Protocols always get the front page and usually involve all of the fancy bells and whistles. They work immaculately for social media; they are easy to champion, copy-paste into one’s brand identity, and easily capture the viewer’s attention so that they, too, can become protocol champions.
The word “protocol” originates from the Greek word protokollon, which is a combination of “proto-” (meaning “first”) and “kollon” (meaning “glue” or “glued sheet”). In ancient history, the protokollon was the first sheet glued to a papyrus scroll, which was then glued to the front of a manuscript. It typically contained a summarized version of the real contents and was essentially the SparkNotes for the ancients. Today, protocol has come to refer to a standardized or agreed-upon way of doing things.
The world of medicine, in all of its shades and colors—from the most hardcore allopathic procedures in hospitals to the latest new-age medical techniques—is dominated by protocols. As our culture moves more and more toward wanting the SparkNotes version of everything, the easiest to digest and assimilate, protocols are king. One-second health hacks on TikTok reign paramount, context and depth be damned.
Hence, protocols are peddled out by quacksters in the medical profession of every conceivable shape, size, and credential (or lack thereof). Protocols are cheap and lazy, usually cheaply repackaged variations on an
old theme with sexier packaging for today’s audience. Everyone who lines up for a protocol gets rammed through its doors and pooped out the other end. Sadly, I see this all too often in my own profession. Many chiropractors learn to master seven basic osseous adjustments (and sometimes not even that) and never have the dedication to learn anything else. This was often deemed the “Flying Seven” in certain chiropractic circles.
With this Flying Seven technique in their toolbox, they then proceed to peddle out outrageously priced packages to poor, unsuspecting patients using a slew of predatory sales tactics predicated on fear-mongering. “Whack ’em, crack ’em, and out the door!” The insane thing is that some chiropractors even delude themselves into thinking this approach is beneficial to the people they see. I often hear about the random outlier patient and the miracle story to help justify this approach. The claim is usually something along the lines of innate intelligence.
Regardless, protocols make for an incredible business model, much akin to a factory pumping out standardized parts. Of course, there is always the tail effect, and at times things break down (or people’s poor health). One sordid story still stands in my mind of an Australian chiropractor in Bali who was practicing just this kind of model in his clinic. The idea was to pump out as many people as possible during the day. While he may have had a slick office space and even posted X-rays above his patients’ adjusting tables, he was not paying the slightest attention to these X-rays and adjusting everyone with the Flying Seven mentality.
There is a small subset of patients who should absolutely not be adjusted manually. We are drilled in this in chiropractic school to look for certain red flags that indicate this condition because they are at an elevated risk for a stroke. Of course, this was glaring in the X-ray, and he ignored all of the signs, adjusting three times a week and cashing in the dollars. And, you guessed it, that poor woman had a stroke shortly after an adjustment one day.
The reality is that the woman would have had a stroke anyway, but the adjustment probably expedited the process. Of course, the chiropractor was banned from the island (but is now back under the protection of having Indonesian chiropractors—no blood on his hands anymore). If I were to guess, we are just waiting for this to happen again.
This example is not limited to the world of chiropractic medicine, however. Allopathic medicine is often thought to be the pinnacle of scientific achievement in the modern world and championed as the paragon of rigorous standards. After all, they are dealing with people’s lives and health. And yet, the disease care machine also runs on pumping people through its manacles, cashing in the money at the expense of people’s health.
But what about the mountains of studies anyone can access on PubMed these days, one might ask? Or, for those that are a little more savvy in this arena, they can point to things like systematic reviews and meta-analyses on certain procedures and drugs to eliminate cherry-picking biases. The truth is that there is extraordinary research being conducted in the medical field, and the evidence speaks for itself. I personally love to explore PubMed, especially in the field of nutrition, lifestyle, and supplements when it comes to managing chronic conditions.
However, the reality is that there is a HUGE disconnect between what is being published in medical journals (evidence) today and what is actually practiced. There are a litany of examples to demonstrate this. Let usexplore a few to hit the point home.
Let us first examine the routine use of antibiotics for chronic upper respiratory conditions. Everyone dreads the coming of the flu season in the Northeast, where I grew up. It is freezing outside, and everyone is crammed indoors together, where pathogens can run rampant. The traditional protocol has always been to prescribe antibiotics for this. The doctor will look into your nose and the back of your throat, assess your symptoms (Flying Seven approach), and immediately dole out antibiotics.
For those here new to looking through evidence on PubMed, which is totally overwhelming at first, basically, you need to know that studies come in a hierarchy of reliability and trustworthiness. At the top of the mountain, you have Cochrane reviews, followed by meta-analyses and then systematic reviews. In other words, Cochrane reviews are THE most reliable source of medical evidence one will find in medical literature. There have been THREE Cochrane reviews showing that prescribing antibiotics for upper respiratory infections (URIs) and one for bronchitis is not effective or efficacious. Go figure that antibiotics are only meant to kill bacteria, NOT viruses (which are the main culprit here). Yet, you guessed it again, this is not what is practiced in the overwhelming majority of medical practices.
If you don’t believe me, please go into your primary care office the next time you have a URI and see what is prescribed. I can almost guarantee that you will not be given antivirals. I encourage anyone to then put their MD on the spot, cite these three Cochrane reviews, and ask what their differential diagnosis is for that of a virus. Chances are you will be ridiculed or have them pissing their pants.
Another glaring (and depressing example, pun intended) is the prescription of antidepressant medications. There have been three meta-analyses published within the past decade that had particularly damning things to say about this class of medication. When you consider it represents the highest-grossing category of drugs in history (billions of dollars, anyone?), and yet rates of depression and suicide continue to skyrocket in Western countries, there is definitely a disconnect here that is not being looked at.
The meta-analyses all basically spoke to these drugs being no more beneficial than the placebo, especially for mild to moderate depression. Yet, when you consider how much money is being generated from the depressing pharma machine, it is no wonder that things have not changed at all. It’s a burgeoning cash cow, pumping out the big pharma protocol to keep it continuously fed.
Have you ever watched cows eating from the pasture? There really is very little time when they are not eating. Something really needs to be amiss for them to stop. The same is true of any well-oiled protocol machine: keep pumping out the money until it breaks down.