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

Misinformation by chiropractors is unfortunately nothing new and has been discussed ad nauseam on this blog. It is tempting to ask whether chiropractors have lost (or more likely never had) the ability to ditinguish real information from misinformation or substantiated from unsubstantiated claims. During the pandemic, the phenomenon of chiropractic misinformation has become even more embarrassingly obvious, as this new article highlights.

Chiropractors made statements on social media claiming that chiropractic treatment can prevent or impact COVID-19. The rationale for these claims is that spinal manipulation can impact the nervous system and thus improve immunity. These beliefs often stem from nineteenth-century chiropractic concepts. The authors of the paper are aware of no clinically relevant scientific evidence to support such statements.

The investigators explored the internet and social media to collect examples of misinformation from Europe, North America, Australia and New Zealand regarding the impact of chiropractic treatment on immune function. They discussed the potential harm resulting from these claims and explore the role of chiropractors, teaching institutions, accrediting agencies, and legislative bodies.

The authors conclude as follows: In this search of public media in Europe, North America, New Zealand, and Australia, we discovered many cases of misinformation. Claims of chiropractic treatment improving immunity conflict with the advice from authorities and the scientific consensus. The science referenced by these claims is missing, flawed or has no clinical relevance. Consequently, their claims about clinical effectiveness are spurious at best and misleading at worst. However, our examples cannot be used to make statements about the magnitude of the problem among practitioners as our samples were not intended to be representative. For that reason, we also did not include an analysis of the arguments provided in the various postings. In view of the seriousness of the topic, it would be relevant to conduct a systematic study on a representative sample of public statements, to better understand these issues. Our search illustrates the possible danger to public health of misinformation posted on social media and the internet. This situation provides an opportunity for growth and maturation for the chiropractic profession. We hope that individual chiropractors will reflect on and improve their communication and practices. Further, we hope that the chiropractic teaching institutions, regulators, and professional organisations will always demonstrate responsible leadership in their respective domains by acting to ensure that all chiropractors understand and uphold their fiduciary duties.

Several previous papers have found similar things, e.g.: Twitter activity about SMT and immunity increased during the COVID-19 crisis. Results from this work have the potential to help policy makers and others understand the impact of SMT misinformation and devise strategies to mitigate its impact.

The pandemic has crystallised the embarrassment about chiropractic false claims. Yet, the phenomenon of chiropractors misleading the public has long been known and arguably is even more important when it relates to matters other than COVID-19. Ten years ago, we published this paper:

Background: Some chiropractors and their associations claim that chiropractic is effective for conditions that lack sound supporting evidence or scientific rationale. This study therefore sought to determine the frequency of World Wide Web claims of chiropractors and their associations to treat, asthma, headache/migraine, infant colic, colic, ear infection/earache/otitis media, neck pain, whiplash (not supported by sound evidence), and lower back pain (supported by some evidence).

Methods: A review of 200 chiropractor websites and 9 chiropractic associations’ World Wide Web claims in Australia, Canada, New Zealand, the United Kingdom, and the United States was conducted between 1 October 2008 and 26 November 2008. The outcome measure was claims (either direct or indirect) regarding the eight reviewed conditions, made in the context of chiropractic treatment.

Results: 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,

Conclusions: 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.

It makes it clear that the misleading information of chiropractors is a serious problem. And I find it disappointing to see that so little has been done about it, and that progress seems so ellusive.

This, of course, begs the question, where does all this misinformation come from? The authors of the new paper stated that beliefs often stem from nineteenth-century chiropractic concepts. This, I believe, is very true and it gives us an important clue. It suggests that, because it is good for business, chiro schools are still steeped in obsolete notions of pseudo- and anti-science. Thus, year after year, they seem to churn out new generations of naively willing victims of the Dunning Kruger effect.

We have often heard it said on this blog and elsewhere that chiropractors are making great strides towards reforming themselves and becoming an evidence-based profession. In view of the data cited above, this does not ring all that true, I am afraid. Is the picture that emerges not one of a profession deeply embroiled in BS with but a few fighting a lost battle to clean up the act?

6 Responses to Chiropractic misinformation during the COVID-19 pandemic

  • Thank you for the informative article.

  • Reform lol. Why would reform be necessary for such an immutable, profound, effective and centuries old treatment? The “reformers” suggest moving away from these descriptors and redefining it to align with the real evidence e.g. very, very, very limited benefits, overly expensive to deliver, consistent mild-to-moderate irritations, occasional death and an extensive informed consent sufficient to eliminate virtually any right thinking adult from getting involved. Their reformation would put them right out of business.

  • @Edzard Ernst
    The “investigators”, “The authors”, “The authors of the new paper” are chiropractors.
    Love how you dodge acknowledging chiropractic researchers or heaven forbid support those researchers.
    “with but a few fighting a lost battle”.
    170+ chiro PhD’s not good enough Edzard? See here (cited many times here):
    https://chiromt.biomedcentral.com/articles/10.1186/s12998-020-00312-x

    “chiro schools are still steeped in obsolete notions of pseudo- and anti-science.”
    This carpet bombing has to stop.
    You are very well aware that the vitalistic colleges have grouped together into the “Rubicon Group” (5 colleges out of how many? We have discussed this in the past) and that the vast majority teach it in a historical context only. They are under threat and circling the wagons.
    How about reading the actual paper before commenting collectively about “chiropractic schools”:
    “Information from chiropractic teaching institutions
    Information was collected from all the websites of CCE-accredited chiropractic teaching institutions in North America, Australia, New Zealand, South Africa, and Europe. At the time of data collection, most institutions had not posted any messages relating to advice on the pandemic. However, those which did, supported the WFC statement. Therefore, we do not further describe their contribution.”

    Stop your BS spin Edzard and support the researchers who write:
    “Members of the chiropractic profession share a collective responsibility to act in the best interests of patients and public health. We hope that all chiropractic stakeholders will view the COVID-19 pandemic as a call to action to eliminate the unethical and potentially dangerous claims made by chiropractors who practise outside the boundaries of scientific evidence.”
    If you fail to support researchers who write this then you are part of the problem and not the solution.
    Here is a starting point:
    “Iben Axén, Cecilia Bergström, Marc Bronson, Pierre Côté, Casper Glissmann Nim, Guillaume Goncalves, Jeffrey J. Hébert, Joakim Axel Hertel, Stanley Innes, Ole Kristoffer Larsen, Anne-Laure Meyer, Søren O’Neill, Stephen M. Perle, Kenneth A. Weber II, Kenneth J. Young & Charlotte Leboeuf-Yde” the chiropractic “investigators” and “authors” of the paper you cite for this blog.

    @Michael Kenny
    “Support Reform lol”
    Not in this echo chamber blog site going on past blogs, but being a chiropractor I’m the eternal optimist. Lets see if Edzard is capable of reform.

    • Critical_Chiro wrote: “…“Support Reform lol” Not in this echo chamber blog site going on past blogs, but being a chiropractor I’m the eternal optimist.”

      @ Critical_Chiro

      I think your optimism is misplaced.

      It’s worth remembering that ‘DC’, who regularly posts here, commented that the chiropractic industry would eventually officially/legally split and that currently it’s “in a bad marriage heading for a divorce”. DC then linked to this paper which was published in February 2019:
      Chiropractic, one big unhappy family: better together or apart?
      https://chiromt.biomedcentral.com/articles/10.1186/s12998-018-0221-z

      I think it’s important to point out here that the World Federation of Chiropractic’s [WFC] Strategic Plan 2019-2022, under its ‘Values’, states: “We respect diversity in the range of approaches that chiropractors take.”
      https://www.wfc.org/website/images/wfc/docs/Strategic_Plan_2019-2022/WFC_STRATEGIC_PLAN_2019-2022.pdf (see p.7)

      Indeed, its Secretary General, Richard Brown, is of this view:

      QUOTE
      “The WFC has unity as one of its core pillars. While it would seem very simple to cut adrift a section of the chiropractic community with whom we disagree, the reality is that this is neither possible nor desirable…The richness of the chiropractic profession lies in its diversity of approaches…Education is delivered differently. The philosophy of chiropractic care takes many forms, some aligned with other health professions, others quite distinct…The WFC values evidence-informed care and promotes research as a means of developing the chiropractic profession.”
      Ref: https://www.wfc.org/website/images/wfc/qwr/QWR_2017JUL.pdf (pp 5-6)

      Apparently in support of the above, in March 2019, the WFC partnered with the European Chiropractors Union (ECU – an autonomous organisation established by chiropractors and with no statutory powers) for an ‘EPIC’ event https://tinyurl.com/yyz7423m and in doing so would have known that the ECU’s education arm accredits the subluxation-based McTimoney and Barcelona chiropractic colleges:
      http://www.cce-europe.org/accredited-institutions.html

      There was a damning, skeptical write up of the event beforehand:
      https://complementaryandalternative.wordpress.com/2019/03/18/world-federation-of-chiropractic-biennial-congress-epic2019-evidence-based-or-not/
      …and another one after it:
      https://edzardernst.com/2019/05/chiros-at-war/

      Both write ups are well worth a read. Note in the final link that Vivian Kil DC, current president of the WFC, states that part of her vision is:

      QUOTE
      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.

      IOW, it looks like the marriage will continue – in the form of an arranged one based on pecuniary interests – similar to what Michael C. Copland-Griffiths, former Chairman of the UK General Chiropractic Council, described some years ago:

      QUOTE
      “In spite of strong mutual suspicion and distrust, the profession united under a group formed specifically to pursue regulation and secured the Chiropractors Act (1994)…..Regulation for a new profession will literally ‘legitimise it’, establishing its members within the community, making them feel more valued. In turn, this brings greater opportunity for more clients and a healthier bank balance.”
      Ref: https://www.ebm-first.com/chiropractic/uk-chiropractic-issues/1437-statutory-regulation-the-chiropractic-experience.html

    • “Love how you dodge acknowledging chiropractic researchers or heaven forbid support those researchers.”
      quite right, I should have written “researchers with varying backgrounds, including some chiros, affilliated to Karolinska Institutet, Institute of Environmental Medicine, Unit of Intervention and Implementation Research for worker health, Stockholm, Sweden. [email protected].
      2The Norwegian Chiropractic Research Foundation “Et liv I Bevegelse”, ELIB, Oslo, Norway. [email protected].
      3Umeå University, Department of Clinical Sciences, Unit of Obstetrics and Gynecology, Umeå, Sweden.
      4Evidence Based Chiropractic Network, Private practice, Kirkland Lake, Ontario, Canada.
      5Faculty of Health Sciences, Ontario Tech University and Centre for Disability Prevention and Rehabilitation at Ontario Tech University and CMCC, Oshawa, Ontario, Canada.
      6Spinecentre of Southern Denmark, University Hospital of Southern Denmark, Odense, Denmark.
      7Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
      8Institut Franco-Européen de Chiropraxie, Ivry-sur-Seine, France.
      9Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada.
      10Discipline of Psychology, Exercise Science, Counselling and Chiropractic, Murdoch University, Perth, Australia.
      11Private practice, Tønsberg, Norway.
      12College of Health Sciences, School of Chiropractic, University of Bridgeport, Bridgeport, CT, USA.
      13Stanford University School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Systems Neuroscience and Pain Lab, Palo Alto, California, USA.
      14University of Central Lancashire, School of Sport and Health Sciences, Preston, UK.”
      MUCH MORE SNAPPY, DON’T YOU THINK?

    • “170+ chiro PhD’s not good enough Edzard?”
      NO, CLEARLY NOT!

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