Confessions of a Quackbuster

This blog deals with healthcare consumer protection, and is therefore about quackery, healthfraud, chiropractic, and other forms of so-Called "Alternative" Medicine (sCAM).

Tuesday, November 15, 2005

The Manipulable Lesion -- A Chiropractic Rose By Any Other Name (Part 1)

An entry in a recent exchange on the Healthfraud Discussion List is worth sharing. I have partially anonymized it. It is written by ex-chiropractor John Badanes, DC, PharmD (more about him later). He comments on some remarks by a chiropractor (Dr. P) who is currently a professor at a chiropractic school:

The Manipulable Lesion -- A Chiropractic Rose By Any Other Name (Part 1)

> Dr. HH wrote:
>> Dr. P recently told us that chiropractic is giving up their old
>> definition of "the subluxation" and is using the new term "the
>> manipulable lesion." Isn't this circular reasoning? If we can
>> manipulate it, it's a manipulable lesion; a manipulable lesion is
>> what we manipulate. Isn't this just an excuse for chiropractors to
>> manipulate whatever they want to manipulate?

Why, yes, it most certainly is, at the VERY least ... ahem ... "circular" Dr. HH. And, speaking of going in chiropractic circles, this isn't the first time we've covered THIS particular chiropractic weaselism, "a Vertebral Subluxation by any other name" --and with Dr. P, no less.

From only eighteen months ago, submitted to the HF list ...

>>> Dr. P, DC:
>>> The subluxation is just a name for a manipulable lesion

I think you got it backwards, Dr. P. Didn't you mean to say that a "manipulable lesion" is just another name for a "subluxation?"

Really, you've got to be kidding. Unless this "lesion" is defined as something more specific than one that chiropractors identify and treat, you might as well call it "macaroni." You mean, for example, that the wide range of chirodigms used by chiropractors are being used to treat NON-manipulable lesions? Colloquializing a chiropractic diagnosis into a "spinal boo-boo" is just as lame since it ALSO allows for any and everything that a chiropractor thinks, says, or does. In case you hadn't noticed, "spinal dysfunction" is JUST as silly since this, too, can be defined "prn" from office to office.

You're giving new meaning to the expression "going nowhere fast" if the "manipulable lesion" is what you're here to tell us. In other words, where's the beef in all this rumored chiropractic reform movement you keep insisting exists despite all evidence to the contrary? Chiropractors still can't tell us what it is they treat. If it's "sprain" and "strain," for example, why not just say so? Or, would that blow the chiropractic cover by making the profession look too much like physical therapy?


And, even more recently, forwarded to the HF list from the bowels of a Real Chiropractic Forum, still another effort made to explain to Dr. P exactly what is so imbecilic about any of the more "modern" weaselisms he offers of chiropractors treating "a Vertebral Subluxation by any other name."

Dr. P is a chiropractor, in case you hadn't noticed :')

Anyways, you may (or may not) recall the following ...

>>> Dr. P, DC:
>>> And despite the fact that my student believe that my preferred
>>> method of treatment is stretching, I have not found "stretching
>>> stretching, exercise, and/or heat modalities to a "stuck" motion
>>> segment" to be effective in helping what I believe was a joint
>>> motion dysfunction (subluxation).

Just a note to remind you that using the term "Subluxation" makes chiropractors sound very stupid. For example, why not just say "joint motion dysfunction" (above) and leave it at that? That's stupid enough and _still_ very "chiropractic"; but it BEGINS to specify what you're saying so as not to include EVERY known chiropractic imbecility currently taking refuge in the word, "Subluxation." If you want to say "Subluxation" in private, I suppose that's your business. But, do your bosses at B [school] insist you talk like this -- parenthetically reminding everyone that it's the Chiropractic Subluxation you had in mind?

What I'm saying should not be dismissed as "just semantics," Dr. P, and I'm going to be very irritated if you, like any other chiropractic meatball, suggest, in any way, that it is. "Words" actually MEAN things and have meaning for those with whom you're talking. One of their main functions is to communicate and convey meaning such that the people "at the other end" KNOW what you're saying. The term "Subluxation" means so MANY things and has so many "meanings" that it effectively _means_ nothing. In other words, it is a meaningless diagnosis because it can be anything any chiropractor wants it to be. Is THAT what you impart to your students at B -- meaningless diagnoses? Or do you teach something SPECIFICALLY meaningless like "The B Subluxation Model of the Manipulable Lesion?"

It doesn't even matter that you, in the privacy of your own mind "know what you're talking about" when no one else does. Of course, the same "goes for" the term "Adjustment" -- since, like a chiropractic horse and carriage, the imbecility known chiropractically as a "Subluxation" is remedied in the chiropractic office by its complementary imbecility, "Thuh" Adjustment." A Chiropractic Adjustment *means* anything that treats a Chiropractic Subluxation, doesn't it. You see the problem ... and it's not just "semantics." A "manipulation," for example, is not an "Adjustment" any more than Mennell, Cyriax, Fisk, and Grieve are chiropractors. So the convention I've seen you and other chiropractors use -- "manipulation (adjustment)" -- suffers similarly and for the same reason as, for example your diagnosis of "joint dysfunction (subluxation)" does.

Now, we've talked about this before, so you'll have to tell me which part you (or I) didn't understand. Be careful, though, about rationalizing your use of the term. You will be adding insult to injury.

>>>> Dr. P, DC:
>>>> However, I believe these muscular problems to be independent
>>>> of the manipulable lesion (subluxation).

So, it's a "manipulable lesion" that distinguishes the Subluxation, is it. More baloney, Dr. P. Stop talking in chiropractic code. Do something to CLARIFY chiropractic things instead of colluding with lumpen chiropractors to cloud the biomedical issues. "Mushy" talk implies "mushy" thinking and you're talking "mush" when you say, "Subluxation" as though it actually means something to anyone but yourself. Speak english, not "chiropractish" if you want others to know what you're saying.

It would be one thing if "Subluxation" was some sort of in-house professional jargon used by chiropractors to talk with other chiropractors when they're sitting around a chiropractic campfire. The problem is, that not even other CHIROpractors know what you're saying. In that case, why not call it "macaroni?"

Honestly, I don't think you and other chiropractors appreciate how counterproductive it is to use the term "Subluxation," except when you're describing something that is UNIQUELY "chiropractic." In that case, it's appropriate, I guess, since more than anything I can think of, it's the "Subluxation" and its "Adjustment" that quickly identifies the chiropractor in any given line-up of quacks. On the other hand, I just finished reminding you that the term is meaningless mush, even _among_ chiropractors. Do you see the problem, then?


John Badanes, DC, PharmD
LCCW '84, UCSF '97

Read Part Two:

To see Dr. Badanes in action, check this out:

Adjusting the Joints: Video - PBS
Go to the "Adjusting the Joints" section. Then turn on your speakers and watch the video.

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