Why This Episode Exists

A few weeks ago, Joe Rogan (who gets something like 100 million podcast downloads per month) had an episode that essentially was titled 'Why Chiropractors are Bullshit'. His guest on the podcast was self-proclaimed science guru Yvette D'entremont, who goes by SciBabe.

[Full disclosure, I actually REALLY enjoy many episodes of Joe's podcast episodes. His podcast is one of my favorites]

The podcast episode was more or less a hit piece on the profession, but factually it was awful. I felt compelled to use The Movement Fix Podcast as a way to voice a rebuttal that is level headed and factual.

I think it is important to note the history of how this all came about. Joe Rogan said in a podcast he had been seeing his chiropractor for a year for a disc herniation in his neck. After it wasn't improving, he said 'hey this is BS' on the podcast.

On June 22nd, 2017 Yvette wrote an article called Chiropractors are Bullshit.

The timing of when Rogan first spoke of this and Yvette's article is suspect. She is a 'popular' science writer and debunker online, whose career would be propelled by getting on a podcast as large as Joe's.

Perhaps she wrote this article after she heard Joe say that as a ploy to get on his podcast. So we must question the motivation of why this all came about in the first place.

Make a click bait title on a controversial topic and views, clicks, and ad revenue are bound to increase.

That is my theory on WHY this happened in the first place, in terms of Yvette getting onto the podcast to voice her opinion. I question the motive.

About my Guest

I am joined in this episode by Jeff Langmaid, DC. Jeff is the founder of The Evidence Based Chiropractor, where he educates chiropractors and other professionals on the current research as well as how to communicate that research to other medical professionals.

He currently works at the Laser Spine Institute in Tampa, FL, which is a large interdisciplinary clinic. He works closely with MDs, DOs, and other healthcare professionals in deciding which cases need back surgery, which should seek conservative care first, etc.

Check this place out:

Definitely a place that would hire 'quacks' who are useless, right?


In this episode we discuss:

  • Are professions allowed to evolve and should we judge them by how they were founded?
  • What did general medical practice look like in the 1800s?
  • Stroke risk with neck manipulation
  • Are chiropractors doctors?
  • How does chiropractic care fare compared to surgery and injections?
  • The difference between chiropractic care and the chiropractic profession
  • Are PTs and DCs getting closer to being synonymous similar to how MDs and DOs did over time?

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SHOW NOTES

Notable Research:

Glucose Metabolic Changes in the Brain and Muscles of Patients with Nonspecific Neck Pain Treated by Spinal Manipulation Therapy: A [18F]FDG PET Study

  • Metabolic changes in brain and skeletal muscles observed after spinal manipulation
  • Subjective pain, muscle tension, and salivary amylase reduction after spinal manipulation

Safety of Chiropractic Manipulation of the Cervical Spine: A Prospective National Survey

  • Treatment outcomes measured for 19,722 patients with 50,267 cervical spine manipulations
  • Details - Serious side effects: There were no reports of serious adverse events. This translates to an estimated risk of a serious adverse event of, at worse ≈1 per 10,000 treatment consultations immediately after cervical spine manipulation, ≈2 per 10,000 treatment consultations up to 7 days after treatment and ≈6 per 100,000 cervical spine manipulations.
  • Details - Minor Side Effects: The highest risk immediately after treatment was fainting/dizziness/light-headedness in, at worse ≈16 per 1000 treatment consultations. Up to 7 days after treatment, these risks were headache in, at worse ≈4 per 100, numbness/tingling in upper limbs in, at worse ≈15 per 1000 and fainting/dizziness/light-headedness in, at worse ≈13 per 1000 treatment consultations.
  • Conclusion: Although minor side effects following cervical spine manipulation were relatively common, the risk of a serious adverse event, immediately or up to 7 days after treatment, was low to very low.

Risk of Vertebrobasilar Stroke and Chiropractic Care
Results of a Population-Based Case-Control and Case-Crossover Study

  • Article is from the European Spine Journal
  • Conclusion: VBA stroke is a very rare event in the population. The increased risks of VBA stroke associated with chiropractic and PCP visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.

Symptomatic Magnetic Resonance Imaging–Confirmed Lumbar Disk Herniation Patients: A Comparative Effectiveness Prospective Observational Study of 2 Age- and Sex-Matched Cohorts Treated With Either High-Velocity, Low-Amplitude Spinal Manipulative Therapy or Imaging-Guided Lumbar Nerve Root Injections

  • This study compared self-reported pain and improvement of patients with symptomatic, MRI confirmed, disc herniations treated with either spinal manipulative therapy (SMT) or nerve root injections (NRI)
  • Most patients in the study reported significantly and clinically reduced back pain and global perception of improvement. There were no significant differences in outcomes between NRI and SMT.

Adding Chiropractic Manipulative Therapy to Standard Medical Care for Patients With Acute Low Back Pain: Results of a Pragmatic Randomized Comparative Effectiveness Study

  • Study is from the journal Spine
  • Compared Standard medical care (SMC) vs SMC + chiropractic manipulative therapy for treatment of acute low back pain among 18 to 35 year old active military personnel
  • Conclusion: The results of this trial suggest that CMT in conjunction with SMC offers a significant advantage for decreasing pain and improving physical functioning when compared with only standard care, for men and women between 18 and 35 years of age with acute LBP.

Spinal High-Velocity Low Amplitude Manipulation in Acute Nonspecific Low Back Pain: A Double-Blinded Randomized Controlled Trial in Comparison With Diclofenac and Placebo

  • Study is from the journal Spine
  • Objective: To compare effective of spinal manipulation compared with the NSAID diclofenac compared with placebo for acute nonspecific low back pain
  • Conclusion: In a subgroup of patients with acute nonspecific LBP, spinal manipulation was significantly better than nonsteroidal anti-inflammatory drug diclofenac and clinically superior to placebo.

 

Chiropractic Education vs Other Professions

From the National Board of Chiropractic Examiners: To earn and maintain accreditation, chiropractic colleges must meet a variety of stringent requirements. Each program’s curriculum must include at least 4,200 instructional hours of course credits.

I have looked long and hard to find a comparison of DC and MD education hours. There is always this chart that pops up (displayed below).

I questioned whether or not it was accurate. And after searching long and hard, I could not find any dispute of the accuracy of this comparison. If it isn't accurate, please let me know.

The largest difference between the two professions, outside of the main educational courses (such as anatomy, physiology, pathology, biochemistry, neurology, etc) is the specifics for that profession.

Medical doctors spend way more time on pharmacology, immunology, general surgery and chiropractors spend more time on kinesiology, biomechanics, soft tissue manipulation.

Here is a chart I found to be most accurate based on all of this:

Source: http://www.backtochiropractic.net/PDF/Chiropractic%20Education%20VS%20Medical%20Education.pdf

As the chart demonstrates, the hours of the basic fundamental sciences is very similar, but the differences are in the profession specific hours.

Of course, medical doctors have a residency after they graduate, which is a notable difference between the two professions and that shouldn't be under-emphasized.

What about the term 'Doctor' and title Dr

This is where things get interesting.

'Doctor' is an academic title, derived from the Latin verb docēre, which means to teach. 

Different countries have different etiquettes around the term.

In Germany, for example, the term doctor (Doktor) refers to a research doctorate (like a PhD) and there is another term Arzt that refers to medical practitioners. That's the technical usage, but they use Doktor colloquially for physician.

In Greece, "Ιατρός" (iatros) is used for physicians and "Διδάκτωρ" (didaktōr) is used for doctorate degrees.

In the United Kingdom, the term doctor isn't really even regulated, unless used in advertising to incorrectly imply someone has medical qualification. Terms that are regulated include: physician, doctor of medicine, suregon, among others.

In the United States we just can't figure out what we want to call people, although it's typically held for people who hold doctoral degrees.

Colloquially in the United States, saying 'I am a doctor' implies medical doctor. Using the title 'Dr.' refers to a level of education that could be from a number of degrees.

I hope those of you who listened to the podcast and read through this post found it useful.

-Ryan

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