Regular readers of this blog will be aware of the many bogus claims made by chiropractors. One claim, however, namely the one postulating chiropractors can effectively treat low back pain with spinal manipulation, is rarely viewed as being bogus. Chiropractors are usually able to produce evidence that does suggest the claim to be true, and therefore even most critics of chiropractic back off on this particular issue.
But is the claim really true?
A recent trial might provide the answer.
The purpose of this study was to compare the effectiveness of chiropractic spinal manipulative therapy (cSMT) to a sham intervention on pain (Visual Analogue Scale, SF-36 pain subscale), disability (Oswestry Disability Index), and physical function (SF-36 subscale, Timed Up and Go) by performing a randomized placebo-controlled trial at 2 Veteran Affairs Clinics.
Older veterans (≥ 65 years of age) who were naive to chiropractic were recruited. A total of 136 who suffered from chronic low back pain (LBP) were included in the study – with 69 being randomly assigned to cSMT and 67 to the sham intervention. Patients were treated twice per week for 4 weeks. The outcomes were assessed at baseline, 5, and 12 weeks post baseline.
Both groups demonstrated significant decrease in pain and disability at 5 and 12 weeks. At 12 weeks, there was no significant difference in pain and a statistically significant decline in disability scores in the cSMT group when compared to the control group. There were no significant differences in adverse events between the groups.
The authors concluded that cSMT did not result in greater improvement in pain when compared to our sham intervention; however, cSMT did demonstrate a slightly greater improvement in disability at 12 weeks. The fact that patients in both groups showed improvements suggests the presence of a nonspecific therapeutic effect.
Hold on, I hear you say, this does not mean that cSMT is a placebo in the treatment of LBP! There are other studies that yield positive results. Let’s not cherry-pick our evidence!
Absolutely correct! To avoid cherry-picking, lets see what the current Cochrane review tells us about cSMT and chronic LBP. Here is the conclusion of this review based on 26 RCTs: High quality evidence suggests that there is no clinically relevant difference between SMT and other interventions for reducing pain and improving function in patients with chronic low-back pain.
In the realm of alternative medicine, we encounter many therapeutic claims that beggar belief. This is true for most modalities but perhaps for none more than chiropractic. Many chiropractors still adhere to Palmer’s gospel of the ‘inate’, ‘subluxation’ etc. and thus they believe that their ‘adjustments’ are a cure all. Readers of this blog will know all that, of course, but even they might be surprised by the notion that a chiropractic adjustment improves the voice of a choir singer.
This, however, is precisely the ‘hypothesis’ that was recently submitted to an RCT. To be precise, the study investigated the effect of spinal manipulative therapy (SMT) on the singing voice of male individuals.
Twenty-nine subjects were selected among male members of a local choir. Participants were randomly assigned to two groups: (A) a single session of chiropractic SMT and (B) a single session of non-therapeutic transcutaneous electrical nerve stimulation (TENS). Recordings of the singing voice of each participant were taken immediately before and after the procedures. After a 14-day wash-out period, procedures were switched between groups: participants who underwent SMT on the first occasion were now subjected to TENS and vice versa. Recordings were assessed via perceptual audio and acoustic evaluations. The same recording segment of each participant was selected. Perceptual audio evaluation was performed by a specialist panel (SP). Recordings of each participant were randomly presented thus making the SP blind to intervention type and recording session (before/after intervention). Recordings compiled in a randomized order were also subjected to acoustic evaluation.
No differences in the quality of the singing on perceptual audio evaluation were observed between TENS and SMT.
The authors concluded that no differences in the quality of the singing voice of asymptomatic male singers were observed on perceptual audio evaluation or acoustic evaluation after a single spinal manipulative intervention of the thoracic and cervical spine.
There is nevertheless an important point to be made here, I feel: some claims are just too silly to waste resources on. Or, to put it in more scientific terms, hypotheses require much more than a vague notion or hunch.
To set up, conduct and eventually publish an RCT as above requires expertise, commitment, time and money. All of this is entirely wasted, if the prior probability of a relevant result approaches zero. In the realm of alternative medicine, this is depressingly often the case. In the final analysis, this suggests that all too often research in this area achieves nothing other than giving science a bad name.
‘Doctor’ Don Harte is former medical student who prematurely left medical school and currently works as a chiropractor in California. He, has served on the Boards of the World Chiropractic Association and the Council on Chiropractic Practice. He has published extensively; on his website, he offers a list of his articles:
- July 16, 2015: “CA SB277: Marin Chiropractor Says Power Structure Bigoted Against Boy in Wheelchair, vs. Leukemia Boy”
- July 1, 2015: “SB277: Marin Chiropractor Charges California with Chemical Child Molestation”
- June 15, 2015: Press release: “Dr. Don Harte warns about the Failure of Big Pharma and Growing Opioid Addiction Crises”
- May, 2015: “The Biological, Economic and Political Case Against Vaccination” in North Bay Biz magazine
- May 15, 2015: “Dr. Don Harte Calls Draconian SB277 Vaccination Initiative Sacramento’s Syringe of Shame”
- April 21, 2015: “End of a Made-up Measles Crisis”
- February 12, 2015: “It’s a childhood disease, not a tragedy” Letter to the Editor in the Pacific Sun, about the measles hysteria.
- January 27, 2015: “California Straight Chiropractor Fights Disney Measles Mania”
- March 5, 2015: “You cannot have vaccination that works, yet doesn’t work” Letter to the Editor in the Pacific Sun. “The grotesque level of bigotry, backed up by the lack of any comprehension of immunology, toxicology and the vitalistic paradigm of Chiropractic, is astounding.”
- April, 2009: “Seize the Time” in The Chiropractic Journal. The future of Chiropractic, as Medicine is breaking down, and bankrupting the country.
- April, 2009: “Refusal to Vaccinate Puts Kids At Risk”Dr. Harte quoted, “Vaccination is based on the medical fallacy that our bodies are stupid.”
- Spring, 2008: “The Future of Chiropractic” Journal of the California Chiropractic Association. For chiropractors, my view on the future of Chiropractic.
- November, 2007: “Is There a Vaccine That Protects Against ‘Non-Science?’”Marin Independent Journal. Discussion of Guardisil, the HPV vaccine, the flu vaccine, and the general foolishness of vaccination, the lack of science and efficacy, etc.
- May, 2005: ”Generations of Unbridled Power” The Chiropractic Journal. In a publication for chiropractors, I am standing up against the harassment and debasement of the chiropractic profession, specifically by the California Board of Chiropractic Examiners.
- October, 2004: “Time for regime Change in Attitude about Medicine” San Francisco Chronicle. The very popular anti-inflammatory medication, Vioxx, was just pulled off the market, at the same time as a massive contamination of flu vaccine.
- January, 2004: “Alternative to the Sting of a Failed Flu Vaccine” San Francisco Chronicle. Discusses the absurdity and the dangers of the annual flu vaccine ritual. The heroic role of Chiropractic in the Great Flu Pandemic of 1918.
- May, 2003: “Where is the Danger in Chiropractic?” San Francisco Chronicle. Responding to another baseless attack upon Chiropractic by medical bigots, noting the extreme risks of Medicine, and the extreme safety of Chiropractic.
- January, 2002: “To X-Ray or Not to X-Ray” The Chiropractic Journal. An article to chiropractors about how essential X-ray is to the practice of Chiropractic. Sadly, very few chiropractors X-ray these days.
- May, 2000: “By Giving Our Kids Certain Drugs, We’re Playing Russian Roulette With Their Lives” Marin Independent Journal. Ritalin and anti-depressants for children, the Columbine massacre, the role of Chiropractic in children’s health.
- December, 1999: “It’s a Myth that Children Need Vaccines” Marin Independent Journal.
- July, 1999: “Too Little Drugs, Too Many Organs” Marin Independent Journal. Does the medical paradigm really make sense? Is it logical?.
- November, 1979: “Interferon and Beyond” OMNI Magazine “Forum,” (Response to a cover story, “Cancer Cure at a Billion Dollars a Pound.”
His website also reveals that Harte views chiropractic as a ‘cure all’ and believes that the “Vertebral Subluxation Complex (VSC) is THE most serious threat to your health and well-being.”
Harte is not impressed with conventional medicine: “Virtually everyone has lost loved ones to medical mistakes and indifference. I, myself, count my father, my favorite uncle and two cousins amongst this unnecessary medical death toll. Though people concoct all kinds of charges against Chiropractic, nobody knows of any deaths from Chiropractic, because there just aren’t any. You might want to read the article that I wrote on this subject in the San Francisco Chronicle, “Where is the Danger in Chiropractic.”
In particular, Harte is no friend of immunisation. Here are some of the things he has been quoted as saying recently about the subject:
- He charged the media with “an evil bigotry” in relation to vaccination.
- He said that “The mass media refuses to acknowledge the existence of vaccine-injured children. This is quite a trick, since we are talking millions of children.”
- He explained that “their whole con game relies on fear, trying to convince you that you and your children have nothing inside to protect them from all those evil germs. That you need their HOLY WATER, the vaccines, or you will die.” Once again, Harte charged the California Governor and the legislature “as Destroyers of the family, as Enemies of liberty, as CHEMICAL CHILD MOLESTERS.”
- He claimed that “His (Mr J Coleman’s) son, Otto, who was paralyzed by a vaccine reaction, was there, in his wheelchair; as were other vaccine-damaged children. Some participants held up photos of their children who had died from vaccines.” And he said, “There were no photos of these children, nor any mention of them in news accounts. Establishment media refuses to put a human face on the suffering caused by vaccinations. I don’t know whether to call them ‘chicken’ or ‘evil.’”
- Harte also stated that “The claim that non-vaccinated children are a threat to Rhett has ZERO scientific basis. First of all, less-vaccinated and non-vaccinated kids tend to be healthier. And more specifically, children recently vaccinated with live virus vaccines will shed viruses, and thus, be contagious, for up to 28 days.”
- “Here we have a case,” explained Harte, “of one boy held up as a potential victim of unvaccinated or less-vaccinated children, who has had, in reality, no harm done by those children. The millions of children who have endured great harm, up to and including paralysis and death, are ignored. This is not science, nor is it reputable news reporting nor reputable public policy. It is naked propaganda, paid for by Big Pharma.”
It seems that Harte is an altogether dangerous person.
Of course, chiropractors will (yet again) claim that Harte does in no way stand for chiropractic as a whole and that chiropractors are just as appalled by such dangerous anti-vaccination propaganda as we are. They will say he is just ‘a rotten apple’ within a mostly laudable profession.
But is that true? What have the professional bodies of chiropractic done against him and his hazardous views? Have they excluded or reprimanded him, or requested that he seeks treatment for what seems to be rampant paranoia?
The answer, I am afraid, is NO! What they did do instead was to name him, in 2006, as “Chiropractor of the Year” – an honour bestowed on him by the World Chiropractic Alliance.
Chiropractors are back pain specialists, they say. They do not pretend to treat non-spinal conditions, they claim.
If such notions were true, why are so many of them still misleading the public? Why do many chiropractors pretend to be primary care physicians who can take care of most illnesses regardless of any connection with the spine? Why do they continue to happily promote bogus treatments? Why do chiropractors, for instance, claim they can treat gastrointestinal diseases?
This recent narrative review of the literature, for example, was aimed at summarising studies describing the management of disorders of the gastrointestinal (GI) tract using ‘chiropractic therapy’ broadly defined here as spinal manipulation therapy, mobilizations, soft tissue therapy, modalities and stretches.
Twenty-one articles were found through searching the published literature to meet the authors’ inclusion criteria. The retrieved articles included case reports to clinical trials to review articles. The majority of articles chronicling patient experiences under chiropractic care reported that they experienced mild to moderate improvements in GI symptoms. No adverse effects were reported.
From this, the authors concluded that chiropractic care can be considered as an adjunctive therapy for patients with various GI conditions providing there are no co-morbidities.
I think, we would need to look for a long time to find an article with conclusions that are more ridiculous, false and unethical than these.
The old adage applies: rubbish in, rubbish out. If we include unreliable reports such as anecdotes, our finding will be unreliable as well. If we do not make this mistake and conduct a proper systematic review, we will arrive at very different conclusions. My own systematic review, for instance, of controlled clinical trials drew the following conclusion: There is no supportive evidence that chiropractic is an effective treatment for gastrointestinal disorders.
That probably says it all. I only want to add a short question: SHOULD THIS LATEST CHIROPRACTIC ATTEMPT TO MISLEAD THE PUBLIC BE CONSIDERED ‘SCIENTIFIC MISCONDUCT’ OR ‘FRAUD’?
I will state my position up front: THERE IS NO CHILDHOOD CONDITION FOR WHICH CHIROPRACTIC SPINAL MANIPULATION GENERATES MORE GOOD THAN HARM. What is more, I have published evidence (published here, here, here, and here, for instance) to support this statement. If you disagree with it, this is the place and time to do so – and please don’t forget to cite the evidence that supports your statements.
Given that there is very little reliable evidence in this area, I find it surprising that so many chiropractors continue to treat kids. Not true! I hear some chiropractors shout, we do not often treat children. Who is correct? Clearly, we need data to answer this question.
The objective of a new paper was to investigate characteristics of clinical chiropractic practice, including the age of pediatric patients, the number of reports of negative side effects (NSEs), the opinions of doctors of chiropractic on treatment options by patient age groups, the conditions seen and the number of treatment sessions delivered by conditions and by patient age.
An Internet cross-sectional survey was conducted in 20 European countries with 4109 chiropractors invited to reply. The 19 national associations belonging to the European Chiropractic Union and the Danish Chiropractic Association were asked to participate. Respondents were asked to self-report characteristics of their practices.
Of the 956 (23.3%) participating chiropractors, 921 reported 19821 pediatric patients per month. Children represented 8.1% of chiropractors’ total patient load over the last year. A total of 557 (534 mild, 23 moderate, and 0 severe) negative (adverse) side effects were reported for an estimated incidence of 0.23%. On the given treatment statements, chiropractors reported varying agreement and disagreement rates based on patient age. The 8309 answers on conditions were grouped into skeletal (57.0%), neurologic (23.7%), gastrointestinal (12.4%), infection (3.5%), genitourinary (1.5%), immune (1.4%), and miscellaneous conditions (0.5%). The number of treatment sessions delivered varied according to the condition and the patient age.
The authors of this survey concluded that this study showed that European chiropractors are active in the care of pediatric patients. Reported conditions were mainly skeletal and neurologic complaints. In this survey, no severe NSEs were reported, and mild NSEs were infrequent.
In my view, a more appropriate conclusion might be that MANY EUROPEAN CHIROPRACTORS ARE ACTIVE IN QUACKERY.
Osteopathy is a difficult subject. In the US, osteopaths are (almost) identical with doctors who have studied conventional medicine and hardly practice any manipulative techniques at all. Elsewhere, osteopaths are alternative healthcare providers specialising in what they like to call ‘osteopathic manipulative therapy’ (OMT). As though this is not confusing enough, osteopaths are doing similar things as chiropractors but are adamant that they are a distinct profession. Despite these assertions, I have seen little to clearly differentiate the two – with one exception perhaps: osteopaths tend to use techniques that are less frequently associated with severe harm.
Despite this confusion, or maybe because of it, we need to ask: DOES OMT WORK?
A recent study was aimed at assessing the effectiveness of OMT on chronic migraineurs using HIT-6 questionnaire, drug consumption, days of migraine, pain intensity and functional disability. All patients admitted to the Department of Neurology of Ancona’s United Hospitals, Italy, with a diagnosis of migraine and without chronic illness, were considered eligible for this 3-armed RCT.
Patients were randomly divided into three (1) OMT+medication therapy, (2) sham+medication therapy and (3) medication therapy only and received 8 treatments during 6 months. Changes in the HIT-6 score were considered as the main outcome measure.
A total of 105 subjects were included. At the end of the study, OMT significantly reduced HIT-6 score, drug consumption, days of migraine, pain intensity and functional disability.
The investigators concluded that these findings suggest that OMT may be considered a valid procedure for the management of migraineurs.
Similar results have been reported elsewhere:
One trial, for instance, concluded: “This study affirms the effects of OMT on migraine headache in regard to decreased pain intensity and the reduction of number of days with migraine as well as working disability, and partly on improvement of HRQoL. Future studies with a larger sample size should reproduce the results with a control group receiving placebo treatment in a long-term follow-up.”
Convinced? No, I am not.
Why? Because the studies that do exist seem a little too good to be true; because they are few and far between, because the few studies tend to be flimsy and have been published in dodgy journals, because they lack independent replications, and because critical reviews seem to conclude that OMT is nowhere near as promising as some osteopaths would like us to believe: “Further studies of improved quality are necessary to more firmly establish the place of physical modalities in the treatment of primary headache disorders. With the exception of high velocity chiropractic manipulation of the neck, the treatments are unlikely to be physically dangerous, although the financial costs and lost treatment opportunity by prescribing potentially ineffective treatment may not be insignificant. In the absence of clear evidence regarding their role in treatment, physicians and patients are advised to make cautious and individualized judgments about the utility of physical treatments for headache management; in most cases, the use of these modalities should complement rather than supplant better-validated forms of therapy.”
Necessity, they say, is the mother of invention. The meaning of this proverb is fairly clear:
- In the Oxford Dictionary the proverb has been defined as– when the need for something becomes imperative, you are forced to find ways of getting or achieving it.
- According to the Cambridge Dictionary, this is “an expression that means that if you really need to do something, you will think of a way of doing it.”
- Finally, the Longman dictionary has defined the proverb as– “if someone really needs to do something, they will find a way of doing it.”
In the world of chiropractic the proverb acquires a special meaning: chiropractic relies almost entirely on inventions. A few examples have to suffice:
- first, instead of pathophysiology, they invented subluxations,
- this required the invention of adjustments which were needed for their imagined subluxation,
- then they invented the ‘inate’,
- then they invented the idea that all sorts of conditions are caused by subluxations and therefore require adjustments,
- finally, they invented the notion that regular adjustments are needed for a healthy person to stay healthy.
I was reminded of the unique inventive capacity of chiropractic when I came across the website of the Foundation for Chiropractic Progress (F4CP). The F4CP is, according to their own statements, a not-for-profit organization dedicated to raising awareness about the value of chiropractic care (which is, of course, another invention).
Experts at the F4CP point out that a growing number of professional athletic teams utilize chiropractic care to maximize overall health and maintain peak performance. “Repetitive motion injuries, including shoulder tendinitis, elbow, lower back pain and muscle spasms, are common conditions and injuries among professional baseball players that can be successfully prevented, managed and treated with chiropractic care,” says Hirad N. Bagy, DC. “Chiropractic adjustments, in conjunction with soft tissue mobilization, provide athletes with proper structure, function and balance to reduce the risk of injury, accelerate recovery time and improve overall performance,” he continues – and he must know, because he has received specialized training and certifications specific to sports medicine, which include the Graston Technique®, Active Release Technique®, Myofascial Release Technique, Impact Concussion Testing and Functional Dry Needling. Dr. Bagy continues: “A number of athletes that I treat regularly understand the importance of chiropractic maintenance care, and also seek treatment when an injury arises. Through the restoration of proper bio-mechanics, doctors of chiropractic are now positioned as key health care providers throughout all of the sports teams that I work with.”
BRAVO! We are impressed! So much so, that we almost forgot to ask: “Is there any evidence for all of these therapeutic claims?”
Just as well! Because had we asked and perhaps even did a bit of research, we would have found that almost none of these far-reaching claims are evidence-based.
But who would be so petty? Instead of criticising the incessant flow of bogus claims made by chiropractors worldwide, we should really admire their remarkable skill of invention:
- When the need for profit becomes imperative, CHIROPRACTORS are forced to find ways of getting or achieving it.
- If CHIROPRACTORS really need to do something, they will think of a way of doing it.
- If a CHIROPRACTOR really needs money, he will advocate ‘maintenance care’.
AND THAT’S WHAT IS CALLED ‘CHIROPRACTIC PROGRESS’!
If you ask a chiropractor, you will probably be told that chiropractic spinal manipulation is a safe treatment. Unfortunately this is not quite true, as regular readers of this blog will appreciate. About half of all patients suffer mild to moderate adverse effects after chiropractic treatments and, in addition, many instances of much more serious complications have been documented, including rare cases of Horner syndrome. It results from an interruption of the sympathetic nerve supply to the eye and is characterized by the classic triad of miosis (ie, constricted pupil), partial ptosis, and loss of hemifacial sweating (ie, anhidrosis).
Danish neurologists recently reported the case of a 60-year-old man with no relevant medical history who was admitted to the Department of Neurology with drooping of his right upper eyelid and an ipsilateral contracted pupil, combined with pain, weakness, and numbness in his upper right limb.
The patient had experienced thoracic back pain of moderate intensity with radiating right-sided belt-like chest pain for 7 days. When the discomfort suddenly intensified, he sought chiropractic treatment. Following manipulations of the thoracic and cervical spine, the pain intensity initially lessened. Approximately one hour after chiropractic treatment, the patient experienced the eye and upper limb symptoms described above, for which he sought medical assistance three days later.
A detailed neurologic examination revealed moderate right-sided ptosis and miosis, no facial anhidrosis, decreased strength of the intrinsic and opponens muscles of the right hand, and reduced cutaneous sensation corresponding to the T1 dermatome, with inability to discriminate pain and light touch. The remaining clinical examination, routine blood tests, and vital parameters were unremarkable.
Brain CT scan and CT angiography including the aortic arch and neck vessels were performed and ruled out cerebral stroke and carotid artery dissection, respectively. As clinical signs of Horner syndrome and a concomitant radiating pain to the medial arm were considered suggestive of either a lower brachial plexopathy, i.e., due to a Pancoast tumor, or a radiculopathy, chest X-ray and electroneurography (ENG) were performed. No apical pulmonary pathology was detected. ENG of the right medial cutaneous antebrachial nerve demonstrated a normal sensory action potential (SAP), consistent with the lesion being located proximally to the dorsal spinal root ganglion, thus suggestive of a spinal nerve root lesion. A subsequent MRI of the thoracic spine showed a para-median herniation of the T1-T2 intervertebral disc compressing the right T1 spinal nerve root.
The patient received no surgery, and follow-up examination 6 months later revealed near-complete recovery, with only mild paraesthesia in the T1 segment of his right arm and a subtle ptosis remaining.
Horner syndrome due to a herniated thoracic disc has only been reported 6 times in the English language literature, though never preceded by chiropractic manipulation.
One of the most frequent causes of Horner syndrome is carotid artery dissection, which may occur spontaneously or due to local trauma to the neck region. Chiropractic manipulation as an independent risk factor for neck artery dissection and a consequent stroke is a controversial topic, though multiple cases of Horner syndrome due to ICA dissections subsequent to chiropractic manipulation have been reported. In the patient described here, an ICA dissection was considered unlikely due to the concomitant prominent radiating medial brachialgia and was furthermore ruled out by a CT angiogram of the neck vessels.
This patient experienced the onset of a Horner syndrome and ipsilateral upper limb symptoms shortly after chiropractic treatment, suggesting the cervico-thoracic manipulation as the cause of or at least worsening factor in the T1-T2 disc herniation. Several cases of disc herniations following chiropractic treatment have been reported.
While the definite pathophysiologic mechanism to explain this patient’s Horner syndrome remains unclear, it seems, according to the authors of this case-report, evident that manipulations as a minimum altered the configuration of an already existing disc protrusion.
Chiropractors like to promote themselves as primary healthcare professionals. But are they? A recent survey might go some way towards addressing this question. It was based on a cross sectional online questionnaire distributed to 4 UK chiropractic associations. The responses were collected over a period of two months from March 26th 2012 to May 25th 2012.
Of the 2,448 members in the 4 participating associations, 509 chiropractors (~21%) completed the survey. The results of the survey show that the great majority of UK chiropractors surveyed reported evaluating and monitoring patients in regards to posture (97.1%), inactivity/overactivity (90.8%) and movement patterns (88.6%). Slightly fewer provided this type of care for psychosocial stress (82.3%), nutrition (74.1%) and disturbed sleep (72.9%). Still fewer did so for smoking (60.7%) and over-consumption of alcohol (56.4%). Verbal advice given by the chiropractor was reported as the most successful resource to encourage positive lifestyle changes as reported by 68.8% of respondents. Goal-setting was utilised by 70.7% to 80.4% of respondents concerning physical fitness issues. For all other lifestyle issues, goal-setting was used by approximately two-fifths (41.7%) or less. For smoking and over-consumption of alcohol, a mere one-fifth (20.0% and 20.6% respectively) of the responding chiropractors set goals.
The authors of this survey concluded that UK chiropractors are participating in promoting positive lifestyle changes in areas common to preventative healthcare and health promotion areas; however, more can be done, particularly in the areas of smoking and over-consumption of alcohol. In addition, goal-setting to support patient-provider relationships should be more widespread, potentially increasing the utility of such valuable advice and resources.
When I saw that a new UK-wide survey of chiropractic has become available, I had great expectations. Sadly, they were harshly disappointed. I had hoped that, after going to the considerable trouble of setting up a nationwide survey of this nature, we would have some answers to the most urgent questions that currently plague chiropractic and are amenable to study by survey. In my view, some of these questions include:
- How many chiropractors actually see themselves as primary care professionals?
- What conditions do chiropractors treat?
- Specifically how many of them believe they can treat non-spinal conditions effectively?
- How many chiropractors regularly treat children?
- For which conditions?
- How many patients get X-rayed by chiropractors?
- How many are in favour of vaccinations?
- How many are aware of adverse effects of spinal manipulation?
- How chiropractors obtain informed consent before starting treatment?
- What percentage of chiropractors use spinal manipulation?
- What other treatments are used how often?
- How often do chiropractors advise their patients about medications prescribed by real doctors?
- How often do they refer patients to other health care providers?
All of these questions are highly relevant and none of them has recently been studied. But, sadly, the new paper does not answer them. Why? As I see it, there are several possibilities:
- Chiropractors do not find these questions as relevant as I do.
- They do not want to know the answers.
- They do not like to research issues that might shine a bad light on them.
- They view research mostly as a promotional exercise.
- They did research (some of) these questions but do not dare to publish the results.
- They will publish the results in a separate paper.
It would be interesting to hear from the authors which possibility applies.
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.