One of my admonitions in SOME GUIDLELINES ON CHOOSING A GOOD CHIROPRACTOR was toavoid one who in any way competitively suggests that chiropractic is in any way better than medicine. It appears I should have said, "greater than or equal to" to addresss the persistent effort of those of the ‘alternate’ school that see
chiropractic as just another kind of medicine and and a viable alternate
healthcare option…a choice… let’s say like choosing between vanilla or
chocolate when you want ice cream. While the impact of picking chocolate on any given day is harmless, I suggest that treating your chiropractor as an entry
level physician when you have a complaint is a more serious choice with greater ramifications, and in my opinion, is inappropriate, since Chiropractors are NOT qualified to be primary care providers.
Please be clear. I’m not saying that certain prodedures done in a chiropractic
office are not occassionally useful with some musculoskeletal conditions (or
even that an unexpected physiologic miracle could occur). I am saying that,
among other things, the training of the chiropractor is inadequate to the task
of diagnosing and treating MOST conditions for which people go to the doctor andRARE conditions which rarely underly patient’s entering complaints
of back pain, but nonetheless do occur (and YOU don’t want to be that patient). Most chiropractors should not even be considered competent musculoskeletal
doctors or even back specialists since almost all their ‘clinical’ training,
including diagnosis and management is dedicated to "finding and fixing the
Subluxation" which I have said before, is delusional.
I am spurred to write this in response to a recent publication of
the the course work that must be completed by chiropractors side-by-side the
requirements of MDs. The suggestion, I imagine, is that, "See, chiropractors
have the same training as MDs…even MORE because they also do…." While I
understand the motivation of a given chiropractor or the profession promoting
this pseudo-equivilent notion by calling each other "doctor", wearing white
coats in school, and publishing similar ‘comparisons’, I wouldn’t rely on the
unconsidered assertions of patients who "really like their chiropractor", are
sure that, "It works" or who "know lots of people who have benefited" when
choosing a primary physician. But most of all, I wouldn’t use chiropractic
education as a justification for my chiropractic proclivity.
You see, the chiropractic profession is fundamentally conflicted about
education. On the one hand, they come from and often prefer to be identified
with a Healer tradition..( some are pretty good Healers) and on the other, they want to participate in the healthcare and insurance industry ..and so are forced to legitimize their therapy in the eyes of the scientific community
and account for their diagnoses and treatments in medical terms to insurance
companies. And so chiropractic’s relationship to the medical model, like any
educational requirement your heart’s not in.. is handled poorly, is unsupported,and most frequently ‘put-up-with’ by students who have no real intent of ever
applying the material professionally. "Adjust the spine..and all is fine."
This schizophrenic attitude toward the western heteropathic tradition
crystalizes in the chiropractic student’s clinic experience which starts in
their 8th quarter (out of 12 total) where for the first time they must reconcilethe basic and clinical sciences with their chiropractic philosophy and
methodolgy. It is as I’ve mentioned before, a conflict between whether there is such a thing as pathology as defined by anatomic and physiologic abnormalities
on the one hand, and a conceptual Pathology (Subluxation) based on the need forthe chiropractor to sell themselves as the Solution on the other (or in other
words, "tissue is the issue"). It was B.J. Palmer (the son of D.D., the ‘father’of chiropractic) who denied the existence of the cranial nerves (anatomy)
because they didn’t fit with his Subluxation paradigm (delusional Pathology).
This kind of denial underlies chiropractic ‘education’ and practice today.
While I don’t think you can get any deeper than fundamental differences (by
definition), the comparison list (which essentially appears accurate to me)
leaves out several important facts pertinent in evaluating it’s implication..
which is that you can rely on a chiropractor for diagnosis and treatment of
things medical, from glaucoma to neck pain, since they like MDs have the same
course-work in basic and clinical sciences. Let me say
something about what’s not on the list and you can make your own decision.
1) Compared to getting into medical school, matriculating to chiropractic
school is a breeze. Only 2 years of undergrad pre-requisites are needed with
only (I believe) passing grades in the required courses. Many chiropractors havetaken their basic science pre-reqs at schools that offer special 6-week-end
courses in each. There is no equivilency in chiropractic to the MCAT
(Medical College Admissions Test) which considered alone is not a good predictorof what kind of doctor you will be, but is an indicator of a certain level of intellectual function. I myself was accepted to a ‘good’ chiropractic school with only a phone call having already met the requirements and having the money.
*I* suggested that they actually meet me personally (as in interview) to make
sure I wasn’t a mass-murderer.
A person’s character and especially their intellectual interests and motivation are not really considered in the application process. Chiropractic schools are
essentially trade schools, for the most part tuition dependent, and can’t affordto be picky as in ‘choosing’ who comes….and because the schools need the
tuition, they also can’t afford to lose anyone who, even at a chiropractic
school, is demonstratebly stupid, incompetent, and/or dishonest. I think the
quality of the entering student has some bearing on the ultimate product.
2) The faculty at chiropractic schools generally do not have expertise in the
areas they teach. Often they are DC’s who have done their best to put together
a course in pathology or diagnosis, but have no experience (as a doctor of
medicine) beyond the textbooks they learned from and the DC’s that taught them. Basic sciences……my "biophysics" teacher, maintained you weighed less when
you picked one foot off the ground and that there was no gravity on the moon.
Clinical sciences…the OBGYN course is taught by a DC who believes that
new-borns need to be Adjusted to treat the neck trauma incurred at birth.
(Well…I guess you can’t be too careful).
3) Being at clinic is like having a free ticket to "Ripley’s, believe it or
not." The atrocities that go on daily in the name of chiropractic are too many
to enumerate…using non-medically diagnostic x-rays to "locate the Subluxation"…Adjusting the first cervical vertebrae on a patient who has passed out (as
an emergency measure)…faculty DC’s, when asked to confirm an arrhythmia,
telling a student not to worry about it…only because they themselves have no
idea what to listen for…and in any case the Adjustment will take care of It…and on..and on.
Chiropractic outpatient clinics, where the so-called ‘clinical’ training takes
place are not affiliated with any hospital. Students do not see the patient’s
they only read about enough to have a valuable opinion about a rash, a bump, or even a pain. The faculty DC’s are genereally adherents of a particular
chiropractic Technique and so frequently only know even a narrow spectrum of
their already narrow chiropractic approach. For example, somone who practices
NUCCA Technique may ask another faculty to help a student who practices
Biomechanics Technique because they (the faculty) "aren’t very good with low
back Adjusting. In NUCCA, any patient complaint is caused by misalignment of thefirst cervical vertebra and "corrected", using the LOC (Line Of Correction)
derived from bogus calculations of lines drawn on special chiropractic X-rays,
employing a ‘triceps pull’ …an Adjustment in which the practitioner stands
over the patient with their pisiform contacting the patient’s Atlas (C1)…
then, by isolating the triceps muscles and slowly contracting them in both arms..the Adjusment is made. If a student spends their entire clinic "mastering" suchan irrelevent medicine…how does this speak to the issue of training for
primary care…or even a back specialist?
I am not aware of any required ‘externship’ above and beyond the clinic
requirements to which I referred. Perhaps this was an inference made somehow
from the literature being quoted. Students when graduating often first go to
work in an established practice to "hone" their Technique…eg Gonstead, Toggle,Network etc….and to learn some billing tricks, but there is nothing in this
country at least, that parallels the 3-5 internship and residency of an MD aftertheir graduation. I believe in Switzerland, there is an attempt at such an
‘externship’, but it is 2 years…and it’s in a practicing in a chiropractor’s
office…again isolated from the mainstream.
John Badanes, DC, CA
rom…@uclink.berkeley.edu