Guest post: There might be an upside
Originally a comment by Enzyme on Crucial.
I wouldn’t want to speculate on what the GMC’s rationale its decision about HRT prescriptions might have been; but let’s allow for the sake of the argument that it was buffoonery. Still: there might be an upside to that – or, at least, there might have been a bullet dodged.
Had the GMC said that it was a specialist area, requiring special training, then who would have undertaken such training? Since doctors are not assigned to specialisms by lottery, the answer to that would have to be that the training would only or overwhelmingly be sought by True Believers in the gender cause. And, in turn, that would have given heft to the idea that there is a whole specialism devoted to this thing, therefore this thing must be 100% legit. (Recall a few years ago a minor kerfuffle over chiropractors setting up a professional organisation and publishing professional standards; the concern was then that this gave a fig-leaf to chiropraxis because it made it look like something real.*)
On the other hand, by not saying that it’s a speciality area – by saying that it’s just a normal part of medicine – the door is left open for normal medics to make normal evidence-based decisions about whether HRT is warranted. And while that means that there’d me more doctors with the liberty to prescribe HRT, there’d also be more who’d be inclined not to.
(*Yes, I’m calling it chiropraxis, because “chiropractic” is an adjective. Lord: if there’s one single thing that makes me, as a layman, suspicious of those charlatans, it’s that they do such obvious violence to the rules of grammar. And if they’re mangling grammar, what’re they going to do with my vertebrae?)
Oof, that’s a killer point. I admire your mind, Enzyme.
An incident in childhood twisted my left leg out of alignment, with the result that as I grew up I experienced increasing pain and disability. The medical profession had nothing to offer. One doctor even told me it was my fault for walking oddly…
Regular treatment from two qualified McTimony chiropractors – one of them passed her practice on to the other when she retired – has largely sorted out the misalignment, has restored my mobility and reduced the pain to a very occasional murmur.
@NightCrow
Whatever those therapists did to help you, the principles behind it were scientific and not superstitious.
Chiropraxis/Chiropractitioning/Chiro… whatever… it was conceived as a batshit-crazy pseudoscience — one that gives Scientology and its Evil Space Lord Xenu backstory a run for its money: magnetic healing, a mystical life-force, something called “subluxations” (seriously, don’t ask) …
It’s fascinating that chiro… whatever… continues to thrive. It’s a rare example of a cult that survived by watering down its tenets. (That’s not usually the way cults play out. The more famous ones lean in, concentrating their extremism until it explodes brightly. See: Jonestown, or the Solar Temple.) Chiros used to be extreme cultists who believed in outrageous nutjobbery. But in order to survive, the cult moderated itself significantly, and basically adopted and absorbed some reasonable practices of physical therapy, with a specific focus on the spine and back.
There’s a big market there: pretty much all of us develop back and spine problems by the time we turn 50. So “chiro” now roughly means, “back-focused physiotherapists who have some degree of science-based training, combined with some degree of pseudoscience-based buffoonery”. Of the two halves, I think you can guess which one gave you beneficial results. And I can confidently guess that the only reason you didn’t go all-in for proper 100% medical therapy (as opposed to its fifty-fifty watered-down cousin) was that it was too expensive, or it was unavailable.
And that’s why people go into the practice: they can’t afford the time or money commitment to become real doctors — ten years of proper medical school training — but “chiro school” offers them a cheap alternative and it grants them some of the credibility they’re seeking in their lives, so they go for it.
That’s what chiro is: it’s a mutant half-medical practice that swoops in to fill a gap that proper medicine has woefully neglected: We need more funding for back stuff. The medical field is ignoring the problem. And there are people who want to be healers, but who can’t cut it with Med school. Voila! Chiro.
It’s a market phenomenon, not a scientific one.
Arty, I don’t think it’s fair to say doctors are ignoring back problems. There are a lot of doctors out there who specialize in it, but the problem is, back problems can be difficult to diagnose. It isn’t unusual for nothing to show on x-rays or other tests. The pain is often more subjective than objective, which isn’t to say it isn’t real, since pain usually is subjective.
When you can’t treat the cause of the problem, all you can do is treat the symptoms. That led a lot of people to become hooked on opioids, and doctors are understandably more cautious these days in prescribing. Steroid shots have serious side effects, and aspirin is often not particularly effective. Physical therapy is sometimes helpful, but a patient with recalcitrant pain may not have many options if those don’t work. Then they turn to chiropractors, who pop their back, or whatever it is they do, and they feel better…usually temporarily. They have to keep going back.
And the back treatments they use have been shown to have some serious side effects, including impacts on the heart.
Overall, I just think it is a good idea to avoid chiropractors. I know pain can be difficult to bear; I have back pain, and at this point, there isn’t much I can do about it. In spite of that, I refuse to go to chiropractors. It has been suggested to me that chiropractors can cure my asthma. My response? Hah! Nope.
But I do understand the temptation to go to someone who makes promises, and who might make you feel better for a little while. Still, you can get the same things at physical therapy, and it is at least more in line with the science.
@iknklast
That’s actually incredibly true. I was trying to structure my comment around at least one concession, that chiro isn’t all bad, that it’s rooted in something sensible… and I failed even at that! I still think it’s true that Chiro’s “patients” and practitioners both have good intentions, but I was too simplistic in throwing the problem at “doctors ignoring back problems.” Fair cop. I apologize.
Hear, hear. This is pure gold, and I back it 100%. Thank you, iknklast, for your honest rejoinder.
Thank you, Ophelia, for fixing my misspellings. :)
I always get a sinking feeling whenever I start to read a story about someone who has consulted a chiroquack, so it was a relief that NightCrow’s story ended without the patient being permanently disabled or killed. Thanks.
Chiroquackery is horribly dangerous. A combination of pseudoscientific theory about everything wrong in the body being caused by tiny misalignments in the joints, plus an enthusiasm for heavy-handed manipulation of joints, without understanding the structure and functions of any of the surrounding organs and tissues, has resulted in damage to nerves and blood vessels from which people have died.
I love physiotherapists. Physiotherapy is undoubtedly hard work – as a patient I have to pay careful attention to the physiotherapist’s instructions, and follow the exercises to the best of my ability – but the results are worth the patience and dedication required, because they are long-lasting. Some of my daily physiotherapy exercises were taught to me forty years or more ago; I only saw that physiotherapist twice. With a connective tissue disorder and autoimmune arthritis, I could have been reliant on a wheelchair decades earlier than I was, and even now I’m still able to use a stick to shuffle to the bathroom.
In my experience, doctors have been great (though sometimes only after decades) at figuring out what’s wrong; but it’s been nurses and physiotherapists who have helped me to work out how to live with the diagnoses.
@Artymorty – Why, thank you. :)
@NightCrow – We don’t have to deny that a chiropractor helped to deny that chiropraxis is any good, though. Lots of medicine proceeds by the fuck-around-and-find-out principle: someone chewing on a willow-twig notices that his toothache has eased; there’s folk-knowledge that artemesia helps with malaria; and eventually we figure out why. So it might be that there’re things that a chiropractor does that are helpful most of the time.
The problem arises when that helpful thing is misidentified, and then misapplied. Chiropractors think they’re a kind of medic, but in reality they’re just doing a diluted form of Brazilian Jiu-Jitsu.
Arty @ 6 – de nada!
Oof! Razor-sharp and delectable, Enzyme. Where have you been hiding all this time? I’m your new Stan.