Archive for the ‘chiropractic’ Category
According to the website for this product, a pen which represents a spine bent by chiropractic subluxations,
“the “Subluxated Pen” is a trusted and proven way to promote your practice. Your personalized information is imprinted on the bent part of the pen. The bend in the pen attracts attention in a unique, fun and powerful way. Using the Bent Pen is the inexpensive and professional method for building your patient community.”
The manufacturers of this promotional product tout the results of a 2008 study performed by ASI (Advertising Specialty Institute) which appear to show that Bent Pens are “the most effective and least expensive form of advertising.” I noticed some shady business when comparing the provided information on the website and the actual report from ASI. Most importantly, the report only mentions writing instruments. It does not specifically look into the effectiveness of Bent Pens themselves. That may not be a distinction that matters, but it could be that people don’t like novelty writing instruments with caps, instead preferring conventional click-top pens. It is unfair to make claims about a specific product based on the data. Despite this fact, the graph used by H.W. Industries on the Bent Pen website, which compares the cost per impression of Bent Pens (using the data based on writing instruments in general) with such advertising entities as magazine ads, prime time television spots and billboards, is made to look as if it came directly from the study. It did not. There is a section which lists the cost per impression of various types of advertising, however. In it, one can easily see that writing instruments, while cheap compared to national magazine ads for example, are no better than caps or bags in this regard.
In addition to the misleading graph, there is a section on the website which is cut and paste verbatim from the ASI study summary of conclusions. Well, almost verbatim. It curiously left out the part which revealed that of all the studied promotional products, wearable bags delivered the most impressions. The same wearable bags which had an equal cost per impression to writing instruments. Writing instruments provided only the fourth highest number of impressions per month. I guess Bent Bags are too difficult for even chiropractic technology to produce though. Of course a better form of advertising might be actually treating a legitimate medical problem.
To be entirely fair, H.W. Industries is not a chiropractic practice building company. They just seem to sell gimmicky crap, and they are apparantly no less concerned about twisting data to improve their profits than chiropractors are. But I probably shouldn’t be making fun of this at all considering I hand out fetus shaped keychain flashlights.
Port Orange, Fl-Shocking the scientific community today, and perhaps taking the first steps towards a new theory on the history of human evolution, chiropractic paleoanthropologists working at the Institute of Chiropaleoanthropological Studies (ICS) announced the discovery of several vertebral subluxation complexes in the well-known Kebara 2 and Shanidar 3 Neanderthal spine specimens.
“This report is the culmination of many months of painstakingly detailed research,” chiropaleoanthropologist and lead researcher Frank Grimes explained. “Not only did our highly trained team employ gentle palpation of the spine in each of the two sets of fossilized remains in order to help diagnose the lesions, the specimens were further analyzed by full spinal xrays, surface and infrared electromyography, thermal scanning, contact reflex analysis and leg length measurement.”
After a consensus vote confirmed their findings, the team set out to explain why the C-4, C-6, T-2, T-8, L-4 and L-5 vertebrae were affected in the two Neanderthals. After weeks of frustration, Arthur Fernandez, an expert in the science of Applied Kinesiology, was brought in. His involvement would prove to be a key component of the unraveling of this prehistoric enigma.
“Chiropractors aren’t used to working with patients that are deceased,” Fernandez revealed. “But we do take care of children. When I realized the connection, the similar inability of both dead people and infants to talk, it hit me.”
Using his chiropractor’s intuition, Fernandez placed his hands on a segment of subluxed Neanderthal spine and tested his own muscle strength while holding a variety of vials, each containing a substance potentially toxic to Neanderthal physiology. “When I noticed my arm feel weak as soon as I grasped the bottle of mercury, I couldn’t help but think of the irony. The same substance which is damaging so many kids today used to wreck havoc on this ancient population of monkey/human hybrids.”
With a diagnosis and an etiology in hand, the team from ICS decided to go public with their findings. And though they are all excited about the potential for future discoveries, team leader Grimes has unearthed a more melancholic interpretation of their results. “Just thinking about how an entire species was wiped off the face of the earth because chiropractic healing techniques were discovered 30,000 years too late, is a little unsettling. I’d hate to see the same thing happen to us.”
Making it as a chiropractor is hard. Some do very well, but because of low demand and marketplace oversaturation many practices fail. In fact, chiropractors are more likely to default on student loans than any other health related profession. It is easy to see why so many turn to the practice building techniques taught in chiropractic school classrooms and seminars run by companies promising to bring more patients in.
Virtually everything you see on a chiropractic website or read about a chiropractor in a local publication, is part of a prepackaged practice building scheme. The wording is carefully chosed to have the biggest impact. Every flyer or handout found in a chiropractor’s waiting room is designed to indoctrinate you so that you not only come back, but you go out and spread the word. Here is a nearly ubiquitous example from a chiropractic website’s FAQ section:
“How long will you need chiropractic care?You’ll need chiropractic care as long as you live in Hanover Park and encounter physical, chemical or emotional stress that you cannot adapt to or accommodate. Ready to get started? Call our office today.”
“Ultimately, the goal of the chiropractic treatment is to restore the body to its natural state of optimal health. In order to accomplish this, I use a variety of treatment methods, including manual adjustments, massage, trigger point therapy, nutrition, exercise rehabilitation, massage, as well as counseling on lifestyle issues that impact your health. Since the body has a remarkable ability to heal itself and to maintain its own health, the primary focus is simply to remove those things which interfere with the body’s normal healing ability.”
These seemingly personal stories always revolve around two things. The chiropractor always tells the story of how he or she, or a family member, was injured and could only find relief in the caring hands of a chiropractor, thus inspiring them to join the field. And they always involve the chiropractor making a confession about how they have been taking the credit for healing all those patients when really it was the chiropractic all along. Check out the links above and you’ll see, and trust me there are thousands more that are easily accessible online.
The reason why the general format is similar, and often exactly the same word for word, is because these chiropractors are using a standard template bought from practice building firms. The chiropractor simply puts in his or her name, practice location and hours, and some personal information such as a picture and a description of his or her beautiful family. I imagine that they choose from a list of personal tragedies that led them into the chiropractors office, and the testimonials typically placed in the ad are likely invented as well.
Many of these ads disparage the medical profession, and I have come across a number which blame vaccines for SIDS and other health problems. I am constantly amazed at the audacity of placing these cookie cutter ads when the internet provides such an easy way to compare them to others and see through the charade. But I don’t think that anyone using such techniques ultimately care. It probably doesn’t take many suckers to fall for this tactic, and to sign a longterm maintenance contract, to turn a profit.
Trick or Treatment
I finished this book on the same day that the Point of Inquiry podcast interview with author Simon Singh.
The first nugget in this book is the discussion of science, evidence, double-blind testing, and historical accounts of how medical science has moved forward, ranging from the story of how George Washington was one in a long line of people killed by excessive blood-letting, Florence Nightgale’s work on improving sanitation in hospitals, and Dr. John Snow’s tracking of the cholera epidemic in Victorian London. They then explain the placebo effect, how it works on tested medicines such as aspirin, and how it works with tested but ineffective remedies.
The authors also set about explaining the history of several alternate treatments (homeopathy, chiropractic, herbal remedies), how clinical trials have been conducted, and what the outcome has been. If you expect a book thoroughly dismissing every type of alternative treatment, you will be disappointed, but neither will you find unqualified support. In general, they report several herbal remedies that have been successfully tested (but warn of both unknown efficacies, dangerous side effects, and high costs); that some chiropractic seems to help minor back pain (but you can also suffer severe injury from neck manipulations); and that acupuncture has limited effect in minor pain (but is largely placebo, and the films of Chinese doctors doing open-heart surgery on ‘anesthetized’ patients are hoaxes).
Two particular parts I enjoyed reading for new information: First, the history about acupuncture having been largely discarded in China until Mao pushed traditional Chinese treatments both from a standpoint of national pride as well as a way to cut health care costs. Second, I appreciated the story about Randi’s involvement with investigating Jacques Benveniste’s Nature paper claiming prove of the efficacy of a particular homeopathic treatment.
My opinion is that the authors did a thorough investigation of the evidence upholding alternative treatment therapies, researched the history, provided documentation supporting their claims, discuss enough science so that the casual reader will understand the concept of evidence-based medicine, and were fair and unbiased in their conclusions.
One of the more common approaches that attending physicians take when teaching medical students and residents is the use of clinical pearls. Rather than cold, hard facts, such as the most common form of congenital adrenal hyperplasia being 21-hydroxylase deficiency, these pearls of clinical wisdom are more akin to generally accepted rules of thumb. My personal favorite example is the admonition to avoid poking the skunk. Poking the skunk occurs when labs are ordered which aren’t necessary in the care of the patient. Checking a basic metabolic profile when all you really need is the serum sodium is risky. In fact, it seems that the less vital a particular lab value is to management decisions, the more likely it is going to come back as falsely abnormal, which often leads to further unnecessary tests. I don’t like to stick needles in babies, although you might not think that if you spent a day with me at work, so this particular clinical pearl comes up pretty often on my rounds.
I also make a point, on an almost daily basis, to incorporate pearls of critical thinking into my teaching of medical professionals in training. Naturally, these tend to focus on my particular area of interest, the myriad and often contradictory therapies falling under the umbrella term alternative medicine. As I’ve said many times before, I prefer terms like unscientific medicine, or quackery to be quite honest, over alternative medicine, integrative medicine, or complementary medicine. These are manipulative marketing terms used to lull the general public into acceptance with a false air of legitimacy, and the academic community into the application of a double standard to the evaluation of safety and efficacy of these therapies. There is only one legitimate means of determining whether a treatment works, and that is with science.
One example of a very helpful critical thinking pearl that should be applied to the claims of a large number of so-called alternative approaches to health, is that there is often an inverse relationship between the number of symptoms or conditions supposedly treated by a therapy and the number that is actually treated. This is better expressed with the adage that if something is claimed to cure everything, it almost certainly cures nothing. The number of alternative medical modalities that fall into this category are numerous and experiencing seemingly exponential growth, however the most important example because of its acceptance by the general public as a legitimate and science-based practice is that of chiropractic.
Though nobody, even chiropractors themselves, have been able to define themselves in a way that allows a consistent and practical understanding of just what it is that they do, there are some safe generalizations which can be made. For instance, they tend to be spine-centered rather than the oft advertised “holistic”, and a significant percentage of them categorize themselves as “straight”. This distinction shares a dichotomous relationship with self-described “mixers”, which as the name implies are prone to incorporating a wide variety of decidedly non-spine centered therapies into their practice such as acupuncture, applied kinesiology, or nutritional supplementation, as well as some science-based modalities like standard physical therapy. Mixers outnumber straights by a large margin, and though they do make use of other therapies, they still primarily focus on the correction of a non-existant entity known as the subluxation.
Subluxations in the chiropractic sense, as opposed to the legitimate medical diagnosis, are as polymorphous as one would expect of something invented out of whole cloth* by a former magnet healer and spiritualist over a hundred years ago. Since 1895, the term has evolved into many different forms with all stages still believed in by varying numbers of chiropractors today. The manifestation which likely is accepted by the largest number of currently practicing chiropractors involves a proposed “complex of functional and/or structural and or pathological articular changes that compromise neural integrity and may influence organ system and general health”. This definition is so slippery as to be rendered utterly meaningless, and is a prime example of the inability of chiropractors to be able to establish a standard definition of who they are and what they do. This fact actually benefits chiropractors however, as it allows for a near limitless scope of practice and the ability to bill many insurance companies for the treatment of a phantom condition.
Regardless of whether a chiropractor is a straight or a mixer, they are likely to claim that they have special insight into your particular complaint regardless of what it is. With rare exception, chiropractors assert their ability to treat not just common musculoskeletal complaints, a category of conditions falsely considered by many to be their area of particular expertise, but the entirety of known medical maladies. Many will even treat one or more of a growing number of fictitious conditions such as adrenal fatigue or Wilson’s Thyroid Syndrome. This is often done overtly with outright claims of personal success in curing conditions ranging from asthma to zoster, with some even touting their ability to treat serious life-threatening illnesses like cancer and HIV.
Straight chiropractors take a different approach, boldly claiming only to treat subluxations, which then allows for the innate healing power of the human body to heal any disease state under the sun via an unimpeded spinal conduit. A critical evaluation of the medical literature reveals a far different reality however. After a little over a century of existence, there is essentially no good evidence that chiropractic care is effective in the treatment of any medical condition, or any made up one either. The one sliver of an exception is the treatment of acute lower back pain, which does appear to resolve under the care of a chiropractor. What they may not want you to know is that it has not been shown to work any better than more standard treatments such as physical therapy and the use of ibuprofen.
*The top link on google when inserting the phrase “invented out of whole cloth” takes one to an article on the history of chiropractic