I spent 43 years in private practice as a “science-based” chiropractor and a critic of the chiropractic vertebral subluxation theory. I am often asked how I justified practicing as a chiropractor while renouncing the basic tenets of chiropractic. My answer has always been: I was able to offer manipulation in combination with physical therapy modalities as a treatment for mechanical-type back pain—a service that was not readily available in physiotherapy or in any other sub-specialty of medicine.
If I had it to do over again, however, I would study physical therapy rather than chiropractic. Considering the controversy that continues to surround the practice of chiropractic, I would not recommend that anyone spend the time, effort, and money required to earn a degree in chiropractic. Physical therapy, which is now beginning to include spinal manipulation in its treatment armamentarium, may offer better opportunity for those interested in manual therapy. Properly-limited, science-based chiropractors are now essentially competing with physical therapists who use manual therapy. Unfortunately, only a few chiropractors have renounced the vertebral subluxation theory, making it difficult to find a “good chiropractor.” I consider physical therapy to be more progressive and more evidence based. For this reason, I generally recommend the manipulative services of a physical therapist rather than a chiropractor.
There are some science-based chiropractors who use manipulation appropriately, but until the chiropractic profession abandons the implausible vertebral subluxation theory and is defined according to standards dictated by anatomy, physiology, and neurology, I would not describe it as a science-based profession.
An article written by 3 chiropractors and a PhD in physical education and published on December 2, 2009 in the journal Chiropractic and Osteopathy may have sounded the death knell for chiropractic.
The chiropractic subluxation is the essential basis of chiropractic theory. A true subluxation is a partial dislocation: chiropractors originally believed bones were actually out of place. When x-rays proved this was not true, they were forced to re-define the chiropractic subluxation as “a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health.” Yet most chiropractors are still telling patients their spine is out of alignment and they are going to fix it. Early chiropractors believed that 100% of disease was caused by subluxation. Today most chiropractors still claim that subluxations cause interference with the nervous system, leading to suboptimal health and causing disease.
What’s the evidence? In the 114 years since chiropractic began, the existence of chiropractic subluxations has never been objectively demonstrated. They have never been shown to cause interference with the nervous system. They have never been shown to cause disease. Critics of chiropractic have been pointing this out for decades, but now chiropractors themselves have come to the same conclusion. (more…)
While manipulation of any kind has the potential to cause injury, stroke caused by neck manipulation is of greatest concern. Risk must always be weighed against benefit when upper neck manipulation is considered. Risk of stroke caused by neck manipulation is statistically low, but the risk is serious enough to outweigh benefit in all but a few rare, carefully selected cases.
When the RAND (Research and Development) organization published its review of the literature on cervical spine manipulation and mobilization in 1996, it concluded that only about 11.1% of reported indications for cervical spine manipulation were appropriate and that stroke and other serious complications occurred about 1.46 times per one million neck manipulations.1 In the same year, after examining 183 cases of vertebrobasilar stroke that occurred from 1934 through 1994 following neck manipulation, the National Chiropractic Mutual Insurance Company (NCMIC) concluded that “It has to be accepted that VBS [vertebrobasilar stroke] following SMT [spinal manipulative therapy] does occur.”2
Chiropractic originated in 1895 when D.D. Palmer claimed to have restored deaf janitor Harvey Lillard’s hearing by manipulating his spine. This makes no anatomical sense, and few if any chiropractors claim to be able to reverse deafness today. But now a chiropractic website is attempting to vindicate D. D. Palmer. They list deafness among a long (wrong) list of “Conditions That Respond Well to Chiropractic”
They list 6 supporting studies. Three are case reports, two are case series, and one is a review of the literature that is labeled in its title as “A Search to Validate” D.D. Palmer. (more…)
There is a very good chance that you will feel worse after seeing a chiropractor.
According to a new systematic review, serious complications of spinal manipulation are rare, but 33-60% of patients experience milder short-term adverse effects such as increased pain, radiation of pain, headaches, vertigo and even loss of consciousness. The study, published in the journal Spine, involved searching PubMed and the Cochrane Library for the years 1966 to 2007. They identified additional studies by hand searching. They looked for all articles that reported adverse effects associated with chiropractic irrespective of type of design. They omitted any reports where patients had underlying diseases (osteogenesis imperfecta, expansive vertebral hemangioma, osteoporotic fracture, etc.) that predisposed them to complications with manipulation.
They found 46 pertinent studies:
- One randomized controlled trial
- Two case-control studies
- Six prospective studies
- Twelve surveys
- Three retrospective studies
- 115 case reports
They recognized that “the heterogeneity of the study designs did not allow conducting a formal meta-analysis.” But they did the best they could to make sense out of what they found. (more…)
Having grown up on a dairy farm, I am one of the least likely people to object to the deification of yogurt. However, as a critical thinker, I cannot help but resist the idea (promoted by some health sites) that probiotics are a reasonable alternative to chemotherapy in the treatment of colon cancer. And there are many other equally unhelpful claims being made all the time. Fish oil for ALS anyone?
What amazes me about the “cherry yoga” camp (as my friend Bob Stern likes to call it), is that they aggressively market CAM as “harmless” and “natural.” They point to the warning labels and informed consents associated with science-based medicines as evidence that the alternative must be safer. In reality, many alternative practices are less effective, and can carry serious risks (usually undisclosed to the patient). For your interest, I’ve gathered some examples of risks associated with common alternative practices that have been described by the CDC and in the medical literature:
Three recent news items about chiropractic have particularly irritated me.
(1) U.S. Army Brigadier General Becky Halstead (Retired) Speaks Out for Chiropractic Care
(2) Chiropractic Helps Child with Brain Disorder
(3) Swine Flu Chiropractor’s Handout
(1) General Halstead has become a spokesperson for The Foundation for Chiropractic Progress, a nonprofit organization dedicated to increasing public awareness of chiropractic. Her quoted comments boil down to
- I like the personal attention and caring I get from my chiropractor.
- Chiropractic advice about healthy lifestyle is essential
- Chiropractic care prevents more serious health concerns
- Chiropractic is essential for assisting in recovery from minor injuries.
- Chiropractors don’t mask the problem with drugs and all their side effects.
- Chiropractors are holistic and involve the patient in her own care.
- “Listening appears to be a major tool.”
This is nothing but opinion based on personal experience and scientific ignorance. She offers no evidence that chiropractic theory is true, that chiropractic adjustments are effective, or that a chiropractor has any advantage over a science-based medical doctor who also spends time listening to patients, is interested in the whole patient, advises about healthy lifestyle, and avoids unnecessary use of drugs. Caring clinicians can be found in chiropractic, in homeopathy, in every kind of quackery, and in scientific medicine, with the advantage that the scientific clinician can also provide effective evidence-based treatments. (more…)
The chiropractic industry must be feeling the pressure. Billboards, signs on the sides of buses, chiropractic victims’ organizations, and lawsuits are telling the world that chiropractic neck adjustments can cause strokes. The risk is very small, but it is very real. We have addressed the subject before on this blog here, here, and here.
Chiropractors are in denial and are trying to shift the blame elsewhere. A correspondent sent me copies of a pamphlet and a “distribution kit” that the FCER (Foundation for Chiropractic Education and Research) is selling to chiropractors so they can inform the public about cervical artery dissection (CAD). It is advertised as a campaign to help the public recognize warning signs of stroke; but in my opinion, it amounts to a cynical, self-serving ploy to divert attention away from neck manipulation and to spread biased information about the recent study in Spine by Cassidy et al. (more…)
Editor’s Note: This is a guest post solicited by Dr. Hall, who describes Dr. Albietz thusly: He’s a skeptical young pediatrician who works in a PICU and recently had a chiropractor come into the PICU to consult on a child with intractable seizures. He was sort of coerced to allow this at the parents’ request and against his better judgment. His hospital had set a precedent of letting alternative practitioners have temporary privileges in cases like this. He was torn between his academic integrity and doing the most humane thing for the patient and family.
“Primum non nocere.” First, do no harm. It is a guiding principle of medicine, and one which is next to impossible to achieve in practice. It is difficult for the general public to hear, but any intervention a physician makes, and indeed the decision to make no intervention, carries a risk of harm with it. Given enough time, every physician will make a decision which results in unintended harm to a patient, even death, and it haunts us every day of our careers. Faced with this horrible certainty, what is one to do? The only responsible, ethical position to take is to ensure that each patient receives the care most likely to generate a positive outcome, in other words, to stack the deck as steeply in favor of the patient as is possible. Diligent application of the scientific method to every therapy, novel and new, old and venerated, is the only way we as physicians can be certain we are doing the greatest good and the least harm to those who seek our help; it is the only way to assuage our conscience if things end badly.
Our professional organizations and academic institutions have been vital in formulating, propagating, and enforcing the practice of evidence based medicine (EBM). They have stood, to borrow the phrase from Carl Sagan, as “a candle in the dark,” promoting the best practices and protecting patients from those that are ineffective, fraudulent, harmful, or even simply sub-standard. It is a heartening environment in which to work.
There was a full-page ad in my local paper today for Back in Action Spine and Health Centers, targeted at sufferers from almost any kind of chronic back pain. It started with “Are You Ready to Throw in the Towel and Just Live with Hurting So Bad?” It went on to make a number of claims:
- Doctors can fix the problem.
- Breakthrough medical technologies.
- Treatments are FDA cleared.
- Treatments are scientifically proven.
- No side effects.
- Best kept secrets for healing “bad backs.”
- Corrects scoliosis.
- Corrects compressed discs.
- Several university studies at Johns Hopkins, Stanford and Duke have confirmed that these treatments work.
- Medical researchers have reported these methods up to 89% effective.
- Treatments work for back and neck pain, sciatica/numbness, herniated and/or bulging discs, degenerative disc disease (arthritis), spinal stenosis, facet syndromes, spondylolisthesis.
- Their questionnaire can determine who will benefit – if you fit even one criterion like “does your back feel out of alignment?” or “do you have arthritis?” you should call right away.
The ad offers a “Free Qualifying Exam” but you “Must Not Wait” because appointments are limited and they can only honor this free offer for 3 weeks. To encourage you to call, they sweeten the pot with a FREE $49 gift bag.
Are you suspicious yet? You should be. (more…)