Shortly after I published my editorial in the New Zealand Medical Journal, Dr Who?, I was delighted to get a letter from someone who had trained in chiropractic and seen it all from the inside.
Sadly this wonderful letter had to be removed within a few weeks of posting it because its author was threatened and bullied by chiropractors. Its author is too young and too vulnerable to risk his future career. As a result of this shameful and vindictive treatment, I was asked to remove the letter and did so immediately. Other copies on the web have now vanished too.
The experiences described in the letter justified much of what I said in the editorial, and in some ways went further. This letter doubtless contributed to dropping of the threatened legal action by chiropractors against the Journal and against me. The letter was posted originally on 21 August 2008, with the permission of its author. See also the follow-up in Chiropractic wars. Part 3: internecine conflict.
Now I have been sent a much more anonymous version, and it is a great pleasure to post this inside information.
I must begin by stating my background in relation to chiropractic. I am a graduate of a chiropractic college and have practiced for several years. I have elected not to register or practice again and have returned to study to begin a new career. Prior to studying chiropractic, I gained undergraduate and postgraduate qualifications in science.
First I would like to address your comment about the validity of a qualification from a private chiropractic college, especially in relation to the difference between studying there and studying at a university.
A major difference is the education and experience of faculty. At the time I was there, most of the faculty at my college had only undergraduate qualifications (I would suggest that the American DC degree is of undergraduate level as it is the primary qualifying degree for chiropractic in the US and Canada -it is not the equivalent of a doctorate in a British or Australasian university) and have not published in peer-reviewed journals. This is quite different to my experience of universities where the all of the faculty usually have at least a PhD and are actively involved in research.
The content of the chiropractic curriculum was voluminous. It included basic sciences, chiropractic subjects and social sciences. The college I attended did not have any laboratory facilities so the experience of learning science from a textbook was quite different to the way I had been taught at university, where each subject had a significant laboratory program that had to be passed separately to pass the subject.
As chiropractic is a clinical discipline, the course contained subjects in common with a medical degree. Sadly, the attitude towards medicine and the medical profession was not always the most constructive. For example, I can recall a noticeboard where newspaper clippings of media reports of medical misadventure and adverse effects of pharmaceuticals were posted regularly.
Clinical experience was gained by a 2 year internship in the school health centre concurrent with the last 2 years of academic study; so it was not a full-time internship. The requirements for passing this component of the course were complex but centred around seeing a number of patients, a number of visits, performing a number of various kinds of x-rays and reading a number of x-ray films. Every student was responsible for finding all of their own patients to meet the requirements. The result of this was a clinical experience that was quite narrow for most people. This would seem to be quite different to the hospital internship of a medical degree, the clinical internship of a dental degree or the range of placements in a physiotherapy degree in terms of the breadth of experience of different kinds of patients of different ages and states of health.
For people who are not aware, there are a range of ideas within chiropractic about what it is and what it is for. The “wellness”, subluxation-based kind of chiropractic is taught by a minority of schools and is what chiropractors call a “philosophical view”. It advocates that chiropractic care be independent from symptoms or treatment and be a regular part of peoples’ lives. The expectation is that healthy, asymptomatic people will be “adjusted” on a regular basis to keep them free from “vertebral subluxation”. To that end, the training at schools that teach this approach is adequate (and probably even excessive).
The issue that you wrote about related to the use of the title “doctor” by chiropractors in New Zealand. In licensing chiropractors and allowing them the use of the title “Dr” in front of their names (provided that the title is qualified by the word “chiropractor”) governments have awarded chiropractors with recognition and prestige that has usually been associated with a level of academic achievement or with a medical qualification. It indicates that the bearer of the title can be trusted to give credible advice within their area of expertise.
The issue may seem benign, but in allowing chiropractors to use the title, people who would not normally feel safe to submit to the treatment of an alternative health practitioner, choose to try chiropractic. I make this point because at its core, chiropractic is quite different to medicine, dentistry and physiotherapy.
A chiropractic office often looks like a lot like a doctor’s surgery. The layout is similar (with waiting rooms and consultation rooms; there are things like stethoscopes and x-ray machines and there are often informative and education posters and brochures. In many cases, the title “doctor” is used in
I have found that some people believe chiropractors are medical doctors. Some even believe that chiropractic is a kind of medical speciality. I have seen patients who choose chiropractic as their primary health care and come to a chiropractic office as their first port of call when they are unwell. I
Two practices are of particular concern in some chiropractic offices and in my view; these alone should be sufficient reason to prevent chiropractors from calling themselves “doctor”. The first is the systematic and deliberate erosion of a person’s confidence in the medical system. Many offices have anti medical literature in their libraries. Chiropractors are sometimes taught practices to subvert medical credibility. See http://chirobase.org/20PB/top7.html for an example.
The second is a subset of the first but is particularly damaging. It is active opposition to vaccination. At chiropractic school, I was taught anti-vaccination information in my paediatrics course. I have seen books written by chiropractors opposing vaccination and I have seen many offices with anti vaccination leaflets and books in abundance. Now I am all for informed choice but this type of material is rarely accurate or balanced. People are being encouraged not to vaccinate their children by professionals who they believe to be a reliable and prestigious source of information.
Although it may sound paternalistic to people who have not had the privilege of clinical practice (albeit in a profession I no longer agree with), it made me realise several things. The first is that people who are unwell are vulnerable. The second is that there are people who trust “medical” advice unquestioningly.
I believe we should be very careful about who we title as a credible source of advice about health care. Legislation treads a fine line between limiting personal freedom and protecting people from harm.
Aside from the qualification being inconsistent with the academic level that is usually required to use the title “Doctor”, the greatest danger, in my opinion, is that the legal recognition and permission to use the title has allowed chiropractors to assume the mantle of a doctor. In the guise of this respectability, some chiropractors are deliberately eroding confidence in doctors and denying children (and possibly populations) the protection of vaccination.
David, thank you for having the courage to question the use of the title “doctor” by chiropractors. Historically (and in your case), chiropractors fight their battles through litigation so it takes personal courage and integrity to do so.
All I can say is, don’t thank me. It doesn’t take much courage at my age. It takes a lot at yours and the world should be grateful to you.
Replies from chiropractors in the NZMJ
The New Zealand Medical Journal, very properly, allowed right of reply to chiropractore. This week’s issue contains three letters, one of which is from Paul Kelly. It is signed “Dr Brian Kelly B App Sci (Chiro), President, New Zealand College of Chiropractic”. This is not quite the same as appears on his College’s web site which shows the president’s welcome.
It seems that Kelly has not been quite so careful about use of his title on the web site because (as of 21 August) the signature on his address looks like this.
“Dr Brian Kelly, President”. That does seem a bit careless, given that his usage of “Dr” was pointed out in my original editorial, published on 25th July.
Replies to these letters appeared in the September 5th issue of NZMJ.
Thank you for another excellent post on chiropractic. It echoes many of the posts made over at the skeptical chiropractic discussion forum, Chirotalk. A particularly relevant thread is this one:
“I’m Screwed 4 Life”
These articles are also interesting:
Overrated Career: Chiropractor
Bitten by chiropractic
As for the validity of chiropractic qualifications, for anyone still unclear about the role of UK universities in chiropractic, this eye-opening post should bring you up to speed…
…as should this:
But probably the greatest concern highlighted by the anonymised letter is that some people believe that chiropractors are medical doctors and that chiropractic is a kind of medical speciality. It is not. And it’s high time that the chiropractic regulators addressed that huge misconception by making widespread *factual and accurate* information available to the public. It’s become a serious health issue – one which was recently very eloquently expressed by neurologist, Steven Novella:
Now bearing in mind that NICE’s draft guidelines for low back pain have recommended chiropractic spinal manipulation as a first line treatment, here’s the UK General Chiropractic Council’s FAQs page:
How helpful is that to a largely unwitting general public?
Thanks David for this. It is seriously depressing (can I be cured of that by a chiro?) and raises my blood pressure – a lot.
Blue Wode: thanks for the links to chirotalk – I’ll go and have a look.
I’ve mentioned it before, but a full list of Universities and Colleges offering quack nonsense through UCAS for 2009 is here: http://www.thinkhumanism.com/files/UCAS%20Courses%20on%20quackery.xls.
This list includes the British College of Osteopathic Medicine and the British School of Osteopathy as well as other more well-known institutions. UCLAN is still on the list the last time I looked.
Well done again to this person for speaking out. I’m an ex-osteopath and I’ve tried to write something which expresses my reasons for leaving that line of work but can never quite produce anything which articulates the complexity of my feelings.
My osteopathy training had a huge medical and clinical component which encouraged us to employ evidence based practice and scientific method, whilst ignoring the lack of evidence or science in osteopathy. Similarly, we were told that we were primary health practitioners, qualified to differentially diagnose all kinds of rare and wonderous illnesses, despite never having seen any of them in clinical practice or having access to any clinical tests.
The beginning of the end for me was when there was a letter from an osteopath in one of the osteopathic journals where he proudly stated that he advised his patients to bring children with measles and mumps to him for treatment rather than get them vaccinated or treated by standard medical practice. The osteopathic principle that ‘the body has a tendancy to heal itself’ and the belief that osteopathic treatment promotes this tendancy meant that he could justify this approach (both to himself and the GOsC). I don’t recall any letters of protest being published in response.
Thanks Mungus. That is quite a scary story. If you ever feel like writing out your experiences at greater length, I’d love to hear more.
Yes, well put. This is, in a nutshell, the rationale for almost all alternative therapists, when combined with the corollary:
Often combined with:
It would be easy to laugh were it not apparent how many people are taken in by this.
There WAS a letter of protest at that published article. It was never printed.
I continue to write…and email…and blog…
Regarding the issue of immunisation, my recent BMJ rapid response could be relevant (http://www.bmj.com/cgi/eletters?lookup=by_date&days=14#205670). Regarding the use of the doctor title, I recently published something in the New Zealand Journal of Medicine (The ethics of chiropractic, Edzard Ernst, 05-Sep-2008 – Vol 121 No 1281).
There was a link to The Ethics of Chiropractic on the earlier post Chiropractic Wars part 3: internecine conflict.
The BMJ link isn’t working for me, but I think it is to Treating Evidence with Contempt. The pdf version is here (but lacks the quick responses).
I could write a very similar letter about my experiences as an acupucture student. It all happended 10 years ago, though, so it’s not current.
You get my vote…
For those with an Athens login, the rapid responses to Edzard Ernst’s “Treating Evidence with Contempt” letter to the BMJ (DC’s link above) are well worth a read.
I vote for Ernst as well! Perhaps he can be persuaded to start a blog?
Edzard Ernst gets my vote too.
For those who may be unaware, he is Editor-in-Chief of the quarterly publication, ‘Focus on Alternative and Complementary Therapies’ (FACT). You can find all the issues online here:
This is a particularly interesting article he wrote about chiropractic back in 2005:
The value of chiropractic
And don’t miss his editorials. They’re always a good read.
March 2008 is pretty good too. Ernst visits CAMEXPO
Most illuminating. I’m almost shocked about the anti-vax stuff. The description of the ‘subluxationist’ chiro fitted the one I saw to a T but I wish now I’d asked him about vaccination as well.
Ahhh… another chiropractic bashing site… awesome.
I’m a chiropractor. I could care LESS if you call me doctor. Whatever… you guys are so hell bent on the word, it’s absolutely amazing. Never saw so many people go on and on and on about a title… give it a break before you pop a blood vessel.
Now, what I find amazing is the disrespect for so many people. I get that there are a lot of bad chiropractors. The problem is people like YOU here… the one’s that stereo-type like every chiropractor is a quack and doesn’t know a thing.
You know, I opened up a new clinic about a year ago, and one of the things I heard from one of my 1st patients: I’ve been going to a physical therapist office (linked to the local hospital), and I told them I was going to come to your office and they rolled their eyes and said I was wasting my time with that mumbo-jumbo.
Now the funny part:
I’ve had AT LEAST five car accident patients that have come from that office UNSATISFIED with the care they were receiving (after one to three months of treatment), only to ALL have felt better in ONE session in our clinic… FACT.
I’ve also had several MVA patients come from other chiropractic and PT offices that have had similar experiences and got great relief in a short amount of time.
I don’t claim to be a miracle worker… and I don’t think I can heal everyone or everything. If I feel you’re not progressing the way I want you to be progressing within three visits, I’ll tell you so. I’ve referred new patients after the very first visit, because it was something that was beyond what I could do for them. I’m not against medicine (long-term yes), and I’m not against physical therapy, when done by a competent PT. I rarely do physiotherapy, I’d rather have a PT handle that… it’s not what I do.
So what makes my results better than other chiropractors I know? Simple… I do muscle work… muscle release… trigger point therapy on pretty much every patient. I consistently have patients who come in with pain at an 8 out of 10… go down to a 1 to 3 in one visit. My PVA (pt. visit average) is eight… very low for chiropractic standards, because people I work on get good results and I have them come in when they need it. I also am averaging 8 new patients a week, with little advertising… most of the patients come from word of mouth because of results.
Lastly, I’ll leave you with a little story… a true story. My wife was in a MVA two years ago. Both cars involved were totaled. I worked on her immediately after the accident and worked on her for three to four days per week for a month. Ultrasound and muscle work was what I attribute working the most to regaining her health and ROM. A month later, she was feeling very good… barely any issues whatsoever, and my brother-in-law rolls into town asking her what doctors she’s been seeing. She says she’s only seen me, and he says… No… I mean a “real doctor”.
Again, I’m not hung up on the doctor thing (really… I’m more confident than that).
So I ask… what is a “real doctor”? You mean a real doctor that when you go to his office, all he can do is say… well, you’re in pain here, let’s give you this medication to turn off your body’s alarm system. We’ll also give you some muscle relaxers… that should help. Oh, and let’s give you a script to see the physical therapist down the street.
Now… did that seem like a hard thing to do? Doesn’t it seem ANYONE could make that diagnosis? (yep)… and tell me… what else could that MD do to help the patient… besides write three scripts for medicine and the PT?
So what does the “real doctor” have over me in treating a patient like that? I don’t know… you tell me. Oh, and chiropractors typically have MUCH more training in looking at x-rays than MDs do (unless they work at a hospital in the ER).
Look… your body has an issue and sounds the alarm… it’s called pain. The MD gives you medication to turn the pain off… mask it. Your shoulder starts feeling better because you’re using medication… you go golfing and after a few weeks the medication isn’t touching the pain. You go back and now your doctor wants an MRI of your shoulder (god only knows… right?). Then the report comes back… and everyone is shocked… OH WOW… you damaged it more… now you need surgery. NO WAY… GET OUT!
Happens more than you know.
Not physical therapist.
Not medical doctors (but perhaps if we call them doctors and don’t use the title as chiropractors they’ll get over it… nahhh… probably not).
And by the way… I have a handful of MDs that refer to my office… and one PA in particular (30 years experience) who refers his patients only to my office. He makes them promise only to my office and I’ve only been at this new office about a year.
You get results, and people will notice, no matter who or WHAT you are.
It’s odd that you should choose to post your comments on this particular post, because this one does not concern my views on chiropractic, but those of an (ex) chiropractor.
It would have been helpful if you’d addressed his criticisms rather than just relating yet more anecdotal testimonials. It is surely well known by now that testimonials are the least reliable form of evidence.