Skeptical Chiropractor: No Sacred Cows

July 9, 2009 at 10:25 pm (Chiropractors & Chiropractic, Critical Thinking, Skepticism)
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Chirocyclist with sacred cow in sidecar

Chirocyclist with sacred cow in sidecar

 ”But it sounds so negative…like you don’t think chiropractic is worthwhile.”

My wife wasn’t really digging the “skeptical chiropractor” moniker I have bestowed upon myself.

“You’re missing the whole idea of the skeptic movement,” I told her.  “I’m not a ‘cynical chiropractor,’ bitter and sneering.  I’m skeptical: questioning,  reasoning, seeking answers.”

“Isn’t there a nicer word?” she asked.

People think that skepticism is a rejection of all new ideas and grumpy skeptics sit around bah-humbugging everything that may be challenging to their ideology.  This is simply not the case.  As a skeptical chiropractor, I am extremely curious about new ideas, techniques and procedures.  I love revolutionary concepts!  I can’t get enough of extraordinary claims!  As long as folks can back up their b.s. and their claims are consistent with logic, reason and science.  In other words, you can sell woo-woo somewhere else — we’re all full up here.  But if you’ve got something offbeat or unusual, I’d like to take a closer look.

By being a skeptical chiropractor, I need to see substantial evidence before I believe something to be true.  This doesn’t mean I don’t believe anything.  Socrates said, “All I know is that I know nothing.”  That’s a bit drastic for my nickel.  For example, I have seen enough evidence confirming the efficacy of spinal manipulation for back and neck pain.  I am not closed to the idea of controversial research but I am satisfied with what I have seen so far to recommend and perform this treatment for patients.  Likewise with low level laser therapy for some conditions.  And Graston technique.  And lots of other science based treatments I use clinically on a regular basis.

On the other hand, crystals, magnets, applied kinesiology and homeopathy aren’t passing by the ol’ crap-o-meter.  I remain doubtful that these will prove to be effective but continue to be open to any new high quality research that comes about.

I do not have any sacred cows within my profession…at least I don’t think I do.  And by being among the stone throwers, I feel I can help improve chiropractic, a profession that I love,  from the inside.  But this, of course, is the most difficult part about being involved in chiropractic and remaining a skeptic.  It would be so much easier to move into the total credulity campsite: anything goes, any time, any where!  Just believe and everything will work out great!  Drink up from the subluxation Kool-Aid bowl!

Alas, I don’t predict that happening any time soon.  Got any throwin’ rocks?

Dr. Brett Kinsler is a skeptical chiropractor in Rochester who blogs at www.rochesterchiro.wordpress.com.  He doesn’t really dig Kool-Aid.

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Blogito Ergo Sum: Skeptical Chiropractor

July 6, 2009 at 10:06 am (Chiropractors & Chiropractic, Critical Thinking, Skepticism)
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Critical_thinking

I like to use the term “skeptical chiropractor” to describe some aspects of my professional personality.  Lately, I have been asked to further define the phrase.  I’ll try…you let me know what I’ve missed.

1. Being a skeptical chiropractor means not clinging to a set of beliefs.  I try not to have any set of principles that are not based upon scientific evidence or, lacking that, at least based on rational, logical thought thought and reason.

2. I am willing to change my thinking as the scientific evidence changes or improves.  If my practice was only based on 100+ year old beliefs, this would not happen.  And while I may be passionate about my convictions, the core is logically founded and I possess enough open-mindedness to alter those cores if and when I am presented with additional, quality evidence. 

3. I do not take it personally when science changes and challenges my practices.

4. I question new methods, procedures and products and do not blindly accept information simply because “some expert” says it is so.  Any gurus I subscribe to are those who I respect because of their critical thinking, not simply rote absorption of their sermons.  I begin from a point of doubt and add confidence as supporting information dictates.

5. I examine new information for bias and attempt to strip that away in looking only at factual information.  I also try whenever possible to remove my own bias in the presentation of information, advice or treatment of patients.

6. I completely avoid using the term “vertebral subluxation” as it is an entity that is unproven, unscientific, confusing to professionals and patients alike and wrought with controversy.

I hope this helps shed some light on what it means, in my opinion, to be a skeptical chiropractor.  As for skepticism in general, let me know if you’d like my JFK conspiracy theory, sightings of Bigfoot or an opinion on crop circles.

 

Dr. Brett L. Kinsler is a skeptical chiropractor in Rochester, NY.

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MVP f/u

June 24, 2009 at 1:46 pm (Managed Care, Rochester, Uncategorized)
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A follow up (f/u) to my postabout MVP Healthcare and their lack of commitment to quality and strong commitment to lies:

We looked into switching our own private health insurance policies since we were also members of Preferred Care, which became MVP during the takeover.

As luck would have it,  we can switch this month and will save about $1000 by changing to Excellus BCBS!  Of course we are doing so, and being employers, we are taking our employees insurance contracts with us as well.

I noticed that the MVP corporate logo is an apple.

mvpHey, MVP….you like apples?

Your dumbass policies in the takeover of Preferred Care in Rochester just cost you a lot of money in premiums from healthy, young subscribers.

You like apples?

Your lack of commitment to quality and propensity toward lying to your members, their doctors and the public has cost you damage to your reputation and your bottom line.

You like apples?

We’re changing to Excellus and hopefully a lot of others will do the math and follow.

You like apples, MVP?

How do you like them apples.

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I led my pigeons to the flag

June 21, 2009 at 10:21 pm (Critical Thinking, Education, Homeschooling)
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pigeon

Father’s Day breakfast in my daughter’s third grade classroom was delightful.  She made me a great book complete with pictures, we had bagels, fruit and (for the dads) coffee.  But there was a bit of a “Big Brother” moment when the principal came on the P.A. system and lead the school in the Pledge of Allegiance.  The class and their fathers obediently placed right hands over hearts and faced the colors of our nation.  The entire class and their guests recited the monotone rendition of that familiar oath of loyalty.

(and to the Republic for Richard Stands)

That evening on the way to meet a friend’s newborn baby (incidently, one that she delivered in a van, in a driveway and essentially directed her husband in her own delivery process), I recalled the moment from that morning.  I asked my first and third grade children what “pledge” meant.  Uh oh.  How about allegiance?  Still no.  Republic?  Hmmm.  How about United?  These are smart, well-read kids.  Indivisible?  Justice? 

Crap.

My kids have been saying “The Pledge” every school day for a collective 6 years, and probably did it at preschool, maybe summer camp, and certainly scout meetings too.  They don’t know what the hell it means.  Nobody ever told them.  Every day they spew out the drivel they are forced to endure without anyone actually teaching them.  In all that time!

(One nation in a dirigible)

I pressed further.  Did they think they ‘had’ to say the pledge?  Well of course.  Everyone said it.  You had to.  They’d get in trouble if they didn’t….wouldn’t they?

(With liver tea, and justice for all)

I couldn’t have been much older then my daughter when I realized that forcing me to say the same thing as a group of other people in my declaration of freedom was actually sadly ironic.  It was at that age I began standing respectfully with those around me, removing a cap or placing my hand on my chest appropriately…but I never again recited the pledge.

It had, and still has, nothing to to with my patriotism.  And I have yet to “get in trouble” for my actions.

I recall a famous Supreme Court case which provided me that right.  One of the judges wisely stated, “Words uttered under coercion are proof of loyalty to nothing but self-interest.  Love of country must spring from willing hearts and free minds…”

If my children learn nothing besides the three R’s in all of their pre-collegiate education, I want them to be critical thinkers.  I want them to question, ponder, deduce and think for themselves.

My kids, my wife and I had a long chat about what the oath means.  We broke it down to its’ simplest parts and discussed it for a while.  We talked about what one “has to do” and how one can quietly protest without being disrespectful.

Then we further solidified our decision to homeschool in the Fall – with a strong bent toward critical thinking. 

(José, can you see?)

 

Dr. Brett Kinsler is a Rochester chiropractor, self-proclaimed proponent of critical thinking and soon to be homeschooling parent.

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MVP – least valuable healthcare player in Rochester

June 20, 2009 at 12:06 am (Chiropractors & Chiropractic, Managed Care)
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appleworm

No Virginia, all is not peaches and sunshine in the formerly blissful RochesterChiro neck of the woods.  MVP Healthcare who pushed in by taking over the more quality oriented Preferred Care, is now flexing muscles over the local chiropractors.  There are so many lies floating out of the MVP machinary it’s like being a long tailed cat in a room full of lying liars in rocking chairs trying to avoid the lies — (which is to say there are a lot of them…lies, that is, not long tailed cats.  Although there may be a lot of long tailed cats too but that’s not really important right now and I don’t know why you’re bothering me with those details). 

Preferred Care was interested in getting doctors, and especially chiropractors, to participate in the most excellent NCQA Back Pain Recognition Program (NCQA BPRP).  They were also interested in paying Rochester chiropractors a fair wage and not making them jump through needless paperwork administrative hoops so long as they were providing good quality, evidence based care to their members.  Preferred Care was interested in forging relationships with Rochester healthcare providers and was trying to stand for quality in healthcare — they were making strides in that regard and I was very proud to be a provider for them.

MVP recently announced that, now that they have taken over Preferred Care, they are canceling the chiropractic contracts mid year (!), outsourcing the chiropractic panel to a horrible third party administration company, and forcibly cutting fees — by 33%!

To add salt to the wound, they are telling their members things like “Rest assured: if you were a Preferred Care member, your benefits are staying exactly the same. This is a change in name only.”

Really?  The benefits are the same?  But if you are canceling my doctor’s contract and my doctor is forced to leave your plan, why don’t my benefits feel the same?  If you are using a different company to manage the chiropractic panel and it will now be much more difficult for me to get the care I need, how is that a change in name only?

They are also saying “Your benefits stay exactly the same. Your coverage stays the same. Our customer service stays the same.”

Really?  Same customer service?  By outsourcing the administration for an entire profession do you think the local reps will have a clue how things are run or will any chiropractic questions be shipped off to the inept third party in California?  We dealt with that company years ago before Preferred Care had the good sense to ditch them.  And I know they’ve gotten even worse since that nightmare.  This is like the joke of taking milk out of the fridge, smelling that it is spoiled and putting it back for someone else to dispose of — only it’s no joke and I’m not buying your spoiled milk.

How about, “we are still the same company and your employees still have the same coverage“

I’ve also gotten bullshit letters in the mail citing MVP’s commitment to quality.  Really?  Quality? Quality is trashing the NCQA BPRP program and all the time, money and effort put toward it by Preferred Care and Rochester chiropractors — a program hailed as one of the best opportunities to improve on the treatment of low back pain ever developed and provide benchmark quality care measures in chiropractic — but at the same time MVP execs are tooting your own horn about your own company’s NCQA recognition?  WTF MVP?  That’s not quality…that’s marketing.

Or perhaps your defination of quality is destroying the relationships chiropractors have spent years building with Preferred Care so that MVP can eliminate jobs in Rochester, outsource management and not even invite local doctor participation in the major changes that are occurring to their contracts?  Oh, but we are free to negotiate those contracts individually, right?  Sure.  You’ll meet with each of us, listen to our individual concerns and tailor fit each contract to each doctor.  Suuuuuure.

Oh, did I forget to mention this lie: “MVP Health Care will continue this dedication to the Rochester community”

Local job cuts?  In this economy?  Yeah, that shows your true dedication — to the dollar.  And every extra dollar you can squeeze out of the Rochester community.

Interested in helping protect your Preferred Care benefits?  Ask your chiropractor if he or she is staying on panel with MVP.  Call MVP member services and ask how they plan to keep your chiropractic coverage the same.  Find out if you have an out of network benefit for chiropractic.  Ask your employer if MVP is kicking back some of the money they expect to save by outsourcing chiropractic. 

I also understand it’s possible to switch to Excellus BC/BS mid year.  Might want to strongly consider sending a message with your wallet….I know MVP sure has.

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Read the News Today? Oh Boy.

June 18, 2009 at 9:36 am (Chiropractors & Chiropractic, Current Events, Evidence Informed Chiropractic, Responsible Chiropractic)
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hot air news

News: something frequently full of hot air and worthy of setting on fire.

“Did you see that thing on the news?” asked my patient of 13 years.

I was sure I hadn’t since I rarely watch or read news anymore.  I guessed she was talking about the same story that was catching most local people’s attention, “Oh, about the bear who fell out of the tree downtown? Sad, isn’t it?”

“No, I mean the chiropractic and stroke thing.”

“Oh!” I said, “Someone just forwarded that to me.  The one where the court decided that the force involved in chiropractic adjustments is nowhere near the force required to injure a healthy vertebral artery, and that if there had been sufficient force to injure the artery, there would have been damage to the surrounding bone?”

“Is that what that case said?” she asked somewhat confused.

“Sure.  Not surprisingly, it rides on the coattails of that recent study that showed that the risk of stroke was about the same whether the patient visited a chiropractor or a medical doctor.  They think is has something to do with the fact that people who are soon to have stroke might visit either type of doctor for headache and neck pain first.  At that point, it doesn’t matter if they get cervical manipulation, an Advil or a cheese omelet – they’re going to have a stroke.”

“Huh.  Well, my husband said there wouldn’t be an article about it if there wasn’t something to it.”

“Yeah,” I responded, “I just read an article about Bigfoot, the Loch Ness Monster and UFO’s.”

“People actually fall for that crap!” she exclaimed, ”Do you believe that!?!”

“Yes.  As a matter of fact I do.”

“My husband just wants me to minimize whatever risks I can,” she said.

“Okay, great.  You didn’t drive to my office, did you?  Since driving here is way more risky than walking.  Oh, and I hope you didn’t eat any animal products today since your risk of heart disease, cancer and diabetes is dramatically increased.  Oh, and you told me you took an ibuprofen last night.  You do know that increases your risk of gastric ulcer and some cardiovascular problems.  And you do know that living in an urban area, your odds of injury and illness are higher than in a rural area so did your husband put the house up for sale yet?”

“Uh…can you do something for this headache I have?”

“When did it start?”

“About a minute ago.”

 

Dr. Brett Kinsler blogs as RochesterChiro and is a chiropractor in Rochester, NY.

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Vegan Elevator Speech Needed

June 12, 2009 at 1:58 pm (Nutrition, Vegan & Vegetarianism)
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elevator_small

 

She wasn’t so much hovering as standing close by and waiting.  I could tell she wanted the cafe table I was sitting at and since I was packing up to leave, I really didn’t mind.  After all, being in the corner near the window is a choice solo lunch spot.

“Oh, sushi,” she says as I’m gathering my empty container, “Which roll did you get?”

“Uh, cucumber with carrots.  Brown rice,” I stumbled out.

“No, I mean which kind of fish?” she asked.

“Oh, I don’t eat meat so it’s just vegetables.”

“Well, I’m a meatatarian,” she declared proudly and as if to prove her point she dropped her plate full of various selections of dead animal products covered in sauce on the table where my rice and vegetables sat seconds before.

I had no reply to “I’m a meatatarian” other than to nod my head dumbly and walk away.  I’ve only been in this role for five months or so and don’t quite feel comfortable waving the flag too much.  When it comes to chiropractic, I have plenty of quick, witty replies to the commonest of remarks.

Them: I don’t believe in chiropractors.

Me: You don’t believe we exist?  Like the Easter bunny?  Wow.

You get the idea.  I need to work on that a bit for the vegetarian thing lest I just come off as self righteous (ask my wife).  I need to work my veganism elevator speech — that 30-60 second pitch you say to sum up your viewpoint on or sell something.  I’ll let you know how that goes.

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Measles…here it comes again

June 10, 2009 at 10:52 pm (Vaccination)
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vaccine

Just when we thought it was out, they pulled it back in. Yes, it looks like the childhood disease measles is on the rise again in the United States. According to recent updates from the Centers for Disease Control and Prevention (MMWR Morb Mortal Wkly Rep. 2008;57:893-896) 131 cases of measles occurred from January-July 2008, the highest year-to-date number of measles cases in the United States since 1996.

Of these 131 cases, 91% were persons who were unvaccinated or who had an unknown vaccination status. 123 were US residents, including 80% under age 20; 112 were unvaccinated or had unknown vaccination status; 95 of these 112 (85%) were eligible for vaccination, and 63 of these 95 (66%) were unvaccinated because of philosophical or religious beliefs.

The only way people are protected from diseases such as measles is when the population achieves herd immunity. The more individuals vaccinated in a population, the lower the chances of coming in contact with an infected person. For measles, herd immunity requires about 85-90% of individuals be successfully vaccinated in order to protect those with weakened immune systems, kids too young to be vaccinated or the fringe groups who refuse to see the obvious benefits of being vaccinated.

Thinking getting measles isn’t so bad? Harmless spots, no?  In the United States prior to the availability of the vaccine in the mid-1960’s, an average of 450 people died from measles and about 4000 developed measles encephalitis annually.  No, that’s not just a coupla polka dots.

Yeah, but you’re figuring you don’t have to vaccinate your kids as long as most of the rest of us do, right? They’ll be protected by the herd, right? Are your kids ever going to leave the country to travel? Will they come in contact with other people who have traveled abroad? Of course. Protection cannot be expected in this manner.

Bottome line: please ensure your kids have received the recommended childhood vaccinations according to current guidelines and make sure anyone who is travelling is up-to-date on their measles vaccination. Oh, and if you’re thinking of not vaccinating your child, please discuss this thoroughly with at least two pediatricians — chances are your logic for doing so is faulty and a second opinion for making such a potentially dangerous decision to your child’s welfare is surely warranted.

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Wanna be friends?

June 9, 2009 at 10:50 am (Uncategorized)
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facebook

 

RochesterChiro and Natural Health Chiropractic of Rochester now have a Facebook fan page!

Facebook Page

Please visit us on Facebook and become a fan (or show you are a fan if you already are one…or whatever, you know what we mean)

Thanks — see you on Facebook!

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As long as it isn’t hurting anyone…

June 2, 2009 at 10:36 pm (Current Events, Homeopathy, Medical Ethics)
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homeopathy

I remember as a teenager, one friend who was a little more reckless in appearance than the rest of us.  He was the first with a mohawk haircut, multiple piercings, crazy punk clothes.  His mother always had this great attitude – no problem as long as he isn’t hurting anyone.

I hear people take that attitude toward various forms of woo within alternative medicine.  As long as it isn’t hurting anyone, what’s the big deal?  Magnets: so what…who’s gonna get hurt.  Foot baths?  You’re soaking in it, Madge, but you’re not hurting anyone, right?  Homeopathy?  With dilutions so infinitesimal, who’s it going to hurt?  Nobody, right?  Wait up a sec, sport.  I think we’ve got a little problem…

Reporting from Australia, Sky News tells of a couple who have gone on trial charged with manslaughter after their nine-month-old baby died of septicaemia and malnutrition.  Thomas Sam, 42, and his 36-year-old wife Manju apparently avoided conventional treatment for their daughter’s severe eczema in favor of homeopathic remedies.

According to the court, Baby Gloria’s life would have been saved if her parents had sought conventional medical treatment for her even days before her death. 

Thomas Sam, a college lecturer in homeopathy, apparently continued to consult homeopaths and natural medicine practitioners as his daughter lost 20% of her body weight.  She weighed just 11 pounds and 11 ounces when she died.

The parents rarely consulted conventional doctors and never contacted a skin specialist after a nurse noticed their previously healthy baby had developed severe eczema at age four, the prosecutor said.

The court also heard Manju Sam, a computer professional, disregarded a doctor’s advice not to take the child to India to visit relatives in the final three months of her life. Gloria became malnourished battling against frequent infections that invaded her bloodstream through skin broken by her severe rashes.

The trial continues.

The moral of this one is of course that in the process of having an open mind, don’t keep it so opened that your brains fall out. To permit a child to die from a truly non-fatal disease simply because of dogmatic stubbornness is unfathomable.

Yes, ignorance hurts people.  Ask any child killed by parental neglect.

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