 Robert Todd Carroll
New York State bill #S590 would permit chiropractors with 300 hours of acupuncture training to call themselves acupuncturists April 8, 2008 Junk medicine: spinal manipulation by Mark Henderson The Florida State University Board of Governors votes 10-3 to turn down a proposal for a chiropractic program (Dec. 2004) Chiropractic school angers Florida State University professors Treatment of Hypertension with Alternative Therapies (THAT) Study: a randomized clinical trial
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chiropractic
The basic idea of classical chiropractic is that "subluxations" are the cause of most medical problems. According to chiropractic, a "subluxation" is a misalignment of the spine that allegedly interferes with nerve signals from the brain. However, there is no scientific evidence for spinal subluxations and none have ever been observed by medical practitioners such as orthopedic surgeons, neurosurgeons, or radiologists. Chiropractors think that by adjusting the misalignments they can thereby restore the nerve signals and cure health problems. This idea was first propounded in 1895 by D. D. Palmer, a grocer from Davenport, Iowa, and a vitalist who considered intelligent energy to be conveying information among various body parts. There is no scientific evidence to support these ideas. Despite the fact that chiropractors claim there are thousands of studies that prove the effectiveness of spinal manipulation, most support for chiropractic comes from testimonials of people who claim to have been helped by manipulation. Whether they were helped because nerves were "unblocked" has not been established. And there is no way to measure whether any so-called intelligent energy is even present, much less affected by manipulation. Most of these testimonials have come from people who believe their back pain was alleviated by spinal manipulation. Whether the manipulation is any more effective than a back rub, hot creams, exercise, or time, is questionable. Relieving back pain is a notoriously tricky area, since our species is poorly designed for upright activity and most people suffer intermittent bouts of back pain. One is likely to seek a chiropractor (or buy magnetic braces or some other bit of quackery) when one's pain is most severe. Natural regression will usually lead to the pain lessening after the treatment, even if there is no causal connection between the two. This is not to say that chiropractors don't help people with aching backs, including people with chronic back problems. Maybe some do. But there is no scientific evidence that subluxation has anything to do with back pain or that correcting these so-called misalignments by manipulation has anything to do with relief from pain. The model of subluxations maintains that all health problems are due to "blockage" of nerves. "A substantial minority of chiropractors pay very little attention to the patient's history or standard physical findings. Rather, they rely on bogus tests to find 'subluxations'."* It is true that nerves from the spine connect to the organs and tissues of the body and it is true that damage to those nerves affects whatever they connect to: sever the spinal cord and your brain can't communicate with your limbs, though your other organs can still continue to function. These facts, however, have nothing to do with the theory of subluxations. Chiropractic is often holistic and often touts the fact that the body is self-healing and usually doesn't need drugs or surgery. (Nor does it need chiropractic, one might add. Most of us will heal from most injuries or diseases without any intervention.) Spinal manipulation allegedly unblocks nerves so the body can heal itself. Chiropractic seems like a materialistic version of Chinese acupuncture used to unblock chi, or therapeutic touch to channel prana. The chiropractor's "needles" are his or her hands and fingers, manipulating nerves rather than the flow of chi. For years chiropractors rarely worked with medical doctors and they were almost never on staff at hospitals. The American Medical Association (AMA) made no bones about its disapproval of chiropractic, which was discredited by their Committee on Quackery. The chiropractors fought back and won a lawsuit against the AMA in 1976 for restraint of trade. Today, the American College of Surgeons sees the two professions as working together (see their position paper on chiropractic). Privately, however, many battles continue between the medical profession and chiropractic. Publicly, the AMA no longer attacks chiropractic. Some chiropractic colleges have a professional relationship with local hospitals or universities and some chiropractic students do internships in medical centers. Today, numerous so-called "complementary medicine" techniques are being allowed to flourish in hospitals and medical clinics around the country without a word of protest from the AMA. The National Institutes of Health has a flourishing division for testing even the most unpromising of alternative health practices. Chiropractors and other "alternative" practitioners have learned one thing from the AMA: it pays to organize and to lobby Congress and state legislatures. The AMA is still the most powerful lobby among health care professionals, but it is no longer flying solo. Even so, the AMA's lobbying is not the only reason that chiropractic's public image has suffered. For years chiropractors relied more on faith than on empirical evidence in the form of control studies to back up their claims about the wonders of spinal manipulation. Chiropractors now claim to have many studies supporting the effectiveness of their art. Like the folks at Transcendental Meditation (TM) who cite every study that indicates some sort of benefit to meditating, the chiropractors cite studies that indicate some sort of benefit to spinal manipulation. The TM folks don't mention that studies show that many relaxation techniques are just as beneficial as meditation, even of the kind of meditation promoted by TM. Nor do the chiropractors who shout loudly about their scientific studies ever mention than there is not a strong body of scientific evidence that their techniques are significantly better than others, such as resting and doing nothing, doing exercises, having surgery, taking drugs, or getting a good massage. There are some published studies that indicate that manipulation may be effective for the treatment of certain kinds of headaches and other pains, but the evidence doesn't show that manipulation is superior to common alternative treatments or that chiropractic spinal adjustments are especially effective. Many chiropractors claim that germ theory is wrong, a fact that does little to make chiropractors seem like advanced medical practitioners.1 To ignore bacteria and viruses, or to underestimate the role of microbes in infections, as chiropractors are wont to do, is not likely to advance their cause. Every misdiagnosis or mistreatment by a chiropractor undermines the whole profession, rather than only the individual malpractitioner, because of the contentious nature of the idea of subluxations. Chiropractic is touted as safer than drugs or surgery. This may seem self-evident but it isn't even true. Some chiropractors have seriously harmed children and adults by their risky procedures, some of which have even proven fatal. Things could get even worse if the current push by chiropractors to become primary care practitioners for infants and children is successful. Pediatrics is much riskier than manipulating the spine of a middle-aged man who is there because he doesn't want surgery and he wants to play golf that afternoon. In short, chiropractic remains controversial. It is attractive because there is no danger from side effects of drugs, since chiropractors don't generally recommend drugs to their patients. It is also attractive because it is seen as an alternative to surgery. And it is attractive because it is seen as generally less expensive than treatment by a physician with drugs or surgery. This is nonsense, however. The people I know who see chiropractors visit them again and again and again, paying for their services over and over and over. Also, it should not be assumed that all medical doctors are quick to prescribe drugs or surgery for patients with back problems. Many, like their chiropractic brothers and sisters, will recommend weight loss or selected exercises for specific back problems. William Jarvis notes that chiropractic has become:
Mixers are not necessarily more scientific than the more conservative straights. Mixers are likely to use such questionable therapies as colonic irrigation, iridology, applied kinesiology, acupressure, and craniosacral therapy. In short, chiropractic may be an unhealthy alternative for most people. See also alternative health practice, complementary medicine, frontier medicine, integrative medicine, and quackery. 1. Someone claiming to be a student at a Canadian chiropractic college wrote to say that his education has included "biochemistry, where clinical examples of how microbes may interrupt biological function and cause disease are often referenced." He says he also took "a year-long course in immunology, pathology, microbiology and public health, in which the germ theory is a major player." further reading
Consumer Reports (September 1995), article on lower back pain. Homola, Samuel. (2007). "Chiropractic - A Profession Seeking Identity." Skeptical Inquirer. Jan/Feb. Smith, Ralph. At Your Own Risk: The Case Against Chiropractors, (New York: Simon and Schuster, 1984). Thyer, Bruce and Gary Whittenberger. (2007). "A Skeptical Consumer's Look at chiropractic Claims: Flimflam in Florida?" Skeptical Inquirer. Jan/Feb. |
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©copyright 2007 Robert Todd Carroll |
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updated 04/30/08 |
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