NBCE Wants No Part of the Education Debate
Dear Editor:
The National Board of Chiropractic Examiners would like to correct a statement made by Dr. Guy Riekeman in your college perspective column in the December 15, 1999 issue. (Editor's note: see "The Power of Perspective: The Education of the Profession's Next Generation," also available on line at www.chiroweb.com/archives/17/26/13.html .)
Dr. Riekeman stated that "The push in the profession from organizations such as the Federation of Chiropractic Licensing Boards (FCLB), the National Board of Chiropractic Examiners (NBCE) and most chiropractic colleges is for higher entrance requirements."
The national board has high standards for testing. While we see nothing wrong with having high standards, the NBCE is not involved in "pushing" this issue in one direction or the other. The NBCE is a reflection of the profession's educational program, a reflection of what is practiced by doctors of chiropractic in their offices, and a reflection of what state statues require.
The NBCE is not a party to the "debate" Dr. Riekeman is having with other college presidents and would like to not have the NBCE's name used in the discussion.
Horace C. Elliott
Executive Director,
National Board of Chiropractic Examiners
Greeley, Colorado
Dear Editor:
I suspect that your recent editorial, "Take That, Murray Katz!" (DC, December 15, 1999; available on line at www.ChiroWeb.com/archives/17/26/14.html), rather than dealing a "mortal blow" to anyone opposed to chiropractic care for children, will simply reinforce the antiscientific attitudes prevalent in the profession and thereby make the work of the chiropractic research community more difficult. In addition to the particularly unfortunate hyperbole (chiropractors do not render "mortal blows"), your recommendation for widespread marketing of chiropractic care for colicky kids is premature. One swallow, the saying goes, doesn't make a summer.
I've never met Murray Katz,MD, but I can't help imagining him reading your editorial and having a good chuckle. Like generations of chiropractors who responded to allopathic charges of quackery by insisting that "chiropractic is not quackery ... it works!", DC has offered up further unjustified claims and marketing rhetoric, thereby providing more fodder for antichiropractic forces. We need to stop shooting ourselves in the foot.
I am acquainted with one of the authors of the randomized controlled clinical trial (RCT) which prompted your editorial (Wiberg et al., 1999). Niels Nilsson,DC,MD,PhD, is a very thorough, conscientious and critical researcher, which adds to my optimism in reviewing his paper. I'm ready to get out my checkbook and send him a donation hoping for more of the same. Yet, this first RCT of manipulation/adjusting for infants with colic is not a basis for making any strong claims within or beyond the profession. Replication is a necessity in the search for therapeutic validation. In the absence of replication, strong claims are not justified. Such is the current state of the literature bearing on adjusting for colic in infants.
Replication is all the more important in situations in which the mechanism(s) of a successful intervention is (are) unknown. This is clearly the case in manipulation for colic, a condition whose causes and processes are also unknown. Given the current state of our knowledge (i.e., our ignorance), this is a genuine "black box" area of study. This is all the more reason for caution, not just in terms of positive assertions about effectiveness, but also for safety's sake. Let's demonstrate that the profession's commitment to the Hippocratic tradition is more than lip service. Let's let the research process take its course. Let's not muck it up - please.
Science is a skeptical process, quite the antithesis of marketing methods. Sensationalism, emotionalism and political feuds are its bane. Accordingly, I ask that Dynamic Chiropractic exercise more discretion when venturing beyond its areas of expertise (e.g., interpretation of research). We don't want to make the work of the chiropractic research community more difficult by promoting unskeptical and antiscientific attitudes among chiropractors and by portraying the profession as antiscientific in the public arena. We don't need more "rah, rah, rah"; instead, we need more funding and more young DCs training to conduct systematic, meticulous clinical research. We need more doctors who promise little and deliver much.
Reference
Wiberg J, Nordsteen J, Nilsson. The short-term effect of spinal manipulation in the treatment of infantile colic: a randomized controlled clinical trial with a blinded observer. JMPT Oct 1999; 22(8):517-22.
Joseph C. Keating Jr.,PhD
Professor, Los Angeles College of Chiropractic
Whittier, California
jckeating@aol.com
Dear Editor:
I have enjoyed reading Dynamic Chiropractic for some time, but I would like to share some thoughts. I think the future of chiropractic is in grave danger, and I feel that those of us who have given this issue years of contemplation have a lot of positive information to share with the profession.
I feel like most DCs are in the same boat as most MDs - they have only a few "tools" in their "toolbox." Chiropractors have manipulation, massage and physical therapy, but they rely too much on "techniques" that really do not get to the bottom of the real causes for the patient's problems. Because of this, most DCs treat symptoms, not causes. This is why patients are always coming back for continual care without really improving long-term. Medical doctors have only two "tools" in their "toolbox": drugs and surgery, which should only be used in extreme cases when nothing else can save the person's life or restore joint stability.
Traditional Chinese medicine (TCM), on the other hand, does get to the cause of the person's problems by checking the pulse and observing organ excess or deficiency patterns, looking at the tongue to check for organ excess or deficiency signs, and performing palpation of the abdomen and spine to confirm the pulse and tongue findings. By incorporating Western tests like blood and urine testing, a complete and thorough evaluation can be made. The patient can then be managed in a very profound way, and true healing can occur.
TCM schools have used chiropractic and osteopathic manipulation for over 4,000 years. In fact, 4,000-year-old texts have been translated that describe chiropractic theory taught in chiropractic colleges today.
What disturbs me about your publication is that there are far too many ads trying to sell DCs on the latest ways to attract new patients. If DCs learned acupuncture and TCM in chiropractic school as it was taught in China for thousands of years, they would be better able to evaluate and treat chronically ill patients, and their referrals would cause their appointment books to be filled for weeks in advance.
As it stands, chiropractic should have joined with the naturopathic colleges 50 years ago. The chiropractic profession has always taken an almost religious distinction for itself, not a true scientific basis for its existence. In my opinion, it takes many levels for the practitioner to proceed through before he or she can truly say that a deep understanding and comprehension of the patient exists in their mind. Because chiropractic is really based on manipulation alone, that is not enough to really evaluate and treat the complex patient of today.
I was visiting a dear friend in Minnesota recently and went to the chiropractic school to share the same feelings with them. I said, "I do not think you will have a college in 10 years unless you offer a diplomate in acupuncture, clinical herbology and nutritional biochemistry." Why would a patient go to a DC when they could get all of the above and spinal manipulation from a ND? It is time to wake up, get back to the books and continue your education. Debating over the best chiropractic technique badly misses the point, which is why most chiropractic techniques produce the same level of success. This has always been the case.
We can never stop going to school and never stop learning. I suggest to those chiropractors who truly love their work, who are concerned for the well being of their patients, and who want to develop the deepest and original holistic medicine, to study acupuncture and TCM, incorporating traditional chiropractic techniques, nutrition, or whatever ancillary techniques you feel are indicated.
Acupuncture delves into the deepest energies of the body; chiropractic does not. Once acupuncture has been performed on a patient, the chiropractic manipulation is always gentle and nontraumatic, because acupuncture relaxes the deepest layers of the spinal muscles. I receive between 3-5 new patients a week from traditional chiropractors addicted to a high-volume practice, who practice rough, harsh and fast manipulations and have almost no understanding of why the patient is there in the first place. These chiropractors are no different from MDs: they are simply treating symptoms.
I am open to discussing this with anyone interested in responding to me.
Craig M. Jones,DC
Grand Junction, Colorado
chomsky@gj.net
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
Spearheaded by burgeoning scientific and clinical research literature, psychedelics have reached a level of media coverage and popular interest that has not been seen for over half a century. By “psychedelics,” we are referring to the unique class of substances that includes psilocybin (the active compound found in so-called “magic mushrooms”), LSD, dimethyltryptamine (DMT), ayahuasca, 5-MeO-DMT, and mescaline – each of which occurs in the natural world (except for LSD, which is a semi-synthetic compound).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
