Chiropractic Internist: A “specialty” to avoid

Real internists train in hospitals and clinics. “Chiropractic Internists” train at The Embassy Suites.

Chiropractors have created a “board certified” specialty called “chiropractic internist.”  We’ve met the “chiropractic internist” before on SBM, as one iteration of the “DC as PCP,” an attempt by one faction within the chiropractic industry to refashion themselves as primary care physicians. For the sordid history of that effort, you can read the posts listed here, which covers the internecine battles between various groups of chiropractors over education, prescription privileges, scope of practice and various other public hangings-out of chiropractic’s huge pile of dirty laundry.

While the chiropractic internist is not new, the American Chiropractic Association (ACA), chiropractic’s largest industry association, has created a shiny new website to promote it. This effort is bolstered by recent attempts to expand the chiropractic scope of practice beyond back cracking and the ACA’s ongoing attempt to get what is essentially the chiropractic practice of medicine covered by Medicare. So, today we take a closer look at “chiropractic internists” and their PR campaign to fool the public into thinking they are real internists who can effectively diagnose and treat real diseases.

The ACA’s new “chiropractic internist” website is headlined with a shot across the naturopathic bow:

“Natural primary care.” Sound familiar? Naturopathic “medicine,” is, according to one of its proselytizers,

a distinct system of primary health care that emphasizes prevention and the self-healing process through the use of natural therapies.

In other (unsaid, but certainly implied) words, naturopathic “doctors” are licensed or regulated in only a handful of states, but “doctors of chiropractic” and “chiropractic physicians” who practice “natural primary care” are licensed in all 50 states. Take that, naturopaths!

But that’s nothing compared to the way they take on medical doctors. If that was a shot across the bow, this is a direct aim at the medical profession:

Such as?

They seem particularly concerned that you might not think they know enough about testing to diagnose “this vast amount of other diseases,” hence:

And, of course, they feel compelled to repeat that famous CAM canard and “vile, false accusation” that, while medical doctors treat only symptoms, chiropractors get to the “root cause” of your problem.

Actually, as we shall see, that’s not exactly how “treatments provided by Chiropractic Internists differ from standard medical care.”

Who’s behind all of this?

The “chiropractic internist” is the creation of the American Chiropractic Association (ACA), the largest of the chiropractic trade associations. The “Council on Diagnosis and Internal Disorders,” (CDID) is one of the ACA’s “specialty councils.” (Others include neurology and pediatrics.) According to its bylaws, the CDID “functions as a subordinate arm of the ACA” and “must act pursuant to and in conformity with ACA policy.” To help the ACA keep tabs on what it’s doing, the CDID must submit “activity reports” and its budget to the ACA.

“Board certification” as a “chiropractic internist” is bestowed by the American Board of Chiropractic Internists (ABCI), and being “board certified” permits one to call oneself a “diplomate” of the ABCI and use the initials “DABCI” after one’s name. However, ABCI is not a separate entity (as the term “Board” would imply); rather, it was established by and operates under the auspices of the CDID, and therefore the ACA. The Board consists of four chiropractors selected by the CDIC and it, too, must submit regular reports to the ACA.  The Board recommends education and training courses for “diplomate” status as a “chiropractic internist.” The CDIC’s bylaws prohibit the Board’s decisions from conflicting with the ACA’s “Master Plan” and the ACA “administers and coordinates the activity of the DABCI post-doctoral specialty.” In sum, the whole operation is firmly in the control of the ACA.

With that in mind, let’s look at this “education and training.”

A company called ProHealth Seminars is the only ABCI-authorized course provider. According to public records, ProHealth Seminars is a Missouri limited liability company registered under the names of Jack Kessinger, a chiropractor, and Virginia Kessinger, presumably a relative. These two are also registered as the managing members of another company, Clint Publications, which publishes a journal of sorts for the “chiropractic internist,” called “The Original Internist.” (There is also a Florida outfit listed as a provider, but its website is down and it does not appear to be active.)

ProHealth’s DABCI seminars are taught in five U.S. cities, two of them in Missouri, where Jack Kessinger practiced. (He passed away in 2011.) The 300-hour seminars take place on 26 weekends, one seminar per month, 9 AM to 6 AM on Saturdays and 9 AM to Noon on Sundays, for a little over 2 years. (There’s also a 100-hour “certificate of completion” course.) Each costs $395 if you register early. With two exceptions, all classes are held in either an Embassy Suites Hotel, an Airport Sheraton, Airport Hilton or Hilton Garden Inn.  The 100-hour “certificate” course and a “Pelvic Workshop” ($750 in advance), which is required of all seminar participants, are held at the National University of Health Sciences, which grants degrees in chiropractic, naturopathy, acupuncture and massage. The “Pelvic Workshop” (“The Natural Approach to Family Practice”) is advertised as “24 Hours and Hands On,” although the flyer doesn’t say whether that means actual live patients or some sort of medical mannequin.  Why the DABCI feels only pelvic exams warrant clinical education is a mystery. In any event, to become a “diplomate” you’ll have to shell out over $10,000 for these courses, not including meals and lodging.

All seminars are identical in topic and faculty, each registration handout changing only the location and the dates. Whether they are live or video presentations, or a combination, is not clear. Whatever their format, each 12-hour weekend covers a topic (or topics) that would ordinarily consume weeks of education and training in a real internal medicine residency. For example, “Infectious Diseases and Emergency Disorders” is covered one weekend, as is “Geriatrics and Mental Health.” Cardiovascular Disease? 12 hours. Pulmonary Disease and Lung Function? 12 hours. Dermatology? 12 hours. And so on. References to dubious diagnostics and treatments are sprinkled throughout the course titles (again, 12 hours each): “Allergies, Sensitivities and Autoimmune Response,” “Detoxification and Diagnosis of Hepatic and Renal Systems,” and “Pharmacognosy – Utilizing Botanicals in a Functional Practice,” or, as we know it, Functional Medicine.

[By way of comparison, you can see what a real, three-year internal medicine residency looks like here. In contrast to the DABCI’s 300-hour course, here’s an internal medicine resident’s account of her first year, during which she worked 3,000 hours.]

Almost half of these courses (11 of 26) are taught by Robert Kessinger, Jack’s grandson, and, along with his father, Jack’s former chiropractic practice partner in Rolla, Missouri. Robert is either a medical genius or way out of his depth. He teaches “Foundations of Chiropractic Family Practice,” along with “Natural Strategies in Laboratory Testing,” as well as the courses covering allergies, endocrinology, blood tests (including tumor markers), infectious diseases, emergency medicine, diseases of the arterial system, geriatrics, mental health, neoplastic diseases and cancer and review of systems, history and physical exam.

Robert’s breadth of medical knowledge, or lack thereof, is closely matched by Darren Kirchner, a Kahoka, Missouri chiropractor, who teaches eight of the courses, including “Gastrointestinal Health and Protocols for a Healthy Gut,” cardiovascular disease, “detoxification,” differential diagnosis, and neoplastic disease and cancer (second course). ProHealth Seminars thankfully devotes 24 hours to the important topic of cancer, the only topic besides pelvic health for which the company offers more than one weekend of instruction.

Robert practices “upper cervical chiropractic care,” which is a variant of straight subluxation-based chiropractic. He refers readers of his blog posts to the National Vaccine Information Center, the notorious anti-vaccination website. A PubMed search reveals that he has published all of two case studies, both in a chiropractic journal and both claiming to have diagnosed upper cervical subluxations, with repeated x-rays and a thermocouple, in one patient with vertigo, hearing loss and tinnitus, and another with trauma-induced kyphosis (22 office visits). Needless to say, he claims treatment was successful. He’s also published in pseudoscientific fluff like the Journal of Vertebral Subluxation Research and says he’s “active in multiple Upper Cervical Research projects in conjunction with multiple clinics.”

I couldn’t find anything Kirchner had published. Nor could I find that either holds a faculty post at any educational institution. Just what might qualify either of them to teach such a breathtaking range of medical topics is another mystery I assume only the ABCI and the ACA could explain.

If you manage to finance, and find the time for, the ProHealth Seminar courses, you are eligible to sit for the ABCI exam, administered by the National Board of Chiropractic Examiners. It consists of 200 multiple choice questions and lasts 3 ½ hours. If you get 75% right, you pass.  There is also a practical exam consisting of “several stations, including but not limited to male examinations, female examinations [and] Regional physical exam . . .” (Again, the creepy emphasis on examining females.) Finally, there is a (yes, one) case presentation.

And it shows

This skimpy education and training shows in their practices. Judging from the websites of “board certified chiropractic internists,” their practice looks a lot like the practice of a naturopathic “doctor”: dubious diagnostic testing and and plenty of dietary supplements, all “proven” with a big dose of testimonials.  Here are some examples:

• Infrared sauna for “detoxification”  (“detoxification” is a bogus concept)
• Treatment of “leaky gut” (a real thing, but not the way CAM practitioners think)
• ALCAT “food sensitivity” testing (no predictive value in the diagnosis of allergy or intolerances)
• Homeopathy (“the one quackery to rule them all“)
• Treatment of “chronic candidiasis” (not a real disease)
• Breast thermography for cancer screening (not evidence-based and not recommended by experts)
• “Functional” lab testing (a part of Functional Medicine)
• Functional medicine
• Hair analysis (bogus)
• Selling dietary supplements to patients (huge conflict of interest)
• Substandard treatments for hypothyroidism (pseudoscience)
• IgG food allergy testing (not predictive)
• Salivary tests for hormones (not reliable)
• MTHFR genetic testing (a real thing but not the way quacks use it)
• IV nutrient injections (e.g., Vitamin C) (not evidence-based)
• Hyperbaric Oxygen (CAM practitioners go beyond limited evidence-based uses)
• Lab tests for heavy metals and “toxins” (quackery)
• Stress-Adrenal “Burnout” (not a real thing)
• “Wellness Blood Testing” (another way of saying “functional medicine” testing)

How is this even legal?

If you are wondering how chiropractors can deceive patients with unvalidated testing, quack diagnoses and worthless treatments, look no further than your state legislators. To legally pull off this make-believe internal medicine practice, chiropractors need certain elements in their practice act: the right to use diagnostic testing and to offer “clinical nutritional” advice in the form of recommending (and, better yet, selling) dietary supplements and homeopathic remedies. Dietary supplements include not only vitamins and minerals, but also herbal remedies (that is, unpurified and unproven drugs) and glandulars (dessicated animal organs). These seemingly innocuous rights to perform diagnostic testing and give clinical nutrition advice can be parlayed into a perfectly legal “chiropractic internist” practice, even if one doesn’t go to the trouble of getting board certified. Even better is a provision allowing them to use all diagnostic and treatment procedures “taught by chiropractic colleges.”

Ohio is a recent example of how chiropractors are expanding their scope of practice to include an ersatz form of primary care. Ohio defines the practice of chiropractic as

utilization of the relationship between the musculo-skeletal structures of the body, the spinal column, and the nervous system in the restoration and maintenance of health, in connection with which patient care is conducted with due regard for first aid, hygienic, nutritional, and rehabilitative procedures and the specific vertebral adjustment and manipulation of the articulations and adjacent tissues of the body.

Sounds like traditional, subluxation-based chiropractic, right? But the Legislature gave jurisdiction over chiropractors to a State Board of Chiropractic, including the authority to enact rules governing chiropractic practice. The Board, which is made up of four chiropractors and one public member (a lawyer), by enacting a regulation, magnanimously interpreted the chiropractic scope of practice to include

the use of such diagnostic and treatment procedures as are taught by board approved chiropractic colleges except as prohibited by law and/or the rules of this board.

As long as a chiropractic college teaches a particular diagnostic or treatment procedure, and the Legislature or the Board hasn’t prohibited it, it’s legal. And what has the Council on Chiropractic Education said that all schools must teach students?

[to] practice primary health care as a portal-of-entry provider for patients of all ages and genders focusing on the inherent ability of the body to heal and enhance function without unnecessary drugs or surgery.

The State Board of Chiropractic, in its approved continuing education courses, supports this view that chiropractic practice extends far beyond musculoskeletal conditions. Courses include:

Endocrine System: “Overview of all hormones with special focus on estrogen dominance, metabolic syndrome, adrenal fatigue.” (Adrenal fatigue is a fake disease invented by naturopaths.)

Nutritional Support for Chronic Fatigue Syndrome

Chiropractic and Pregnancy, including how to recommend homeopathic remedies and herbs for pregnant patients.

In 2016, just to make sure, chiropractors got the Ohio Legislature to pass a bill authorizing chiropractors to administer, sell and provide advice regarding dietary supplements, homeopathic remedies and non-prescription drugs “to restore and maintain health.”

So, in bits and pieces of legislation and regulations, Ohio chiropractors have cobbled together a legal framework that takes them far beyond detecting and correcting subluxations into what is essentially primary care practice, just “without drugs or surgery.” This strategy is repeated in other states.

The ACA, for its part, is heavily lobbying Congress to expand Medicare coverage of chiropractic so it will, as the ACA cryptically says,

allow doctors of chiropractic (DC) to perform to the fullest scope of their license in Medicare. . seniors are being denied the full range of chiropractic services that could help them lead healthier and happier lives.

The ACA doesn’t explain what the “fullest scope of their license” or what the “full range of chiropractic services” might be, but you can bet their “Chiropractic Internists” want a part of the publicly-funded pie.

The average state legislator probably has little idea what seemingly innocuous bills allowing chiropractors to give “clinical nutrition” advice to “support and maintain health” or practice diagnostic methods and treatments “taught in chiropractic colleges” really mean.  They likely think of chiropractors as “back doctors,” along with the rest of the public. That ignorance results in poorly educated and trained “chiropractic internists” who prey on the sick and worried well with their quack diagnoses and dubious treatments.

from Science-Based Medicine http://ift.tt/2idiGu8