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:
- 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.
- 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.
- 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.
- 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
Great job Ryan and Jeff, enjoyed the discussion.
Being a long time follower and respector of Joe Rogan I was disturbed by the podcast regarding chiropractors. His guest seemed rather casual and suspect and I was surprised that Joe accepted her. He is usually more objective. I’m pleased with your rebuttal as I have had great success with my chiropractor. Of course, I have had some bad experiences with some practicioners as with some medical doctors.
Thanks for your feedback
I am a physical therapist and I appreciated the discussion and clarification on Chiropractic care. As a practitioner who often sees patients who have both successful and unsuccessful treatments, I have heard a lot on both sides. My issue is with what you mentioned regarding the healing of all kinds of ailments via spinal manipulation, the vitamins, nutritional supplements and the get adjusted for the rest of your life mentality. One chiro tried to sell my husband a $5000 package deal. It seems to want to foster a model of dependency rather than treat, train and move on. I definitely find your style of chiropractic an anomaly rather than the norm. Most patients get little to no exercise, stretch, strengthen after months of chiropractic care, just adjustment after adjustment. Anyway, love your podcast and keep up the good work.
Julie I’m sure the skill and knowledge of chiropractors vary just like the skills of Physical therapist and evey other profession. It’s unfortunate you never got to experience this beautiful profession and how much it helps people. I strongly disagree that most patients get no stretches or exercises. I have treated many patients that have said they got better under my care and received no relief or aggravated their condition under physical therapy. I also have come across some physical therapt horror stories. Like one of my patients who was given extensive shoulder exercises right after surgery and had tremendous pain. That doesn’t stop me from referring to your profession. It’s important to find the gifted people in your area.
I hope you can experience this beautiful profession and find some gifted chiropractors in your area. Interreferral for certain conditions can strongly benefit your patients.
While chiropractic medicine can be a tool towards health, I’m still not convinced of its empirical evidence against physical therapy. The sources you cite don’t necessarily state that chiropractic methods are gold standard or advantageous over physical therapists. In fact, they do state that they don’t harm anyone. Comparison between PCP and MDs seem counterproductive as the professions are not the same. I would recommend that you showcase effectiveness and efficacy empirical studies that show the comparison in PT and chiropractic. In addition, it is laughable that you used a .net source as your last citation. Lastly, answer the question as to why no accredited universities offer chiropractic programs, but they do offer physical therapy. Food for thought.
Empirical evidence “against” physical therapy? You will find most of the evidence is supportive of both chiropractic and physical therapy. Rarely is there a clear cut winner so to speak. Many studies do find chiropractic superior when both efficacy and cost are weighed. The studies do in fact rate chiropractic as very safe and this is easily confirmed by the lack of severe adverse events in all the studies I have read. Lastly, all chiropractic colleges/universities are accredited, and one must graduate from an accredited school to obtain their license.
I’m a chiropractor. Been successfully practicing for 8 years. Love chiropractic itself; but the profession and schooling is a JOKE. Comparing medical school to chiropractic school is like comparing the training of Navy Seals (MDs) to a basic police academy (DCs). Even the “post-doc” education the profession provides such as ICPA certification is laughable at best. My wife completed all 14 modules AND THERE WAS NEVER EVEN A CHILD PRESENT. She could literally go and become certified as a “pediatric” chiropractor and never have treated a child in a peer-reviewed setting. The moment I’m done paying off my absurd $200,000+ loan I’m leaving this joke of a profession. It will take me a decade to forgive myself from going to chiro school and not getting a “real” education.
What a joke of an article. You my friend are delusional to think that a medical doctor and a chiropractor receive equivalent training. I would trust an EMT basic with 4 months of training than a chiropractor claiming to be a professional healthcare provider.