New CCE Standards Will Improve Chiropractic

The Council on Chiropractic Education (CCE) has released a Draft of the proposed 2012  standards for chiropractic education.  There are some extremely important changes proposed in this draft and I urge all chiropractors (and informed non-chiropractic health care providers) to immediately comment in support of the new standards.  The major changes, with my personal comments in italics, are:

  • Removing the term “subluxation”

This is an antiquated, arbitrary term that only belongs in history textbooks.  New chiropractic students deserve a scientific premise for what they will be treating.

  • Removing the phrase “without drugs or surgery” in reference to chiropractic practice

More chiropractors and states are considering opening their scopes to allow limited prescription rights. Why should we be limiting our own scope of practice?

  • Modifying language from its definition of Chiropractic Primary Care Physician that distinguishes a chiropractor from other types of primary care physicians.

Chiropractors are primary spine care and even primary musculoskeletal care but we are not primary care physicians. You simply cannot have it both ways.  If we cannot use drugs or perform simple surgical procedures (removing a splinter or prescribing an aspirin) we are not primary care doctors.  The definition with respect to chiropractic education requires modification.

I applaud the CCE for drafting language that will do much to improve and reform the chiropractic profession.  The time is now for chiropractors to embrace actions that will lead us into rational, collaborative, scientifically sound practice and denounce that which may have had its time but now is holding us back.

I hope you will do as I have done and provide the CCE with your strong support of these proposed changes.

The deadline for providing feedback on this issue is Sept. 24, 2010.

A link to the current draft and a response form are posted on the CCE website at:

You do not need to complete the response form in detail. It is enough for you to state that you support the CCE’s draft as written.


Breaking News

Several years ago I went on a “news diet.” It wasn’t that I was a news junkie or anything but just that I felt my exposure to talk radio, the morning newspaper, Google news headlines and the evening television news wasn’t adding anything of value to my life. Some people get all worked up over watching or reading the news. Not me. I don’t take it personally when a politician acts like a politician. And entertainment news rarely got beyond Who’s Doing Who, Who’s Leaving Who and Who’s Got a Thumb That Looks Kinda Like a Toe. Digesting this garbage is like sitting with a bowl of candy during a bad movie. Neither have any redeeming or nutritional value and yet we continue consuming both until they’re used up. But unlike that bowl of candy, the news is never used up. It’s never ending. I suppose that’s why they call it news. If it wasn’t a growing body of knowledge, it would have to be called something like Sames.

So I canceled the daily delivery of the newspaper, switched to using my iPod in the car instead of listening to the radio, changed my homepage to avoid Today’s Headlines, and stopped turning on the television at night. And do you know what happened; what I missed? Not a whole heck of a lot. In fact, people I trust tell me about the most important news items of the day, along with their own personal slant — free of charge! It was rare that I completely missed something that was truly important. Hollywood plodded along whether or not I was present to witness the social minutia that occurred daily. And politics continued to be political. In short, the only thing I missed was the daily comics (though I prefer reading Funny Times anyhow). And I gained a bunch of time and headspace that I could devote to the really important things like updating my Facebook status or figuring out how to make my Blackberry act like a guitar tuner.

The fact is that news is a business and there are few really important occurrences. Much of it is exaggerated to stir the public into feeling great danger, fear or uncertainly. “This next story will may save your life, keep your kids from harm and possibly prevent an explosion in your own basement. Stay tuned.” Or we might be exposed to: “What does the earthquake in Haiti mean to your safety?” The news agencies create a need for their product and, by feeding that need, keep you hooked and buying more.

I’m not saying everyone should be ostriches and ignore what is going on in the outside world — though it is working well for me. I just think that more people might benefit from switching off the news and focusing more on the things for which they can make a difference. Forget about Haiti for a while and go help your elderly neighbor with her groceries. Turn away from the latest flood and assist the deluge in your own community. Of course you can make some bit of a difference worldwide but doesn’t charity begin at home? Aren’t there problems close by that you can really have an impact in helping?

Though some may argue local charity is short-sighted and selfish, I disagree. It is not selfish to place our energies where we have the most impact even though that place might be right next door. In emergency medical situations, you are taught to secure the scene of an injury or accident and ensure it is safe. The first act is ensuring your own safety. After all, what good is an emergency medic who is too injured to help others? There is an important lesson here. Secure your own scene and that of the area close to you before you worry about spreading your influence far and away.

Brett L. Kinsler is a chiropractor in Rochester, NY who continues his news exposure currently.

Kill a Subluxation

When I had a back injury that first brought me to a chiropractor, my father asked me what the injury was. I told him the doctor said I had an L3-L4 subluxation. No, my father explained, that was just some nonsense the chiropractor made up. What was the real problem? Oh, well it turned out to be a herniated disc — but that was my welcome into the world of chiropractic subluxation.

It may not surprise you to know that for as long as I have been writing this blog, even though there is no topic that is more inherently chiropractic as the subluxation, I have hesitated to address it. Seemingly so integrated into chiropractic history the concept to me is antiquated and unnecessary to modern, evidence informed practices. I have avoided discussing this hotbed of chiropractic silliness due to the lack of good that usually accompanies such a can-opening of any similar collection of worms.

Now, however, thanks to recent statements on the vertebral subluxation complex from the General Chiropractic Council in the UK and the British Chiropractic Association, I have selected to be silent no more. Instead, I have chosen to be paraphrasic. The statement from the General Chiropractic Council (GCC), appears here:

There is much in there with which to agree and also with the BCA‘s positive reaction to it. I am borrowing heavily from both as I develop my own affirmation:

The chiropractic vertebral subluxation complex is a historical concept but it remains a theoretical model. It is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease or health concerns. This is not to say that chiropractic treatment is not effective and important — but it is not lifesaving. Subluxations are not fatal.

Chiropractors must make sure their own beliefs and values do not prejudice their patients’ care. Furthermore, chiropractors must provide evidence based care, which is clinical practice that incorporates the best available evidence from research, the preferences of the patient and the expertise of the practitioner.

Any advertised claims for chiropractic care need to be based only on the best research of the highest standard. Think this is a no-brainer for everyone? I suggest you see what Bill Esteb over at Patient Media thinks about using evidence in advertising ( Hint: he thinks it’s stupid.

In light of the absence of supporting evidence I do not support the concept of the vertebral subluxation complex as the cause of disease and serious illness nor am I in favor of teaching vertebral subluxation complex theory to chiropractic students in any other context than historical and theoretical.

I fully support and encourage the inclusion of chiropractic into mainstream healthcare and know that in order to facilitate this integration we need to discard ambiguous terminology and unsubstianted historical concepts. We need to emphasize an evidence-based care model that is easily understood by the other members of the healthcare delivery team.

I feel that chiropractors should refrain from making any reference to vertebral subluxation complex in any media to which their patients or the general public may have access.

Chiropractors are the leaders in non-surgical spine care and there is strong evidence to support the inclusion of chiropractic in musculoskeletal healthcare initiatives. Chiropractors have been shown to possess specific expertise in the assessment, treatment and management of spinal and joint pain and are well-placed to deliver cost-effective services within mainstream healthcare. Let’s not mess it up by speaking another language that other healthcare professionals don’t understand while waving the lunatic flag of our now dead forefathers. There was a reason for the reliance on subluxation dogma in this profession. We needed to prove ourselves separate and distinct from medicine in courts of law. That time is passed. We’ve also given up on that whole flat Earth thing. Get over it and move on.

The GCC and BCA statements are the best thing we’ve gotten from England since Hugh Laurie and perhaps we should all strive to be a little more British.

Dr. Brett L. Kinsler is a skeptical chiropractor in Rochester, NY who is 1/4 British — but is now working on increasing that ratio.

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The Cow Has No Legs


Many people, of course, prefer food in what the vegetarians call ’the secondhand form’, i.e. after it has been digested and converted into meat for us by domestic animals kept for this purpose. In all these processes, however, ninety-nine parts of the solar energy are wasted for every part used. We shall escape the absurdity of growing a whole chicken in order to eat the breast or wing, by growing these parts separately under a suitable medium.”

Winston Churchill, 1931

Fifty Years Hence

Strand Magazine

Know what you call a cow with no legs?  Ground beef.  Know what you call beef with no cow?  Me neither.  But Winston Churchill once opined that it would be possible to grow meat without needing to tend to an actual animal.  This sci-fi concept of Jurassic Park meets Transmetropolitan meets Soylent Green is showing the vat cloning of livestock becoming a reality.   Scientists are growing nuggets of meat in laboratories without the ongoing use of animals.  In vitro meat production is a specialized form of tissue engineering, a biomedical practice in which scientists try to grow animal tissues like bone, skin, kidneys and hearts. Proponents say it will ultimately be a more efficient way to make animal meat, which would reduce the carbon footprint of meat products.  Much of the newest technology was presented at the Norwegian In Vitro Meat Symposium (motto: “Tastes Like Chicken!”).

This process seemingly solves many of the problems with a meat-eating world.  Contamination issues could be nearly eliminated.  Environmental issues such as the wasting of land, greenhouse gasses and water concerns raised by factory farming would be a thing of the past. And the problems of animal cruelty and barbaric slaughter processes would be non-existant in the laboratory kitchens.  Once the animal has been cloned, there really is no further suffering at the cost of producing the meat.  It’s like the joke about the lady in the supermarket’s meat section who couldn’t find the larger turkeys.  She asks the young clerk: 

“Sonny, do these turkeys get any bigger?”

“No, Ma’am.  They’re dead.”

Dead is dead and the damage has been done.  For PETA, not killing animals is good enough.  They have offered $1 million to the first people who produce an in vitro chicken-meat product that has a taste and texture indistinguishable from real chicken flesh to non-meat-eaters and meat-eaters alike.   And to the animals, not killing them is the good part.   But therein lies the (dry?) rub.  The reduction of our planet’s suffering and that of her animals are not really the only problems at hand.  The damage to humans from cloned, lab produced meat probably doesn’t occur until the meat is eaten.  In case you’ve forgotten, the evidence is very strong that eating animal protein causes cancer.  Like an on/off switch.  Eat enough of it…you are many times more likely to develop cancer.  Eat very little or none of it, you markedly reduce your likelihood of developing many cancers and heart disease.

Whether the animal product is from a test tube or gnawed off the animal itself, I do not think this fact will change. Cloned meat will probably prove to be just as unhealthy, just as dangerous and just as carcinogenic as farmed meat albeit a bit nicer to the donor.  Which makes it a slightly better idea than picking up packages of dead animal flesh from your friendly neighborhood grocer as long as you don’t plan to eat it.

Dr. Brett Kinsler writes for and doesn’t think lab meat sounds tasty at all.

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Rethinking Cancer Screening


Mark Twain sent a note to the New York Journal in 1897 responding to a story error in which the illness of Mark Twain’s cousin was incorrectly reported as Twain’s death. Twain told the Journal: “The reports of my death are greatly exaggerated.”

Dr. Otis Brawley, chief medical officer of the American Cancer Society told the New York Times on October 21, 2009, “We don’t want people to panic, but I’m admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated.”  In other words, the reports of the benefits of screening have been greatly exaggerated.

The recommendations for mammograms and prostate cancer screening have been off target and set against what the evidence suggested for decades.   An article in the October 21, 2009 issue of Journal of the American Medical Association, titled “Rethinking Screening for Breast Cancer and Prostate Cancer”, says so.  Millions of patients have been damaged by the universal and overly enthusiastic recommendations of early detection programs and screenings.   Oops.  The American Cancer Society’s sorry.  Their bad.  Buy you a drink? 

Enough good scientific evidence to stop these screening programs has been readily available for more than 30 years.  In 1976 Pietro M. Gullino presented his findings on the natural history of cancer, showing early detection is really late detection.  Many other researchers have stated that mammography, breast self-examination, PSA and digital rectal exam are really late detection methods and cannot be expected to save lives by catching cancer before it spreads. By the time these methods “catch” a tumor, the likelihood is that it has already metastasized. 

Sadly, as in so many other fields, there is no money to be made in telling the truth and more than $20 billion is spent annually on screening for breast and prostate cancer.  And while the press may have you believing that there has been a massive breakthrough in the literature leading to the guideline changes, the truth is that the evidence has not changed — only now, more people are willing to tell the truth and give up their chunk of the $20 billion screening pie and hundreds of billions more for the tests and treatments that follow.

And Dr. Brawley (chief medical officer of the American Cancer Society) has “never had a PSA and I do not desire one.” He compares prostate screening to the Tuskegee Experiment—research on the natural progression of untreated syphilis performed on black male patients between 1932 and 1972. This study caused serious mistrust by the black community toward public health efforts in the United States, the ripples of which continue to be evident in some areas today.   Ironically, black males are heavily targeted for prostate cancer screening and treatments.  Brawley has further noted that he is aware of twenty-three different organizations of experts in screening around the world who have considered the question and all have chosen not to make the blanket statement that screening saves lives and men should be screened. Most actually recommend men not get the test because it is not proven effective.

So when the United States Preventive Services Task Force (USPSTF) announced changing its guidelines for mammography and no longer recommending routine screening for women between the ages of 40 and 49 Brawley seems to have changed his tune somewhat. “The American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40. When recommendations are based on judgments about the balance of risks and benefits, reasonable experts can look at the same data and reach different conclusions.” Okidokie, spin doctor.  Interesting how his views change once he is on the payroll for the ACS (his anti-screening opinions were published when he was at the NCI).

The benefits of screening and early detection are theoretically possible for prostate and breast cancer.  But as of yet, these benefits are unknown.  What is known are the risks and harms of screening and the resultant unnecessary treatment for millions that lead to morbidity, mortality, breast mutilation or loss of sexual function.

So the ACS is sorry they have mislead you.  I’m sure they promise never to do it again.  In fact, given the extremely strong evidence linking the consumption of animal protein to cancer, the ACS clearly states that people should, “limit intake of processed and red meats”.  Wow!  Strong words, there.  Limit intake?  Whoa.  Let me process that for a while.  Oh, and we are suggested to “choose fish or poultry”.  Right, because they’re plants, right?  “When you eat meat, choose lean cuts.” 

This is a very interesting strategy on the part of the American Cancer Society.  They are already preparing us for the next big apology.  See, in another 15 or 20 years, they are going to report on the evidence which we already know today.  Animal protein increases cancer rates.  They’re so sorry.  Really. They should have told you that sooner, too.  Buy you a drink?


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Could Your PCP Pick You Out Of A Line Up?


I doubt mine could.  Which makes me think about Little House on the Prairie.  Anyone around in the 1970s remembers idyllic Walnut Grove, where Doc Baker took care of everyone and their pets.  He gave advice, dispensed medicines and sent the tough cases to Mancato (the big city).  People ran into him at the general store and he promised to stop on by the next time he was out their way.  To our modern ears, it sounds very quaint until you realize that this is the model of health care that we aspire to and were supposed to get with the onset of HMOs.  Under that model, we were each supposed to have a PCP who would monitor our health, give us lifestyle advice and send us to a specialist if any red flags showed up.  This would be the ‘gatekeeper’ (insurance term) that would be familiar enough with our health history that his or her decision would be one based on a long view of our individual health status.  Unfortunately, this model was managed to death by efficiency experts until it is neither efficient or effective.  The political choices we have before us continue this trend. Until we as patients demand better, the push will be for PCPs to do more with less.  In a recent poll (Investors Daily)  45 % of primary care physicians will consider quitting medicine if the government takes over the health care system.  That is approximately 360,000 doctors that will consider quitting practice.  Clearly, doctors are as frustrated as their patients.  Health care reform, to make any meaningful changes needs to redefine the role of doctor and patient.  The most efficient role the doctor can play is health coach in a proactive way.  That can’t be done in 5-10 minutes once a year. Or with a quick blood test.  Patients that are empowered by their relationship with their doctor will make the most beneficial (and coincidentally, the most cost-effective) changes to their own health.  In that climate, there will be less of a role for bean counters and government pencil pushers.  Let’s not give up the idea of Doc Baker too quickly. 

Dr. Michalene Elliott is a chiropractor in Rochester, NY who doesn’t want to be managed anymore.

Instant heart attack – just add bacon. Oops, too late.

Turns out meat is the new bread.  Thanks to a loyal blog reader for alerting me to this all-in-one vegan nightmare, cardiology freak show and only in America culinary death missle that virtually punches you directly in the organs.  KFC introduced in several test markets their “Double Down” sandwich.

This “sandwich” consists of two deep fried chicken fillets wrapped around bacon, cheese and some type of sauce.  The chicken is the bread.  You heard me — instead of  bread, they use two pieces of fried chicken.  Even Robert Atkins would push this away as being just a bit too meaty, dontcha think?

The name, “Double Down” (which won out over “Double Bypass”), is linked to the chances of developing heart disease during that meal (easily doubled).  And, after signing the required medical release form KFC requires,  you can listen carefully and actually hear your own arteries hardening.kfc-doubledown

Rochester Chiropractors’ New Clothes


Chiropracticly speaking, Rochester is a pretty close knit town. We have also produced more than our fair share of excellent, outspoken chiropractors.  It always seems like whenever there are responsible movers and shakers in this profession, there is some Rochester link.  I can hardly swing a dead subluxationist without running into an article written by fellow Rochester chiros. In fact, I just read an excellent article in Dynamic Chiropractic by Drs. Ventura, Dougherty and Justice discussing the unanswered questions about patient care.  They’ve done a nice job calling the profession to task in that one.  This week, I see a letter in D.C. by Dr. Lange discussing the improprieties of insurance contracts.  Another chiropractor from Rochester with something important to tell the world.

What’s happening is interesting.  There have been some nasty occurrences around here lately surrounding some insurance agreements (the MVP contract predominantly) and some cross words have been spoken.  But, as it should be, the chiropractic community in Rochester is coming out fighting.  It’s okay to be angry at each other.  It’s okay not to agree.  Hell, there are tons of things we can’t even legally discuss as a group.  What’s not okay is to completely discontinue talking.  We have to maintain the dialogue.  We must continue communicating as a community if Rochester is to remain the crowning jewel of a cohesive chiropractic town as it always has been.

So many doctors here are the product of parents whose footsteps they are following.  Parents who fought together, celebrated together, even went to jail together for the sake of the profession when they had to.  We cannot let that go to waste.

Talk to your colleagues.  Tell them what’s on your mind.   Preserve your working relationships and your friendships; and in the process, you will preserve your profession.

Educate your friends on why they may be making bad decisions and how those decisions affect the entire region, both patients and doctors alike.   Perhaps they will see the light.

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Read the News Today? Oh Boy.

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.

As long as it isn’t hurting anyone…


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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