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Jonathan Ward Elizabeth Caruso Engl 1102 10 April 2013

Medical Neurologist attacks Chiropractic Neurology legitimacy Memo: The article below is a response to an article written by a skeptical medical neurologist, Dr. Steven Novella, pertaining to the field of chiropractic neurology, more specifically the fields pioneer Dr. Ted Carrick. This article written below is in defense to the field of chiropractic neurology, and to the chiropractic profession as a whole to the repeated attacks it may receive as a result of skepticism. This is an effort to inform the informed patient about the dangers of taking one medical practitioners opinion at face value without either seeking a second opinion or looking at the underlying facts as to why their opinion is voiced the way that it is. Dr. Novella while he does voice his opinions, they are not based on scholarly research. His underlying motives are that of general skepticism towards alternative medicine, and the still lingering preconceived notion that chiropractors are quacks, a notion that was started by the American Medical Association. Novella, Steven. Chiropractic Neurology. Science Based Medicine. Blog. March. 2013. Web 25 February 2013. < http://www.sciencebasedmedicine.org/index.php/chiropracticneurology/>
Comment [BC1]: Where will this article be published?

In recent news the field of Chiropractic Neurology is gaining popularity with mainstream media, regarding its practitioners ability to heal their patient where other medical practitioners have been unsuccessful. The pioneer of Chiropractic Neurology, Dr. Ted Carrick, was featured

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on ABC news regarding his unorthodox methods. The media attention does not come without the responses of skeptics both from inside and outside the medical community. One such skeptic is Dr. Steven Novella, a Medical Neurologist, who holds a faculty appointment at Yale School of Medicine. Dr. Novella claims that because of the susceptible nature of neurological conditions Chiropractic Neurology treatments appear to work because they are heavily based on the effects of placebo. It would appear to the uninformed patient to heal them, while in reality being nothing greater than a trick (Novella par. 8). Dr. Novella also points out that the field does not base it approaches to treatment on [evidence based] research findings, and the validity of its approaches do not pass the rigorous standards of medical science (Novella par. 7,12). Few uninformed people would question the legitimacy of the article written by Dr. Novella; however, is the information presented based on scholarly sources, or is it merely an opinion of one [allopathic] physician? The Chiropractic Neurologist in question, Dr. Carrick, only treats patients who are referred to him by Medical Neurologist, once it has been determined by them that their treatments are not effective (or an alternate approach would be more effective). Why would Dr. Novella, be biased towards alternative approaches to treatment? While his education and resume are extravagant, from attending medical school at Georgetown University to completing his residency at Yale, where he now teaches, Dr. Novella could be consider the crme of the crop of the medical profession. However, he has become very involved in a skeptic movement towards the debunking of alternative medical methods. He is the President of the New England Skeptics Society (ww.theness.com), a society dedicated to the revealing of medical practices that are [as those members claim] pseudoscience. A science that is not firmly based on research studies published by scholarly researchers, or is contradicting thereof. In performing research, researchers conduct studies in a way to eliminate their own
Comment [BC2]: You have given a few terms in brackets that are not labeled as being parts of larger quotes. What is the function of brackets such as these in your text? Comment [BC3]: Is this fragment referring to pseudoscience?

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personal influence over the outcome of the study. Called the experimenter-bias, researchers can influence the study by simply wishing a certain outcome of the study, and may subconsciously attempt to skew the data to achieve the desired outcome. Given the mindset Dr. Novella holds as a skeptic, it could be argued that he has experimenter bias towards the field of Chiropractic Neurology. Wanting the field to be pseudoscience before he analysis the field, could influence the opinions he expressed in his article, and to him it may very well appear to be full of smoke screened treatments. Why would it appear that Dr. Novella has hard feelings towards Chiropractors? Aside from the influence of skepticism Dr. Novella had when writing this article, his professions lobbying body the American Medical Association (whom he is a member of) has a history of strongly discriminating against the Chiropractic field. In 1976 a lawsuit was filed, by several Chiropractors, in Federal Court against the A.M.A for conspiring against Chiropractors. The association strongly urged its practitioners to not work with them on a professional level, because the A.M.A felt as though the field was illegitimate. The presiding Judge over the case Judge Getzendanner stated the conspiracy as systematic, long-term wrongdoing and the longterm intent to destroy a licensed professionlabeling all chiropractors unscientific cultists and depriving chiropractors of association with medical physicians, injury to reputation was assured by the A.M.A.'s name-calling practicewith the function to destroy the Chiropractic Profession (Getzendanner, New York Times). The Judge ruled in favor of the Chiropractors who brought about the lawsuit, and noted that the A.M.A did have a committee on quackery since 1962. This committee was tasked with a similar task to that of the New England Skeptics Society, seeking out and debunking alternative methods of care that were deemed by their association to be inadequate. However, in a country run by capitalism, it is not startling to find that such a highly
Comment [BC4]: Analyzes?

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regarded organization would seek to knock out the competition if they felt threatened, and these hard feelings may very well still linger as evident in Dr. Novellas article. For a large part of American history, Medical Doctors, have been the sole providers of health care and the most common medical practitioners who were unchallenged until Chiropractic Medicine. Mixers vs. Straights Challenged and won against the American Medical Association was a profession that seemed divided amongst its beliefs. Still in todays era it is divided among its practitioners belief and philosophies, though that divide is fading with the movement towards evidence based practices. Dr. Novella points out this divide (Novella, par 1), and capitalizes on the beliefs that are held by the minority of Chiropractors, beliefs that have not been proven completely by science. Those are the beliefs held by straight Chiropractors. In Chiropractic Medicine you have Mixers, and Straights. Mixers are those Chiropractors whos approach to medicine are evidence based-more closely associated with Medical Doctors. Hence why they are called mixers because they mix the philosophies of original Chiropractic, with evidence based medical science. These are the majority of the field. Few practice today as straight chiropractors who still hold true to the original philosophy of the founder of Chiropractic Daniel Palmer. Palmers methods are highly controversial and very easy debunked with modern physiological processes of the central nervous system. Still, some swear by the methods and practice by it; however in Novellas article he makes claims that Chiropractic Neurology treats their patients the same way as Straight Chiropractors in an effort to make Chiropractic Neurology seem illegitimate (Novella, par. 3). Chiropractic Neurology is an evidence-based field and Dr. Carrick treats his patients with an evidence-based approach, and does not hold to the same beliefs as straight Chiropractic.
Comment [BC7]: You might want to combine the ideas in these sentences to make the writing here clearer and a bit more succinct. Comment [BC6]: Word form Comment [BC5]: Im not sure I understand what youre saying here, due to the sentence structure.

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Research, Research, and More Research At the time that straight chiropractic was developed, and well chiropractic medicine in general, our understanding of the way the nervous system worked was very premature to our understanding of it now. In the late 1800s our understanding of the nervous system was about a simple as understanding how to pull an object with a rope or single piece of string as the form of communication between you (the brain), and the object being the body part. Nowadays we understand that the nervous system is far more complex and it is more of a spider web of strings with complex processes used to move that object. With our advances in research, and in how the body functions, it is evident that straight chiropractic is outdated hence the movement towards mixers. This also holds true for Dr. Novella and his medical doctors, for their understanding of medicine in the late 1800s was just as premature then as compared to now. Nowadays medical practitioners do not perform blood-letting procedures, and the germ theory is outdated. Given that medical doctors do not practice the same way now as they did then, yet they are not criticized for practicing now as they would have in the late 1800s. It is understood by researchers today that the underlying causes of disease processes are more so related to immunoendocrinology and psychoneuroimmunology (Barwell, par 9). Given the wealth of medical knowledge that is vastly known today as compared to a hundred years ago, why then does Dr. Novella focus on the practices of the past when seeking to analyze Chiropractic Neurology? Could it be that Dr. Novella seeks to make his argument against the profession strong therefore focuses on the past or the practices of Chiropractors that is not held by the majority? The sources Dr. Novella uses for his information regarding Chiropractic Medicine are not scholarly sources, or medical book sources. As an example, he includes a definition of straight chiropractic in his article and his source for the definition was a
Comment [BC9]: Although you give an example below, it may help make your point if you give a quick indication of the types of sources he does use. Comment [BC8]: Conversational

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website titled chiropractors.org. However, when visited the site offered no such information, and merely was a site utilized to find local practitioners. Chiropractors publish their medical knowledge in medical books, even the knowledge regarding straight chiropractic is published in chiropractic textbooks. Why is it that Dr. Novella does not utilize these textbooks when giving a definition of the field, or a more legitimate source when attempting to inform the public on the legitimacy of a field? Dr. Novella argues that Dr. Carricks approach to treatment is not based on research, that chiropractic neurology is not based on research, and that the chiropractic profession as a whole is not based on research. Dr. Carrick is a pioneer of the field, and does seek to produce research related to neurology not just in terms of chiropractic medicine but in terms of neuroscience as a whole. Carrick owns an institute dedicated to the study of this field and to producing findings directly related towards treatment, www.frcarrickresearchinstitute.org. Placebo effect? Modern research has found through clinical studies, that patients claim to be healed or cured, despite the fact that no real medical treatment was given, the patients were just under the influence that they were receiving medical treatment for the particular condition. This is called the Placebo effect, and it is equivalent to giving someone, who complains of a headache, a sugar pill and stating to them that it is Tylenol. Through the power of believing it will work, their headache is cured. This is the placebo effect that Dr. Novella, and others, have criticized chiropractic neurology treatments being nothing more than giving the fact that [according to medical neurologists] neurological conditions are highly susceptible to placebo effects. In the interview with the ABC News reporter, Dr. Carrick does not deny the possibility of placebo, however he challenges the assumption by arguing that if the treatments are working

Comment [BC10]: This phrase seems to invoke you, which will be awkward for the reader, since you do not use yourself throughout the article.

Comment [BC11]: This sentence is a bit wordy. Is there a way that you could condense it?

Comment [BC12]: This paragraph seems to nd make its point in the 2 sentence, but then this third sentence sees to beg a close of the paragraph.

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because of this effect then their utilization of it is very good because they are seeing the same clinical results in patients every time (Carrick, ABC News report). Medical neurologist are not immune to the same possibilities of placebo effect as chiropractic neurology is not, yet medical neurologist argue different because they are regulating the neurological symptoms through the use of medication. One could argue through placebo that those medications have no greater of an effect on the regulation of those symptoms any more than a sugar pill would have as long as the patient believed. In conclusion Despite the reality of the possibility of the placebo effect, or the legitimacy of the research being published and the informed manner a practitioner approaches treatment, the informed patient should always seek to obtain second opinions when considering treatment for unusual conditions, especially neurological conditions. Dr. Novella is one medical practitioner with one opinion that does appear to be skewed given his history of being a skeptic and his feelings towards alternative medicine as a whole. Chiropractic Neurology is a licensed specialty and its practitioners do receive referrals for treatment from medical neurologist.
Comment [BC14]: You might want to consider changing up the structure of this paragraph. The first sentence doesnt seem to tra nsition well from what you have been talking about, and that first sentence also sounds like a concluding sentence. Comment [BC15]: Jonathan, You have a very strong article here, and it is certainly evident that you are an expert in this field and that you have worked a great deal on the writing itself. I would have to say that this article was quite an interesting read, and even though I am not invested in this field, the ways in which you discussed the subject matter held my interest. Overall, I think you have done a great job with this project, and I would love to keep a copy of it as an example. Please let me know if this is ok with you. As you look to revise, I would suggest that you continue to work on the sentence level to be sure that you eliminate wordy sentences and those that may be long and winding. You have quite a few, and when a reader gets to one, he or she will need to read it a few times to understand the idea. Also, be sure you read over your paper out loud, so you will be able to catch the more minor mistakes. You mentioned in your note that you wanted help with grammar also. I didnt see too many grammar mistakes, but I did see many instances in which you left out or improperly used commas. You may want to review the rules of commas (which I can get to you if youd like) so that these punctuation marks can correctly cue your reader as to when to pause and separate ideas. Let me know! -Ms. C Comment [BC13]: You mention the idea of the placebo effect very early on in your work, and it seems awkwardly placed here at the end. Is there a way that you could move up this discussion? Its a discussion worth having toward the beginning.

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Works Cited Barwell, Richard. Neurologically Based Chiropractic. Chiroeco.com. Jan. 2011. Web 1 April 2011 <http://www.chiroeco.com/news/chiropractic-news.php?id=10731> Chang, Juju Chiropractic Neurology: Miracle Method or Placebo. ABC News Report. 18 August 2012. Web 10 April 2013. < http://abcnews.go.com/Nightline/video/chiropracticneurology-miracle-method-placebo-17032877> Novella, Steven. Chiropractic Neurology. Science Based Medicine. Blog. March. 2013. Web 25 February 2013. < http://www.sciencebasedmedicine.org/index.php/chiropracticneurology/> N.P. U.S. Judge Finds Medical Group Conspired Against Chiropractors. New York Times Health. New York Times. 29 August 1987. Web. 19 March 2013. < http://www.nytimes.com/1987/08/29/us/us-judge-finds-medical-group-conspired-againstchiropractors.html>

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Pre Research Writing The purpose of my piece is to inform the chiropractic patients about the legitimacy of those who attack the profession, and to not take someones opinion on face value. I will need research from legitimate sources to fulfill this purpose I understand a lot of the stuff that is talked about in the article I am responding to. I may need to research more on germ theory and the history of Chiropractic Medicine. I do know why this article came about, it was in response to a news report. Also I would need to look into reasons as to why Dr. Novella felt compelled to write this article in the first place, to really bring things full circle. I need to research more about the background of Dr. Novella, along with more about Chiropractic Neurology For intro, same as above My intended audience is the informed chiropractic patient, and this article would be published in a chiropractic magazine or health magazine My unintended audience could be chiropractors, medical doctors, and someone who just so happens to pick up the magazine and read the article. The unintended audience could get confused as I do not elaborate on the terminology used in this article, given that the informed chiropractic patient would already know the terminology.

Comment [BC16]: