The Difference Between Evidence Based Chiropractic Care and Quacks

https://bengreenfieldfitness.com/chiro

Last week, podcaster and comedian Joe Rogan interviewed (click here to watch or listen) a woman who calls herself the "SciBabe" (Yvette d'Entremont) about her juicy, controversial, attention-grabbing article on The Outline entitled "Chiropractors Are Bullshit". Now don't get me wrong - Yvette has some interesting ideas and I appreciate both her willingness to question some of the more radical aspects of alternative medicine and potential quackery, as well as her ability to keep us all on our feet and wary of being duped by ineffective therapies. She's even been a podcast guest on my episode "Is The Food Babe Really Full Of Sh*t?". At the same time, I see a chiropractor regularly. Some of my dear friends are chiropractors. From sacroiliac joint issues to neck pain to digestive problems, chiropractors have fixed my body many a time. So I wanted to give someone from the chiropractor community a chance to speak up on the actual science and evidence-based research of chiropractic medicine.

Enter Dr. Jason Jaeger, DC, FCBP. Jason is a chiropractic physician at Advanced Spine & Posture in Las Vegas. He has practiced since 1999 and has been a chiropractic physician in Las Vegas since 2001 where he has brought his passion for health and wellness to the community that he and his family have called home since the late 1940’s. He is the Administrative Director of Aliante Integrated Physical Medicine, one of Nevada’s leading integrated physical medicine practices. Dr. Jaeger is one of only approximately 1000 chiropractors around the world trained in Chiropractic BioPhysics®, a technique which corrects and restores the spine back to alignment, and one of only 19 instructors for the CBP technique. Dr. Jaeger is also Board Certified in Nevada in CBP®. He is the developer of the Universal Tractioning System (UTS) and received the “2014 Researcher of the Year” award for the Advancement of Chiropractic Science at the Annual Chiropractic BioPhysics® Research Symposium held in New York City. Dr. Jaeger attended the University of Nevada, Las Vegas (UNLV) during his undergraduate program and graduate school at Southern California University of Health Sciences (SCUHS). As class representative and Student American Chiropractic Association Vice President SCUHS chapter, he successfully lobbied in Washington D.C. for such issues as Medicare and HMO reform. Dr. Jaeger participated in a rotation through Cal State Northridge’s prestigious Physical Therapy program where he successfully integrated neuro-musculoskelatal therapies on paralysis and stroke victims. Dr. Jaeger currently holds adjunct faculty positions at Southern California University of Health Sciences in Whittier, CA; Cleveland Chiropractic College in Kansas City, KS; Parker University in Dallas, TX; and Palmer Chiropractic University in Davenport, IA. He is the Secretary of the International Chiropractic Association’s (ICA) Research and Guidelines committee (FACTS). Dr. Jaeger is a professional speaker and has lectured throughout the United States, Europe and Australia on spinal biomechanics, research and the clinical work he has performed. He is a published author in the peer-reviewed literature on clinical biomechanics. Dr. Jaeger is a literature-reviewing doctor for the International Chiropractic Association’s Best Practices Guidelines, a guideline recognized & accepted federally by the National Clearinghouse of Guidelines. He is a past board member for the Nevada Chiropractic Association (NCA), is a current board member for the Nevada Chiropractic Council (NCC) and has been deemed an expert by the courts in the State of Nevada.

During our discussion, you'll discover:

-What Jason thinks of Yvette's statement that "little more than the buffoonery of a 19th-century lunatic who derived most of his medical theory from séances"...[8:00]

-Whether those in chiropractic medicine actually respect Daniel David Palmer, founder of chiropractic medicine...[11:42]

-Whether it is true that "The defining principle of chiropractic is that health is a state that can be either maintained or lost due to vertebral subluxations"...[13:30]

-The type of chiropractic care Jason practices, and the difference between evidence based chiropractic care and "quacks"...[22:40]

-What Jason's schooling looked like, and whether it is true that 100% of chiropractic docs graduate from their institution...[26:20]

-How big of a problem is "quackery" in chiropractic care, and Jason's thoughts on some of the people Yvette discusses in her article, like Josh Axe, Billy Demoss, and Eric Berg...[30:40]

-Where medicine and supplements fit into Jason's practice, and whether his supplements are regulated...[41:00 & 45:50]

-What Jason thinks about infant chiropractic care...[47:00]

-How you can know if you're getting a "good" vs. a "bad" chiropractic doc...[52:05]

-And much more!

Resources from this episode: -The Joe Rogan podcast in which Joe interviews SciBabe Yvette d'Entremont about her article "Chiropractors Are Bullshit". -Ben Greenfield's previous interview with Yvette: "Is The Food Babe Really Full Of Sh*t?" -Article: The Sci Babe is Neither Scientist Nor Babe: She’s Bullshit -Dr. Isaac Jones podcast interview on 5 hidden causes of fatigue -Functional Medicine Practitioner directory -Ideal Spine Practitioner directory -Best Practices for Chiropractic Care of Children: A Consensus Update.

But the podcast ain't all... ...in addition to the interview with Jason, my friend and chiropractic physician Dr. Patrick Gentempo penned his own response to the Joe Rogan interview. Over the course of three decades Dr. Gentempo has built one of the most reputable and recognized names within all of Chiropractic by leveraging tenacity of conviction and unrivaled business acumen. His name has become synonymous with innovation. a mindset which has spawned a myriad of liberating business ventures that all work toward a legacy level goal- to elevate chiropractic in a way never before attempted. Dr. Gentempo has taken a hands on role and has shaped the core business strategy and market entry approach. His direct involvement has been critical for establishing operating philosophies and aligning partnerships that facilitate a purpose driven business model which will ultimately inspire more doctors to serve more people. He is the Chairman on Circle of Docs, a website dedicated to chiropractors. Here's what Dr. Gentempo had to say...

The Case for Chiropractic: An Appeal to Open and Rational Minds in Healthcare Introduction

Doctors of chiropractic practice throughout the world and in the U.S. are licensed to practice in all 50 states. Although the basic science and clinical science research supporting chiropractic is robust and very compelling, the overwhelming number patient testimonials regarding their experience with chiropractic care is truly remarkable. Most pro sports franchises have team chiropractors. Many celebrities, entertainers and rock bands travel with chiropractors. I have personally taken care of celebrity athletes and have toured with a very famous rock-n-roll band. However, the chiropractic profession, even after over 100 years of extraordinary results serving countless millions of people, remains the target of illiterate controversy and imbecilic attacks. Many in the profession believed that after a United States federal court in September of 1987 found the American Medical Association guilty of Anti-Trust as it conspired to “contain and eliminate the chiropractic profession, that these unfounded and malicious attacks would end. Although many medical doctors regularly refer patients to chiropractors and personally utilize their services, the attacks and misinformation continues. Let me say that this article is not meant to be an anti-medicine rant, although since the practice of medicine is the standard that many use to judge chiropractic, certain data must be brought to light. I appeal to the reader to, for a few moments, suspend conventional, indoctrinated thinking relative to healthcare so the perhaps a new and better understanding can emerge. In many respects, chiropractic is for the pioneer, the forward thinker. The person who has a bias toward a more natural approach to life and healing. It is indisputable that for over 100 years, chiropractic has radically and positively transformed the lives of many, many people throughout the world. The question is: why? Volumes of books have been published to more fully answer this question. My attempt here is to give a brief summary that organizes the logic and thinking around a truly unique and powerful service to humanity, chiropractic.

History Of Chiropractic (Was D.D. Palmer A Quack?)

The birth of chiropractic occurred in 1895 after the founder of chiropractic, D.D. Palmer, had given what he described as a specific spinal adjustment to a partially deaf man named Harvey Lillard, resulting in the restoration of his hearing.  Many detractors refer to this as a myth and incorrectly cite that there is no physiological basis for this account.  In fact, there are many published cases of improved hearing after chiropractic care. These reports, published in refereed, peer-reviewed scientific journals come from around the world.  Here is a link to a review article published in a trade publication by Dr. Christopher Kent, who has assembled some of these references and proposes some of the neurological mechanisms. On a personal note, in my own practice experience, I have had patients with hearing deficits experience marked improvement in their hearing as a result of chiropractic adjustments.  One story I’d like to share occurred within my first year of practice.  A gentleman in his late 60s, let’s call him Stan, came into my office with primary complaints of low back and neck pain.  He had hearing aids in both ears and had a significant hearing deficit for over 10 years.  After Stan’s first adjustment, he left the office. A few minutes later he came walking back in. He had tears in his eyes.  I saw him in the reception room and quickly approached to see what happened.  He asked, “Is it possible that what you did cured my hearing loss?”  I replied, “Yes, as a matter of fact, that is the first case chiropractic was founded on.”  He sobbed as he said, “Normally in my car, I have to turn the radio volume all the way up to hear it.  I just now barely cracked the knob and I heard it clearly!”  He then hugged me with quite a bit of force (he was a big guy), turned and left.  Now, this is an ‘anecdote’ and some may say, “it doesn’t matter”.  But I will tell you, it mattered to Stan.  And it mattered to me. We can debate the probability of a chiropractic adjustment being able to restore hearing deficits and it is a worthy debate.  But personally, I have zero tolerance of fools who shrilly cry, "there is no plausible explanation for the Harvey Lillard story". Like any healthcare profession, chiropractic consists of a philosophy, science and art.  And in fact, the philosophy leads the science and art.  So let’s break some of this down.

Philosophy Of Chiropractic (And Why Medicine Isn't Really "Healthcare")

I have always subscribed to Ayn Rand’s assertion that when you have contradictions in your basic philosophical premises, the only possible result is destruction.  The amount of destruction is relative to the level of the contradiction.  We are in the midst of what is described as an unprecedented healthcare crisis.  In the United States we spend over $3 trillion per year on what we call healthcare, yet we are getting sicker, using more drugs, and some predict that the current generation is the first generation that will have a lifespan less than that of their parents.  I assert that the biggest contradiction in our culture today is calling medicine "healthcare".  The practice of medicine is not healthcare, it is sick-care, and when you take sick-care and give it to a culture as healthcare, you end up with a sick society.  And no matter how much money you spend, you will never solve the problem. In contrast, what are some of the foundational premises chiropractic is based upon?

1. A living body is a self-healing, self-regulating organism. Cut your hand, it heals.  Right now, your heart is functioning, kidneys, liver, digestion, etc. All this happens without you taking anything or  thinking about it.  It is an innate/inborn process.
2. The nervous system is the master system and controller of your body coordinating and controlling all the functions of the body. This is universally understood although there could be debate over some of the nuances and details.  But let’s stay big picture for now.
3. Based on numbers 1 and 2 above, it stands to reason that if you interfere with nervous system function, you necessarily interfere with the ability for the body to heal and regulate.
4. Stress in 3 dimensions, physical (how you use your body), biochemical (what you put into your body) and psychological (the mind/body connection), beyond what your nervous system can adapt to and dissipate, leads to patterns of vertebral subluxation (more on this in a minute) which diminishes the ability for the nervous system to function, thereby resulting in a state of declining health.

Are Vertebral Subluxations For Real?

Critics of the chiropractic profession try to assert that there is no evidence of this phenomenon referred to as vertebral subluxation.  The term subluxation describes a bone that is moved out of place, but is not dislocated.  So, a vertebral subluxation, in the chiropractic culture, refers to spinal segments that due to stress are misaligned causing interference of nervous system function and reducing the body’s ability to heal and regulate.  The goal of chiropractic is to identify these vertebral subluxations and apply adjustments to the spine for the purpose of restoring alignment and improved nervous system function.  To be clear, technically speaking there is much more to this.  However, for the purposes of this paper which is to be read by the general public, I offer a simplified explanation. I have heard ‘skeptics’ erroneously say that “there is no evidence that vertebral subluxation exists”.  This is absurd.  Personally, I have co-developed technology which I hold patents on and has been registered with the FDA for the purposes of helping to characterize the structural and neurological components of vertebral subluxation.  It is being utilized by thousands of chiropractors throughout the world.  Further, myself and others have authored and co-authored numerous articles in peer-reviewed, indexed journals outlining operational definitions of vertebral subluxation. The Association of Chiropractic Colleges unanimously adopted a position paper with reference to much of this that can be accessed here. Some may attempt to disagree with the conclusions relative to all this, but only a fool would assert that “there is no evidence”. Below is a graphic that helps one understand the healthcare continuum in the chiropractic paradigm: Many falsely accuse chiropractors of making claims about ‘curing’ diseases like cancer or diabetes.  Let’s be clear… chiropractic is not the treatment of any limited number of diseases.  Through the correction of subluxation, the body’s own recuperative powers are unleashed resulting in the ability for the body to increase the potential to heal, regardless of disease.  There are numerous randomized controlled clinical trials published in peer-reviewed research journals demonstrating that subjects with a wide range of conditions respond positively to chiropractic care. As a partial list, these conditions include ulcers, headaches, infantile colic, dysmenorrhea, visual impairment, high blood pressure, middle ear infections and a host of others.  What is important to understand is that there is not a headache adjustment versus a high blood pressure adjustment versus and infantile colic adjustment.  There is just the adjustment of subluxation which gives the body the best opportunity to heal. It is of course true that many patients, especially those who have failed in the medical system, have sought chiropractic care in hopes of relief from a particular set of symptoms or conditions. And many times they attain the desired outcome.  But unlike medicine, who has a different drug or intervention depending on the condition they are treating, chiropractic aspires to harness the innate healing power of the body regardless of condition.  In my practice I had seen a good number of patients with debilitating and sometimes terminal conditions.  Some completely recovered.  Some didn’t.  All had a better quality of life as a result of the care. Right now the skeptics are saying, “this is unproven, unscientific, even unethical!  All doctors must practice evidence based care!” This debate, which I have been in for many years boils down to one critical question: what will you accept as evidence?  And this is a philosophical question that stems from the second branch of philosophy, epistemology - the theory of knowledge. Many try to contend that the gold-standard of evidence is the RCT (or randomized controlled clinical trial).  And although this certainly is a part of a composite for evidence, it has some very well documented shortcomings.  This is how, for example, a drug like Vioxx can go through RCTs, get approved by the FDA, and then have as many as 60,000 people die as a result of adverse reactions (according to David Graham, M.D. of the FDA).   Further, an article published in the Journal of the American Medical Association (JAMA) cited that over 100,000 people per year die from adverse drug reactions when the drugs are ‘properly prescribed’…meaning that this doesn’t include negligence.  All these drugs were cleared by the FDA after submitting RCTs for safety and efficacy. In the meantime, many decry the "risk" of chiropractic due to this perceived lack of evidence and proper testing.  This is on its face ridiculous.  Two things (and again, this isn’t about medical bashing, I wouldn’t want to live in a culture where medical care wasn’t available – it is about getting the facts and comparisons straight):

• Medical errors are the 3rd leading cause of death in the United States ahead of stoke, diabetes and many other conditions. All the details are here.
• The real measurement of risk is malpractice rates. The actuaries don’t care about politics or opinions.  They simply run data.  Chiropractic malpractice rates are incredibly low because the risk of a law suit is incredibly low.  Rates for the highest coverage available are typically under $2000 per year.  Contrast that to medical rates for varying specialties that can be 10 to 100 times that amount.  It is indisputable that chiropractic is a much safer form of care than medicine.

In my view, there are four major forms of evidence to substantiate efficacy of care.  None by themselves are adequate.  They must be taken in concert.  They are:

• Deduction: Using one’s knowledge of anatomy, physiology, biology, etc. and applying logic to draw conclusions.
• Induction: In health research applications, this is the randomized, controlled clinical trial.
• Outcome Assessment: Measuring parameters on individual patients longitudinally as they receive care.  I spent much of my career in this area.
• Case Research: This is taking actual patients being cared for by actual doctors in the real world.  These cases are written up in detail, go through peer-review and are published.

By looking at these four as variables in the evidence equation, chiropractic stands very proud and strong in the realm of evidence. I think it is important to point out that chiropractic, based on its philosophy and understanding the deeper principles of life and nature, has taken controversial positions throughout the decades. For example, chiropractors quite some time ago raised concerns about the widespread indiscriminate use of antibiotics. Logic being that human-beings aren’t the only organisms on the planet that adapt.  Microbes do to, and they do it faster.  So if you are constantly killing off microbes, it is the weaker ones that die, leaving the stronger ones to evolve.  In the meantime, our human immune systems get weaker as we don’t have the opportunity to strengthen immunity naturally.  We find ourselves today in a full-blown crisis as we have now have created antibiotic resistant ‘super-bugs’. The World Health Organization and the CDC anticipate that if nothing is done, by the year 2050, the yearly deaths due to antimicrobial resistance worldwide will be about 10 million and have a global cost of $70 trillion!  With a little logic and humility (we can’t arrogantly think that we can just wipe out all disease-causing microbes without consequence), we wouldn’t have this mess.

The Art of Chiropractic & Why Some Chiros Are Different Than Others

Chiropractors vary in their modes of practice.  Some choose to limit their practice to back and neck pain only.  Some not only adjust and correct spines, but they also get into general lifestyle wellness protocols.  Others specialize in particular health challenges as they have special expertise there.  All this does create brand confusion for sure.  There is not one definitive mode of service practiced in the marketplace.  However, I think this is true of many allied health professions and the diversity breeds choice. The art of chiropractic rests in the delivery of the chiropractic adjustment.  And there are many ‘techniques’ practiced by doctors of chiropractic.  Some focus in specific areas of the spine.  Some use very low force.  Some use instruments.  Here’s what I know.  They all work.  For sure, some patients prefer or respond better to technique approaches.  But there are many effective chiropractic technique approaches that help people.  The key is finding the one that best suits you. There is no doubt that there are some bad actors out there in chiropractic.  But of course, the same must be said for medicine, law, tax accounting and any other professional service.  An expression about babies and bathwater comes to mind when considering this.

Summary

In summary, the chiropractic profession offers a very unique and powerful service to humanity.  People benefit most when pro-actively engaging in chiropractic care to upgrade their health expression as compared to waiting till there is a problem and then trying to deal with it.  Chiropractic truly shines in this area. Unfortunately, there are still many ignorant voices out there spewing nonsense and dissuading people from seeing chiropractors.  But fortunately, there is less of them every day while more people of influence become public about their incredible experiences with chiropractic care. As a cardiologist once said to a patient of mine, “chiropractors must be doing a lot of good out there, otherwise how could they have possibly lasted this long?”.

Do you have questions, thoughts or feedback for Jason, Patrick or me? Leave your comments at BenGreenfieldFitness.com and one of us will reply!

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