MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Henry Louis Mencken (1880-1956) was an outspoken American journalist, essayist and literary critic famous for his vitriolic attacks on what he considered to be the hypocrisy of much of American life. In 1924, he published an essay on chiropractic which, I think, is still poignant today. I take the liberty of reproducing here in a slightly abbreviated form.

This preposterous quackery [chiropractic] flourishes lushly in the back reaches of the Republic, and begins to conquer the less civilized folk of the big cities. As the old-time family doctor dies out in the country towns, with no competent successor willing to take over his dismal business, he is followed by some hearty blacksmith or ice-wagon driver, turned into a chiropractor in six months, often by correspondence… [Chiropractic] pathology is grounded upon the doctrine that all human ills are caused by pressure of misplaced vertebrae upon the nerves which come out of the spinal cord — in other words, that every disease is the result of a pinch. This, plainly enough, is buncombe. The chiropractic therapeutics rest upon the doctrine that the way to get rid of such pinches is to climb upon a table and submit to a heroic pummeling by a retired piano-mover. This, obviously, is buncombe doubly damned.

…Any lout with strong hands and arms is perfectly equipped to become a chiropractor. No education beyond the elements is necessary. The takings are often high, and so the profession has attracted thousands of recruits — retired baseball players, work-weary plumbers, truck-drivers, longshoremen, bogus dentists, dubious preachers, cashiered school superintendents. Now and then a quack of some other school — say homeopathy — plunges into it. Hundreds of promising students come from the intellectual ranks of hospital orderlies.

…[The chiropractor’s] trade is mainly with ambulant patients; they must come to his studio for treatment. Most of them have lingering diseases; they tour all the neighborhood doctors before they reach him. His treatment, being nonsensical, is in accord with the divine plan. It is seldom, perhaps, that he actually kills a patient, but at all events he keeps any a worthy soul from getting well.

…But chiropractic, of course, is not perfect. It has superb potentialities, but only too often they are not converted into concrete cadavers. The hygienists rescue many of its foreordained customers, and, turning them over to agents of the Medical Trust, maintained at the public expense, get them cured. Moreover, chiropractic itself is not certainly fatal: even an Iowan with diabetes may survive its embraces. Yet worse, I have a suspicion that it sometimes actually cures. For all I know (or any orthodox pathologist seems to know) it may be true that certain malaises are caused by the pressure of vagrant vertebra upon the spinal nerves. And it may be true that a hearty ex-boilermaker, by a vigorous yanking and kneading, may be able to relieve that pressure. What is needed is a scientific inquiry into the matter, under rigid test conditions, by a committee of men learned in the architecture and plumbing of the body, and of a high and incorruptible sagacity. Let a thousand patients be selected, let a gang of selected chiropractors examine their backbones and determine what is the matter with them, and then let these diagnoses be checked up by the exact methods of scientific medicine. Then let the same chiropractors essay to cure the patients whose maladies have been determined. My guess is that the chiropractors’ errors in diagnosis will run to at least 95% and that their failures in treatment will push 99%. But I am willing to be convinced.

Where is there is such a committee to be found? I undertake to nominate it at ten minutes’ notice. The land swarms with men competent in anatomy and pathology, and yet not engaged as doctors. There are thousands of hospitals, with endless clinical material. I offer to supply the committee with cigars and music during the test. I offer, further, to supply both the committee and the chiropractors with sound wet goods. I offer, finally, to give a bawdy banquet to the whole Medical Trust at the conclusion of the proceedings.

I imagine that most chiropractors would find this comment rather disturbing. However, I do like it for several reasons:

  • it is refreshingly politically incorrect; today journalists seem to be obsessed with the notion of ‘balance’ thus often creating the impression that there are two valid sides to an issue where, in fact, there is only one;
  • it gets right at the heart of several problems which have plagued chiropractic from its beginning;
  • it even suggests a way to establishing the truth about the value of chiropractic which could easily been followed some 90 years ago;
  • finally it predicts a result of such a test – and I would not be surprised, if it turned out to be not far from the truth.

Please let me know what you think, regardless of whether you are a chiropractor or not.

11 Responses to CHIROPRACTIC: an early and delightful critique

  • It says nothing of the new wellness movement were the patient does not even have to have a disease. Treatment is initiated to prevent a pathology from developing in the first place. This new approach does not even require a “cure”. The patient is just fine tuned into optimum health (something defined by the practitioner). I got this sort of pitch from an acupuncturist when I was told to be “open minded” and give it a try. I argued that I had nothing to treat. I was then told that everyone could have their health improved. I wish H. L. were around to comment on that bovine scat.

    Your book finally arrived. Amazon said that it was delayed by weather or natural disaster. The gods of Quack must be displeased.

  • I received Wonderland from Amazon on Monday and am more than half through. Well written and engaging, congratulations!
    The anti-science stance of many alties troubles me greatly. Attacking the structure of a randomized, placebo controlled study saying ‘the placebo is not a placebo’ and that it is ‘too Western’ without offering any superior alternative reveals cognitive bias, not an interest in discovering or proving truths. Chiropractors and acupuncturists now should be worrying that their patients in the waiting room are pulling up quality studies on their smartphones.

  • Just saw today a full – well, double – page full colour centre fold advert for a local chiropractor (near Barcelona) promising the earth, of course: the theory is now explained as being adjusting the nervous system through spinal manipulations. I have seen this chap’s adverts before, infant colic, headaches, all the usual: I comment today becuse he is now insisting that chiropractic can deal with osteoporosis and fibromyalgia. He’s Australian. Mencken must be turning in his tomb.

  • @ Edzard and other commenters:

    Is it the treatment that chiropractors use or the reasoning behind the treatments they perform that is the issue?

  • Barcelona college is a full on subluxation based temple. That is one of the reasons they failed accreditation. The profession needs to purge the fringe minority and it looks like we are approaching that point! The sooner the better IMHO!

  • I guess the views of someone who from my readings seems to have been a racist, ant-semite and elitest are especially important to the debate about chiropractic.

  • that should have read ‘anti-semite’ -apologies.

  • I wish I stumbled on your website. I’ve seen a PT and have had no improvement. I’ve seen one chiropractor who believes that good spinal cures many symptoms. I am on my 2nd chiropractor who practices ART. My lower back hurts and now the 2nd chiropractor I am seeing added tingling and numbness to my leg. Ugh!

    I read your article on “20 thing most chiropractors won’t tell you”.

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