The End of Chiropractic
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.
In “An epidemiological examination of the subluxation construct using Hill’s criteria of causation” Timothy A. Mirtz, Lon Morgan, Lawrence H. Wyatt, and Leon Greene analyze the peer-reviewed chiropractic literature in the light of Hill’s criteria, the most commonly used model for evaluating whether a suspected cause is a real cause. They ask whether the evidence shows that chiropractic subluxations cause interference with the nervous system and whether they cause disease. The evidence fails to fulfill even a single one of Hill’s nine criteria of causation. They conclude:
There is a significant lack of evidence in the literature to fulfill Hill’s criteria of causation as regards chiropractic subluxation. No supportive evidence is found for the chiropractic subluxation being associated with any disease process or of creating suboptimal health conditions requiring intervention. Regardless of popular appeal this leaves the subluxation construct in the realm of unsupported speculation. This lack of supportive evidence suggests the subluxation construct has no valid clinical applicability. [emphasis added]
While some chiropractors have rejected the subluxation paradigm, it is supported by the major chiropractic organizations and schools and is considered essential by the great majority of practicing chiropractors. In two recent studies cited in the Mirtz et al. article, 98% of chiropractors believed that “most” or “many” diseases were caused by spinal misalignments and over 75% of chiropractors believed that subluxation was a significant contributing factor to 50% or more of visceral disorders (such as asthma and colic), an implausible idea that is not supported by any evidence whatsoever. Simon Singh was sued for saying so when he correctly referred to “wacky ideas” and “bogus treatments.”
When chiropractors use spinal manipulation therapy for symptomatic relief of mechanical low back pain, they are employing an evidence-based method also used by physical therapists, doctors of osteopathy, and others. When they do “chiropractic adjustments” to correct a “subluxation” for other conditions, especially for non-musculoskeletal conditions or “health maintenance,” they are employing a non-scientific belief system that is no longer viable.
As the authors of this paper indicate, the subluxation construct must go. And without the subluxation, the whole rationale for chiropractic collapses, leaving chiropractors no justifiable place in modern medical care except as competitors of physical therapists in providing treatment of certain musculoskeletal conditions.
The absence of publicity is astounding. This study has not even been noticed by the media. Where are the sensationalist journalists who usually exaggerate the news and make up provocative headlines? They could be trumpeting “Chiropractic Is Dead!” “Chiropractors Admit They Were Deluded by False Beliefs” “Simon Singh Vindicated: Chiropractic Really Is Bogus” and so on. Chiropractors demolishing the basis for chiropractic ought to be big news.
When the news finally gets out, I predict contorted efforts at damage control. Chiropractors will claim that it is not appropriate to apply the Hill criteria in this way, and that the criteria are not a valid test of causality. That’s a straw man: not even Hill suggested that the criteria were a definitive test. They are more of a guide to thinking about causality. Edzard Ernst, the world’s first professor of complementary and alternative medicine, finds them useful. He has recently applied Hill’s criteria to neck manipulation as a cause of stroke: he found that it fulfilled all but one of the criteria for causation. (Article pending publication). Chiropractors won’t like that either.
I predict the authors of this paper will be attacked as traitors by their colleagues. And I predict my own comments will be misinterpreted as some kind of personal vendetta and I will be called ugly names. I also predict that no one will dispassionately offer acceptable scientific evidence to contradict the findings of the paper (They can’t, because there isn’t any!). The first comment (and so far the only comment) on the Chiropractic and Osteopathy website offers no counter-evidence but rather calls for not letting evidence-based protocols overshadow clinical experience.(!) The Weekly Waluation of the Weasel Words of Woo could have a lot of fun translating that statement.
If chiropractors reject the conclusions of the Mirtz et al. paper, the burden of proof falls on them to show
- that the subluxation can be objectively demonstrated,
- that it does cause interference with the nervous system, and
- that it does cause disease.
They have failed to do so for 114 years.
Most chiropractic research falls under the category of Tooth Fairy Science. Instead of doing good basic research to examine the subluxation construct as a falsifiable hypothesis, they blindly forged ahead, implemented it for diagnosis and treatment, and studied various aspects of its clinical use.
The chiropractic emperor has no clothes, and now even some chiropractors have realized that. This study should mark the beginning of the end for chiropractic, but it won’t. Superstition never dies, particularly when it is essential to livelihood.
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When I attended chiropractic college there was little talk regarding the theory of the “subluxation” complex. Rather my core chiropractic education was based on clinical human biomechanics and associated neuromusculoskeletal(NMS) conditions. When the “subluxation” complex was discussed it was explained as theory and would require much needed research. I consider myself a NMS practitioner with a philosophy of optimizing function/”health” of the human frame. I personally, don’t refer to the “subluxation” complex but rather osseous/segmental frame dysfunction. This may be similiar to some physical therapists and osteopathic physicians. Of course, many know that some osteopathic physicians use manipulation as do a growing number of physical therapists. For those interested in evidence-based literature regarding manipulation refer to the recent study that was published in The Journal of Human Hypertension 2007(May); 21(5): 347-352…we conclude that restoration of the Atlas Alignment is associated with marked sustained reduction(s) in blood pressure(BP)similiar to the use of a two drug combination therapy(17 point decrease). Does this reveal some proof regarding the “subluxation” complex it depends who you ask. The “subluxation” complex is currently a theory and a work in progress.
Face, re research into chiropractic theory—.
Harking back to the glib “absence of evidence does not mean evidence of absence” saying — even if the subluxation complex is conceived in the broadest possible terms, i.e. that “something can go on in the spine that can be relevant to the treatment of a range of human systemic and visceral illnesses”, we would ask “where are the grounds for such a speculation?”
The available clinical evidence can be adequately explained by other well-known phenomena. There is nothing in it to distinguish this area of chiropractic practice and theory from medical “systems” making similar dubious claims, such as homeopathy and naturopathy.
There is even contrary evidence in this case, as “chiropractic” effects are not observed in patients with genuine spinal pathology or spinal trauma of infinite variety.
Here lies the problem. Why should we consider the subluxation complex a serious scientific hypothesis, and thus worthy of research funds?
face said,
“it also hasn’t been completely defined with only one profession wide accepted definition”
tahoe69 wants to re-name it “osseous/segmental frame dysfunction” – whatever that means.
I see this confusion of terminology as even a bigger problem for chiropractic than the lack of evidence for “subluxation.”
A diagnosis like diabetes can be easily defined so that anyone can determine whether a patient has diabetes or not on the basis of a quantitative blood test. The causal lesions that chiropractors cite as a reason for chiropractic adjustments don’t even begin to approach that kind of clarity. Until they become more precise and figure out what they are really treating, it seems they are making up whatever words they choose to use as a justification to adjust the spine of any patient they choose. And it is impossible to do research on something that isn’t well-defined.
No, tahoe69, NUCCA still looks like hogwash, despite the hypertension study. Conscious or unconscious manipulation of the results or other error is far more likely than that this technique will have any reliable and durable effect on blood pressure.
I am not thinking only of the extreme implausibility of NUCCA claims.
The lack of essential steps in validating the methodology makes it look like the typical pseudoscience of the naive enthusiast. Just as chiropractors thought they could find subluxations on X-ray until they were tested out under controlled conditions, it is extremely doubtful if such tiny degrees of misalignement of the atlas could be consistently detected, and be “corrected”, let alone have any relevance to general health.
I see this is a rough crowd. Like i said before I don’t use “subluxation” complex as that was not the basis of my chiropractic core education. Rather I use many neuromusculoskeletal/orthopedic normenclature/terms used in “physical medicine”. I said the theory of the “subluxation” complex was taught to me as theory that would require research. You can belittle my definition of what I dx./treat with conservative chiropractic care/treatment but I have very good relations with medical physicians that seem to understand my diagnosis/treatment plans. All types of physical/orthopedic procedures/practitioners are being challenged regarding “evidence” of care provided. I was just on the American Pain Society web site and it refered to a recent study done by Stanford researchers published in Health Affairs. It shows that areas of the country with the highest number of MRIs have the highest incidence of surgery for lower back pain. Although, most of us are aware previous studies have shown that increased surgery for back pain doesn’t improve outcomes.” The net result is increased risks of unnecessary surgery for patients and increased costs for everyone else” said Dr. John Birkmeyer professor of surgery University of Michigan(not involved in study) regarding this study in Health Affairs. Maybe there’s plenty of finger pointing to do regarding “evidence”/unnecessary treatment/care.
@face on 18 Dec 2009 at 5:29 pm “Joe- You must have been burned bad by a chiro to have such a chip on your shoulder…former lover? …”
I have never been involved with a chiro in any way because, even when I was a child, it was clear they are idiots. It is really sad that high school graduates can believe in chiros.
ahoe69 on 19 Dec 2009 at 5:41 pm “I see this is a rough crowd. Like i said before I don’t use “subluxation” complex as that was not the basis of my chiropractic core education.”
Well, according to the above-cited Association of Chiropractic Colleges (cited below, again), you were cheated. You should sue your college since subluxation is the core value of chiropractic. You have spent money on a sham (well, all of you do that).
See the Association of Chiropractic Colleges http://www.chirocolleges.org/paradigm_scope_practice.html
“Chiropractic is Concerned with the preservation and restoration of health, and focuses particular attention on the subluxation.
A subluxation is 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.”
wow, I see this is the wrong place for me. I’m not only one of the “idiots” but I also was cheated during my professional education when I was told the “subluxation” complex is a theory. Now I have a busy chiropractic practice that refers and receives referrals from other health care providers. I have good intentions. I provide conservative chiropractic care for NMS patients/ conditions that you would find in many physical therapy/osteopathic clinics. Many of us in the chiropractic profession understand our professions short-comings. Many of the chiropractors I associate with don’t refer to the “subluxation” but rather “physical medicine” jargon/terminology. BUT speaking of “evidence” and the short-comings for that matter, a patient brought to my attention last month the “whistle blower” lawsuit against Pfizer and other PhRMA companies. I found it interesting because the “salepeople” of these drug companies were pushing the use of drugs for conditions not approved by the FDA. Pfizer has been fined/fees several billions of dollars over the last 10 yrs. The prosecutor in the recent case stated,” they’ve repeatedly marketed drugs for things they knew they couldn’t demonstrate efficacy for. That’s clearly criminal.” The latest drug I believe was Bextra that Pfizer was having it’s salespeople push it was found dangerous and taken off the market. Could it be that medications are being prescribed for conditions they’re not approved? I don’t see how that could be when all I hear is how all medicine is done/performed in absolutes/”evidence based”. Maybe it’s just “theory” that doctors/allied health care only listen to “salespeople” regarding the prescription/use of drugs.
When someone suggests that a person should not let a chiropractor touch their neck, does that concern apply to ALL physical therapists, osteopathic and medical physicians that perform cervical manipulation?
Regarding “evidence”/proof of medical procedure/care/treatment, I came accross this article; that about 15% of all drug sales in the U.S. are for unapproved uses without adequate evidence the medications work according to medical professor Randall Stafford at Stanford University. He estimates that doctors write MORE than 10 million such prescriptions.
Could it be that doctors are prescribing medication for which there’s inadequate “evidence”? GOOGLE the drug Zyprexa for which Lilly pleaded guilty $1.42 billion in fines/penalties January 2009. Is it that some doctors are listening to the “salespeople” and not the literature and/or the lack thereof. Maybe there’s lot’s of “idiots”.
@tahoe69 on 19 Dec 2009 at 7:23 pm
Am I to understand that you are proud to be an idiot and to cheat people out of their money on a daily basis? You know, if other people cheat, it doesn’t make you legit. The tuo quoque argument you tendered is how I know you are an idiot.
But, hey, don’t let me interfere with your grifting. Do tell us how many spinal maintenance adjustments a person needs to keep you financially flush …
tahoe69,
The defects of conventional medicine are not relevant to this discussion. You are attempting to distract our attention and are using the tu quoque logical fallacy. It would be much more productive if you would respond directly to the points in the article. Why is what you do “chiropractic” rather than physical therapy? It is a historical fact that the subluxation construct was the basis of chiropractic; and if you think the situation has changed, you should provide us with data rather than telling us what “many of the chiropractors you associate with” have said. Specifically, how many practicing chiropractors today believe that they are diagnosing chiropractic subluxations that cause nerve interference and disease?
“When someone suggests that a person should not let a chiropractor touch their neck, does that concern apply to ALL physical therapists, osteopathic and medical physicians that perform cervical manipulation?”
The concern applies to neck manipulation itself, not to the type of provider. The concern is greater when the treatment is given for a spurious diagnosis that is not known to cause nerve interference or disease. Or when neck manipulation is the primary treatment used by the provider for the great majority of patients.
Your correct regarding the procedure of cervical manipulation vs. the provider. But of course that question should apply to all who manipulate the cervical spine(is it worth the risk?). I’m not making such attempt to distract attention away from the topic. As I read through many of these entries I see many negative and hateful like comments. I said it earlier, I’m fully aware of the short-comings of the profession I have choosen. I will repeat this one more time I do not use the term “subluxation” and/or the theory “subluxation complex”. I also know many chiropractors who do not use that term but rather physical medicine jargon/terminology. You’ve belittled me with my other references/comments and others have used derogatory comments regarding chiropractic/chiropractors. I don’t have to believe/adhere to the “subluxation theory” nor do I, to be a licensed doctor of chiropractic. The university I attended did not emphasize the “subluxation” complex as I mentioned. I brought up medical doctors prescribing medication for conditions for which they have inadequate evidence since they’re often are the profession that seems to judge/condemn with ABSOLUTEs that chiropractic as lacking “evidence”. My diagnosis/treatment is based on neuromusculoskeletal(NMS) conditions found in physical medicine text/treatment facilities. I often get/give medical referrals. Your using a broad brush because you want to put every chiropractor in a box. It’s a theory. I provide conservative chiropractic care for physical medicine conditions. I suppose me commenting on the unnecessary lower back surgeries is inappropriate also. Again, these are the same people pointing fingers that prescribe and perform surgeries without adequate “evidence”. I guess doing it for profit at all cost is okay like the “spinal maintenance” comment “financially flush”. I don’t use the “subluxation” reference and I have a conservative approach to NMS conditions but I’m a terrible/predatory human being…….pathetic.
Theory:
I don’t think it means what you think it means.
Subluxation is not a theory. There is nowhere enough evidence to support the concept as a scientific theory. Or, as the authors of the article under review show, there is no evidence supporting subluxation.
tahoe69,
I am not your enemy. I support chiropractors who limit their practice to short-term treatment of musculoskeletal conditions, who reject the subluxation myth and quack methods like applied kinesiology, and who don’t discourage immunization (over half of chiropractors do). Some of these individuals are very skilled at SMT and have a lot of experience and can help patients. I just don’t think those individuals are doing “chiropractic” and I think they will have to distance themselves from that designation and re-invent what they do under another name.
This website is dedicated to criticizing non-science-based practices wherever they are found, in quackery, alternative medicine or conventional medicine. The medical journals are full of discussions of problems like unnecessary surgery, and we are trying hard to do better. Conventional medicine at least tries to be self-policing and self-correcting, and it is steadily increasing its percentage of evidence-based practices. Conventional medicine is constantly changing its practice to give up treatments that have been found ineffective. If chiropractic had been similarly science-based and self-policing, we would not be having this discussion. Chiropractic has no such tradition. The only thing I have ever found that the ENTIRE chiropractic community gave up was BJ’s nerve tracing nonsense where he claimed to palpate non-anatomical nerves through the skin.
Enemy or not is of no consequence. I have good intentions for patients and provide conservative chiropractic care for neuro-musculo-skeletal conditions. Again, I do not support or discuss with patients the “subluxation” complex. I have/maintain professional relationships with other health care providers. I consider myself part of the community physical medicine team that specializes in clinical human biomechanics/NMS conditions that uses/performs manual manipulation/mobilization of osseous joints that lack mechanical function. I also encourage a lifestyle to enhance the human frame ie. exercise, proper/optimal ergonomics and sound nutrition. I often refer patients to other medical professionals.
This discussion brought on an interest to the osteopathic lesion/philosophy. I will try to read a bit about the “osteopathic lesion”. It’s been a while but if my memory is correct the osteopathic philosophy has been/is concerned/interested in the functional disturbance of the osteopathic lesion. I believe early osteopathic doctors were preoccupied with the vascular system as opposed to the nervous system. Like I said I can’t recall, but it seems to me osteopathic doctors were taught/believe somatic dysfunction to preclude long-term sequelae. I have a friend wh happens to be a chiropractic who teaches at a osteopath college, I have a good reason to give him a call. You mentioned how the unnecessary surgeries can be explained, I also find it interesting drugs are being prescribed for conditions with inadequate evidence. Why prescribe a medication without refering to the absolute evidence based literature not a PhRMA sales person? Just asking of those asking of me. I will and do limit my practice of chiropractic to neuro-musculo-skeletal conditions…I hope that’s okay with you.
Enemy or not is of no consequence. I have good intentions for patients and provide conservative chiropractic care for neuro-musculo-skeletal conditions. Again, I do not support or discuss with patients the “subluxation” complex. I have/maintain professional relationships with other health care providers. I consider myself part of the community physical medicine team that specializes in clinical human biomechanics/NMS conditions that uses/performs manual manipulation/mobilization of osseous joints that lack mechanical function. I also encourage a lifestyle to enhance the human frame ie. exercise, proper/optimal ergonomics and sound nutrition. I often refer patients to other medical professionals.
This discussion brought on an interest to the osteopathic lesion/philosophy. I will try to read a bit about the “osteopathic lesion”. It’s been a while but if my memory is correct the osteopathic philosophy has been/is concerned/interested in the functional disturbance of the osteopathic lesion. I believe early osteopathic doctors were preoccupied with the vascular system as opposed to the nervous system. Like I said I can’t recall, but it seems to me osteopathic doctors were taught/believe somatic dysfunction to preclude long-term sequelae. I have a friend who happens to be a chiropractor who teaches at an osteopath college, I have a good reason to give him a call. You mentioned how the unnecessary surgeries can be explained, I also find it interesting drugs are being prescribed for conditions with inadequate evidence. Why prescribe a medication without refering to the absolute evidence based literature not a PhRMA sales person? Just asking of those asking of me. I will and do limit my practice of chiropractic to the treatment of neuro-musculo-skeletal conditions…I hope that’s okay with you.
tahoe69 went to chiropractic school, has a diploma that says “Doctor of Chiropractic”, has a chiropractic license, practices according to chiropractic scope, using the knowledge and skills taught at chiropractic school, ………..and now Harriet declares he is not “doing chiropractic”! Really Harriet? Wow that’s rich!
“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.”
I doubt it. Homeopathy has been found to be unsupported by scientific inquiry and, yet, it’s still going strong. Peter Popoff was thoroughly exposed as a fraud in the ’80s, went bankrupt, and is now back in business and filthy rich again. Yes, chiropractic is nonsense but it’s unlikely to go away just because it’s been shown to be nonsense.
The nonsense will remain popular and very little will change.
tahoe69, if you are fighting against the subluxation end of the spectrum, great. But you should realize that you are coming across as defending those same practitioners as you defend the entire field.
You and others that think like you really need to start addressing the regulatory definitions or otherwise, Dr. Hall is right, you are not practicing chiropractic, as defined by the relevant regulations and laws. For example, Florida Statues, Title XXXII, chapter 460.403 (emphasis mine):
The legal definitiion of the practice specifies subluxations and also says that chiropractors do more than skeleto-muscular adjustments and treatment.
A quick survey of local chiropractor websites found statements supporting subluxation, the treatment of infant cholic (one of the things the BCA is suing Simon Singh about) and one even claimed that the Hep B vaccine was linked to autism. These were all in the top 5 Google search results for my area.
If you really want good, evidence-base care, then the people here are your allies, not your enemies.
@Harriet Hall on 20 Dec 2009 at 12:23 am “tahoe69,
I am not your enemy. I support chiropractors who limit their practice to short-term treatment of musculoskeletal conditions, who reject the subluxation myth and quack methods like applied kinesiology, and who don’t discourage immunization (over half of chiropractors do).”
Doctor Hall, this is what I do not understand about your stance. When yo consider that 50% of chiros oppose vaccination, 90% believe in subluxations, 75% believe they can treat visceral illnesses etc.- 99.99% of them make the rest look bad. Those you think are rational are mere masseurs with delusions of grandeur. They would like us to think they are substitutes for PTs; but they don’t have that education unless they learned it ad hoc. I don’t trust ad hoc medical education.
I know I must be getting it about right when I am criticized both for being too mean to chiropractors and for being too nice.
I have sympathy for the rational chiropractors who are victims of their education and who are trapped in an unfortunate situation. Samuel Homola was one. He couldn’t afford to start over in a new profession, and he managed to separate the wheat from the chaff and help patients who otherwise would have resorted to a less scrupulous chiropractor. I’m in favor of trying to leave people like Sam a means of livelihood.
Ah, back in the action.
@ nobs – Sure. Might an MD briefly share where and when they received their research methods training? I am not pretending to assume they recieve it.
@ face – ah, ‘the debate” is strong in you as well?! I willed myself to avoid this site all weekend for that reason, sorry to compel you further…
I accept your position and merely reinforce that the burden of proof rest sqaurely on the shoulders of those making the claims. I am sorry your field lacks the tools and funding (or whatever it may be) to do better research. I am not sure any level of understanding will shield it from further criticism, not that you imply it would…but all the same.
My eyes widen at some of things you are witnessing, in that, this seemingly underfunded, intellectually resistant, minimally researched, folly-perpetuating field is the same field that we should trust to provide quality care? Not exactly stoking confidence in the practice, for me personally.
Not trying to twist your statements here, but I keep hearing, “yea, we got a lot of problems, but we’re working on it! Just give us a sec!”
The Gallileo comment was more directed at whoever cited the wright brothers and to anyone else who tempted to fall back on that fallacy. It just happened to come to mind immediately after a post directed at you. As well, *I* rehashed that quote from elsewhere in the site (as in, I’m not taking credit), not a slight to you. Apologies for lack of clarity.
@ Tahoe – my question is simple:
Can you or can you not provide evidence to support subluxation theory? That is, after all, the point of this blog entry. Your personal experience, though having made for a sufficiently engaging exchange, has seemingly evoked unnecessary back and forth barbs if you don’t agree that subluxation is the lynchpin on which the entire practice of chiro rests.
I was able to find a few minutes to discuss this site/topic with a couple other doctors of chiropractic. One of the chiropractors mentioned the voice and power of the anitvaccination minority( a small minority). I was also directed to an article published in The Journal of Chiropractic Humanities: Survey of U.S. Chiropractor Attitudes and Behavior about Subluxation. I looked this article over rather quickly as my Vikings were getting beat by the Carolina Panthers. Anyways, out of 67,217 chiropractors 5,931 were surveyed “nearly” 50% responded. Of those responded 48% reported their chiropractic education was predominately “subluxation” based. It went on to say that ‘most chiropractors typicaly reported that over 75% of their clinical approach to neuromusculoskeletal or biomechanical disorders such as back pain was “subluxation based”. Conversely, most chiropractors also reported less than 20% of their clinical approach was “subluxation based” for patients deemed to be principally problems with circulation, digestion or similarly visceral in nature.
Although, not allowed here… I consider myself a progressive and change-orientated doctor of chiropractic. My core chiropractic education did not emphasize the “subluxation” complex nor do I use that teminology instead I use physical medicine jargon/terminology. There are several schools that have rejected the historical concept of the chiropractic subluxation. Instead biomechanical terms are used like joint complex dysfunction. As I mentioned earlier, I’m well aware of the professions short-comings as are many others. The old school/vocal minority is lingustically framed to be perceived as the majority by many who can’t resist the broad brush approach at the expense of others.
tahoe – i like that response. however, lets put it this way.
suppose 80% of all chiro reject subluxations. The term “chiropractor” still encompasses those that do not. this provides shelter to those who believe in archaic terms and mystical origins of ill-health.
I think what HH is getting at (and please feel free to disagree, HH or anyone else) is that chiro needs a makeover, a “member review” or to somehow make a distinction between the two – as demonstrated by the call to label your type as a PT or something else. can you really feign surprise that someone would broad stroke brush it, given the context you just discussed?
a chiro can either be a woo based quack or a science based “neuromusculoskeletal or biomechanical” practioner. you of course are the latter. busting subluxation helps to separate you from the quacks, i see the findings as beneficial if you wholly represent everything you have thus far claimed to be.
I was just searching for this article that was mentioned to me when I came across some info. about a nearby M.D. H.M.D practice that specializes in cancer chelation treatment/therapy just 30-40 miles from here. I’ll look into that later. Anyways, it was mentioned earlier that all those terrible chiropractors are against vaccinations. So I was directed to a few articles. Here’s one:Chiropractors and Vaccination: A Historical Perspective it’s published in Pediatrics Vol. 105 4 April 2000, p. e43; To determine the prevalence of antivaccination attitudes within the community, Colley and Haas conducted a survey of about 1% licensed chiropractors. Although, the response rate to the the survey was VERY small 36%/171 respondents believed there is no scientific proof that immunization prevents disease. IN the discussion portion it was stated: Today this antivaccination sentiment continues to be espoused by what seems to be a minority of chiropractors. More progressive evidence-based chiropractors have embraced the concept of vaccination. I wonder if a devilish chiropractor was/is behind all those health care workers (worldwide) that have/are refusing the H1N1 vaccine?
Many of the chiropractors who say they are not anti-vaccine are not pro-vaccine either, and they tell their patients to choose for themselves in such a way that tends to discourage them from vaccinating. For more on chiropractic and vaccinations (with references cited), see http://www.chirobase.org/06DD/chiroimmu.html
An excerpt:
“In 1999, Dynamic Chiropractic invited readers to state whether they have immunized their children. This method is not precise way to collect such data, but the answers were still interesting. Of 140 responses, the results were:
My children have received absolutely no vaccinations: 59 (42%)
My children received only some of the usually required vaccinations: 31 (22%)
My children have received all of the usual required vaccinations 50 (36%)”
There are still chiropractors who deny the germ theory. There is at least one in my local community. He told me “If germs caused disease, we’d all be dead.”
wow, I see no matter what I say/claim it’s wrong/false. Now chiropractors don’t believe in the “germ theory”. I have to laugh. The strategy of giving full attention to the vocal minority(very small) is somewhat like the strategy of a false attack. I was hoping to learn something in this thread instead it was often a written(verbal) beat down. NO nuance, but guilty by association/black and white thinking/your either with us or against us…..pathetic. I suspect many here are of a different/earlier generation. I admitted that short-comings existed in the profession of chiropractic, but I know of the claims made are of a very small/shrinking minority. I have been criticized by others for attending a school that didn’t emphasize the “subluxation” complex but instead the joint dysfunction complex/clinical human biomechanics. I can assure you I have a very good understanding of the “germ theory” from biology class in high school. I did take a history of medicine class that did mention the “soil or seed” mental battle(s) between Bernard and Pasteur. Well, I tried my best to climb out of the box I was put in. No worries…… we are getting 8-10″ of white powder tonight……the skiing will be great.
tahoe69,
Did you even read the link I provided, showing the published statements of the major chiropractic organizations and other data?
The statistics from the 1999 Dynamic Chiropractic poll indicate that chiropractors who accept immunizations for their own children are the minority. How about the info on the chiropractic pediatric text? How about the 2002 study showing that anti-vaccine opinions increased as students progressed through chiropractic school?
No one has put you personally in an anti-vaccine or germ theory denial box, or even in a subluxation box. You put yourself in a “chiropractic” box. We are simply trying to show that the chiropractic box contains a lot of pro-subluxation, anti-vaccine individuals. You tell us the bad apples in that box are in the minority, when many of us believe they are a majority. Even if they are a minority, how can the consumer know what he is getting when he picks an apple out of that box at random? Can’t you see the advantage to both you and your patients of moving all the good apples to a separate box? Or getting rid of the bad apples? Some people want to throw out the whole box; I personally think the good apples are worth saving.
My children have received absolutely no vaccinations: 59 (42%)
My children received only some of the usually required vaccinations: 31 (22%)
My children have received all of the usual required vaccinations 50 (36%)”
Personally, no offense I’m not going to waste my time with stephen barrett board “certified” psychiatrist. Regarding this 10 yr. old poll,
out of 140 respondents=(some vacs.31+all vacs.50)=81/58%
(absolutely no vacs…….59)=59/42%
Well, it’s been somewhat interesting. Thanks for the input. If you ski check out tahoe. Maybe you can tell me about the M.D.,H.M.D. using chelation/homeopathics for cancer treatment in my area.
tahoe69,
I’m disappointed to see you falling into the same tired old logical fallacies other chiropractors use when trying to defend their livelihood.
“Personally, no offense I’m not going to waste my time with stephen barrett board “certified” psychiatrist.”
What? Stephen Barrett has nothing to do with this. I linked to his website as a convenient source of information. He referenced a vaccine attitude study published in a chiropractic magazine. He also mentioned other references that you choose to ignore, like the article showing increased anti-vaccine attitudes as students progress through chiropractic school.
If you are ignoring any references cited on that website because of the person who cited them, you are committing the worst kind of ad hominem fallacy.
“Maybe you can tell me about the M.D.,H.M.D. using chelation/homeopathics for cancer treatment in my area.”
I warned you about the tu quoque fallacy earlier. Medical sins do nothing to confirm chiropractic virtues. As a matter of fact, we have already “told you” about doctors like the one you mention. There are several articles on our website condemning chelation, homeopathy, and bogus cancer treatments.
Chiropractic was and is based on the subluxation construct. Your attempts to deny this fact are not convincing.
Well, maybe we can agree to disagree. I realize my profession is less than perfect. I also realize I’m less than perfect. To me this is much more than science so I often (not always) follow the money and the
culture club/politics trail. I was often (purposely) misunderstood here but that’s ok, I understand the strategy. I have a best practice/evidence based approach to patient care of NMS conditions. I don’t bad mouth other practitioners and I read the literature(medscape)routinely. My skin has thicken being a chiropractor(second class citizen/professional) so the insults don’t damage.
HH-
“Even if they are a minority, how can the consumer know what he is getting when he picks an apple out of that box at random? Can’t you see the advantage to both you and your patients of moving all the good apples to a separate box? Or getting rid of the bad apples? Some people want to throw out the whole box; I personally think the good apples are worth saving.”
well put, i speculated that this was your ultimate point. Not sure why tahoe is choosing to ignore it twice, when the conclusion is ultimately to his(?) benefit.
I don’t know why I’m responding to this, but I just couldn’t help myself. It’s hilarious how chiropractic is still branded, by the ignorant, as the quacks that rant on about subluxations and schedule patients appointments 3x/wk for a patient’s lifetime. I finished chiropractic school earlier this year and among all the students and faculty I encountered, less than 10% ever even used the word “subluxation.” Way too much time is spent trashing the false precepts of some of the older practitioners instead of educating yourselves in what is currently being taught at the majority of institutions.
In the same way that modern medicine was absolutely not founded on empirical evidence, chiropractic wasn’t either. The end of subluxation (which is actually just a matter of syntax as it has nothing to do with how a practitioner actually renders treatment) will not end chiropractic. Chiropractic has continually evolved over the years and will continue to serve the public as a non-invasive means of treatment by a provider who has passed 4 parts of national boards and undergone 10 semesters of graduate training in physical diagnosis, manipulation, physical medicine, differential diagnosis, diagnostic imaging, and a wide array of other courses required to earn the brand of Primary Care (and in my state to be licensed by the board of medicine).
To bash and banter about the machine known as chiropractic is futile, because it’s too big to stop now and too valuable to the public for anyone to just shrug their shoulders and say… “well it was a good run, but it’s finally over.” All this energy would be better spent (for the patients and practitioners) trying to IMPROVE the profession to the safest, most effective, research-based level of treatment within the chiropractic scope. Maybe that doesn’t sound appealing though… maybe it’s simply more fun to preach to the same chaps that will chime in with you, and snicker with fellow colleagues about the worthless chiropractors and their silly ways which will SOMEDAY finally come to an end.
Let’s deconstruct this point by point, shall we?
“All the professional organizations and schools are lying through their teeth, not teaching what they claim to teach, and don’t believe what they claim to believe” presented as a reason to have confidence in chiropractic. Hilarious.
Utterly false. Being founded on evidence is what DEFINES modern medicine.
No, just the end of any reason for it to actually exist. Other than making lots of money by defrauding victims – er, excuse me, patients.
Now compare that to the training of REAL doctors, and observe that “Primary Care” and licensing are determined by politicians rather than people with the faintest clue what they’re talking about.
Argumentum ad populum.
Evidence that it has ANY meaningful value to the public outside the very narrow field of uncomplicated back pain, please.
Observing that the profession is unscientific and primarily offers quackery, and should therefore not be patronized by anyone, is a crucially important task until and unless those facts are addressed by the profession.
Protecting people from wasting their money on quackery that might kill them isn’t worthwhile now?
You reinforce my point, Scott. You’ve successfully “deconstructed” everything I’ve written with nothing other than your own narrow opinions and fallacious arguments. Instead of hearing anything constructive I wrote, you simply retaliate under the same false premise I described. Because… you enjoy it more. Bravo, thoughtful citizen!
Why don’t you actually provide some evidence that anything I said was inaccurate?
Actually I would be extremely interested in knowing what kind of things this recent chiropractic graduate has been taught to diagnose and treat, within his capacity as a “Primary Care” practitioner.
Care to advise us, user9876?
pmoran,
I completed internships at the university clinic, VA hospital, St. Patrick’s Medical Center, and a Sports Medicine orthopedic surgery practice. I did go above what was required, because I wanted to be the best practitioner I could. However, the academic opportunity, for virtually any current chiropractic student, is excellent to those interested in pursuing it. I can accurately diagnose most anything a competent general practitioner MD or DO could (be it fractures, infections vs viruses, CHF, UMNLs, sprain/strains, DJD, RA, etc.). I have close friends who went to medical school and it’s clear that our training differs mostly in treatment… not diagnosis.
As a primary care provider, this training is useful to be confident in where to refer the patients when necessary, not because I think I can treat cancer or cast fractures. It simply means that I’m competent enough to know how to rule out the red flags and send them elsewhere if it isn’t a mechanical NMS issue.
What I am authorized to do is SMT, rehab of damaged muscles or ligaments, exercise prescription, occupational or physiotherapy, and nutrition counselling. I’m fine with limiting my practice to this and I’m certainly not threatened by PTs or OTs. I know they’re effective practitioners, but chiropractic school appealed to me more due to being more thorough and versatile. Sadly, there’s more than enough hurting people, needing care, to go around to all physical medicine providers.
user9876-I’m an non-subluxation chiropractor as well but I had just a slight correction on what you said. You might have known this but I think it came across a little incorrectly.
Chiropractors are authorized to function as primary care physicians however what you described is more of a portal of entry provider. Primary care would be more of a doc who serves to moniter the general health needs of a patient (like high BP or obesity) while the patient is undergoing treatment by another provider for a specific condition. If a person is against using drugs and surgery but needs the care of an neurosurgeon for removal of a glioma, the chiropractor could serve to monitor their basic health problems and refer them to specific providers accordingly.
Personally I think it’s more of a burden to carry and prefer to function solely as portal of entry rather than primary care. Unfortunately I do believe chiropractors like us are more of the exceptions than the standard. Why are you on this site though? There are better ways of wasting time…lol. Happy New Years!
@user9876 on 31 Dec 2009 at 6:53 pm
The Assoc Chiro Colleges maintains that the central tenet of chiro is the subluxation, if you did not learn same, you were cheated. More likely, you just applied a different term because “sublux” has become as embarrassing as Innate Intelligence. The McDonald survey shows that 90% of chiros believe in sublux. The sources have been cited many times.
You are not the first person to try that dodge.
@user9876 on 31 Dec 2009 at 6:53 pm “I can accurately diagnose most anything a competent general practitioner MD or DO could”
In your dreams.
@user9876 on 31 Dec 2009 at 6:53 pm “What I am authorized to do is SMT, rehab of damaged muscles or ligaments, exercise prescription, occupational or physiotherapy, and nutrition counselling.”
Except for SMT, that is not chiro. You may be “authorized” by ignorant legislators, it doesn’t mean you are well-trained.
You are a masseur with delusions of grandeur.
@jasons on 31 Dec 2009 at 9:00 pm “user9876-I’m an non-subluxation chiropractor as well …”
And another chiro who claims not to practice chiro. Did it ever occur to you that there was more wrong with your “education” than sublux and II? Or do you still kinda believe believe in sublux, perhaps by some other name? You people are tiresome.
@user 9876:
“What I am authorized to do is SMT, rehab of damaged muscles or ligaments, exercise prescription, occupational or physiotherapy, and nutrition counselling.”
The various regulators of the separate (from you and from each other) professions known as physiotherapy and occupational therapy, would disagree. You are NOT authorized to “do” occupational or physiotherapy. Not by them. As a physiotherapist, I resent chiros who claim to be able to “do” PT. So go get some professional boundaries, would you?
@Diane, Chiro is a cult, not a profession. Once licensed, they do whatever they please. However, do you recall the Arkansas chiro board fining a PT for performing an “adjustment” rather than a “manipulation” of a patient’s back? It cost the guy $10,000 plus untold legal defense bills merely because the patient’s back made a popping sound.
@Joe, I do remember that incident.
Canada’s situation is a bit different. Here, individual PTs have never, to my knowledge, been legally predated in such a manner. We have always had/retained the right to perform manual treatment of any sort.
Diane,
I do apologize if you’re offended that I know how to do physiotherapy, but I had 2 years of PT classes in chiro school, have an additional master of science degree in rehab, and hold national board certification in physiotherapy and adjunctive procedures. Whether you like it or not, I’m authorized to do provide these services. I don’t think you should feel threatened or angered by this. I didn’t become a chiropractor so I could pretend to be a PT. I gained further rehab knowledge to have as many tools in my belt as possible to help patients. I think you guys are great at what you do and I’m sorry for the chiros that don’t know jack about PT, and claim they can do it as well as you.
Joe,
I don’t mind responding to people who actually have something to say, but like Scott, your comments aren’t even worth entertaining. Telling me how little I know and what I believe without ever meeting me is as dangerous as prejudging a man based on the color of his skin. You disgust me.
Some chiropractors may be qualified to diagnose, but they are the exception. One study showed that most chiropractors failed to recognize the classic symptoms of a heart attack and offered manipulation for it rather than sending the patient to a hospital. Another study showed that they did not know that fever in a newborn was a medical emergency. Chiropractors are not equipped to act as point-of-entry or family health care providers.
@user9876
>”I do apologize if you’re offended that I know how to do physiotherapy, but I had 2 years of PT classes in chiro school, have an additional master of science degree in rehab, and hold national board certification in physiotherapy and adjunctive procedures.”
In other words, your chiro school told you you were qualified, not actual PT or OT schools.
>”Whether you like it or not, I’m authorized to do provide these services.
Yup. Just like chiro has got itself legislated and continues to get itself legislated into legality of this or that, by continually ignoring boundaries of other professions. If there is a code for something, chiro will figure out a way to legally bill for it.
>”I don’t think you should feel threatened or angered by this. I didn’t become a chiropractor so I could pretend to be a PT.”
I’m sure you didn’t, you likely just want to be able to uninterferedly bill for it.
>”I gained further rehab knowledge to have as many tools in my belt as possible to help patients. I think you guys are great at what you do and I’m sorry for the chiros that don’t know jack about PT, and claim they can do it as well as you.”
Does that include you? Gee, I wonder why I feel patronized? Not threatened nor angered. No. More like annoyed and patronized.
user9876,
If you and your recent classmates are so grounded in science-based procedures, why are you not in the lead in fighting those “Old school” chiropractors that are diagnosing and treating subluxations? Why are you not fighting back against those the push all forms of quackery on the public? Why are you not working to get state licensing statutes (like that for Florida I quoted earlier in this thread) changed to reflect that your practice is not based on diagnosing and treating subluxations?
To me, it would be in your best interest to fight against these practices that make your profession look bad.
Please explain to me how I can search for chiropractors for almost any city in the US and find the top search hits include chiropractors that talk about subluxation, or mention treating infant cholic, or the value of maintenance adjustments on children and adults.
If you are among those that are trying to change the system, Great. This place could be a great resource for you. However, if you wish to defend the entire system, then you are going to have to expect people to wonder about your committment to science-based treatments.
Diane,
Oh my goodness! Another person I wasted a paragraph on. The level of hostility the PTs on this site bring to someone, based on nothing more than their profession, is ASTOUNDING! Were your families murdered by chiropractors or something???? How you could possibly turn my last post towards to you into what you did is remarkable. Well done. You’re a natural born antagonist.
Harriet,
It appears you’re about the only one on here without some sort of personal vendetta. I find those studies disheartening, but what I’m saying is that the focus should be on demanding better training for my colleagues rather than attempting to obliterate or end the profession that patients clearly appreciate (As it was surveyed by the public to be the most satisfying treatment for back pain – http://www.consumerreports.org/health/medical-conditions-treatments/back-pain/overview/back-pain.htm).
When I took Part IV of national boards, one of the patient actors actually did demonstrate symptoms of a heart attack we had to identify. Perhaps the NBCE heard about that study and is working to improve medical emergency protocol training.
Bug Guy,
You’re right. That is what I try to do. However, it’s difficult enough to get legislature in place, let alone, to change it. The written scope of practice in many states is still so ancient (talking about nerve energy and whatnot) that it is embarrassing, but it’s very difficult to get this stuff changed without complete support.
A lot of these older docs don’t want to change how they talk to patients. The BOOP model is incorrect, but it’s easy for patients to understand. It’s tough for a doc that’s been using that explanation and seen thousands of patients getting out of pain, for the past 30 years, to explain it differently. The changes will come as the older docs retire and the new generation is all that is left. Already, there is a paradigm shift in place.
I do continue to try to educate those docs, but with that said, I still think that the profession(as a whole) does MUCH more good than harm. It wouldn’t be right for me to just bash them completely. I know that some are absolute criminals and I have to trust that they will eventually be exposed and stop giving the rest of us a bad name.
@user9876 What “paradigm shift?” Below is the Association of Chiro Colleges “paradigm” for 2009:
“Chiropractic is Concerned with the preservation and restoration of health, and focuses particular attention on the subluxation.”
http://www.chirocolleges.org/paradigm_scope_practice.html
That’s right out of DD Palmer. You’ll never get rid of it because, despite your claim that only 10% of your classmates talk about subluxations, 90% of chiros believe in it by some name.
So, your school gave you two years of PT training, did they offer dentistry and rocket-science too? Do you know how many years a PT studies in a real school these days?
@user9876 on 01 Jan 2010 at 2:35 pm “… The BOOP model is incorrect, but it’s easy for patients to understand.”
Okay, what is the correct model?
“A subluxation is 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.”
http://www.chirocolleges.org/paradigm_scope_practice.html
What does that mean? “Anything we can bill for”?
“As it was surveyed by the public to be the most satisfying treatment for back pain”
Not an acceptable argument.
User9878 ” Telling me how little I know and what I believe without ever meeting me is as dangerous as prejudging a man based on the color of his skin. You disgust me.”
But you do come across as having the prevalent chiropractic delusion that primary patient care is easy.
Talk to any doctor, and they will tell you that they learnt far more about practical medicine (and their own limitations) during the first two or three years after finishing med school than in med school itself, during mandatory supervised experience under intense patient load within hospitals and group practices. No chiropractor has this kind of hands-on training or, for that matter, a patient load that will maintain clinical skills.
Yet even doctors with these advantages make basic diagnostic and management errors, not all of which get picked up before the patient comes to harm. Medicine is very complex, common illnesses can present in very atypical ways, and what looks easy on paper can be anything but in the real world.
So I ask you why we would feel comfortable with LESS well-trained personnel taking over a primary care role?.
Of course, a great deal of primary medical care IS easy. Most everyday medical complaints are either placebo responsive or get better on their own. Chiropractic practice is likely to be heavily slanted towards these kind of conditions through the self-selection of patients.
This helps create the general illusion among chiropractors that what doctors do, and *also have to take take full responsibility for*, is a piece of cake.
My favorite part is when they say, “YOU FEEL BETTER NOW.” Isn’t that great after 5-7 minutes? Somebody’s making big bucks! Oh, this has been discussed earlier. I was taking my 5 yr old to get vaccines from our MEDICAL doctor. The chiro stopped, looked at me in mortal dread. He then gave me loads of info about extreme dangers of vaccines to my children. Guess what! My daughter GOT THOSE VACCINES from her medical doctor anyway. AND we get the flu shot EVERY year!
A few chiropractors have weighed in here now, and at least three have flamed out, exiting the discussion with parting insults and ad hominems, often equating criticism with insult. Only chiro1, I think, was consistently polite despite being badly out-numbered and (in my opinion) out-gunned. The others, especially “DrFrankmeister,” “face”, “tahoe69″, and “user9876″, have generally dragged the level of discourse down.
DrFrankmeister repeatedly used the defense that people who disagree with him aren’t sincerely interested in science, while citing such weak and irrelevant science himself that it became difficult to believe we were having the same conversation.
Face called one of his critics a “moron” early on, and generally did his bit to portray criticism as attack: “let the bashing begin,” and telling Joe, “You must have been burned bad by a chiro to have such a chip on your shoulder….”
Tahoe69 stuck it for a long time but became increasingly defensive and finally took his marbles somewhere else with the parting shot “I don’t bad mouth other practitioners,” presumably implying that he’s been bad-mouthed here — when, on the contrary, I thought the SBM regulars made a real effort to recruit him as a potentially critical-thinking chiro.
And user9876 thinks that “the level of hostility” at SBM.org “is ASTOUNDING! Were your families murdered by chiropractors or something??” That was a hyperbolic exaggeration of (particularly) Diane’s mild annoyance.
Criticism is not bashing, bad mouthing or hostility. If the chiropractors who joined this conversation expected anything less than strong criticism from well-armed opponents, they were being naive. To dismiss that criticism as mean-spirited simply confirms for all observers that their own arguments are lacking in substance.
Views and opinions of a “science-based chiropractor”:
I spent 43 years in private practice as a chiropractor. If I had it to do over again, 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 now offers better opportunity for those interested in science-based manual therapy.
After my second year in chiropractic college, I came to the conclusion that the chiropractic subluxation theory was not a credible construct. From perusal of orthopedic and physical medicine texts, however, I felt that spinal manipulation in combination with physical therapy modalities had something special and unique to offer in the treatment of back pain, a service that was not readily available in physiotherapy or in any other sub-specialty of medicine—a service that I could offer.
In an effort to separate the good from the bad in the use of manipulation by chiropractors, I published my book Bonesetting, Chiropractic, and Cultism in1963, renouncing the implausible chiropractic vertebral subluxation theory and suggesting that chiropractors should limit their use of spinal manipulation to treatment of back pain. Over the years, I wrote many articles critical of chiropractic, always suggesting that the definition of chiropractic be changed in chiropractic colleges and state laws so that the next generation of chiropractors would be properly limited. Science-based chiropractors could be separated from their subluxation-based counterparts under a new degree, such as a “Doctor of Chiropractic Therapy” (DCT) or a “Chiropractic Manual Therapist” (CMT). I suggested that it would not be necessary for chiropractors to practice as “doctors”—they could practice as therapists offering non-surgical, drug-free treatment for back pain and related musculoskeletal problems, a new specialty combining use of manipulation with physical therapy modalities. Needless to say, this change never occurred and I was labeled a “chiropractic heretic” by my colleagues.
Today, the educational requirements for obtaining a degree in chiropractic have been raised. But the basic definition of chiropractic has not changed. As currently defined by the Association of Chiropractic Colleges, “Chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on the subluxation.” Although most chiropractic college applicants now have undergraduate degrees, the majority of chiropractors still adhere to some version of the subluxation theory (How Chiropractors Think and Practice, 2003). Few chiropractic college graduates may able or willing to abandon a belief system they must depend upon for an income.
That said, I still think that spinal manipulation is not yet as readily available in medical practice as it should be, leaving an opening for the services of a good, science-based chiropractor who combines manipulation with physical therapy modalities. But it would be necessary for such a chiropractor to openly renounce the chiropractic vertebral subluxation theory (more of a belief than a theory) and publicly state that his or her practice is limited to care of musculoskeletal problems. Unfortunately, as indicated by the Association of Chiropractic Colleges Paradigm, such chiropractors may be in the minority, even among recent graduates.
Physical therapy is now beginning to include use of high-velocity, low-amplitude spinal manipulation in its treatment armamentarium, but such treatment is not yet commonly used by physical therapists. For this reason, orthopedists and neurologists who are familiar with manual medicine are often willing to refer back-pain patients to a good chiropractor for manipulation as well as to steer patients away from subluxation-based chiropractors. Physicians can often locate good chiropractors by reading their office notes and by talking with their patients.
Most cases of back pain are self limiting, and spinal manipulation is not often more effective than other physical treatment modalities in affecting the final outcome. But in many cases, appropriate spinal manipulation provides more immediate symptomatic relief than other forms of therapy. And in special cases, thrust-type manipulation may be the best way to restore mobility in spines stiffened by post-traumatic adhesions. Use of manipulation combined with instruction, physical therapy, and rehabilitation may be the best way to relieve back pain and keep the patient mobile until recovery is complete—provided, of course, that treatment is based on a correct diagnosis. A science-based chiropractor who works in concert with a patient’s physician, can often provide such a treatment regimen—as opposed to solo subluxation-based chiropractors whose primary concerns are locating and correcting vertebral subluxations.
Since the subluxation theory continues to form the foundation of chiropractic, it seems unlikely that the chiropractic profession will ever abandon the belief that adjusting spinal joints will restore and maintain health. Many chiropractors who say that they reject D.D. Palmer’s subluxation theory simply come up with new terminology that identifies some kind of vertebral joint “dysfunction” that allegedly affects the nervous system, thus interfering with the body’s ability to heal itself. Failure of chiropractic colleges to reject such vitalistic nonsense and make the changes needed to develop chiropractic into a musculoskeletal back-pain specialty (with commensurate changes in state laws) may simply allow chiropractic to continue as an alternative healing method, such as homeopathy or acupuncture, permitting its practitioners to treat the gamut of human ailments as “primary care providers.” It may then be necessary to depend upon physical therapists for appropriate use of manipulation based on credible research. Chiropractors who can no longer tolerate the stigma associated with chiropractic can retrain as physical therapists, making good use of their training in the use of manipulation. Forty-three states now grant physical therapists direct access to patients; that is, referral from a physician is not needed.
Although I am a critic of chiropractic, I would not hesitate to offer support to a good science-based chiropractor who has separated himself or herself from the herd by expressing views that oppose the implausible treatment methods that are so prevalent among chiropractors. When I was in practice as a chiropractor, I felt an obligation to speak out so that friends, patients, and health-care professionals would not assume that my approach represented chiropractic in general. I worried that a patient who was pleased with my services might assume that treatment by any other chiropractor would be the same. Unfortunately, chiropractic treatment based on the dubious vertebral subluxation theory may be so inconsistent and so dubious that treatment for any condition may range from an atlas adjustment to a sacral adjustment, all purported to be effective in improving health by removing “nerve interference.” So far, apparently reluctant to bite the hand that feeds them, chiropractic associations have failed to publicly renounce the vertebral subluxation theory or to condemn the multitude of dubious treatment methods based on subluxation theory. Science-based chiropractors continue to struggle…
Today, chiropractic treatment is like Forrest Gump’s box of chocolates: “You never know what you’re gonna get.”
____________________
In response to critics who often accuse me of being a hypocrite, bashing chiropractic only after ending my career as a chiropractor, I have provided links to published articles to show that I have always been a critic of the chiropractic vertebral subluxation theory. My use of manipulation as a chiropractor, from the day I graduated from Lincoln Chiropractic College in 1956 to the day I retired in 1998, was limited to treatment of back pain and related musculoskeletal problems.
Bonesetting, Chiropractic, and Cultism. Critique Books, 1963. Full text available online at:
http://www.chirobase.org/05RB/BCC/00c.html
Finding a good chiropractor. Archives of Family Medicine. 1998;7:20-23.
http://archfami.ama-assn.org/cgi/content/full/7/1/20
What a rational chiropractor can do for you. Inside Chiropractic, Prometheus Books, 1999.
Chapter 13. http://www.chirobase.org/07Strategy/goodchiro.html
How chiropractic subluxation theory threatens public health? Scientific Review of Alternative Medicine. Winter 2001. http://www.chirobase.org/01General/risk.html
Chiropractic: History and overview of theories and methods. Clinical Orthopaedics and Related Research. 443:236-242, March 2006.
http://journals.lww.com/corr/Abstract/2006/03000/Chiropractic_History_and_Overview_of_Theories_and.35aspx
Can chiropractors and evidence-based manual therapists work together? The Journal of Manual and Manipulative Therapy. Vol. 14, No. 2, 2006. http://jmmtonline.com/documents/HomolaV14N2E.pdf
@pmoran on 01 Jan 2010 at 4:19 pm “… Talk to any doctor, and they will tell you that they learnt far more about practical medicine (and their own limitations) during the first two or three years after finishing med school than in med school itself, during mandatory supervised experience under intense patient load within hospitals and group practices. No chiropractor has this kind of hands-on training or, for that matter, a patient load that will maintain clinical skills. ”
You may be amused by this, written by a chiro about his “training” and first experiences:
“Sometimes a patient asks me, “Who did you practice on when you were learning to adjust?” … [W]e practiced on each other and have the scars to prove it.
“As a greenhorn DC, I clearly recollect the first patient who told me, straight out, that he needed a “good cracking.” … Since I was just out of school and without any meaningful experience, this seemed perfectly reasonable.”
http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=53681
Hi folks,
Thank you for the discussion thus far. It has raised some good points. I am a DC much along the lines that chiro1 (many thanks for your groundwork) has already laid out. I am also involved in academia at a chiropractic teaching institution completing my residence training. Yep, there are a few opportunities for chiros out there, they are just few and far between, but at our school, the opportunities are increasing.
There are growing numbers within chiropractic that are concerned with the same concerns this post has illuminated. These same folks are fighting for reform. We aren’t “true believers” in the S-word and treat it for what it is, history. We are definitely fighting an uphill battle.
I am not opposed to dropping the name chiropractor altogether if it would show separation. I have advocated a split of the profession based on those who would like to adhere to historical notions and those who would like to follow the evidence.
Thanks for the honest commentary and for giving chiros like myself and chiro1 the benefit of the doubt.
_boon
Wow, I have seen alot of funny commentary, mostly from people who read more than they do. While there are studies that show chiropractic to be ineffective, there are many studies to show chiropractic as highly effective.
There are actually a multitude of studies going on currently that will either make or break chiropractic. And as the research is going now, yes this is the death of the old Chiropractic, because the new research is showing that Chiropractic is not only beneficial in musculoskeletal problems but visceral problems as well.
Just look at the Chicago Hypertension Study, chiro manipulation out performed the leading 2 meds not only in temporary reduction but at the followup 8 week.
Its so funny how people talk about the division in chiropractic, when if you look around allopathic medicine you will not only find division but also more diverse.
Why you ask because MODERN MEDICINE IS FAILING.
We have more chronic illness and death than ever before. Several chronic illness studies show that 75% of all deaths in Western nations are diseases of civilization (lifestyle) which is rarely addressed in allopathic medicine and addressed daily in most chiropractic practices.
As modern medicine continues to fail natural approaches to care continue to rise. Want proof of that just look at my practice 40% of my patients are in the healthcare field. 10% are MD’s and their children!
Wow I can’t believe I wasted this much time reading this dribble and responding to it. To each his own. Knowledge is power, not information.
Why don’t you point us to those studies that show chiropractic to be effective that are as large, numerous, and high-quality as those that show it is not? When it’s the small, poorly designed studies that show an effect and the large, well-designed studies do not, the only rational response is to trust the latter.
I can’t see how you can claim that with a straight face, given that the already overwhelming mountain of evidence against is ignored. More studies will just provide more for quacks to ignore.
Cite. I suspect it’s already been comprehensively demolished.
By this same logic, we should be promoting the use of headstands as health care. See, you haven’t actually shown that chiropractic is any better!
True, because of the success of scientific medicine in reducing the toll of all the things that used to kill people before they had to worry about chronic illness. Not to mention various conditions that used to be a death sentence (type 1 diabetes, for instance) which have been reduced to chronic illnesses by, again, scientific medicine.
This is a straight-up lie. Mainstream medicine has stressed healthy lifestyle factors (proper diet, exercise, smoking cessation, etc.) for many decades. You do your cause no good by lying so blatantly.
As a chiropractic student, I have given and received many adjustments–gentle manipulative procedures. My instructors have done the same; some have done so for more than fifty years. The history of the manipulative professions shows a progression of thought worth considering. The progression I am referring to was made possible by the simple discovery that some people with muscle and joint complaints may be helped by physical manipulation. It is a simple observation that many can relate to.
Have you ever felt a sore muscle or an uncomfortable tightness of a joint following an injury or a period of inactivity? If you have, you are among the majority; this is not surprising. Have you ever considered the possibility that your problem may have been caused by your own behavior? If you have, you are probably among the minority. The problem with the mentality of the majority of people in this country is the lack of mindfulness applied during the execution of physical behaviors.
Those studying environmental psychology or ergonomics are quite aware of this issue; they work to improve the relationship between humans and their environment. Chiropractors and others in the manipulative professions seek to instruct people to become more mindful about their physical behavior. The goal is to break degenerative cycles of behavior and replace them with ones that support health.
Institutions such as my own emphasize patient education as the primary goal of our profession, emphasize science as the primary method of gaining knowledge for practice, and emphasize the concept of “primum non nocere”, or, “first, do no harm” as our guiding principle. The chiropractic profession has struggled to survive for many years, but has continued to progress successfully because of the efforts of those who proceed with integrity–with the patient’s best interests in mind at all times.
The profession has reached a position of prominence during recent years because of the congruence of the public’s desire for effective care of certain complaints and the ability of chiropractor’s to facilitate the alleviation of those complaints. This profession will never die if those among us continue to rise above the negative rhetoric, to seek answers through science, and to put our patients first. As the profession gains more attention and funding, significant studies will be done to put the question of the efficacy of our manipulative practices to rest. At this time, the best among us continue to confidently provide the effective care and patient education that we know changes lives for the better.
For those interested, the UK General Chiropractic Council recently commissioned an ‘independent’ review of the effectiveness of chiropractic. It has finally been published and you can read about it here:
http://www.zenosblog.com/2010/02/the-gccs-plethora/
I’ve printed out this blog, the original PDF and also the Lancet Wakefield retraction to take to my chiropractor this afternoon. I imagine it will be an interesting visit.
@Blue Wode on 25 Feb 2010 at 11:34 am
Updating BW’s post, see it for the link. First, as BW knows, the review was undertaken after the debacle of the British Chiro Assn’s (BCA) “evidence supporting chiro” was shown to be a joke http://www.sciencebasedmedicine.org/?p=555
Second, the review (aka Bronfort) is not about chiro, it is about “manipulation.” The chiros want to claim all types of manipulation by all sorts of therapists (e.g., PTs) and pseudotherapists (e.g., exto-USA osteos) as endorsing chiro. That is ironic since chiro claim their work is unique and that they are more experienced and, therefore, better.
So, looking at the tabular summary at the end of Bronfort, it is easy to see that 32% of the recommendations are based on non-chiropractic treatments. Moreover, claims simply labeled “Manipulation/mobilization” are not attributed to chiro (PT is common), as well.
Then, one must wonder whether Bronfort was more discriminating than the BCA. After a limited review, the answer is “Not much.” They found two RCTs each for treatment of enuresis and carpal tunnel syndrome. In the former, both studies concluded that there was no difference between chiro and non- or sham-treatment; yet they called that “favorable.” Likewise, treatments for the latter were termed “favorable” despite both studies concluding the treatments were useless.
Chiro has yet to produce data that support it (beyond, possibly, low back pain).
Joe on 03 Mar 2010 at 12:48 pm “Moreover, claims simply labeled “Manipulation/mobilization” are not attributed to chiro (PT is common), as well.”
Should be “Moreover, many claims simply labeled “Manipulation/mobilization” are not attributed to chiro (PT is common), as well. “