Chiropractors managing herpes?

Chiropractors managing herpes?

The National Board of Chiropractic Examiners (NBCE) periodically conducts a survey of chiropractors to see what they do in their practices. The NBCE's Practice Analysis of Chiropractic 2015 is out now and provides an intriguing inside look at this insular group of health care practitioners. The survey certainly deserves more than one look, but I provide some initial observations here.

First, the Analysis is not good news for the group of chiropractors trying to rebrand themselves as primary care physicians.  In actual practice, they hardly ever see the diseases and conditions the average MD or DO PCP would diagnose and refer or treat. For example, asthma, COPD, respiratory infections, colitis, ulcers, UTIs, angina, thyroid disorders, anemia, menopausal issues, and ENT disorders were seen once or twice a year, and in some cases not even that frequently.

Yet, with a hubris that far exceeds their actual experience with these problems, they reported in many cases that they "co-managed" these issues with other health care professionals. Chiropractors virtually never saw a case of appendicitis, yet reported that they co-managed 21% of these cases and managed 5.1% by themselves. (Surely that is a statistical anomaly and a chiropractor didn't actually manage a case of appendicitis!) They saw less than 1 case per year of herpes simplex or herpes zoster, but co-managed almost half of the cases.


Here are a few other co-managed (with percentage of cases co-managed, rounded), although rarely seen, conditions:

Kidney stones:  44%

Angina or myocardial infarction:  40%

Thyroid disorders:  42%

Infertility female/male:  64%

How so?  The NBCE provides this helpful explanation:

Co-management of many conditions by chiropractors consists primarily of identifying and correcting spinal subluxations; additionally, many chiropractors provide nutritional counseling, corrective or therapeutic exercises, or physiotherapies which may benefit patients with the condition. 

Got it! Who knew herpes could be improved by correcting subluxations? Perhaps it was the "dietary counseling" as well, which is code for prescribing and selling nutritional supplements of dubious utility to patients. (I have to assume exercise and physiotherapy weren't in the picture here.)

Ah, yes, the chiropractic "subluxation."  They diagnosed and treated lots of those. In fact, it was the number one condition (or maybe I should say "condition") they saw in practice. Over at SBM, we sometimes get comments from chiropractors that the "subluxation" is a relic of the past, not taught anymore in chiropractic college except in chiropractic history.  Like this:

. . . comments were posted positing that the Science-Based Medicine blog “is not informed  on contemporary chiropractic practice,” that “the profession does not support [the chiropractic] subluxation as a cause of disease,” that chiropractors who treat the chiropractic subluxation are “on the fringe,”  and that the chiropractic “subluxation” is no longer taught in chiropractic colleges as a clinically relevant concept, but merely as an artifact of chiropractic history.

Someone needs to tell that to the practitioners. And to the NBCE. They are, after all, the organization responsible for administering chiropractic board exams, which all chiropractors must pass to get a state license to practice. 

How are they defining the subluxation these days? Good question, because the Association of Chiropractic Colleges still defines it with this nice word salad (helpfully included by the NBCE):

A subluxation is a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health. A subluxation is evaluated, diagnosed, and managed through the use of chiropractic procedures based on the best available rational and empirical evidence.

 But that's not how the NBCE defines it in the Practice Analysis Glossary:

The alteration of normal biomechanical or physiological dynamics of contiguous articular structures; it is essentially a functional entity

So, is it functional/structural/physiological and "may" influence organ function and health? Or is it biomechanical/physiological and essentially functional? Perhaps this definition, also from the glossary, will clear things up:

Non-subluxation diagnosis: A diagnosis other than “subluxation.” Because the detection and treatment of subluxations is unique to the chiropractic profession, a distinction is made in this report between subluxation and other diagnoses.

I think this nails it. Other healthcare professions (physicians, nurses, physical therapists and so on) know that the subluxation is "unique" to chiropractic because they made the whole thing up and subluxations don't exist. And when you are making things up, the choices are endless. 



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