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this post was submitted on 05 Dec 2023
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Chiropractors and osteopaths only exist in such large numbers because they bill less to insurers than actual doctors & hospitals. So of course insurers are going to promote these quacks because it's cheaper than somebody going to an actual physiotherapist for treatment.
There should really be legislation that requires insurers to cover science & evidence based treatments. If someone wants woo it should be at additional expense to them, not part of a standard policy.
So, DO's in many of not most states in the US have the same licensure and practice limitations as MDs and charge/are reimbursed similarly. I'm many cases they actually attend the same residency programs as allopathic/MDs. Most I've worked with drop 99% of the Osteopathic manipulation stuff soon as they graduate. Naturopaths on the other hand....
If I pay for a business to make me a chocolate milkshake under the same health code regulations and standards as the place across town, I don't want them finishing it off by stirring in a spoonful of shit with the ice cream as a bonus. Even if >99% of what's in the cup is not shit, it isn't somewhere I'll go and I'll make an effort to discourage people from going there too.
Osteopaths, chiropractors and all those other flavors of cargo cult imitation medical quackery differ only by the proportion of ingredients. Making a distinction between them is meaningless, it just lets the less-obvious liars get a foot in the door.
(Additional note because this is the internet: This is a "spherical cow in frictionless vacuum" scenario and ignores things like accidental contamination as well as the narrow range of illnesses where an appropriately-prepared and administered fecal transplant (which this is not) may be indicated.)
I think you're misunderstanding what most of them keep practicing. It's not the kooky cranial/cervical manipulation(you can make an argument that them having to learn that stuff in the first place is BS and a waste of time), but most do pick up a few muscle pressure point tricks and stretches that are essentially the same as what PT instructs patients on how to do. Is it bullshit? No more so than most medicine that's practiced(the data behind the vast majority of what your average physician does is at best all over the place, the truly "settled" clinical questions are few and far between). In my book though, anything that keeps you from having to prescribe a scheduled drug (read as:narcotic or muscle relaxer) to get someone functional from something like severe trapezius tightness or piriformus syndrome is a heck of a tool to have at your disposal in a primary care or urgent care setting.
A broken clock might be right twice a day but that doesn't mean you should rely on it for timekeeping. If something works, we study it in search of why, how and other details that may not be immediately obvious but could have an impact on patient outcomes. From what their product quality shows, chiropractors and their snake oil salespeople colleagues appear to be some combination of less diligent, less motivated and less capable when it comes to doing that sort of evaluation. Trying to blend that part of the market into the realm of legitimate evidence-based medicine is bad for almost everybody involved. Might as well start having the nurse follow the vitals check with a palm reading if the standard of "has a basis in reality" is too onerous for modern medicine.
We're constantly making bigger and brighter lights to shine out into the darkness of what we don't yet know while the Supplementary, Complementary and Alternative Medicine crowd sprints for the first patch of darkness to plant a flag and hide. You're right that there are a lot of unanswered questions but an answer is not a valid substitute for a correct answer.
You've got it in reverse. See that "possible exception for back pain"? Chronic pain related to joint issues is ALL chiros do, insurance used to cover that when you had a back injury or whiplash, things it works for. Then insurance stopped covering that, pretty sure it's because they favor you getting a prescrip for pain killers but that's conspiracy on my part, and a lot of chiros started to turn to less savory things, as they did that more and more snake oil types who claim chiropractic work is some fuckin miracle come out of the woodwork.
I've worked with these issues a lot in representing injured workers, including litigating coverage of chiro treatment. In my experience, insurers will always cover chiropractic if it is under the direction of a doctor. A lot of orthos send their patients to chiros for treatment. Insurer is fine approving eight or twelve sessions as ordered by the treater. Where they have a problem is when it's the chiropractor directing the care. You know, if you get hurt and you just go straight to the chiropractor, they will say they need to treat you indefinitely, twice a week or something.
As for efficacy, it's undeniable that chiropractic care feels good. If it feels good and the patient believe it's working, that's enough to make it work for real. No doubt, there are plenty of studies that bear out improvements of objective functional capacity and subjective pain ratings after chiropractic care. The mechanism is that the "adjustments" affect the autonomic, sympathetic, and parasympathetic nervous systems, and prompt the release of neuroendocrine factors such as serotonin and dopamine. For some people that is enough to feel better and even heal. For insurers, many of them are happy to pay for a course of chiro care because doing so may save them from having to pay for continued Ortho followups, skilled PT, guided injections, or even surgical interventions.
On the other hand, chiropractic education and practice is highly subjective, and the entire field lacks consistency and validity, and IMO is inadequate for the forces it exerts on the most sensitive part of the human body: the cervical spine. Cervical manipulations are highly dangerous. It can severe arteries, cause strokes, cause stroke-like symptoms from nerve palsy, and can break vertebrae; this can easily paralyze or kill a patient, and the chiro cannot know these forces are likely safe for a patient unless they've reviewed prior imaging of the cervical spine and know for sure there are no preexisting stress fractures, lesions, or neural impingement.
At this point the industry is so large and powerful that the medical industry and regulatory structure has decided that patients may decide to bear these risks for themselves.
This comment is a hot mess of personal experience and fatalism wrapped in the vaneer of scientific authority. Chiropractor bad ... Unless doctor say go. Then bad not bad anymore.
Just my medicolegal experience. Not sure what you mean by fatalist or veneer of scientific authority, though medicolegal science is a thing, I said up front I wasn't a scientist and that my experience was in resolving and litigating coverage disputes or how you'd simplify my conclusions into such a slogan. I clearly said the entire art suffers from inadequate validity and training that ends up getting people seriously injured or killed.
Oh, it's fatalist of me to say the law and insurance industry say patients may elect that risk? I suppose, that's the way it is right now. Certainly doesn't have to be. The political will of regular people is too distracted by culture wars and disinformation to be hopeful that Congress is going to step in and regulate chiropractic. We have serious challenges like maintaining democratic governance to be so focused on this. You want to regulate something that maims and kills people, I have about twenty other things way more urgent before we get to chiropracty. If you want to spend all your political capital in this one place, have at it. I hope you're right and chiropractic medicine is the most imminent of our problems; is that fatalist?
Welcome to Lemmy. Enjoy your stay. 🤷
The reason is that if the doctor says go, they're just going to do what a physical therapist does.
I personally would prefer to go to the person whose training was based in reality instead of a fraud who might paralyze me.