Skeptical Chiropractor: No Sacred Cows

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.comHe doesn’t really dig Kool-Aid.

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My Letter to the Editor in Chiro Trade Pub

dynamicchirologo1

 

 

Just came across a letter I wrote a while ago to Dynamic Chiropractic that was published earlier this month…I must have missed it. Link is here and the letter is reprinted below:

Decompression: Thanks for Separating Fact From Myth

Dear Editor:

Thank you for Dr. Edwards’ article on nonsurgical spinal decompression (“Decompression Facts, Myths and Hyperbole, Part 3,” Sept. 23 DC). It is so refreshing to read an article about decompression that isn’t filled with marketing exaggeration, false claims of superiority and invented statistics. Dr. Edwards (and Dr. Dan Kennedy) present decompression for what it is: an expensive treatment that is similar to other traction devices in its effectiveness. I would like to see more real-world device examinations and debunking of chiropractic myths in future issues of DC.

Brett L. Kinsler, DC
Rochester, NY

 

The fact is, that happened to be a decent article and is worth reading.  Much of what shows up in the trade mags is either the same old drivel or else not worth the time it takes to read.  Once in a while we get surprised by a quality piece.

500 Words About the Medical Conscience Rule

compassHave you heard about the governmental approval of a new medical “conscience protection” rule?  It allows health care workers to opt out of administering any form of medical care they feel is objectionable on moral or religious grounds. Hmm…sounds good in theory. People shouldn’t be forced to do things they find objectionable, should they?

A press release on the Department of Health and Human Services Web site says the law will “protect health care providers from discrimination.” DHHS secretary Michael Leavitt said that doctors have a duty only “to provide care that they are comfortable providing.”

But religion is a discussion hotbed and healthcare is a hot button on the front burner of that hotbed and I have a few questions and a somewhat queasy feeling about this rule.

The goal of this rule, supposedly, is to make sure doctors who are firmly against abortions aren’t forced to perform them. However, the new rule also permits emergency room workers to withhold information from rape victims about access to emergency contraception. It also allows doctors in federally-funded clinics to refuse to tell a pregnant woman that her fetus has a severe abnormality.

The U.S. Conference of Catholic Bishops praised the new rules, saying medical workers “should not be required to take the very human life they are dedicated to protecting.” The rule is scheduled to take effect the day before President Bush leaves office.  Coincidence?  Sure, like cops with white powdered sugar on a dark colored uniform.

But a large number of medical groups oppose the rule.  Wacko fringe groups?  Not quite.   The American Medical Association, the American Nurses Association, the American Academy of Family Physicians, the American Academy of Pediatrics, and 27 state medical associations. Democratic House Representatives Diana DeGette (Colorado) and Louise Slaughter (New York ) plan to introduce a Congressional resolution rejecting the Bush administration’s last-minute rules.

Perhaps they have questions like me.  Perhaps they, too, are the teensiest bit afraid of Dr. Government.  Perhaps they are wondering:

Does the law mean a doctor can refuse to treat someone who is gay? Or refuse to prescribe medications for someone who is gay and has HIV because they feel that homosexuality is wrong?

Can care be refused to someone who overdosed using illegal drugs because the doctor doesn’t approve of drug use or of illegal activities?

How about refusal of treatment of an unwed mother because they disapprove of premarital sex or having children out of wedlock?

Wait a second! What if the doctor is anti-gun? Does the law permit withholding treatment to someone who was injured by a gun?  What if it was the patient’s own gun that went off when he was cleaning it?

Should medical professionals be permitted to refuse to treat a member of any particular group who they deem as immoral?

Of course not. This is a dicey, ill-conceived last minute plan to slip in a policy that makes sense to some people on isolated religious grounds but the risks if its implementation are too great and far reaching.

 

Dr. Brett Kinsler is a chiropractor practicing in Rochester, NY who does not support the conscience rule….and no, wiseguy, this does not count as part of the 500 words.

Live & Let Live or Sort ’em Out?

carefulSome of my more outspoken opinions (who, moi?) on topics like decompression and autism have sparked an interesting debate that is being held mostly by private email.  Without naming names and pointing fingers, I would like to hear what you think…

If a colleague is practicing in a manner that you find objectionable and unethical, what should be your course of action, if any?  Some people are saying that people should be able to practice however they see fit and writing like mine actually harms the practices of others.

Other folks say that it is the job of honest, ethical chiropractors to weed out the “sick” members of the chiropractic flock in order to advance the heard.

Yet another sect says that, yes, in fact we should denounce unethical practices but for Pete’s sake, do it quietly.

Ready for a fun social experiment?  Here is a practical, real world example and I will abide by the most convincing argument.  I was recently given an advertisement of a chiropractor who is basically offering money for referrals of patients.  Illegal?  Probably.  Unethical?  Definitely.  Should be stopped for the benefit of the profession?  Certainly.

What to do, what to do.careometer

Choice A: Ignore it and let him go on doing what ever he wants — after all, he’s a fellow chiropractor.

Choice B: Send Dr. Bribes-a-lot a private note asking him to kindly stop making the profession look bad.

Choice C: Pass the ad along to the state board and let them handle it.

What do you think?

Cold Laser Treatment for Autism?

autism-19Dear Dr. Kinsler.

Can cold laser therapy help autism?

Y.G. Denver, CO

Are you kidding me?  Do I really need to write a post on this?  No.  There is not a scrap of evidence that application of cold laser therapy can improve autism.

Save your money, save your time and save your sanity.

Cold laser treatment is a really nice therapy that is showing some promise for musculoskeletal problems.  Neurological issues, not so much.

I am sick and tired of seeing people rip off desperate patients in the name of healthcare…and especially in the name of chiropractic.  Cut it out!

We have plenty of treatments that work and lots of people with spinal problems that require our help.  We don’t need to make up treatments for illnesses that we cannot help and water down our profession even further.

 

Dr. Brett Kinsler is a chiropractor in Rochester, NY who will not treat people for autism using chiropractic, cold laser or by flinging marshmallows at them since none of these things will actually work to improve autism.

Cold Laser for Smoking Cessation – Fact or Crap?

no-smoking

Ok, ok…you keep asking.  At least once per week.  You want the answer?  Fine.  What do I think of the use of cold laser therapy for the treatment of smoking cessation?  Alrighty, then.  It’s time I publicly comment on my opinion.  The short answer is that it sort of works and sort of doesn’t.  Cold laser therapy in the form of laser acupuncture, applying laser stimulation to specific acupuncture points, seems to reduce some of the effects of nicotine withdrawal.  Great, you say…so it works…sign me up!

Well, not so fast.  See, nicotine chewing gums and patches also reduce the effects of nicotine withdrawal and their success rates are pretty lousy.  By themselves, the success rates are about as poor as cold laser.  Plus, they really do not help to break the actual nicotine addiction.  To paraphrase Einstein, you cannot treat a problem with the exact chemical that caused it.  In other words, treating an alcoholic who prefers vodka by giving him whiskey simply won’t do it.  There is no easy fix, be it a pill, laser or what have you, that will make someone wake up one day and say “I never want to smoke again.”

The best recommendation is for someone who wants to quit to get Franchise  For Laser Unit1.pubeducated about nicotine addiction and the cycle of addiction.  Going to a website like www.whyquit.com or, well, quite frankly, there is no electronic media substitute.  Reading what is posted there can change the way you look at nicotine and smoking.

In answer to the question, will I perform cold laser for smoking cessation?  Okay, sure.  As long as you understand that the treatment is not a cure for smoking cessation and that I make no promises and you are just using it to decrease your symptoms while quitting and will still get educated about nicotine addiction.  I would rather know that you were getting the treatment in my office rather than somewhere where you might be lied to or taken advantage of.

Deal?

 

Dr. Brett Kinsler is a chiropractor in Rochester, NY who performs cold laser therapy — sometimes as part of a smoking cessation program.

Are you giving money to Terry Rondberg?

Do you know who Terry Rondberg is?  If you are a chiropractor on this planet, you have probably received his yellow journalistic rag unfortunately over-titled as “The Chiropractic Journal”.  You may have also heard of his self-important, again over-titled organization called “World Chiropractic Alliance”.  Most responsible, reasonable chiropractors who have read the crap this Rondberg has written and done go running the other way.  Personally, I have been tossing out his newspapers unread for years unless I need something to protect the table when the kids are working on a painting project.  I don’t agree with him, I don’t respect him, I don’t like him and I certainly don’t support him.

Well, not on purpose, anyway.

I was informed of something this weekend that I hadn’t thought of before.  Rondberg’s paper is mailed free to all chiropractors.  He makes his money on advertisements based on his circulation numbers.  My wife also being a chiropractor gets a copy as do I and we both get them at home and in the office.  That’s an increase of four copies to Rondberg’s circulation numbers.

If everyone who disagrees with Rondberg and his wacko writings simply calls and cancels the delivery of the “Chiropractic Journal” their falsely inflated numbers would be decreased, his advertisers will pull back and, perhaps, just maybe, this garbage tabloid embarrassment to the profession will disappear.

So…are you giving money to Rondberg?  Call them at 1-800-347-1011 and cancel your subscription.

NY Chiropractors Are Going To Be Losers

I have just been informed that New York State chiropractors are about to lose something very important. If we do not reach the threshold of 500 members of the American Chiropractic Association by the close of business 10/31/08 NYS will lose a delegate. This would be more than unfortunate.

I believe in a few things in this world. I believe there is a general intelligence to the universe with the exception of certain parts of some states. I believe that personal freedom is usually better than it’s opposite. I believe it is easier to tell the truth than to remember a bunch of lies. And I believe in supporting my state and national chiropractic associations.

The ACA is the only real voice we have as a profession that serves the national forum and we need to support it. Five hundred members in NY is pathetic…falling below that mark is ridiculous. You may not always agree with your national organization but it is the only way we have to protect our rights in this country for the chiropractic profession.

You need to take action on this…..NOW!

If you are a chiropractor who practices in New York, please go to the ACA website http://www.aca.org

Click on Member Center and click on join ACA.

Thank you for being part of the solution, not the problem.

If you have comments about the ACA or other chiropractic associations, I would love to hear them.

 

Dr. Brett L. Kinsler is a member of the American Chiropractic Association and the New York State Chiropractic Association among other Associations.

One Pill Makes You Larger And One Pill Makes You Lie

 

A person critical of chiropractic recently told me he believed the only reason chiropractic showed any effectiveness was entirely placebo effect.  He was wrong.  I’m not getting into that in this article.  However, it looks like he could have made a similar statement about many medical practices and not been too far off the mark.

It turns out, according to a recent study published in the British Medical Journal (BMJ), almost half of U.S. medical doctors use placebos with their patients.

If your doctor has prescribed antibiotics for the flu or told you to try B-12 vitamins for fatigue, those treatments were just a placebo — an unproven therapy offered with the hope you would feel better if you took something…anything.

Treatment with placebos is far more common than you might think, according to the national survey about 58 percent of U.S. physicians admitted using placebos regularly. Only 5 percent said they tell patients explicitly that they are doing so. The survey was sent to 1,200 internists and rheumatologists with a response rate of about half of them. 

Classic examples of placebos are sugar pills, saline injections and other treatments that seem to inspire confidence even though they are inert. But the physicians surveyed were far more likely to use active agents as placebos, including over-the-counter painkillers, vitamins, sedatives and antibiotics.  What classified them as placebos was the context. If the recommended treatment hasn’t been shown, physiologically, to work for the condition in question, then it was a placebo.

Two years ago, the American Medical Association said it was wrong to use placebos without a person’s knowledge.  But some make a case for what they call “benevolent deception” — letting a patient believe she’s getting a useful treatment because, paradoxically, it might work.  I think that when placebos involve medications like antibiotics and sedatives there is a line that has been crossed.  Furthermore, when the AMA code of Ethics states that “a physician shall … be honest in all professional interactions” I don’t see the wiggle room in there to tell Mrs. Smith that the garlic tablets you gave her will have a chance at curing her cancer.

So what’s to be done with patients who insist on a prescription for something they don’t need?  I say, educate them, don’t lie to them.  Tell them why they don’t need an antibiotic, give them a lollipop and send them home.

What do you think?

Saline Irrigation for Sinuses – Fact or Full of Snot?

Oh, thank you U.S. researchers, for your cleverness and sense of humor.  Thank you for having the courage to shoot salt water up the noses of 121 adults with chronic nasal and sinus symptoms (stuffiness, congestion, or thick/ discolored nasal discharge).   Thanks for referring to part of the procedure as a large volume nasal irrigation flowed into the nostril and drained out the mouth.  Well, maybe not so many thanks for that as I am actually choking in the back of my throat a little just thinking about a large volume of anything being instilled into my nostril and drained out my mouth.  Echh.

The patients in this study were evaluated using a previously validated instrument, a 20-item Sino-Nasal Outcome Test.  Yes, this tool is called…are you ready…the SNOT-20.  (Thanks for, without a doubt, my favorite named clinical measurement tool to date).  Interestingly, this study showed SNOT scores improved approximately twice as much on average in the irrigation group versus the group that just had regular old saline spray.  There were significant changes at both 4 and 8 weeks.

Bottom line: Nasal irrigation using a stream of normal saline, is more effective in decreasing general nasal or sinus symptoms than saline spray. The saline can be made at home, purchased as a kit, or administered using a neti pot (online videos in places like YouTube will have demos of this).

I know you’re excited but I feel it is my duty to warn you not to go randomly shooting large volumes of liquid up your nose and out your mouth at home without at least doing a smidge of research first.

 

Source: Arch Otolaryngol Head Neck Surg. 2007 Nov;133(11):1115-20

Dr. Brett Kinsler writes RochesterChiro, the skeptical chiropractor in Rochester, NY.

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