MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

In the bizarre world of chiropractic, the war between vitalistic subluxationists and reformers has reached a new climax. The World Federation of Chiropractic (WFC) has just announced that its president, Laurie Tassell, has resigned. The move follows what the International Chiropractor’s Association (ICA) called a “blatant offensive behaviour on a public stage” that “speaks for itself” and “cannot be excused under any circumstances.” The ICA’s alleged an embarrassing display of unprofessional and disruptive behaviour of presenters and attendees at the WFC Conference in Berlin in March 2019. It involved attacks on subluxationist chiropractors and included the throwing of water bottles onto the stage and clapping and cheering as the management of subluxation was denigrated.

The ICA President, Stephen Welsh, subsequently demanded that:

  1. The current Chair of the WFC Research Council be immediately removed from his current position and denied future participation in any activities on behalf of the WFC.
  2. An additional member of the WFC Research Council be publicly reprimanded and sanctioned and prohibited from the opportunity to serve in any leadership role at the WFC for at least 5 years.
  3. The sponsoring organization that coordinated, reviewed and permitted the alleged questionable presentations be sanctioned for conduct not reflecting the professional, inclusive and collegial respect for the values embedded in the WFC Strategic Plan, Governing Documents and the WFC Official Policy Statements.

According to Welsh, and others who attended, the Chair of the WFC Research Council, Greg Kawchuk DC, Ph.D, compared bringing a child to a vitalistic chiropractor to bringing them to a Catholic priest at a children’s school.

The WFC has now announced the appointment of Vivian Kil DC as Interim President to take over from Tassel. Kil is a graduate of the AECC, full-time clinician and the owner of a multidisciplinary clinic in the Netherlands. Kil is an advocate for chiropractors as practitioners of so called “primary spine care”. She stated her vision as follows:

  1. That we will (the chiropractic profession) set aside our differences within the profession, unite as a profession, and agree that becoming the source of nonsurgical, nonpharmacological, primary, spine care expertise and management should be a primary common goal.
  2. That for us to do the necessary work to fulfill this role and do it with the entire profession, every chiropractor will be involved and not just a small active group of leaders.
  3. And finally, that we will become the source of nonsurgical, nonpharmacological, primary, spine care expertise and management worldwide.

In my view, the problem of the chiropractic profession is unsolvable. Giving up Palmer’s obsolete nonsense of vitalism, innate intelligence, subluxation etc. is an essential precondition for joining the 21st century. Yet, doing so would abandon any identity chiropractors will ever have and render them physiotherapists in all but name. Neither solution bodes well for the future of the profession.

58 Responses to Chiros at war

  • Precisely & exactly. Primarily they MUST change their name. THAT would be the first step in reducing the critical opprobrium that is chiropractic to those logical enough to see through the ruse. But that would be THE kiss-of-death….because “who & what” would they then become? The name is intricate to their being, their history and their essence. It is synonymous with “spinal adjusting and aligning i.e. the reduction of a subluxed-vertebral-segment” (WHY “adjust” that which is either already aligned OR can’t really “misalign”?)
    So to keep the name is to keep the subluxation and all, or most of its baggage….to rename it is virtually impossible and thus will destroy it. Like Scientology it is truly a great religion and profession!

  • FWIW, I was informed that Laurie Tassell stepped down due to health reasons and to spend more time with his family. So it has nothing to do with the ICAs complaints.

    Also, the ICA membership is about 5% of the profession. A fringe group which advocates non evidence based use of x rays, treating of infants for a myriad of conditions, that everyone needs to be under chiropractic care, adherence to Palmer philosophy, etc.

    So if the ICA is having a pissy fit it might just mean the WFC is moving in the right direction.

    • so the rumour you have heard is more reliable that the article I cited?

      • Let’s see, the article you sited was most likely written by Matthew McCoy, DC. I assume you know who he is and what he stands for.

        The “rumor” I heard was from those who personally know Laurie and also attended the Berlin conference.

        You can decide who you want to believe.

        • I honestly don’t care.
          the issue here is what chiros might do, and as I tried to point out in my post, neither solution bodes well for the future.

          • Well, IMO the profession has a better chance of providing a valuable healthcare service without the ICA members tagging along and raising a stink whenever someone challenges their model or views.

    • You are just a chiropractor who wants to be a MD. With any profession, you must have a philosophy or stand for something. If you didn’t believe in the philosophy of the science, philosophy and art of Chiropractic, then you shouldn’t have become a chiropractor.

      I believe in all three. We as chiropractors must believe and stand for something or we will lose what we have. Just look at the osteopaths?

      Just because the minority of the profession are members of ICA, remember that that minority got chiropractic to where it is today.

      • I have no desire to be a MD.

        However, just because I am a chiropractor doesn’t mean I have to blindly accept and promote the Palmer philosophy, that would be dogmatism.

      • Just for the record, what is the nature of the doctorate Dr Bryan Cox has?

        PhD? MD?

      • Every other valid health care profession has moved along from its origins, incorporating science and evidence. Medicine, physical therapy, pharmacy, nursing and dietary science no longer adhere to the principles and philosophy of Hippocrates – although he is revered as a great thinker of his time.

        The rest of us can’t ignore the immense advances that technology has brought – including the ability to measure tiny electrical currents in cardiac and neural tissue and to image tissue at sub-cellular level.

        If Chiropractic wants generalised credibility, it can only be presented as manual therapy. Otherwise, it remains with the astrologers and water diviners – still popular but not scientifically valid.

  • Professor… I am uncertain as to the impact score of the prestigious journal… however, I am not sure “the chronical of Chiropractic, the source for news on conservative, traditional chiropractic” is the reference to count on

    • Apparently it is if it says what he wants to hear.

    • you probably mean ‘IMPACT FACTOR’!
      look it up to understand what it means and that it cannot be a score.
      anyway, the article originates from a newsletter, as you know.
      and, as you know, I often use such sources for my blog.
      NOW TO THE REAL ISSUE: what will chiros do? will they continue to be Palmer disciples, or will they become physios?

      • Ee…will they continue to be Palmer disciples, or will they become physios?

        Logical fallacy: false dichotomy

        • only if these had been presented as the only two choices!
          ]sorry to see that you are not good at logic either]
          what are the other options, in your view?

          • One example, sure…

            Physio goes the direction of specialists in pre and post surgical rehab.

            Chiro goes the direction of specialists of conservative spinal care.

          • you mean physios abandon the field of back pain so that chiros can continue to make a living?

          • No, it has more to do with projected attrition rates, healthcare demands, training in specialities, accessibility, etc.

            But yes, chiropractic could eventually be phased out. Alot of variables. Time will tell.

        • Physiotherapy practice goes far beyond “pre- and post-surgical rehab”. Physio has much more rigorous training, science-base and wider scope of practice than chiro, spanning everything from plaster application for setting fractures to respiratory therapy for ventilated intensive care patients.

          It makes no sense to propose to shrink the scope of the better trained profession, which already has a firm place in science-based healthcare, to accommodate the scope of an outdated profession with far too much regard for history and philosophy over science.

          Chiro could survive as a manual therapy for back pain and perhaps sports injuries – otherwise, what community need is there? All those people who attend weekly for all of their lives for “wellness” could save their money and remain well anyway.

          • Sue…Chiro could survive as a manual therapy for back pain and perhaps sports injuries – otherwise, what community need is there?

            I think many chiropractors would be content at this time with specializing in nonspecific back and neck pain, maybe a few cervicogenic disorders as the research unfolds.

            Especially considering the impact low back pain has on the world.

            Example…https://ard.bmj.com/content/73/6/968

          • @Sue
            Sue has Friends of Science in Medicine (FSM) applied the same critical rigor to physiotherapy that they apply to chiropractic?
            I pointed out this article to FSM when it was published a month ago and questioned what would be the response if “physiotherapist” was replaced by “chiropractor”. Response – Crickets.
            “Anthony got a blood clot after visiting a physio. But the worst was still to come”.
            https://www.abc.net.au/news/2019-08-05/concerns-over-the-rise-of-resistant-superbugs/11377930
            What would Edzard’s and Blue Wode’s response have been if it was a chiro?
            To this article – Crickets.

            Remember we discussed manual therapy on infants so I took as an example congenital muscular torticollis (CMT) and you cited the APTA guidelines. I pointed out that you should scroll down and look at their interventions level of evidence and commented that if chiro’s treated babies with that level of evidence you would crucify us. Response – Crickets.

            Maybe its past due for FSM to critically examine physiotherapy’s “science-base”.

          • sorry, but this is pathetic!
            sounds like a pharmaceutical firm defending their trade by saying: “if you applied the same rigor to our competitors …”
            you might benefit from learning about logical fallacies, I think.

          • Which ones fix dental caries?? Straights or mixers?

            None of them realign spines..

  • But why is it even an issue??? You know the chronical you sited is dubious to say the least, why defend it?

    If anything, you should congratulate the WFC for pursuing a more professional, ethical, responsible practice… as I am sure that is your interest.

  • Prof. Ernst wrote: “In my view, the problem of the chiropractic profession is unsolvable”

    I agree. It’s worth noting that the new President of the World Federation of Chiropractic (WFC), Vivian Kil DC, has a dream of “uniting the profession and decreasing the global burden of disease”, but has cautioned, “If we miss the boat, the nightmare has set in, and our profession may no longer have a reason to exist”.
    Ref: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4685193/

    Most interestingly, “The profession eagerly awaits whether Kil’s dream of unity will come to pass, what and who she considers to be in the extremes and what she will do about them.”
    Ref: http://chiropractic.prosepoint.net/164440

    Given that, less than a year ago, the ex-President of the WFC went on record with “Chiropractic reform has failed…the profession now more diverse than it’s ever been…chiropractors now practice in a range of different settings, using a wide range of interventions, and practicing from varying philosophical standpoints” https://www.wfc.org/website/images/wfc/qwr/2018/QWR_2018JUL.pdf (p.3), Ms Kil may find herself running rapidly out of ideas.

    • Prof. Ernst wrote: “In my view, the problem of the chiropractic profession is unsolvable”

      Then the chiropractic profession will most likely wither away and skeptics can move onto other stuff.

      • “Then the chiropractic profession will most likely wither away”

        Remarkable. Is there any part of this decision that is not about you?

        When will you stop thinking of yourselves and do what’s right for patients? Continuing to string them along simply cos you haven’t the stones to act is beyond disgraceful.

        Acknowledge it’s failed, shut it down, and move on yourself. There’s no shame in that. It’s the right thing to do.

        • You make a very trenchant point, has. From several comments on this blog it’s pretty clear that the ‘no true Scotsman’ situation applies to several branches of SCAM, most notably chiropractic, homeopathy and reiki. Practitioners write indignantly about the reluctance of some of their colleagues to embrace reforms (chiropractic), or that only the commenter understands the correct way to apply treatment (reiki and homeopathy). The main theme of this particular thread is entirely concerned with this problem.

          While orthodox medicine moves increasingly to adopt standardized protocols, algorithms and guidelines for diagnosis and management of diseases, pseudo-medicine seems often to move in the opposite direction. Perhaps this is unsurprising when its ‘treatments’ consistently fail to produce scientifically acceptable evidence of efficacy. Once a ‘profession’ has been established, no matter how absurd its premises, it inevitably seeks to sustain the livelihoods of its practitioners.

          However, it is equally clear from many comments on this blog that there is no shortage of proponents of SCAM who do genuinely believe they work in the interests of their patients, and to deny this is unfair. Their claims to have patients referred to them by orthodox physicians are not false: many hospital cancer units even offer forms of SCAM in-house. Clearly there is a need for some patients to have recourse to some kind of extra comfort; that many hospitals have chaplains of religion on their payrolls is testament to this fact.

          For me, the problem is not with people offering ancillary tender loving care, physical and/or psychological, to those in need of it. It is when the individuals offering such care do so under the title of a modality that consistently makes extravagant, unsupportable claims for treating diseases and say they have special knowledge for doing so.

          Where chiropractic is concerned (the topic of this thread) it is abundantly clear that the overlap between what chiropractors and physiotherapists actually do to patients means that one or the other needs to go. Since, historically, physiotherapy emerged fairly seamlessly as a discipline within orthodox medicine while chiropractic was a business model set up by a fraud and his son, the choice should be fairly obvious.

          • Frank..Where chiropractic is concerned (the topic of this thread) it is abundantly clear that the overlap between what chiropractors and physiotherapists actually do to patients means that one or the other needs to go.

            I would ask…

            Are they prepared to handle the approximately 35 million patients that now see chiropractors in the USA?

            The PTs in my area have a 2 to 3 week waiting list.

            Surveys also show that MDs aren’t real confident that PTs can help nonspecific back pain. Increase that confidence and that adds more burden on PTs.

            With the aging population the burden will grow even more over the next few decades.

            So sure, let’s get rid of 100,000 chiropractors and see how the healthcare system responds.

            Or shall we deal with reality?

          • or shall we retrain/rename the 100 000 as physios?

          • EE…or shall we retrain/rename the 100 000 as physios?

            Is that even a feasible option considering who we are dealing with?

            No.

          • @DC: “Oh, there aren’t enough PTs to go around and we don’t want to leave a gap in the marketplace.”

            That’s your argument, really?

            Guess what, Einstein: if you’re peddling quackery and you know it, then that’s exactly what you should do. Don’t worry, with the market driving demand, any gaps will fill up again with newly trained PTs. Heck, some of those new PTs might even be ex-chiros honest enough to admit they made an initial career error and determined to do it over right this time.

            Chiro can be gone in a generation, discarded like bloodletting and leeches and humors before it, and the world can move forward with superior science-based practices and practitioners. There’s only one reason for keeping it going now that Palmer’s been found so utterly wanting, and that reason has nothing to do with patients’ best interests.

          • Has…I usually don’t respond to your posts because, well, they are usually silly, filled with vitriol and/or show a good level of ignorance on the topic.

            Just the affect on the Medicare and private insurance system with increased visits to medical providers to obtain referrals (when required) and imaging (usually increased) would overload an already stressed system. Heck, just the increase use of ER services alone would heavily tax the system (back pain already being one of the main reasons for ER visits).

            Mean PT class size is currently around 40 students. What would it take to replace 60,000 chiropractors in the USA alone?

            Some areas have wait times up to 12 months to see a PT. Example:

            (Beatty and colleagues reported that of the 32.2% of patients with arthritis (RA or OA) who felt they needed rehabilitation services (including PT, OT, and assistive devices), only 58.3% actually received these services.11 Another study reported similar results: of the 39% of patients with arthritis (RA or OA) who felt they needed rehabilitation services, including PT and OT, only 61% received them.12. For both scenarios (OA and RA) combined, 13% of calls resulted in an appointment within 6 months, 13% within 6–12 months, and 24% within >12 months; in 22% of cases, services were refused Physiotherapy Canada 2013; 65(3);238–243)

            But sure, let’s dump an additional 35 million people (just in the USA) into the medical system and watch what happens (yes, I know, there are some that duplicate services, referrals, etc)

            Think about it “has”…maybe try living in reality.

          • DC asks “Are they prepared to handle the approximately 35 million patients that now see chiropractors in the USA?”

            Considering the large number of those patients that are getting “adjusted” for dubious reasons like newborn “colic” or for “wellness” – that translates into many fewer treatments required for evidence-based musculoskeletal care.

            Let the physios continue to do what they do well for patients who need it, save everyone else’s money.

          • Sue…Considering the large number of those patients that are getting “adjusted” for dubious reasons like newborn “colic” or for “wellness”

            You do know there is data out there on this? How about posting us some hard data?

            BTW, the 2015 Gallup poll found that if someone is experiencing back or neck pain and they had the choice of same cost provider that 29% would see a chiropractor but only 9% would see a PT.

          • Surely they would go to a better woo??

          • Doing some rough math, if chiropractic was dismantled and patient care was transferred to physical therapists, that would mean in the USA that every PT would have to take on around 150 additional patients. For those on Medicare they would have to be run thru the MDs first adding more burden to MDs. But since MDs don’t seem to have a lot of confidence in PTs for nonspecific back pain, that may decrease the case load but increase medication usage in the geriatric population.

            Now I will say that if PT colleges fast tracked DCs to a DPT you would see at least some migration. Same for DO colleges. Not so much as a distaste for chiropractic but for better access to certain patient populations.

            I like the PTs in my area, I refer patients to them, they are good at what they do. In fact I am trying to get one of them to come and work out of my clinic.

          • @DC: Don’t like the vitriol? Stop exploiting vulnerable people for your own profit and ego!

            Ignorant, me? Sure. Lots of things in the world I don’t know. But what I do know, I try to ensure is right (or at least not wildly wrong). Whereas I’m sure Mr Daniel Palmer knew a great many things, but the stuff he knew was absolute horseshit, pulled from his own ass. That’s what happens when you’ve a big ego and no ability (or desire) to self-correct.

            So I don’t need to know much to know Palmer’s chiro is a crock, because for all its pomp and ceremony, it’s just another “energy medicine” variant (see also: chi, prana) where the one true cause and cure of dis-ease is interminable spinal kinks.

            At least Hahnemann had the excuse that his “medicine” worked better than the conventional medicine of the day, in that conventional medicine was so harmful it was actually an improvement to do nothing, “amusing the patient while nature cures the disease”. By the time Palmer rolled up, mainstream medicine was already a completely different beast: magical humors were dead, killed by science and Pasteur and Nightingale and Mendeleev. We had a working model of infectious disease, surgical anaesthesia, statistical analysis, and clinical trials.

            Hippocrates’ humors stood for over two millennia as the gold standard of disease models and treatment, and real medicine had zero qualms putting a bullet in it once it was found to be wrong. No surprise Palmer got busted for practising medicine without a license; he was already a century too late.

            Evidentiary and ethical standards. Do you have them?

            Cos there can only be two kinds of chiropractor: Palmerists, who are Religiously Right in their worship of their mythical subluxations, and mis-trained physio wannabes with gross delusions of importance, desperately trying to defend their egos from what they know deep down to be wrong.

            So which are you?

            If you’re the former, you’re wasting everyone’s time by passing yourself off as anything other than a willfully self-deluding narcissistic kook.

            And if you’re the latter, you’re simply being dishonest. Not with us, mind, but with yourself. Cos if you’re already renounced Palmer then there simply isn’t anything of value left in your “chiro” that isn’t already being done to much better quality and reputability, and you owe it to patients to raise yourself to that standard before proceeding further.

            TL;DR: So answer me this: if you know Palmer’s wrong, why haven’t you retrained as a PT already?

            Cos like I say this is not about you—it’s about other people, and doing right by them.

            But you keep making it all about you, and you’re going on the full-fuckwit list along with Dana and Greg and the rest. Because stuff like this is what AltMed enables and encourages, and if you think that doesn’t warrant vitriol and far more then you really are human excrement.

          • Has. I noticed you didn’t really address any of the points I raised, but I am not surprised.

            Oh, and you may want to review the history of chiropractic and medicine around that era and why the AMA went after him because you seem to be confused on some topics.

          • @DC: “I noticed you didn’t really address any of the points I raised, but I am not surprised.”

            My mistake, I just took it as self-evident that “We need chiropractors because we don’t have enough PTs” isn’t actually an argument for the continued existence of chiro.

            Especially with Frank and Sue already explaining it to you. Repeatedly.

            “Oh, and you may want to review the history of chiropractic and medicine around that era and why the AMA went after him because you seem to be confused on some topics.”

            Do feel free to point out specific errors.

  • @DC: IMO you conflate “patient visits” with “necessary-care”. DCs, like preachers are always creating a necessity to their care and overstating their influence…since invariably results are ALWAYS minimal and/or coincidental at best.
    How many of those millions of people (and billions in wasted money) were getting several repeat-treatments based on the DCs’ conniving, pecuniary-based, hyperbolic rhetoric? How many repeat-treatments were based on “wellness-care”? The farcical notion any & all types of Chiroquackery has a profound influence on the CNS and immune function…not just (expensive) transient pain gating? Seems to me most chiroquackery rarely matches the relief from an NSAID or Tylenol.
    As you deduce a patients’ need for your course-of-care I can’t help but wonder that if you (and virtually any DC) did absolutely NO assessment how different would the eventual treatment(s) actually look? My guess: the same since there are no valid chiropractic-procedures to determine “what” generates the pain, let alone “how” to relieve it. It’s all about the reimbursement, just admit it and move on.

    • The reimbursement? I had an established patient in this morning, Medicare, acute mid back pain. Went to urgent care, said NP touched the back once, got scripted flexerall. No significant relief. I did my exam, history, etc. Performed SMT in mid thoracic. Got up and significant reduction in pain and increase left arm function. Will do followup in two days. If resolved I will release him from active care. My reimbursement from Medicare for today? $27.

      Yah, i am in it for the money.

      • @D(umb) C(onfused): great reply! I will ask if you have crafted your own Nobel Prize certificate for humanitarian work? My god you deserve it! Doing a procedure every high school football player does to each other for free! And you got $27.00. How impressive…and selfless. So for a 6 year $200,000 education, federal and state licensing, malpractice and daily office expenses you punch someone in the back, whose pain would have gone away anyway? And you’re complaining to “us” you ONLY got $27.00?!! Well that’s a $26.50 over payment.
        And I’m guessing you had just the one patient all day? Congratulations on keeping your overhead at record lows! Does your mom let you practice in her sewing room?

  • Michael.. does he not read anything in your comments as well? I remember DC hounding everyone who commented under Edzards twitter 5 years ago.

    How long have you been seeing that Chiropractor?
    Oh years!
    He must be good!
    Oh, its a nondescript ailment

  • This has been my experience. As a team leader in Child & Family Health I was approached by a Chiro “specialising in paediatric chiropractic” 20 years ago to attend a professional development session and address the nursing team. I had recently arrived from the UK and was not familiar with Chiropractic. – it certainly did not figure in any shape or form in Paediatrics in the UK. Some members of the nursing team were keen to learn more. The Chiro attended and brought a couple of research articles claiming “successful interventions” in infant colic. The research was poor and related to only a handful of infants. Wearing my sceptical hat I remarked that since infant colic was developmental and infants grew out of it how could he be sure that the chiropractic intervention had any effect?. He told us that just doing something made the parents feel better. I checked out his website later and there was a section for professionals – he was a mentor for other Chiropractors teaching paediatric techniques. There was a section on the website about building the practice – the advice was “treat infants and children and you will have patients for life.” Clearly recruiting C&FH Nurses to refer clients was a business initiative. He repeatedly approached me over the next 20 years but I never invited Chiropractic back to the table. I did invite a senior Paediatrician to expand on the lack of evidence and the potential harms. On several occasions I had to counsel C&FH Nurses that there were no conditions where a chiropractic referral was appropriate for infants. Invariably these were Nurses who personally used chiropractic wellness checks and clearly reported my directives to this particular Chiro . On one occasion the same Chiro wrote to my manager and asked “what were our referral protocols?” and I was able to confidently state that there were no infant conditions that could be treated by chiropractic and referred him to the Cochrane Review. Following the work of Dr Ken Harvey this Chiropractor’s website no longer states Chiropractic is a valid treatment modality for a long list of paediatric conditions including, colic, otitis media, bed wetting etc. but still offers paediatric wellness checks. How else to grow a business for a “Chiro specialising in paediatric”?

  • @has: ⭐️⭐️⭐️⭐️⭐️!

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