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

DD Palmer, the founder of chiropractic, famously claimed that 95% of all diseases are caused by subluxations of the spine and the rest by subluxations of other joints. He said and stated this theory in different forms not once but dozens of times, and it thus quickly became the mantra of chiropractic. When it was noted that subluxation, as imagined by Palmer and his son BJ, did not exist, chiropractors found themselves with a considerable amount of egg on their faces.

Ever since, they have tried to cover up the blemish, some by repeatedly re-defining subluxation, others by claiming that they do not believe in Palmer’s theory anyway. The issue was and is fiercely fought over even threatened to break up the profession. At present, we are being told incessantly that large chunks of the profession are reformed, have come to terms with their profession’s foundation in a fictional concept, and have now abandoned subluxation altogether.

Critics, in turn, are quick to point out that, if that is so, chiropractors lack a ‘raison d’être’. The best chiropractors of this persuasion could do, they say, is to re-train as physiotherapists who also use spinal manipulation but without the nonsensical chiropractic ‘philosophy’.

While this debate is ongoing and shows no sign of subsiding, it is relevant, of course, to ask what proportions of the chiropractic profession belongs to which persuasion. This paper evaluated the issue of the professional identity within the profession of chiropractic based on the literature from 2000 to 2019. Initially 562 articles were sourced, of which 24 met the criteria for review.

The review confirmed three previously stated professional identity subgroups:

  • a vitalistic approach pro subluxation,
  • a approach contra subluxation,
  • a centrist or mixed view.

Whilst these three main chiropractic identity sub-types exist, the terminology used to describe them differs. Research aimed at categorising the chiropractic profession identity into exclusive sub-types found that at least 20% of chiropractors have an exclusive vertebral subluxation focus. However, deeper exploration of the literature shows that vertebral subluxation is an important practice consideration for up to 70% of chiropractors.

The review also found that practising chiropractors consider themselves to be primary care or primary contact practitioners with a broad scope of practice across a number of patient groups not limited to musculoskeletal management.

So, if I understand these findings correctly, they confirm that chiropractors like to see themselves as physicians who are able to treat most conditions that present themselves in primary care. At the same time, their majority considers that vertebral subluxation is an important practice consideration. This clearly suggests they are likely to treat most conditions by adjusting spinal subluxations. In turn, this implies that DD Palmer’s dictum, ‘95% of all conditions are caused by subluxations of the spine’, is still adhered to by about 70% of all chiropractors.

If this is so, the best advice I can give to the general public is this: if you have a health problem, the last person you should consult is a chiropractor.

37 Responses to If you have a health problem, the last person you should consult is a chiropractor

  • At one time I thought Chiros were another medical field. Learned a lot last several years. Internet is ruining this field, they are not doctors of any sort of medicine and feel stupid believing in them in 80’s and 90’s prior to internet research engines. The majority are witch doctors and the few who practice in scope regret their choice of field.

  • I have repeatedly asked why anyone would want to study chiropractic, and go to all the trouble of qualifying as a chiropractor, rather than as a physiotherapist or a physician. Or an osteopath.

    The only suggestions I have had are that these practitioners have failed to get into medical school, are not up to practising medicine, and are unable to accept the disclipine required of physiotherapists – whilst wanting the status and financial benefits of being a physician.

    But such motivation would identify them as quacks, charlatans, wannabees – and unworthy of acceptance by regularly organised society.

    If there are any other explanations, please could we learn of them?
    Patients have to give informed consent.

  • @ Richard Rawlins

    According to a Cleveland Chiropractic College survey of prospective chiropractic students, more than 94% came to chiropractic either through a referral from a chiropractor (31.4%) or from a personal experience with chiropractic (62.9%).

    Ref. https://www.chiroeco.com/best-chiropractic-colleges/

  • Once every few weeks you feel the need to go back 130 years to bash the founders of the Chiropractic profession… I believe you yourself were practicing and advocating homeopathy (giving out water ) not so long ago… Psychiatrists used to treat women for “hysteria” in strange ways etc… People and professions move on and develop even if it does not suit your political agenda.

    • I never advocated homeopathy;
      I have no political agenda;
      “People and professions move on and develop”
      the paper discussed in my post suggests chiros don’t

  • What a dramatic failure in Ernst’s attempt to use logic.

    “This clearly suggests they are likely to treat most conditions by adjusting spinal subluxations.”

  • A look at 1890’s medicine. To be equitable, you’ll need to chastise your modern day colleagues for what their predecessors were up to 130 years ago. I’m certain they will find your input relevant, timely and instrumental in moving the modern day health care fields forward. https://www.history.com/news/7-of-the-most-outrageous-medical-treatments-in-history

    Now, to be fair, they no longer do these things. And they have moved on to other theories and practices. And, they sitll exist as a profession. Same, same. And there is nothing you can do about either one. Except continue to rail at the wind. And if you think you having an effect, your results should be verifiable and measurable. Where is your data that shows that your efforts on this blog are having a effect on the world at large? After all, you’ve dedicated an amazing amount of time and effort to it. And, please, no more opining. Let’s see your evidence. You, of all people, should know the difference.

    • the best evidence that I have an impact is perhaps that chiros like yourself are commenting and feeling less comfortable about the nonsense they are telling the gullible public.

      • And if chiropractors want to “move on”, why don’t they qualify as MD’s?

        Blue Wode suggests: “According to a Cleveland Chiropractic College survey of prospective chiropractic students, more than 94% came to chiropractic either through a referral from a chiropractor (31.4%) or from a personal experience with chiropractic (62.9%).

        Ref. https://www.chiroeco.com/best-chiropractic-colleges/

        But that does not explain why the putative students chose to study chiropractic and not medicine.
        What was the attraction?
        They must know of the controversies.

        What do we call people who court controversies?
        Trouble makers?
        Certainly not ‘professional’.

        • @ Richard Rawlins

          As per the survey, referral from a chiropractor (who may be very persuasive and/or paid to recruit) – or personal experience with chiropractic – suggest to me a lack of critical thinking skills. I think that might be the only explanation required. In other words, I should imagine that the prestige of the title ’Dr’, a career that that requires a narrower skills set than an MD, and the very real possibility that they are ignorant regarding the controversies surrounding chiropractic, would be enough to see quite a few naïve folk sign up for chiro school.

        • How many chiropracrors want to be like MDs?

          What is the track record of MDs in dealing with nonspecific jpint pain?

          What is so attractive about being a MD?

          • … for starters, we have some effective treatments.

          • DC:

            Had you been a MD, you could have trained as a chiropractor as a post-grad (as I did extra to be an orthopaedic surgeon.)
            And then we would not be having this discussion.

            When I was on the panel for admission of students to KIngs’ College (London) Dental School, 80% admitted they would have preferred to have been doctors. Probably 95% felt that way.

            I don’t know how many chiropractors want “to be like MDs”.
            Can you tell us? 95%?

            MDs try to make specific diagnoses.
            No diagnosis? Then no treatement is likely to help (other than TLC/Placebo).
            That’s the point!

            If chiropractors do not find a career as an MD attractive, why do they use the title ‘Dr’ and not ‘Chiro’.
            Are they not proud of their chosen profession?

            Do tell.

          • @EE

            “… for starters, we have some effective treatments.”

            MD’s have many effective TEMPORARY treatments, few real cures.

            Try again

          • Not sure what’s your point about using Dr. Most i have seen either use DC or Doctor of Chiropractic. We can’t use just Dr.

            But i guess it might be better to be a MD dealing with most back issues. Much easier to just write a script, takes less time and probably make more money.

            And yes, some drugs are pretty effective in numbing people up. Too bad it carries such a high risk of harm.

          • @DC

            I think I preferred your comments when you called yourself “DrDale”. At least you were open enough back then (2018) to acknowledge you relished the title Dr and were happy to use it when there was a thrust from chiros to be regarded as primary care physicians (which they’re not and never will be qualified for, however much their “official organizations” kick and squeal their special pleading).

          • RG…like this?

            Epidural corticosteroid injections for lumbosacral radicular pain

            “The treatment effects are small, however, and may not be considered clinically important by patients and clinicians.”

            https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013577/full?fbclid=IwAR0UFktErBWK9Xzo4Lc2b3MtQExpir7zY53UtHHQxaQLIVP33_0nMkMnQ_M

          • Another one of those effective treatments? Hey, let’s all become a MD.

            NSAIDs seemed slightly more effective than placebo for short-term pain reduction (moderate certainty), disability (high certainty), and global improvement (low certainty), but the magnitude of the effects is small and probably not clinically relevant.

            https://www.cochrane.org/CD013581/BACK_anti-inflammatory-drugs-acute-low-back-pain?fbclid=IwAR1ysnA9zfNYAObUDsdShsnHduLMy6DU93XRUBCq_tsYkHN-vh1d4NaJ9jc

  • So, why not style yourself “Chiro Deecee” (or whatever your name is)?
    In UK some chiropractors also use ‘Dr’ (though that is misleading) and in the US, surely all do?
    Are there any who are styled ‘Mr/Mrs/Ms’)?

    My point is – it appears chiropractors are prepared to mislead patients as to their professional status.
    That is unprofessional and to be deprecated.

    (Ironically, for historical reasons, as a UK surgeon I was always ‘Mr Rawlins’. Never bothered me. I only use ‘Dr’ now so folks know I am medically qualified.)

    • Many of my patients don’t call me Doctor. I don’t care. The word isn’t what gets them better.

      Regardless, here in the USA when the Dept of Ed set up the educational requirements for chiropractors, upon graduation, they title us as Doctors of Chiropractic. Same for Doctor of Optometry, Doctor of Physical Therapy, Doctor of Osteopathy, etc.

      I suppose if you strip everyone of the title of Doctor, except MDs, well, good luck with that.

      • No excuse.

        Why do those other professional groups style themselves ‘Dr’?
        Why not ‘Opt X’; ‘Physo Y’?

        In the armed services they would be ‘Capt Z’ or whatever. No problem.
        Who are these folks trying to kid?
        And, why?

        It’s called ‘Integrity’.

  • RR you are quite right. So as a surgeon, you would be referred to as “Surgeon Rawlins”, as a medical practitioner, one would be called, “Medical Practitioner Rawlins”, and as a dentist, “Dentist Rawlins”. I think that your undergraduate degree in medicine is a double bachelors, without the word “doctor” in it.
    The use of the title “Dr”would be totally confined to the domain of those people with a post graduate “Doctorate” degree e.g. “Doctor of Philosophy” as in Dr. Ernst, a Doctor of Theology, or a Doctor of Laws, just to give you an example.
    Now that is called ‘integrity’ and I think that you should contact the relevant authorities and propose this change. Go on, I dare you!!!!

    • Dear Gibley Squared,

      Have done!
      Frequently!

      In the UK doctors do indeed qualify as Bachelors of Medicine and of Surgery (even ladies!).
      But after the Anatomy Act of 1832 (which regulated schools of anatomy), graduates in medicine styled themselves as ‘doctors’ – as a matter of courtesy. Accepted by all.

      Such courtesies should not be extended to practitioners who have not qualified in medicine – to do so misleads patients.
      That’s the point.
      That is to be deprecated.

      • RR, You have hit the nail on the head, “graduates in medicine styled themselves as ‘doctors’ – as a matter of courtesy”.

        But they are not “doctors”as they do not have a post graduate “doctorate”. Thus they use the title as a courtesy, but who allowed them to do it? They just assumed that they could do it.
        Thus, all those practitioners without a post graduate doctorate are using it as a courtesy. This includes dentists, medical practitioners, veterinarians, chiropractors, osteopaths and soon physiotherapists (as they get a Doctor of Physical Therapy qualification in the U.S.A.). What are you going to do about this?

  • It is ironic that EE suggests that MDs have effective treatments. If you take LBP as an example MDs of EE’s and RR’s generation we’re advocating bed rest, opiates and facet injections. Chiropractors were using manual therapy and exercise. Fast forward to today and organisations like NICE recognise this and now the guidelines for LBP advocates manual therapy and exercise as part of multi modal care. Despite this many dinosaur MDs still push opiates and facet injections and even tell patients to use bed rest.

  • @EE

    Right you are professor. LBP is a symptom to other problems, but 90% of the MD’s do little more than treat the symptoms for LBP. So why is this known as SBM ? … treating the symptom of LBP.

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