In 2008, I published a paper entitled ‘CHIROPRACTIC, A CRITICAL EVALUATION’ where I reviewed most aspects of this subject, including the historical context. Here is the passage about the history of chiropractic. I believe it is relevant to much of the current discussions about the value or otherwise of chiropractic.
The history of chiropractic is “rooted in quasi-mystical concepts.” Bone-setters of various types are part of the folk medicine of most cultures, and bone-setting also formed the basis on which chiropractic developed.
The birthday of chiropractic is said to be September 18, 1895. On this day, D.D. Palmer manipulated the spine of a deaf janitor by the name of Harvey Lillard, allegedly curing him of his deafness. Palmer’s second patient, a man suffering from heart disease, was also cured. About one year later, Palmer opened the first school of chiropractic. There is evidence to suggest that D.D. Palmer had learned manipulative techniques from Andrew Taylor Still, the founder of osteopathy. He combined the skills of a bone-setter with the background of a magnetic healer and claimed that “chiropractic was not evolved from medicine or any other method, except that of magnetic.” He coined the term “innate intelligence” (or “innate”) for the assumed “energy” or “vital force,” which, according to the magnetic healers of that time, enables the body to heal itself. The “innate” defies quantification. “Chiropractic is based on a metaphysical epistemology that is not amenable to positivist research or experiment.”
The “innate” is said to regulate all body functions but, in the presence of “vertebral subluxation,” it cannot function adequately. Chiropractors therefore developed spinal manipulations to correct such subluxations, which, in their view, block the flow of the “innate.” Chiropractic is “a system of healing based on the premise that the body requires unobstructed flow through the nervous system of innate intelligence.” Anyone who did not believe in the “innate” or in “subluxations” was said to have no legitimate role in chiropractic.
“Innate intelligence” evolved as a theological concept, the representative of Universal Intelligence ( = God) within each person. D.D. Palmer was convinced he had discovered a natural law that pertained to human health in the most general terms. Originally, manipulation was not a technique for treating spinal or musculoskeletal problems, it was a cure for all human illness: “95% of all diseases are caused by displaced vertebrae, the remainder by luxations of other joints.” Early chiropractic pamphlets hardly mention back pain or neck pain, but assert that, “chiropractic could address ailments such as insanity, sexual dysfunction, measles and influenza.” D.D. Palmer was convinced that he had “created a science of principles that has existed as long as the vertebra.” Chiropractors envision man as a microcosm of the universe where “innate intelligence” determines human health as much as “universal intelligence” governs the cosmos; the discovery of the “innate intelligence” represents a discovery of the first order, “a reflection of a critical law that God used to govern natural phenomena.”
Early chiropractic displayed many characteristics of a religion. Both D.D. Palmer and his son, B.J. Palmer, seriously considered establishing chiropractic as a religion. Chiropractic “incorporated vitalistic concepts of an innate intelligence with religious concepts of universal intelligence,” which substituted for science. D.D. Palmer declared that he had discovered the answer to the timeworn question, “What is life?” and added that chiropractic made “this stage of existence much more efficient in its preparation for the next step – the life beyond.”
Most early and many of today’s chiropractors agree: “Men do not cure. It is that inherent power (derived from the creator) that causes wounds to heal, or a part to be repaired. The Creator…uses the chiropractor as a tool…chiropractic philosophy is truly the missing link between Religion or Power of the various religions.” Today, some chiropractors continue to relate the “innate” to God. Others, however, warn not to “dwindle or dwarf chiropractic by making a religion out of a technique.”
Initially, the success of chiropractic was considerable. By 1925, more than 80 chiropractic schools had been established in the United States. Most were “diploma mills” offering an “easy way to make money,” and many “were at one another’s throats.” Chiropractors believed they had established their own form of science, which emphasized observation rather than experimentation, a vitalistic rather than mechanistic philosophy, and a mutually supportive rather than antagonist relationship between science and religion. The gap between conventional medicine and chiropractic thus widened “from a fissure into a canyon.” The rivalry was not confined to conventional medicine; “many osteopaths asserted that chiropractic was a bastardized version of osteopathy.”
Rather than arguing over issues such as efficacy, education, or professional authority, the American Medical Association insisted that all competent health care providers must have adequate knowledge of the essential subjects such as anatomy, physiology, pathology, chemistry, and bacteriology. By that token, the American Medical Association claimed, chiropractors were not fit for practice. Some “martyrs,” including D.D. Palmer himself, went to jail for practicing medicine without a licence.
Chiropractors countered that doctors were merely defending their patch for obvious financial reasons (ironically, chiropractors today often earn more than conventional doctors), that orthodox science was morally corrupt and lacked open-mindedness. They attacked the “germo-anti-toxins-vaxiradi-electro-microbioslush death producers” and promised a medicine “destined to the grandest and greatest of this or any age.”
Eventually, the escalating battle against the medical establishment was won in “the trial of the century.” In 1987, sections of the U.S. medical establishment were found “guilty of conspiracy against chiropractors,” a decision which was upheld by the U.S. Supreme Court in 1990. In other countries, similar legal battles were fought, usually with similar outcomes. Only rarely did they not result in the defeat of the “establishment:” In 1990, a Japanese Ministry of Health report found that chiropractic is “not based on the knowledge of human anatomy but subjective and unscientific.”
These victories came at the price of “taming” and “medicalizing” chiropractic. In turn, this formed the basis of a conflict within the chiropractic profession – the dispute between “mixers” and “straights” – a conflict which continues to the present day.
The “straights” religiously adhere to D.D. Palmer’s notions of the “innate intelligence” and view subluxation as the sole cause and manipulation as the sole cure of all human disease. They do not mix any non-chiropractic techniques into their therapeutic repertoire, dismiss physical examination (beyond searching for subluxations) and think medical diagnosis is irrelevant for chiropractic. The “mixers” are somewhat more open to science and conventional medicine, use treatments other than spinal manipulation, and tend to see chiropractors as back pain specialists. Father and son Palmer warned that the “mixers” were “polluting and diluting the sacred teachings” of chiropractic. Many chiropractors agreed that the mixers were “bringing discredit to the chiropractic.”
The “straights” are now in the minority but nevertheless exert an important influence. They have, for instance, recently achieved election victories within the British General Chiropractic Council. Today, two different chiropractic professions exist side by sided “one that wishes to preserve the non-empirical, non-positivist, vitalist foundations (the straights) and the other that wishes to be reckoned as medical physicians and wishes to utilize the techniques and mechanistic viewpoint of orthodox medicine (the mixers).” The International Chiropractic Association represents the “straights” and the American Chiropractic Association the “mixers.”
(for references, see the original article)
It has long been argued that chiropractic spinal manipulations are mere placebo interventions. Yet few controlled trials have assessed the efficacy of spinal manipulative therapy (SMT). No high quality trials have been performed to test the efficacy and effectiveness of Graston Technique® (GT), an instrument-assisted soft tissue therapy.
The objective of this trial was to determine the efficacy of SMT and GT compared to sham therapy for the treatment of non-specific thoracic spine pain.
People with non-specific thoracic pain were randomly allocated to one of three groups: SMT, GT, or a placebo (de-tuned ultrasound). GT is a popular soft-tissue technique in the United States and becoming more popular in other developed countries. GT is an instrument-assisted soft-tissue therapy involving the use of hand-held stainless steel instruments. The promoters of the GT claim that the instruments resonate in the clinician’s hands allowing the clinician to isolate soft-tissue “adhesions and restrictions”, and treat them precisely. Each participant received up to 10 supervised treatment sessions at Murdoch University chiropractic student clinic over a 4 week period.
The two outcome measures were self-administered instruments. Participants were given blank questionnaires in a package by a research assistant following their first treatment. Participants were instructed to complete the instruments at each assessment time point. After completion of the forms the participant posted them back to the Murdoch University Chiropractic Clinic. Research assistants remained blind to the outcome data for the entire study period. The participants and treatment providers were not blinded to the treatment allocation as it was clear that the groups were receiving different treatments. Participants in the placebo group were blinded to their placebo allocation until follow-up was complete at 12 months. Participants were surveyed for the adequacy of the placebo blinding at the end of the study.
Treatment outcomes were measured at baseline, 1 week, and at one, three, six and 12 months. Primary outcome measures included a modified Oswestry Disability Index, and the Visual Analogue Scale (VAS). Treatment effects were estimated with intention to treat analysis and linear mixed models.
One hundred and forty three participants were randomly allocated to the three groups (SMT = 36, GT = 63 and Placebo = 44). Baseline data for the three groups did not show any meaningful differences. Results of the intention to treat analyses revealed no time by group interactions, indicating no statistically significant between-group differences in pain or disability at 1 week, 1 month, 3 months, 6 months, or 12 months. There were significant main effects of time (p < 0.01) indicating improvements in pain and disability from baseline among all participants regardless of intervention. No significant adverse events were reported.
The authors concluded that this study indicates that there is no difference in outcome at any time point for pain or disability when comparing SMT, Graston Technique® or sham therapy for thoracic spine pain, however all groups improved with time. These results constitute the first from a fully powered randomised controlled trial comparing SMT, Graston technique® and a placebo.
Some people claim that there is little wrong with placebo therapy, as long as it helps patients. This is not what I think, but even the proponents of this argument would agree that the placebo used in this way has to be safe. As SMT is by no means free of adverse effects, the argument cannot be applied here.
Other people will argue that this is about SMT and not chiropractic implying that I am conducting a vendetta against the poor chiropractors. I would disagree: we have just learnt that 93% of chiropractors consider SMT as their primary treatment. Yes, osteopaths and physiotherapists also use SMT but certainly not to this extent. Thus this discussion is mostly about chiropractic, and the onus is on chiropractors to demonstrate beyond doubt that SMT does more good than harm.
The true significance of this study is, I think, that the chiropractic profession now must convince us that spinal manipulation has any usefulness at all. They will have to conduct rigorous trials along the lines of this study to test for which condition these interventions generate outcomes that are significantly better than those achievable by sham.
Until such data are available, it would be wise, I think, to consider all therapeutic claims made for chiropractic unproven and bogus.
WATCH THIS SPACE!
In 2010, we published an investigation of 200 chiropractor websites and 9 chiropractic associations’ World Wide Web claims in Australia, Canada, New Zealand, the United Kingdom, and the United States. The outcome measure was claims (either direct or indirect) regarding the eight reviewed conditions, made in the context of chiropractic treatment.
We found evidence that 190 (95%) chiropractor websites made unsubstantiated claims regarding at least one of the conditions. When colic and infant colic data were collapsed into one heading, there was evidence that 76 (38%) chiropractor websites made unsubstantiated claims about all the conditions not supported by sound evidence. Fifty-six (28%) websites and 4 of the 9 (44%) associations made claims about lower back pain, whereas 179 (90%) websites and all 9 associations made unsubstantiated claims about headache/migraine. Unsubstantiated claims were made about asthma, ear infection/earache/otitis media, neck pain.
At the time, we concluded that the majority of chiropractors and their associations in the English-speaking world seem to make therapeutic claims that are not supported by sound evidence, whilst only 28% of chiropractor websites promote lower back pain, which is supported by some evidence. We suggest the ubiquity of the unsubstantiated claims constitutes an ethical and public health issue.
Have things changed since?
I fear not! I regularly come across websites of chiropractors where they happily make bogus claims. On this website, for instance, chiropractor Karen Smith claims that muscles in the upper neck affect the ear canals. “We don’t actually treat the ear infection, or the symptoms. What we do is, we assist the body’s natural healing ability,” says Smith. “So if there’s something going on with the joints and the muscles soft tissue, the nerves coming out that supply those muscles, those muscles can’t relax, so then they’re almost tight and in spasm, so that can’t allow the drainage to happen properly.”
When fluid builds up in the ears, it’s a breeding ground for bacteria and infection. Smith says specific, gentle adjustments, can help the body drain those fluids through the nose. “What we do is we get some motion in the upper neck, with my hands, or I might use an instrument as well,” says Smith. “There’s a few other techniques that we can do. We can do some sinus drainage. We can drain some of the fluid in the ear.”
A simple ear pull technique can also help. “So what we do is, we just take the ear of the child and we do a little pull and that can actually drain the fluid as well,” says Smith. Smith says a child’s overall health and immune system impacts how quickly they see results from the treatment. In some cases, relief can be instant. “What we notice right after an adjustment is a lot of times you’ll actually see the fluid drain through the nose,” says Smith… Smith says she also treats adults who have had chronic ear issues as a child or who are experiencing pain in the ear.
When I or others expose such nonsense, the apologists say that these are just a few ‘rotten apples’, and that the chiropractic profession is fast progressing. Yet, I very much doubt this claim. For any fast progression, one would want to see the profession taking decisive and effective action against the ‘rotten apples’. This is clearly not happening, at least not to an extend that would stop such dangerous quackery.
What practical lesson can be learnt from such insights?
The only responsible advice I can think of is this: IF YOU OR YOUR CHILD IS ILL, AVOID CONSULTING A CHIROPRACTOR.
I just came across this website entitled 11 HARD QUESTIONS ABOUT CHIROPRACTIC PHYSICIANS. The title fascinated me; I am always in favour of addressing hard questions. I therefore read the 11 questions with interest; and I quite liked them. However, the answers provided by the author, a chiropractor of course, struck me as being more than a little uncritical towards chiropractic (feel free to click on the above link and see for yourself). Therefore, I decided to try my own answers (except for No 5). And then – being in the swing of it – I added a few more supplementary questions as well.
In other words, the first 11 questions are the ones posed by the chiro but the 4 additional ones are mine, and so are all the answers. Here we go:
Question No 1: What can a chiropractic physician do for me that another doctor can’t?
Question No 2: Does chiropractic therapy really work?
No. The best evidence available today fails to show that chiropractic spinal manipulations work for any condition. If one is generous, one might make an exception for back pain, but even for this symptom, the evidence is flimsy.
Question No 3: What other types of health problems can chiropractic treatment help?
Question No 4: What does a chiropractic physician do to find my problem?
He/she often uses non-validated diagnostic techniques that are prone to give fantasy-results. You might also get extensive X-rays – mostly because the chiropractor wants to pay for the expensive equipment.
Question No 5: What therapies do chiropractic physicians use?
Chiropractic physicians may use manual and physical therapies including manipulation of the spine and joints of the arms and legs. Supportive therapies may also include massage, myofascial release, and therapeutic modalities such as ultrasound, electric stimulation and diathermy. Rehabilitative measures are often used such as specific corrective exercises to stabilize your problem. (This is the only answer I roughly agreed with, and I therefore left it unchanged.)
Question No 6: What is the standard length of treatment?
This depends mainly on the patient’s ability to pay. As a rule of thumb, as many treatments as possible will be given. Many chiros even advocate ‘maintenance treatment’ which means you receive regular spinal manipulations even when there is nothing wrong with you. The little porky they give you as an explanation is that this prevents future illnesses.
Question No 7: Is chiropractic care covered by insurance?
Because of very active lobbying by chiro interest groups, it may well be.
Question No 8: If I need a referral, how do I ask my doctor to refer me to a chiropractic physician?
Chiros are presently trying very hard to be accepted as ‘primary care physicians’; this means you can consult them directly without the need of a referral.
Question No 9: If I go see a chiropractor do I need to keep on going?
Only if you believe the nonsense about maintenance treatment they often tell you (see above) for which there is not a jot of convincing evidence.
Question No 10: What training do chiropractors have?
Not enough to realise that their spinal adjustments fail to generate more good than harm.
Question No 11: How should I select a good chiropractic physician?
If you are ill, it’s best to see are real doctor and avoid chiros.
AND NOW MY SUPPLEMENTARY QUESTIONS
No 1 Are chiros really physicians?
The definition of a physician is : ‘A person trained and licensed to practice medicine; a medical doctor’. Therefore, the answer is no.
No 2 What are the risks of spinal manipulations or adjustments, the main treatments used by chiros?
~50% of all patients have mild to moderate adverse effects that last 2-3 days.
In addition, several hundred cases of severe complications have been noted, including strokes and deaths.
No 3 How are such adverse outcomes monitored?
There is no effective monitoring system at all.
No 4 Is such an omission responsible or ethical?
Amidst the current controversy of chiropractic spinal manipulation for new-born babies, the previous director of Chiropractor’s Association of Australia NSW, Alex Fielding, published an interesting article. In it, he declared:
- I do not condone the chiropractic treatment of children for non-musculoskeletal conditions it is simply not our place. There is little to no evidence for it and it should not be done. If a chiro is report them to AHPRA.
- There is no evidence for “subluxation” it simply has not been shown to exist by any credible source.
- Chiropractic does not equal spinal manipulative therapy (SMT) or adjustment. We are trained to assess and treat musculoskeletal conditions, use exercise rehab, various forms of manual therapy including SMT, give sound evidence based advice and refer to better suited health professionals in the appropriate circumstance. To say there is no evidence for chiropractic is an ill informed politically charged statement, if you mean SMT, say SMT.
Here I only want to comment on his last point. I think it is important, not least because we hear it ad nauseam. As soon as there emerges new evidence to show that SMT does little for back or neck pain or is ineffective for non-spinal conditions, chiropractors insist that they do so much more than just SMT, and therefore any such findings do not ever lend themselves to a verdict about chiropractic care.
In my view, this argument is a bit like ‘wanting the cake and eat it’ (chiros want to be different from physios by adhering to SMT, but they don’t want to be judged by the uselessness of SMT). It begs the following questions:
- What other modalities do chiros use?
- For which conditions do they use them?
- What is the evidence for or against them?
- In what percentage of patients do chiros use SMT?
The last question may be the most important one. I am not aware of data from ‘down under’ but, in the UK, the percentage is close to 100%. This is why I often call SMT the ‘hallmark therapy of chiropractors’. No other profession employ it more frequently. It is the treatment that defines the chiropractic profession.
If the evidence for SMT is flimsy or negative or non-existent, it seems not unreasonable to voice doubts about the profession that uses it most. The fact that chiropractors also administer other modalities – most of which, by the way, have a shaky evidence-base too – is simply a smoke-screen used to mislead us.
An example might make this a bit clearer. Imagine a surgeon who takes out the tonsils of every patient he sees, regardless of any tonsillitis or other tonsil-related condition (historically, this fad once existed; tonsillectomy was even used to treat depression). This surgeon also does all sorts of other things: he prescribes pain-killers, gives antibiotics, orders bed-rest, gives life-style advice etc. etc. Yet he is a charlatan because his hallmark intervention is not effective and even puts patients at unnecessary risks.
I know, the analogy is not perfect, but it makes the point: chiropractors refuse to be judged by the uselessness of SMT. Yet it is what defines them and they continue using SMT pretty much regardless of the evidence. Fielding pleads: To say there is no evidence for chiropractic is an ill informed politically charged statement, if you mean SMT, say SMT. I’d say there is no good evidence for SMT nor for chiropractic care that includes SMT.
My advice for chiropractors therefore is: abandon SMT and become physiotherapists. This will make you a bit better grounded in evidence, but at least you would have rid yourself of the Palmer-cult with all the BS that comes with it.
Informed consent is an essential ethical precondition for any therapeutic intervention. This obviously cannot exclude alternative medicine. Yet, one gets the impression that alternative therapists systematically ignore informed consent. Chiropractors in the UK, for instance, have been shown to often take this issue more than a little light-heartedly.
The General Chiropractic Council (GCC) has issued guidance to its members about informed consent. Here is a passage from their website which I find particularly interesting:
The information you provide to the patient must be clear, accurate and presented in a way that the patient can understand… Patients must be fully informed about their care. You must not rely on a patient to ask questions about their care, the responsibility to fully inform patients about their care lies with you. When discussing with patients the expected outcomes of their care, chiropractors must fully discuss the risks as well as the benefits and explore with the patient what other factors they may see as relevant to making a decision.
When explaining risks, you must provide the patient with clear, accurate and up-to-date information about the risks of the proposed treatment and the risks of any reasonable alternative options, in a way that the patient can understand. You must discuss risks that occur often, those that are serious even if very unlikely and those that a patient is likely to think are important. You must encourage patients to ask questions, so that you can understand whether they have particular concerns that may influence their decision and you must answer honestly.
I have repeatedly written about the fact that, in alternative medicine, informed consent has remained an almost alien concept. Yet, there can be no doubt, it is an ethical imperative in ALL healthcare. The above guideline makes this perfectly clear. Essentially, it proscribes that a chiropractor has to inform each patient who is about to be treated with a spinal manipulation – virtually 100% of all patients consulting chiropractors – that:
- this treatment has not been shown to be effective for non-spinal conditions,
- for back and neck pain, it might help but not better than other conservative therapies,
- in about half of all patients, it leads to mild to moderate adverse effects that typically last 2-3 days and are severe enough to interfere with the patient’s quality of life,
- in an unknown number of patients, it might lead to severe complications, including stroke and death,
- there are other options for your problem that are more effective and/or less harmful.
The chiropractor then has to document the patient’s consent. Only then can he start treatments.
My question to the GCC is: have you tested how many patients would consent under these conditions?
I suspect the answer is No.
And my questions to UK chiropractors is: who is actually following these guidelines?
I suspect the answer is VERY FEW. If that were true, most chiropractors would violate their own ethical guidelines and could therefore be struck of the GCC’s register. Or did I get this wrong?
For many years, I have been impressed with the high quality and originality of chiropractic research. Here is the abstract of a particularly remarkable, new investigation.
The purpose of this study was to compare characteristics, likelihood to use, and actual use of chiropractic care for US survey respondents with positive and negative perceptions of doctors of chiropractic (DCs) and chiropractic care.
From a 2015 nationally representative survey of 5422 adults (response rate, 29%), we used respondents’ answers to identify those with positive and negative perceptions of DCs or chiropractic care. We used the χ2 test to compare other survey responses for these groups.
Positive perceptions of DCs were more common than those for chiropractic care, whereas negative perceptions of chiropractic care were more common than those for DCs. Respondents with negative perceptions of DCs or chiropractic care were less likely to know whether chiropractic care was covered by their insurance, more likely to want to see a medical doctor first if they were experiencing neck or back pain, less likely to indicate that they would see a DC for neck or back pain, and less likely to have ever seen a DC as a patient, particularly in the recent past. Positive perceptions of chiropractic care and negative perceptions of DCs appear to have greater influence on DC utilization rates than their converses.
We found that US adults generally perceive DCs in a positive manner but that a relatively high proportion has negative perceptions of chiropractic care, particularly the costs and number of visits required by such care. Characteristics of respondents with positive and negative perceptions were similar, but those with positive perceptions were more likely to plan to use-and to have already received-chiropractic care.
END OF ABSTRACT
- 1Chair, Clinical and Health Services Research Program, Palmer Center for Chiropractic Research, Davenport, IA; Professor, The Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH. Electronic address: email@example.com.
- 2Vice Chancellor, Research and Health Policy, Palmer College of Chiropractic, Palmer Center for Chiropractic Research, Davenport, IA.
- 3President, Palmer College of Chiropractic West Campus, San Jose, CA.
- 4Chancellor, Palmer College of Chiropractic, Davenport, Iowa.
Not just inexperienced novices then! The authors belong to the crème de la crème of the chiropractic establishment and research!!!
In comparison, I feel like a mere beginner. But let me nevertheless try to design my own study along similar lines. It is so brilliant that I might even get the Nobel Prize for it. Here we go:
The purpose of my study would be to compare characteristics, likelihood to use, and actual use of spectacles for survey respondents with positive and negative perceptions of spectacles and opticians***. From a nationally representative survey of about 5000 adults, I would use the respondents’ answers to identify those with positive and negative perceptions of spectacles and opticians. My results would show that positive perceptions of opticians are more common than those for spectacles, whereas negative perceptions of spectacles are more common than those for opticians. Respondents with negative perceptions of opticians or spectacles were less likely to know whether spectacles were covered by their insurance, more likely to want to see a medical doctor first, if they were experiencing poor eye-sight, less likely to indicate that they would see an optician for poor eye-sight, and less likely to have ever seen an optician as a patient, particularly in the recent past. Positive perceptions of spectacles and negative perceptions of opticians appear to have greater influence on optician utilization rates than their converses. From these data, I would conclude that my sample generally perceive opticians in a positive manner but that a relatively high proportion has negative perceptions of spectacles, particularly the costs and number of visits required for getting them. Characteristics of respondents with positive and negative perceptions were similar, but those with positive perceptions were more likely to plan to use – and to have already received – care from opticians.
*** instead of opticians and spectacles, I might also opt for other things like
- acupuncturists and needles,
- aroma-therapists and essential oils,
- herbalists and herbs,
- fast food restaurants and hamburgers,
- politicians and politics,
- priests and religion,
- etc., etc.
YOU MUST AGREE, THIS DESERVES A NOBEL PRIZE!
I thank the authors of the above paper for having inspired me with their ground-breaking science. In case they receive a Nobel Prize before I do, I congratulate them on their extraordinary achievement in designing, conducting and publishing this truly cutting-edge investigation.
I just came across this article which I find remarkable in several ways. Here is the abstract:
The purpose of this report is to describe 2 patients with coronary artery disease presenting with musculoskeletal symptoms to a chiropractic clinic.
A 48-year-old male new patient had thoracic spine pain aggravated by physical exertion. A 61-year-old man under routine care for low back pain experienced a secondary complaint of acute chest pain during a reevaluation.
INTERVENTION AND OUTCOME:
In both cases, the patients were strongly encouraged to consult their medical physician and were subsequently diagnosed with coronary artery disease. Following their diagnoses, each patient underwent surgical angioplasty procedures with stenting.
Patients may present for chiropractic care with what appears to be musculoskeletal chest pain when the pain may be generating from coronary artery disease necessitating medical and possibly emergency care.
I FIND THIS REMARKABLE FOR AT LEAST 3 REASONS:
- I don’t remember coming across the term ‘medical physician’ before. It is clear what the author meant by it. But it is also quite clear that such phraseology is nonsensical. My Oxford Dictionary defines ‘physician’ as: “A person qualified to practise medicine, especially one who specializes in diagnosis and medical treatment as distinct from surgery.” Therefore, a ‘medical physician’ would be ‘a medical person qualified to practise medicine.’ This begs the question why this term is used in a chiro-journal. The answer is probably quite simple: they want to arrive at a point where we all accept that there are two types of physicians: medical and chiropractic. But, using again my dictionary, this would be not just a little confusing. A chiropractic physician would be ‘a chiropractor qualified to practice medicine.’ And for that you need to go not to chiro-college but to medical school.
- The two case reports are remarkable in themselves, I find. They show that “patients may present for chiropractic care with what appears to be musculoskeletal chest pain when the pain may be generating from coronary artery disease necessitating medical and possibly emergency care.” The remarkable thing about this is that such basic knowledge ever merited a mention and publication in a journal. It should be clear to anyone who is in healthcare! I even know shop assistants who have called an ambulance because a customer suffered from what might have been misdiagnosed as a muscular problem in the left arm but was in truth due to coronary hear disease. The fact that chiros and editors of their journals feel that it worthy of publication seems a bit worrying and begs the question: how many other elementary things about the human body (known even to shop assistants) are unknown to the average chiro?
- Lastly, I must praise the chiro-profession for the progress they now seem to start making. About 120 years ago, DD Palmer, the founding father of chiropractic, famously treated a man with coronary heart disease by adjusting his spine. The author of the above article did not do that! Yes, progress was painfully slow, but the above article seems to indicate that at least some chiros have come around to agreeing with real physicians that the Palmer-gospel is based on little more than wishful thinking.
On their website, the American Chiropractic Association (ACA) recently updated its members on their lobbying activities aimed at having US chiropractors recognised as primary care physicians. The president of the ACA posted the following letter to ACA members:
For much of this past year, ACA’s staff and key volunteers have been laying the groundwork to achieve just that — quietly spending time building key support on Capitol Hill for this important legislative change. As you know, our progress advanced to the point where we were able on Oct. 27 to publically launch our grassroots campaign centered on the widespread circulation of our National Medicare Equality Petition.
Since the launch of our campaign, through very public and transparent means, ACA has received the support of various organizations and individuals within the profession. These supporters fully understand the importance of eliminating any and all provider discrimination by CMS. Further they fully understand and agree with the soundness of the strategic and tactical decisions we have made and continue to make an effort to achieve the desired reformation in Medicare.
Towards building a unified consensus within the profession for our objectives and plans to accomplish them, we have engaged in prolonged discussions, mostly via the Chiropractic Summit Steering Committee and Roundtable process that includes ACA, COCSA, ACC, ICA, NBCE, FCLB and CCE. Throughout this process we have provided for them written legal opinions and analyses relative to the precise legislative language needed to achieve the full-physician status we seek. We have outlined our strategy numerous times; have shared our materials and updates with any group wishing to review them; and have repeatedly urged state chiropractic associations, chiropractic colleges, corporate partners and individual DCs to join with us and enthusiastically support this reformation campaign.
While there was high consensus on the objective of Medicare reform during the Summit Roundtable process, there was much discussion surrounding the proposed legislative language. Specifically, whether or not “detection and correction of subluxation of the spine through manual manipulation” would need to be eliminated and replaced with language simply designating DCs as physician level providers on the same level as MDs and DOs who report/bill services to Medicare based on their individual state laws.
ACA is of the opinion that nothing less than removal of the “subluxation” language in the definition of physician section will accomplish our objectives. Historically, the facts are that this language has proven to be the major barrier within HHS and CMS when we advocated for regulatory remedies expanding our reimbursement and coverage for the full range of services provided by a DC. ACA (and our profession) has expended massive resources over the past decade or longer to no avail through regulatory channels (HHS, CMS). Based on these experiences, the only reasonable recourse to eliminate 40+ years of Medicare discrimination is through a thoughtful profession-wide legislative effort.
During the Roundtable discussions, compromise language was reached placing the current “subluxation language” into the preamble of a proposed law stating that DCs must continue to have the ability to detect and correct subluxations of the spine for Medicare beneficiaries. Six of seven Summit Roundtable organizations voted in favor of this language that was offered by the Association of Chiropractic Colleges.
ACA`s intent on removing the “subluxation” reference in the Social Security Administrative statute is in no way an attempt to quash our ability to perform those services that so many of the Medicare population need and deserve. Rather, the ultimate goal of this historic effort is to gain the privilege to manage our Medicare patients within state scopes of practice and allow reimbursement for all those services that the Medicare beneficiaries are currently forced to pay out of pocket. ACA supports fully our continued ability to correct subluxations through appropriate active care and, in fact, achieve coverage for manipulation of all areas, not simply limited to the spine.
Expanding Medicare scope reimbursement will allow our profession to practice contemporary chiropractic and to potentially increase utilization of our services to the ever-increasing aging population. Expansion and reformation will also place DCs in a position to participate in alternative payment models, quality healthcare initiatives, community health centers, hospitals and other integrated settings which are vital to professional growth.
In conclusion, should you as an HOD member be questioned on our intent you should be able to answer unequivocally that ACA supports the right to manage our patients as dictated by our training and competencies based on state scopes of practice. Further, we support those who wish to provide necessary active subluxation care for the Medicare population. Please support this initiative and let’s join together to encourage your state association, colleges and universities, corporate partners, patients and individual DCs to become true partners in order to make this a success for our patients and for our grand profession.
A list of talking points will be distributed in the coming days.
Sincerely, Tony Hamm, DC President, ACA
Do I read this correctly?
The term subluxation is a hindrance to business. Therefore chiros need to do something about it. Never mind that the principle of subluxation as used in the realm of chiropractic is nonsense!
This might throw an entirely different light on those chiros who want to get rid of the term ‘subluxation’.
And what about chiros as primary care physicians?
Recently Dave Newell posted on this blog: “chiropractors in the UK … are primary care clinicians”. I objected and he insisted to be correct because “Primary Care is defined as a clinician that is the first port of call for patients seeking help.” Frank Odds then countered: “This business of “primary care provider” is becoming enervating! Edzard has now spelt out the meaning of the term as defined by Wikipedia. You are quite right that a dentist is a primary care provider: people go to a dentist when they have symptoms affecting their mouth in general — more often their teeth and gums in particular. They know that’s what dentists deal with. A general practitioner is a primary care provider: people go to a GP when they have symptoms anywhere. They know that’s what GPs deal with. A chiropractor is indeed a primary care provider: of chiropractic. ”
I think that primary care physicians are doctors who are capable of handling everything or at least most of what primary care may present to them. Chiros do not fulfil this criterion, I think.
I would be interested what you feel on this important issue.
‘Megalomania’ of a clinician is (for the purpose of this blog-post) defined as a practitioner claiming to cure everything. It seems to me that this dangerous condition is endemic in the realm of alternative medicine, and particularly in chiropractic. Perhaps they catch it at chiro school, I don’t know, but an awful lot of them seem to suffer from it.
We all had to get used to this fact, and there is nothing remarkable about it anymore. But recently I came across a website where an extraordinarily severe case is being disclosed. Let me share some of the text (including its grammatical and other errors) with you:
How many of the 10,000 patients Dr. Del Monte has – upon whom he has performed one million spinal adjustments – with his hands – healed themselves?
The woman who could not get pregnant. Doctors told her she would never conceive.
She came to Dr. Del Monte, got adjustments and soon after, somehow – she got pregnant and gave birth to a healthy child.
The person with the brain tumor that went away. Science can’t prove it – no more than you can X- Ray for a headache and prove it. Maybe he would have healed his tumor without spinal adjustments.
The two year old that couldn’t speak who suddenly opened her mouth and babbled one hour after her first adjustment.
Asthmatics, bedwetters, people in pain, their back and neck, indigestion, earaches.
People set for surgery because they couldn’t bear the pain – who went to Dr. Del Monte and never met the surgeons’ knife.
Dr. Del Monte is an apostle – and I use the word advisedly – for chiropractic is not religion – although its founder D.D. Palmer thought of making it a religion – because it seems to unleash God’s healing power.
Chiropractic can open up impossible doors, unlock the door to free-flowing, “Innate Intelligence” – the natural tendency of the body to seek and maintain a condition of balance or equilibrium.
You don’t believe in Innate Intelligence?
One chiropractor explained it this way: “At the moment of your conception, 23 chromosomes from your mother and 23 chromosomes from your father combined to form one cell, the unique ‘You’.
“Barely the size of a pinhead, that one cell began to divide into what is now an estimated 80 quadrillion cells that make up your body. This process is driven by something – call it an Innate Intelligence, an inborn wisdom, which knows how tall you will be, the length of your fingers, where your nose should be on your face, and where your vital organs belong.
“This Innate Intelligence stays with you after you are born and guides every function of your body until your last breath of life.
“The master control system for this is your nervous system which consists of your brain, spinal cord and nerves that go to every cell, tissue and organ. Nerves control your heartbeat, respiration, hormone balance, digestion, immune system, muscle contraction and every other function that is necessary for you to live.
“Your Innate Intelligence is ‘wise’ to the importance of this system. Fully encased in bone, your skull protects your brain and your spinal column protects your spinal cord.”
While no chiropractor can guarantee that your Innate Intelligence will self cure any specific symptoms or diseases, they can guarantee that when your body is free of nerve interference it will work better.
Some have regained eyesight.
Several threw away their canes.
You will often hear people say, when they leave Dr. Del Monte’s office “My back is so much better, I can stand up straight; My migraines are gone; My blood pressure is down; My heartburn is gone; Menstrual cramping went away; My digestion is better; I haven’t had a cold in years.”
Dr. Del Monte explains: “Anything that could be effected by the nervous system can be improved by chiropractic manipulation, and the nervous system controls and coordinates almost every function of the body.
“Why would you mask the symptoms with drugs, when you could allow your own body to heal?”
“Sick cells makes sick tissues which make sick organs. Then there are sick people. Symptoms are the last to show up. If the spine is healthy, the body needs no help in healing. It does the healing.”
The main procedure is “spinal manipulation,” or “adjustments” which restore mobility by applying force into joints that became restricted – as a result of injury — caused by a traumatic event or through repetitive stresses – causing inflammation, pain, and diminished function.
Manipulation, or adjustment of the joint and tissues, alleviates pain and muscle tightness, and allows tissues to heal.
“It should be tried first ahead of drugs and surgery,” Dr. Del Monte says.
The focus is therefore on spotting and curing “vertebral subluxations”, said to be the cause of many diseases. Sometimes chiropractic assumes the sole cause of an individual’s health problems are subluxations.
These subluxations, commonly caused by birth trauma, childhood falls, accidents and all types of stress, reduce the function of the areas supplied by these nerves.
Nerve pressure can affect areas that are directly supplied by those nerves: muscles, bladder, prostate or heart; they can affect the entire body because of the relationship that each cell, organ and system share…
The list of ailments Dr. Del Monte has seen his patients cured of – self healed – are nearly endless: Bowel/bladder problems, chronic colds, allergies, ringing in the ears, earaches, bed wetting, sciatica, colds, fevers…
“So many times people come in with a cold or fever. We see an almost instant response- within hours. It’s not like you are waiting days.
“Ninety percent of the time patients get favorable results. Rarely does a patient go to a Chiropractor and say ‘it didn’t work for me’…
“I don’t need a referral. I don’t need a script. People do refer patients here, but I am primary healthcare. They don’t have to go through their medical doctor. They just come and see me. They just call the office, “ said Dr. Del Monte.
END OF QUOTE
THE ONLY CONDITION THAT CHIROPRACTIC MANIPULATION CANNOT CURE IS MEGALOMANIA!
On a good day, I can heartily laugh at this sort of thing (of which this article is merely one of hundreds of example available on the Internet). On a not so good day, however, I ask myself questions:
- Where does such idiocy come from?
- Do chiropractors ever learn anything about medical ethics?
- Why is this chiropractor still allowed to practice?
- What happens to the poor patients who fall for it?
- Why is nobody stopping it?
- Where are the protests of chiropractors who boast of being reformed and evidence-based?