The Philosophy of Profit over People

“Don’t borrow trouble” is an idiom that means don’t worry about something before it is time to worry about it. This is especially true when a chiropractor wants to take X-rays of your low back. An x-ray is incapable of diagnosing nonspecific low back pain and seeing degenerative changes only extends the length of the care plan, not the type of care provided. Unless there is justified concern of an underlying pathology, like metastasis, it is in the patient's best interest to reject the x-ray and move on to the adjustment.

“Straight” and "Mixed" chiropractors often use evidence for best care practices to increase profit at the cost of patient health. They are ignoring evidence-based advocacy guidelines for patient care while profiting from the rationale of those recommendations for profit.

The guidelines

According to the guidelines from The American College of Physicians and Pain Society, imaging studies are only appropriate when severe or progressive neurologic deficits are noted, or if an underlying pathology is suspected. The use of x-rays, or any routinely obtained imaging is not recommended.

The Rationale

Pain science is changing our understanding of pain. “It’s all in your head” is now a working diagnosis. Pain is always a construct of the mind and that complicates diagnosing and treating chronic pain conditions. Nociplastic pain in combination with ongoing nociceptive or neuropathic pain can be exacerbated by images of disc degeneration, spondylosis and spinal osteoarthritis which are often asymptomatic.

Multiple studies have shown that disc degeneration, bulge, protrusion and annular fissures are common and often asymptomatic. A systematic literature review found that the prevalence of disk degeneration in 3,110 asymptomatic individuals was around 37% of 20-year-olds and 96% of 80-year-old individuals. Disk bulge, disk protrusion and annular fissure were also common in both younger and older pain free individuals.

A study published in 2013 found that low back pain patients that received imaging studies early in care, despite guideline recommendations, were associated with worse outcomes. The study concluded that early imaging provides no benefits, worse outcomes and could result in unnecessary medical procedures.

Early imaging has been associated with greater acute care costs and less favorable patient outcomes. Apparently being shown “evidence” of something wrong increases pain and the amount of money spent on treatment.

No brain, no pain: it is in the mind, so test results can make it worse (theconversation.com)

Profiting from the Rationale

This is how x-rays can be used to “certify necessity for care” and “support long-term chiropractic treatment plans.” Research findings and a better understanding of pain science is influencing medically inappropriate diagnostic studies that are entirely profit-motivated.

Chirotouch offers a webinar on “how to effectively apply the tool of x-ray imaging to your daily practice” (routine). This type of instruction disregards evidence-based advocacy guidelines for patient care while exploiting the rationale of those recommendations for profit.

Mark Studin, FASBE(C), DAAPM, lacks the necessary credentialling to provide qualified professional instruction on radiographic diagnosis. The illegitimacy of the presenter is further clarification of the medically inappropriate, profit motivated nature of this instruction.