing?
Diane
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Re: Chiropractic madness!!!!!!!!!!!! - March 14, 2002 7:43:00 PM
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Andrew M. Ball MS MBA PT
Posts: 271
Joined: September 30, 2001
From: Chapel Hill
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Sort of yes, but not entirely.
Qualitative research is not the same thing as clinical experience, nor single-subject research, though it does recognize that it's hard, if not impossible to identify all independent and contaminating variables upon the cause and effect relationship being tested.
There are several types of qualitative research. One type tries to describe a culture of individuals (ethnographic), another tries to describe a phenomenon (phenomenologic), and still another tries to generate hypotheses (grounded theory). Single subject studies are something different. They are usually attempting to quantify a lot of results and outcomes in a single subject, and furthermore, data is not saturated with but one person (read on for a definition of saturation).
Observation of a treatment encounter, therefore, would simply be one piece of non-numerical data. The information obtained would have to be triangulated with multiple encounters with multiple subjects until the data was saturated (no new themes or concepts emerged with subsequent observation) and checked for reflexivity and positioning (which are threats to validity of a quantum study).
You've got the critical piece though . . . "Each treatment encounter [or more accurately, each treatment outcome] is a unique event, with an outcome that we might hope has something to do with us, and our intervention, but may have something to do with lots of other things as well..."
The "sample of one" concept, however, is a single-subject design that is usually quantitative, not qualitative in nature.
One of the best books on the subject, is "Using Qualitative Research: A Practical Introduction for Occupational and Physical Therapists," by Whalley-Hammel, Carpenter, and Dyck. Domholt also has a nice section on the subject.
Andrew M. Ball, PT, MS, MBA
PhD Candidate
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Re: Chiropractic madness!!!!!!!!!!!! - March 14, 2002 10:14:00 PM
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Diane
Posts: 1507
Joined: March 9, 2001
From: Vancouver, B.C., Canada
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Thanks again, Drew...
For the further clarification. And you mentioned something else that caught my eye, the idea of "clinical artist."
I like how "clinical artist" encompasses:
1.) attention one must pay to detail,
2.) how that detail relates to the whole, and
3.) how the whole must relate back to the
world within which it is embedded.
Same as any artist doing any sort of art. Also "clinical artist" suggests that what we strive to do can perhaps contain an element of beauty or elegance. (Something that is more kinesthetic than visual or auditory, but sensorialy pleasing to both artist and participant in the art.)
Bye for now,
Diane
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Re: Chiropractic madness!!!!!!!!!!!! - March 17, 2002 9:06:00 PM
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ChiroGuy
Posts: 63
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From: Toronto, Ontario, Canada
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Hey everyone,
Seeing as we're moving our discussion away from "Chiropractic Madness" and towards research methods, I thought I'd incorporate the two and possibly get a new line of discussion going (not that the recent stuff hasn't been interesting!).
One of the biggest criticisms the chiropractic profession receives (often without foundation) is that we follow dogmatic reasoning rather than evidence based medicine when treating patients. Although there is some truth to this statement as there is still tons of research to be done on many of the therapies we provide, many chiropractors find it downright frustrating that we seem to be held to a higher bar than Western medicine. For instance, although cervical manipulation is significantly safer than taking NSAIDS for similar pain conditions (even according to critics' most horrifying and ridiculous claims of incidence), medical doctors seem to love going to the media with a “new expose” on the evils of chiropractic care on a regular basis. Of course, the media is happy to oblige and sell papers with unfounded claims of death and quackery.
The complaint I have is not that chiropractors are held to a high standard for providing safe and effective care, but rather that our counterparts often seem to be immune to similar criticisms. To stimulate debate, I will point everyone to a recent article about “The need for ‘Evidence Based Medicine’ in Orthopaedic Surgery”. According to this article, the philosophy of evidence-based medicine has only recently been introduced to the orthopaedic community. The poor use of evidence based surgery is not profoundly explored, but I can also tell you from 1 year experience working with Thoracic Surgeons that many of the techniques used are not evidence based. While I am not attempting to vilify surgery, I am amazed that procedures are performed on a daily basis that may have little or no efficacy and may even do more harm than good to patients. Why Chiropractic is continually attacked in light of the poor evidence base for so many other medical therapies perplexes me. I cannot quote a specific source unfortunately, but I attended a lecture by a medical researcher last year who estimated that only 10 – 15% of medical procedures performed presently are evidence based.
Any ideas on why Medicine has escaped large scale criticism so far, remaining relatively unscathed? I’m hoping for an informative response here, as may contributors to this forum have commented on a lack of evidence behind chiropractic care.
Looking forward to your opinions,
ChiroGuy
The article can be found at : [URL=http://www.medscape.com/viewarticle/408539]www.medscape.com/viewarticle/408539[/URL]
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Re: Chiropractic madness!!!!!!!!!!!! - March 18, 2002 8:40:00 AM
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Andrew M. Ball MS MBA PT
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From: Chapel Hill
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ChiroGuy,
Is 10-15%, in your opinion, a greater or lesser evidence base than for that of physical therapy or chiropractic?
Drew
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Re: Chiropractic madness!!!!!!!!!!!! - March 18, 2002 11:19:00 AM
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Bobcat
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Funny, I cannot quote a specific source either, but I attended a different lecture by a medical researcher last year and she estimated that only 97.7% of medical procedures performed are evidence-based, whereas 97.3% of chiropractic procedures are not.
As for why people have a higher opinion of standards set by medicine, as compared to standards set by chiropractic, massage therapy, or phrenology, consider a trip through the historical record: [URL=http://www.nobel.se/medicine/laureates/index.html]http://www.nobel.se/medicine/laureates/index.html[/URL]
Out of curiosity, what sorts of activities specifically did your one-year experience working with Thoracic Surgeons actually entail? And could you perhaps enlighten us all in detail regarding the procedures performed on a daily basis which you, with your broad expanse of academic knowledge, perceived so astutely as having little or no efficacy for patients, and to such an extent as to do more harm than good?
Looking forward to your highly-educated and brilliant opinion.
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Re: Chiropractic madness!!!!!!!!!!!! - March 18, 2002 1:56:00 PM
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ChiroGuy
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From: Toronto, Ontario, Canada
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Hey Bobcat, good to finally have you back. I’ll get to you in a minute. Drew, unfortunately I can’t presume to have the answer to your question. While I can’t comment on the situation in physiotherapy (but your opinion on this would be interesting), I can tell you that a good amount of what we are being taught in school has an evidence based foundation to it. The efficacy of chiropractic care for low back pain is now virtually undisputed, research on neck pain is quickly accumulating, high quality headache studies are near completion (a $1 M headache study is almost finished at my school which was made possible by a collaboration with the National Institute of Health), patient satisfaction for various treatments has been documented and studies on overall well-being (which admittedly are fault-prone) are being done. I will point out that while I say a wealth of research exists for Chiropractic, not all of it is positive. To many students in my class it sometimes seems as though we are taught more of what we are NOT able to handle (so we know when to refer out) than where our strengths are. Of course we ARE taught who we can help, and I believe it is this style of teaching that will make us great clinicians in the future. It is also important that we are taught which procedures we still haven’t got research for (and I’ll be the first to say that there are plenty of them), so that once we graduate we can keep up to date with progress in research and adapt our practices.
My point in the last posting was not to imply that chiropractic is far superior to medicine due to an overflow of research, but rather that we are not alone in being ignorant of the efficacy of many of the procedures performed. I feel that more research needs to be done in ALL fields of medicine which takes the interests of the patients rather than those of outside influences (ie. drug companies, funding agencies, special interest groups) so that maximal patient care can be delivered. No patient is served well when care is provided, even with the best intentions, by procedures which are less efficacious than others available.
ChiroGuy
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Re: Chiropractic madness!!!!!!!!!!!! - March 18, 2002 3:04:00 PM
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ChiroGuy
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From: Toronto, Ontario, Canada
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Bobcat, thought we’d lost you there for a while. Your insightful and thought provoking comments have given me much to ponder. While I gave the statistic of 10-15% more as an abstract number to stimulate debate and point out that many medical procedures are not evidence based, I must thank you for giving me the impotice to further investigate the source. You’ll be happy to know that not only did I discover where the figure came from (October 1994’s British Medical Journal) but also that much other information exists detailing the true extent of the ignorance many clinicians practice under. According to David Eddy, MD, PhD (look on google for his very impressive credentials), “Only about 15% of medical interventions are supported by scientific evidence. This is partly because only 1% of the articles in medical journals are scientifically sound”. Wow, there’s a quote that caught my eye. Kinda makes you question whether the “evidence” we’re using in EBM has any value anyways; but that’s a discussion for a different time.
As per usual, I am a bit confused by some of your comments. How does a visit to the winners of previous Nobel prizes for medicine excuse the use of non-efficacious therapies? If you are trying to suggest that the reason people don’t question medicine is because it has been glorified so much historically, I’d only agree with you to a point; I think the days of seeing MD’s as gods began to wane quite a while ago and patients are becoming more conscious of health care options. This is why I am amazed that medicine is not challenged by critics more, as it has become more acceptable in our society to question the advice and performance of physicians.
As to my experience in thoracic surgery, I was a co-op student taken on by the Chief Thoracic Surgeon at a teaching hospital in Toronto. It was an amazing experience which then had me aiming to be a thoracic surgeon some day. After several months of working in the clinic and observing operations, I was allowed to scrub in and eventually gave very minor assistance during surgeries (ie. suction, retraction, etc). This was an incredible learning experience, and I have kept in touch with the surgeons since. Due to my interactions with several chiropractors and many physicians at the hospital however (I also did breast cancer research at the hospital for 3 summers), I decided that being an MD was not for me (and no, Bobcat, it wasn’t because I was a university flunkout [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG].
With regards to the lack of evidence based medicine, I was referring to most of the surgeries I observed on a regular basis. Does a lack of evidence mean the surgeries were not indicated? Of course not. I’m sure even you would accept without evidence that an aggressive malignant tumour occupying several lobes of a left lung, for instance, should be resected. Have any double blind studies been performed to indicate this – sorry, but no. However, does this mean the particular type of surgery that was performed was the most beneficial for the patient? Unfortunately, no again. In observing the 4 thoracic surgeons, I “astutely” noticed that each surgeon performed surgeries for the same conditions in a different way – surely each technique could not be equally advantageous for the patient (eg. some were less invasive, some could be performed much more quickly, etc). I’m sorry if you interpreted my post as indicating that all procedures performed without information of their efficacies do more harm than good, as this was not my intent. I meant to imply, rather, that many medical procedures currently performed may be of little value and potentially dangerous (see MCAP’s post on March 6th, [URL=http://bmj.com/cgi/content/full/324/7338/626,]http://bmj.com/cgi/content/full/324/7338/626,[/URL] [URL=http://www.docguide.com/news/content.nsf/news/8525697700573E1885256B790071E53C?OpenDocument&id=069943142AC81C4C852568DD0000EF62&c=Otorhino%2e%20Other&count=10,]http://www.docguide.com/news/content.nsf/news/8525697700573E1885256B790071E53C?OpenDocument&id=069943142AC81C4C852568DD0000EF62&c=Otorhino%2e%20Other&count=10,[/URL] etc.).
To close, I’ll direct you to my posting to Bendnflex on March 6th. It is apparent that you have allowed the letters after a name influence you more in whether to respect an opinion than the quality of the information (and not just in this forum). With a risk of appearing patronizing but with no such intent, I’d like to suggest that in future postings you provide intelligent comments without the dripping sarcasm and inflammatory insults. They do nothing but make you appear childish and foolish. But don’t stop challenging us – it’s only in being forced to validate our opinions that we will truly become evidence based practitioners.
ChiroGuy
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Re: Chiropractic madness!!!!!!!!!!!! - March 18, 2002 7:03:00 PM
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Bobcat
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Gosh, I never meant to suggest anyone was a pre-medical university flunkout. It must be a matter of what one reads when delving too far in between the words. I personally find that in my priestly clinical ministrations there are those whom perceive themselves to be more at the center of attention than others, and desire this attention so much that despite being more atypically sensitive than others regarding past life failures, the negative attention is still pathologically desirable, but that's a whole analysis of a psychological profile that may not be fully relevant right now.
The comments on curriculum are interesting because I wonder just what portion of the courses taught in chiro school actually have an evidence-based foundation. It must be limited given that many core courses are based on or fully derived from medicine, which, as has been rightly suggested, is a field in which most practice has no foundation in evidence, and probably none in science as well. Strangely, such a conclusion must render most chiropractic knowledge inane by principle of associativity. Why doesn't chiropractic just abandon the medical/scientific basis altogether and go back to its more genuine roots? It must tire chiropractic to feel required to justify an existence on this baseless body of so-called knowledge which medical professionals have glorified for so long as to eclipse chiropractic so unfairly.
And yet, such a conclusion can't be true either, because chiropractic is so effective. Why anyone would cast doubt on the effectiveness of chiropractic is unclear to me, now that we have been given such startling evidence to the contrary. Especially all the research decisively supporting chiropractic. I am sure that with all the clinical experience and know-how, particularly anecdotal knowledge of the dangers and unnecessary procedures found in the thoracic surgery room, from the perspective of a highly-trained orderly, we could fully illuminate our understanding of many of the errors committed in vanity and sloth by these inconsistently practicing allopathic surgeons. It's a wonder any of the clients of surgeons survive at all -- and to think these clients survived life-threatening illnesses initially dispelled via the miraculous effects of placebo therapy, only to be killed in the prime of their life by routine thoracic surgery. If only people disbelieved the effects of a ruptured spleen or cardiac tamponade, they could overcome their ailments, and also avoid messy surgical bills. I mean, that surgery stuff seems so straightforward, I bet I could probably comprehend it all in a year while helping to wipe down the autoclaves and be able to critique the surgical methodology without any old medical school training. No wonder medicine is so expensive -- it's all this money wasted on sending these guys through years of unnecessary schooling and selective testing and weeding-out where they learn to ultimately cause harm to clients. It's a good thing society has chiropractic to fall back on, especially when lumbago rears its ugly head.
One point I think that you are really right about too is how people don’t question medicine because it has been glorified so much historically and unjustifiably so. To think if they had only given chiropractic a chance, instead of forcing that Salk/Sabine vaccine on the populus, lots more babies wouldn't have all these childhood allergies these days, and kids could be much more active and wheel themselves to school without need of albuterol puffers. Of course, I wonder if it is just Medicine being unimaginative and lazy again -- instead of letting their minds wander into all manner of exciting new therapies using diet supplements and mood alteration, these robotic medical researchers constantly apply scientific methodology over years and years of exhaustive, tiresome exclusion trials which might at best ultimately lead to nothing except some minor cures for stuff like Alzheimer's disease, muscular dystrophy or juvenile diabetes. Who needs a Kreb's Acid Cycle anyway?? I can't use that in my daily routine, right? Why do I have to learn this stuff? If only they spent more time on headaches and neck pain therapies, and gave the people what they really want and are willing to pay hard cash for.
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Re: Chiropractic madness!!!!!!!!!!!! - March 18, 2002 7:24:00 PM
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Sebastian Asselbergs
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From: Barrie, Canada
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bobcat,
feel better?
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Re: Chiropractic madness!!!!!!!!!!!! - March 18, 2002 9:31:00 PM
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ChiroGuy
Posts: 63
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From: Toronto, Ontario, Canada
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Wow, really struck a nerve with Bobcat on that one. My sincere appologies if you took my comments as a personal attack, which they were not. As per usual, I will respond to your comments specifically and thoroughly and once again ask that you do the same. Unfortunately I don't have time right now to comment, but will respond to your post at my earliest convenience.
My intention here is not to enter into some school-yard shouting match, but rather to rationally and professionally discuss health care issues as they pertain to chiropractic and medical care as a whole. To this purpose, I will refocus attention to the initial questions I asked March 18th regarding why Chiropractic seems to be held to a higher bar than many other medical fields.
Looking forward to your inputs,
ChiroGuy
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Re: Chiropractic madness!!!!!!!!!!!! - March 18, 2002 10:24:00 PM
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swoodard23
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Joined: March 18, 2002
From: Abilene
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I have considered both chiropractic and physical therapy as careers and have done observation with many practitioners of both sciences.
I believe the reasons Chiropractic is under more scrutiny than mainstream medical techniques (scientific or not) is the following:
1. While most physical therapist I visited had different personalities, strengths, and weaknesses, all seemed to practice mostly the same techniques and use the same theories to be much more consistent. Chiropractic, on the other hand, ranged from "mixers" who blended physical therapy with manual manipulation to very untraditional therapy such as throwing different minerals on me to see how my skin reacted to detect deficiencies.
2. One of the things that turned me off most to the profession was that chiropractors don't even believe what chiropractors at other schools teach is valid. Reading posts on chiroweb forced me to be critical of chiropractic. I was lucky enough to have met two incredible chiropractors that graduated from Parker that have made my view of the profession much brighter.
I have been accepted to both Parker for chiro SWT for pt and have decided to go the pt route planning on getting certified in manual therapy postgraduation. My main reason is chiro cost over $60,000 and probably would require a substantial investment afterwards to open my own practice or buy an existing one. I could become an associate but they don't make enough to cover the substantial student loan. PT is only going to cost me about $15,000 and many companies offer tuition reimbursment and starting salaries in the thirties.
P.S. I heard rumors of an idea for a chiropractic union to stand against insurance companies. Sounds like a great idea and would display the unity the profession seems to lack.
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Re: Chiropractic madness!!!!!!!!!!!! - March 19, 2002 3:00:00 PM
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echan77
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From: usa
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Hello all:
I'm about to make a big career change. I am currently work in the technology industry.
I am having a hard time deciding between physical therapy and chiropractic.
Can anyone give me advice? What are the pros and cons of both professions?
Thanks in advance for your advice/suggestions.
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Re: Chiropractic madness!!!!!!!!!!!! - March 19, 2002 7:17:00 PM
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swoodard23
Posts: 36
Joined: March 18, 2002
From: Abilene
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I would suggest PT if you have a public college you can get into. The one I am going to is only $46 and hour oppossed to the $5900 a trimester tuition at the chiropractic schools. You have either 9 or 10 trimesters depending on the school and you have to add books and fees on top of that. Chiropractic schools tend to be much easier to get into however. Parker only requires a 2.5 and the avg gpa of those getting in was only a 3.0. The Pt school I got in required at least a 3.0 and the avg. gpa of those accepted was something like 3.4.
Another reason I chose PT is that associate chiropractors (those that go and work for another chiropractor) usually make under $40,000. The alternative is to start your own practice(which takes time and a ton of money until you build a patient base) or to buy an existing practice which is also expensive considering you still have to pay off school loans. [URL=http://www.parkercc.edu]www.parkercc.edu[/URL] is a great place to check out how much school cost and they even list practices for sale. Check out the demographics too, gives pretty good info on income and other things.
I chose PT because I didn't want $100,000 in debt, to provide my own benefits, or for it to be difficult to pick up and move.
All this said, the two chiropractors that I spent the most time observing do very well for themselves and love being their own boss. One of them makes nearly a quarter of a million a year doing something he loves and is very respected in the community. Good luck with whichever decision you make!
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Re: Chiropractic madness!!!!!!!!!!!! - March 30, 2002 7:04:00 PM
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researchdoc
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Chiroguy:
You say: "One of the biggest criticisms the chiropractic profession receives (often without foundation) is ..."
And then you say: "Although there is some truth to this statement ..."
Well, which is it? If there is "some truth" to the statment, then what is your issue with it? Like all the other chiropractic apologists, you think that a cursory acknowledgement of the limitations of chiropractic theory is sufficient to remove these limitations from discussion. What needs to be understood is that the dogma to which you refer is the very underpinning of the chiropractic profession. It is the foundation of the practice of chiropractic.
"for instance, although cervical manipulation is significantly safer than taking NSAIDS for similar pain conditions"
Your bias and inability to critically evaluate the literature is evident here. Are you suggesting that for a given condition, say acute neck pain, the RISK of adverse effects from taking NSAIDS is greater than that of cervical manipulation? Well, Chiroguy, tell us, what is the RISK of taking NSAIDS for acute neck pain? I have read that the RISK for strokes from cervical manipulation is b/w 1 in a million and 1 in 5 million. What is my RISK of an adverse effect for taking an Advil for this neck pain, for comparison's sake? And well, what about neck manipulation in asymptomatic patients for "wellness" or "maintenance"? This is a very common practice in the chiropractic profession.
"Any ideas on why Medicine has escaped large scale criticism so far"
Do you actually read anything outside of your chiropractic trade rags? If you did, you would realize that medicine not only endures much criticism, most of which comes from within, but it has for years and years, and...get this...medicine actually even changes in response to valid criticism. In fact, you even link to an article that does the very thing you are claiming doesn't occur- criticism of the medical profession- by the medical profession, no less.
When is the last time the chiropractic profession ever changed in response to criticism? Answer: never. And what happens to chiropractors who openly criticize chiropractic? They get blacklisted and denigrated by the chiropractic profession.
"attended a lecture by a medical researcher last year who estimated that only 10 – 15% of medical procedures performed presently are evidence based"
More misinterpretation. Tell me, who was this "medical researcher"? Or are you engaging in the appeal to anonymous authority? As well as the argument to quoque? Anyway, the fact is, there is much "evidence" underlying medical practices. Go here to read a little more:
[URL=http://www.seanet.com/~vettf/CTiM.htm]http://www.seanet.com/~vettf/CTiM.htm[/URL]
"The efficacy of chiropractic care for low back pain is now virtually undisputed..."
This is a common misrepresentation of facts made by chiropractors. No, the evidence of efficacy of spinal manipulation for acute uncomplicated back pain is good. As for the evidence for chronic LBP- not good. LBP with neurological complications- not good. In fact, spinal manipulation in acute LBP seemingly offers only this- slighty faster improvement than the natural course of the disease.
There is NO evidence that SMT prevents chronicity in those back patients who would become chronic anyways (IOW, the rate of chronicity is the same in chiro vs. non-chiro patients); There is no evidence that SMT reduces recurences of LBP; There is no evidence that SMT applied to asymptomatic patients prevents back pain- all of these are common claims of chiropractors.
"...research on neck pain is quickly accumulating..."
Really? I suggest you go to PubMED and type in the terms "neck pain chiropractic". Pretty embarassing, really, that you would make this claim.
"...high quality headache studies are near completion..."
We await the results with anticipation. Of course, since chiropractors have been claiming efficacy in headaches for 100 years, it is only slightly disconcerting that only now are studies "near completion".
"It is also important that we are taught which procedures we still haven’t got research for..."
Yet these procedures are still taught. Simply amazing.
"While I gave the statistic of 10-15% more as an abstract number to stimulate debate and point out ..."
No, sir, you gave this "statistic" in order to justify the virtual lack of scientific support enjoyed by the chiropractic profession- in an argumentum tu quoque- as if the amount of scientific support in medicine has ANYTHING AT ALL to do with chiropractic.
"David Eddy, MD, PhD (look on google for his very impressive credentials)"
Does the "appeal to authority" fallacy get any more blatant? Say, Chiroguy, what does Dr. Eddy have to say about chiropractic's scientific basis? I mean, since that IS the topic here and all.
Chiroguy, you seem to think, as do so many other chiropractors, that diverting the attention from the lack of evidence for chiropractic interventions to the problems of the medical profession is somehow a valid method for justifying your practice. It is not. Medicine has the legitimacy of science behind it. Chiropractic doesn't. Chiropractic would be best served to simply knuckle down, do the necessary work, and let the chips fall where they may. I seriously doubt that is what will happen, though.
echan77:
Go to PT or PA school. There are virually no decent jobs out there for new chiropractors, who are saddled with enormous debt and face declining reimbursement. Despite the rah-rah attitude of practicing chiroprators, the market for their services is virtually stagnant, while there is a projected nearly doubling of the number of chiropractors in the next decade. This is a recipe for professional diaster. Nearly half of all newly licensed chiropractors are out of practice within 5 years, and I suspect this will only get worse over time.
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Re: Chiropractic madness!!!!!!!!!!!! - April 1, 2002 4:50:00 PM
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swoodard23
Posts: 36
Joined: March 18, 2002
From: Abilene
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Hello,
I'm a PT student so I believe if anything I should be biased toward PT, but in chiropractics defense I saw people that had to be carried into the clinic walk out without any pain in one session. Did the treatment last? I am not certain but for the price and the effectiveness how can you argue? Would the patient enjoy more long term relief from PT? Maybe, maybe not. But research or not, chiropractic does work(and so does PT). Lets all have a great day!
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Re: Chiropractic madness!!!!!!!!!!!! - April 2, 2002 4:07:00 AM
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researchdoc
Posts: 34
Joined: March 29, 2002
Status: offline
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swoodard23-
"in chiropractics defense I saw people that had to be carried into the clinic walk out without any pain in one session"
Great. So what I would suggest is that you, as a PT, learn SMT, so that in those patients who might benefit from SMT, you can provide it, as well as the other services you can provide.
You say: "chiropractic does work"; you see, this is the mantra we hear constantly from chiropractors- IT WORKS!!
But "works" for what? So spinal manipulation has been shown effective for acute lower back pain and possibly a couple other musculo-skeletal conditions- great, learn SMT and there you are- just as effective as a chiropractor for acute LBP.
I would also suggest that you will see people go into chiropractic offices, receive treatment, and get NO relief, unlike your "miracle" one vist scenario described above. But for some reason, you don't choose to consider those- hence, "chiropractic works".
I also wonder- when this person who was carried in and got relief in one visit- was he told to come back for several more visits? Or maybe for "regular checkup adjustments" for "wellness" of "prevention" to remove his "subluxations"?
Therein lies the difference: the scientific application of effective therapeutic interventions (clincial practice guided by evidence) vs. the recalictrant adherence to unsubstantiated beliefs (clinical practice guided by dogma).
"...how can you argue?"
Quite well, thank you.
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Re: Chiropractic madness!!!!!!!!!!!! - April 2, 2002 9:53:00 AM
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swoodard23
Posts: 36
Joined: March 18, 2002
From: Abilene
Status: offline
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The chiropractor in question told the patient to only come back if the problem persists. I do see your point, however, because other chiropractors I have observed have called patients back for an endless number of appointments. I have also observed some PT's do the same thing(giving patients exercise programs to do in the gym that could easily and effectively been done at home). So I find it hard to only make chiropractors the bad guy.
As far as spinal manipulation, I do plan to get certified in manual therapy after graduation. But I do have to say that I have trouble convincing myself that a few month course taken on the weekends will prepare me as well as a chiropractor who has two years of experience before he/she even graduates. I still think my services will be very benificial to patients and in many ways exceed that provided by chiropractic but probably not in that area.
As it has been said many times in this post, there are good and bad practitioners in both professions. I hope to be a good or even a great one for PT but refuse to believe chiropractic is the root of all evil. I have had too many good experiences with them concerning my own health.
Thank you,
Scott
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Re: Chiropractic madness!!!!!!!!!!!! - April 2, 2002 11:31:00 AM
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researchdoc
Posts: 34
Joined: March 29, 2002
Status: offline
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swoodard23-
I did not mean to imply that chiropractic is the "root of all evil". My initial posting was in response to Chiroguy's posts regarding the supposed lack of evidence for medical interventions being an excuse for chiropractic having so little evidence for their practices.
However, please allow me to explore this "chiropractors aren't the only bad guys" theme for a moment.
The chiropractic profession, unlike PT or medicine, was FOUNDED upon the (unproven) belief the spinal dysfunction is a cause of disease, far beyond the reasonable (based on evidence) affect of musculo-skeletal problems. Chiropractors tend to have a basic philosophical belief system that is often times contradictory to the scientific evidence. They think that spinal manipulation imparts a preventive effect on health- that "adjustments" allow people to "express optimum health".
It is this belief system that compells some (many) chiropractors to ask, cajole, and often times harass patients into continuing care, well beyond the point of a reasonable expectation of benefit (a more cynical person might suggest that it is actually the desire for money that compells this behavior). Regardless, this is the FOUNDATIONAL BELIEF SYSTEM of the entire chiropractic profession. Getting adjustments = health prevention. Getting adjustments = wellness. Etc etc etc.
You may have been associated with a rare type of chiropractor who limits his practice to those things that are reasonable (based on evidence). Hence, you have a somewhat different take on the situation. I have no doubt that there are "good guys" in the chiropractic profession. And I know that there are "bad guys" in other professions as well- but really, this is not the issue, is it?
The issue is, in WHAT realm is the KNOWLEDGE BASE guiding the PRACTICE of chiropractic? Is it science? Or is it dogma?
I would put it forth that it is in fact DOGMA that is the underlying guiding principle in chiropractic. If it were science, we could hold out hope that a correction to this problem would arise, as science tends to be self-correcting. Dogma, on the other hand, is highly resistant to change.
I would also put forth that while there are indeed SOME chiropractors who do not subscribe to these dogmatic principles, most do. And the mere fact that you (the public) can't tell one chiropractor (dogmatist) from another (evidence-based) is a severe problem facing the chiropractic profession- for instance, in the VA system- is it only the "reasonable" chiropractors who would be allowed in? How do you know which ones are the "reasonable" ones?.
Even if the dogmatists were a minority, the fact that there is no active movement by the leadership of the chiropractic profession to distance themselves from this group amounts to essentially being an accomplice. Guilt by association, you might say. And the fact that there is a deafening silence from the "leaders" of the chiropractic profession regarding these unreasonable practices raises alarm bells in my mind.
As for your contention that you will not have the opportunity to become skilled at manual therapy- this is a propaganda smokescreen used by chiropractors. The fact is, the SKILL of manual therapy, like any other skill, requires time, but it will come- it is not that hard to learn. Like riding a bike or hitting a baseball. It only requires manual dexterity. There are many, many PTs who are highly skilled in manual therapy.
It is the appropriate APPLICATION of these skills that one should be concerned about. And it is in the APPROPRIATE application of manual therapy that PTs can excel beyond the chiropractic profession.
Certainly, if EVERY patient who walked in your clinic doors receives spinal manipulation, you will become proficient faster. But is it really APPROPRIATE that every patient gets spinal manipulation? Should asymptomatic patients return each month for "checkup" spinal manipulation, in order to ensure their "wellness"?
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