Latest from the British Chiropractic Association’s president Richard Brown (The guy who thought it was a good idea to sue Simon Singh). No icebergs sail on, full speed ahead.

August 6, 2010
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Oh Dear! The bit I like best is in the last paragraph I believe the BCA President is an avid reader of this blog and advises  “dont believe all you read. In recent months Ive seen comments made about the BCA that are clearly designed to damage its reputation and adversely affect the confidence of members” ??

Richard Brown does not need help from anyone to damage the reputation of the BCA, Tony Metcalfe and himself did that all by themselves, next week I shall look at some of his most recent comments in the BCA newsletter “In Touch”.

Browns-response-to-the-alliance

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Related posts:

  1. Richard Brown Vice President of British Chiropractic Association argues that the criticism of his profession is wide of the mark
  2. Quote of the week by Richard Brown President of the British Chiropractic Association.
  3. Last June Jack of Kent summarised the BCA’s decision to sue Simon Singh.
  4. Give generously to the British Chiropractic Association so they can build their bridge to oblivion.
  5. BCA and GCC member David Byfield would seem to concur with Simon Singh that the BCA were making bogus claims about the efficacy of chiropractic
  6. How are the General Chiropractic Council and the British Chiropractic Council going to deal with Zeno’s complaints
  7. Why the United Chiropractic Association (UCA) and traditional chiropractors, should be supporting Simon Sings campaign for free speech.
  8. British Chiropractic Association asks the General Chiropractic Council to seek prescribing rights for its members
  9. Highlights of this weeks ECU conference in London: David Byfield – how to make friends and influence Simon Singh
  10. Born again, British Chiropractic Association joins skeptics “attack” on chiropractic.

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  • Fedup

    It looks like it’s not over. Anybody see the preview of ” see you in court” due to show a week on Tuesday on the BBC ? I’m sure several seconds show simon Singh leaving court!

  • Dr Bilbo Baggins

    @ Stefaan

    Sorry, what I was alluding too in my penultimate post was, at lease as I understand it, Richard wasn’t the BCA President at the time the decision to sue Singh was made and therefore was not responsible per se for that decision.

  • Dr Bilbo Baggins

    @ Stefaan

    A cynic and a hippy, how do you square that one :-)

    Have a good Christmas Stefaan.

  • http://www.chiropractorswarwick.co.uk Stefaan Vossen

    I think it was primarily the solicitors…. Oh cynical me!

  • Dr Bilbo Baggins

    Actually, it wasn’t Richard who made that decision to sue Simon Singh.

  • Dr Bilbo Baggins

    Appreciating there is currently a vote of no confidence in the way the GCC carries out it’s business and the proportionality of the same. The latest GCC Bulletin of Nov 18 shows that both the AUKC and the BCA  had reservations about some or all of the proposals made by the GCC, in relation to its proposed changes to the Professional Conduct Committee rules. The PCC are the judge and duty of any case brought against a chiropractor in the UK.  

    The  College of Chiropractors on the other hand agreed with ‘every’ item the GCC proposed.  

     So has the GCC found itself another coallition partner, who either failed to read the document being debated, didn’t understand it, or blindly accepted the GCC’s proposals. The clue is in the ‘profession’  who through their associations had reservations. So why didn’t the college of chiropractors, an alleged pan association, apolitical body whose function is simply postgraduate education and CPD which pulls it’s membership from the very profession who laid a vote of no confidence in the way the GCC conducts itself,  have any reservations at all?

      Of course there is always the possibility that the college of chiropractors genuinely did support all the GCC suggestions. This must  therefore raise the serious question ‘is the college of chiropractors out of step with it’s membership and therefore the profession as a whole’?  

    One can only  argue that the associations objected and made alternate suggestions to the GCC’ proposals for the benefit of the profession, and to promote a far more reasonable approach to regulation. If this is the case what could possibly be the College of Chiropractor’s motives and agenda, and should they have the support of the UK chiropractic profession at this time?  

    Answers on a postcard please :-)

  • http://spinaljoint.com Richard Lanigan

    Take a guy like Steven Williams. He has been a council member now for near on 8 years. He is a good chiropractor lots of good ideas. But a politician he is not.

    Coats and Dixon look into to his eyes say what he wants to hear and he believes everything will be OK. When I wrote my first letter to the Privy Council and DOH in 2005 he was asking me not to do it, because things were going to get better. Steve was the person who suggested that I should run for election to council in 2007 and he probably is the council member I am most annoyed with because of his naivety.

    In an ideal world Steve would be an excellent council member he is objective and would treat people fairly. However in a council where you have a turf war going on and chiropractors with a vested interest pushing agendas, fair minded people get lost in the quagmire and end up looking like fools. Steve trusted Peter Dixon,and aligned himself with Peter and Coats. Time will tell if he feels that trust was misplaced.

    Last week the leaders of the four associations met with the GCC council members. The fact we know so little about what went on in the meeting suggests they associations have held firm and the GCC members have decisions to make to gain the trust of the profession.

    If the chiropractic profession does in fact have statutory “self” regulation and its not regulation by Coats and Dixon. Steve Williams and the others chiropractic members have the opportunity to demonstrate what “self” means. They change the structure or they resign simple as that. They will have no excuses if they fail the profession and our patients yet again.

  • Dr Bilbo Baggins

    @ Paul

    I think many may be sympathetic with some of the things you say, but it doesn’t change the facts. What the current situation has done will change many things and the profession will be stronger because of that. Many think the GCC and it’s Council members have a lot to answer for.

    Education is one thing the skeptics will/ are hitting, if the MCC is not up to scratch it will either fail in the spotlight or get better. If it comes out the education committee has failed in it’s statutory duties, it will come back to haunt them. I was told the other day that many ordinary chiropractors now see the GCC chiropractic members with disdain, who should be treated as pariahs by the profession at home and abroad for allowing the situation to get out of control. Not convinced I totally agree, but their reputations have been greatly tarnished. Change needs to occur and I think it will be a long time before members of the BCA would allow their council to support anyone for a ‘gong’ if that was ever on the cards.

  • Dr Bilbo Baggins

    @ garland

    Reason/ excuse, please Garland you are better than that. Let me simplify it for you, what ever reason/ excuse you give, in my opinion they should be prosecuted in law for what they are doing and if they don’t hold residency, deported otherwise, criminal prosecution.

    You guys educated them, your laws you suggest, has given them licence to practice this way in the UK, under the guise of being members of the UK profession, then it must be time that they were sent home so that you can deal with them in whatever way you see fit.

    Hope this make it clear how many of us feel about those ‘chiropractors’ working as they do, in the UK.

  • Paul

    @Eugene

    Religeous fanatisism is when you refuse to listen to an argument based on belief or dogma.

    I could charge the same back.

    “Patients need the right to choose a private room I guess. My own experience is that the patients I have seen, having been to high volume practices, have not preferred it to a private treatment room, and on the whole I would consider that their treatment plans have been exessive even if they have been PAYG.”

    I think this clarifies the difference in practice. One is a practice where people come with problems and expect/require privacy to relay their problem to you. It may also require more detailed examination and so again the expectation/requirement. They also travel further to see ‘the man.’

    The other is a practice where clients have no day to day problems, the bulk of members attending on a regular basis of their choice / or recommendation on the basis of maintenance or wellness / goal orientation health care. They don’t travel very far and may attend with family or friends.

    One (in the UK) does expect/require an amount of privacy the other does not.

    @ Dr Bilbo Baggins

    “It is irrelevant why the accreditation process went in favour of the MCC, it occurred, they are accredited by the GCC, their students graduate as chiropractors in the UK and as such register with the GCC.”

    It was possibly the most divisive decision to have been made by the GCC. The technique has no evidence and its graduates until then, were devoid of education.

    Worse still was the politics of the MCA which single handedly played its own agenda against the greater good of the profession.

    Leeches.

    Eugene I agree that it would be best if we could have all had this discussion round a table with a tea or beer and gone through it. I this statement of yours is probably the best the whole way through the thread and puts things in perspective a bit more.

    “It would be nice to sit down and discuss this all over a beer. Subluxation is just a word, Meds are just Chemicals that require training to give to patients, same as Supplements which require no training. Hardly worth tearing a profession apart over. Unethical practice is ;)”

  • rod macmillan

    Like me, many people were baffled by the revalidation case. So just to check—did it work out that £350,000 was spent to propose saving £34 a year for ten years?

  • Garland Glenn

    @ Bilbo

    I didn’t say it was an excuse. I said it’s the reason.

  • Dr Bilbo Baggins

    @ garland

    Sorry mate that is a lame excuse, they live in the UK, not the states. If the y want to act irresponsibly or ‘defensively’ as you put it, let them practice in the US.

    Situations like this have caused the regulatory committee for X-rays in the UK to publish concerns against the whole profession. They are a disgrace and no excuse in the world will make what these people do, either ethical or clinically appropriate.

  • Garland Glenn

    Just an FYI comment about x-rays. 95% of all the litigation in the world is filled in the US. Therefore every patient has a lawyer standing right behind them. I would venture to say that a large portion of the x-rays taken in the US are done so for protection from malpractice suit exposure not for patient care. For the practice builders teaching the taking of a lot of x-rays (while there is certainly a financial side to it) it is just what they are acoustomed to. They think this is “normal”. For US chiropractors this is normal. It is not scene as excessive.

  • Eugene Pearce

    Read JMPT this month analysis of Swiss Chiropractors. The conclusions clearly show a the benefit they have from a little medicalisation.

    Stop the emotional nonsense spouted about medicalising our profession and prescribing a read the evidence, perhaps Richard can post it up.

    It has improved things for chiropractors has not reduced scope of practice and they have retained their identity.

    Stop the fear tactics and open your eyes.

  • Dr Bilbo Baggins

    I remember reading something someone once said, seemed to make sense ‘ it is not the chiropractors perception of what they do that is important, it is the patients’.

    I took from that, that if patients think chiropractors can help them, they will come and the outcomes in many cases speak for themselves, if they believe the profession is full of high volume, X-ray every patient, sign up for huge treatment regimes then that us nonsense and they won’t come. If what us posted here based on ICA guidelines, reflects what the AUKC is about, then I am saddened by that stance.

    That’s why the profession may split, not because of people like Eugene. I get embarrassed when I hear some of the stuff that goes on out there and yes, you are right, it is mainly Americans who couldn’t cut the mustard back home but also some Australians and now some Brits. These are the guys that need another profession, not people like Eugene.

  • Eugene Pearce

    Glenn, absolutely agree, I wonder if a potential patient having never seen a chiropractor read this blog, whose comments they would agree with, and which chiropractor they would choose.

    I wonder…

  • Garland Glenn

    I should claify my survey statement. Of the people who had been to a chiropractor 80%+ had had a good result. If only 80% of the population would come to see us.

  • Garland Glenn

    Also I only said torn apart in jest because it’s such a hot potato.

  • Garland Glenn

    Eugene interesting you metion California. About 16-18 years ago there was a survey done in L.A. of about 5000 people. 80%+ said they had been to chiropractors and received a good result. Of those 80% said they would go back to a chiropractor but not the same on. Why? Because they felt like they were sold too much care. I said this a few weeks ago…In the end the market will decide who survives.

  • Dr Bilbo Baggins

    @ Paul

    It is irrelevant why the accreditation process went in favour of the MCC, it occurred, they are accredited by the GCC, their students graduate as chiropractors in the UK and as such register with the GCC. It is also true that they are not ECCE accredited which doesn’t limit their practice in Britain, only in Europe and overseas, if my understanding is correct. Therefore my post was simply relating to the situation in the UK and the comments relating to the MCC and it’s graduates.

  • Eugene Pearce

    Glen why would you be torn apart, everything you said is fair comment. We are exceedingly lucky over here I really hope we dont go down the (with the greastest respect) American Road. My sister lives in California I know how the average person regards a Chiropractor there, its not nice.

  • Eugene Pearce

    Oh my god, High volume and jealousy you sooo have no idea what I am about. I think they are a blight on our profession, I am ashamed most exist. I refused to work in one when I graduated. But jealous not at all. Richard I take your point about Cuba and I can see how it is useful as a learning enviroment. Patients need the right to choose a private room I guess. My own experience is that the patients I have seen, having been to high volume practices, have not preferred it to a private treatment room, and on the whole I would consider that their treatment plans have been exessive even if they have been PAYG.

    “The patient is not getting the best care by some second rate prescriber of medication who has done a couple of weekend courses”.

    What like, Practice Nurses, Opticians, Radiographers, Radiologists, Physiotherapists, Chiropodists, Podiatrists all second rate prescribers, dont talk rubbish, and undersell your collegues, and the recognised educational pathways to non medical prescribing.

    Religeous fanatisism is when you refuse to listen to an argument based on belief or dogma, “blowing up my clinic is a stereotype”… theres no need to go Bin Laden on me.

    With regard to the DDx. I said in the first post all movements except flexion aggravated the pain, the second post was for clarity and to explain why I thought the DDx was wrong. And there are still no discs in the thoracic outlet so they are not involved. And whats the use of a differential if its wrong, VV acute facet would be ok DDx, but then again, ingrown toenail wouldnt.

    Saw her today, numb thumb, upper and forearm heavy, dull toothachy pain, anyway slept last night, has a weeks course of Amitryptiline, not upset today, adjusted C5-6, at least she is sleeping can manage pain, but it could have all happened a day sooner with prescription rights is my point. I also realise this may have happened without meds wheres an RCT when you need one.

    The 1 1/2 hour statement you make is absolutely absurd. Do you want to phone all your reps who drive for a living and tell them to cancel, because clearly your treatment is ineffective for them.

    Do you give you patients exercises? or advise on how to manage pain, how to sleep, How they can deliver a Bowl and not get arm pain? Do you give balance exercises to prevent falling in osteoporosis, teach old people how to get up off the floor if the fall, how to lift carry, Eply’s manouvre for BPPV, Stand at the river ness and watch someone fly casting (world distance champion) to determine why they have impingement. Do you make orthotics, do you provide supports, Use Boston Brace for unstable Spondy following RTA, or just flick spinal switches. I love my job and I couldnt do it properly in 5 minutes. I am in no way jealous high volume switch flickers. Now considering the distances can you understand why in v. acute case I might want to prescribe.

  • Garland Glenn

    Richard alluded to “when the wolf is at the door” and this is critical. Unfortunately you can’t legislate morals or ethics. Because most of us practice autonomously, we can get away with a lot if we chose to. In the medical community where you’re most likely sharing your clinic with others etc. you have to some degree pier pressure that keeps everyone closer to the queue. It would do the profession as a whole a tremendous amount of good if real business practices were taught to students by doctors that have been successful and have earned the right to do so, before the wolf showed up at the door.

    By the way I’ll step out here and share what I do in my office as far as payment goes. I’ve done this for years. I run a totally cash practice which here in the US is exceedingly rare. You guys don’t know how fortunate you are. Patients pay as they go. However they have the option, if they wish to pay in advance and receive a discounted fee. This is not a plan. I do not put patients on plans. Each patient is evaluated on each visit for what’s best for them and when the next visit should be. Tomorrow or 6 weeks from now or 3 months from now. For many patients it is obvious thought that their care is going to require several visits. OR several members of the same family are or want to be under care OR they chose to be on some type of “maintenance” (now there’s a dirty word) schedule. For these people they can buy visits in advance. 10% saving for 6 and 20% savings for 12. Why 6 and 12? Because the back side of the business card divided up nicely at those numbers. Anyone wants to see mine I’ll gladly post it up. Husband and wife can buy a card and share it. Kids can share it etc. Person can buy a card in January and it will cover their maintenance for an entire year. They like it. I like it. Makes things goes quicker at the desk for check out. Patient doesn’t have to make certain they have their card or check book, reduces the book keeping time and on and on. This is not the same thing as looking at a patient and saying you’ll need 25-45 visits and if you pay for them now you get a discount. AND if you don’t follow through with my recommendations you’ll die.

    I’m on holiday through the weekend so if you’re going to tear me apart for this, I wont be able to respond.

    Cheers

  • Paul

    @ Eugene

    sorry but your last post smacks of jealousy.

    Again worth stating – I have seen high volume, open practices, without xray, without practice management coaching and with low pay as you go fees that are ethical and chiropractic in nature. Ricahrd’s post goes much further on the same point. Chiropractors using a WLP scare care management style should be ashamed.

    Yes – an hour and a half away is too far – no matter how you want to dress it up.

    I missed the post on TOS – I think it was Richard came to that diagnosis then you asked about neck extension affecting it. Well done on coming to a diagnosis and differential….

    “@ Paul. I cant argue against what I consider religeous fanatisism, you simply havent put up a single argument as to why what I have suggested is not in the best interests of the patient.”

    Eugene religious fanaticism is when I come over and blow up your practice because I disagree with it, direct discourse is what we are presently engaging upon, on the subject of chiropractic not religion..,

    The patient is not getting the best care by some second rate prescriber of medication who has done a couple of weekend courses. God forbid this would be taken up buy therapists trained over a couple pf weekend courses too.

    The patient’s best interests lie in a chiropractor continuously training in chiropractic. Not some weekend warrior giving them drugs.

    @ Dr Bilbo Baggins

    I think your post in its entirety requires correction. The MCC course was accredited by the GCC on the basis of politics alone.

    It was its striving for ECCE accreditation that has now finally in 2010 (almost 20 years later) in a course equivalent to that in every other chiropractic college on the planet.

  • Eugene Pearce

    Interesting post Bilbo. I hope that GCC didnt accept MCC college to avoid a tirade of legal cases. At the time of registering I believe MCC chiro’s constituted 1/3 of the profession, a credible force.

    I am sure this will come out in the fullness of time. I think the attack on WIOC and AECC by the “skeptics” is futile. WIOC and AECC only teach subluxation as a historical model (whether you agree with that or not).

    And it cant be Ernst making the request for WIOC course details, the skeptics said “Eminent” Scientist.

  • Eugene Pearce

    Fair point on the instinctive referring Paul McT AECC.

    (If the GCC are reading this, I have no preference at all, none absolutely not, we are all the same). Why however do you see low level limited prescribing in a small number of case so dangerous and misguided, I dont get it I really dont.

    We have an NHS service. Who is going to pay for long term meds from a Chiro when they can get them free (ish) on the NHS. I highlighted the 3 situations where I think it could be useful for a chiropractor “as extended scope type practice”.

    1. Patient too acute to examine or treat.
    2. AECC does an accredited sonography course. Failing treatment for tendinopathy / Subacromial Bursitis / Impingement Syndrome. US Guided Cortisone injection to remove inflammatory component, sometime Rx. is successful following this intervention when failing before. (And yes before everyone writes in I am aware of the recent studies questining efficacy in the long term).
    3. There is very interesting research in the use of GTN patches, Green Tea, and high volume saline injections for chronic tendinopathy. (Can I prescribe Green Tea?) I fail to see how can be helped with chiropractic adjusting.

    Some of us deal mainly in well being, some back / musculoskeletal pain, it all comes under spinal / muscoloskeletal care. Some of us have specialised to where we feel we are having most effect with our treatments, and I fully accept this is not for everyone.

    And as far as GP / drug dealer comparison, that is wrong and we should retain interprofessional respect. Of course there are poor GP’s, but its just like saying chiropractor / conman, and I really think you should retract that comment. I like what one of my GP patients said to me, “we are all about the front, you can have the back”.

    A british comedian joked on TV last week “all you get when you see a chiropractor is another appointment”, its sad when these jokes are now found funny in the UK. Insidious acceptance of high volume practice is whats happening. Strive for quality, quantity will come Paul.

    It would be nice to sit down and discuss this all over a beer. Subluxation is just a word, Meds are just Chemicals that require training to give to patients, same as Supplements which require no training. Hardly worth tearing a profession apart over. Unethical practice is ;)

  • Dr Bilbo Baggins

    At the end of the day, what has gone before, has gone before. The MCC has been accredited by the GCC it is that simple. 

    The difficulty may be that according to the skeptic sites, the University of Wales is being investigated for alledged weak accreditation processes. It is this university which accredits the MCC undergraduate and postgraduate courses. 

     I believe that skeptics may be  pushing for the MCC course to be reevaluated by the university itself or by an outside academic body. and of course this will include course content, delivery and outcome. But skepticat could enlighten us about this I am sure.  

    I think the attack may in part be their stance as a college offering an education in ‘traditional chiropractic’ and promoting the subluxation. The skeptics see that as a weakness and through that, if it is a weakness, an attack on chiropractic education as a whole.  The skeptics have already said that an eminent scientist has written to WIOC asking for their course details. If it was Ernst, I am sure he will be ignored for the reasons many have voiced before.

     But as the GCC has accredited the MCC based on the content and outcomes  of their course I presume we must accept that the college itself is fit to graduate chiropractors. If not the GCC has a serious problem, as has their education committee.  

    Personally I think the GCC and a few of it’s major players may have a serious credibility problem from here on in. The MCC accreditation by the GCC may or may not, end up being be part of that process. 

    To summarise, we can’t change the past but we can try and make the future better and I think that is what the profession is currently trying to do.

    @ Paul one guys direct is another man’s aggressive stance. 

    @ Paul and Garland, I am not sure my posting said either of you were straights, it did say with regards prescriptions you were at the opposite end of the argument to Eugene. I can only apologise if you misunderstood my post.

     

  • http://spinaljoint.com Richard Lanigan

    I love Pauls comment, “I only wish i had a high volume clinic” dont we all. I am closing my practice in Dublin now the lease is up, paid £30,000 for it three years ago at the peak of the Celtic tiger times are hard for everyone. I would rather take the hit and leave with a good reputation, than resort to scaring people into care

    Like Paul I have been in many “high volume” “open plan” practices and I have no problem with it as a way of practicing its the way some of the chiropractors sign people up that troubles me and you are absolutely right its very often to do with a lack of business skills in college. Its funny in many quarters practice management, wellness, subluxation are pejorative terms. Anyone who has worked with athletes will have worked in an open plan setting. When I worked in Cuba often there would be about ten people in the room at a time. Patients would stay chatting and watching. I loved working like that One day I saw over 100 people, I was seeing 12 an hour as I was not making money from it so no one would question my ethics. I have no doubt high volume can be done ethicaly. I had three students from Glamorgan observing me. It was an interesting experience for all of us.

    A chiropractors education is structured in a similar vein to a doctor, in the UK a doctor has to fit into this huge organisation a chiropractor very often will be working for them selves a few years after leaving college and they will have been told the way to build a practise is write good GP letters and the have no idea how to build a business and generate goodwill.

    The wolves are at the door and they get a letter from CJ Mertz telling them how he was burned out and broke until he discovered his WLP, and while we could all benefit from improving our office systems it must always be in the patients best interest. No doubt many are able to convince them selves that scaring them into care is in their best interest.

  • Eugene Pearce

    “it is no reflection of poor ethics to have a high volume open room practice”.

    I really have a problem with this statement made by Paul. (I hope I’m not the only one). Can someone please tell me how open plan high volume practice can ever be in the best interest of the patient. (I fully understand why a chiropractor would want to practice this way).

    I have an idea for a new business model thats fits in perfectly for Alliance members. None of this breaches ICA best practices you are ok I have checked.

    New patient comes to plush consulting room. Show them a nice video, when cuts heal, except when they dont.

    Examine patient. Dont make a diagnosis because that is medicalising the profession, and ignore symptoms, they are not important subluxations are.

    Take full spine Xrays. Show they are in phase two of degneration and are full of subluxations.

    Now the clever bit. Cut a hole in the front and back of your building a build a drive through. Tell the patient they need 25 treatments followed by a reassessment to correct the subluxations.

    Now they can drive up with the window open. Monday Wednesdays and Fridays we Activator / Adjust the right side, Tuesdays, Thursdays the left. All the while definately not prescribing, because its evil, or second rate (Quote: Practice Media leaflet) GP’s / drug dealers for that, no difference apparently, see comment by Paul. As long as we are being true to our patient centred model of care, complete with “ethics” and strong philosophical justification.

    You Paul may see operating the MacDonalds equivolent of our profession as ethical, I dont. No wonder 1 1/2 hours is too far away in your eyesto be a chiropractic patient, MacDonalds only fills me up for 10 minutes. Must of us strive to give a decent service. Who would train to be a chef and choose to work in MacDonalds?
    Anyone who thinks open plan is athything other than clinic and chiropractor centred care is deluded, and will need to remain deluded by attending seminars telling them the are ethical in an unethical world, or creating a winning mindset or other such clap trap. Otherwise one day they will wake up knowing eaxactly what they are paracting and it isnt a for of medicine, complementary or otherwise. But I bet they have a nice car!

    Its the insidious acceptance of the high volume open practice con, which is never, ever best for the patient, that is ruining our profession. Not the desire toward integrated patient care and the possbilty some chiropractors might want to prescribe.

    And you want me to retrain!

  • Paul

    Thank you Eugene.

    Not sure why you chose to highlight the first remark but yes I am as qualified as you and together more qualified than others grandfathered in. If you had to refer a patient to another chiropractor in their area and there were two chiropractors (GCC reg’d) – one a 1978 McT grad and a 1978 AECC grad – on only this information, to whom would you instinctively refer to?

    I only wish I had a high volume practice but I know of practices that haven’t required unethical practice management skills to build high volume practices where clients pay per visit and pay a lower fee than for local low volume practices.

    High Volume Open Practice does not equate to WLP Shysters.

    The ‘drug dealer’ – whilst it might be a bit blunt for your flavour, its not far off the truth in some areas, many GPs write scripts with little or no consideration.

  • Eugene Pearce

    “Another problem you haven’t highlighted Dr. Baggins was the integration through grandfathering of hundred and hundred of therapists under chiropractic registration in the UK whose education was base to say the least”

    “but it is no reflection of poor ethics to have a high volume open room practice”.

    “Btw if someone here wanted proper painkiller which of their dealers should they visit – gp or drug dealer? Should now we add chiropractor?”

    So Paul you have a good standard of education choose to practice as above and equate GP and drug dealers.

    You are a chiropractor I respect.

  • Paul

    @Dr Bilbo Baggins

    First off my view is not aggressive rather it is direct.

    I agree with you and Richard that financially driven scare care practices are a problem but it is no reflection of poor ethics to have a high volume open room practice.

    Business management and practice management if properly taught at college would starve the oxygen out of WLP or FPL4Life as it is now known. But colleges continue to throw out clinically skilled graduates with no business or practice management skills.

    Another problem you haven’t highlighted Dr. Baggins was the integration through grandfathering of hundred and hundred of therapists under chiropractic registration in the UK whose education was base to say the least.

    @ Stefaan

    My detection of insecurity is best put by Richard;

    “How can you think a GP who cracks backs as a child cracks knuckles, respects the time you have put in to get where you are today? He is not showing respect to what you do, let him do proper training that would be showing respect.”

    Eugene can get all the prescribing rights he likes and jump up and down and then give out vaccinations too but you know what that same GP will still think he is a tosser.

    @ All

    Like Glenn I to do not count myself as a straight. Much as I would like to have a true chiropractic principled practice, it has plenty of pain patients. I think also Glenn’s final line sums up the issue very well;

    “I can’t be all things to all people even though I may want to be.”

    However if I endeavour to be the best chiropractor I can be instead of trying to be all things to all men then this is the best service as a chiropractor I can provide to my community otherwise I will be lost in the quagmire of other back crackers out there rather than providing a service that no other health care provider offers and that is removing interference to and enhancing the function of the nervous system.

    Do I still believe that Eugene should consider retraining – with respect yes or choosing another profession title. Chiropractors do not prescribe drugs. Manual therapists with chiropractic degrees elsewhere might do elsewhere but it it not part and parcel of chiropractic.

  • Eugene Pearce

    Bilbo wonderful post, who are you, be nice to meet at a seminar. Can email me privately web address is http://www.highlandchiro.co.uk email is on there.

    @ Paul. I cant argue against what I consider religeous fanatisism, you simply havent put up a single argument as to why what I have suggested is not in the best interests of the patient.

    TOS is a nerve / blood vessel entrapment in the Thoracic outlet. That is not where the disc is, read your anatomy books. If it is involved its a double crush.

    “Btw if someone here wanted proper painkiller which of their dealers should they visit – gp or drug dealer? Should now we add chiropractor”

    Wow GP’s and drug dealers, get the same professional respect, totally see how your argument is in the best interests of your patients.

    And “Too far to be a chiropractic patient”, does what you do really have such little effect that 3 hours sitting down will stop it working, I hope your patients dont watch TV in the evening.

    @ Richard

    “I was thinking wouldn’t it be nice if the bigots would discuss like this. Actually it would be nice if the chiropractic associations could organise conferences together and encourage this type of discussion and let the most convincing argument rather than the dogmatic point of view prevail.”

    Here Here!

    @ Everyone

    I was going to post almost the same thing, Richard and Bilbo beat me. I was thinking about Glenns real concerns about Chiropractic opening the Pandoras box, and it is fair enough. A Chiropractor prescribing as I see it is a short term thing only. We should not be involved in the long term use of meds, I agree with that. To be absolutely clear for everyone rather than simply using the word “prescribing” this was what I believed was in the best interests of a patient.

    These are the situations where I see it as useful.

    1. Patient too acute to examine or treat.
    2. AECC does an accredited sonography course. Failing treatment for tendinopathy / Subacromial Bursitis / Impingement Syndrome. US Guided Cortisone injection to remove inflammatory component, sometime Rx. is successful following this intervention when failing before. (And yes before everyone writes in I am aware of the recent studies questining efficacy in the long term).
    3. There is very interesting research in the use of GTN patches, Green Tea, and high volume saline injections for chronic tendinopathy. (Can I prescribe Green Tea?) I fail to see how can be helped with chiropractic adjusting.

    “I have no problem with you training to prescribe, but if we are all chiropractors and practicing chiropractic and the WFC says chiropractors dont prescribe”.

    Richard when were you ever one to do as you were told? A Chiropractor in the States had Melatonin in his clinic which he gave me as it was going to be good for my jetlag. In the UK its a prescription only drug (in the US an OTC supplement), surely he is prescribing, should he and pilliaried by the WFC for doing it. Same goes for Glucosamine when we sell that or Biofreeze its all prescribing of sorts, just because its not on a certain list.

    We need to sit down as a mature profession discuss what might be useful, how it could be implemented in a way that does not upset the profession.

    I have no problem with the core / traditional practice of chiropractic is non invase conservitive treatment that does not use drugs or surgery. Some Chiropractors may have undertaken further training in …. …. and may use needling, electrotherapy, medication in certain situations. It needs discussion and refinement but its hardly insurmountable.

  • Garland Glenn

    @Dr Bilbo Baggins

    Please let me make one thing very clear, I am not a straight chiropractor and I’ve never suggested that people should leave the profession only that maybe they chose the wrong profession. If that’s the case, they may have chosen because chiropractic has already, to certain degree, lost its identity. If the colleges as well as the doctors were very clear in who and what we are, then maybe this wouldn’t have happened as often as it seems to have. I only stand by the things that I say and even in those I’m open to change if persuaded by good argument.

    I graduated from the school (National) for which the term mixer was created to denigrate. And yes I consider the activities of the “very” high volume practitioners to be reprehensible. I object not because of the money but because of the degeneration of patient care as volume get beyond a certain point. What point is that? More to the point is that I see chiropractic at a crossroads. One at which it could lose its identity even further. This is not exactly the same thing as happened when National College of Chiropractic began teaching physical therapy modalities to its students. By using physical therapy modalities the profession is still “drug free, surgery free”. National was the first school to teach its students to do a proper exam. Let me also say that right or wrong / good or bad, much of this stuff starts in the US. There are over 75,000 chiropractors here. (As an aside I love the UK as a place to live and practice and chose to live there 9 years and that I am an Irish citizen) “Research” in the “old” days was directed towards chiropractors better understanding how their treatment worked and how to make it better. It wasn’t until US chiropractors began being covered by third party insurance that research became about proof and RCTs etc. Also the development of the high volume practice came again from the US. At present I live in a town of 120,000 and we have 36 chiropractors. Any of you can do the math and compare it to the situation in Europe. It unfortunately leads to “practice management abuse”. That isn’t to say that learning good management skills relevant to chiropractic aren’t helpful. You still have to run a business.

    Stefaan’s example of the podiatrist is very good and helps to highlight the issue without using the incendiary arena of drugs. I can’t be all things to all people even though I may want to be.

  • http://spinaljoint.com Richard Lanigan

    I was thinking wouldn’t it be nice if the bigots would discuss like this. Actually it would be nice if the chiropractic associations could organise conferences together and encourage this type of discussion and let the most convincing argument rather than the dogmatic point of view prevail.

    While I disagree fundamentally with the bio medical view on the direction chiropractic should take it does not make me feel embarrassed to call myself a chiropractor. Scaring people that they will fall apart if they don’t have £3,000 worth of chiropractic care in the next 12 months does.

    This and Margaret Coats are the two parasites the professions needs to disassociate itself from quickly. People either get chiropractic or they dont if they get it they will maintain their spine if they dont we have to accept it, rather than using questionable tactics to convince them otherwise. I agree with Dr Bilbo most chiropractors are somewhere in the middle. I believe we should focus on what we have in common, but I would not be opposed to traditional/modernist chiropractors with clear definitions.

    Eugene, two points; You spent four years at AECC learning your “trade” and 17 years developing your adjusting skills. How can you think a GP who cracks backs as a child cracks knuckles, respects the time you have put in to get where you are today. He is not showing respect to what you do, let him do prober training that would be showing respect. Which is presumably what you want to do with prescribing , I have no problem with you training to prescribe, but if we are all chiropractors and practicing chiropractic and the WFC says chiropractors dont prescribe, they should refer to GPs if they feel its necessary. I guess until that changes chiropractic should be defined as being drug free. If the day comes when the majority of chiropractors want prescribing then there is a case to change but I think you should have more than 51% for a change of the magnitude.

    In July I asked the Presdident of the ECU Oystein Ogre the following questions. He felt I was childish to ask and just wanted an argument, he has not given me an answer. AS a member of the Irish Chiropractic Association I am a member of the ECU and I asked him again yesterday.
    1) The World Federation of Chiropractic has defined the practice of chiropractic and stated clearly it does not involve the prescription of Drugs. What is the ECUs position on this statement and does the ECU believe that prescribing is part of the practice of chiropractic.

    2) Does the ECU have a view on the fact the General Chiropractic Council has a physiotherapist chairing the committee that sets education standards for UK chiropractors which are not up to ECCE standards.

    3) What does the ECU consider to be the “principles” of chiropractic? and how does the ECU explain how chiropractic is different from physiotherapists that use spinal manipulation.

    Regarding neurology Dr El Dars (AECC neorology tutor) made a similar comment about Tedd Carrick, EL Dar’s training focused on using neurological examination to diagnose pathology. Carrick uses neurology to observe changes after an adjustment or neural stimulus. Garland could explain this better than me, (thats where we met, I just did not have the time to complete the course, which in my opinion is the most extra ordinary chiropractic course out there if only because it makes you think about what you are doing when you adjust and teaches you to make observe changes objectively. We were not treating “blind spots” we were observing asymmetry and changes in the blind spots after chiropractic care.

    A few years Ben Goldacre wrote about Carrick in his ” Improbable science” colum in The Guardian about playing classical music into a patients ear to help people walk. Goldacre scoffed at the idea because he sees music and movement.

    Carrick is thinking activating or inhibiting neurons on sides of the brain and anyone who has done the course has observed these changes and I would recommend the programme aired on CBS awakening the brain http://www.carrickinstitute.org/CIAbout.asp

  • Dr Bilbo Baggins

    Interesting, the argument between straights and mixers has been going on for years. The prescription battle as I see it is an emotive one and must be a seen as a spin off, or even, as some may say, a natural progression from the latter. On one extreme in this current slice of the debate is Eugene on the other, and offering a slightly more aggressive view, is Paul. 

    To say the majority of chiropractors worldwide are of Paul or Garlands persuasion, may be right, but personally I think most chiropractors sit somewhere in the middle eg are mixers, whatever that entails, even in the North America and Australasia.

    However, whether people agree with prescribing or not, it may have merit if the European directive is to be believed, as prescription goes beyond simply prescribing drugs.  So maybe the statement ‘ the right to prescribe is more important that the prescribing rights’ may be accurate on many levels? Remember, that Europe and the UK is not legally nor culturally North America or Oz and this may play a part in any decision making process

    Would I therefore ‘stop’ Eugene or others who, like him wish to prescribe, (whatever prescription entails to include limited drug rights), no. It already happens in Switzerland, some Scandinavian countries have been discussing it for years and it happens in some American states.  So do we denounce these people, or prevent them from being called chiropractors, and whatever your feelings, the answer for me is no. If they retain registration in the UK, for better or worse, they are chiropractors, if not, they are not. The choice therefore is not for any posters here to decide.

     However Paul, you and Garland still talk of people leaving or even being removed from the profession. You allude to the failure of remaining in and falling short of the ethos that is chiropractic and therefore they missed their calling by not sharing your views. What about another segment of chiropractic society, do they share your views?

    Interestingly, the ‘chiropractors’ that worry me more than people like Eugene ever will, are the high volume, multiple benches in a room, financially driven  practices designed to over treat and frighten people into treatment by showing them ‘potentially fatal’ subluxations on X-ray. These are the same individuals who have highjacked the term of wellness chiropractic care for their own benefit rather than the patients. They claim to be offering ‘traditional chiropractic’  by  treating the subluxation, sorry traditional chiropractic, if the term exists, surely it does not encompass nor condone these people.

     For me and many others like me, these are the people causing problems in the chiropractic profession, these are the ones that a great many people wish to distance themselves from because they see them as an embarrassment, as being the worst side of any health care ‘business’ and this includes medicine etc which, because of the title ‘chiropractor’ they are linked with the chiropractic profession. 

    I would rather stand shoulder to shoulder with Eugene than live in the same town as these ‘chiropractors’ who many would say, simply disgrace the profession and the name.

    So the answer may be easy; those who wish to practice as above can use their chosen prefix ‘traditional’, those who wish to prescribe can use the suffix ‘physician’  and because of where they choose to sit in the chiropractic spectrum, one never wishing to use the others title. This will allow the public to decide where it wishes to go for treatment, and let each group distance itself from the other by virtue of ethos and practice.  Those who disagree with both groups will just be as they were meant to be, and could simply call themselves chiropractors.

      My concern though is that you and Garland may actually get your wish and the profession would follow a natural mitosis, into two parts rather than the three alluded to above.  Is this a good thing, not convinced, will prescription rights go away, not convinced. Will it all be good for chiropractic, sadly only time will tell but neither is unethical practice.

  • http://www.chiropractorswarwick.co.uk Stefaan Vossen

    @GG
    I think the assertion you make in the last post is bang on. But I also think that there is such a thing as a “clinician’s need to please” by which I mean no condescension, just an observation that we all try to do what we perceive to be best for the patient. despite my agreement with you, I do appreciate what Eugene says. I think it is worthwhile considering the question and not just throw it away JUST because chiropractic says “we’re drug free”. I think it is a really good thing to consider the question “why are we drug free?”, even meditate on it, to realise what the deeper context and understanding of that concept is. Secondly we must consider “what is chiropractic?” and “what is its authority to dictate to me, a trained, skilled and qualified physician what I should and shouldn’t do?” and finally the question of ethics associated to this question. “Is it ethical for me NOT to provide a service which has clear (in the physician’s educated view) benefits to MY patients just because a theory says something that does not agree with it?” I don’t think it can be truly resolved without resorting to dogmatic attitude without at least resolving these questions satisfactorily.
    @Paul, I understand some of the attitudinal issues you highlight, but I do feel that you may be projecting sentiments onto Eugene’s case which do not apply. I don’t know Eugene, but I do know that I could not discern the insecurity (professional or personal) you seem to attribute to his case-making but see only a purely practical issue being brought to the table. I agree that those sentiments you express in your posts do apply to some, but I reckon they do not apply to all, and certainly not to Eugene.

    I personally feel that chiropractic care in the UK should remain drug free. It helps us define our scope of practice and I personally like that scope but I do understand that it can be tough sometimes. I had a similar issue with podiatry, something I have a great deal of good use for. I decided to employ the services of podiatrists for those cases where functional stability required gait-based support. I struggled with the quality of the work done and trained, did courses, read up and educated myself but only used that education to find the best podiatrist. Why? Simply because it isn’t what I do as a chiropractor. As a chiropractor I find cause where cause can be found and where there is likelihood for recovery, fix it myself or with the help of others, and leave well alone. If I got it right, the person will get better.
    But, and this to me is what Eugene highlights, what if there wasn’t a good podiatrist near me (I make my patients already travel 45 mins+ to see my guy)? Simply put; I would have had to do the work on interpersonal and ethical grounds even if I didn’t really want to from of philosophical point of view. Would that be a sell-out? I appreciate this example is different as it does not employ drugs, but neither does it employ spinal adjusting…Fundamentally I am still looking for the root-cause of dysfunction, something analgaesic medication does not seek to do and that, and that alone makes me adamant that I don’t want to be given or even pursue prescription rights. I don’t deny its uses, I don’t deny it could make life easier, but unlike Eugene, my life is already easy because I have great GP’s in the area who are cooperative with my efforts. In consequence the question for me becomes simply: what is chiropractic care? And my feeling and understanding of what I bought into is that it is the pursuit of correction of root cause of dysfunctional movement patterns, dietary patterns and thought patterns. If that is deemed to not be chiropractic, then I will have to step out and call myself something else, because that is what I believe in with heart and soul. As a chiropractor I am primarily a case-manager who helps identifying these and secondarily refer to others or myself where appropriate.
    Many kind regards,
    Stefaan
    Regards,
    Stefaan

  • Garland Glenn

    Ok Folks here is the soul of the issue. Eugene asked the question. To paraphrase:

    Does medication (perscription rights) have a place in the treatment of “back pain”. to which the answer is Yes.

    BUT

    Does medication and persription rights have a place in chiropractic to which the answer is No.

    Chiroprtactic isn’t about back pain it’s about an alternative. Your position on this is where this issue lies.

  • Paul

    @ Eugene

    Osteopaths were drafted during the second world war – why? Because they were fragmented by pseudo osteopaths who wanted to be medics and were seen as fodder – why were chiropractors not drafted in? Competition?

    Do you know the figures for flu treatment at the time?

    Perhaps this is a lesson to chiropractors that you didn’t meaningly post here to remind us why not go toward drug prescription?

    Btw if someone here wanted proper painkiller which of their dealers should they visit – gp or drug dealer? Should now we add chiropractor?

    “As far as the first post, I fail to see how TOS is acggrivated on. extension of the cervical spine into neutral.”

    Surely not denying discal involvement in TOS?

    “I dont think abortion is a good idea in most cases, but I respect a womans right to choose.”

    Sweet jesus – straw man – I don’t agree with killing myself but there is an excuse for everything? What if a man stands up and forces a woman to have an abortion cos its his right to choose too?

    Eugene you try to patch up the ground between you and I by claiming agreement – your argument is puerile – radiology has always been part of chiropractic and used widely before being incorporated into medicine – drugging a human so as to negate normal body processes and signals has not ever been – it’s has been about correction of DIS-EASE. Nothing more nothing less.

    “Richard 3 time a week for my cervical disc lady is pretty unlikely she lives 1 1/2 hours away, I dont even see it as humane to make her do that drive, even as a passenger, until the pain had settled somewhat hence I meds being useful in this case.”
    Too far to be a chiropractic patient – this is why the palmers set up chiropractic hospitals.

    @Glenn

    “The profession has tried to accommodate both sides for many years. For those in the second group, the very idea of prescription rights is the antithesis of what they stand for.”

    Agreed and time for chiropractors real chiropractors to stand up like osteopaths didn’t, call it as it is and respectfully find a way for Eugene and those who wish to part and parcel of manual medicine to get a way out without loss of face and become what they want to become for their communities and let us do what it is our communities need.

    Sorry Eugene but someone here should call it as it is. I think its time for you to take time out and find yourself and what you want to be. It doesn’t seem to be a chiropractor and I think its time to realise you spent years making a life mistake.

    I didn’t nor, with respect, do I want my profession changed by the like of a confused you.

  • Garland Glenn

    Stefaan has a point and I can see it especially for those in remote areas where the chiropractor could be the primary care doctor. This was originally the role osetopaths saw for themselves in the years following WWII. Over the years they became medical doctors that sometimes adjust. Make prescription rights an extra training that is optional. This is still dangerous as it would create a two tiered profession. These docotrs would need the same access to testing, specialist, referals and hospitals as GPs. Why not become a GP and focus on seeing backpain patients? There isn’t a prefect solution.

  • http://www.chiropractorswarwick.co.uk Stefaan Vossen

    I think that Eugene has an entirely different point to make (read response on in toto et summo) and that it has nothing to do with “wanting to play doctors” but rather “having to meet the need”. The problem Eugene is that I would suggest that it is, or at least it seriously should be considered that it very well could be as Glenn suggests a “Pandora’s box” (I once knew a girl called Pandora). Maybe it is up to the individual to train and qualify according to their practice needs? A little like sports, paeds etc?
    I will respond to your post tomorrow.
    Many kind regards,
    Stefaan

  • Garland Glenn

    @ Eugene

    It was not my intention to offend you.In the case you mention, I can understand the argument and would even sympathize with you if it wasn’t for the Pandora’s Box it would open. Here in the US chiropractors in New Mexico can prescribe and even do some injections. They are the ones that live in very remote areas where the closest MD could be 100 miles away.
    This brings me to what is in my opinion the crux of the matter. There are two generalized perceptions of chiropractic among the profession.
    1. For some it is a specialized form of care for musculoskeletal conditions. For these people prescription rights make sense.
    2. For others (and this is the historical position and that is held by the majority of chiropractors though out the world) it is an alternative form of health care. This is crucial in understanding the opposition to drugs. Chiropractic is alternative. There are, for many reasons, chiropractors who find themselves in the wrong profession. These chiropractors don’t want to treat mechanical problems; they want to offer an alternative.

    The profession has tried to accommodate both sides for many years. For those in the second group, the very idea of prescription rights is the antithesis of what they stand for. Those in the first group have a tendency to ridicule and marginalize the convictions of those in the second group. We have unfortunately bought into this odd paradigm.
    Scientific = Truth and that Unscientific = Questionable or not True. This is a very dangerous position to find one’s self in. Scientific does not equal true, it only equals scientific.

    With regards to blind spot mapping, forgive me for saying this but, if you understood what it does, you wouldn’t make the comment that you made. I would refer you to The Neurology of Eye Movements by R. John Leigh. I very seriously doubt you could find someone who has completed the neurology course that would support your position. I have completed the Diplomate in Neurology program and can say that the level of neurology training most chiropractors receive does not give them the depth of understanding to appreciate this. It is the same thing with eye movement. I have a computer based blind spot mapper and do so for many of my new patients. It gives an informative window into hemisphericity which can help in determining if there is cerebellar control asymmetry.

  • eugene pearce

    On last post before I stop, damn this OCD,

    If a GP incorporated manipulation, Homeopathy, and Acupuncture into his clinical armory, is it to gain the respect of the Chiropractor Acupuncturist, and Homepath, dont be so ridiculous. Its as a result of a desire to provide the best most effective care for his or her patient.

    This whole “if I act like them I will be respected by them” is quite insulting really, can you please give it up, you are wrong, I know my motivation, so does Richard as we have discussed this by email on a few occasions. If you persist with this sam old argument, I can only assume that you have a chip on your shoulder and that being a Chiropractor is somehow less respected in your eyes than being a GP, and you are projecting onto me because I dare have a different opinion on one small aspect of our profession.

  • eugene pearce

    Richard 3 time a week for my cervical disc lady is pretty unlikely she lives 1 1/2 hours away, I dont even see it as humane to make her do that drive, even as a passenger, until the pain had settled somewhat hence I meds being useful in this case.

    As for Carrick no way you were going to adjust this lady, crying upset, anxious, and if you look critically at the Carrick institutes ideas on neurology they are quite odd, the whole blind spot thing, utter nonsense. Bullshit baffles brains, as my father in law used to say.

  • eugene pearce

    @ Glenn

    “First off I’m not picking on you but you made this comment, “Firstly, I see this as a matter of inter-professional respect”.

    No you misunderstand what I mean, and couldnt be more wrong about my motivation. It is respecting and acknowledging the sometimes medication has a valid role to play in treating back pain, which is what I do every day. I know a GP locally who manipulates Thoracic spines gets ok results, when he doesnt he sends them to me. I see that as a nod of respect to what I do and I have no issue with it whatsoever. My results are fine so is my image and respect, but I always think I could do more, and our training could be improved and more clinically relevent.

    If I took my car to a garage I would want one with a full set of tools not just a box of hammers.

    As for the Osteopathy red herring. Are you implying they were all bad adjusters. Read the history, Osteopaths were drafted in during the Second world war to cover the shortage of GP’s. We are talking limited short term prescribing. Activators, drop piece, SOT, NIP, BEST are for those who cant adjust (I can feel the fury now). I am absulutely arguing for the occasional patient (or perhaps they dont count), do we stop x-raying because its for the occasional patient. Why is this such a big deal I dont know.

    @ Richard

    I dont disagree with anything you said, in the second post. As far as the first post, I fail to see how TOS is acggrivated on. extension of the cervical spine into neutral. MRI is accessed up here only after seeing a Orthopod, 4-6 months wait, and no direct private option except Glasgow or Aberdeen and only after seeing a consultant in Aberdeen Glasgow is 4 hours drive. The whole carpenter analagy is purile on both our behalves, we are talking about having the opportunity for chiropractors to follow a recognised to limited prescribing they will be both trained and insured. I still fail to see why you have an issue with chiropractors having the choice. I dont think abortion is a good idea in most cases, but I respect a womans right to choose.

    @ Paul.

    Partially I agree with you. The sad truth is patients dont even know what they are taking half the time except its a pink one in the morning a a yellow and brown capsule in the afternoon, I would love it if they all read the label. They should all also be getting regular BP checks at their GP too, so is this a reason we shouldnt check that either. In fact to follow your argument to the logical conclusion, why do we bother learning pharmacology at all. Either we do it properly, so where recognised pathways are available we should look at them, and tailor these to the needs of the chiropractor (very short term, very limited list).

    Alternatively have nothing whatoever to do with them not learn pharmacology at all in college, and put our head in the sand and leave it all up to the patient.

    “Its not educational authority that’s required here. I realise now what you have perhaps realised subconsciously and that is that the GP you claim is a colleague has little or no regard for you or chiropractic and you think you need to be able to big it up to him by saying ‘I have the power to prescribe too”.

    You know as well as I a minority of GP’s dont like changes in treatment being suggested to them by Chiropractors, (perhaps it is any other professional or maybe its me, I dont know), but the “big up” as you put it is, educational authority, ie the GP knows we have the appropriate training to a medically recognised level to make this request.

    I would argue the same thing that our radiology, and plain film radiography component of our training should be to a medically recognised level, just as the AECC has done with the Sonography course. I would love to see chiro’s in hospitals integrated with the medical profession. Part of our training needs to be in hospitals alongside medics so they can see what we do and how well we do it, ultimately then we will see the respect we deserve as a profession.

    “The proof is in the Pudding”

  • Garland Glenn

    @ Eugene

    First off I’m not picking on you but you made this comment, “Firstly, I see this as a matter of inter-professional respect”.

    This is part of what I see as one of the main issues for those looking for prescription rights. Selfimage. If you can write prescriptions they’ll have to take you seriously. This will then validate you. I can tell this is not going to be the case. In my career I’ve been on the staff on two hospitals in the US and did the neurosurgery grand rounds for three years being consulted on several hundred spinal surgery cases. Respect comes from knowing what your doing and achiving good results. Self worth comes from the appreciation you receive from your patients.

    I appreciate you case about the women needing the “help” to get through and maybe in the occasional patient that could be argured for. However the Pandora’s box here is that it will not be the occasional patient that gets drugs if perscription rights are implemneted. It will be the ocassional patient that gets adjusted. As many chiropractors suufer from self image problems and are poor adjusters, they will abandon adjusting altogether. If you think this isn’t true, I’ll give you an example.

    Richard mentions Osteopaths in the US as an example. First know that ostoepaths in the US are medical doctors. They prescribe and perform surgery. While they began as adjusters in the era of Palmer they are in no way similar to oestopaths in the UK. During the 1960s,70s and early 80s maniplution became an elective in their educational program with the majority of osteopaths graduating without ever having had even one course in it and some schools not even teaching it. During this time most osteopaths went to osteopathy school because they couldn’t gain admisson to medical school. Manualtherapy has returned to osteopathy in recent years though you’d be very hard pressed by watching one work to conclude they are not MDs.

    Prescription will not gain you respect. Good results will.

  • http://spinaljoint.com Richard Lanigan

    I have always thought that the argument for prescribing “we would be able to offer advice on medications” was a red herring As Paul says they can read the product insert.

    40 year old come in and has recently been put on blood pressure medication. I dont want to give “advice” who knows whats around the corner. However I want to know the person has made an informed decision having tried or rejected exercise and diet knowing they may be taking the medication until the day they die. So I would ask why is you BP high and when do you stop taking this medication. Invariable they have not asked or considered the prognosis. In which case I would say ask your doctor when you can stop talking the medication. Its up to the individual after that its their choice whether to take medication no one forces it on them and they dont need someones permission to stop taking it.

    People have to take responsibility for achieving good health we are not healers or fortune tellers we merely facilitate the healing process.

    And Eugene if you have a fire in your loft because your carpenter was messing around with the electrics the insurance would not look favourably on your claim. In Denmark the carpenter would refuse to touch your electrics because he could be prosecuted. A good carpenter would have thought ahead and been aware another expert may be necessary .

    Often with hot discs I say to the patient chiropractic may help it may not, I would like to see you twice maybe even threes a week for a few weeks. But go back to your GP now telling him you want to see an orthopod and be put on the waiting list.

    If I help he is delighted, if I dont help he is in the system and its a few weeks less waiting. I was thinking ahead of when other more invasive interventions might be necessary and reduced the time the patient might have to wait. I try to do the best for my clients and I am not above “treating” a bad back.

  • Paul

    “I also would like some small educational authority when I write to a GP and say I think the pain / weakness might be caused by Beta Blockers / Statins, could you consider changing these meds / stopping for a short period, to see if they improve.”

    Its not educational authority that’s required here. I realise now what you have perhaps realised subconsciously and that is that the GP you claim is a colleague has little or no regard for you or chiropractic and you think you need to be able to big it up to him by saying ‘I have the power to prescribe too.’

    Perhaps telling the truth to your patients and asking them read the information with their beta blockers or statins or whatever and let them realize the amount of side effects themselves and perhaps bring it up with their GP.

    You don’t have to be a rocket scientist or be a prescriber to read ‘muscle weakness and fatigue’ on the side effects advisory and bring it and new found symptoms to your GP attention.

    Also by the presentations you are seeing you perhaps should serve your community better rather than prescribing pain killers etc by educating them how to look after their spines so they have them for a longer more productive less pain filled life, even if you don’t believe in chiropractic science.

  • http://spinaljoint.com Richard Lanigan

    I would probably call the first Thoracic Outlet if there is no neurological deficit. If the problem is caused by a cervical subluxation I would correct with an adjustment and postural advice. If patient did not respond after 3 visits I would send them back to GP looking for an MRI. Tedd Carrick might argue traction would cause the neurons to exceed their metabolic rate and produce more pain and spasm rather than inhibit pain and reduce spasm as with a high velocity adjustment.

    Second trauma, Ice again and check spine and rib joints.

  • Eugene Pearce

    Talk about coincedence. Last 2 patients.

    Patient just presented with severe right sided Brachialgia. Cannot put her arm by her side. Is sleeping in a chair or with 4 pillows to ease pressure from nerve root. All movement except neck flexion makes pain worse. Sleeping 1-2 hours past 4 nights. GP prescribed ibuprofen and paracetomol. Treated gently traction, showed home traction technique, advised on sleeping position.

    I have now referred her back to her GP (1 1/2 hours) away to suggest she try a CNS suppressant for her pain to get her sleeping so she can tolerate the pain throught the day better. Suggested either Gabapentin or Amitriptiline, (not whisky).

    All being well they will see their GP tommorrow who may or may not agree with my suggestion, and they might get meds by say lunchtime tommorrow. For me, I think I could have given this lady a better service by being able to offer a short course of meds onsite, and advising her to see her GP for follow up. If they help the GP can then follow up, if not offer something else. This is in adition to the Chiropractic treatment, not instead of. (Bit like hospital using n. root injection to determine if spinal decompression likely to help)

    2nd patient. Kicked in back in May. Pain around right chest wall since. “Subluxtion T7-8″ or “Chronic Costovertebral sprain strain T7-8″ equivolent medical diagnosis. (Well it hurt if you pressed on it and deep breath referred pain, as did lifting). (He had be tested for Gallstones Chest Xray and LFT’s already). This I wouldnt dream of suggesting meds, its a perfect Chiropratic Case (unless you read Bronfort in which case it insnt supported by RCT’s).

    Can you explain where the problem lies with would I would consider best practice. They are 2 different cases that require 2 totally different approaches in the early stages of treatment, and meds do have a potential role to play in the first case but almost certainly not the second.

  • Eugene Pearce

    For the life of me I dont understand why you are so keen to take this path to prescribing.

    Firstly, I see this as a matter of inter-professional respect. We cannot as a profession be seen to continually knock what medicine does. We are hurt enough already as a profession by some quite mad anti-vaxers (who have no logical argument, not you Richard), who very publically do our profession harm. In recent times several pathways to non medical prescribing (which we would fall under along with chiropodist, optician, dentist, radiographer, physiotherapist), have developed and they are good. We already learn pharmacology in college, frankly to an arbitary level. I am keen that we learn this to a recognised level then allow the individual to make a choice on prescribing based on their knowledge, not their belief.

    “If I want my sink unblocked I call a plumber not an electrician and I would not think any less of an electrician who did not know his way around an S bend”.

    By the same token if a joiner is laying a floor in my loft and he had to cut a couple of notches into the joists for cables but then said I had to wait for 3 days for an electrian to move the cables across, I would be a bit annoyed.

    “I dont think the public think any less of chiropractors for not prescribing”

    Thats not the point at all. If Chiropractors dont prescribe I would want them to choose not to, not for it to be default for everyone from a point of ignorance. I also would like some small educational authority when I write to a GP and say I think the pain / weakness might be caused by Beta Blockers / Statins, could you consider changing these meds / stopping for a short period, to see if they improve.

    “Because if skeptics do pick up on the ICA guidlines they would be having a field day if chiropractors had been prescribing Vioox, Celebrx et al”.

    Only if the simultaneously attacked medicine if we were acting on the best available evidence at the time. You must realise we would have followed the recognised pathway to non-medical prescribing. Also I dont want my scope of practice dictated by what “skeptics” think, a sentiment I know you share.

    “It is very rare I have felt a patient needed medication for joint dysfunction”.

    It is very rare that I think it is clinically essential to X-ray a patient, or refer a patinet for nerve root injection or surgical decompression. Occasionally it could be useful. AECC has developed a wonderful dept of sonography. Whilst steroid injections remain controversial it is illogical that they would not teach US guided injections, if we are going to use them at least put them in the right place.

    What is wrong with the GPs up in Scotland that you dont want to send patients to them?

    Nothing I refer patient to their GP’s on an almot daily basis, but, their practices are sometimes on another island from where I am, so occasionally for severe pain being able to offer something on premises stronger than OTC meds. We have patients come over from the outer Hebrides for 10 days for me to treat their Sciatica, if I have to compromise my chiropractic roots to speed things up a bit, I think I would be ok with it.

    I am not the enemy here, it is the fools that havent read the ICA guidelines and what they are signing up to.

  • http://spinaljoint.com Richard Lanigan

    Eugene,

    All SCA, UCA, amd MCtims dont “think this” and you know it. I doubt if they had even read the entire document before signing up to it. For starters McTims dont even take X-rays.I dont think you can use this to justify chiropractors prescribing.

    I dont prescribe because my goal is to improving joint function rather than inhibit pain. The inhibition of pain is a product of joint motion by the activation of joint mechanoreceptors. If I am not able to help someone I send them elsewhere. For example I believe a surgeon has far more to offer some one with a degenerated hip joint than I have.

    If patients want drugs to numb the pain they could have them prescribed by a doctor or purchase a bottle of whiskey which I believe works well. If I want my sink unblocked I call a plumber not an electrician and I would not think any less of an electrician who did not know his way around an S bend and I dont think the public think any less of chiropractors for not prescribing. In fact they are impressed when they feel better after a skilled adjustment.

    We all have different views on this and I dont think these excerpts from the ICA guidelines should be seen as anything more than a dated recipe book of chiropractic guidlines, the BNF (British National Formulary) of traditional chiropractic if you like. For the life of me I dont understand why you are so keen to take this path to prescribing. Because if skeptics do pick up on the ICA guidlines they would be having a field day if chiropractors had been prescribing Vioox, Celebrx et al. I have never ever felt a patient needed medication for joint dysfunction/subluxation.

    Having said that I get attacks of gout and the only thing that touches it is Diclofenac which I get from a GP who is also a patient. What is wrong with the GPs up in Scotland that you dont want to send patients to them?

  • Eugene Pearce

    Please read the ICA document the Alliance has signed up to.

    340 seperate diseases that can be helped with spinal care

    25 visits in 8 weeks for simple axial pain

    85 visits in 28 weeks when complicated by loss of cervical lordosis

    Xray every new patient including children beaking IRMR government radiation guidelines.

    Seriously is it true all SCA UCA and MCC chiropractors think this. I hope not.

    The Alliance has given the skeptics a huge stick with which we can be beaten. It promotes breaking health and safety radiation protection law in the UK. Those who signed up to this are very foolish indeed. At least the BCA had the good sense to read what they were signing up to.

    I would urge individual chiropractors to think for themselves. Because some chiropractors are in favour of limited prescribing or raising the educational standard to a level where we make an educated choice about prescribing (not a dogmatic one), does not make them less chiropractors in any way.

    “Notthereyet” makes the point “There are around 3000 UK chiropractors and 20,000 physiotherapists. Right now Chiropractic in the UK has a separate identity but the way things are going that’s fading fast”, and yet Bronfort Report draws evidence from all Manual Therapy to defend chiropractors. We cant have it all ways.

    So is the sad truth “not prescribing, our professional belief,and taking x-rays, what gives us a seperate identity. I say rubbish, we are certainly better than that. A 5 year training in basic sciences, a working knowledge in biomechanics, radiology and radiography, proficieny in spinal and peripheral joint manipulation / mobilistation / adjusting, and a working model for back pain, together with a unique history is what makes us distinct.

    It would be realy sad if we want to be defined simply by what we dont do, ie drugs and surgery, we used to be non invasive but those needling and ultrasound b@st%d$ ruined all that.

  • Notthereyet

    It’s regularly pointed out to WIOC students that we don’t have the monopoly on spinal manipulation so we have to be the best.

    Agreed, but being “the best” simply cant be enough…

    There are around 3000 UK chiropractors and 20,000 physiotherapists. Right now Chiropractic in the UK has a separate identity but the way things are going that’s fading fast.

    The general public (and certainly the NHS) soon wont perceive any difference so how long before UK chiropractic is subsumed by the majority. Drug prescribing rights will even further blur the boundaries.

  • dazed

    please do the alliance survey (just once)

    http://www.surveymonkey.com/s/6GNST8B

  • Paul

    “Behind the scenes we are getting things done, professionally and effectively ”

    read we are sneakily screwing the profession behind everyone’s back

    sneaky good for little tramps

  • Nick R

    My one burning question to Mr Brown is how he differentiates his view(hence the BCA’s)of chiropractic from osteopathy or physiotherapy? From my point of view, chiropractic is distinct because of its fundamental philosophy. If these are eroded away then what is the difference?

  • dazed

    Interesting that the BCA leadership recognise the nature of the rumour mill and that a lie can get twice around the world before the truth has got its boots on.

    Think about the rumours and bad press the BCA have given McTimoney over the years, think about the internal complaints made against Richard Lanigan when he was a BCA member and how he was told that as a private ‘club’ the BCA did not need to adhere to the human rights act, think about the 80 complaints lodged at the GCC against the UCA leadership by members of the BCA, think about the rumour that the McTimoney College was closed down due to its accreditation being withdrawn in 2005 – Privy Council never signed the papers so that never happened. Think about the BCA councils’ conduct in respect of the Simon Singh affair.

    Pah! a plague on both your houses (GCC & BCA), I say!

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