MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

Many chiropractors try to tell us that vaccinations are not necessary, if we receive regular spinal adjustments. This claim is based on the assumption that spinal manipulations stimulate the immune system. Take the text published on this website, for instance:

The nervous system and immune system are hardwired and work together to create optimal responses for the body to adapt and heal appropriately. Neural dysfunctions due to spinal misalignments are stressful to the body and cause abnormal changes that lead to a poorly coordinated immune response. Chiropractic adjustments have been shown to boost the coordinated responses of the nervous system and immune system…

Subluxation is the term for misalignments of the spine that cause compression and irritation of nerve pathways affecting organ systems of the body. Subluxations are an example of physical nerve stress that affects neuronal control. According to researchers, such stressful conditions lead to altered measures of immune function & increased susceptibility to a variety of diseases.

Inflammatory based disease is influenced by both the nervous, endocrine, and immune systems. Nerve stimulation directly affects the growth and function of inflammatory cells. Researchers found that dysfunction in this pathway results in the development of various inflammatory syndromes such as rheumatoid arthritis and behavioral syndromes such as depression. Additionally, this dysfunctional neuro-endo-immune response plays a significant role in immune-compromised conditions such as chronic infections and cancer.

Wellness based chiropractors analyze the spine for subluxations and give corrective adjustments to reduce the stress on the nervous system. A 1992 research group found that when a thoracic adjustment was applied to a subluxated area the white blood cell (neutrophil) count collected rose significantly.

Other websites go even further:

The best way to prevent meningitis, and other illness, is to develop a robust immune system. The most important element in developing a robust immune system is optimum communication between all systems of the body. Chiropractic does this. The goal of chiropractic is to remove interference in the nervous system, the system that controls and coordinates all other parts of the body. Interference is caused by subluxations or misalignments in the spine. When subluxations are corrected, the body’s nervous system functions optimally and boosts the immune functioning. In fact, individuals who receive chiropractic care have 200% greater immune competence than individuals who don’t. This is why it is vital to receive regular chiropractic adjustments…

If we look at the actual research that might support such strange claims, we find that that it is scarce, flimsy and unconvincing. To the best of my knowledge, nobody has yet shown that people who receive regular chiropractic care are protected from conditions mediated via the immune system. Unless such a phenomenon can be demonstrated beyond reasonable doubt, we should be highly sceptical of the claim that chiropractic care stimulates the immune system and thus generates better health. In my view, regular chiropractic adjustments stimulate only one thing: the cash flow of the therapist.

My conclusion: The claim that chiropractic adjustments have such profound effects on human health is highly irresponsible.

18 Responses to Do spinal ‘adjustments’ stimulate the immune system or just the chiropractors’ cash flow?

  • Chiropractic has been shown to help with certain types of lower back pain. What is not known is whether this improvement is due primarily to the manipulation itself or to the thinning of an overly fat wallet carried in a pants pocket. Unfortunately even if there are benefits from spinal manipulation, how much confidence can one have in someone making bogus claims. This concern also applies to pharmacists promoting useless nostrums and any health care professional claiming to be “Holistic”.

    • Lessening of pain always brings relief and, since even chiropractors do not deny that you will most likely feel sore for couple of days after the treatment, you will certainly feel better after that.

  • Those claims about boosting the immune system are a load of BS.
    Interesting recent article:
    Crosstalk between the nociceptive and immune systems in host defence and disease.
    http://www.ncbi.nlm.nih.gov/pubmed/26087680

  • This seems to be the perfect platform upon which to invite the UK’s Anglo European College of Chiropractic (AECC) to explain why it has, apparently, chosen to step away from evidence-based public health policy.

    Last year, its website declared:

    QUOTE

    “we endorse and recommend the NHS vaccination programme”

    Link: http://web.archive.org/web/20140410173038/http://www.aecc.ac.uk/clinic/whatischiro.aspx

    However, that current AECC link appears to be devoid of any mention of its former endorsement and recommendation of the NHS vaccination programme: http://www.aecc.ac.uk/clinic/whatischiro.aspx

    Furthermore, a search of the AECC’s website for its position on vaccinations doesn’t return anything: http://www.aecc-clinic.co.uk/search/?search=vaccination

    Can anyone from the AECC tell us if it has changed its stance on vaccinations, and if so, why? If it hasn’t, is its omission of its endorsement and recommendation of the NHS vaccination programme an oversight?

  • The College of Chiropractors of British Columbia issued this two months ago: Policy on Vaccination & Immunization:

    The prevention and treatment of infectious disease is not within the scope of chiropractic practice. Accordingly, British Columbia chiropractors must not provide any professional advice or counseling to patients in relation to vaccination issues. Patients with vaccination questions should be advised to contact their local public health officials.

    As a result of the adoption of this policy, registrants may not:

    * Counsel patients with respect to immunization and vaccination
    * Conduct seminars as a chiropractor about immunization and vaccination
    * Supply immunization information (electronic, paper or verbal) in your clinic or any other venue where you are acting as a chiropractor
    * Provide immunization information on your public website

    Their full policy document can be read here.

    What’s the chances of that being adopted universally by chiros, chiro regulators and chiro training providers?

    The statement is fine as far as it goes, but it ends:

    As primary care practitioners, chiropractors play an important role in identifying disease, illness or injury conditions and directing their patients to the proper health care when the treatment required is not within the scope of chiropractic. When a pandemic threatens, B.C.’s chiropractors are fully prepared to support the public health authority response to the pandemic.

    I shudder to think…

    • If a patient asks me about vaccination my response is:
      “Both myself and my family are up to date with our vaccinations! I believe in health and prevention and nothing in medicine does this better than vaccinations. If you have any concerns talk to your doctor! There is a lot of rubbish out there from self appointed guru’s and so called experts!”.
      Its a no brainer!

    • It’s been over a week since I made my comment above. I can’t believe that nobody from the Anglo European College of Chiropractic reads this blog. As we’re talking about a serious public health matter here, it speaks volumes that the chiropractic educational leaders at the UK’s foremost chiropractic college have chosen to remain silent.

  • There’s nothing in the quotes you’ve included that explicitly makes the claim that that vaccinations are not necessary.

    The author of the first linked article is not a chiropractor. It is dishonest of you to claim that a non-chiropractor’s views are representative of “Many chiropractors”.

    The author of the second linked article is indeed a Chiropractor.
    The phrase “The best way to prevent meningitis, and other illness, is to develop a robust immune system” is taken out of context. The context is one of a meningitis outbreak in a college. The point was that typical student life can be unhealthy, and that a strong immune system will be of general benefit. I would add that vaccination is only one way of resisting infection into a population, even if as it seems the authorities misused it in this case: general good health is surely a valid starting point.

    So NOW you can start to examine whether chiropractic care protects from conditions mediated via the immune system. But actually what you’ve done is undermine credibility of the argument, and finally you’re failing to provide any evidence in support of your claim that it doesn’t.

    I’m not in favour of quackery by any stretch, but your approach does the cause of truth-seeking no service Mr Edzard.

    • implicit is enough for me.
      I do not make this ‘dishonest’ claim.

      • implicit is enough for me.

        Yeah, obviously. But if you want to take down the quacks then *surely* you can find stronger examples? Too many times you claim you’ve nailed homoeopathy or something by reference to some crap on a non-practitioner’s marketing site. It doesn’t lift you above the ranks of ranters on the interwebs, despite your history and reputation.

        I do not make this ‘dishonest’ claim.

        Yes you do. You started with “Many chiropractors claim…” and you evidenced it with an example from a non-chiropractor. That’s dishonest of you. Couldn’t you find a single chiropractor (in *any* flavour of chiropractic) who actually makes that claim?

        C’mon dude: hold yourself to the standards you’re asking the quacks to meet. It’s just yelling in the playground otherwise while you’ve got your fingers jammed in your ears. ((hugs))

    • @Rich Lee
      “The author of the first linked article is not a chiropractor.” Oh yeah? I googled his name (Dr. David Jockers) and found this: “Dr. Jockers is a maximized living doctor with the Exodus Health Center in Kennesaw specializing in chiropractic care.” Also: “Exodus Health Care – David C. Jockers, DC Chiropractor” in the call-out box that appears with his name, address and phone number. So who’s the dishonest one — you or Edzard Ernst?
       
      The second quote is by no means taken out of context. The article pours scorn on the use of a meningitis B vaccine in a college outbreak (which was done with the support of guidelines from the CDC, even though the vaccine is not yet FDA approved) It goes on to provide general guidance about “The best way to prevent meningitis”, which it claims is to use chiropractic or acupuncture (the latter to ‘balance the flow of energy’ through the entire body’s energetic systems — whatever they may be). Indeed the quotes don’t explicitly make the claim that vaccination is unnecessary (is it not possible that chiropractors know how to avoid regulatory intervention?): they merely scorn the use of vaccines and suggest their own witchcraft is superior.
       
      “The point was that typical student life can be unhealthy, and that a strong immune system will be of general benefit.”
        First of all, the assumption that student life can be unhealthy is a paraphrase of what’s on the website: “The chronic stress from classes, late nights of studying and partying, poor hygiene practices, lack of sleep, alcohol/illicit drug use, and poor diets drastically lowers the resiliency of a person’s immune system.” Where’s the evidence to support this? This description of student life is a caricature and an exaggeration, and anyway there are plenty of other lifestyles that also include late nights, poor hygiene, poor diet, drugs and alcohol: the homeless, for a start.
       
      “I would add that vaccination is only one way of resisting infection into a population”. Yep, public health measures, particularly breaking the faecal-oral transmission route for microbes by separating a purified water supply from the sewage system, and reducing overcrowding to minimize respiratory spread of pathogens led to a massive reduction in rates of serious infection since the turn of the 20th century, and have rightly been hailed as the most important single advance in medical history since 1840 (http://www.bmj.com/content/suppl/2007/01/18/334.suppl_1.DC3). Vaccination was voted the second most important advance. So, assuming you live in a place with good sanitation, what are you suggesting is an alternative to vaccination to resist infection into a population?
       
      One final comment. For those who like to babble about ‘strong’ immune systems and ‘boosting’ immune systems, please refer to the trial of TGN1412 that was done in Northwick Park in 2006. This ‘super-agonist’ antibody ‘boosted’ the immune system of six young, healthy males by nonspecifically activating T-lymphocytes. All six ended up in intensive care with multi-organ failure. Immune responses are remarkably complex; to be up to date understanding them takes a lot of very hard study. Sure, specific things can go wrong and predispose an individual to particular infections, but the idea that manipulating spines or sticking needles into people can conceivably have any meaningful influence on immune processes is simply laughable.

      • I was wrong about the guy having a chiropractic qualification. It didn’t stand out though. Genuine mistake, I have no particular axe to grind.

        Re the second quote: I’m not arguing the content, but pointing out Edzard’s selective extract. If one weren’t trying to write a watertight argument then one might understand the flow, and the intention, of the piece better from its’ context. Instead Edzard has drawn a hard conclusion from what was probably intended more loosely.

        The best way to prevent many diseases is good health, nutrition, sanitation – as you say really clearly in your comment. Surely there’s an immune system connection in there somewhere?

        ‘balance the flow of energy’ through the entire body’s energetic systems — whatever they may be

        whether you agree with them or not there are several very extensive and long-lived models around the world that use these ideas. IMO they deserve a little respect, if if only to the degree you’d respect Descartes or Hume even though we don’t necessarily take their arguments too seriously any more. That doesn’t mean I’m asking you to respect homoeopaths though ;). Adding “whatever”, or “witchcraft” emphasises your bias.

        Student life: Why isn’t it OK to paraphrase that bit? Were you never a student? Have you never visited a University town? And just because there are other unhealthy lifestyles doesn’t mean that student lifestyle (stereotypically) isn’t.

        So, assuming you live in a place with good sanitation, what are you suggesting is an alternative to vaccination to resist infection into a population?

        I’m not any kind of health professional, certainly not an immunologist. So I don’t know. I’m not advocating chiropractic or homoeopathy, and I’ll look into it further.

        TGN1412 that was done in Northwick Park in 2006

        The trial was privately run and was evidently a screw-up. Protocols were changed as a result. But – and I think this is where you lose it – you’re arguing from an extreme by citing this example. Sticking needles is surely a very different uh “scale” in intention and effect than a massive dose of an untested drug?

        the idea that manipulating spines or sticking needles into people can conceivably have any meaningful influence on immune processes is simply laughable.

        Well, not to the Chinese, or the Indians before them. Apparently the Chinese used vaccination as well, and had models of pathogens while we were being invaded by the Normans.

        Anyways, recognising that I’m an expert in nothing much, and without getting too far down the rabbit hole… My big beef here is that Edzard isn’t typically applying the same rigorous standards as he demands from the quacks. He cherry-picks, misrepresents, makes logical fallacies of his own, cites papers that don’t support his claims or aren’t publicly/easily available, and so on. I think debunking needs to be absolutely rigorous. In the event that a debunk doesn’t stand up then it shouldn’t be deployed – in such a case it actually detracts from the intended purpose.

        • @Rich Lee
          “Genuine mistake, I have no particular axe to grind.” Fair enough; it happens. But you’ve placed a lot of comments on this site over the past 24 hours, all fairly aggressively worded, and at least one where it’s impossible even to understand what you’re driving at. Your main complaint, well spelt out in the above, is that “Edzard isn’t typically applying the same rigorous standards as he demands from the quacks.” But we now see your own rigorous standards are not necessarily impeccable.
           
          “The best way to prevent many diseases is good health, nutrition, sanitation – as you say really clearly in your comment. Surely there’s an immune system connection in there somewhere?” Yes, there’s an immune connection with good health and nutrition, but discovering which of the vast numbers of immune components are affected in which way by which condition is far from straightforward. Those who obssess about their health tend to simplify the association. Sanitation works simply by preventing you from being exposed to the worst bugs. Vaccination works by leaving important parts of your immunity primed should you become exposed nevertheless.
           
          Re energy flows: “whether you agree with them or not there are several very extensive and long-lived models around the world that use these ideas. IMO they deserve a little respect, if if only to the degree you’d respect Descartes or Hume even though we don’t necessarily take their arguments too seriously any more.” You seem to be saying we should respect them as facts of history, not as facts. Personally, I have zero respect for people who think the world is flat, who think that their fates can be predicted by the alignment of stars and planets, or who think illnesses can be cured with sugar pills or water. Since you like to pick up logical fallacies, you seem here to be arguing from popularity (400 billion flies can’t be wrong: eat shit! [thanks to Guy Chapman for that one.])
           
          Sure, I was a student; my diet and lifestyle probably left something to be desired. But I knew other students who were serious athletes, dietary obssessives, lived at home with parents who created a barrier to poor diet, and so on. You’re most unfair to characterize all students as layabouts: where’s your evidence? The majority of students these days are really anything but layabouts in my (extensive) experience.
           
          My choice of the Northwick Park episode was deliberatrely extreme. Among the media, my friends and casual acquaintances, the notion of ‘boosting the immune system’ one way or another comes up with surprising frequency. The Northwick Park trial involved an antibody that directly stimulates cellular immune responses; it shows what happens if you do that in healthy people. And what’s this “massive dose” stuff? The six people involved received a total dose from 7 to 9 mg. If that’s ‘massive’ I’m a man from Venus. It all goes to show how primitive and naive the man in the street’s view both of immunity and pharmacology really are.
           
          Manipulating spines and sticking needles laughable? “Well, not to the Chinese, or the Indians before them. Apparently the Chinese used vaccination as well, and had models of pathogens while we were being invaded by the Normans.” Manipulating spines is an American invention of the late 19th century. Indian medical history is based in a mix of mysticism and herbalism: they neither manipulated spines nor used acupuncture. The ancient Greeks, around 400 BC, noticed that people who’d survived a smallpox plague never became reinfected — the cornerstone of immunity to infection. The Chinese indeed used variolation for smallpox as early as the 10th century, and the slow spread of the practice across Asia and into Europe over the following 700 years ended with Jenner getting a rational handle on the general principle of vaccination by the end of the 18th century. The Chinese never had “models of pathogens while we were being invaded bvy the Normans”; where do you get this idea from?
           
          “…recognising that I’m an expert in nothing much…”. Believe me, it shows. It’s great that you tackle Edzard; I don’t know him at all, but I get the impression he enjoys a good debate. But you need to be arguing from a basis of knowledge, reason and evidence, not from some sort of gut feeling that he’s being unreasonable.

  • Hello, I came across your article and was quite fascinated/saddened to see how we as Chiropractors are viewed. I am a practicing Chiropractor in Minnesota, USA and absolutely love how I get to help patients on a daily basis. I do want to let you know that while we are not fans of the ingredients that are put into the vaccinations the theory of vaccinating is a great one. But the bigger picture to bring to light is that we as a profession do not tell our patients (or at least my colleagues that practice chiropractic) that by getting adjusted you won’t need vaccinations. That in my opinion is archaic thinking. So my apologies if you thought differently of this chiropractor. From what I gathered he was trying to paint a positive light with the few research articles we have. The chiropractor in the article you reference was using the stat of the 200% immune competence from research that Ronald Pero published in 1975. There are other studies published for immune modulation after a chiropractic adjustment found in PubMed. But because they are published in smaller journals it probably wont meet standards.

    Working in a research laboratory as a Genetic and Cell Biologist prior to Chiropractic school, I soon realized that chiropractic research is not always highly funded as we are a small community and not supported by large pharmaceutical companies. Someday I hope to have more support from the medical world to help to have properly funded research that will finally make Medicine happy. As of now because we are lone little wolfs we get picked on and bullied on more than any other profession. Case in point the ACA (American Chiropractic Association) suing the AMA in the 80’s for boycotting us and name shaming us…and we won. But the name calling sadly continues:(

    Here’s the good news, we currently have multiple pediatric M.Ds. that refer patients to us when they need their pediatric patients to thrive. The top referrals we get from M.D’s are for ear infections and bowel issues. In addition, these Medical professionals admit themselves they too don’t like the ingredients put into vaccines. We all just want better vaccines that are “cleaner” but nobody seems to want to address that…they just argue over theory. In addition, what I love seeing is that more and more medical clinics are including Chiropractors on staff as they are seeing the tremendous benefit of the relationship of having both professions for their patients. Best part too is that the patients love that we all work together and get excited when they have a D.C. and an M.D. that work together for the greater good.

    My hope is that someday we will not be called Quacks and have the continued passive aggressive “boy-cotting” to come to an end. In addition, just to any profession there are people that give their profession a bad name but some how chiropractors continue to be the black sheep despite our efforts to be humble about having a valid place in health care. We really are not as vulgar as you paint us to be. Seeing the current trend of having Chiropractors in medical clinics gives me hope that we are legit and can and do help patients. So here’s to hopefully being able to work together in the future and that we can all get along:) Thank you.

    • ‘Dr. Faith’ said:

      we are not fans of the ingredients that are put into the vaccinations

      Why?

      chiropractic research is not always highly funded as we are a small community

      Chiro is a multi-billion dollar industry, so what’s the problem with research?

      Here’s the good news, we currently have multiple pediatric M.Ds. that refer patients to us when they need their pediatric patients to thrive. The top referrals we get from M.D’s are for ear infections and bowel issues.

      Who is that good news for?

      Seeing the current trend of having Chiropractors in medical clinics gives me hope that we are legit and can and do help patients.

      What do you think gives chiros legitimacy – association with medical doctors or robust evidence for what they do?

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