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chiropractic
Chiropractic is the most significant nonscientific health-care delivery system in the United States. --William T. Jarvis, Ph.D.
....chiropractic today includes more than 60,000 practitioners that represent a wide range of positions, from the traditional subluxation theorists to reformers who are critical of subluxation theory and its related pseudoscientific claims. --Ron Good
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. Palmer claimed that he cured a deaf man, Harvey Lillard who was a janitor by trade, by manipulating his spine. As Dr. Harriet Hall comments: "This makes no anatomical sense."
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.
For those who say chiropractic is perfectly safe, take a look at these pictures of Sandra Nette before and after chiropractic spinal manipulation.
In short, chiropractic remains controversial. It is attractive because there is no danger of side effects from 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. Some doctors may even admit that there's nothing that can be done.
William Jarvis notes that chiropractic has become:
a conglomeration of factions in conflict, bound together only by opposition to outside critics. At least a dozen different notions about how the spine should be corrected divide practitioners. Some say only the Atlas needs adjusting; others go to the other end of the spine and say only the sacral area is important. Still others use both ends (sacrooccipital). Several adhere to specific vertebral levels for specific organs or diseases. Some measure leg lengths or test muscles -- called "applied kinesiology" (AK) -- for weakness or strength in association with foods, colors, music, and just about anything else.
The most obvious rift among chiropractors is between "straights" and "mixers." Straights adhere more to chiropractic's original theory and practice, while "mixers" (a term applied by the straights and unpopular among the mixers) may incorporate almost any modality into their practices. The ICA is the straights' national organization, and the ACA represents mixers.
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 many people. The SkepDoc, Harriet Hall, writes: "One study [on chiropractic] found: 115 case reports included strokes (66), spinal fluid leak (5), spinal epidural hematoma (7), cauda equina syndrome (2), herniated disc (20), radiculopathy (7), myelopathy (3), diaphragmatic palsy (3) and pathologic fractures of vertebra (2)." See Adverse Effects of Chiropractic.
But if you still want to give it a try, as several of my friends have, go ahead. You won't cause me any pain at all. Some of my friends have been going to a chiropractor for twenty years or more. They wouldn't be going back if they didn't think they were getting their money's worth, right?
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
books and articles
Barrett, Stephen M.D. 2009. Chiropractic's Dirty Secret: Neck Manipulation and Strokes
Homola, Samuel. (2007). "Chiropractic - A Profession Seeking Identity." Skeptical Inquirer. Jan/Feb.
New Jüni, Peter et al. A randomised controlled trial of spinal manipulative therapy in acute low back pain. Ann Rheum Dis. Published Online First: 5 September 2008. doi:10.1136/ard.2008.093757 Copyright © 2008 BMJ Publishing Group Ltd & European League Against Rheumatism. "Conclusions: SMT is unlikely to result in relevant early pain reduction in patients with acute low back pain."
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.
Consumer Reports (September 1995), article on lower back pain.
websites
Chiropractic Lawsuit - Steven Novella, M.D.
ChiroBase A Skeptical Guide to Chiropractic History, Theories, and Current Practices (Operated by Stephen Barrett, M.D. William T. Jarvis, Ph.D. and Charles E. DuVall Jr., D.C.)
National Council for Reliable Health Information Position Paper on Chiropractic
NCAHF Fact Sheet on Chiropractic (1998) William T. Jarvis, Ph.D.
Don't Let Chiropractors Fool You by Stephen Barrett, M.D.
A Comparison of Active and Simulated Chiropractic Manipulation as Adjunctive Treatment for Childhood Asthma - New England Journal of Medicine October 8, 1998 v. 339 issue 15 (found no benefit from chiropractic)
A Comparison of Physical Therapy, Chiropractic Manipulation, and Provision of an Educational Booklet for the Treatment of Patients with Low Back Pain - New England Journal of Medicine October 8, 1998 v. 339 issue 15 (found no difference between physical therapy and chiropractic and found any benefit from either to be minimal)
New Fatal Adjustments: How Chiropractic Kills by J. D. Haines, MD "A review of 116 journal articles published between 1925 and 1997 reported 177 cases of neck injury caused by manipulation. Sixty percent of these cases resulted from injury inflicted by chiropractors....The public is led to believe that physicians disparage chiropractors out of some sort of professional jealousy. Yet there is only one reason that physicians judge chiropractors so harshly. Medicine is scientifically based, whereas chiropractic is not supported by a single legitimate scientific study."
Chiropractors cause controversy by Ben Goldacre, M.D. ...there is no good evidence that chiropractic is effective for ... children's colic, sleeping and feeding problems, ear infections, asthma, and prolonged crying....
Chiropractic – A Brief Overview by Steven Novella M.D.
Adverse Effects of Chiropractic by Harriet Hall, M.D.
Chiropractic and Stroke by Harriet Hall, M.D.
Chiropractic’s Pathetic Response to Stroke Concerns by Harriet Hall, M.D.
Chiropractic and Deafness: Back to 1895 by Harriet Hall, M.D. Chiropractic still can't cure deafness. Hall writes: "There is a rumor (unconfirmed) that Harvey Lillard’s widow later said he was deaf until the day he died. We will never know enough about his case to understand what really happened. But I think we can reasonably conclude that spinal manipulation is not an effective treatment for hearing loss."
The Problem with Chiropractic NUCCA (National Upper Cervical Chiropractic Association)
news stories
Health care privatizing in stealth mode--UNA boss (The Alberta, Canada, government has "stopped covering a portion of chiropractic care and sex-change surgeries to save approximately $54 million, some of which will be funneled to boost home care for seniors."
McTimoney Chiropractic Association has ordered all its members to take down their websites lest they be used as evidence by Simon Singh (see next news item) to support his claim that they promote bogus therapies. The Quackometer has posted a copy of the letter. For those who don't have time to click on the Quackometer link, here is a copy of the letter:
Date: 8 June 2009 09:12:18 BDT
Subject: FURTHER URGENT ACTION REQUIRED!
Dear Member
If you are reading this, we assume you have also read the urgent email we sent you last Friday. If you did not read it, READ IT VERY CAREFULLY NOW and - this is most important – ACT ON IT. This is not scaremongering. We judge this to be a real threat to you and your practice.
Because of what we consider to be a witch hunt against chiropractors, we are now issuing the following advice:
The target of the campaigners is now any claims for treatment that cannot be substantiated with chiropractic research. The safest thing for everyone to do is as follows.
If you have a website, take it down NOW.
When you have done that, please let us know preferably by email or by phone. This will save our valuable time chasing you to see whether it has been done.
REMOVE all the blue MCA patient information leaflets, or any patient information leaflets of your own that state you treat whiplash, colic or other childhood problems in your clinic or at any other site where they might be displayed with your contact details on them. DO NOT USE them until further notice. The MCA are working on an interim replacement leaflet which will be sent to you shortly.
If you have not done so already, enter your name followed by the word ‘chiropractor’ into a search engine such as Google (e.g. Joe Bloggs chiropractor) and you will be able to ascertain what information about you is in the public domain e.g. where you might be listed using the Doctor title or where you might be linked with a website which might implicate you. We have found that even if you do not have a website yourself you may still have been linked inadvertently to a website listing you or your services.
CHECK ALL ENTRIES CAREFULLY AND IF IN DOUBT, CONTACT THE RELEVANT PROVIDER TO REMOVE YOUR INFORMATION.
CHECK OUR PREVIOUS EMAILS FOR SPECIFIC ADVICE AND KEY WORDS TO AVOID.
KEEP A LOG OF YOUR ACTIONS.
If you use business cards or other stationery using the ‘doctor’ title and it does not clearly state that you are a doctor of chiropractic or that you are not a registered medical practitioner, STOP USING THEM immediately.
Be wary of ‘mystery shopper’ phone calls and ‘drop ins’ to your practice, especially if they start asking about your care of children, or whiplash, or your evidence base for practice.
IF YOU DO NOT FOLLOW THIS ADVICE, YOU MAY BE AT RISK FROM PROSECUTION.
IF YOU DO NOT FOLLOW THIS ADVICE, THE MCA MAY NOT BE ABLE TO ASSIST YOU WITH ANY PROCEEDINGS.
Although this advice may seem extreme or alarmist, its purpose is to protect you. The campaigners have a target of making a complaint against every chiropractor in the UK who they perceive to be in breach of the GCC’s CoP, the Advertising Standards Code and/or Trading Standards. We have discovered that complaints against more than 500 individual chiropractors have been sent to the GCC in the last 24 hours.
Whatever you do, do not ignore this email and make yourself one of the victims. Some of our members have not followed our earlier advice and now have complaints made against them. We do not want that to happen to you.
Even if you do not have a website, you are still at risk. Our latest information suggests that this group are now going through Yellow Pages entries. Be in no doubt, their intention is to scrutinise every single chiropractor in the UK.
The MCA Executive has worked tirelessly over the last week keeping abreast of development and contacting at risk members. We have decided that this is our best course of action to protect you and the Association at this time of heightened tension. This advice is given to you solely to protect you from what we believe is a concerted campaign, and does not imply any wrongdoing on your part or the part of the Association. We believe that our best course of action is simply to withdraw from the battleground until this latest wave of targeting is over.
Finally, we strongly suggest you do NOT discuss this with others, especially patients, Firstly it would not be ethical to burden patients with this, though if they ask we hope you now have information with which you can respond.
Most importantly, this email and all correspondence from the MCA is confidential advice to MCA members alone, and should not be shared with anyone else.
Please be aware that the office phone lines are likely to be busy, so, if you need our help, please send an email to the office and we will get back to you as soon as we can.
Yours,
Berni Martin
MCA Chair.
Best wishes,
Nicki
Silenced, the writer who dared to say chiropractic is bogus (Dr. Simon Singh is sued for libel by the British Chiropractic Association (BCA) for saying that it happily promotes "bogus" therapies. The BCA might have provided evidence that its therapies aren't bogus, I suppose, but it chose to try to silence a critic rather than prove him wrong.
On May 7th Sir David Eady, a high-court judge, ruled that the “natural and ordinary meaning” of 'bogus' is to be consciously dishonest and knowingly promoting quack treatments. So, he did libel the BCA. Singh is appealing the ruling.)
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
Last
updated 10/27/09
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