Last month the following showed up in my feeds: In a First, Academic Center Offers Chiropractic Program. Sigh. Well, at least it is not associated with the Medical School. Yet.
I suppose I could clutch my pearls and cry, baby, but no point in that. In The Demon-Haunted World: Science as a Candle in the Dark, Carl Sagan noted
The candle flame gutters. Its little pool of light trembles. Darkness gathers. The demons begin to stir.
To judge from the widespread offering of SCAMs in major medical centers, in health care the candle is out. All that is left is the red coal, producing smoke but little light or heat. And soon that too, is likely to be extinguished.
But, to use contradictory metaphors, while medicine burns, I have my proto-guitar to occupy my time.
As the old saying notes, when life hands you lemons, make an army-navy and forget your troubles.
I thought it would be interesting to look over the first of its kind Chiropractic degree in a
research-intensive public university, providing an educational experience unmatched by any other program. Based on its strong reputation in the health sciences, Pitt is uniquely positioned to train a new generation of chiropractors who will be at the leading edge of science for spine and musculoskeletal disorders.
and see what they offer and how it compares to reality. If the program is part of a research-intensive public university, and they are offering a DC doctorate, I have to wonder just how much research Pitt did into the realities of chiropractic. But perhaps I am cynical. Or skeptical. Or both.
Get It While You Can
First, cost.
$15,398 per term ($123,185 total for 8 terms) for in-state students
$18,400 per term ($147,202 total for 8 terms) for out-of-state students
Holy Cannelloni. Cost for a DC degree vary widely, but this appears to be a bit more than the average, especially for out-of-state students. Still, they will acquire the patina of fool’s gold legitimacy, getting a quack degree from a University, albeit one that has likely abandoned scientific standards, instead of a quack degree from a quack institution. That patina must be worth a bit more for the graduates. With 40 students in the first year, that is at minimum a cool $4,927,400. Not bad. Now I know why they are offering the program.
And chiropractic students may be a susceptible group to price gouge:
These chiropractic students demonstrated inadequate financial literacy and did not engage in many recommended financial habits.
Such as spending money on a Doctor of Chiropractic degree, I suppose.
Student Body
Who will these 40 students be? They need to have an average GPA of 3.0. A ‘B”. 2.75 is enough for some schools I looked at. It is safe to say that best and brightest do not become chiropractors. It is a career choice that suggests a surfeit of magical thinking or a deficiency of critical thinking skills. Or both. I mean, did you do any research on what it means to be a chiropractor? And if so, you were not dissuaded from that career path?
And I had to laugh when I saw that under technical skills, they expect
Intellectual Abilities: Chiropractors are required to think critically and solve problem.
As this blog routinely demonstrates, critical thinking is not a must in the field; if critical thinking were applied we would see
“Oh dear,” says a chiropractor “I hadn’t thought of that,” and the field promptly vanishes in a puff of logic.
The Curriculum
Starting a new school is a good opportunity to discard the problematic baggage of the past and start afresh. The chance to reinvent oneself and leave the old you in the dustbin of history is tempting and should not be passed up. Especially if the old you is reality avoidant.
The front page of the website says
From day one, students will receive a combination of rigorous, evidence-based education and clinical experiences within an interprofessional academic environment.
Rigorous. Evidence-based. Chiropractic. Elmo might have something to say.
Makes an old SBM skeptic like myself wonder just what parts of chiropractic will be taught.
Now I am going to define terms here. SCAMs tend to be very Humptydumptian in their use of language. Precision of language is not their strong suit. And you learn in medicine that precise speaking is a manifestation of precise thinking. God forbid you should call a patient dehydrated on rounds. Although it is done humorously, that is EXACTLY what happens.
So moving forward, for the sake of precision, when I say chiropractic I am referring to the straight chiropractic approach pulled out of the ass of its founder, D.D. Palmer. Disease is caused by subluxations of the spine that interfere with the movement of inane, er I mean innate intelligence and that by manipulating the spine, the subluxations are removed to allow the flow of innate intelligence and resolution of illness.
That is the defining characteristic of chiropractic, its sine qua non, and as this blog has demonstrated over and over, is all a load of fetid dingoes kidneys. All sound and fury, signifying nothing. A fiction from start to finish. It is Oakland. You get my drift.
But here is the odd thing. The fundamental fiction that uniquely determines what is a chiropractor is not mentioned anywhere on the site. Are they embarrassed? Or are they abandoning the core idea that makes a chiropractor and turning out a tarted-up physical therapist? I don’t know. In the FAQ under what is a chiropractor, they say
Doctors of Chiropractic (DCs) are first contact providers (i.e. there is no need for a referral) licensed to practice chiropractic in all 50 states, the District of Columbia, the U.S. Virgin Islands and Puerto Rico. DCs perform the diagnosis, treatment and prevention of spine and musculoskeletal problems with a focus on back and neck pain. As part of their practice, DCs conduct physical exams, order and interpret radiological imaging and laboratory tests, diagnose and treat musculoskeletal dysfunction, counsel patients on health and wellness, and co-manage or refer to other health care providers when appropriate. DCs exercise autonomy in clinical decision-making and provide a broad range of diagnostic and therapeutic services focused mainly on spine-related and other musculoskeletal disorders. The use of manipulation, manual therapy, therapeutic exercises and lifestyle modifications are the cornerstones of chiropractic practice.
Sound good. Nice and non-specific. The DC is in the details, and the details are not mentioned on the site.
There are useless adjunctive diagnostics and therapies used by chiropractors such as applied kinesology or actuators but they are not unique to chiropractic practice.
And there are useful adjunctive therapies used by chiropractors such as massage, heat, stretching, and exercise but they are also not unique to chiropractic.
As has been noted about many a SCAM, what is unique is not helpful and what is helpful is not unique. And so it is with chiropractic.
But if they are going to offer a rigorous, evidence-based education, then no part of chiropractic, as defined above, needs be taught. And the only thing that chiropractic has benefit for is early improvement of low back pain. And even for that, I am skeptical, as when you look at the details of these studies spinal manipulation is used with other, actually useful, adjunctive therapies making it difficult to determine just what chiropractic adds to the care. I bet nothing. So why not avoid the fiction-based chiropractic and go for a physical therapy degree? Probably because you don’t get to be called doctor.
Looking at the outline of the curriculum it looks be a cursory review of medicine but, since the first class is not until Aug 2025, is understandably short on specifics. But it does raise questions.
What is taught is woefully inadequate for the DC to be a primary care provider, as is encouraged by some DCs, although not in Pennsylvania. Hell, a real medical school education does not prepare you to take care of patients. That only occurs after internship, residency and fellowships, 3 to 7 years of training post-medical school depending on specialty. But they do mention that what is taught will be at a level useful for chiropractors. I am Joe’s Body level I would suppose. That dates me. And I really do not think much of chiropractors, do I?
The Director of the program is evidently a proponent of the primary spine practitioner, akin to a podiatrist. Not a bad idea, I always appreciated the expertise of the podiatrists I worked with. But I would not want my primary spine practitioner to be trained as a chiropractor. I want my health care providers to be grounded in reality.
The program will offer Chiropractic Science. Hm. As you know, I am not a fan of adjectives preceding the word science. But I suppose there is biologic science. And medical science. And social science. But chiropractic science? Now there are two words I never thought I would see together; very humptydumptian. How does one have a science based on a fiction? It usually doesn’t end up well, as Lysenko horrifically demonstrated. Perhaps, and I have always been both skeptical and a optimistic pessimist, they will actually change the profession and make it reality based. I can hope.
They have a public health section. I wonder how they are going to cover vaccines, as anti-vaccination sentiments are common in chiropractors and start in school:
we found in both colleges that anti-vaccination attitudes were more prevalent in the later years of the programs.
And the chiropractic profession was not a shining beacon of science during COVID. Although, if they are abandoning the whole subluxation fiction, there may be hope yet.
Musculoskeletal spine-care chiropractors were more adaptive to certain COVID-19 public health changes within their practice setting than subluxation-based chiropractors.
I see they have a section on cervical mobilization and manipulation. I note that the head of the program appears skeptical of the chiropractic hanging, er, I mean neck manipulation leading to vertebral artery dissection. He prefers to go with the Cassidy study calling it a
landmark study by Cassidy et al., considering that it is arguably the best epidemiological evidence published on this topic to date.
I would argue the paper is the chiropractic equivalent of inconceivable and I have. it is a study where, if you read the paper, you will find that the body contradicts the assertion in the abstract that cervical manipulation does not cause strokes. But, that takes careful critical thinking to determine.
So more questions than answers on just how evidence-based this DC degree will be. Perhaps this will be the start of something new, like DOs, who have mostly moved on from their quasi-chiropractic beginnings. Fiction-free chiropractic?
To crack, or not to crack; that is the question;
Whether ‘tis nobler in the mind to suffer
The slings and arrows of chiropractic manipulation,
Or to take arms against a sea of pseudo-science,
And by opposing end them. Science. Evidence.
Critical Thought; applied to end
The heart-ache and the thousand natural shocks
That subluxation is heir to; ‘tis a consummation
Devoutly to be wished.
We shall see.
Post Graduation
There are 60,000 unneeded chiropractors in the US, with 2500 added to the workforce every year. Three years from now, they will add 40 more. Are they going to have jobs, since they can only legitimately care for acute low back pain. Income? They will start out at $50,000 a year and reach a top pay of $90,000 a year. I found a variety of numbers on the web. Can you actually reach those numbers as a rigorous, evidence-based ie chiropractic-free DC? Or will the graduates go down the rat holes of subluxations, spinal maintenance, anti-vaccination, and other SCAMs that permeate the profession today?
We can hope that these DCs are going to be different.
But you can probably guess where I would put my money.