$545 million wasn't enough for chiropractors. Now they're lobbying Congress for much more.

Medicare currently wastes more than $545 million a year on chiropractors, as I revealed in an article last year. Wasteful as this is, it's not enough for chiropractors, who have successfully lobbied to have two Congressmen propose a new bill, HR3654, that will require Medicare to pay chiropractors for the full range of services that real doctors offer.

The American Chiropractic Association is practically rubbing its (metaphorical) hands together with glee. As they proudly point out, this endorsement of quackery is bipartisan: the bill is sponsored by two New York Congressman, Democrat Brian Higgins and Republican Tom Reed.

The idea of having chiropractors function as regular physicians is very troubling. Chiropractors do not receive proper medical training: they get their Doctor of Chiropractic (D.C.) degrees from one of a very small number of special chiropractic schools, which do not provide the full medical training that real medical schools do. Their curriculum also includes a heavy dose of pseudoscience, especially the training around subluxations.

For a detailed discussion of why chiropractors are not competent to be family physicians, I recommend this article by an experienced physician, Dr. Harriett Hall, titled "Chiropractors as family doctors? No way!" Dr. Hall goes into considerable detail explain why many of the medical practices of chiropractors are non-standard, not evidence-based, and possibly harmful. Or see this lengthy takedown of chiropractic subluxations by Sam Homola, a former chiropractor.

Many chiropractors are also anti-vaccine, unfortunately, as documented just two weeks ago in this article by attorney Jann Bellamy. Among other things, Bellamy points out that a major chiropractic conference this fall will feature a keynote talk by anti-vaccine activist Robert Kennedy Jr. (about whom I've written before).

Even more alarming, as I've explained before, is that chiropractic neck manipulation has been shown to carry a small but real risk of stroke, because it can create a tear in your vertebral arteries. For example, this report from 2016 documented a case of cerebral hemorrhage apparently caused by chiropractic manipulation. The patient in that case was a 75-year-old woman, which puts her squarely in the class of patients eligible for Medicare.

And to those chiropractors who've read this far: I'm sorry that you were hoodwinked into spending 3-4 years in a chiropractic school, paying nearly $200,000 in tuition and fees, with the promise that you'd be a legitimate medical professional. You were scammed, and I'm sorry about that. And I understand that most (perhaps all) chiropractors want to help their patients. The problem is, the training offered by chiropractic colleges is far short of a proper medical degree.

If the chiropractors' lobbying association get its way, this $545 million (annually) in wasted Medicare dollars will soon become a far higher amount–to the detriment of patients. The bill will allow chiropractors to bill Medicare for pretty much any service that a bona fide physician offers.

It's also worth noting that in 2018, Medicare's Inspector General issued a report titled "Medicare needs better controls to prevent waste, fraud, and abuse related to chiropractic services," which revealed that almost half of Medicare spending on chiropractic care from 2010-2015, between $257 million and $304 million per year, was likely wasted or fraudulent. One wouldn't think this is a time to expand Medicare's coverage of chiropractic.

Congress, don't be fooled by arguments that this proposed new law will lower medical costs, or give patients what they need: it won't. Instead, it will dramatically increase the amount of funds wasted on ineffective treatments. The U.S. does need a better health care system, but this bill would be a big step in the wrong direction.

Hey, NY Times: Keep your hands off my smoked salmon

For lovers of smoked salmon, the New York Times featured an alarming headline last week: "Do Lox and Other Smoked Fish Increase Cancer Risk?" The article reported that the American Institute for Cancer Research, a respected nonprofit organization, considers smoked fish (including lox) to be in the same category as "processed meat." The Times answers its own question with "it might."

The Times is wrong. If anything, smoked salmon is good for you. Let me explain.

Where does the concern come from? In 2015, a major report from the International Agency for Research on Cancer (IARC) concluded that red meat and processed meat probably cause cancer, especially colon cancer. To be precise, they wrote that

"there is sufficient evidence in human beings for the carcinogenicity of the consumption of processed meat."

And what, you might ask, is processed meat? According to the IARC:

"Processed meat refers to meat that has been transformed through salting, curing, fermentation, smoking, or other processes to enhance flavour or improve preservation."

Although the 2015 IARC report didn't mention smoked fish, the NY Times reporter, Sophie Egan, points out that smoked salmon (lox) is also transformed through salting and smoking (or curing, if you consider gravlox). To support this concern, Egan quotes Alice Bender, a dietitian (with a master's degree but not a doctorate) from the American Institute for Cancer Research. According to Bender, who was not involved in the IARC report,

"Even though it’s possible that processed fish and even chicken and turkey could be better alternatives [to processed meats], for now we have to look at all of it as processed meat."

No, we don't.

I read the IARC report, and it doesn't mentioned smoked fish. It states that processed meats usually "contain pork or beef, but might also contain other red meats, poultry, offal (eg, liver), or meat byproducts such as blood." And an earlier report gave these examples of processed meats: ham, bacon, sausages, blood sausages, meat cuts, liver paté, salami, bologna, tinned meat, luncheon meat, and corned beef. Nothing about fish.

However, I wanted to be certain, so I dug down into the original research. The IARC report is based on a whole raft of earlier studies, which they combined and summarized, and it turns out that some of those studies did indeed look at smoked fish.

In particular, this IARC study from 2007–one of the studies that the 2015 IARC report relied upon–looked at both meat and fish and how they affected the risk of colon cancer. The 2007 study found that consumption of fish reduced the risk of cancer. And most important for today's discussion, they stated explicitly that

"Fish included fresh, canned, salted, and smoked fish."

There you have it. Consumption of fish, including smoked fish, reduces the risk of colon cancer. (A minor caveat: smoked salmon does have a high level of salt, which can be a concern for people with high blood pressure.)

So my response to the NY Times: keep your hands off my bagels and lox. Really, you should know better.