Chiropractic controversy and criticism
Encyclopedia
Throughout its history chiropractic
has been the subject of internal and external controversy and criticism. According to Daniel D. Palmer, the founder of chiropractic, subluxation is the sole cause of disease and manipulation is the cure for all diseases of the human race. A critical evaluation stated "Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today." Chiropractors, including D.D. Palmer, were jail
ed for practicing medicine without a license. For most of its existence, chiropractic has battled with mainstream medicine, sustained by antiscientific and pseudoscientific ideas such as subluxation. Chiropractic has been controversial, though to a lesser extent than in past years.
Chiropractic authors have stated that fraud, abuse and quackery
are more prevalent in chiropractic than in other health care professions. Unsubstantiated claims about the efficacy of chiropractic have continued to be made by individual chiropractors and chiropractic associations. The core concept of chiropractic, vertebral subluxation
, is not based on sound science. A critical evaluation found that research has not demonstrated that spinal manipulation
, the main treatment method employed by chiropractors, is effective for any medical condition, with the possible exception of treatment for back pain
. Although rare, spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death; these can occur in adults and children.
Chiropractors historically were strongly opposed to vaccination
based on their belief that all diseases were traceable to causes in the spine, and therefore could not be affected by vaccines. Some chiropractors continue to be opposed to vaccination, one of the most effective public health measures in history. Early opposition to water fluoridation included chiropractors in the U.S. Some chiropractors oppose water fluoridation
as being incompatible with chiropractic philosophy and an infringement of personal freedom. Recently, other chiropractors have actively promoted fluoridation, and several chiropractic organizations have endorsed scientific principles of public health.
The birth of chiropractic was on September 18, 1895. What actually happened, and what has been claimed, are two different things. Daniel D. Palmer later claimed that on that day he manipulated the spine of Harvey Lillard
, a man who was nearly deaf, allegedly curing him of deafness. Palmer said "there was nothing accidental about this, as it was accomplished with an object in view, and the expected result was obtained. There was nothing 'crude' about this adjustment; it was specific so much so that no chiropractor has equaled it."
However, this version was disputed by Lillard's daughter, Valdeenia Lillard Simons. She said that her father told her that he was telling jokes to a friend in the hall outside Palmer's office and Palmer, who had been reading, joined them. When Lillard reached the punch line, Palmer, laughing heartily, slapped Lillard on the back with the hand holding the heavy book he had been reading. A few days later, Lillard told Palmer that his hearing seemed better. Palmer then decided to explore manipulation as an expansion of his magnetic healing practice. Simons said "the compact was that if they can make [something of] it, then they both would share. But, it didn't happen."
In spite of the fact that Lillard could hear well enough to tell jokes, B.J. Palmer claimed under sworn testimony that Lillard was "thoroughly deaf". Since 1895, the story of Palmer curing a man of deafness has been a part of chiropractic tradition. Palmer's account differs significantly from what actually happened, in that, according to Lillard's daughter, his improved hearing was likely caused by an accidentally fortuitous jarring of Lillard's body and not, as claimed by D.D. Palmer, caused by a "specific" adjustment. It was after this event that Palmer began to experiment with manipulation. He also claimed that his second patient, a man with heart disease, was also cured by spinal manipulation.
He defined chiropractic as "a science of healing without drugs" and considered establishing chiropractic as a religion
. Chiropractic included vitalistic ideas of Innate Intelligence
with religious attributes of Universal Intelligence
to substitute science. Evidence suggests that D.D. Palmer had acquired knowledge of manipulative techniques from Andrew Taylor Still
, the founder of osteopathy
. Although D.D. Palmer combined bonesetting to give chiropractic its method, and "magnetic healing" for the theory, he acknowledged a special relation to magnetic healing when he wrote, "chiropractic was not evolved from medicine or any other method, except that of magnetic." According to D.D. Palmer, subluxation is the sole cause of disease and manipulation is the cure for all diseases of the human race.
Chiropractic has a strong salesmanship element since it was started by D.D. Palmer. His son, B.J. Palmer, asserted that their chiropractic school was founded on "…a business, not a professional basis. We manufacture chiropractors. We teach them the idea and then we show them how to sell it". D.D. Palmer established a magnetic healing facility in Davenport, Iowa, styling himself ‘doctor’. Not everyone was convinced, as a local paper in 1894 wrote about him: "A crank on magnetism has a crazy notion hat he can cure the sick and crippled with his magnetic hands. His victims are the weak-minded, ignorant and superstitious, those foolish people who have been sick for years and have become tired of the regular physician and want health by the short-cut method…he has certainly profited by the ignorance of his victims…His increase in business shows what can be done in Davenport, even by a quack." D.D. Palmer remarked that "Give me a simple mind that thinks along single tracts, give me 30 days to instruct him, and that individual can go forth on the highways and byways and get more sick people well than the best, most complete, all around, unlimited medical education of any medical man who ever lived."
Chiropractic has seen considerable controversy within the profession over its philosophy.
Chiropractic is rooted in mystical concepts
, leading to internal conflicts between straights and mixers which continue to this day. It has two main groups: "straights", now the minority, emphasize vitalism
, innate intelligence and spinal adjustments, and consider subluxations to be the leading cause of all disease; "mixers" are more open to mainstream and alternative medical techniques such as exercise, massage, nutritional supplements, and acupuncture
. The straights adhere religiously to the gospel of its founders while mixers are more open. There is a lack of uniformity and consensus among chiropractors in regard to their role. Depending upon whose point of view; chiropractors are, for example, subluxation-correctors, primary care physician
s, neuromusculoskeletal specialists, or holistic health specialists. Straights have claimed mixers are not real chiropractors because they do not acknowledge Palmer's foundation of chiropractic therapy.
In 1906, D.D. Palmer was the first of hundreds of chiropractors who went to jail
. Chiropractors were jailed for practicing medicine without a license. In the 1920s hundreds of unlicensed chiropractors chose jail rather than fines. Herbert Reaver was the most jailed chiropractor in the U.S. Chiropractors were charged with not complying with the medical practice act. California chiropractors adopted the motto, "Go to jail for chiropractic." 450 chiropractors were jailed in a single year at the peak of the controversy. Many chiropractors treated fellow prisoners and visiting patients while in jail.
For much of the history of the chiropractic profession chiropractors have shown little interest in scientific research and have regarded their principles and practices as valid. Despite heavy opposition by mainstream medicine, by the 1930s chiropractic was the largest alternative healing profession in the U.S. The lack of acceptance with mainstream public health was contributed to by the long standing American Medical Association (AMA) policies against chiropractic. The AMA created the Committee on Quackery "to contain and eliminate chiropractic." Using the Committee on Quackery, efforts were made to prevent the participation of chiropractic in organized health care. In 1966 a policy passed by the AMA House of Delegates stating: "It is the position of the medical profession that chiropractic is an unscientific cult whose practitioners lack the necessary training and background to diagnose and treat human disease. Chiropractic constitutes a hazard to rational health care in the United States because of its substandard and unscientific education of its practitioners and their rigid adherence to an irrational, unscientific approach to disease causation." The longstanding feud between chiropractors and medical doctors continued for decades. The AMA labeled chiropractic an "unscientific cult
" in 1966, and until 1980 held that it was unethical for medical doctors to associate with "unscientific practitioners". This culminated in a landmark 1987 decision, Wilk v. AMA
, in which the court found that the AMA had engaged in unreasonable restraint of trade and conspiracy, and which ended the AMA's de facto boycott of chiropractic. The rivalry was not solely with conventional medicine; many osteopaths proclaimed that chiropractic was a bastardized form of osteopathy.
Serious research to test chiropractic theories did not begin until the 1970s, and is continuing to be hampered by antiscientific and pseudoscientific ideas that sustained the profession in its long battle with organized medicine. By the mid 1990s there was a growing scholarly interest in chiropractic, which helped efforts to improve service quality and establish clinical guidelines that recommended manual therapies for acute low back pain. Some people believe chiropractic has little more than a placebo effect, but there have been many satisfied patients and many randomized trials of spinal manipulation have verified its effectiveness for the treatment of low back pain. There are several barriers between primary care physicians and chiropractors for having positive referral relationships which includes a lack of good communication. The medical establishment has not entirely accepted chiropractic care as mainstream. After 100 years, the chiropractic profession has failed to define a message that is understandable, credible, and scientifically valid. The future of chiropractic is uncertain due to the economic struggles and restrictions of the science and methods in chiropractic. Chiropractic has been controversial, though to a lesser extent than in past years, and continues to be more controversial than indigenous medicine.
The 2008 book Trick or Treatment
states that in 1913 B.J. Palmer ran over his father, D.D. Palmer, at a homecoming parade during the Palmer School of Chiropractic. Weeks later D.D. Palmer died. The official cause of death was recorded as typhoid. The book Trick or Treatment indicated "it seems more likely that his death was a direct result of injuries caused by his son. Indeed there is speculation that this was not an accident, but rather a case of patricide." A 1999 documentory study suggests D.D. Palmer's widow may have also played a role in the patricide
controversy. D.D. Palmer's attending physician
s were persuaded to change their opinion
s about the main cause of death. Chiropractic historian Joseph C. Keating, Jr.
has described the attempted patricide of D.D. Palmer as a "myth" and "absurd on its face" and cites an eyewitness who recalled that D.D. was not struck by B.J.'s car, but rather, had stumbled. He also says that "Joy Loban, DC, executor of D.D.'s estate, voluntarily withdrew a civil suit claiming damages against B.J. Palmer, and that several grand juries repeatedly refused to bring criminal charges against the son." A 1969 article stated that in July 1913 at the Palmer School of Chiropractic B.J. Palmer "insisted on leading the alumni procession, but was prohibited from doing so by the marshal of the parade, who was a student at the school. An altercation ensued. B.J. drove up in his automobile. Words passed between father and son. What happened after that depends on whom you believe. Daniel David claimed that B.J. struck him with his automobile, and D.D's friends and allies later produced affidavits of witnesses to prove it. B.J. flatly denied it, and produced many more affidavits to this effect than D.D.'s cohorts were able to muster."
" for others in the profession, and that they "might be responsible for the negative opinion people have about the ethics of the chiropractic profession." Many chiropractors have sought to address their minor status within the U.S. medical community by attending practice-building seminars to assist chiropractors to persuade their patients of the efficacy of their treatments, increase their revenue, and boost their morale as unorthodox medical practitioners.
Historically the profession has often been accused of quackery
, with the profession often responding negatively to such accusations. In its early days, the accusation of quackery was voiced in a 1913 editorial in the Journal of the American Medical Association
:
The view that chiropractic was a trade, rather than a profession, was stated clearly by B.J. Palmer, who asserted that chiropractic was founded on "…a business, not a professional basis. We manufacture chiropractors. We teach them the idea and then we show them how to sell it".
In more modern times (1991), when the president of the ACA called accusations of quackery a "myth", chiropractic historian, Joseph C. Keating, Jr.
responded by calling his comments "absurd" and stated:
In an article on quackery, W.T. Jarvis has stated that "Non-scientific health care (e.g., acupuncture, ayurvedic medicine, chiropractic, homeopathy, naturopathy) is licensed by individual states. Practitioners use unscientific practices and deception on a public who, lacking complex health-care knowledge, must rely upon the trustworthiness of providers. Quackery not only harms people, it undermines the scientific enterprise and should be actively opposed by every scientist."
The fact that chiropractors are licensed and most chiropractic schools have achieved accreditation has been discussed and criticized. In an August 1983 interview of Stephen Barrett
by the ACA Journal of Chiropractic
, Barrett responded to questions by stating that the licensing "law has nothing to do with science. If enough people are interested in getting a law passed, and do it cleverly, they can get a lot accomplished. Other forms of health quackery have been legalized in a number of states. The state legislatures simply say if you can make it and sell it in the state, then it's legal." As to accreditation, he responded that accreditation "has nothing to do with what's taught. You can get accreditation if you develop the correct form and structure in your school. And that has nothing to do with what you teach. Actually, chiropractic is proof that the accreditation system has a hole in it. The accreditation system worked until chiropractic got accredited."
J.C. Smith, a chiropractor in private practice, wrote in a 1999 article that ethical issues are "in dire need of debate" because of "years of intense medical misinformation/slander" and because of well publicised examples of tacky advertising, outlandish claims, sensationalism and insurance fraud: "Why do we tolerate the charlatans, hucksters, profiteers, and wild-eyed 'philosophers’ who taint our profession's image, who obstruct political unity and espouse untrue science that cannot withstand the test of research; who recruit patients with gimmicks, and who mislead naive students and young practitioners with dogma and promises of great wealth? Is it because profession ethics is mostly lacking in chiropractic? Is it due to a laissez faire attitude within chiropractic where anyone can say anything under the guise of “philosophy”? Or is mainstream chiropractic simply scared to confront these fringe elements, fearful of litigation or argument?"
In a 2008 commentary, the chiropractic authors proposed that "the chiropractic profession has an obligation to actively divorce itself from metaphysical explanations of health and disease as well as to actively regulate itself in refusing to tolerate fraud, abuse and quackery
, which are more rampant in our profession than in other healthcare professions," a situation which violates the social contract
between patients and physicians. Such self-regulation "will dramatically increase the level of trust in and respect for the profession from society at large." Another chiropractic study documented that the largest chiropractic associations in the U.S. and Canada distributed patient brochures which contained unsubstantiated claims. Chiropractors, especially in America, have a reputation for unnecessarily treating patients. Sustained chiropractic care is promoted as a preventative tool but unnecessary manipulation could possibly present a risk to patients. Some chiropractors are concerned by the routine unjustified claims chiropractors have made. In English speaking countries the majority of chiropractors and their associations appear to make efficacy claims that are unsupported by scientific evidence. Claims not supported by solid evidence were made about asthma, ear infection, earache, otitis media, and neck pain.
A 2009 chiropractic spinal manipulation review for infant colic stated "Some chiropractors claim that spinal manipulation is an effective treatment for infant colic but the "evidence fails to demonstrate the effectiveness of this treatment. It is concluded that the above claim is not based on convincing data from rigorous clinical trials."
Some New Zealand chiropractors appeared to have used the title 'Doctor' in a New Zealand Yellow pages telephone directory in a way that implied they are registered medical practitioners, when no evidence was presented it was true. In New Zealand, chiropractors are allowed to use the title 'doctor' when it is qualified to show that the title refers to their chiropractic role. A representative from the NZ Chiropractic Board states that entries in the Yellow Pages under the heading of 'Chiropractors' fulfills this obligation when suitably qualified. If a chiropractor is not a registered medical practitioner, then the misuse of the title 'Doctor' while working in healthcare will not comply with the Health Practitioners Competence Assurance Act 2003.
UK chiropractic organizations and their members make numerous claims which are not supported by scientific evidence. Many chiropractors adhere to ideas which are against science and most seemingly violate important principles of ethical behaviour on a regular basis. The advice chiropractors gave to their patients is often misleading and dangerous. This situation, coupled with a backlash to the libel suit filed against Simon Singh, has inspired the filing of formal complaints of false advertising against more than 500 individual chiropractors within one 24 hour period, prompting the McTimoney Chiropractic Association to write to its members advising them to remove leaflets that make claims about whiplash and colic from their practice, to be wary of new patients and telephone inquiries, and telling their members: "If you have a website, take it down NOW." and "Finally, we strongly suggest you do NOT discuss this with others, especially patients."
On 19 April 2008, Simon Singh
wrote a cautionary article about chiropractic therapies in The Guardian
which resulted in him being sued for libel by the British Chiropractic Association
. Singh wrote in The Guardian criticising the claims made by chiropractors about the efficacy of spinal manipulation in treating childhood ailments, among other things. He suggested there was "not a jot" of evidence to support such interventions for these ailments, and argued that the British Chiropractic Association "happily promotes bogus treatments". Singh stating that he will "contest the action vigorously… There is an important issue of freedom of speech at stake." The article developed the theme of Singh's recently published book Trick or Treatment? Alternative Medicine on Trial, making various claims about the usefulness of chiropractic
. Commentators suggest this ruling could set a precedent to restrict freedom of speech
to criticise alternative medicine
. The charity Sense About Science
has launched a campaign to draw attention to this particular case. They have issued a statement entitled "The law has no place in scientific disputes", which has been signed by myriad signers representing science, journalism, publishing, arts, humanities, entertainment, skeptics, campaign groups and law. , over 50,000 have signed. On 1 April 2010, Simon Singh won his court appeal for the right to rely on the defence of fair comment. On 15 April 2010, the BCA officially withdrew its lawsuit, thus ending the case.
Vertebral subluxation
, the core concept of chiropractic, is not based on solid science. A 2010 review found that manual therapies commonly used by chiropractors are effective for the treatment of low back pain, neck pain, some kinds of headaches and a number of extremity joint conditions. A 2008 review found that with the possible exception of back pain, chiropractic manipulation has not been shown to be effective for any medical condition. The concept of subluxation remains unsubstantiated and largely untested, and has been debated about whether to keep it in the chiropractic paradigm for decades. The dogma of subluxation is the biggest single barrier to professional development for chiropractors. Vertebral subluxation skews the practice of legitimacy in ways that bring ridicule from the scientific community and uncertainty among the general public. Commitment to the subluxation dogma undermines the desire for scientific investigation of subluxation as hypothesis, and further perpetuates a cycle of a marketing tradition, inevitably bringing charges of quackery. The cost, effectiveness, and safety, of spinal manipulation are uncertain. Edzard Ernst stated "the best evidence available to date fails to demonstrate clinically relevant benefits of chiropractic for paediatric patients, and some evidence even suggests that chiropractors can cause serious harm to children". A 2007 survey of Alberta
chiropractors found that they do not consistently apply research in practice, which may have resulted from a lack of research education and skills though the chiropractic profession has research-focused professional training encouraged by professional association incentives which provide time and support for research. According to David Colquhoun
, chiropractic is no more effective than conventional treatment at its best, and has a disadvantage of being "surrounded by gobbledygook about 'subluxations'", and, more seriously, it does kill patients occasionally. He states that chiropractic manipulation is the number one cause of stroke under the age of 45. Neck spinal manipulation has a risk of stroke or death. Although rare, spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death; these can occur in adults and children. Most of the adverse events were benign, however, there are complications that were life threatening. A 2010 systematic review found that numerous death
s since 1934 have been recorded after chiropractic neck manipulation typically associated with vertebral artery dissection
. Some chiropractic proponents seem to think that a critical evaluation of the research is tantamount to a 'scare story' or to 'puffing up (the evidence) out of all proportion'. A reasonable approach to serious risk from chiropractic therapy, however, requires an open examination.
The 2008 book Trick or Treatment
states that "chiropractors may X-ray the same patient several times a year, even though there is no clear evidence that X-rays will help the therapist treat the patient. X-rays can reveal neither the subluxations nor the innate intelligence associated with chiropractic philosophy, because they do not exist. There is no conceivable reason at all why X-raying the spine should help a straight chiropractor treat an ear infection, asthma or period pains. Most worrying of all, chiropractors generally require a full spine X-ray, which delivers a significant higher radiation dose than most other X-ray procedures". Recent research suggests that most chiropractors in Canada are taught and follow stringent radiography guidelines, which were developed to reduce unnecessary radiography.
Quackwatch
is critical of chiropractic; its founder, Stephen Barrett
, has written that it is "absurd" to think that chiropractors are qualified to be primary care providers and considers applied kinesiology
to be a "term most commonly used to identify a pseudoscientific system of muscle-testing and therapy".
A 2009 perspective stated there is consistent evidence that manual therapies such as chiropractic manipulations are "helpful and generally produce moderate but significant and sustained improvement for back pain in populations" and writes that the suggestion that chiropractic does more harm than good as "specious". The author went on to write that the more serious suggestion is that chiropractic treatment can kill people, and it is often claimed that chiropractic manipulation causes strokes. Common sense suggests that these people were most likely to be in the prodrome of a stroke when they sought help. The author writes "To portray only part of the relevant information in a critique is itself pseudoscience."
Lon Morgan, DC, a reform chiropractor, expressed his view of Innate Intelligence
this way: "Innate Intelligence clearly has its origins in borrowed mystical and occult practices of a bygone era. It remains untestable and unverifiable and has an unacceptably high penalty/benefit ratio for the chiropractic profession. The chiropractic concept of Innate Intelligence is an anachronistic holdover from a time when insufficient scientific understanding existed to explain human physiological processes. It is clearly religious in nature and must be considered harmful to normal scientific activity."
Chiropractic historian, Joseph C. Keating, Jr.
, articulated that "So long as we propound the "One cause, one cure" rhetoric of Innate, we should expect to be met by ridicule from the wider health science community. Chiropractors can’t have it both ways. Our theories cannot be both dogmatically held vitalistic constructs and be scientific at the same time. The purposiveness, consciousness and rigidity of the Palmers' Innate should be rejected."
William T. Jarvis, Ph.D. has stated: "Chiropractic is a controversial health-care system that has been legalized throughout the United States and in several other countries. In the United States in 1984, roughly 10.7 million people made 163 million office visits to 30,000 chiropractors. More than three fourths of the states require insurance companies to include chiropractic services in health and accident policies. The federal government pays for limited chiropractic services under Medicare, Medicaid, and its vocational rehabilitation program, and the Internal Revenue Service allows a medical deduction for chiropractic services. Chiropractors cite such facts as evidence of "recognition." However, these are merely business statistics and legal arrangements that have nothing to do with chiropractic's scientific validity."
are based on philosophies that oppose vaccination and have practitioners who voice their opposition. These include some elements of the chiropractic community. The reasons for this negative vaccination view are complicated and rest, at least in part, on the early philosophies which shape the foundation of these professions. Chiropractors historically were strongly opposed to vaccination
based on their belief that all diseases were traceable to causes in the spine, and therefore could not be affected by vaccines; D.D. Palmer wrote, "It is the very height of absurdity to strive to 'protect' any person from smallpox or any other malady by inoculating them with a filthy animal poison." Some chiropractors continue to be opposed to vaccination, one of the most effective public health measures in history. Early opposition to water fluoridation included chiropractors in the U.S. Some chiropractors oppose water fluoridation
as being incompatible with chiropractic philosophy and an infringement of personal freedom. Recently, other chiropractors have actively promoted fluoridation, and several chiropractic organizations have endorsed scientific principles of public health.
Chiropractic
Chiropractic is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. It is generally categorized as complementary and alternative medicine...
has been the subject of internal and external controversy and criticism. According to Daniel D. Palmer, the founder of chiropractic, subluxation is the sole cause of disease and manipulation is the cure for all diseases of the human race. A critical evaluation stated "Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today." Chiropractors, including D.D. Palmer, were jail
Jail
A jail is a short-term detention facility in the United States and Canada.Jail may also refer to:In entertainment:*Jail , a 1966 Malayalam movie*Jail , a 2009 Bollywood movie...
ed for practicing medicine without a license. For most of its existence, chiropractic has battled with mainstream medicine, sustained by antiscientific and pseudoscientific ideas such as subluxation. Chiropractic has been controversial, though to a lesser extent than in past years.
Chiropractic authors have stated that fraud, abuse and quackery
Quackery
Quackery is a derogatory term used to describe the promotion of unproven or fraudulent medical practices. Random House Dictionary describes a "quack" as a "fraudulent or ignorant pretender to medical skill" or "a person who pretends, professionally or publicly, to have skill, knowledge, or...
are more prevalent in chiropractic than in other health care professions. Unsubstantiated claims about the efficacy of chiropractic have continued to be made by individual chiropractors and chiropractic associations. The core concept of chiropractic, vertebral subluxation
Vertebral subluxation
Vertebral subluxation is a term that is commonly used by some chiropractors to describe signs and symptoms of the spinal column. Those chiropractors who assert this concept also add a visceral component to the definition...
, is not based on sound science. A critical evaluation found that research has not demonstrated that spinal manipulation
Spinal manipulation
Spinal manipulation is a therapeutic intervention performed on spinal articulations which are synovial joints . These articulations in the spine that are amenable to spinal manipulative therapy include the z-joints, the atlanto-occipital, atlanto-axial, lumbosacral, sacroiliac, costotransverse...
, the main treatment method employed by chiropractors, is effective for any medical condition, with the possible exception of treatment for back pain
Back pain
Back pain is pain felt in the back that usually originates from the muscles, nerves, bones, joints or other structures in the spine.The pain can often be divided into neck pain, upper back pain, lower back pain or tailbone pain...
. Although rare, spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death; these can occur in adults and children.
Chiropractors historically were strongly opposed to vaccination
Vaccination
Vaccination is the administration of antigenic material to stimulate the immune system of an individual to develop adaptive immunity to a disease. Vaccines can prevent or ameliorate the effects of infection by many pathogens...
based on their belief that all diseases were traceable to causes in the spine, and therefore could not be affected by vaccines. Some chiropractors continue to be opposed to vaccination, one of the most effective public health measures in history. Early opposition to water fluoridation included chiropractors in the U.S. Some chiropractors oppose water fluoridation
Water fluoridation
Water fluoridation is the controlled addition of fluoride to a public water supply to reduce tooth decay. Fluoridated water has fluoride at a level that is effective for preventing cavities; this can occur naturally or by adding fluoride...
as being incompatible with chiropractic philosophy and an infringement of personal freedom. Recently, other chiropractors have actively promoted fluoridation, and several chiropractic organizations have endorsed scientific principles of public health.
Historical controversial and critical elements
William Harvey Lillard
William Harvey Lillard was the first chiropractic patient.- Biography :Harvey Lillard was an African American janitor who worked in the Ryan Building in Brady Street, Davenport, Iowa, USA. He was the first person to be treated with chiropractic by D.D. Palmer.Lillard maintained the building where...
, a man who was nearly deaf, allegedly curing him of deafness. Palmer said "there was nothing accidental about this, as it was accomplished with an object in view, and the expected result was obtained. There was nothing 'crude' about this adjustment; it was specific so much so that no chiropractor has equaled it."
However, this version was disputed by Lillard's daughter, Valdeenia Lillard Simons. She said that her father told her that he was telling jokes to a friend in the hall outside Palmer's office and Palmer, who had been reading, joined them. When Lillard reached the punch line, Palmer, laughing heartily, slapped Lillard on the back with the hand holding the heavy book he had been reading. A few days later, Lillard told Palmer that his hearing seemed better. Palmer then decided to explore manipulation as an expansion of his magnetic healing practice. Simons said "the compact was that if they can make [something of] it, then they both would share. But, it didn't happen."
In spite of the fact that Lillard could hear well enough to tell jokes, B.J. Palmer claimed under sworn testimony that Lillard was "thoroughly deaf". Since 1895, the story of Palmer curing a man of deafness has been a part of chiropractic tradition. Palmer's account differs significantly from what actually happened, in that, according to Lillard's daughter, his improved hearing was likely caused by an accidentally fortuitous jarring of Lillard's body and not, as claimed by D.D. Palmer, caused by a "specific" adjustment. It was after this event that Palmer began to experiment with manipulation. He also claimed that his second patient, a man with heart disease, was also cured by spinal manipulation.
He defined chiropractic as "a science of healing without drugs" and considered establishing chiropractic as a religion
Religion
Religion is a collection of cultural systems, belief systems, and worldviews that establishes symbols that relate humanity to spirituality and, sometimes, to moral values. Many religions have narratives, symbols, traditions and sacred histories that are intended to give meaning to life or to...
. Chiropractic included vitalistic ideas of Innate Intelligence
Innate intelligence
Innate Intelligence is a chiropractic term to describe the organizing properties of living things. It was originally coined by Daniel David Palmer, the founder of chiropractic. This vitalistic concept states that all life contains Innate Intelligence and that this force is responsible for the...
with religious attributes of Universal Intelligence
Universal Intelligence
Universal Intelligence is a term used by some to describe what they see as organization, or order of the universe. It has been described as "the intrinsic tendency for things to self-organize and co-evolve into ever more complex, intricately interwoven and mutually compatible forms."A general...
to substitute science. Evidence suggests that D.D. Palmer had acquired knowledge of manipulative techniques from Andrew Taylor Still
Andrew Taylor Still
Andrew Taylor Still is considered the father of osteopathy and osteopathic medicine. He was also a physician & surgeon, author, inventor and Kansas territorial & state legislator. He was one of the founders of Baker University, the oldest 4-year college in the state of Kansas, and was the founder...
, the founder of osteopathy
Osteopathy
Osteopathy and osteopathic medicine are often used interchangeably for the philosophy and system of alternative medical practice first proposed by A. T. Still MD, DO in 1874....
. Although D.D. Palmer combined bonesetting to give chiropractic its method, and "magnetic healing" for the theory, he acknowledged a special relation to magnetic healing when he wrote, "chiropractic was not evolved from medicine or any other method, except that of magnetic." According to D.D. Palmer, subluxation is the sole cause of disease and manipulation is the cure for all diseases of the human race.
Chiropractic has a strong salesmanship element since it was started by D.D. Palmer. His son, B.J. Palmer, asserted that their chiropractic school was founded on "…a business, not a professional basis. We manufacture chiropractors. We teach them the idea and then we show them how to sell it". D.D. Palmer established a magnetic healing facility in Davenport, Iowa, styling himself ‘doctor’. Not everyone was convinced, as a local paper in 1894 wrote about him: "A crank on magnetism has a crazy notion hat he can cure the sick and crippled with his magnetic hands. His victims are the weak-minded, ignorant and superstitious, those foolish people who have been sick for years and have become tired of the regular physician and want health by the short-cut method…he has certainly profited by the ignorance of his victims…His increase in business shows what can be done in Davenport, even by a quack." D.D. Palmer remarked that "Give me a simple mind that thinks along single tracts, give me 30 days to instruct him, and that individual can go forth on the highways and byways and get more sick people well than the best, most complete, all around, unlimited medical education of any medical man who ever lived."
Chiropractic has seen considerable controversy within the profession over its philosophy.
Chiropractic is rooted in mystical concepts
Mysticism
Mysticism is the knowledge of, and especially the personal experience of, states of consciousness, i.e. levels of being, beyond normal human perception, including experience and even communion with a supreme being.-Classical origins:...
, leading to internal conflicts between straights and mixers which continue to this day. It has two main groups: "straights", now the minority, emphasize vitalism
Vitalism
Vitalism, as defined by the Merriam-Webster dictionary, is#a doctrine that the functions of a living organism are due to a vital principle distinct from biochemical reactions...
, innate intelligence and spinal adjustments, and consider subluxations to be the leading cause of all disease; "mixers" are more open to mainstream and alternative medical techniques such as exercise, massage, nutritional supplements, and acupuncture
Acupuncture
Acupuncture is a type of alternative medicine that treats patients by insertion and manipulation of solid, generally thin needles in the body....
. The straights adhere religiously to the gospel of its founders while mixers are more open. There is a lack of uniformity and consensus among chiropractors in regard to their role. Depending upon whose point of view; chiropractors are, for example, subluxation-correctors, primary care physician
Primary care physician
A primary care physician, or PCP, is a physician/medical doctor who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis....
s, neuromusculoskeletal specialists, or holistic health specialists. Straights have claimed mixers are not real chiropractors because they do not acknowledge Palmer's foundation of chiropractic therapy.
In 1906, D.D. Palmer was the first of hundreds of chiropractors who went to jail
Jail
A jail is a short-term detention facility in the United States and Canada.Jail may also refer to:In entertainment:*Jail , a 1966 Malayalam movie*Jail , a 2009 Bollywood movie...
. Chiropractors were jailed for practicing medicine without a license. In the 1920s hundreds of unlicensed chiropractors chose jail rather than fines. Herbert Reaver was the most jailed chiropractor in the U.S. Chiropractors were charged with not complying with the medical practice act. California chiropractors adopted the motto, "Go to jail for chiropractic." 450 chiropractors were jailed in a single year at the peak of the controversy. Many chiropractors treated fellow prisoners and visiting patients while in jail.
For much of the history of the chiropractic profession chiropractors have shown little interest in scientific research and have regarded their principles and practices as valid. Despite heavy opposition by mainstream medicine, by the 1930s chiropractic was the largest alternative healing profession in the U.S. The lack of acceptance with mainstream public health was contributed to by the long standing American Medical Association (AMA) policies against chiropractic. The AMA created the Committee on Quackery "to contain and eliminate chiropractic." Using the Committee on Quackery, efforts were made to prevent the participation of chiropractic in organized health care. In 1966 a policy passed by the AMA House of Delegates stating: "It is the position of the medical profession that chiropractic is an unscientific cult whose practitioners lack the necessary training and background to diagnose and treat human disease. Chiropractic constitutes a hazard to rational health care in the United States because of its substandard and unscientific education of its practitioners and their rigid adherence to an irrational, unscientific approach to disease causation." The longstanding feud between chiropractors and medical doctors continued for decades. The AMA labeled chiropractic an "unscientific cult
Cult
The word cult in current popular usage usually refers to a group whose beliefs or practices are considered abnormal or bizarre. The word originally denoted a system of ritual practices...
" in 1966, and until 1980 held that it was unethical for medical doctors to associate with "unscientific practitioners". This culminated in a landmark 1987 decision, Wilk v. AMA
Wilk v. American Medical Association
Wilk v. American Medical Association, , was a federal antitrust suit brought against the American Medical Association and 10 co-defendants by chiropractor Chester A. Wilk, DC, and four co-plaintiffs...
, in which the court found that the AMA had engaged in unreasonable restraint of trade and conspiracy, and which ended the AMA's de facto boycott of chiropractic. The rivalry was not solely with conventional medicine; many osteopaths proclaimed that chiropractic was a bastardized form of osteopathy.
Serious research to test chiropractic theories did not begin until the 1970s, and is continuing to be hampered by antiscientific and pseudoscientific ideas that sustained the profession in its long battle with organized medicine. By the mid 1990s there was a growing scholarly interest in chiropractic, which helped efforts to improve service quality and establish clinical guidelines that recommended manual therapies for acute low back pain. Some people believe chiropractic has little more than a placebo effect, but there have been many satisfied patients and many randomized trials of spinal manipulation have verified its effectiveness for the treatment of low back pain. There are several barriers between primary care physicians and chiropractors for having positive referral relationships which includes a lack of good communication. The medical establishment has not entirely accepted chiropractic care as mainstream. After 100 years, the chiropractic profession has failed to define a message that is understandable, credible, and scientifically valid. The future of chiropractic is uncertain due to the economic struggles and restrictions of the science and methods in chiropractic. Chiropractic has been controversial, though to a lesser extent than in past years, and continues to be more controversial than indigenous medicine.
The 2008 book Trick or Treatment
Trick or Treatment
Trick or Treatment? Alternative Medicine on Trial is a 2008 book about alternative medicine by Simon Singh and Edzard Ernst. Singh is a physicist and the writer of several popular science books...
states that in 1913 B.J. Palmer ran over his father, D.D. Palmer, at a homecoming parade during the Palmer School of Chiropractic. Weeks later D.D. Palmer died. The official cause of death was recorded as typhoid. The book Trick or Treatment indicated "it seems more likely that his death was a direct result of injuries caused by his son. Indeed there is speculation that this was not an accident, but rather a case of patricide." A 1999 documentory study suggests D.D. Palmer's widow may have also played a role in the patricide
Patricide
Patricide is the act of killing one's father, or a person who kills his or her father. The word patricide derives from the Latin word pater and the Latin suffix -cida...
controversy. D.D. Palmer's attending physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
s were persuaded to change their opinion
Opinion
In general, an opinion is a subjective belief, and is the result of emotion or interpretation of facts. An opinion may be supported by an argument, although people may draw opposing opinions from the same set of facts. Opinions rarely change without new arguments being presented...
s about the main cause of death. Chiropractic historian Joseph C. Keating, Jr.
Joseph C. Keating, Jr.
Joseph C. Keating, Jr. was trained as a clinical psychologist who spent the majority of his life teaching and researching the chiropractic profession. He is best known for his published works as a historian of chiropractic.-Early life:...
has described the attempted patricide of D.D. Palmer as a "myth" and "absurd on its face" and cites an eyewitness who recalled that D.D. was not struck by B.J.'s car, but rather, had stumbled. He also says that "Joy Loban, DC, executor of D.D.'s estate, voluntarily withdrew a civil suit claiming damages against B.J. Palmer, and that several grand juries repeatedly refused to bring criminal charges against the son." A 1969 article stated that in July 1913 at the Palmer School of Chiropractic B.J. Palmer "insisted on leading the alumni procession, but was prohibited from doing so by the marshal of the parade, who was a student at the school. An altercation ensued. B.J. drove up in his automobile. Words passed between father and son. What happened after that depends on whom you believe. Daniel David claimed that B.J. struck him with his automobile, and D.D's friends and allies later produced affidavits of witnesses to prove it. B.J. flatly denied it, and produced many more affidavits to this effect than D.D.'s cohorts were able to muster."
Ethics and claims
A study of California disciplinary statistics during 1997–2000 reported 4.5 disciplinary actions per 1000 chiropractors per year, compared to 2.27 for medical Doctors, and the incident rate for fraud was 9 times greater among chiropractors (1.99 per 1000 chiropractors per year) than among medical Doctors (0.20). According to a 2006 Gallup Poll of U.S. adults, when asked how they would "rate the honesty and ethical standards of people in these different fields", chiropractic compared unfavorably with mainstream medicine. When chiropractic was rated, it "rated dead last amongst healthcare professions". While 84% of respondents considered nurses' ethics "very high" or "high," only 36% felt that way about chiropractors. Other healthcare professions ranged from 38% for psychiatrists, to 62% for dentists, 69% for medical doctors, 71% for veterinarians, and 73% for druggists or pharmacists. Similar results were found in the 2003 Gallup Poll. Chiropractic authors have placed these results in perspective in articles, with one writing that "we were the least trusted and least believed health care discipline", and another writing that chiropractors who use unethical marketing methods "poison the wellPoison the Well
Poison the Well was an experimental hardcore band from Miami/Ft. Lauderdale, Florida who were last signed to Ferret Music. Guitarist Ryan Primack and drummer Chris Hornbrook were the only remaining members of the band who were involved since their inception, although vocalist Jeffrey Moreira was...
" for others in the profession, and that they "might be responsible for the negative opinion people have about the ethics of the chiropractic profession." Many chiropractors have sought to address their minor status within the U.S. medical community by attending practice-building seminars to assist chiropractors to persuade their patients of the efficacy of their treatments, increase their revenue, and boost their morale as unorthodox medical practitioners.
Historically the profession has often been accused of quackery
Quackery
Quackery is a derogatory term used to describe the promotion of unproven or fraudulent medical practices. Random House Dictionary describes a "quack" as a "fraudulent or ignorant pretender to medical skill" or "a person who pretends, professionally or publicly, to have skill, knowledge, or...
, with the profession often responding negatively to such accusations. In its early days, the accusation of quackery was voiced in a 1913 editorial in the Journal of the American Medical Association
Journal of the American Medical Association
The Journal of the American Medical Association is a weekly, peer-reviewed, medical journal, published by the American Medical Association. Beginning in July 2011, the editor in chief will be Howard C. Bauchner, vice chairman of pediatrics at Boston University’s School of Medicine, replacing ...
:
- "Chiropractic is a freak offshoot from osteopathy. Disease, say the chiropractors, is due to pressure on the spinal nerves; ergo it can be cured by "adjusting" the spinal column. It is the sheerest quackery, and those who profess to teach it make their appeal to the cupidity of the ignorant. Its practice is in no sense a profession but a trade - and a trade that is potent for great harm. It is carried on almost exclusively by those of no education, ignorant of anatomy, ignorant even of the fundamental sciences on which the treatment of disease depends." (p. 29)
The view that chiropractic was a trade, rather than a profession, was stated clearly by B.J. Palmer, who asserted that chiropractic was founded on "…a business, not a professional basis. We manufacture chiropractors. We teach them the idea and then we show them how to sell it".
In more modern times (1991), when the president of the ACA called accusations of quackery a "myth", chiropractic historian, Joseph C. Keating, Jr.
Joseph C. Keating, Jr.
Joseph C. Keating, Jr. was trained as a clinical psychologist who spent the majority of his life teaching and researching the chiropractic profession. He is best known for his published works as a historian of chiropractic.-Early life:...
responded by calling his comments "absurd" and stated:
- "The so-called 'quackery myth about chiropractic' is no myth.....the kernels of quackery (i.e., unsubstantiated and untested health remedies offered as "proven") are ubiquitous in this profession. I dare say that health misinformation (if not quackery) can be found in just about any issue of any chiropractic trade publication (and some of our research journals) and much of the promotional materials chiropractors disseminate to patients. The recent unsubstantiated claims of the ACA are exemplary [examples provided]...It escapes me entirely how Dr. Downing, the ACA, MPI, and Dynamic Chiropractic can suggest that there is no quackery in chiropractic. Either these groups and individuals do not read the chiropractic literature or have no crap-detectors. I urge a reconsideration of advertising and promotion policies in chiropractic."
In an article on quackery, W.T. Jarvis has stated that "Non-scientific health care (e.g., acupuncture, ayurvedic medicine, chiropractic, homeopathy, naturopathy) is licensed by individual states. Practitioners use unscientific practices and deception on a public who, lacking complex health-care knowledge, must rely upon the trustworthiness of providers. Quackery not only harms people, it undermines the scientific enterprise and should be actively opposed by every scientist."
The fact that chiropractors are licensed and most chiropractic schools have achieved accreditation has been discussed and criticized. In an August 1983 interview of Stephen Barrett
Stephen Barrett
Stephen Joel Barrett is a retired American psychiatrist, author, co-founder of the National Council Against Health Fraud , and the webmaster of Quackwatch. He runs a number of websites dealing with quackery and health fraud. He focuses on consumer protection, medical ethics, and scientific...
by the ACA Journal of Chiropractic
American Chiropractic Association
The American Chiropractic Association , based in Arlington, VA, representing doctors of chiropractic. Its stated mission is to preserve, protect, improve, and promote the chiropractic profession and the services of Doctors of Chiropractic for the benefit of the patients they serve.- Purpose and...
, Barrett responded to questions by stating that the licensing "law has nothing to do with science. If enough people are interested in getting a law passed, and do it cleverly, they can get a lot accomplished. Other forms of health quackery have been legalized in a number of states. The state legislatures simply say if you can make it and sell it in the state, then it's legal." As to accreditation, he responded that accreditation "has nothing to do with what's taught. You can get accreditation if you develop the correct form and structure in your school. And that has nothing to do with what you teach. Actually, chiropractic is proof that the accreditation system has a hole in it. The accreditation system worked until chiropractic got accredited."
J.C. Smith, a chiropractor in private practice, wrote in a 1999 article that ethical issues are "in dire need of debate" because of "years of intense medical misinformation/slander" and because of well publicised examples of tacky advertising, outlandish claims, sensationalism and insurance fraud: "Why do we tolerate the charlatans, hucksters, profiteers, and wild-eyed 'philosophers’ who taint our profession's image, who obstruct political unity and espouse untrue science that cannot withstand the test of research; who recruit patients with gimmicks, and who mislead naive students and young practitioners with dogma and promises of great wealth? Is it because profession ethics is mostly lacking in chiropractic? Is it due to a laissez faire attitude within chiropractic where anyone can say anything under the guise of “philosophy”? Or is mainstream chiropractic simply scared to confront these fringe elements, fearful of litigation or argument?"
In a 2008 commentary, the chiropractic authors proposed that "the chiropractic profession has an obligation to actively divorce itself from metaphysical explanations of health and disease as well as to actively regulate itself in refusing to tolerate fraud, abuse and quackery
Quackery
Quackery is a derogatory term used to describe the promotion of unproven or fraudulent medical practices. Random House Dictionary describes a "quack" as a "fraudulent or ignorant pretender to medical skill" or "a person who pretends, professionally or publicly, to have skill, knowledge, or...
, which are more rampant in our profession than in other healthcare professions," a situation which violates the social contract
Social contract
The social contract is an intellectual device intended to explain the appropriate relationship between individuals and their governments. Social contract arguments assert that individuals unite into political societies by a process of mutual consent, agreeing to abide by common rules and accept...
between patients and physicians. Such self-regulation "will dramatically increase the level of trust in and respect for the profession from society at large." Another chiropractic study documented that the largest chiropractic associations in the U.S. and Canada distributed patient brochures which contained unsubstantiated claims. Chiropractors, especially in America, have a reputation for unnecessarily treating patients. Sustained chiropractic care is promoted as a preventative tool but unnecessary manipulation could possibly present a risk to patients. Some chiropractors are concerned by the routine unjustified claims chiropractors have made. In English speaking countries the majority of chiropractors and their associations appear to make efficacy claims that are unsupported by scientific evidence. Claims not supported by solid evidence were made about asthma, ear infection, earache, otitis media, and neck pain.
A 2009 chiropractic spinal manipulation review for infant colic stated "Some chiropractors claim that spinal manipulation is an effective treatment for infant colic but the "evidence fails to demonstrate the effectiveness of this treatment. It is concluded that the above claim is not based on convincing data from rigorous clinical trials."
Some New Zealand chiropractors appeared to have used the title 'Doctor' in a New Zealand Yellow pages telephone directory in a way that implied they are registered medical practitioners, when no evidence was presented it was true. In New Zealand, chiropractors are allowed to use the title 'doctor' when it is qualified to show that the title refers to their chiropractic role. A representative from the NZ Chiropractic Board states that entries in the Yellow Pages under the heading of 'Chiropractors' fulfills this obligation when suitably qualified. If a chiropractor is not a registered medical practitioner, then the misuse of the title 'Doctor' while working in healthcare will not comply with the Health Practitioners Competence Assurance Act 2003.
UK chiropractic organizations and their members make numerous claims which are not supported by scientific evidence. Many chiropractors adhere to ideas which are against science and most seemingly violate important principles of ethical behaviour on a regular basis. The advice chiropractors gave to their patients is often misleading and dangerous. This situation, coupled with a backlash to the libel suit filed against Simon Singh, has inspired the filing of formal complaints of false advertising against more than 500 individual chiropractors within one 24 hour period, prompting the McTimoney Chiropractic Association to write to its members advising them to remove leaflets that make claims about whiplash and colic from their practice, to be wary of new patients and telephone inquiries, and telling their members: "If you have a website, take it down NOW." and "Finally, we strongly suggest you do NOT discuss this with others, especially patients."
On 19 April 2008, Simon Singh
Simon Singh
Simon Lehna Singh, MBE is a British author who has specialised in writing about mathematical and scientific topics in an accessible manner....
wrote a cautionary article about chiropractic therapies in The Guardian
The Guardian
The Guardian, formerly known as The Manchester Guardian , is a British national daily newspaper in the Berliner format...
which resulted in him being sued for libel by the British Chiropractic Association
British Chiropractic Association
The British Chiropractic Association was founded in 1925 and represents over 50% of UK chiropractors. It is the largest and longest established association for chiropractors in the United Kingdom...
. Singh wrote in The Guardian criticising the claims made by chiropractors about the efficacy of spinal manipulation in treating childhood ailments, among other things. He suggested there was "not a jot" of evidence to support such interventions for these ailments, and argued that the British Chiropractic Association "happily promotes bogus treatments". Singh stating that he will "contest the action vigorously… There is an important issue of freedom of speech at stake." The article developed the theme of Singh's recently published book Trick or Treatment? Alternative Medicine on Trial, making various claims about the usefulness of chiropractic
Chiropractic
Chiropractic is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. It is generally categorized as complementary and alternative medicine...
. Commentators suggest this ruling could set a precedent to restrict freedom of speech
Freedom of speech
Freedom of speech is the freedom to speak freely without censorship. The term freedom of expression is sometimes used synonymously, but includes any act of seeking, receiving and imparting information or ideas, regardless of the medium used...
to criticise alternative medicine
Alternative medicine
Alternative medicine is any healing practice, "that does not fall within the realm of conventional medicine." It is based on historical or cultural traditions, rather than on scientific evidence....
. The charity Sense About Science
Sense About Science
Sense About Science is a British charity that promotes the public understanding of science. Sense About Science was conceived in 2002 by Lord Taverne, Bridget Ogilvie and others to promote respect for scientific evidence and good science. Sense About Science was established as a charitable trust in...
has launched a campaign to draw attention to this particular case. They have issued a statement entitled "The law has no place in scientific disputes", which has been signed by myriad signers representing science, journalism, publishing, arts, humanities, entertainment, skeptics, campaign groups and law. , over 50,000 have signed. On 1 April 2010, Simon Singh won his court appeal for the right to rely on the defence of fair comment. On 15 April 2010, the BCA officially withdrew its lawsuit, thus ending the case.
Efficacy
Not all criticism originated from critics in the medical profession. Some chiropractors are cautiously calling for reform. Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs antiscientific reasoning and unsubstantiated claims, that are ethically suspect when they let practitioners maintain their beliefs to patients' detriment. Samuel Homola writes that the bottom line is "A good chiropractor can do a lot to help you when you have mechanical-type back pain and other musculoskeletal problems. But until the chiropractic profession cleans up its act, and its colleges uniformly graduate properly limited chiropractors who specialize in neuromusculoskeletal problems, you'll have to exercise caution and informed judgment when seeking chiropractic care."Vertebral subluxation
Vertebral subluxation
Vertebral subluxation is a term that is commonly used by some chiropractors to describe signs and symptoms of the spinal column. Those chiropractors who assert this concept also add a visceral component to the definition...
, the core concept of chiropractic, is not based on solid science. A 2010 review found that manual therapies commonly used by chiropractors are effective for the treatment of low back pain, neck pain, some kinds of headaches and a number of extremity joint conditions. A 2008 review found that with the possible exception of back pain, chiropractic manipulation has not been shown to be effective for any medical condition. The concept of subluxation remains unsubstantiated and largely untested, and has been debated about whether to keep it in the chiropractic paradigm for decades. The dogma of subluxation is the biggest single barrier to professional development for chiropractors. Vertebral subluxation skews the practice of legitimacy in ways that bring ridicule from the scientific community and uncertainty among the general public. Commitment to the subluxation dogma undermines the desire for scientific investigation of subluxation as hypothesis, and further perpetuates a cycle of a marketing tradition, inevitably bringing charges of quackery. The cost, effectiveness, and safety, of spinal manipulation are uncertain. Edzard Ernst stated "the best evidence available to date fails to demonstrate clinically relevant benefits of chiropractic for paediatric patients, and some evidence even suggests that chiropractors can cause serious harm to children". A 2007 survey of Alberta
Alberta
Alberta is a province of Canada. It had an estimated population of 3.7 million in 2010 making it the most populous of Canada's three prairie provinces...
chiropractors found that they do not consistently apply research in practice, which may have resulted from a lack of research education and skills though the chiropractic profession has research-focused professional training encouraged by professional association incentives which provide time and support for research. According to David Colquhoun
David Colquhoun
David Colquhoun, FRS is a British pharmacologist at University College London . He has contributed to the general theory of receptor and synaptic mechanisms of single ion channel function. He previously held the A.J. Clark chair of Pharmacology at UCL, and was the Hon. Director of the Wellcome...
, chiropractic is no more effective than conventional treatment at its best, and has a disadvantage of being "surrounded by gobbledygook about 'subluxations'", and, more seriously, it does kill patients occasionally. He states that chiropractic manipulation is the number one cause of stroke under the age of 45. Neck spinal manipulation has a risk of stroke or death. Although rare, spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death; these can occur in adults and children. Most of the adverse events were benign, however, there are complications that were life threatening. A 2010 systematic review found that numerous death
Death
Death is the permanent termination of the biological functions that sustain a living organism. Phenomena which commonly bring about death include old age, predation, malnutrition, disease, and accidents or trauma resulting in terminal injury....
s since 1934 have been recorded after chiropractic neck manipulation typically associated with vertebral artery dissection
Vertebral artery dissection
Vertebral artery dissection is a dissection of the inner lining of the vertebral artery, which is located in the neck and supplies blood to the brain. After the tear, blood enters the arterial wall and forms a blood clot, thickening the artery wall and often impeding blood flow...
. Some chiropractic proponents seem to think that a critical evaluation of the research is tantamount to a 'scare story' or to 'puffing up (the evidence) out of all proportion'. A reasonable approach to serious risk from chiropractic therapy, however, requires an open examination.
The 2008 book Trick or Treatment
Trick or Treatment
Trick or Treatment? Alternative Medicine on Trial is a 2008 book about alternative medicine by Simon Singh and Edzard Ernst. Singh is a physicist and the writer of several popular science books...
states that "chiropractors may X-ray the same patient several times a year, even though there is no clear evidence that X-rays will help the therapist treat the patient. X-rays can reveal neither the subluxations nor the innate intelligence associated with chiropractic philosophy, because they do not exist. There is no conceivable reason at all why X-raying the spine should help a straight chiropractor treat an ear infection, asthma or period pains. Most worrying of all, chiropractors generally require a full spine X-ray, which delivers a significant higher radiation dose than most other X-ray procedures". Recent research suggests that most chiropractors in Canada are taught and follow stringent radiography guidelines, which were developed to reduce unnecessary radiography.
Quackwatch
Quackwatch
Quackwatch is an American non-profit organization founded by Stephen Barrett with the stated aim being to "combat health-related frauds, myths, fads, fallacies, and misconduct" and with a primary focus on providing "quackery-related information that is difficult or impossible to get elsewhere."...
is critical of chiropractic; its founder, Stephen Barrett
Stephen Barrett
Stephen Joel Barrett is a retired American psychiatrist, author, co-founder of the National Council Against Health Fraud , and the webmaster of Quackwatch. He runs a number of websites dealing with quackery and health fraud. He focuses on consumer protection, medical ethics, and scientific...
, has written that it is "absurd" to think that chiropractors are qualified to be primary care providers and considers applied kinesiology
Applied kinesiology
Applied kinesiology is an alternative medicine method used for diagnosis and determination of therapy. According to practitioners using Applied Kinesiology techniques, it provides feedback on the functional status of the body. AK is a practice within the realm of alternative medicine and is...
to be a "term most commonly used to identify a pseudoscientific system of muscle-testing and therapy".
A 2009 perspective stated there is consistent evidence that manual therapies such as chiropractic manipulations are "helpful and generally produce moderate but significant and sustained improvement for back pain in populations" and writes that the suggestion that chiropractic does more harm than good as "specious". The author went on to write that the more serious suggestion is that chiropractic treatment can kill people, and it is often claimed that chiropractic manipulation causes strokes. Common sense suggests that these people were most likely to be in the prodrome of a stroke when they sought help. The author writes "To portray only part of the relevant information in a critique is itself pseudoscience."
Lon Morgan, DC, a reform chiropractor, expressed his view of Innate Intelligence
Innate intelligence
Innate Intelligence is a chiropractic term to describe the organizing properties of living things. It was originally coined by Daniel David Palmer, the founder of chiropractic. This vitalistic concept states that all life contains Innate Intelligence and that this force is responsible for the...
this way: "Innate Intelligence clearly has its origins in borrowed mystical and occult practices of a bygone era. It remains untestable and unverifiable and has an unacceptably high penalty/benefit ratio for the chiropractic profession. The chiropractic concept of Innate Intelligence is an anachronistic holdover from a time when insufficient scientific understanding existed to explain human physiological processes. It is clearly religious in nature and must be considered harmful to normal scientific activity."
Chiropractic historian, Joseph C. Keating, Jr.
Joseph C. Keating, Jr.
Joseph C. Keating, Jr. was trained as a clinical psychologist who spent the majority of his life teaching and researching the chiropractic profession. He is best known for his published works as a historian of chiropractic.-Early life:...
, articulated that "So long as we propound the "One cause, one cure" rhetoric of Innate, we should expect to be met by ridicule from the wider health science community. Chiropractors can’t have it both ways. Our theories cannot be both dogmatically held vitalistic constructs and be scientific at the same time. The purposiveness, consciousness and rigidity of the Palmers' Innate should be rejected."
William T. Jarvis, Ph.D. has stated: "Chiropractic is a controversial health-care system that has been legalized throughout the United States and in several other countries. In the United States in 1984, roughly 10.7 million people made 163 million office visits to 30,000 chiropractors. More than three fourths of the states require insurance companies to include chiropractic services in health and accident policies. The federal government pays for limited chiropractic services under Medicare, Medicaid, and its vocational rehabilitation program, and the Internal Revenue Service allows a medical deduction for chiropractic services. Chiropractors cite such facts as evidence of "recognition." However, these are merely business statistics and legal arrangements that have nothing to do with chiropractic's scientific validity."
Vaccination and water fluoridation
Many forms of alternative medicineAlternative medicine
Alternative medicine is any healing practice, "that does not fall within the realm of conventional medicine." It is based on historical or cultural traditions, rather than on scientific evidence....
are based on philosophies that oppose vaccination and have practitioners who voice their opposition. These include some elements of the chiropractic community. The reasons for this negative vaccination view are complicated and rest, at least in part, on the early philosophies which shape the foundation of these professions. Chiropractors historically were strongly opposed to vaccination
Vaccination
Vaccination is the administration of antigenic material to stimulate the immune system of an individual to develop adaptive immunity to a disease. Vaccines can prevent or ameliorate the effects of infection by many pathogens...
based on their belief that all diseases were traceable to causes in the spine, and therefore could not be affected by vaccines; D.D. Palmer wrote, "It is the very height of absurdity to strive to 'protect' any person from smallpox or any other malady by inoculating them with a filthy animal poison." Some chiropractors continue to be opposed to vaccination, one of the most effective public health measures in history. Early opposition to water fluoridation included chiropractors in the U.S. Some chiropractors oppose water fluoridation
Water fluoridation
Water fluoridation is the controlled addition of fluoride to a public water supply to reduce tooth decay. Fluoridated water has fluoride at a level that is effective for preventing cavities; this can occur naturally or by adding fluoride...
as being incompatible with chiropractic philosophy and an infringement of personal freedom. Recently, other chiropractors have actively promoted fluoridation, and several chiropractic organizations have endorsed scientific principles of public health.
Internal criticism
- Faulty Logic and Non-skeptical Arguments in Chiropractic. Joseph C. Keating, Jr.Joseph C. Keating, Jr.Joseph C. Keating, Jr. was trained as a clinical psychologist who spent the majority of his life teaching and researching the chiropractic profession. He is best known for his published works as a historian of chiropractic.-Early life:...
- Open Letter to the Profession - George P. McAndrewsMcAndrews, Held & MalloyMcAndrews, Held and Malloy is a law firm based in Chicago, Illinois and founded in 1988. The firm specializes in intellectual property law and was featured in Kimm Walton's book America's Greatest Places to Work With A Law Degree....
(commented in Chiroweb) - Chiropractic, Bonesetting, and Cultism. Samuel Homola, (book review at Chiroweb)
- Critical thinking. Christopher Kent, DC president of the Council on Chiropractic Practice
External criticism
- Chiropractic, Skeptic’s Dictionary
- Critical views of chiropractic - CitizendiumCitizendiumCitizendium is an English-language wiki-based free encyclopedia project launched by Larry Sanger, who co-founded Wikipedia in 2001....
- Chiropractic - H. L. MenckenH. L. MenckenHenry Louis "H. L." Mencken was an American journalist, essayist, magazine editor, satirist, acerbic critic of American life and culture, and a scholar of American English. Known as the "Sage of Baltimore", he is regarded as one of the most influential American writers and prose stylists of the...
, Baltimore Evening Sun - Spin Doctors: The Chiropractic Industry Under Examination - Paul Benedetti, Wayne MacPhail
- Keeping Your Spine In Line, Adjusting the Joints, and Video - Alan AldaAlan AldaAlphonso Joseph D'Abruzzo , better known as Alan Alda, is an American actor, director, screenwriter, and author. A six-time Emmy Award and Golden Globe Award winner, he is best known for his role as Hawkeye Pierce in the TV series M*A*S*H...
, PBSPublic Broadcasting ServiceThe Public Broadcasting Service is an American non-profit public broadcasting television network with 354 member TV stations in the United States which hold collective ownership. Its headquarters is in Arlington, Virginia....
, Scientific American FrontiersScientific American FrontiersScientific American Frontiers was an American television program primarily focused on informing the public about new technologies and discoveries in science and medicine. It was a companion program to the Scientific American magazine. The show was produced for PBS in the U.S... - Chirobase: Skeptical guide to chiropractic history, theories, and current practices - Stephen BarrettStephen BarrettStephen Joel Barrett is a retired American psychiatrist, author, co-founder of the National Council Against Health Fraud , and the webmaster of Quackwatch. He runs a number of websites dealing with quackery and health fraud. He focuses on consumer protection, medical ethics, and scientific...
, MD, and Samuel Homola, DC