I Dare You to Print This

April 29, 1999

As a chiropractor the one thing I hate the most is an unethical chiropractor. That makes my job harder because I have to fight the perception that the bad apples create for my profession. Just to let you know , I am a chiropractor who specializes in rehabilitation of the musculoskeletal system. I don't do it for any particular philisophical reason. I just love rehab and find it incredibly interesting.

With that said I must say that I am disappointed in your website! For purposes of discussion I will reference your subject, "Don't be Fooled". My problem is that you make statements with either no references or references that do not back up your statements.

Case #1. You state that the new medicare policy to eliminate x-rays for chiropractic patients is expected to lead to an increase in the number of claims Medicare pays for chiropractic services. Strong statement with no reference to back it up. Has some study been done to predict this outcome or is it just opinion on your part? [Opinion, although I have seen government-generated estimates.]

Case #2. This is your sentence "But when manipulations are done without valid reason - as they are often done - no complication is excusable ". Once again there is no reference listed for this statement. It is once again your opinion that manipulations are often done without a valid reason or do you have research showing that this is a fact? [Opinion, based on extensive investigation—SB]

Case #3. You make a strong statements about the difference between chiropractic school education and medical school education. I would like to refer to the October 1998 edition of the Journal Of Bone and Joint Surgery titled "The adequacy of medical school education in musculoskeletal medicine". The study tested the knowledge of medical school graduates about the musculoskeletal system. The results were quite impressive...82% of surgical residents failed, 87% of medical residents failed, and 43% of orthopedic residents failed the test. The authors concluded that "the current study clearly documents the inadequacy of medical school education with regard to musculoskeletal medicine". When 25-30% of what comes into the typical family practice is musculoskeletal related does it not concern you that the MD in charge has no idea what is going on and may fail to diagnose a serious condition? A full 1/4 of their patients may be in danger. Using your logic, family practice physicians should not be able to treat or diagnose musculoskeletal conditions until they receive proper training. [To determine what family practititioners know, it would be necessary to test family pracitioners, who have three years of practical training before entering unsupervised practice. It would be interesting to see how they would do on a test and how this would compare to a cross-section of chiropractors. It would also be incorrect to assume that the test results mean that patients would be endangered. In some of the test examples of the cases, the appropriate strategy would be to refer the patient to an orthopedist—knowing certain details would not be necessary.]

I agree that chiropractic school education needs to improve. I graduated in 1995 and some classes were the pits, just awful. However, some were amazing, just wonderful. If you are truly concerned about a lack of clinical exposure for chiropractors why do you not push for hospitals to open up their clinical rounds for chiropracitc students? If medicine was truly concerned with the patient wouldn't you think that hospitals would allow chiropractic students to have access to the vast number a cases so that they could increase their knowledge base. [I have supported an effort to set up a chiropractic residency program, but, as far as I know, the state chiropractic board was opposed to it.]

It wouldn't be that hard as there are not that many chiropractic schools in the nation when compared to number of teaching hospitals. I suggest that the medical profession either does not care or is afraid of giving up any more turf to chiropractors... think $$$$$$. [I don't think money is a factor. Most doctors holds a low opinion of chiropractors because of what patients tell about their negative experiences.]

A little example: I traveled with a group of medical doctors to mexico to treat people in a poor village. During one day I treated 100 people referred by the orthos and family docs from my hometown. When I get back to my hometown I never see another patient from them. I ask other chiropractors if they have ever received referrals from them and the word was NO. You know why, because in mexico the care was free and in the US every patient sent to me was money out of their pocket.

Dr. Barrett while you protray yourself as some sort of alturistic doctor who is only out there to expose the truth, a little bit of thinking and reading of your material reveals that you do not hold yourself to your own standards. You distort the truth and make claims that are not backed up by research...just what you accuse so many others of doing.

I know that you will not print this whole letter in the jeers section because it will be too long, but I dare you to anyway. Allow the people who read your column to see a jeer that is not just a rant and rave with foul language.

Patrick J. Ryan, DC
Soquel, California

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