NZ Chiropractors vs NZ Medical Journal

11 08 2008

Thanks to Mary’s comment and a few other sources for pointing out this interesting development in the New Zealand medical scene.

New Zealand has created a small buzz internationally with an interesting dispute based on a very well written and timely New Zealand Medical Journal editorial piece by David Colquhoun entitled “Doctor Who?  Inappropriate use of titles by some alternative “medicine” practitioners.”  The full editorial is available here

Two points stood out from this editorial for me.  Firstly Colquhoun states:

The first thing one wants to know about any treatment —alternative or otherwise — is whether it works. Until that is decided, all talk of qualifications, regulation, and so on is just vacuous bureaucratese. No policy can be framed sensibly until the question of efficacy has been addressed honestly.

This really hits home the problem with chiropractic “medicine”: there simply is no true indication of its efficacy as a treatment for anything, but plenty of evidence it can cause problems such as strokes.  Yet they give off an aura of being a profession with equal academic backing to standard medicine. 

The second point that I thought was interesting was that chiropractors who claim to be medical doctors are already breaking NZ law but the law is simply not enforced.  I did a quick search and it seems the relevant legislation is the Health Practitioners Competence Assurance Act 2003, of which section 7 contains the relevant information.  It seems the issue could be solved quite quickly by simply applying the law as written and this is what Colquhoun recommends.  I do wonder if the penalties are severe enough though, entailing a fine not exceeding $10,000, and I also wonder about the wording – I suspect a good lawyer could wriggle a pseudo-doctor out of any fine.

What makes things interesting however is that this article was met with a rather aggressive response from the New Zealand Chiropractic Association via a letter to the NZMJ from their lawyer, Paul Radich.  The NZMJ reproduced the letter (here).  The claim is made that the editorial (and another paper by Dew et al) is “one of the most blatant examples of defamation that we have seen.”  The letter then goes on to demand a retraction, apology, opportunity for rebuttal and costs under the Defamation act. 

What has really set the world alight however is the response by the editor of the NZMJ, Frank Frizelle.  In it he discusses the letter from Radich, and then concludes with:

The Journal has a responsibility to deal with all issues and not to steer clear of those issues that are difficult or contentious or carry legal threats. Let the debate continue in the evidence-based tone set by Colquhoun and others.

I encourage, as we have done previously, the chiropractors and others to join in, let’s hear your evidence not your legal muscle.

As the Holford Watch blog states, “it isn’t often that you come across a newly-minted phrase that is destined to become a classic but Professor Frank Frizelle has managed it”.  I can see people quoting that last sentence for years to come, myself included.  Evidence based thought rather than lawyer based thought all the way!

What I find disappointing is that the New Zealand media doesn’t seem to have picked up on this issue (if someone has heard of it on the news or radio please let me know).  Without media coverage it will probably die down quite quickly which is a shame because it is a lost opportunity to raise public awareness of this important issue.  Far too many people (including me until a couple of years ago) think that, as a dentist is a “tooth doctor” and an optometrist is an “eye doctor”, that a chiropractic is a “back doctor”.  This is manifestly not the case even if what they do is genuinely beneficial (which in my opinion it is almost certainly not) and the general public need to realise this.

For what it is worth, my advice is that if you have back problems go and see your doctor or a physiotherapist.  I have had back problems and my physio sorted it, and I have been fine since.  For extensive information about chiropractors check out chirobase and for the flipside, check out the New Zealand Chiropractors Association website.

For more details and posts about the NZMJ legal “battle” check out this page which seems to be keeping up to date with posts about the issue, and Colquhoun’s own site here.

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32 responses

11 08 2008
Professor Frizelle’s Instant Classic:

[…] seems that New Zealand blogs are picking up the story. Evidence-based Thinking has a fine account: NZ Chiropractors vs NZ Medical Journal. There is some confirmation that the matter of the use of an appropriate, non-misleading title […]

11 08 2008
dvnutrix

Yes – we are aiming to update our list of who is covering this story because it is an interesting one for all of the reasons that you outline. It would be useful if the wider NZ media were to pick up on it because it is an excellent opportunity for the sort of public education that you discuss.

Plus, it is always refreshing to read appropriately robust responses to the sort of nonsense that Murray Gell-Mann so pithily described as flapdoodle.

15 08 2008
John L. Ateo

The topic was covered this morning (15th Aug) on Radio New Zealand National’s Nine to Noon program and can be heard here:

http://www.radionz.co.nz/national/programmes/ninetonoon

Click on “Doctor?” at 9:00am

16 08 2008
Ian

Thanks John.

It is an interesting discussion although disappointingly it seemed the discussion focused purely on the title. It seemed to me there was an undercurrent of whether or not there is any validity to chiropractic medicine but for legal and practical reasons no-one was willing to actually raise the issue. Sadly anyone listening to this would have got an elevated sense of the credibility of chiropractic medicine and indeed alternative medicine in general.

23 08 2008
Tat Loo

As a chiropractor based in Dunedin, New Zealand I would like to make the following comments:

1) There has been a long history of legal contention between the medical and chiropractic professions dating back to ~1905, with a peak around the New Zealand Royal Commission of Inquiry on Chiropractic circa 1979.

2) The public are voting with their feet as to which practitioners they want to see. It is not too difficult to find people who feel that the conventional medical system is not able to meet all of their healthcare needs. These people have two choices: go with those needs unmet, or look for help from other sources.

3) Patients who suffer an accident in New Zealand can see a physiotherapist and have 100% of their treatment costs covered (by ACC). If they choose to see a chiropractor instead, they must make out of pocket payments. It should be noted that tens of thousands of New Zealanders a month choose in favour of chiropractic care.

4) Between reports of medical doctors receiving all expenses paid conference trips to exotic locales paid for by drug or medical device industry interests, reports of peer reviewed drug articles being ghost written by industry and being passed off as being impartial (Vioxx), and even a New Zealand wide immunisation programme (MeNZ B) which pushed a vaccine to parents who thought that it provided far more protection than it actually did…I suspect it is not the “credibility of chiropractic medicine” which is being “elevated” but that the credibility of conventional medicine which is being eroded.

Personally, I’m glad that the writer of this blog was successfully helped by a physiotherapist for a back problem – and that its clear in the blog that the recommendation to go see a physiotherapist is opinion and anecdotal, not evidence based.

24 08 2008
Tat Loo

It appears that you’ve decided to remove the comments I posted on your blog yesterday which is somewhat disappointing. As a registered chiropractor practicing in New Zealand I thought that you might have found another viewpoint relevant to having a fair discussion.

To summarise: people need a choice in their healthcare when they feel that the conventional medical system is not meeting all of their needs. You cannot ask people simply to exist with their needs unmet.

IMHO a major factor is not the question of an “elevated sense of credibility of chiropractic medicine” (as you put it), but rather a general erosion in the credibility of conventional medicine due in part to many reports of how its practice and evidence has been negatively affected and influenced by private industry (pharmaceutical and medical devices) money.

24 08 2008
Tat Loo

…or possibly by web browser had cached an old version of your blog site which didn’t show my previous comments…sorry about that!

25 08 2008
Evidence Based Thought

Sorry about the delay in the comments, new commenters need to be approved for their first post and I had not checked the comments for a day or so. Any further comments you post should now go up straight away.

25 08 2008
Ian

Thanks for posting Tat Loo.

Some thoughts/questions in response:

1) There has been a long history of contention. Why do you think this is the case?

2) Have you got any figures for attendance at chiropractors versus GP/physio for treating back problems? What about non-back problems? (I am genuinely curious).

Personally I think any trend towards alternative medicine such as chiropractors is a symptom of an overworked medical system. A GP gives a patient 5-10 minutes of their time, throws a diagnosis, and gets on to the next patient. This is a matter of necessity.

I believe chiropractors give longer and more personal sessions? Since seeing a GP can often be enough to make you feel better even when so short, it doesn’t surprise me longer more personal sessions at a chiropractor would give a greater effect in that manner. That has little or no bearing on the actual method’s efficacy however.

3) Do you have any idea what percentage this is of total relevant ACC numbers?

4) There are no doubt problems with the medical profession (as with any profession) but that is a little irrelevant to this debate. Even if conventional medicine was utterly corrupt and useless (and it clearly isn’t) it takes us no closer to answering the real issue at hand:

Is there any truth behind the chiropractic claim for curative power beyond placebo and the inherent physio-like treatments? Certainly I have heard of chiropractors that are essentially physios so, if suitably trained, there is no big deal (although I don’t see why they don’t just call themselves physios). However the entire field of subluxations and curing disease through spinal manipulation seems utterly mystical.

It’s already been said so well so I’ll repeat it again… “let’s hear your evidence, not your legal muscle.”

25 08 2008
Tat Loo

In response:
1) In history, it appears to have been an anti-competitive strategy employed by the influences who eventually created the American Medical Association.

2a) I don’t have the figures – however there are (ball park) 400 registered chiropractors in NZ, 3000 registered physios and 1400 GPs: the chiropractic profession is absolutely tiny in comparison.

2b) The use of the term “non-back problem” is fraught with issues e.g. would you say that radiating frontal rib pain due to a problem with the spine (even though the back feels fine) is a back problem or a “non-back problem”. As a chiropractor I am more than happy to treat a case of chest pain: if it is coming from the spine, not from the heart that is.

2c) I’ve never seen a single research study which shows that spending 30 minutes with a patient leads to a better placebo effect than spending 10 minutes. This idea seems designed to minimise CAM therapy i.e. “if patients do get better from CAM, it’s just in their head”. FYI after initial assessment of a new patient, my treatment sessions are 8-10 minutes. Many physios I know of spend 30 minutes per session with a client. By your reasoning then physio treatment must benefit more greatly from the placebo effect than chiropractic treatment?

2d) The efficacy of a treatment is important. But in practice, its not as important as the effectiveness of the treatment.

3) No, I don’t have these numbers unfortunately, but I rather suspect they could be synthesised from an ACC annual report or similar.

4a) I may have to disagree with you here because I see one of the key issues being the unmet needs of patients. If conventional medicine is not addressing a specific person’s needs or if that person is concerned with the limited medical options they have been given, what are they to do? Exist with their needs unmet? Ignore their concerns?

In fact, it appears that choosing CAM therapy (and paying out of pocket for it) is what many resort to.

4b) I’m under the impression that most physios do fewer years of tertiary education then most chiropractors (it takes 5 years to train to be a chiropractor in NZ). In fact, lets turn your statement around: since the advent of the “manipulative physiotherapist” in the last 10 years it could be said that more physios are using chiropractic-like joint manipulation techniques: would you really consider them as being “essentially chiropractors” then?

4c) With regards to the “chiropractic subluxation” and its role in causing or curing disease: this model is outmoded IMHO having been around since the early 20th century but some chiropractors hold on to it.

4d) What is the specific claim that you are seeking evidence for? The quote from the NZJM is glib but repeating it without qualification or clarification merely makes it a bludgeon. Its ironic because I’ve already pointed out that important parts of the medical evidence base may be tainted, a point you suggest is irrelevant even though you clearly believe in the primacy of “evidence”.

I will say this: physiotherapists are being taught more joint manipulation techniques – a treatment method that chiropractors are heavily associated with – then ever before. The implications are obvious, are they not?

26 08 2008
Ian

Thanks for engaging Tat Loo.

1) That sounds a bit conspiracy theorist for me. If it works mainstream medicine would be all over it (even a cynic would recognise there is money to be made lol). With that in mind it seems more likely to me that they simply don’t think it works.

2a) 400 still leaves plenty per major city however – there are at least seven clinics in Palmerston North alone.

2b) I have no doubt the back plays a part in many musculoskeletal problems. However using back manipulations to improve immunity or to alleviate breathing problems or allergies (as claimed on the NZ Chiropractic website) is stretching things a bit far.

2c) My mistake, I didn’t quite say what I meant here. It is not really pure time that makes the difference – it is acting as if the practitioner cares (of which time can play a part). IMO many GPs simply don’t act that way whereas my one experience with a chiropractor (a free initial check that I never followed up on) was a friendly and welcoming one. Many people will often feel better just from thinking someone actually cares or from receiving a nice experience. Many GPs could learn from this in my opinion.

2d) I tend to agree although I don’t think the difference is significant in this case.

3) Ill send ACC an email.

4a) If that is the case then surely the real question becomes “how do we fix conventional medicine” rather than “how do we provide alternatives”?

4b) I am no expert on physios but my experience with them (once for a badly strained ACL and once for a upper back/neck problem) is that they focus mostly on muscles. By building strength and flexibility into the right muscles my problems have been pretty much solved. Now there may well be medically justified manipulations that chiropractors do and I have no problem with those, nor with physios doing them. However manipulations to boost ones energy levels (again NZ chiropractors site) is probably not one of them.

4c) The NZ chiropractors site states

All this may result in a malfunction of the spine called a vertebral subluxation, which hinders the body’s effort to maintain organs and systems working in harmony (homeostasis).

Sounds like the professional body still buys it. How would you define chiropractic care?

4d) There are two things that chiropractors need to provide evidence for: The first is that their manipulations have a positive and safe effect on specific ailments. The second is that doing so can cure disease, improve the immune system, relieve allergies and the like.

27 08 2008
Tat Loo

Hi, thanks for your comprehensive response. You may find it worthwhile to review the modern history of the medical profession. The formative time for the profession was 1900-1930, partly as a result of the so-called “Flexnor Report”.

1) As for your comment that the medical profession employing anti-competitive strategies against chiropractors seems just an unlikely conspiracy theory: this is exactly what happened. Not only did the medical profession act in an anti-competitive way, they attempted to destroy our much smaller profession:
—-
Appeals Court Rules A.M.A. Acted Against Chiropractors
AP

LEAD: A Federal appeals court has upheld a 1987 ruling that the American Medical Association violated antitrust laws by trying to destroy the chiropractic profession.

A Federal appeals court has upheld a 1987 ruling that the American Medical Association violated antitrust laws by trying to destroy the chiropractic profession.

On Wednesday, the United States Circuit Court of Appeals for the Seventh Circuit affirmed the finding of Federal District Judge Susan Getzendanner, who barred the medical association from boycotting chiropractors, whose treatment is manipulation focusing on the spine.

George McAndrews, a lawyer for the chiropractors, said the rights they want include ”fair treatment by tax-supported institutions, hospitals, insurance plans, H.M.O.’s and other groups that have burdened those patients with anticompetitive barriers.”

A.M.A. policy, the plaintiffs charge, has prevented doctors from referring patients to chiropractors or taking referrals from them. The doctors were accused of preventing chiropractors from treating patients at hospitals controlled by medical doctors.

Association’s Curbs Enjoined

On Sept. 25, 1987, Judge Getzendanner, who has since retired, permanently enjoined the A.M.A. from ”restricting, regulating or impeding” its 275,000 members or hospitals where they work from associating with chiropractors. Earlier she found a conspiracy ”to contain and eliminate the chiropractic profession.”

A three-judge appellate panel ruled that Judge Getzendanner had reached a ”reasonable” decision. The panelists were Judges David Manion, Harlington Wood Jr. and Kenneth Ripple.

She ”found a cognizable danger of recurrent violations, was unimpressed with the A.M.A.’s expressed intent to comply with antitrust laws, was unpersuaded by the effectiveness of the A.M.A.’s discontinuance of its boycott and properly considered the systematic and long-term nature of the boycott,” the appeals panel said.
——
If you google the above you will find sites which still cache this AP article.

I’d be interested in your comments. If you bear in mind that medicine is as much about politics and money as it is about science, you shouldn’t be too surprised.

2b) What’s your reasoning for doubting that a problem with the spine can go on to make a patient’s breathing more difficult? I suspect that if you think through the biomechanics of breathing that it would be extremely obvious how problems in different parts of the spine could seriously impede natural respiratory patterns.

27 08 2008
Tat Loo

One other thing, if I may add: you wrote

4a) If that is the case then surely the real question becomes “how do we fix conventional medicine” rather than “how do we provide alternatives”?

My point does not change even with this new strategy however: what do all the people who currently have unmet healthcare needs do while we turn the grindstone in the background working on providing a “fix” to existing problems? Do we suggest to them that they sit back and put their lives on hold with their needs unmet while a team of scientists and/or management consultants get down to sort out the issues?

I’m not sure that’s very practical – or humane.

In fact, “providing alternatives” looks like what is required, and indeed it is what is happening.

31 08 2008
Justin Vodane

Please read the latest edition (23nd of August, 2008) of the New Zealand Medical Journal. There are in it responses to the poorly researched and badly written articles by Gibley and Colqhoun. The replies are from the New Zealand Chiropractors Association, New Zealand College of Chiropractic, New Zealand Chiropractic Board as well as Professor Kevin Dew, a Medical Sociologist from Victoria University.

5 12 2008
Andy Ho

Hi Justin,

A few points of clairifaction:

Gibley [sic] is actually Gilbey. He has a doctorate from a leading UK university and therefore may be addressed as Doctor. Check where he works and you will find out he does not use his title. His students call him Andrew.

ii) Colquhoun is a professor – his title is not given away lightly. He is extremely well respected by scientists.

iii) Chiropractors in NEw Zealand should not call themselves doctor. MR Roughan states that the Royal Commision of 1979 gives them permission to do so. Not as far as I can see. Perhaps he should read chapter 42 (it’s aviaiable in a few librarys – commision into chiropractic 1979 shoudl find it). It’s clear abut the title, should he actually read it. The HCPAA 2003 also states that they may not call themselves doctors.

iv) Want a real laugh? One of these people state on their website that 14 of 15 women unable to concieve, had, after seeing a chiropractor for 1-year, already given birth. Extraordinary! Actually, it’s not even slightly funny–wishing to conceive and not being able to do so must be heartbreaking. I have chosen not to put his weblink here, but I have a hard copy of his page.

v) As far as I am aware, the NZCA know well that they would lose their silly case, becuase, quite simply everything said by Gilbey and Colquhoun is true. Maybe Paul Radish esq checked the literature and told them so.

As for the 1979 report, give it a read. It’s risible – Some of the chiropractors must have been stunned by it.

25 12 2008
James Brown

Have a look at MOERMAN, D. E. & HARRINGTON, A. (2005) Making space for the placebo effect in pain medicine. Seminars in Pain Medicine, 3, 2-6.
Part of the review considers the modifying effect of clinicians’ beliefs upon the effectiveness of various placebos. Given the emphasis on passion and belief in chiropractic education, it is hardly surprising that the placebo component of their treatments is high.

It is actually difficult to attribute positive outcomes in “chiropractic” to anything other than placebo. The treatment offered by chiropractors is not consistent. Some practice using only manipulation, while others use no manipulation at all. Even amongst those that do use manipulation, there are myriad methods for determining which vertebrae require attention because diagnostic procedures are not consistent either. Some x-ray and draw lines to determine “misalignments”. Others use instruments such as a “neurocalometer” (or nerve-o-scope) and others use kinesiology-type muscle testing to “ask questions” of the patients body. Some claim that the first cervical vertebra is the most important, so important that there are even chiropractors who only adjust this vertebra (this is called “hole-in-one” or HIO technique), others emphasise the thoracic vertebrae. Never mind the diagnostic method or the treatment, chiropractors cannot even agree on the lesion they claim to influence! How can “chiropractic” be considered scientifically when it seems to consist of doing pretty much whatever the individual chiropractor thinks is best but this may not even closely resemble what the chap around the block would do to treat the same patient on the same day. What is consistent is the belief and passion for practice. As you will read in Moerman’s review, this is actually quite important for obtaining a good placebo effect.

With reference to the Wilk case, possibly this kind of thing was in Judge Getzendanner’s mind when she commented

” The plaintiffs clearly want more from the court. They want a judicial pronouncement that chiropractic is a valid, efficacious, even scientific health care service. I believe that the answer to that question can only be provided by a well designed, controlled, scientific study… No such study has ever been done. In the absence of such a study, the court is left to decide the issue on the basis of largely anecdotal evidence. I decline to pronounce chiropractic valid or invalid on anecdotal evidence.”

Making pedantic distinctions between effectiveness and efficacy are somewhat ironic coming from a chiropractor. How can your profession answer questions about the effect of a treatment when widely used in practice (effectiveness) when that treatment is not consistent? In reality, you don’t know that much about the true biological effect (efficacy) or the effectiveness of the potpourri of methods that find themselves under the chiropractic banner. What is the efficacy of a drop table or of craniopathy? How about the effectiveness of Gonstead technique in comparison to Chiropractic Biophysics?

Why has your profession failed to obtain a consensus of practice and standards that are in accordance with the best evidence in musculoskeletal medicine? Can you name one chiropractic technique that has been widely discredited for its lack of effectiveness? Surely they can’t all “work”! It is true that, some of your profession are trying their best and obtain postgraduate qualifications in scientific musculoskeletal management but why should we accord all of you with the title “doctor” and not allow a physiotherapist or an optometrist to use it?

Respectfully, Dr Loo, what has chiropractic done, since its discovery over one hundred years ago, to study and be critical of itself? I would suggest, not much at all. It cannot prove the validity of its treatments in scientific journals, or even in court. Surely, any profession that wants its members to wear the mantle of being “learned” should have done better by now. It is fine to “provide alternatives” for “unmet healthcare needs”, but let’s label them appropriately.

27 12 2008
Christiaan

Hi Tat,

Further to the previous comment, I note that you state:

“With regards to the “chiropractic subluxation” and its role in causing or curing disease: this model is outmoded IMHO having been around since the early 20th century but some chiropractors hold on to it.”

What medical model do you employ when dealing with patients? If you do not agree with the concept of subluxation then I take it that you do not believe that spinal manipulation will assist with medical problems wider than spinal and related musculoskeletal complaints.

I note from the advertisements you have placed in the Dunedin’s ‘The Star’ you subscribe to some parts of the subluxation model as you claim relationships between spinal manipulation and improved health including increased brain function.

20 01 2009
Justin Vodane

Hello Andy,

it is absolutely commendable that Andrew Gilbey has a PHD, and he is entitled to use the title “Doctor”. No one is arguing that, nor Professor Colquhoun’s use of the title “professor”.
Where their research is questionable is (amongst other places) the belief that the sole right to use the title “Doctor” is reserved for those in the medical profession. The title “Doctor” is purely a courtesy title, used by medical practitioners, dentists, chiropractors, osteopaths and some vets. In New Zealand all these practitioner groups have undergraduate degrees, not doctorates.
If Dr. Gilbey’s research was thorough he would also have looked at the use of the title “Doctor” by all practitioner groups, and taken the view that the only people who should honestly use the title are those with a PHD, Doctor of Science, Doctor of Law or Doctor of Theology. If Dr. Gilbey had done this, then his research would have been more accurate and less able to be criticized. In fact, to carry on this argument, Dr. Gilbey should really be asking all those people without doctorates to cease using the title “Doctor” as it is actually incorrect usage of the title.
After this issue was raised, the Health Department spokesperson was interviewed on the National program. He did not find that there was a problem as long as the person identified what practitioner group they belonged to.

25 01 2009
James Brown

Hi Justin

The question of whether to accord Chiropractors the courtesy of the title is valid. The qualification is clearly not comparable to post-graduate doctorate degrees, such as the ones you mention. Furthermore, holders of those degrees do not set themselves up in offices that look like medical practices and they do not make use of stethoscopes, x-ray machines, sphygomometers. They do not interpret x-ray films, make diagnoses and they do not provide professional advice on a wide range of health issues. Can you see why there may be some concern that people may be confused and believe that they are seeing someone who has had proper medical training?

As you say, there are certain undergraduate clinical qualifications where we accord graduates the courtesy of the title “doctor”. Shall we examine them?
Medicine is the obvious place to start. If we consider the 2 medical degrees offered in New Zealand using the New Zealand Register of Quality Assured Qualifications (KiwiQuals http://www.kiwiquals.govt.nz )as our guide, we see that the degree offered in Auckland is Level 7 and has credit of 720. You can see the definition of credits at on the kiwiquals website , where you will note that 1 credit represents 10 hours of learning time. So we can conclude that Auckland’s MBChB requires 7200 hours of learning time. The entrance requirement is “A prescribed first year in either the Bachelor of Health Sciences or the BSc in Biomedical Science prior to applying for selection into the MBChB.”

The Otago medical degree is the same, 720 credits at Level 7.

New Zealand’s dental degree is rated 600 credits at Level 7, as is the vetinary science degree from Massey University.

Chiropractic comes in at 480 credits at Level 7, which is the same as Physiotherapy . Both of these are 120 credits more than Auckland’s nursing degree .

I’m not sure that degrees from private training establishments, such as the New Zealand College of Chiropractic, are on a par with university degrees but that is a personal bias, I’ll leave that question alone. The New Zealand Register of Quality Assured Qualifications rates them all as “Level 7” so I’m happy to conceed that the degrees are all Bachelors degrees.

It is clear, however, that the chiropractic degree has significantly less content than the other degrees that qualify a person for a profession that is accorded the courtesy of the title “doctor”. Are you suggesting that, we should just use the title for anyone who gets a qualification of any kind from anywhere? A less ridiculous question may be why chiropractic and not physiotherapy?

6 02 2009
Justin Vodane

Hello James

Your comments about chiropractors using stethoscopes, x-ray machines, sphygomometers etc. are interesting, but incorrect. Physical examination is taught as part of the curriculum of chiropractic colleges. The use of these items and many others comes within the scope of practice of chiropractors. The use of them is not just the domain of medical practitioners. I can imagine nurses would be quite upset if you prevented them from using stethoscopes, just as physiotherapists would be upset if you prevented them from using reflex hammers on the remote chance a patient would think that they are a medical practitioner.
Chiropractors do interpret x-ray films, make diagnoses and they do provide professional advice on a wide range of health issues. That also comes within the scope of practice and is part of the curriculum of chiropractic colleges. This is responsible health care.
It is illegal for any health-care provider to mis-represent themselves a having qualifications they do not have.
Please provide the evidence that chiropractors have told patients that they are “medical practitioners” because they happen to take a patients blood pressure, look in the back of the patients eye, check the reflexes or take and interpret radiographs?
I would have thought that no matter who does this, (GP, Chiro, Dentist, Nurse, Physio etc.) the practitioner is practicing responsibly?
One could argue semantics for a long time over the issue of the use of the courtesy title “doctor”. It was put into perspective to me by an acquaintance, who has a PHD and his wife a medical practitioner. He said, “I am the only proper doctor in our house, my wife just calls herself one”.

11 12 2009
wendell

San Franciscan Christopher Norberg went to a chiropractor after being injured in a car accident in 2006. After a disagreement with the chiropractor over billing, he posted a negative review of the business on Yelp suggesting that the doctor was dishonest. Now he is facing a defamation lawsuit that could chill self-expression on the popular gripe Web site.

11 12 2009
Kim

Your life is busy… you’re in a hurry… waiting in line… waiting for calls… always waiting. But when it comes to getting pain relief… waiting is just out of the question.

12 12 2009
calgary chiropractor

There are too many organization that always trying to debate with chiropractors. They can’t accept that chiropractic treatment can cure many kind of sickness. They still want to prove that they are the only one who can heal people.

22 12 2009
Tim

Dear Calgary:

You wrote “They can’t accept that chiropractic treatment can cure many kind of sickness.”

Oh yeah, like what? As Dr. (and I mean Doctor) Frizelle states above “let’s hear your evidence”. The evidence DOES NOT support that “spinal adjustment” cures… anything. Not high blood pressure, liver disease, not migraines, not indigestion, osteoporosis, depression, kidney problems or any of the other hundreds of crazy quack claims.

Go back to charging big bucks for back-cracking people too foolish or ignorant to seek proper medical care, and laughing all the way to the bank.

13 03 2010
Sandy Chiropractor

Ah! This is great! Thank you for putting to rest severalsome
misconceptions I have seen about this as of late.

13 03 2010
Utah Chiropractor

Oh! This is great! Thank you for dispelling severalsome
misconceptions I had seen on this recently.

1 07 2010
Brian J Bussard DC

Its unfortunate that some of you can’t see the benefit of Chiropractic’s role in the medical world. With the most recent posting on WebMD about chiropractic and high blood pressure, you would think that more people would be accepting of chiropractic as a low cost treatment option to healthcare. By the way, are they going to attack the physical therapist who now have a doctorate program?

28 09 2010
Broomfield Chiropractor

There alays seems to be a whirlwind of controversy surrounding the Chiropractic profession. Unfortunately, there is no rational arguement that any type of medical treatment is appropriate or helpful for everyone. Since each person is unique, their treatment will also be unique. Unfortunately, there are treatments and “cures” in every facet of health care that will inadvertently cause harm, where improvement is the aim. No Doctor, or field of practice is blessed with predictable results. Whether or not you choose to be rational, or subjective about this truth, it is still truth.

3 10 2010
Søren Kramer

Hi Doctors and Witches

A letter from an observer in Denmark

What an interesting discussion you are having!

I have a French friend who came to Denmark to practice as a chiropractor.
In Denmark the system is as in NZ, we have the cost covered for physiotherapist but not for chiropractors. My friend had to go back to France. In France the subsidization at least at that time – aprox 10 years back – was opposite he told me. There was subsidization for chiropractors but not for physiotherapist.

It kind of reminds me of ICD-10. It is very good to share the same diagnosis system. Unfortunately the Americans – not us – changed their content but not the headline. What that means is you better remember your prescription, as your ISC-10 number, can give you different medicine if you travel.

And then, even with your medicine and the right stamp you better believe in the stuff. I remember there was as study from Århus Univercity, showing that 90% of the effect of anti depressive medicine (its called something like happy pills in Denmark – it makes you feel nothing), could be explained using blind test with drugs having the same side effects as the medicine. The measured effect went from very small, to barely measurable.

All those stories, clearly show, that evidence is shaped by time and culture. But there is more to it.

In Denmark there is this fight going on between the cognitive psychologist and the psychoanalytic psychologists. The cognitive use words like objective and evidence. They say evidence every time they open their mouth. The wider result is for example that the cognitive methods is used for teaching medicine.

The cognitive psychologist do all their examination of own methods and it clearly shows effect, compared to the other old stuff. Nobody cares they have not evidence for the basic theoretical assumption – there is absolutely no biological evidence for the fundamental assumption in Cognitive psychology. The evidence is based solely on effect. Its good. Cognitive psychology sucks, but they are very good at adopting new methods an making them their own. And thereby making it evidence based. But there is some side effects.

Evidence is now a very popular word. The politicians adopt it. Our government just dictated a plan for the public school – you know like North Korea planning. There is 7 goals. One of them says: The methods should be evidence based

Here we are. At the end of the day, the word evidence is just word to position yourself in a higher, more power full position than the ones you are communication to. And its good for nothing. Its only digging trenches.

There is very good intentions behind it, but unfortunately the consequences is a society making distance between them and us. And we all want the opposite. We want the best treatment, and the best education for all.

Best regards

3 10 2010
Søren Kramer

Hi, a little clarification. The Americans use DSM-4 not ICDT-10. The point is, with the same observed behavior you get different categorization between the countries, and thereby different treatment.

An example of change over time: In the start of the nineties, we talking a lot about borderline in Denmark. The result was that a lot of people was diagnosed as borderline. Today we talk a lot about ADHD. So we get a lot of ADHD.

The diagnosis system, based on evidence, takes cares of explaining all the abnormal behavior, for example when the child is noisy in the classroom. So what evidence do, is to take care of the real critical thinking for us.

4 07 2012
Chiropractors Calgary

You can say what you want about chiropractors, but the fact is that thousands of people are helped by their treatments every day. Yeah they are a little unconventional but it is worth a try before you start pumping your body full of drugs.

24 04 2013
Edmonton chiropractor

While there may be no definitive proof that chiropractic treatment cures anything, there is no doubt they do provide relief of pain to the majority of the patients they treat. More likely, they should be used in conjunction with other types of care from medical doctors and physiotherapists. Many professional sports teams use chiropractors on their millionaire athletes, so there must be some benefit. One could also argue that traditional medicine doesn’t cure many ailments either. Most doctors prescribe drugs to treat and control medical conditions and diseases, but few of those drugs cure anything. They only keep the patient on expensive prescription drugs for life.

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