Chiropractic Healthiness

Question:

<<Well, I guess you had a 50/50 chance of getting this correct, Steve, but you "guessed" wrong. >> Are you keeping score? Jay H.   B.Sc. (4/99 add D.C.)—– Research studies on Chiropractic and medicine can be found on MEDLINE at PubMed:  http://www.ncbi.nlm.nih.gov/PubMed/ RPG Greyhawk:  http://members.aol.com/emirikol7——-

Response:

 * Steve Agocs, chiropractic student:  * George (don’t know his first name) was a DC at Palmer.  * He came up with an entire system of orthopedic tests.  * One of them is referred to siomply as "George’s test"  * although it might be more accurately called George’s Test  * for Vertebrobasilar Artery Patency.  Anyway, the patient  * is asked to rotate their head about 40 degrees to one  * side.  Then they look up toward the ceiling.  This  * compromises the ipsilateral vetebral artery and checks  * for the contralateral’s ability to compensate. Well, I guess you had a 50/50 chance of getting this correct, Steve, but you "guessed" wrong.  Turning the head to one side "kinks" (stretches and narrows) the vertebral artery on the OPPOSITE (contralateral) side and "straightens" (relative to its neutral position) the vertebral artery on the SAME (ipsilateral) side to which the head is turned. In this rotated position, the ipsilateral (side to which the head is turned) vertebral artery remains "open." If blood flow in this artery is compromised, then symptoms of cerebral ischemia (decreased supply of blood to the brain) including dizziness, ringing in the ears, nausea, blurred vision, and even fainting might appear when the head remains like this for 30-45 seconds. Understanding which side is affected by this maneuver is a VERY common mistake made by chiropractic students, Steve, so don’t concern yourself. It will also help for you to figure out which is your left side and which is your right. You will then be able make similar determinations on your patients. Also, since one of the biggest decisions you will have to make as a chiropractor is whether to "crack" your patient on the right side or the left, you will find this knowledge of "right vs left" very useful. You know, Steve, at some point, it’s possible you’ll get SOMETHING right if you keep posting…  or was that something "left?" Dr Badanes [TEO.]

Response:

- Hide quoted text — Show quoted text ->>Like I said, these organs are under SOME control by the body, no? >   The control is minor.   >    How so?  If the nervous system control an endocrine gland that in turn >controls the heart with its secretions, how is this condidered "minor"? >And in the cases where it’s hormonal, it’s >likely to be under hypothalamic-pituitary control, and not something >subject to a "subluxation".   >    That wasn’t your point originally!  Anyway, the hypothalamus and the >pituitary are under direct control of the nervous system.  While spinal nerves >might not influence these two organs directly, accessory nerves do supply the >vasculature there.  Subluxations could influence the movement of products >(hormones) toward and away from these organs…  I disagree with your >statements. >Transplanted hearts are the best example >of general response to both adrenal and general sympathetic release of >norepinephrine and epinephrine, but even here most of the control in a >normal heart is direct, and the fact that people with transplanted >organs hearts do well, indicates that the direct control isn’t that >important for health.  See the point?  For kidneys and livers the same >argument applies in spades. >    I disagree.  While you may be able to argue that the direct nervous >control isn’t as big a factor as other control systems, these other control >systems are still under nervous control.  YOu can’t get away from the influence >of the nervous system!  And while one system may have MORE control than >another, this does not mean that pathologies cannot arise in cases where the >"minor" system is compromised. >> It serves to reason that teh control mechanism of the nervous system >may be either direct or indirect.  I figured you’d have been taught >this in medical school…it’s basic anatomy and physiology, really.< >   It’s not.  It confuses influence with "control."   >    Okay.  What’s the big difference, then?  It still stands to reason that >the nervous system controls most organs and influences all of them.  I’m not >only looking at direct means, but also through teh vasculature and accessory >systems of each organ.   >The fact that >most internal organs can be disconnected from the spinal nerves without >a bit of trouble is strong evidence that direct spinal nerve enervation >is not a major cause of disease and organ dysfunction.   >    I don’t agree.  There is still important innervation to the blood >supply, etc.  The body is more complicated than your model, where you suggest >that organs can be disconnected and rewired in various bodies.  All systems are >intertwined.  The whole is greater than the sum of the parts! >That, I >believe, is contradictory to the views of many chiropractors, but is >never the less, the truth. >    Well, if we could discuss some specific examples maybe we could get >down to the "truth".  Opinion and truth are two different things!  8-) >   As for indirect hormonal influence of organs, it mostly originates >from the brain.  If chiropractic manipulation influences that, it’s not >by any mechanism related to vertebral subluxations or nerve >compressions (all that machinery is buried deep in your brain, inside >your skull).   >    But what about the vasculature supplying the brain?  And sensory >innervation from these organs back to the CNS?  If these aspects aren’t >functioning, the organ in question suffers. >Therefore this too is contrary to the Palmer subluxation >theory of chiropractic. >    I don’t think you’ve given enough factual information to conclude this. >While what you are saying seems to be, on the surface, contradictory to some >theories of subluxation, you haven’t shown me that what you are saying is fact >and not opinion. >>  In any case, what is the >>number of transplantees that DC’s treat, just out of curiosity? >   I don’t know, but it’s irrelevent.  I’m not merely making the >argument that chiropractic doesn’t work on transplantees.  I’m pointing >out that the very existence of healthy transplantees gives real >problems to many "classic" chiropractic ideas of what it is that >maintains internal organ health.  If Ms. Jones’s kidneys aren’t working >well, it’s a pretty dumb idea that the reason is some subluxation in >her back, cutting off the spinal root nerve supply to them.  Since we >know (as Palmer did not) that her kidneys would work fine with no >spinal nerve supply AT ALL.  Understand? >    Yep, I understand.  But, you’re looking at one model of subluxation, >and from one view: direct control.  YOu’re not looking at the support >structures that each organ has, sensory innervation, etc etc. >Steve >DC student >                                        Steve Harris, M.D.

     Tell ya what, Steve.  Why don’t we excise the nerves going to Mr Harris’s heart and see how long he lives for.  Maybe if he dies he will believe it. Patrick V. Suglia Life University School of Chiropractic http://www.collegeclub.com/~suglia Please remove "NOSPAM" when replying by e-mail.

Response:

- Hide quoted text — Show quoted text – >(Backcrkr) writes: >From Anatomy Of The Head, Neck, and Back by Harvey B. Morter, Jr. >(professor of spinal anatomy at Palmer College of Chiropractic) >" At Palmer you will be expected to become familiar with a diagnostic >series of tests collectively called George’s Test. One of the >components of this series is a rapid test fo vertebrobasilar artery >insufficiency. (There is no such artery as the vertebrobasilar; the >exam tests the patency of the vertebral artery and it’s terminal >fusion, the basilar artery). By rotating and extending the head and >neck, the contralateral artery to the direction of head tilt is >stretched or compromised. This requires the ipsilateral vertebral >artery to compensate for the the compromised artery or dizziness, >vertigo, and other problems occur when normal position of the head and >neck are restored." >Backcrkr >   Right.  At Palmer they teach you that patients who become dizzy when >you rotate their heads have vertebral artery insufficiency?  Did I get >that right?  Just want to make sure.

        Not just rotation.  Rotation and extension.  Specific number of degrees as well.  This was th most used orthopedic test to determine this, but not the only one performed.  I’ve already written this to you, but you don’t seem to care.  Anyway, there has been some discussion within the profession as to its validity, so it isn’t the sole test used!  Unfortunately neither Backcrkr nor I are near clinical stages yet, so we can’t really say one way or the other what Palmer may or may not teach in its Neuromusculoskeletal Diagnosis classes. This is the only one either of us know because that is the only one mentiooned, but again, we haven’t gotten to any diagnosis classes, so don’t think what we are writing is the bible.  Plus, you obviously misunderstood the mechanics of the test, so please reread it again.  Considering Palmer DC’s have an excellent track record as chiropractors, being highly regarded worldwide, I would think that there are other tests to determine patency of the vertebral arteries. Steve DC student – Hide quoted text — Show quoted text ->                                        Steve Harris, M.D.

Response:

>THere’s a case-history of at least one such death on www.quackwatch.com

        I’ll have to read it for myself.  The bottom line is that chiropractors have an excellent record in this department. Steve – Hide quoted text — Show quoted text ->AF > > I don’t have a problem with questions, but please be > > open about what you want to achieve.  To me it is clear that you are trying to > > substantiate a belief that chiropractic can cause spinal cord injuries.   > I’ve been completely open.  I’m trying to learn one way or another if cord > injury is a problem because it’s a self-evident possibility.  It’s called > curiosity and skepticism, and shouldn’t be confused with a pre-formed agenda. > > It > > seems to me that you already believe it happens and you are siomply looking for > > facts that prove this.  I disagree.  I haven’t seen one report of a case > > remotely like this.  Millions of adjustments have been delivered and not once > > have I ever seen anything like this. > A news program (don’t recall which one… 20/20 or somesuch) did a story > several years ago in which they stated that several deaths occured every year > from chiropratic c-spine manipulations.  Perhaps my memory is faulty and the > deaths were due to CVA, but it seems to me it was cord injury.  This is why > I’ve been asking — to get the facts. > Now that this thread has been running a while and no one has stepped forward > with data showing it does happen, I’m leaning toward believing that it is > indeed very rare or non-existent. > — > Carey Gregory >Aaron A. Fox >Assistant Professor of Music (Ethnomusicology) >Columbia University >    web: http://roar.music.columbia.edu/~cecenter/afindex.html >JUSTIN TREVINO’s "TEXAS HONKY-TONK" is here!  See: >http://roar.music.columbia.edu/~cecenter/Justin.html

Response:

> I don’t have a problem with questions, but please be > open about what you want to achieve.  To me it is clear that you are trying to > substantiate a belief that chiropractic can cause spinal cord injuries.  

I’ve been completely open.  I’m trying to learn one way or another if cord injury is a problem because it’s a self-evident possibility.  It’s called curiosity and skepticism, and shouldn’t be confused with a pre-formed agenda. > It > seems to me that you already believe it happens and you are siomply looking for > facts that prove this.  I disagree.  I haven’t seen one report of a case > remotely like this.  Millions of adjustments have been delivered and not once > have I ever seen anything like this.

A news program (don’t recall which one… 20/20 or somesuch) did a story several years ago in which they stated that several deaths occured every year from chiropratic c-spine manipulations.  Perhaps my memory is faulty and the deaths were due to CVA, but it seems to me it was cord injury.  This is why I’ve been asking — to get the facts. Now that this thread has been running a while and no one has stepped forward with data showing it does happen, I’m leaning toward believing that it is indeed very rare or non-existent. — Carey Gregory

Response:

- Hide quoted text — Show quoted text – >(Backcrkr) writes: >From Anatomy Of The Head, Neck, and Back by Harvey B. Morter, Jr. >(professor of spinal anatomy at Palmer College of Chiropractic) >" At Palmer you will be expected to become familiar with a diagnostic >series of tests collectively called George’s Test. One of the >components of this series is a rapid test fo vertebrobasilar artery >insufficiency. (There is no such artery as the vertebrobasilar; the >exam tests the patency of the vertebral artery and it’s terminal >fusion, the basilar artery). By rotating and extending the head and >neck, the contralateral artery to the direction of head tilt is >stretched or compromised. This requires the ipsilateral vertebral >artery to compensate for the the compromised artery or dizziness, >vertigo, and other problems occur when normal position of the head and >neck are restored." >Backcrkr >   Right.  At Palmer they teach you that patients who become dizzy when >you rotate their heads have vertebral artery insufficiency?  Did I get >that right?  Just want to make sure.

        By the way, you didn’t get that right.  YOu forgot a few of the components, such as time involved and rotation with extension, which is clearly written above.  Just out of curiosity, what tests do MD’s do that are non-invasive to determine vertebral artery patency?  PReferably ones that don’t require radiography and radioactive dyes… Steve – Hide quoted text — Show quoted text ->                                        Steve Harris, M.D.

Response:

– Hide quoted text — Show quoted text -(Backcrkr) writes: >From Anatomy Of The Head, Neck, and Back by Harvey B. Morter, Jr. >(professor of spinal anatomy at Palmer College of Chiropractic) >" At Palmer you will be expected to become familiar with a diagnostic >series of tests collectively called George’s Test. One of the >components of this series is a rapid test fo vertebrobasilar artery >insufficiency. (There is no such artery as the vertebrobasilar; the >exam tests the patency of the vertebral artery and it’s terminal >fusion, the basilar artery). By rotating and extending the head and >neck, the contralateral artery to the direction of head tilt is >stretched or compromised. This requires the ipsilateral vertebral >artery to compensate for the the compromised artery or dizziness, >vertigo, and other problems occur when normal position of the head and >neck are restored." >Backcrkr

   Right.  At Palmer they teach you that patients who become dizzy when you rotate their heads have vertebral artery insufficiency?  Did I get that right?  Just want to make sure.                                         Steve Harris, M.D.

Response:

- Hide quoted text — Show quoted text – >x-no-archive:  yes >   This sounds pretty questionable.  Tell us about "George’s Test." >From Anatomy Of The Head, Neck, and Back by Harvey B. Morter, Jr. >(professor of spinal anatomy at Palmer College of Chiropractic) >" At Palmer you will be expected to become familiar with a diagnostic >series of tests collectively called George’s Test. One of the >components of this series is a rapid test fo vertebrobasilar artery >insufficiency. (There is no such artery as the vertebrobasilar; the >exam tests the patency of the vertebral artery and it’s terminal >fusion, the basilar artery). By rotating and extending the head and >neck, the contralateral artery to the direction of head tilt is >stretched or compromised. This requires the ipsilateral vertebral >artery to compensate for the the compromised artery or dizziness, >vertigo, and other problems occur when normal position of the head and >neck are restored."

        Thanks…I quoted it backwards!  I guess it’s been a long trimester (it’s finals week right now)… Steve – Hide quoted text — Show quoted text ->Backcrkr >– >CoT/KoB   >515

Response:

>>      The rate of incidence for a cerebral vascular accident following > a cervical spinal manipulation is 2 per million adjustments. >Thank you.  Could you tell us the source of that figure?

        It’s from A. G. J. Terrett’s publication _Vertebrobasilar Stroke Following Manipulation_ from 1996. >Also, what are the figures for spinal cord injury during c-spine manipulation?

        What kind of spinal cord injury?  I’ve never seen a study that looks at cord injuries after manipulation.  I’m not sure there’s ever even been a reported case… Steve – Hide quoted text — Show quoted text ->      Absolutely not.  Asking if *ALL* chiropractors agree on something > is a pretty absurd question. Can you name me a health care profession > where you’re going to find 100% agreement among the members?  Can you > name me one profession in general where you’re going to find 100% > agreement? >No, I most certainly can’t.  Disagreement among professionals is usually a >sign of a thinking profession.  But if you look back at the message I was >responding to, I think you’ll see why I asked. >– >Carey Gregory

Response:

>> correct subluxations.  While chiropractors may have many techniques > for doing just this, I have never seen any harm being done by the > differences in these techniques.  After 12 years of being in the > medical field, I have seen people die or be maimed needlessly because > of the differences that exist between medical doctors who couldn’t > agree on how to treat the patient.  So much for iatrogenic illness. >Patrick, >On the average, how many patients of chiropractors die or are severely >disabled every year from c-spine manipulation?

        The only literature review I’ve seen that addresses this question is _Vertebrobasilar Stroke Following Manipulation_ (by A.G.J. Terrett, 1996). Incidence is reported as 0.0002% (2 cases per million manipulations). Interestingly, a close review of the literature shows that chiropractors are not the only ones included…Terrett sites studies showing medical practitioners, medical specialists, osteopaths, physiotherapists, naturopaths, the patient himself, a blind masseur, a kung-fu practitioner (!), a wife (!), and an Indian barber as being the manipulator.  So, there is no definitive answer as to what incidence of risk there is when DC’s alone are considered. Whatever the case, chiropractic is extremely safe, and your chances of being injured by your MD, struck by lightning, etc are much higher than suffering stroke following a cervical adjustment by a DC. >Do all chiropractors agree on the indications, contraindications, and methods >of c-spine manipulation?

        Methods?  No.  There are many techniques, ranging from no-force to classic Diversified moves such as modified rotary’s.  MEthods depend on the patient and doctor’s preferences, as well as contraindications to certain moves that are evident during the history and physical.  One of the most widely used tests for vertebrobasilar patency is George’s Test, which determines the ability of one veretbral artery to compensate for the other.  Also auscultation of the carotids should be performed.  I’m sure this is more, but this is all I’ve learned so far! Steve – Hide quoted text — Show quoted text ->– >Carey Gregory

Response:

> >Also, what are the figures for spinal cord injury during c-spine manipulation? >       That figure I do not know. But I would suspect that it’s far > less than the stat for stroke following c-spine manipulation (which > itself is 0.0002%.

Okay, anyone else know?  I’m prone to think it happens. >      No, I’m afraid I don’t see why you asked, nor am I sure which > message(s) you were referring to. If you are insinuating that all of > the chiropractic students in this group  agree with each other 100% of > the time, let me assure you that you’re wrong. I have often expressed > my dissent from those views expressed by some of the other > chiropractic students.

I’m not insinuating anything.  The original poster was berating MD’s for "killing patients" by not being able to agree on dx and tx.  That led me to wonder if DC’s were miraculously able to agree on everything all the time, and also to confirm that spinal manipulation was not risk free. — Carey Gregory

Response:

>Like I said, these organs are under SOME control by the body, no?

   The control is minor.  And in the cases where it’s hormonal, it’s likely to be under hypothalamic-pituitary control, and not something subject to a "subluxation".  Transplanted hearts are the best example of general response to both adrenal and general sympathetic release of norepinephrine and epinephrine, but even here most of the control in a normal heart is direct, and the fact that people with transplanted organs hearts do well, indicates that the direct control isn’t that important for health.  See the point?  For kidneys and livers the same argument applies in spades. > It serves to reason that teh control mechanism of the nervous system

may be either direct or indirect.  I figured you’d have been taught this in medical school…it’s basic anatomy and physiology, really.<    It’s not.  It confuses influence with "control."   The fact that most internal organs can be disconnected from the spinal nerves without a bit of trouble is strong evidence that direct spinal nerve enervation is not a major cause of disease and organ dysfunction.  That, I believe, is contradictory to the views of many chiropractors, but is never the less, the truth.    As for indirect hormonal influence of organs, it mostly originates from the brain.  If chiropractic manipulation influences that, it’s not by any mechanism related to vertebral subluxations or nerve compressions (all that machinery is buried deep in your brain, inside your skull).  Therefore this too is contrary to the Palmer subluxation theory of chiropractic. >  In any case, what is the >number of transplantees that DC’s treat, just out of curiosity?

   I don’t know, but it’s irrelevent.  I’m not merely making the argument that chiropractic doesn’t work on transplantees.  I’m pointing out that the very existence of healthy transplantees gives real problems to many "classic" chiropractic ideas of what it is that maintains internal organ health.  If Ms. Jones’s kidneys aren’t working well, it’s a pretty dumb idea that the reason is some subluxation in her back, cutting off the spinal root nerve supply to them.  Since we know (as Palmer did not) that her kidneys would work fine with no spinal nerve supply AT ALL.  Understand?                                         Steve Harris, M.D.

Response:

>>Like I said, these organs are under SOME control by the body, no? >   The control is minor.  

        How so?  If the nervous system control an endocrine gland that in turn controls the heart with its secretions, how is this condidered "minor"? >And in the cases where it’s hormonal, it’s >likely to be under hypothalamic-pituitary control, and not something >subject to a "subluxation".  

        That wasn’t your point originally!  Anyway, the hypothalamus and the pituitary are under direct control of the nervous system.  While spinal nerves might not influence these two organs directly, accessory nerves do supply the vasculature there.  Subluxations could influence the movement of products (hormones) toward and away from these organs…  I disagree with your statements. >Transplanted hearts are the best example >of general response to both adrenal and general sympathetic release of >norepinephrine and epinephrine, but even here most of the control in a >normal heart is direct, and the fact that people with transplanted >organs hearts do well, indicates that the direct control isn’t that >important for health.  See the point?  For kidneys and livers the same >argument applies in spades.

        I disagree.  While you may be able to argue that the direct nervous control isn’t as big a factor as other control systems, these other control systems are still under nervous control.  YOu can’t get away from the influence of the nervous system!  And while one system may have MORE control than another, this does not mean that pathologies cannot arise in cases where the "minor" system is compromised. > It serves to reason that teh control mechanism of the nervous system >may be either direct or indirect.  I figured you’d have been taught >this in medical school…it’s basic anatomy and physiology, really.< >   It’s not.  It confuses influence with "control."  

        Okay.  What’s the big difference, then?  It still stands to reason that the nervous system controls most organs and influences all of them.  I’m not only looking at direct means, but also through teh vasculature and accessory systems of each organ.   >The fact that >most internal organs can be disconnected from the spinal nerves without >a bit of trouble is strong evidence that direct spinal nerve enervation >is not a major cause of disease and organ dysfunction.  

        I don’t agree.  There is still important innervation to the blood supply, etc.  The body is more complicated than your model, where you suggest that organs can be disconnected and rewired in various bodies.  All systems are intertwined.  The whole is greater than the sum of the parts! >That, I >believe, is contradictory to the views of many chiropractors, but is >never the less, the truth.

        Well, if we could discuss some specific examples maybe we could get down to the "truth".  Opinion and truth are two different things!  8-) >   As for indirect hormonal influence of organs, it mostly originates >from the brain.  If chiropractic manipulation influences that, it’s not >by any mechanism related to vertebral subluxations or nerve >compressions (all that machinery is buried deep in your brain, inside >your skull).  

        But what about the vasculature supplying the brain?  And sensory innervation from these organs back to the CNS?  If these aspects aren’t functioning, the organ in question suffers. >Therefore this too is contrary to the Palmer subluxation >theory of chiropractic.

        I don’t think you’ve given enough factual information to conclude this. While what you are saying seems to be, on the surface, contradictory to some theories of subluxation, you haven’t shown me that what you are saying is fact and not opinion. >  In any case, what is the >number of transplantees that DC’s treat, just out of curiosity? >   I don’t know, but it’s irrelevent.  I’m not merely making the >argument that chiropractic doesn’t work on transplantees.  I’m pointing >out that the very existence of healthy transplantees gives real >problems to many "classic" chiropractic ideas of what it is that >maintains internal organ health.  If Ms. Jones’s kidneys aren’t working >well, it’s a pretty dumb idea that the reason is some subluxation in >her back, cutting off the spinal root nerve supply to them.  Since we >know (as Palmer did not) that her kidneys would work fine with no >spinal nerve supply AT ALL.  Understand?

        Yep, I understand.  But, you’re looking at one model of subluxation, and from one view: direct control.  YOu’re not looking at the support structures that each organ has, sensory innervation, etc etc. Steve DC student – Hide quoted text — Show quoted text ->                                        Steve Harris, M.D.

Response:

> correct subluxations.  While chiropractors may have many techniques > for doing just this, I have never seen any harm being done by the > differences in these techniques.  After 12 years of being in the > medical field, I have seen people die or be maimed needlessly because > of the differences that exist between medical doctors who couldn’t > agree on how to treat the patient.  So much for iatrogenic illness.

Patrick, On the average, how many patients of chiropractors die or are severely disabled every year from c-spine manipulation? Do all chiropractors agree on the indications, contraindications, and methods of c-spine manipulation? — Carey Gregory

Response:

>writes (quoting a chiropractor): >>>Chiropractic is based on the premise that every gland, organ and >>>cell of the body needs a nerve supply to function properly. >   Then it has real problems as a discipline based on a good theory, >right there.  For it would predict that transplanted organs— kidneys >or livers, for example, would not function properly.  Any nerves which >supply them, after all, are cut and cannot be reconnected.  They do not >(cannot) grow back.  

        True.  IN the example of the heart, though, the main means of control is hormonal.  The endocrine and exocrine glands of the body have secretion regulated by nervous tone.  In this way, the transplanted heart mayu not be under the direct control of the nervous system, but it is via the hormones that the nerves regulate.  There is clear evidence that even in an intact body not all tissues and cells are directly innervated, but the nervous system still exerts its control by influencing the control factors of said tissues. >Alas for chiropractic, however, these organs often >work just fine.  Not always, but often enough to put the lie to the >theory, it seems to me.  

        Maybe there is an assumption that others know the above information? >    Now let’s get this straight: I’m supposed to remember the many >patients I’ve seen living completely healthy lives with completely >functional and completely nerveless and disconnected transplanted >kidneys– and at the same time believe that some guy is fixing major >malfunction in kidneys by adjusting their nerve supply imbalances by >back manipulation?  You’ve got to be kidding.  

        Like I said, these organs are under SOME control by the body, no?  It serves to reason that teh control mechanism of the nervous system may be either direct or indirect.  I figured you’d have been taught this in medical school…it’s basic anatomy and physiology, really.  In any case, what is the number of transplantees that DC’s treat, just out of curiosity? Steve DC student – Hide quoted text — Show quoted text ->                                       Steve Harris, M.D.

Response:

>      The rate of incidence for a cerebral vascular accident following > a cervical spinal manipulation is 2 per million adjustments.

Thank you.  Could you tell us the source of that figure? Also, what are the figures for spinal cord injury during c-spine manipulation? >      Absolutely not.  Asking if *ALL* chiropractors agree on something > is a pretty absurd question. Can you name me a health care profession > where you’re going to find 100% agreement among the members?  Can you > name me one profession in general where you’re going to find 100% > agreement?

No, I most certainly can’t.  Disagreement among professionals is usually a sign of a thinking profession.  But if you look back at the message I was responding to, I think you’ll see why I asked. — Carey Gregory

Response:

>>      The rate of incidence for a cerebral vascular accident following > a cervical spinal manipulation is 2 per million adjustments. >Thank you.  Could you tell us the source of that figure?

1. Mason v Forgie, S/C/1569/82, Court of Queen’s Bench, New Brunswick, Canada, decision dated December 27, 1984, accepting expert evidence of Scott Haldeman, D.C., M.D., Ph.D.   19,27 2. Henderson DJ (1992)  ’Vertebral Artery Syndrome’, Chapter 6 in ‘Chiropractic Standards of Practice and Quality of Care’, ed Vear HJ, Aspen Publishers, Gaithersburg, Maryland, 115-143. 3. Terrett AGJ (1987) ‘Vascular Accidents from Cervical Spine Manipulation: Report of 107 Cases’, J Aust Chiro Assoc 17:15-24 4. Dvorak J and Orelli F (1985) ‘How Dangerous Is Manipulation to the Cervical Spine?", Manual Medicine 2:1-4. 5. Guttman G (1983) ‘Injuries to the Vertebral Artery Caused by Manual Therapy’, Manuelle Medizin 21:2-14. 6. Carlini WG et al (1994) ‘Incidence of Stroke Following Chiropractic Manipulation’, Abstract, American Heart Association’s 19th International Joint Conference on Stroke and Cerebral Circulation, San Diego, February 19, 1994 and AHA news release. 7. Human CNS Structure (5th Edition) by Gale R. Lewellen page 39. 8.  The Chiropractic Report  May 1994 Volume 8 Number 3. Pages1-6. >Also, what are the figures for spinal cord injury during c-spine manipulation?

      That figure I do not know. But I would suspect that it’s far less than the stat for stroke following c-spine manipulation (which itself is 0.0002%. >No, I most certainly can’t.  Disagreement among professionals is usually a >sign of a thinking profession.  But if you look back at the message I was >responding to, I think you’ll see why I asked.

     No, I’m afraid I don’t see why you asked, nor am I sure which message(s) you were referring to. If you are insinuating that all of the chiropractic students in this group  agree with each other 100% of the time, let me assure you that you’re wrong. I have often expressed my dissent from those views expressed by some of the other chiropractic students. Backcrkr — CoT/KoB   515

Response:

>         Why?  What types of injuries are you looking for?  I’ve had some sore > muscles after atlas adjustment once, but I wouldn’t call that an injury.  What > do you have in mind that you are looking to prove, might I ask?  Chiropractic > is an incredibly safe form of health care.  There simply aren’t spinal injuries > resulting from it that I know of.

If I were looking to prove something I’d go do my own research and not bother giving those in chiropractic an opportunity to answer.  Sorry if these questions bother you, but here comes another… Manipulation of the bones of the c-spine carries an obvious risk.  For example, I’ve seen a death from intubation in a pt with osteoporosis.  The simple act of tilting her head back fractured c1/c2 and transected her cord. Are you saying this never happens during chiropractic manipulation? >         It isn’t risk free.  There is a 1/2,000,000 chance of stroke following > a cervical manipulation.  Other than that and the occasional broken rib is > osteoporotic patients during a thoracic adjustment, there is nothing. > Chiropractic is very safe and very gentle.  Sorry if this doesn’t help your > agenda much!

Are you really this paranoid?  I’ve asked a few questions and accepted the answers as factual.  From that you conclude I have an agenda.  Perhaps a chiropractic adjustment would help with that chip on your shoulder. — Carey Gregory

Response:

>> >Also, what are the figures for spinal cord injury during c-spine manipulation? >       That figure I do not know. But I would suspect that it’s far > less than the stat for stroke following c-spine manipulation (which > itself is 0.0002%. >Okay, anyone else know?  I’m prone to think it happens.

        Why?  What types of injuries are you looking for?  I’ve had some sore muscles after atlas adjustment once, but I wouldn’t call that an injury.  What do you have in mind that you are looking to prove, might I ask?  Chiropractic is an incredibly safe form of health care.  There simply aren’t spinal injuries resulting from it that I know of. >      No, I’m afraid I don’t see why you asked, nor am I sure which > message(s) you were referring to. If you are insinuating that all of > the chiropractic students in this group  agree with each other 100% of > the time, let me assure you that you’re wrong. I have often expressed > my dissent from those views expressed by some of the other > chiropractic students. >I’m not insinuating anything.  The original poster was berating MD’s for >"killing patients" by not being able to agree on dx and tx.  That led me to >wonder if DC’s were miraculously able to agree on everything all the time, and >also to confirm that spinal manipulation was not risk free.

        It isn’t risk free.  There is a 1/2,000,000 chance of stroke following a cervical manipulation.  Other than that and the occasional broken rib is osteoporotic patients during a thoracic adjustment, there is nothing. Chiropractic is very safe and very gentle.  Sorry if this doesn’t help your agenda much! Steve – Hide quoted text — Show quoted text ->– >Carey Gregory

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>    Methods?  No.  There are many techniques, ranging from no-force to >classic Diversified moves such as modified rotary’s.  MEthods depend on the >patient and doctor’s preferences, as well as contraindications to certain >moves that are evident during the history and physical.  One of the most widely >used tests for vertebrobasilar patency is George’s Test, which determines the >ability of one veretbral artery to compensate for the other.  

   This sounds pretty questionable.  Tell us about "George’s Test."                                    Steve Harris, M.D.

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– Hide quoted text — Show quoted text ->>>here is the full, unedited text of the Quackwatch page with regard to >>>chiropractic… >>>it’s been much maligned, but never directly quoted here. >>>note that Dr. Barrett includes dissenting views… >>>read, and decide for yourself. >[major snippage] >>>Chiropractic is based on the premise that every gland, organ and cell of >>>the body needs a nerve supply to function properly. Therefore it would seem >>>logical that malfunctions in these areas would also respond to >>>chiropractic adjustments. >>>It is with this basic thought in mind that the answer to, "What can you >>>treat, doctor?" could be as varied and vast as the nervous system itself. >>    And none of this has been outright disproven.   >Boy, there’s an inspirational slogan: >  "Chiropractic — much of what we believe has not been outright >   disproven!" >Makes me want to go right out and sign up for a few treatments. >>>that D.D. Palmer envisioned. But they do not agree among themselves about >>>what subluxations are. >>    And all MD’s don’t have agreement on their theory of disease and >>treatments.  OS what’s the point?  A little dissention within the ranks is a >>good thing.  It leads to development. >Maybe, but on the other hand, who says your analogy is valid?  There >is certainly disagreement within the ranks of MDs, but is it of >anything like the magnitude of the variation of chiropractic theories?

        Sure!  Chelation therapy, surgery, medication, nutrition, and exercise are all things different doctors may "prescribe" for treating heart disease. Go to a medical convention and listen to some of the papers sometimes…there is a LOT of argument within the medical profession on treatments.  Look at cancer alone! Steve – Hide quoted text — Show quoted text ->  – David Wright :: wright at ibnets.com :: Not a Spokesman for Anyone >     These are my opinions only, but they’re almost always correct. >     "The daily floggings will continue until morale improves." >     There are only five theories of the pathophysiology of a >subluxation.  There is only one cause of a subluxation — the loss of >tone or too much tone on a nerve caused by a displaced vertebra or >other osseous structure. >     All systems do not "need a nerve supply to function properly" — >all body systems are controlled by the nerve system, PERIOD.  If there >is too much or too little tone in the nerves supplying these systems, >dis-ease results which can, over time, produce symptoms. >     Chiropractors do not treat diseases.  Chiropractors find and >correct subluxations.  While chiropractors may have many techniques >for doing just this, I have never seen any harm being done by the >differences in these techniques.  After 12 years of being in the >medical field, I have seen people die or be maimed needlessly because >of the differences that exist between medical doctors who couldn’t >agree on how to treat the patient.  So much for iatrogenic illness. >Patrick V. Suglia >Life University School of Chiropractic >http://www.collegeclub.com/~suglia >Please remove "NOSPAM" when replying by e-mail.

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writes (quoting a chiropractor): >>Chiropractic is based on the premise that every gland, organ and >>cell of the body needs a nerve supply to function properly.

   Then it has real problems as a discipline based on a good theory, right there.  For it would predict that transplanted organs— kidneys or livers, for example, would not function properly.  Any nerves which supply them, after all, are cut and cannot be reconnected.  They do not (cannot) grow back.  Alas for chiropractic, however, these organs often work just fine.  Not always, but often enough to put the lie to the theory, it seems to me.       Now let’s get this straight: I’m supposed to remember the many patients I’ve seen living completely healthy lives with completely functional and completely nerveless and disconnected transplanted kidneys– and at the same time believe that some guy is fixing major malfunction in kidneys by adjusting their nerve supply imbalances by back manipulation?  You’ve got to be kidding.                                          Steve Harris, M.D.

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- Hide quoted text — Show quoted text ->>here is the full, unedited text of the Quackwatch page with regard to >>chiropractic… >>it’s been much maligned, but never directly quoted here. >>note that Dr. Barrett includes dissenting views… >>read, and decide for yourself. >[major snippage] >>Chiropractic is based on the premise that every gland, organ and cell of >>the body needs a nerve supply to function properly. Therefore it would seem >>logical that malfunctions in these areas would also respond to >>chiropractic adjustments. >>It is with this basic thought in mind that the answer to, "What can you >>treat, doctor?" could be as varied and vast as the nervous system itself. >        And none of this has been outright disproven.   >Boy, there’s an inspirational slogan: >  "Chiropractic — much of what we believe has not been outright >   disproven!" >Makes me want to go right out and sign up for a few treatments. >>that D.D. Palmer envisioned. But they do not agree among themselves about >>what subluxations are. >        And all MD’s don’t have agreement on their theory of disease and >treatments.  OS what’s the point?  A little dissention within the ranks is a >good thing.  It leads to development. >Maybe, but on the other hand, who says your analogy is valid?  There >is certainly disagreement within the ranks of MDs, but is it of >anything like the magnitude of the variation of chiropractic theories? >  – David Wright :: wright at ibnets.com :: Not a Spokesman for Anyone >     These are my opinions only, but they’re almost always correct. >     "The daily floggings will continue until morale improves."

     There are only five theories of the pathophysiology of a subluxation.  There is only one cause of a subluxation — the loss of tone or too much tone on a nerve caused by a displaced vertebra or other osseous structure.      All systems do not "need a nerve supply to function properly" — all body systems are controlled by the nerve system, PERIOD.  If there is too much or too little tone in the nerves supplying these systems, dis-ease results which can, over time, produce symptoms.      Chiropractors do not treat diseases.  Chiropractors find and correct subluxations.  While chiropractors may have many techniques for doing just this, I have never seen any harm being done by the differences in these techniques.  After 12 years of being in the medical field, I have seen people die or be maimed needlessly because of the differences that exist between medical doctors who couldn’t agree on how to treat the patient.  So much for iatrogenic illness. Patrick V. Suglia Life University School of Chiropractic http://www.collegeclub.com/~suglia Please remove "NOSPAM" when replying by e-mail.

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>>here is the full, unedited text of the Quackwatch page with regard to >chiropractic… >it’s been much maligned, but never directly quoted here. >note that Dr. Barrett includes dissenting views… >read, and decide for yourself.

[major snippage] >Chiropractic is based on the premise that every gland, organ and cell of >the body needs a nerve supply to function properly. Therefore it would seem >logical that malfunctions in these areas would also respond to >chiropractic adjustments. >It is with this basic thought in mind that the answer to, "What can you >treat, doctor?" could be as varied and vast as the nervous system itself. >    And none of this has been outright disproven.  

Boy, there’s an inspirational slogan:   "Chiropractic — much of what we believe has not been outright    disproven!" Makes me want to go right out and sign up for a few treatments. >that D.D. Palmer envisioned. But they do not agree among themselves about >what subluxations are. >    And all MD’s don’t have agreement on their theory of disease and >treatments.  OS what’s the point?  A little dissention within the ranks is a >good thing.  It leads to development.

Maybe, but on the other hand, who says your analogy is valid?  There is certainly disagreement within the ranks of MDs, but is it of anything like the magnitude of the variation of chiropractic theories?   — David Wright :: wright at ibnets.com :: Not a Spokesman for Anyone      These are my opinions only, but they’re almost always correct.      "The daily floggings will continue until morale improves."

Response:

- Hide quoted text — Show quoted text – >here is the full, unedited text of the Quackwatch page with regard to >chiropractic… >it’s been much maligned, but never directly quoted here. >note that Dr. Barrett includes dissenting views… >read, and decide for yourself. >Don’t Let Chiropractors Fool You >Stephen Barrett, M.D. >Chiropractors claim their profession was founded in 1895 when Daniel David >Palmer restored the hearing of a deaf janitor by "adjusting" a bump on his >spine. Soon afterward, he concluded that misaligned bones ("subluxations")

        The most widely accepted anatomical explanation is as follows:         The internal labyrinthine artery drains the important hearing organs of the ear.  Vasomotor control (i.e. dilation and constriction) of the internal labyrinthine is from the upper parasympathetics (which exit with spinal nerves T1-L2).  As a result, upper thoracic adjustment could have affected the vasomotor nerves supplying the internal labyrinthine artery, resulting in increased quality of hearing.  We will never know exactly what happened, but this is a perfectly sound hypothesis. >interfered with the body’s expression of "Innate Intelligence" — the >"Soul, Spirit, or Spark of Life" that controlled the healing process.

        Chiropractic philosophy (see Stephenson’s Chiropractic Textbook) states that there are two kinds of intelligence in the universe:               1)  Universal Intelligence- had by everything material.  ROcks, people, etc.         2)  Innate Intelligence- separates the living from the dead.  Rocks don’t have it, people do.           Early chiropractic philosophers used this as a means to explain why chiropractic does what it does.  It’s nothing to be afraid of! >Although philosophy and treatment vary greatly from one practitioner to >another, most of today’s 50,000-or-so chiropractors can be classified as >"straights" or "mixers."

        This would’ve held true….oh…over fifty years ago.  This is typical of Barrett’s site.  He likes to interject things like this that were true of the profession in its early years, but aren’t really considered in the modern view of chiropractic.  When BJ Palmer developed his Toggle-Recoil upper cervical technique, anyone adjusting anything below C1 and C2 were considered mixers!  This is an archaic, rarely used esignation that has little, if anything, to do with the state of modern chiropractic. – Hide quoted text — Show quoted text ->Straights tend to cling to Palmer’s doctrine that >most disease is caused by misaligned spinal bones ("subluxations") >correctable by spinal adjustment. Mixers acknowledge that factors such as >germs and hormones play a role in disease, but they tend to regard >mechanical disturbances of the nervous system as the underlying cause of >lowered resistance to disease. Louis Sportelli, D.C., who later became >chairman of the American Chiropractic Association’s board of governors, >expressed this concept in a pamphlet called "What Kinds of Conditions Do >Chiropractors Treat?" which he distributed in the 1980s. The pamphlet >stated: >The doctor of chiropractic directs his attention to the spine, searching >for an area which is deviant from normal. The deviation or malpositioning >of a spinal vertebra may cause a neurological imbalance within the body, >setting the stage for lowered resistance, and subsequently a disease >process. . . . >Chiropractic is based on the premise that every gland, organ and cell of >the body needs a nerve supply to function properly. Therefore it would seem >lofgical that malfunctions in these areas would also respond to >chiropractic adjustments. >It is with this basic thought in mind that the answer to, "What can you >treat, doctor?" could be as varied and vast as the nervous system itself.

        And none of this has been outright disproven.  Much of what is occurring is science further substantiates the claims that chiropractors have made all along.  FOr example, throughout the earliest writings of chiropractic there is reference to the mental component of poor health.  Science has discredited this vehemently until about the last 15-20 years.  Now you can get a PhD in psychoneuroimmunology!  Until recently the sacroiliac joint was thought to have no movement potential whatsoever.  DC’s have known it can move all along.  Science just substantiated this within the last ten to fifteen years.  Some ideas are ahead of their time! >In addition to spinal manipulation, mixers may prescribe nutrient >concoctions, homeopathic products, and various types of physiotherapy >(heat, cold, traction, exercise, massage, and ultrasound). Straights tend >to disparage medical diagnosis, claiming that examination of the spine is >the proper way for chiropractors to analyze their patients. Mixers are more >likely to diagnose medical conditions in addition to spinal abnormalities, >and to refer patients to medical practitioners for treatment. Some >practitioners claim that chiropractic treatment is effective against nearly >the entire range of human ailments. A small percentage of chiropractors >reject Palmer’s dogma and treat only musculoskeletal problems. I do not >believe that spinal manipulation is effective against other problems.

        Again, archaic designations that have no meaning to chiropractic today. Writing a "factual" account of medicine as it was a hundred years ago as if it were the modern state of the profession would make a pretty scary article, too, but it wouldn’t be the truth. >Research Findings >During the past few years, two reports about the treatment of low-back pain >have placed chiropractic in a favorable light. One, issued by the RAND >Corporation, concluded that spinal manipulation was appropriate for some >cases of low-back pain. The other, produced by the Agency for Health Care >Policy and Research (AHCPR), judged manipulation useful for controlling >symptoms while awaiting the spontaneous recovery that occurs within a month >in most patients with low-back problems.

        What about the most recent AHCPR guidelines?  What about studies that have occurred more recently?  WHy not any mention of any of those? >Although chiropractors have promoted these reports as endorsements of >chiropractic, they are not. They merely support the use of manipulation in >carefully selected patients. Only a few of the research studies on which >their conclusions were based involved manipulation by chiropractors; most >were done by medical doctors and physical therapists whose practices are >not identical to those of chiropractors. Most chiropractors manipulate the >vast majority of patients who walk through their door, some use techniques >that have not been studied scientifically, and many urge all of their >patients to undergo monthly or even weekly "preventive maintenance" visits >throughout their life. In addition, many chiropractors emphasize a >technique that is more vigorous (and therefore less safe) than the >controlled manipulation used by other practitioners. The only places where >"chiropractic" and "chiropractors" are mentioned in the body of the AHCPR >report are in the passages about the make-up of the AHCPR expert panel.

        Blah blah.  Read them for yourself.  Don’t take his interpretation of them as the Bible. >X-rays and Medicare >Most chiropractors claim that x-rays help them locate the "subluxations" >that D.D. Palmer envisioned. But they do not agree among themselves about >what subluxations are.

        And all MD’s don’t have agreement on their theory of disease and treatments.  OS what’s the point?  A little dissention within the ranks is a good thing.  It leads to development. – Hide quoted text — Show quoted text ->Some chiropractors believe they are displaced bones >that can be seen on x-rays and can be put back in place by spinal >adjustments. Others define subluxations vaguely or say they do not >necessarily show on x-rays. But what chiropractors contend about x-rays >also depends upon who asks and how the question is posed. >Chiropractic coverage under Medicare, which began in 1973, was limited to >manual manipulation of the spine for the treatment of "subluxations >demonstrated by x-rays to exist." To enable payment, federal officials >accepted an elaborate chiropractic "definition" of subluxations for which >payment could be made. During the mid-1980s, the U.S. Department of Health >and Human Services’ Office of the Inspector General (OIG) surveyed 145 >chiropractors by telephone about their billing practices. Eighty-four >percent said that some subluxations do not show on x-rays. Nearly half >responded that when billing Medicare, they "could always find something" >(by x-ray or physical examination) to justify the diagnosis, or they >actually tailored the diagnosis to obtain reimbursement. The OIG’s report >noted that chiropractic manipulation was the ninth most frequently billed >procedure under Medicare during 1983. >In 1997, after many years of intense lobbying, chiropractors persuaded >Congress to remove the mandatory x-ray provision. The Balanced Budget Act >of 1997 eliminates the requirement as of January 1, 2000, and requires the >Secretary of Health and Human Services to develop and implement utilization >guidelines for chiropractic coverage when a subluxation has not been >demonstrated by X-ray. The new policy is expected to increase the number of >claims Medicare pays for chiropractic services.

        As they should.  Why shouldn’t DC’s be reimbursed for what they do?  I agree that it is wrong to tailor diagnoses, bvut then fee-shifting in hospitals isn’t very ethical, yet it still occurs. – Hide quoted text — Show quoted text ->Primary-Care Providers? >Managed-care plans provide unlimited access to one’s primary physician, but >specialized care must be authorized by that

… read more »

Response:

here is the full, unedited text of the Quackwatch page with regard to chiropractic… it’s been much maligned, but never directly quoted here. note that Dr. Barrett includes dissenting views… read, and decide for yourself. Don’t Let Chiropractors Fool You Stephen Barrett, M.D. Chiropractors claim their profession was founded in 1895 when Daniel David Palmer restored the hearing of a deaf janitor by "adjusting" a bump on his spine. Soon afterward, he concluded that misaligned bones ("subluxations") interfered with the body’s expression of "Innate Intelligence" — the "Soul, Spirit, or Spark of Life" that controlled the healing process. Although philosophy and treatment vary greatly from one practitioner to another, most of today’s 50,000-or-so chiropractors can be classified as "straights" or "mixers." Straights tend to cling to Palmer’s doctrine that most disease is caused by misaligned spinal bones ("subluxations") correctable by spinal adjustment. Mixers acknowledge that factors such as germs and hormones play a role in disease, but they tend to regard mechanical disturbances of the nervous system as the underlying cause of lowered resistance to disease. Louis Sportelli, D.C., who later became chairman of the American Chiropractic Association’s board of governors, expressed this concept in a pamphlet called "What Kinds of Conditions Do Chiropractors Treat?" which he distributed in the 1980s. The pamphlet stated: The doctor of chiropractic directs his attention to the spine, searching for an area which is deviant from normal. The deviation or malpositioning of a spinal vertebra may cause a neurological imbalance within the body, setting the stage for lowered resistance, and subsequently a disease process. . . . Chiropractic is based on the premise that every gland, organ and cell of the body needs a nerve supply to function properly. Therefore it would seem lofgical that malfunctions in these areas would also respond to chiropractic adjustments. It is with this basic thought in mind that the answer to, "What can you treat, doctor?" could be as varied and vast as the nervous system itself. In addition to spinal manipulation, mixers may prescribe nutrient concoctions, homeopathic products, and various types of physiotherapy (heat, cold, traction, exercise, massage, and ultrasound). Straights tend to disparage medical diagnosis, claiming that examination of the spine is the proper way for chiropractors to analyze their patients. Mixers are more likely to diagnose medical conditions in addition to spinal abnormalities, and to refer patients to medical practitioners for treatment. Some practitioners claim that chiropractic treatment is effective against nearly the entire range of human ailments. A small percentage of chiropractors reject Palmer’s dogma and treat only musculoskeletal problems. I do not believe that spinal manipulation is effective against other problems. Research Findings During the past few years, two reports about the treatment of low-back pain have placed chiropractic in a favorable light. One, issued by the RAND Corporation, concluded that spinal manipulation was appropriate for some cases of low-back pain. The other, produced by the Agency for Health Care Policy and Research (AHCPR), judged manipulation useful for controlling symptoms while awaiting the spontaneous recovery that occurs within a month in most patients with low-back problems. Although chiropractors have promoted these reports as endorsements of chiropractic, they are not. They merely support the use of manipulation in carefully selected patients. Only a few of the research studies on which their conclusions were based involved manipulation by chiropractors; most were done by medical doctors and physical therapists whose practices are not identical to those of chiropractors. Most chiropractors manipulate the vast majority of patients who walk through their door, some use techniques that have not been studied scientifically, and many urge all of their patients to undergo monthly or even weekly "preventive maintenance" visits throughout their life. In addition, many chiropractors emphasize a technique that is more vigorous (and therefore less safe) than the controlled manipulation used by other practitioners. The only places where "chiropractic" and "chiropractors" are mentioned in the body of the AHCPR report are in the passages about the make-up of the AHCPR expert panel. X-rays and Medicare Most chiropractors claim that x-rays help them locate the "subluxations" that D.D. Palmer envisioned. But they do not agree among themselves about what subluxations are. Some chiropractors believe they are displaced bones that can be seen on x-rays and can be put back in place by spinal adjustments. Others define subluxations vaguely or say they do not necessarily show on x-rays. But what chiropractors contend about x-rays also depends upon who asks and how the question is posed. Chiropractic coverage under Medicare, which began in 1973, was limited to manual manipulation of the spine for the treatment of "subluxations demonstrated by x-rays to exist." To enable payment, federal officials accepted an elaborate chiropractic "definition" of subluxations for which payment could be made. During the mid-1980s, the U.S. Department of Health and Human Services’ Office of the Inspector General (OIG) surveyed 145 chiropractors by telephone about their billing practices. Eighty-four percent said that some subluxations do not show on x-rays. Nearly half responded that when billing Medicare, they "could always find something" (by x-ray or physical examination) to justify the diagnosis, or they actually tailored the diagnosis to obtain reimbursement. The OIG’s report noted that chiropractic manipulation was the ninth most frequently billed procedure under Medicare during 1983. In 1997, after many years of intense lobbying, chiropractors persuaded Congress to remove the mandatory x-ray provision. The Balanced Budget Act of 1997 eliminates the requirement as of January 1, 2000, and requires the Secretary of Health and Human Services to develop and implement utilization guidelines for chiropractic coverage when a subluxation has not been demonstrated by X-ray. The new policy is expected to increase the number of claims Medicare pays for chiropractic services. Primary-Care Providers? Managed-care plans provide unlimited access to one’s primary physician, but specialized care must be authorized by that physician — usually a family practitioner. Chiropractors are worried that if they cannot be accessed directly, their income will suffer. Moreover, in communities where managed care predominates, nonparticipating chiropractors could lose their ability to earn a living. Chiropractic leaders are attempting to deal with this threat by claiming that chiropractors are primary-care providers to whom patients should be given access without referral. In line with this viewpoint, most chiropractors claim they can diagnose conditions within their scope and refer the rest to appropriate providers. However, clinical training in chiropractic schools is vastly inferior to that in medical schools. Whereas medical school faculties are large and contain experts in virtually every aspect of medical practice, chiropractic schools have little or no input from medical experts. Whereas medical students see patients encompassing the full range of disease, most patients seen by chiropractic students have musculoskeletal problems. Although some of their courses are based on standard medical textbooks, chiropractic students lack the clinical experience necessary to make the information meaningful. Chiropractic schooling in such subjects as pediatrics, obstetrics, and gynecology is usually limited to classroom instruction with little or no actual patient contact and no experience with hospitalized patients. One school, for example, has used only rubber models to teach students how to perform pelvic and rectal examinations! The thousand-member Federation of Straight Chiropractors and Organizations (FSCO) asserts that chiropractic practice should be limited to the analysis and correction of "subluxations." FSCO asserts that chiropractors are neither licensed nor trained to diagnose medical problems or make medical referrals. Large percentages of chiropractors do not believe that immunizations are effective and do not recommend them to their patients. For these reasons and more, the claim that chiropractors are generally qualified to be "primary-care providers" is absurd. Spinal Roulette? In 1992, researchers at the Stanford Stroke Center asked 486 California members of the American Academy of Neurology how many patients they had seen during the previous two years who had suffered a stroke within 24 hours of neck manipulation by a chiropractor. The survey was sponsored by the American Heart Association. One hundred seventy-seven neurologists reported treating 56 such patients, all of whom were between the ages of 21 and 60. One patient had died, and 48 were left with permanent neurologic deficits such as slurred speech, inability to arrange words properly, and vertigo. The usual cause of the strokes was thought to be tearing of the vertebral artery walls. <Picture> One patient proven to have been killed by neck manipulation was Kristi A. Bedenbaugh, a medical office administrator and former beauty queen from Little Mountain, South Carolina. In 1993, Kristi consulted a chiropractor seeking relief from the pain of sinus headaches. During her second visit, she suffered a stroke immediately after the chiropractor manipulated her neck. She died three days later, one day before her 25th birthday. The autopsy … read more »

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