Articles

The War Against Chiropractors

In 2011, chiropractor J.C. Smith published The Medical War Against Chiropractors: The Untold Story from Persecution to Vindication. He promises an exposé comparable to Harriet Beecher Stowe’s exposé of slavery in Uncle Tom’s Cabin. His thesis is that the AMA waged a shameless attack on competition, motivated only by money. I think the reality is closer to what he quoted from Dr. Thomas Ballantine, Harvard Medical School:

The confrontation between medicine and chiropractic is not a struggle between two professions. Rather it is more in the nature of an effort by an informed group of individuals to protect the public from fraudulent health claims and practices.

The book is self-published, long-winded, repetitive, and flawed. It is a vicious screed crammed with bias, half-truths, insulting language, and innumerable references to Nazis and racial prejudice. In my opinion, Smith not only fails to make his case but degrades chiropractic.

Practicing Medicine without a License

Before chiropractic licensure was approved, many chiropractors were jailed for practicing medicine without a license.  Smith thinks this was a bogus charge because they never used drugs or surgery. (He’s wrong: practicing medicine is not defined as using drugs or surgery, but as diagnosing and treating any human disease, pain, injury, deformity, or physical condition. They were clearly breaking the law.) Chiropractors were forced to hide like Anne Frank or like slaves on the Underground Railroad. The Juice Man squeezed them for protection money; if they couldn’t pay, his thugs beat them up.

The AMA

The AMA did some very regrettable things. They used inappropriate language, referring to chiropractors as rabid dogs. They attacked chiropractors as killers without any supporting evidence. Their intent was to destroy chiropractic. They tried to conceal what they were doing. Their biggest mistake was to prohibit MDs from associating with chiropractors.

The Code of Ethics stated:

A physician should practice a method of healing founded on scientific bases; and he should not voluntarily associate professionally with anyone who violates this principle.

According to Smith, this expanded to prohibit a physician from belonging to any club, church, or organization if a chiropractor was also a member. If this is true, it is inexcusable. He relates a story from a chiropractor whose mother came home from a bowling league game crying because an MD on the opposing team had made a big stink that he wouldn’t bowl against her husband just because he was a chiropractor.

The AMA distributed “Quack Packs” and 10,000 copies of an anti-chiropractic book, Ralph Lee Smith’s At Your Own Risk: The Case Against Chiropractic. The complete text of that book is available online.

It had made an enemy of Scientology when it accused it of practicing psychiatry without a license. Smith says L. Ron Hubbard turned Dianetics into a religion just to escape AMA persecution, but it’s my understanding that he deliberately set out to invent a religion. At any rate, Scientology was so mad at the AMA that it decided to help chiropractic retaliate against At Your Own Risk. Scientologists pilfered secret documents about chiropractic from AMA headquarters and published them in the book In the Public Interest. The book not only had ties to the Church of Scientology, but had a cover illustration that superimposed the AMA caduceus on a swastika.

The Wilk Case

In 1976 an antitrust lawsuit was filed by Chester A. Wilk and 4 other chiropractors (one of whom later dropped out) against not only the AMA but also against 9 other medical organizations such as the American College of Radiology, and against 4 individuals. This began an odyssey lasting 14 years, with two separate federal trials, a series of appeals, complicated legal wrangling, and conflicting evidence. Some of the defendants settled out of court; 6 organizations and one individual went to trial. The AMA won, but the judge was accused of improperly instructing the jury and allowing inaccurate documents into evidence, so there was a second trial. In 1987, Judge Susan Getzendanner dismissed the charges against some of the defendants but found the AMA guilty of violating Section 1 (but not Section 2) of the Sherman Antitrust Act. No damages were awarded. The AMA was only required to pay the plaintiffs’ legal costs and to change its policy and inform MDs that they could associate with chiropractors. Chiropractors crowed about their victory, but it actually did little to change “discriminatory” practices or to enhance the reputation of chiropractic.

The decision was not by any stretch of the imagination an endorsement of chiropractic. The judge said:

The study of how the five original named plaintiffs diagnosed and actually treated patients with common symptoms was particularly impressive. This study demonstrated that the plaintiffs do not use common methods in treating common symptoms and that the treatment of patients appears to be undertaken on an ad hoc rather than on a scientific basis…  I am persuaded that the dominant factor was patient care and the AMA’s subjective belief that chiropractic was not in the best interests of patients… [but] this concern for scientific method in patient care could have been adequately satisfied in a manner less restrictive of competition.

Saved By George

He eulogizes chiropractor Jerry McAndrews and his brother George, the lead attorney in the Wilk v. AMA antitrust trial. The McAndrews family was heavily invested in chiropractic ever since their father’s asthma was relieved by a chiropractic adjustment where his heels allegedly touched the back of his head. (Really? What kind of adjustment does that?) They blamed his early death on persecution by the AMA. George “saved chiropractic.” Had it not been for him, the AMA would have destroyed chiropractic just as it destroyed homeopathy, naturopathy and other alternative health care professions. (Wait — aren’t those still around? And if chiropractic was saved, why is he still complaining?) Jerry reminisced to Smith, recalling that during the Wilk trial George’s office was burglarized and their phones were tapped, forcing them to speak in the cornfields behind Jerry’s home. (Really? Did they have any actual proof of wiretapping? Did they report it at the time? Did the corn have ears?)

How Powerful is the AMA?

The 1910 Flexner report attempted to reform medical education by recommending that American medical schools adopt higher standards and adhere to science. Smith thinks that the Flexner Report made the AMA an invisible branch of the government and an accrediting agency. It didn’t. He thinks the AMA controls the entire healthcare system, but today less than 30% of American physicians belong to it.   It is a professional association that promotes the art and science of medicine, lobbies on issues that affect its members, and publishes several highly respected medical journals. The AMA never had any power to accredit or regulate physicians or punish them; the most it could do was deny membership.

Smith really hates Morris Fishbein, AMA spokesperson and quackbuster who fought quack MDs like John Brinkley, the goat gland doctor.  He refers to Fishbein as a demagogue, dictator, Mussolini, and racketeer; he compares his persecution of chiropractors to Hitler’s persecution of the Jews.  He thinks Fishbein took dictatorial control of state licensing agencies. (Total nonsense!)

To put Fishbein’s anti-chiropractic campaign into perspective, it began in the 1930s, two decades after the Flexner Report. The value of science was widely accepted but evidence-based medicine was in its infancy.  Until 1974, chiropractors were still not licensed in Louisiana, where they were still guilty of practicing medicine without a license. Fishbein encountered rampant quackery in product and drug sales, among conventional medical doctors and among people practicing medicine without a license. He fought against it wherever he found it, and he found reason to put chiropractic high on his list.

Smith is irate because under Fishbein the AMA accepted advertising from tobacco companies, even touting the supposed health benefits of cigarettes. But they didn’t know any better. As soon as they did know better, in the 1950s, when evidence of harm mounted, they stopped accepting tobacco ads, well before the first Surgeon General’s Report was published.

How powerful could the AMA be when it was not able to prevent the licensing of chiropractors in all 50 states or block coverage of chiropractic by Medicare?

The Evidence for Chiropractic

Smith contradicts himself. He re-defines what chiropractic claims to treat, saying that no displacement can be seen on x-ray but that there is a problem with function. Then he continues to speak of subluxations and of misalignments that require correction. Then he says obvious misalignments like scoliosis may not be problematic. He speaks of proper flow of nerve energy, saying spinal dysfunctions disrupt this flow to cause heart attacks and visceral disorders like dysmenorrhea, asthma, enuresis, and infantile colic. He even believes that spine dysfunctions can cause brain damage and premature aging. He believes that manipulation is effective in all these disorders. Worst of all, he believes there is credible scientific evidence to support these beliefs. (Maybe there is some “evidence,” but it isn’t credible.) He claims that chiropractic has outgrown its origins and become more science-based, but in reality he sounds very much like D.D. Palmer.

He relies on old, discredited evidence like the 1979 New Zealand Chiropractic Report. Its three-person panel consisted of a barrister, a chemistry professor, and a retired headmistress of a girls’ school. It relied heavily on testimonials, failed to appreciate the scientific process, and demonstrated bias.   He thinks it vindicates chiropractic, but its recommendations were actually devastating to chiropractic: chiropractors should be strictly monitored, should not present themselves as doctors, should not encourage patients to consult a chiropractor in preference to a medical doctor for any condition, and should not mislead the public into believing that chiropractic is an alternative to medicine.

He ignores more definitive, up-to-date evidence that spinal manipulation therapy (SMT) is effective but not superior to other treatments for low back pain and is ineffective for non-musculoskeletal conditions. Even the NCCAM damns it with faint praise:

[Spinal manipulation] can provide mild-to-moderate relief from low-back pain. Spinal manipulation also appears to work as well as conventional treatments such as applying heat, using a firm mattress, and taking pain-relieving medications.

He quotes Gary Null, Natural News, and Dana Ullman (all infamous on this blog.) He devotes several pages to attacking Ann Landers for being in cahoots with the AMA and getting her information from them. (Isn’t it reasonable for a non-medical columnist to consult medical experts to ensure accuracy?)

His defense of chiropractic is based on questionable evidence plus fallacious arguments from popularity, patient satisfaction, and cost-effectiveness. Also the argument from antiquity: Hippocrates and Imhotep wrote about it. (No, they didn’t write about chiropractic; they wrote about manipulation.)

He doesn’t understand what science means. He calls chiropractic “an unorthodox science.” He says the first chiropractor was not unscientific. I explained in a previous post why chiropractic is not scientific.

Strokes

He presents the Cassidy study as if it were definitive proof that chiropractic neck manipulation doesn’t cause strokes. He fails to report or respond to the criticisms of that study.

He downplays the risks of chiropractic, resorts to tu quoque arguments about the risks of medical care, and cites the low cost of chiropractic malpractice insurance. He compares rate of neck manipulation stroke to rate of death from surgery (apples and oranges — but they are both fruits, so maybe I should say cabbages and carburetors!). He calls neck manipulation safe but doesn’t consider the risk/benefit ratio (if there is no benefit, any risk is unacceptable).

Back Surgery

He devotes a great deal of space to criticizing doctors for doing back surgery, especially spinal fusions. He doesn’t need to: the medical establishment itself has already criticized back surgery. It has recommended reforms: elimination of unnecessary and ineffective operations and sticking rigorously to indications that are evidence-based. Smith says the disc theory is dead. It isn’t. He’s right that too many back surgeries have been done for disc disease, but ruptured discs can cause permanent nerve damage and disability, and surgery can improve outcomes when done only for proper indications. He quotes a doctor who called for a moratorium on back surgery when he found that after 2 weeks of rehabilitation his patients no longer required surgery. Rehabilitation, not manipulation. Smith doesn’t seem to realize this is as much an argument against chiropractic as against surgery. He doesn’t admit that back surgery is ever indicated and he blames its use on the machinations of a medical industrial complex motivated only by profits. One wonders how much he really understands: at one point he even refers to the disc as cartilage. He seems to think proving that back surgeries are unnecessary equates to proving that chiropractic is effective; it doesn’t. He calls for doctors to reform back surgery but doesn’t call for reforming chiropractic to adhere to similar evidence-based standards.

In 1994 a report by the Agency for Health Care Policy and Research (AHCPR) concluded that SMT was one of only 3 treatments for acute low back pain that were supported by evidence (the others were over-the-counter nonsteroidal drugs (NSAIDs) and heat/cold applications). The report didn’t recognize chiropractic or even mention chiropractors.

Because of the report’s endorsement of spinal manipulation and its criticism of spinal surgeries, the North American Spine Society and the manufacturers of spinal fusion hardware sought an injunction to prevent its release. When that failed, NASS took the fight to Congress, where the agency’s budget was cut and it was stripped of its ability to make treatment recommendations. Smith blames the AMA for this, although he does not show that they were involved.

FSU

He devotes 21 pages to the failed attempt to establish a school of chiropractic at Florida State University (FSU), an effort that was ridiculed in the famous campus map parody showing other pseudoscientific departments like the Bigfoot Institute. The state legislature had appropriated $9 million annually to support such a school, with 151 votes for and only 1 against. So Smith claims FSU went against the will of the people. Ironically, nearby Life Chiropractic College opposed the bill because of fear it would lose students to a cheaper and more scientific program. Several FSU faculty members threatened to resign, and eventually the school’s Board of Governors squashed the proposal, voting it down by a wide margin. 3 chiropractors at the Board meeting spoke out against a school.

According to Smith, a noble cause was killed by medical demagogues and political subterfuge. He argued that it would have allowed chiropractors to explore the clinical scope of chiropractic and conduct research in an academic setting.

He thought that MDs were only attacking chiropractic because it was based on a vitalistic philosophy, which doctors and scientists oppose because they are mostly atheists. He characterized the fight as a “religious war to keep the heretics out of the medical den of iniquity.” He also characterized it as an attack on academic freedom and compared it to the bigotry in America before Civil Rights, when desegregation led to resentment and deadly attacks.

Raymond Bellamy, MD, orthopedic surgeon and professor at FSU (and husband of our own Jann Bellamy), became the lightning rod leading what Smith calls an academic revolt. He characterizes Bellamy’s effort as “not a studious argument as much as it digressed into a tirade of propaganda and slanderous accusations.” He rants about Bellamy for several pages, accuses him of conflict of interest, and says “instead of demeaning black Americans as unworthy of a college education alongside white students, Bellamy and his mob debased chiropractors as unworthy of a university presence alongside them.” He likens it to Creationists being allowed to ban the study of evolution from the biology program. He compares FSU to a white country club that only invites its white friends.

He considers Bellamy the embodiment of the undercover dictatorship at FSU, says his book-burning mindset will go down in the annals of academia alongside the book-burning policy of Joseph Goebbels, accuses him of suppressing free speech, and even says:

Gov. Wallace demonstrated his racial politics to the world and Dr. Raymond Bellamy felt justified with the same intense prejudice to keep the “nigger-chiropractors” out of FSU.

Such despicable and defamatory accusations are beneath contempt and don’t even deserve a response.

He says

The FSU project would have cleared the air on many issues and either proved chiropractic to be placebo as Bellamy contends or else it would have brought an ageless healing art to the forefront to help millions of people who suffer from both musculoskeletal disorders and those who suffer from spinovisceral reflex nerve disorders that mimic serious visceral disorders.

In other words, chiropractic should be accepted in a university on equal terms with established sciences so we can then test it and find out if it is scientific (!?). Don’t imagine for a minute that chiropractors would alter their practice if the tests found it to be unscientific. No, it would only give chiropractic a foot in the door and lend it a prestige it has not earned.

Whining

He admits that “a small percentage” of chiropractors can be viewed as charlatans, but then he makes excuses. They have been reduced to “desperation” and they are not to blame because they have been “ghettoized.” It is the medical societies who are to blame for any chiropractic malfeasance.

He feels slighted because chiropractors are not featured on national TV as spokespersons on health like Dr. Sanjay Gupta and because there has never been a chiropractor TV hero like Marcus Welby.

He says the AMA’s war has left a lingering stigma harmful to chiropractic, but he himself undermines that argument: he says chiropractic has achieved its place as “the third-largest physician level health profession in the world, only behind medical physicians and dentists.” Does he imagine that if prejudice were eliminated chiropractors would be first or second? Chiropractors are licensed in every state, are practicing in the VA and military hospitals, are funded by Medicare and insurance companies… and yet he still feels unfairly persecuted.

Language

His use of language is inflammatory and offensive. He calls the AMA “the most terrifying trade association on earth.” Edzard Ernst is a “medical spin doctor.” Stephen Barrett is a “renowned medical propagandist” and a “medical misinformer.” The medical profession is guilty of war crimes. Suppression of chiropractic is a social injustice like racism and sexism. Marcus Welby is like Joseph Goebbels. Attacking chiropractic was like making Rosa Parks sit in the back of the bus. Doctors are like storm troopers. He accuses the AMA of bigotry and of attacking free enterprise. He compares it to the KGB, Gestapo and CIA, and even mentions the showers of Auschwitz.

Harriet Hall “Medical Chauvinist”

He devotes 4 whole paragraphs to attacking me, based only on 2 short sentences attributed to me in an article about alternative medicine in the Boston Globe. It reported my concern that “Congress will elevate [alternative] practitioners to the same level as medical doctors.” He said “Her arrogance was clear that there is no room on the medical throne for anyone other than MDs.” He said I showed my “bias” when I said “If it [alternative medicine] were shown to be truly effective, it would be part of regular medicine.” He countered that if conventional medicine were truly effective, we would not be in the present healthcare crisis — something of a non sequitur, no? He said I was “spewing propaganda.” And was a “medical monarchist” who didn’t want to see my “medical Bastille” toppled by equality. (I certainly don’t want to see science toppled by equality with pseudoscience and quackery.)

Consider that my two quoted comments were about alternative medicine and didn’t even mention chiropractic. Also consider that he didn’t bother to find out that I have written extensively about chiropractic (which he could easily have discovered just by Googling my name) and he has not tried to answer any of my arguments against chiropractic.

What He Doesn’t Say

Nowhere does he mention chiropractors like Sam Homola, a regular guest author here, who have criticized chiropractic from within. Nowhere does he mention that half of chiropractors are still undermining public health by discouraging immunizations. Nowhere does he acknowledge or respond to the arguments against chiropractic, for instance the wealth of material on Quackwatch’s Chirobase, Homola’s numerous books and articles, and magazine and blog articles by me, Steven Novella, David Gorski, and many others. Nowhere does he acknowledge the critiques of the Cassidy stroke study and the other studies he cites.

What Might Have Been

Throughout, he confuses chiropractic with spinal manipulation. They are not the same thing. SMT is a specific treatment also used by other practitioners including MDs, DOs, and PTs for specific indications; chiropractic is a whole system of care built around manipulation. Chiropractors do perform the majority of manipulations; but they do them for indications that the other professions do not accept, and many of them do a lot of other silly things that can only be described as quackery.

The Flexner report resulted in accreditation standards that closed half of American medical schools. Most schools of competing medical systems like homeopathy, naturopathy, and eclectic medicine closed. Many osteopathic schools stayed in business by bringing their schools into compliance with Flexner’s recommendations. Chiropractic might have done the same, but it didn’t.

The AMA fought optometrists the same way they fought chiropractors. Optometrists were in competition with ophthalmologists for the eye market, and the AMA tried to prohibit MDs from associating with them, but they lifted the prohibition when faced with an anti-trust lawsuit similar to Wilks.  Optometrists agreed to play a limited role within mainstream medicine; they are licensed to do only certain of the many things ophthalmologists do. Chiropractic might have done the same, but it didn’t.

What if chiropractic had policed its own ranks, limited itself to providing only short-term treatment for certain types of musculoskeletal pain, worked hard to determine which manipulation techniques were most effective, abandoned techniques that it found ineffective, and denounced vaccine rejection, applied kinesiology, and other forms of quackery? Manipulation might have been more widely accepted as a therapeutic tool if it had not been so tainted by the company it kept. Chiropractors could have become “physical therapists for the back,” experts in manipulation that MDs could refer patients to with confidence.  Chiropractic might have been integrated into the medical mainstream just like osteopathy and optometry, but it didn’t even try.

Not Recommended

The AMA did some bad things in pursuit of a good end (fighting quackery), but Smith’s book does bad things in pursuit of a bad end (promoting unscientific health care).

I didn’t buy the book. I requested it from my public library through Interlibrary Loan. They had to search far afield for a copy, and they eventually located one in a library 2370 miles away, the Texas Chiropractic College Library. From the date due sticker, it appears to have never been checked out. I can only suspect the book is not very popular or widely read, even by chiropractors. I don’t regret reading it, because I learned a few things about history and about the thinking processes of chiropractors; but it left a very bad taste in my mouth and I certainly can’t recommend it.

 

 

Posted in: Book & movie reviews, Chiropractic, History

Leave a Comment (85) ↓

85 thoughts on “The War Against Chiropractors

  1. windriven says:

    “So Smith claims FSU went against the will of the people. ”

    Is this the same “will of the people” that wants creation science taught in public schools? That said, why on earth would anyone assume that university curricula should be decided by the “will of the people?”

    * * *

    The AMA may claim only 30% of physicians but remains a potent force in DC. As the best known and, to the best of my knowledge and belief, the largest organization of American physicians, AMA is the default spokesman for the interests of the physician community. Consider, for example, the role of AMA in shaping the Affordable Care Act. AMA works to shape the political battlefield through AMPAC, its political action committee. AMPAC spent about $1.7 million in the 2010 election cycle. For comparison’s sake the NRA spent about $20 million during that cycle.

    * * *

    It is all well and good that AMA is politically active but it must be said that much of that activity is more reactive than proactive. It is one thing to support candidates who reflect physicians’ interests and to help to shape legislation mooted by others, quite another to take a leadership position in defining what a future healthcare delivery and funding system should look like and sketching a path to get there.

    * * *

    The AMA was right, if heavy handed, to bar physicians from associating professionally with quacks. Chiropractic, acupuncture, and the range of magic potions and mystical manipulations is given tacit equivalence to medicine when embraced by mainstream – even leading – medical schools and medical centers. What the hell are you people thinking? Academic freedom is one thing, embracing unscientific nonsense is quite another.

    Those who countenance so called integrative medicine programs in their institutions should be made to write Crislip’s Law 100 times each day on a blackboard:

    Mixing cow pie with apple pie improves neither.

  2. tgobbi says:

    Question for Dr. Hall who states, “In my opinion, Smith not only fails to make his case but degrades chiropractic.” How can chiropractic be further degraded? Seems to me, based on what I see day after day, that it’s already in a deep state of degradation.

    As for the Wilk case, many years ago I met one of the AMA’s lawyers who flat out admitted that the defense team blew the case. It’s too long ago to remember the specifics but he told me, in effect, that they chose the wrong tactics. The ACA, realizing that chiropractic’s pseudoscientific stand hadn’t been vindicated, enjoined its membership not to use the decision to justify chiropractic’s (putative) efficacy to convince their customers they were legitimate healthcare providers. However, not all DCs complied. I saw notices posted on chiropractic office bulletin boards that boasted of the “victory” of the chiropractic philosophy.

  3. TsuDhoNimh says:

    According to Smith, this expanded to prohibit a physician from belonging to any club, church, or organization if a chiropractor was also a member. If this is true, it is inexcusable.

    Not true. For example, the Freemasons have both physicians and chiropractors as members. And I’m sure that the Catholic church has a few of each, as do the Baptists.

  4. Wolfring says:

    For what its worth – and I realize that here it may not be worth much. The term chiropractic means a lot of different things sadly . This is one of the issues that has held us back for decades. But due to the wide variation in perspectives on health and techniques applied, you can’t lump us all in the same group. There are MANY of us who don’t espouse subluxation theory. I don’t agree with many of the things that are stated in the book, but again, there was a lot of truth to what the AMA was attempting to do. This guy does not represent us all, so don’t paint us with same brush. The review as also “crammed with bias, half-truths, insulting language”. And it does many of us who do practice a great disservice by propagating the myth that all chiropractors are quacks and that there is no inherent value in chiropractic as a health profession. Feel free to visit my site. Find one thing that is quackery and let me know. There are many chiropractors out there who do great work as well. http://www.inspirechiropractic.ca

    1. Harriet Hall says:

      @Wolfring,

      “propagating the myth that all chiropractors are quacks and that there is no inherent value in chiropractic as a health profession”

      I didn’t say that. I said “many of them do a lot of other silly things that can only be described as quackery,” and even you don’t deny that. In fact, I said SMT had value and suggested how chiropractors could have gained acceptance as providers of SMT. If you are doing the things I suggested, good for you!

      “Feel free to visit my site. Find one thing that is quackery and let me know. ”

      I can’t approve of everything on your website. For one thing, you advocate Andrew Weil’s breathing exercises, which are not supported by any credible scientific evidence. And you urge patients to try other non-science-based things like acupuncture.

  5. Janet says:

    And yet, just this past week I had to relieve my PT of the notion that chiros are not medical professionals. After a bit of discussion in which I was the one defending PT (she was leaning to equating PT and chiro and thought they were good for “alignment”–to which I asked, “alignment” of WHAT?), she admitted confusion and asked: “Where DO they get their training?” I was astonished and nearly lost my confidence that she was competent at anything, but I calmly explained as much as I could dredge up from here about Palmer, et al. The PT seemed taken aback and will hopefully find the time to visit this site–I wrote it down for her, and gave her Quackwatch as well.

    With seemingly thriving chiropractic “clinics”, “wellness centers” and the like on every corner and in many strip malls, I think JC Smith, D.C. (can’t bring myself to type DR Smith) doth protest too much. On the bright side, few seem to be reading him–even at chiro “college”.

    By the way, how did you hear of this book?

  6. Smith is irate because under Fishbein the AMA accepted advertising from tobacco companies, even touting the supposed health benefits of cigarettes. But they didn’t know any better. As soon as they did know better, in the 1950s, when evidence of harm mounted, they stopped accepting tobacco ads, well before the first Surgeon General’s Report was published.

    Unfortunately, the AMA doesn’t seem to know a lot of things not healthy or in fact harmful for us, with all the ‘science’ and facts present to show otherwise. Things like chemical compounds (most medicine) that are not compatible with our body systems. http://www.bmj.com/content/344/bmj.e3989 And, usually the answer to it is “It’s the dose of the poison”…however, 100,000 people die each year by taking the correct ‘dose of poison’, ..affected Very adversely..to death, and millions more in other ways. That tells me, what the AMA considers ‘medicine’, or ‘science’ is not really reliable imo anyway :)

  7. Harriet Hall says:

    @TsuDhoNimh,

    “Not true.”

    Obviously it’s not true today, and even when the AMA’s prohibition against professional association with chiropractors was in effect, I question whether they ever prohibited social association as in belonging to the same church. I suspect Smith is exaggerating.

  8. Harriet Hall says:

    @Janet,

    “how did you hear of this book?”

    As I remember, I got an e-mail that a PR agency sent out to journalists asking if I wanted to interview J.C. Smith and saying he had written this book.

  9. tgobbi says:

    Dr. Hall asks: “What if chiropractic had policed its own ranks, limited itself to providing only short-term treatment for certain types of musculoskeletal pain, worked hard to determine which manipulation techniques were most effective, abandoned techniques that it found ineffective, and denounced vaccine rejection, applied kinesiology, and other forms of quackery?”

    This question has been answered before, by me and many others – on various forums including this one. The answer is simply that if chiropractic had made these changes it would no longer be chiropractic! I used to believe that there was only one feature of chiropractic that distinguished it from mainstream, science-based medicine: the illusory (and, according to some alarmists, often fatal) subluxation. Now, however, I realize that it’s defined by multiple factors: just about any cockamamie theory that sets it apart from the mainstream! There seems to be an obsession amongst chiropractors, at least the ones I’ve been in contact with, that anything they can do to distance themselves from doctors is a positive step toward giving them – what? Legitimacy? Certainly it keeps them separate despite what we often hear is a nonsensical insistence that some of them (how many – or, rather, how few?) want to work hand-in-hand with genuine healthcare professionals.

    Chiropractic remains a junkheap piled high with a combination of its own pseudoscience and that of naturopathy since “mixers” (roughly 75% of DCs) practice as much of the latter as they do of the former.

  10. CarolM says:

    “I had to relieve my PT of the notion that chiros are not medical professionals. ”

    Yet it sounds like you did quite the opposite.

  11. windriven says:

    @Wolfring

    “There are MANY of us who don’t espouse subluxation theory.”

    If subluxation theory is the, ahem, intellectual underpinning of chiropractic and one doesn’t subscribe to subluxation theory, how does one claim to be a chiropractor?

  12. Scott says:

    @ Wolfring:

    As I see it, even if we accept all of your statements at face value, that really just means “chiropractors are wildly variable from the reasonable to the completely quack.” And since there’s no real way for a layperson to tell the difference, how exactly does that NOT lead inevitably to the conclusion that the chiropractic profession is too suffused with quackery to be credible?

    If you want it to mean anything that some chiropractors try to follow good science and limit their claims and scope of practice accordingly, then that reasonable group MUST shut down the quacks!

  13. Wolfring says:

    @windriven – its called evolving as a profession. Doctors once used to do and prescribe all sorts of things today that we now know to be useless and or dangerous. Chiropractic, as we know it, is in its infancy and as a result, we have to evolve as our knowledge expands. It sometimes seems like critics of chiropractic are more likely to cling to the relationship between chiropractic and subluxation theory than we are.

    @ Harriet – actually there is credible research that shows that acupuncture can be helpful, but it doesn’t appear to be through the mechanism that acupuncture typically suggests. There is some positive effect from interaction between practitioner and client that can help. Is it the breathing aspect you have difficulty with or the fact that I reference Dr Weil – I suspect the latter. Many of the physiotherapists I follow who are at the forefront of their field strongly utilize breath work as a means of facilitating use of the diaphragm which is an essential aspect of motor programming and stability in the spine. If learning to take a few deep breaths from the diaphragm also helps someone feel calmer, I have no problem recommending it. It costs nothing and won’t hurt the patient.

  14. pharmavixen says:

    There is no credible research finding efficacy for acupuncture. Look to earlier articles on this site for info.

  15. Harriet Hall says:

    @Wolfring,

    “Chiropractic, as we know it, is in its infancy”

    If so, it’s the oldest infant in history! :-)

    ” there is credible research that shows that acupuncture can be helpful”

    Have you read the many posts on acupuncture on SBM?

    ” Is it the breathing aspect you have difficulty with or the fact that I reference Dr Weil”

    Not at all. My objection is that there is no credible evidence to back up the claims for its efficacy.

    “facilitating use of the diaphragm which is an essential aspect of motor programming and stability in the spine.”

    That doesn’t even mean anything.

    “helps someone feel calmer”

    If you told the patient you were recommending it to help them feel calmer, I would have no objection. If you tell them you are recommending it to facilitate use of the diaphragm for motor programming and stability in the spine, you are baffling them with bullshit.

  16. tgobbi says:

    Wolfring, in separate comments, makes some statements that I wish to address:

    “The term chiropractic means a lot of different things sadly . ”

    I haven’t had a chance to look at his website yet so I don’t know precisely how he practices and which aspects of chiropractic he espouses and/or eschews. He is indeed correct in the above sentence. I contend that this is one area where chiropractic differs from medicine. There may be some differences of opinion but, on the whole, “medicine” has a very clear meaning. Chiropractic has been defined (don’t ask me where I read it) as “whatever chiropractors do.” The majority of them look for and treat subluxations; oppose vaccinations; practice naturopathy (anything they do that’s not directly related to correcting subluxations falls under this category). All three of these fit the definition of quackery.

    “… its [sic] called evolving as a profession. Doctors once used to do and prescribe all sorts of things today that we now know to be useless and or dangerous. Chiropractic, as we know it, is in its infancy and as a result, we have to evolve as our knowledge expands. It sometimes seems like critics of chiropractic are more likely to cling to the relationship between chiropractic and subluxation theory than we are.”

    Chiropractic has not evolved! Or, if it has, it’s been a retrograde evolution because it hasn’t become more scientific. Mainstream doctors discard things that “we now know to be useless or dangerous.” I ask Wolfring to specify any nonsensical theories or practices chiropractic has discarded. Chiropractic is NOT in its infancy – unless one consider 117 years to fit the category. Scientific medicine is roughly the same age and appears to have made some strides in human (and animal) health. The relationship between chiropractic and subluxation IS chiropractic; no matter that there’s a smattering of practitioners who have rejected it, the chiropractic mainstream is defined by it.

    “… there is credible research that shows that acupuncture can be helpful [no there isn't - tgobbi], but it doesn’t appear to be through the mechanism that acupuncture typically suggests.”

    “There is some positive effect from interaction between practitioner and client that can help.”

    Yes, and it’s called the placebo effect. And it applies to a helluva lot more than to acupuncture. Once again I urge everyone to read Bausell’s “Snake Oil Science.”

  17. nybgrus says:

    Agreed. I can’t refer patients to chiropractors because I have no idea which ones will be legit or super quacky.

    Also, “evolution of a profession” is a cop out. You have the evidence there. No need to reinvent the wheel as if chiropractic were evolving in a vacuum.

    And lastly, as pharmavixen said, there is no credible evidence for any efficacy of acupuncture and plenty against it. Same with the breathing exercises.

  18. Scott says:

    its called evolving as a profession. Doctors once used to do and prescribe all sorts of things today that we now know to be useless and or dangerous. Chiropractic, as we know it, is in its infancy and as a result, we have to evolve as our knowledge expands.

    This sounds an awful lot like “just let us keep doing whatever random junk anybody comes up with, eventually we’ll figure out how to be safe and effective.” Cart. Horse.

    It sometimes seems like critics of chiropractic are more likely to cling to the relationship between chiropractic and subluxation theory than we are.

    When it’s no longer true that

    – Chiropractic is specifically defined (in the very law that makes the profession legal) as detecting and correcting subluxations
    – Subluxation theory is not taught in chiropractic school or tested on the exams
    – The overwhelming majority of chiropractic websites do not explicitly embrace the subluxation (and claim to treat asthma, colic, allergies, etc.)

    you can make that argument.

  19. daijiyobu says:

    There are no chiropractors in Star Trek.

    So, I think we know where the future lies for them.

    ;)

    -r.c.

  20. Robb says:

    Well, if Star Trek is the future, at least we can look forward to beautiful extra-sensory empaths instead then!

  21. @Wolfring

    “Chiropractic, as we know it, is in its infancy”

    As long as it is treated with kid gloves, it will remain so. It’s time to grow up and move out of mom and dad’s basement. The other kids have jobs, spouses, families, and a mortgage.

    Frankly, this infancy claim only has a chance of being valid if medical science is also in its infancy, since nearly any form of pseudoscientic quackery can make the same claim. Even if it’s many hundreds of years old, just claim the modern practice of (insert favorite quackery here) is still in its infancy.

    Osteopathy is not appreciably older than chiropractic, and it has “grown up” for the most part (at least in the US) .

    ——————–

    “…there is credible research that shows that acupuncture can be helpful, but it doesn’t appear to be through the mechanism that acupuncture typically suggests. ”

    Actually, what credible research shows is that acupuncture has no specific or objective effects whatsoever, and the only mechanism really needed to explain its apparent effects is the placebo effect.

  22. Blue Wode says:

    Wolfring wrote on 23 Oct 2012 at 10:07 am: “There are MANY of us who don’t espouse subluxation theory.”

    nybgruson wrote on 23 Oct 2012 at 1:32 pm: “I can’t refer patients to chiropractors because I have no idea which ones will be legit or super quacky.”

    This highlights a HUGE problem. What well-publicised, official resource is there for those who want to ensure that treatment will be administered by an evidence-based chiropractor?

  23. BillyJoe says:

    Wolfing,

    “there is credible research that shows that acupuncture can be helpful, but it doesn’t appear to be through the mechanism that acupuncture typically suggests. There is some positive effect from interaction between practitioner and client that can help”

    This is the placebo effect. If all acupuncture does is the placebo effect, then acupuncture itself does not work. It really is as simple as that. I suggest you peruse the articles on acupuncture on this forum.

  24. Wolfring says:

    @ Harriet

    “facilitating use of the diaphragm which is an essential aspect of motor programming and stability in the spine.” – That doesn’t even mean anything.

    Not sure which part of that you have a problem with. Its common knowledge at this point in the rehabilitation field that the diaphragm relates to spinal stability in that appropriate engagement of the diaphragm in conjunction with the pelvic floor, multifidi and transverse abdominus creates a stiffening effect for the spine at a segmental level, creating a buttress for the spine so that it can remain stable with movement. Many people as a result of their over-reliance on chest breathing are unable to position the diaphragm properly for spinal stability as well as respiration concurrently. This leaves them vulnerable. Training diaphragmatic movement through breathing exercises allows them to learn to engage and use the diaphragm for respiration as well as spinal stability – that’s motor programming.

    http://www.mikereinold.com/2012/03/core-stability-from-the-inside-out.html
    http://www.muscleimbalancesyndromes.com/wp-content/uploads/2012/04/Kolar2012.jpg

    ” If you tell them you are recommending it to facilitate use of the diaphragm for motor programming and stability in the spine, you are baffling them with bullshit.” As I said, its not bull shit, it’s the reality of spinal rehabilitation in this day and age. This idea is not novel as Vladimir Janda and more recently Pavel Kolar from the Prague school of rehabilitation have been teaching this for decades.

    “The research supports the basis of Janda’s approach: the interdependence of the musculoskeletal and central nervous system. Janda states that these two anatomical systems cannot be separated functionally. Therefore, the term “sensorimotor” system is used to define the functional system of human movement. In addition, changes within one part of the system will be reflected by compensations or adaptations elsewhere within the system because of the body’s attempt at homeostasis (Panjabi, 1992).

    @tgobbion
    Chiropractic has been defined (don’t ask me where I read it) as “whatever chiropractors do.”

    You cant be serious. If I made a statement as vague and unsubstantiated as that you guys would be all over me.

    ” The majority of them look for and treat subluxations; oppose vaccinations; practice naturopathy (anything they do that’s not directly related to correcting subluxations falls under this category). All three of these fit the definition of quackery.”

    Sure – some of them do. But a lot of us do not. And likely, those of us who don’t are too busy actually staying up to date on current research in manual medicine and integrating the most current information into our practices to spend a lot of time going on and on about chiropractic philosophy. Not sure what you mean by naturopathy – focusing on getting people to eat a nutritious diet, manage their stress, and avoid unhealthy lifestyle behaviours? Guilty. Sell a bunch of vitamins – nope. And if that’s quackery, better talk to the pharmacists while you’re at it.

    “… its [sic] called evolving as a profession. Doctors once used to do and prescribe all sorts of things today that we now know to be useless and or dangerous. Chiropractic, as we know it, is in its infancy and as a result, we have to evolve as our knowledge expands. It sometimes seems like critics of chiropractic are more likely to cling to the relationship between chiropractic and subluxation theory than we are.”
    Chiropractic has not evolved! Or, if it has, it’s been a retrograde evolution because it hasn’t become more scientific.

    Man – it IS evolving. And it is becoming more scientific – but then I guess it depends on what your definition of chiropractic is. Research on subluxation and the miraculous (sarcasm implied) effect of correcting subluxation? No. research on the role of spinal manipulative therapy, pain science, vertebral disc stem cell research, and rehabilitation in the treatment and management of musculoskeletal disorders? Totally.
    http://www.chiropracticcanada.ca/en-us/about-chiropractic/research-foundation.aspx

    “The relationship between chiropractic and subluxation IS chiropractic; no matter that there’s a smattering of practitioners who have rejected it, the chiropractic mainstream is defined by it. Its defined by it in part because folks like yourself cannot let go of that paradigm.”

    I never use the word subluxation with my patients ever. Because I don’t believe such a thing exists in terms of “subluxation theory”. If you check the Canadian Chiropractic Association website the only reference to subluxation is the WHO definition as a” functional problem related to a joint and structures associated with the joint” and the only talk about its effect on nerves is relating to arm or leg pain.

    @nybgruson

    Agreed. I can’t refer patients to chiropractors because I have no idea which ones will be legit or super quacky. Also, “evolution of a profession” is a cop out. You have the evidence there. No need to reinvent the wheel as if chiropractic were evolving in a vacuum.”

    Yes. And the profession is headed that way in my opinion. Again as certain procedures in medicine fell out of favour because the idea behind them were found to be bunk, or they were just downright dangerous or ineffective, did all doctors abandon them immediately? Doubt it. But no one said we better shut down medicine until everyone is on board right? Not sure how you can argue against the idea that medicine also evolved.
    .

    @Scotton
    “This sounds an awful lot like “just let us keep doing whatever random junk anybody comes up with, eventually we’ll figure out how to be safe and effective.” Cart. Horse.
    It sometimes seems like critics of chiropractic are more likely to cling to the relationship between chiropractic and subluxation theory than we are.
    When it’s no longer true that
    – Chiropractic is specifically defined (in the very law that makes the profession legal) as detecting and correcting subluxations
    – Subluxation theory is not taught in chiropractic school or tested on the exams
    – The overwhelming majority of chiropractic websites do not explicitly embrace the subluxation (and claim to treat asthma, colic, allergies, etc.)
    you can make that argument.”

    Actually in Ontario where I practice, nowhere in the Chiropractic Act does the term subluxation exist.
    At my school I never once heard a professor talk about subluxation. Segmental joint dysfunction or restriction, yes, in a biomechanical sense, but not subluxation. I can’t argue for any chiros that want to use that terminology or make those claims. I don’t.

    @daijiyobuon
    “There are no chiropractors in Star Trek.
    So, I think we know where the future lies for them.”

    If you’re using star trek as an example of future reality……

    @Blue Wodeon

    Wolfring wrote on 23 Oct 2012 at 10:07 am: “There are MANY of us who don’t espouse subluxation theory.”
    nybgruson wrote on 23 Oct 2012 at 1:32 pm: “I can’t refer patients to chiropractors because I have no idea which ones will be legit or super quacky.”
    This highlights a HUGE problem. What well-publicised, official resource is there for those who want to ensure that treatment will be administered by an evidence-based chiropractor?

    I agree 100%. Huge problem. And one that has kept chiropractic from the place in healthcare it could rightfully exist.

    You all have valid points, just as I do. And I doubt I can change any of your minds but at least give me this: The profession is changing, maybe too slowly, but it is. Many of your ideas about what chiropractic is are old and outdated. And from the inside, I am actually encouraged by what I see in terms of the schools in Canada and more of the US schools in terms of evidence informed curriculum. So don’t stick a fork in us yet. I appreciate the chance to dialogue with you guys. Cheers.

  25. windriven says:

    @Wolfring

    “[I]ts called evolving as a profession. Doctors once used to do and prescribe all sorts of things today that we now know to be useless and or dangerous.”

    While accurate that the medical profession evolves as our understanding of medical science grows it is inaccurate to claim equivalence for chiropractic. Medicine does not enshrine ‘malevolent humors’ among its foundational beliefs. If chiropractic has moved beyond subluxation then one wonders upon what chiropractic is now based.

    It sometimes seems like critics of chiropractic are more likely to cling to the relationship between chiropractic and subluxation theory than we are. ”

    Who speaks for chiropractic and what is it that they say regarding subluxation? Is subluxation theory taught in schools of chiropractic? Isn’t subluxation cited in the licensure enabling legislation in most states?

    You can’t have it both ways.

  26. jmb58 says:

    @wolfring

    “Find one thing that is quackery and let me know.”

    In 30 seconds on your site if found a few. In addition to those mentioned above you recommend “forgiveness” as a preventative health measure. Love to see the references on that. Bible doesn’t count.

    Your site says “You are Body. You are Mind. You are Spirit.” We can skip the dualist debate, but “you are spirit”. Really?

    You also recommend naturopathic medicine. Quackery.

    I do appreciate your recommendations to excercise, use seat belts, and refrain from drinking and driving.

    @HH
    Thank you for sparing the rest of us the pain of reading that book.

  27. windriven says:

    @jmb58

    “I do appreciate your recommendations to excercise, use seat belts, and refrain from drinking and driving.”

    Thanks. I never made it to Wolfring’s site.

    I’m going to have to get on my internist about this though. She is forever telling me that drinking relaxes the spirit and that I should always have 3 or 4 fingers on single malt scotch before driving to the store; that seatbelts constrict my abdomen and could lead to constipation or, worse still, explosive meteorism; and that exercise should be avoided because it raises the heart rate and produces lots of icky sweat.

    Thank goodness we have cutting edge chiropractic to set us straight.

  28. Wolfring says:

    Wow. You guys could have taken the dialogue as an opportunity to maybe re-examine your ideas about what my profession is or see the direction it is headed, but instead choose to be dismissive. Emotions don’t affect health? huh. Alright. The World Health Organization defines health as being “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity”. I can’t speak to what the states use as basis for licensure and scope of practice, I already told you what is used in Ontario. Still not sure how encouraging good nutrition and a healthy lifestyle is quackery, but whatever… Fair enough. I’ll continue to help people my way, you feel free to do things your way. And honestly, if that’s the worst you guys can come up from my website, I’m feeling pretty satisfied…..

  29. windriven says:

    @Dr. Gorski-

    Can you embed some theramin music for background when the subject is quackery? It might settle my turbulent qi when the apologists start waxing eloquent about spiritual well-being.

  30. Robb says:

    @jmb58, Wolfring
    I also went to Wolfring’s site – I couldn’t find the “forgiveness” recommendation that you are asking for references for. I think we can agree that forgiveness generally is good for one’s emotional well-being without requiring an RCT. Or was he saying forgiveness can do something more specific – like some specific end point? Otherwise, asking for references is silly.

    You are also questioning “You are Spirit”. By your glib “Really?” it’s hard to know exactly what you are objecting to here but I’ll admit Spirit is pretty wide open to interpretation. I may be wrong but I take it to mean some combination of mood or emotion – joy, inspiration, etc. rather than some reference to the after-life. I think that interpretation definitely applies to health, even if mostly mental health. Would you similarly question emotional concepts like Love? Would you tell your significant other “My brain is secreting dopamine, serotonin, and oxytocin in your presence” as more accurate?
    You’re nitpicking silly things from his website…

    I don’t know much about chiropractic practices but from the little I’ve read it does seem filled with its own internal disagreements and contradictions. Wolfring, if you want more of a dialogue, I’d suggest ignoring the attack comments and focus on some of the good questions that were raised: practitioner-patient interaction as placebo effect? How different contradictory practices, theories and standards may affect other potential patients’ and health professionals’ confidence? In Canada, is there a national association that tries to address evidence based treatment standards?

  31. Harriet Hall says:

    @Wolfring,

    Wait just a minute! You invited me to look at your website for quackery and I did not say I found “quackery” on it. I did say I could not accept some of the things I found there, things that I would rather characterize as pseudoscience or unscientific rather than using the label quackery, but that others would readily call quackery. You did not address our criticism of your “infancy” defense. You did not provide any evidence in defense of acupuncture or breathing exercises, but simply ignored the issues. You did not even try to defend your statement about “facilitating use of the diaphragm…” Instead, you accuse us of being “dismissive.” Then you try to say we are categorizing nutrition and exercise as quackery, which clearly we are not. You say we should re-examine our ideas about chiropractic and the direction it is headed, but you give us no reason to do so. You have not explained any rationale for the separate existence of chiropractic when SMT, exercise, and all that other stuff is available from mainstream medicine. And you did not answer the question about how we could find a chiropractor who avoided quackery. And what are you doing to eliminate the quackery that so many other chiropractors offer?
    Your whole tenor smacks more of J.C. Smith’s whining, defensive opinions than of a rational discussion of the evidence appropriate to a science-based forum.

    Just to be clear, offering breathing exercises for relaxation is perfectly acceptable as a “comfort measure” even if there is no scientific evidence for its effectiveness. But offering breathing exercises with bogus physiologic claims is quackery. SMT for short-term treatment of musculoskeletal pain is evidence-based; SMT to correct subluxations is quackery.

  32. Quill says:

    Some days life seems very short. So when someone of demonstrable intelligence and who is not given to hyperbole declares a book to be a “vicious screed” then there are far too may other things to do then look into it further.

  33. windriven says:

    @Robb

    “By your glib “Really?” it’s hard to know exactly what you are objecting to here but I’ll admit Spirit is pretty wide open to interpretation.”

    I don’t speak for jmb58 but that “pretty wide open to interpretation” is entirely objectionable. When people tell me they’re ‘spiritual’ I have no freaking idea what that is supposed to mean. I take it to mean they’re incoherent or inarticulate or can’t be bothered to figure out how they see their place in the universe. It is like saying, “I’m C minor diminished.” It means precisely nothing.

    When some jabbering clown uses ‘spirit’ in the context of medical (or pseudo-medical) practice it takes me right off my hinges. Repair of an abdominal aortic aneurism is medicine. “You are Spirit” is bullshit.

  34. ConspicuousCarl says:

    Wolfring:

    Your wording on some stuff might be tweaking them. Specifically in the part jmb58 quoted, I notice that you list both “mind” and “spirit”. I would have accepted “spirit” on its own to possibly be a loose word for mental health, but by listing both it sounds like wooish dualism, not like the WHO definition. Maybe you don’t mean that, but that’s how it sounds.

    Also, as Harriet Hall already mentioned, your suggestion to try acupuncture (in the paragraph which suggests “alternative” in general) is not so good.

    The thing on your website I wonder about is this:
    http://www.inspirechiropractic.ca/chiropractic-care/

    Specific chiropractic adjustments can help correct joint dysfunction created by the various physical, chemical, and emotional stresses in our lives.

    Can you give an example or two of “chemical” stresses (leading to dysfunction) which are corrected by chiropractic adjustments?

    I also looked at your twitter feed, and based on some of the articles you posted, you seem to have a GMO-vs-Organic thing going on. I don’t want to expand your challenge unfairly to your personal tweets, but is that view included in the nutrition counseling you mention on the website?

  35. tgobbi says:

    Wolfring: “Still not sure how encouraging good nutrition and a healthy lifestyle is quackery, but whatever… Fair enough.”

    Red Herring! Everyone agrees that good nutrition is important. Quackery enters the picture with the chiropractic interpretation of what constitutes good nutrition. Every DC I’ve ever encountered who practices “nutrition” has a vastly different approach to the subject than mainstream dietitians. All the chiropractic “nutritionists” espouse overdosing on vitamins and other supplements. They also sell them. Most of them insist that white flour, sugar and “processed” foods are unhealthy. I wrote recently of a lecture I attended a few months ago given by a DC (NUCCA type, no less) who insisted that all artificial sweeteners cause myriad diseases up to and including cancer. When I confronted him with the fact that there have been over 200 reliable, valid studies that put the lie to the dangers of aspartame and other sweeteners, his response was to eject me from the room.

    So, Wolfring, I suggest you tread lightly when discussing chiropractic and nutrition.

  36. tgobbi says:

    For the record, here’s a quote from the Getzandanner decision:

    She wrote, “None of the court’s findings constituted a judicial endorsement of chiropractic. All of the parties to the case, including the plaintiffs and the AMA, agreed that chiropractic treatment of diseases such as diabetes, high blood pressure, cancer, heart disease, and infectious disease is not proper, and that the historic theory of chiropractic, that there is a single cause and cure of disease is wrong. There was disagreement between the parties as to whether chiropractors should engage in diagnosis. There was evidence that the chiropractic theory of subluxations was unscientific, and evidence that some chiropractors engaged in unscientific practices.”

    Comment, again drawing from my own 35 years of experience investigating chiropractic: DCs appear to be bipolar about “diagnosis.” When faced with litigation due to missing a diagnosis and treating inappropriately they hide behind the claim of “we don’t diagnose; we treat the whole person.” (Paraphrased and condensed from many examples). On the other hand, many claim training and qualification to diagnose in order to justify their existence. They drift in whatever way the wind wafts them.

  37. Janet says:

    @Carol M

    It was just a bad sentence–the not should not have been there. I was only a few sips into the morning coffee. To be clear, I meant to say that I had to inform the PT that chiros go to Chiro “College” (which isn’t accredited by anyone but themselves), teach stuff that Palmer made up years ago, and aren’t anything akin to real health professionals who go to accredited colleges and universities and actually study anatomy, chemistry, biology and that sort of thing, and have to pass state exams. She seemed to think that they were educated more like optometrists or PT’s or nurse practitioners.

  38. Ken Hamer says:

    “He feels slighted because chiropractors are not featured on national TV as spokespersons on health like Dr. Sanjay Gupta and because there has never been a chiropractor TV hero like Marcus Welby.”

    But I bet a chiropractor would make a great super-villian.

  39. As a person involved in the literary world, I’d like the question the necessity of this post. As Dr. Hall mentioned, this book was self-published, is poorly written, and didn’t seem to be very popular, considering there was no previous due date. Self-published books are generally ignored in the literary world for the same reasons (unless we are talking about James Joyce and JC Smith is obviously no James Joyce). With no review (and no marketing budget), they are left to rot into obscurity. So isn’t this post bringing more publicity to this book than it deserves? Wouldn’t it have been more useful to have written a post on a book published by an established CAM press? Something that CAM advocates would actually read?

    1. Harriet Hall says:

      @Francois Luong,

      I had reservations about writing this post for the very reasons you cite, and it certainly didn’t merit writing about it at such length. But I decided it would be useful to write about it because it was so typical of the faulty arguments of chiropractic apologetics and so revealing of chiropractic thought processes and attitudes. Also because the history of the AMA and the Wilk trial was worth telling, especially since chiropractors frequently refer to it as a vindication of chiropractic. I started with a statement about the book’s lack of worth, and I tried to break the post into labelled sections so readers could choose what they were interested in reading and could ignore the rest.

      Also, the book made me angry and rebutting it in print served as psychotherapy and lowered my blood pressure. :-)

      I do indeed fervently hope the book will rot into obscurity!

  40. Wolfring says:

    Harriet, I did submit a detailed reply but for some reason it is still saying that it is awaiting moderation so I guess you are not able to read it. I posted it before the post that you most recently responded to. Hopefully it will give you further insight into the relationship between the diaphragm and spinal stability /motor control.

    Robb – thank you for furthering discussion. I appreciate that. Didn’t realize each individual word on my site was going to be dissected as to inherent meaning. For the record, the forgiveness quote was part of a note I wrote on steps to improving your health and went as follows:

    “Step 1: Think PREVENTION. Modify your lifestyle and habits so that they have the least negative impact possible on your health. Avoid excess relating to diet and alcohol. Get your rest. Exercise (just walk 20 min a day). Manage your stress. Laugh. Socialize. Get a pet. Drink water. Eat your fruits and veggies. Forgive. Love. Breathe.”

    pretty controversial for sure…….

    There is a great deal of internal conflict in our profession, most of which centers around the same things we are discussing here (or attempting to). The philosophical basis behind “subluxation theory” is one which is eschewed by many of our peers and as mentioned in the post which hasn’t shown up yet, the Canadian Chiropractic Association on their website makes no attempt to describe or endorse “subluxation theory” . The only mention of subluxation is a description offered by WHO which describes it as basically joint dysfunction, and attaches no significance to it other than in a biomechanical sense. And yes, the inability to distinguish one type of chiropractor from another is a huge issue, one which I happen to know the Ontario Chiropractic Association is making an attempt to rectify as I was part of a focus group where we were discussing that very issue. And out of the 8 DC’s around the table, only one was a subluxation based practitioner.
    I don’t at all blame a general practitioner for not referring to me because how the hell are they supposed to know what I do specifically? I do make an effort to make sure that I send reports to GP’s for any significant neuromusculoskeletal conditions I am treating or rehabbing in their patients and that seems to have been generally well received.
    The CCA has also been in the process over the past few years of setting up evidence based guidelines for treatment of whiplash type injuries as well as other conditions. This is definitely the route they are heading down. Thanks again for your question.

    Carl – I may need to rethink the word chemical as in my mind it pertains more to the effect of stress or emotional reactions in the body and is covered already under emotional . Thanks for pointing that out. I personally think that there is a difference between the mental and spiritual parts of a person, and that they can both affect overall health. My opinion, not sure there have been any RCT’s to determine that…..
    I do have a GMO – Organic thing going on because I think that people should have a choice as to what foods they are going to eat. I do think there is a pesticide residue issue with conventionally grown food. I don’t think organic food is necessarily more nutritious, but if I can choose between foods grown with pesticides and those without, I choose without. I don’t proselytize about it in the office, but if someone asks I feel free to explain my position.

    tgobbi – Yes there is a lot of variation across DC’s as to what they consider good nutrition, just like there is amongst medical doctors, so not really a valid criticism. I sell Vitamin D in my clinic and no other vitamins. And its just sitting htere so that if people want to buy it, its there. No one is compelled to buy it from me. Do I think processed foods and sugar are unhealthy? Yep. And you don’t? Seriously? With the obesity epidemic as bad as it is and the increase in obesity related illnesses, given the choice between eating processed food and sugar, or whole foods – fruits , vegetables, whole grains – wouldn’t you encourage your patient to the latter? Or maybe you’re like the surgeon who told my patient that a suitable food for her to eat after jaw surgery was a McDonald’s cheeseburger……. Don’t judge all of us who have training to provide good nutritional advice to our patients based on a bad experience you had with a NUCCA practitioner, whose treatment techniques I don’t agree with either……. tread lightly indeed.

  41. Wolfring says:

    Repost of post that didn’t go through:

    @ Harriet

    “facilitating use of the diaphragm which is an essential aspect of motor programming and stability in the spine.” – That doesn’t even mean anything.

    Not sure which part of that you have a problem with. Its common knowledge at this point in the rehabilitation field that the diaphragm relates to spinal stability in that appropriate engagement of the diaphragm in conjunction with the pelvic floor, multifidi and transverse abdominus creates a stiffening effect for the spine at a segmental level, creating a buttress for the spine so that it can remain stable with movement. Many people as a result of their over-reliance on chest breathing are unable to position the diaphragm properly for spinal stability as well as respiration concurrently. This leaves them vulnerable. Training diaphragmatic movement through breathing exercises allows them to learn to engage and use the diaphragm for respiration as well as spinal stability – that’s motor programming.

    http://www.mikereinold.com/2012/03/core-stability-from-the-inside-out.html
    http://www.muscleimbalancesyndromes.com/wp-content/uploads/2012/04/Kolar2012.jpg

    ” If you tell them you are recommending it to facilitate use of the diaphragm for motor programming and stability in the spine, you are baffling them with bullshit.” As I said, its not bull shit, it’s the reality of spinal rehabilitation in this day and age. This idea is not novel as Vladimir Janda and more recently Pavel Kolar from the Prague school of rehabilitation have been teaching this for decades.

    “The research supports the basis of Janda’s approach: the interdependence of the musculoskeletal and central nervous system. Janda states that these two anatomical systems cannot be separated functionally. Therefore, the term “sensorimotor” system is used to define the functional system of human movement. In addition, changes within one part of the system will be reflected by compensations or adaptations elsewhere within the system because of the body’s attempt at homeostasis (Panjabi, 1992).

    @tgobbion
    Chiropractic has been defined (don’t ask me where I read it) as “whatever chiropractors do.”

    You cant be serious. If I made a statement as vague and unsubstantiated as that you guys would be all over me.

    ” The majority of them look for and treat subluxations; oppose vaccinations; practice naturopathy (anything they do that’s not directly related to correcting subluxations falls under this category). All three of these fit the definition of quackery.”

    Sure – some of them do. But a lot of us do not. And likely, those of us who don’t are too busy actually staying up to date on current research in manual medicine and integrating the most current information into our practices to spend a lot of time going on and on about chiropractic philosophy. Not sure what you mean by naturopathy – focusing on getting people to eat a nutritious diet, manage their stress, and avoid unhealthy lifestyle behaviours? Guilty. Sell a bunch of vitamins – nope. And if that’s quackery, better talk to the pharmacists while you’re at it.

    “… its [sic] called evolving as a profession. Doctors once used to do and prescribe all sorts of things today that we now know to be useless and or dangerous. Chiropractic, as we know it, is in its infancy and as a result, we have to evolve as our knowledge expands. It sometimes seems like critics of chiropractic are more likely to cling to the relationship between chiropractic and subluxation theory than we are.”
    Chiropractic has not evolved! Or, if it has, it’s been a retrograde evolution because it hasn’t become more scientific.

    Man – it IS evolving. And it is becoming more scientific – but then I guess it depends on what your definition of chiropractic is. Research on subluxation and the miraculous (sarcasm implied) effect of correcting subluxation? No. research on the role of spinal manipulative therapy, pain science, vertebral disc stem cell research, and rehabilitation in the treatment and management of musculoskeletal disorders? Totally.
    http://www.chiropracticcanada.ca/en-us/about-chiropractic/research-foundation.aspx

    “The relationship between chiropractic and subluxation IS chiropractic; no matter that there’s a smattering of practitioners who have rejected it, the chiropractic mainstream is defined by it. Its defined by it in part because folks like yourself cannot let go of that paradigm.”

    I never use the word subluxation with my patients ever. Because I don’t believe such a thing exists in terms of “subluxation theory”. If you check the Canadian Chiropractic Association website the only reference to subluxation is the WHO definition as a” functional problem related to a joint and structures associated with the joint” and the only talk about its effect on nerves is relating to arm or leg pain.

    @nybgruson

    Agreed. I can’t refer patients to chiropractors because I have no idea which ones will be legit or super quacky. Also, “evolution of a profession” is a cop out. You have the evidence there. No need to reinvent the wheel as if chiropractic were evolving in a vacuum.”

    Yes. And the profession is headed that way in my opinion. Again as certain procedures in medicine fell out of favour because the idea behind them were found to be bunk, or they were just downright dangerous or ineffective, did all doctors abandon them immediately? Doubt it. But no one said we better shut down medicine until everyone is on board right? Not sure how you can argue against the idea that medicine also evolved.
    .

    @Scotton
    “This sounds an awful lot like “just let us keep doing whatever random junk anybody comes up with, eventually we’ll figure out how to be safe and effective.” Cart. Horse.
    It sometimes seems like critics of chiropractic are more likely to cling to the relationship between chiropractic and subluxation theory than we are.
    When it’s no longer true that
    – Chiropractic is specifically defined (in the very law that makes the profession legal) as detecting and correcting subluxations
    – Subluxation theory is not taught in chiropractic school or tested on the exams
    – The overwhelming majority of chiropractic websites do not explicitly embrace the subluxation (and claim to treat asthma, colic, allergies, etc.)
    you can make that argument.”

    Actually in Ontario where I practice, nowhere in the Chiropractic Act does the term subluxation exist.
    At my school I never once heard a professor talk about subluxation. Segmental joint dysfunction or restriction, yes, in a biomechanical sense, but not subluxation. I can’t argue for any chiros that want to use that terminology or make those claims. I don’t.

    @daijiyobuon
    “There are no chiropractors in Star Trek.
    So, I think we know where the future lies for them.”

    If you’re using star trek as an example of future reality……

    @Blue Wodeon

    Wolfring wrote on 23 Oct 2012 at 10:07 am: “There are MANY of us who don’t espouse subluxation theory.”
    nybgruson wrote on 23 Oct 2012 at 1:32 pm: “I can’t refer patients to chiropractors because I have no idea which ones will be legit or super quacky.”
    This highlights a HUGE problem. What well-publicised, official resource is there for those who want to ensure that treatment will be administered by an evidence-based chiropractor?

    I agree 100%. Huge problem. And one that has kept chiropractic from the place in healthcare it could rightfully exist.

    You all have valid points, just as I do. And I doubt I can change any of your minds but at least give me this: The profession is changing, maybe too slowly, but it is. Many of your ideas about what chiropractic is are old and outdated. And from the inside, I am actually encouraged by what I see in terms of the schools in Canada and more of the US schools in terms of evidence informed curriculum. So don’t stick a fork in us yet. I appreciate the chance to dialogue with you guys. Cheers.

  42. The Dave says:

    “He feels slighted because chiropractors are not featured on national TV as spokespersons on health like Dr. Sanjay Gupta and because there has never been a chiropractor TV hero like Marcus Welby.”

    The only chiro on TV that I can think of is Alan from Two and a Half Men and that character even had to go to Mexico (according to the story line) for chiro school and is, well, Alan… :)

  43. ConspicuousCarl says:

    Bruce Campbell play an osteopath in the movie Alien Apocalypse.

  44. Wolfring says:

    @Janet – Ummm, really? As so many of you are such sticklers for razor sharp accuracy, anyone want to step in here and handle that one? Anyone?

    “To be clear, I meant to say that I had to inform the PT that chiros go to Chiro “College” (which isn’t accredited by anyone but themselves), teach stuff that Palmer made up years ago, and aren’t anything akin to real health professionals who go to accredited colleges and universities and actually study anatomy, chemistry, biology and that sort of thing, and have to pass state exams. ”

    Chiropractic Colleges and their curriculum do have to be sanctioned by provincial licensing bodies in Canada and I would assume as well in the US. We did learn about Palmer, but we learned about Hippocrates as well – that was in a health history unit. And thats about all Palmer had to do with my education. And surprisingly, yes, I did have to “actually” study anatomy, chemistry, biology, , you know, that sort of thing…. as well as microbiology, immunology, pathophysiology, neurophysiology, neuroanatomy, embryology, biochemistry, histology, biomechanics, genetics, dermatology, physical diagnosis, clinical pathology, and on and on…. Oh, and then there were those nasty National board exams that we had to do – 2 days of written exams and a day of practical. So, there’s that…….

  45. windriven says:

    @Wolfring

    “Anyone? ”

    I’m game. Just as on the television show Jeopardy I will present my answer in the form of a question:

    What are the indications for chiropractic other than temporary relief of lower back pain that are supported by quality, peer-reviewed RCTs and what are the citations to these studies?

  46. Wolfring says:

    @windriven – chiropractic or spinal manipulative therapy? As someone pointed out earlier, two different things…. i don’t actually adjust every patient – sometimes I stretch them, do some soft tissue work, run them through some corrective exercises and rehab. Does that mean I’m not a chiropractor? Fine. I don’t need a label to know I can help people in pain.

  47. tgobbi says:

    Wolfring: “Yes there is a lot of variation across DC’s as to what they consider good nutrition, just like there is amongst medical doctors, so not really a valid criticism.”

    I don’t know if that’s the case with MDs but I seriously doubt that there’s all that much disagreement amongst RDs, the people who specialize in the field.

    Wolfring: “I sell Vitamin D in my clinic and no other vitamins.”

    Why only vitamin D?

    Wolfring: “Do I think processed foods and sugar are unhealthy? Yep.”

    Why? Please be specific and avoid generalities. This is an important point for me.

    Wolfring: “And you don’t? Seriously?”

    What I think isn’t important; I’m not a healthcare professional, only an investigator and consumer advocate.

    Wolfring: “With the obesity epidemic as bad as it is and the increase in obesity related illnesses, given the choice between eating processed food and sugar, or whole foods – fruits , vegetables, whole grains – wouldn’t you encourage your patient to the latter?”

    Are you blaming processed foods for the obesity epidemic?

    Wolfring: “Or maybe you’re like the surgeon who told my patient that a suitable food for her to eat after jaw surgery was a McDonald’s cheeseburger…….”

    Isn’t it possible that the surgeon had a point? And does one example indicate that he recommends a diet of cheeseburgers?

    Wolfring: “Don’t judge all of us who have training to provide good nutritional advice to our patients based on a bad experience you had with a NUCCA practitioner, whose treatment techniques I don’t agree with either……. tread lightly indeed.”

    Respectfully, Craig (or are you Jeff?), I’ve never encountered a chiropractor with bona fides in nutritional counseling. The version of nutrition science taught in chiropractic schools isn’t quite in alignment (pun intended) with what’s taught to mainstream dietitians. Correct me if I’m wrong on this but doesn’t the post-school nutrition “science” DCs are exposed to come mostly from the supplement manufacturers?

  48. Harriet Hall says:

    @Wolfring,

    “Hopefully it will give you further insight into the relationship between the diaphragm and spinal stability /motor control.”

    I looked at your references, but neither of them had anything to do with breathing exercises. They don’t tell me what I want to know: have those breathing exercises been properly tested to show whether they result in actual measurable clinical improvement? I don’t think so. I think you are recommending them based on speculation.

  49. Harriet Hall says:

    @Wolfring,

    “The profession is changing”

    I wish I could believe that. Really, I do. If chiropractors could do what the osteopaths did, I’d welcome them into the scientific fold with open arms just as we welcomed DOs. On the Healthfraud list, Steven Perle tried to convince us that it was changing, but he could not support his assertions with any convincing data. The majority of chiropractic websites still mention subluxation, about half of chiropractors use applied kinesiology, and I haven’t seen any evidence that the percentage of chiropractors discouraging vaccines has diminished.

    I’ll be more encouraged when the major chiropractic organizations firmly reject the subluxation concept and speak out strongly against members who engage in quackery. Maybe they need to employ tactics like the AMA to discourage non-science-based practices and prohibit associating with those who don’t comply. :-)

  50. Wolfring says:

    Harriet, I could spend the next while pulling up links for you to look over regarding the involvement of diaphragm in spinal stability but respectfully, I’m done for the night. If it is only speculation, then I am speculating along with some of the best physical and rehabilitative therapists in the US, and I’m ok with that.

    Tgobbi- if you think RD’s are getting good credible information then you should check out #fnce on Twitter. The food and nutrition conference and expo took place in Philly a couple of weeks ago and guess who the major sponsors were? Coke. PepsiCo. McDonald’s. Corn refiners association of America. Hershey. There were many rd’s upset with the unabashed influence of big food on their conference. My nutrition training came through a year of nutrition science as part of my school training, not afterwards.

  51. nobs says:

    Janet claims:
    “……chiros go to Chiro “College” (which isn’t accredited by anyone but themselves)…..”

    Kindly, please provide your source for this claim.

  52. Jimmylegs says:

    @Wolfring:

    I assume you are the DC on the website, after all you say it is your website. Anyhow, it says you went to University of Western States (Portland, Oregon). I wondered why that name was so familiar, it’s because I actually looked it up in the past (about another DC).

    You claim you don’t subscribe to subluxations, and I believe you as I cannot find any posts on their website about it. You are not off the hook however, your school claims:

    “Additionally, many patients have used chiropractic treatment for the successful treatment of their non-musculoskeletal conditions such as allergies, digestive disorders and otitis media.”

    If spinal adjustments can treat other things, please refer me (us?) to such studies as I have only read negative results.

    Also the support of naturopathy and acupuncture doesn’t help, that is deep in quackery.

    On your site; “[regulating breathing can] help your digestive system without taking drugs.” I have actually never heard of this, do you have any studies that can back this up?

    Your reasons for vitamin D are just a copy-and-paste (which is on purpose I know) from a “news” site. Aside from them supporting some dubious claims and people (eg Dr. Oz) that’s not the point, they (and in turn you) don’t link the studies which could back up these claims. No citations, no reference bank, nothing.

    The take home message from me is, if you don’t want everything you say to be nitpicked, questioned, and told to back it up with research (from peer-reviewed journals) then don’t say it. If you cannot defend your reasons on every attack, maybe you don’t have any (or any good ones) that can withstand the barrage.

  53. Harriet Hall says:

    @Wolfring,

    You needn’t bother pulling up any more links to show that “the diaphragm is involved in spinal stability.” We could argue about whether such studies justify your interpretations such as “Many people as a result of their over-reliance on chest breathing are unable to position the diaphragm properly for spinal stability as well as respiration concurrently.” but the real question is whether claims about spinal stability justify prescribing specific breathing exercises. Either you have credible evidence from clinical studies that such exercises have a measurable objective effect, or you are speculating. Which is it?

  54. @Dr. Hall: I’ll retract my objection then. I know next to nothing regarding the history of medicine in the United States and the point you are bringing forth with the Wilk trial help shed some lights I had. I’ve always been baffled by the strange distrust patients have with their doctors in the United States and the prevalence of quackery there. That might not necessarily be the case, just a phenomenon that occurs where I live (San Francisco), but that is certainly not the case in France or Germany. That CAM practitioners institutionalize (formed associations) early on, right in the middle of a period of large scientific investments in research and education, seem to form something of the beginning of an explanation. I also think that a history of weak regulations, which you mention in your “Practicing Medicine Without Licensing,” plays a role in this. Because, what is licensing quackery if not a weakening of medical regulations?

  55. Badly Shaved Monkey says:

    At my school I never once heard a professor talk about subluxation. Segmental joint dysfunction or restriction, yes, in a biomechanical sense, but not subluxation. I can’t argue for any chiros that want to use that terminology or make those claims. I don’t.

    Wolfring, please explain how “segmental joint dysfunction or restriction” is not just a proxy term for the mythical chiropractic subluxation. How do you demonstrate its existence? How do you demonstrate its alleviation by chiropractic manipulation? How do you demonstrate a causal relation between the existence of such a thing with any clinical signs or symptoms? How do you demonstrate that alleviation of such a thing is causally connected to alleviation of any medical signs or symptoms?

  56. Badly Shaved Monkey says:

    @Harriet Hall

    You comment in this blog about the resort to Nazi/fascist namecalling by the book’s author, which reveals a sense of persecution that is evidenced very frequently by SCAM advocates of all stripes when we challenge them.

    I think the fundamental problem for them is that they are simply wrong. It’s not us persecuting them but nasty old reality that has refused to make room for their fantasies to exist. The problem is that instead of recognising their being on the losing side of an argument for what it is and adapting their worldview accordingly, instead they make a conscious or unconscious choice to sidestep rational discussion altogether and switch to an emotive political mode of dispute, in which appeals to their rights to free speech and not to be oppressed are deployed as if they are substitutes for relevant facts and evidence.

    Sadly for them it’s not The Man or Big Pharma that’s out to ‘get’ them. It’s the universe.

  57. ConspicuousCarl says:

    Wolfring on 23 Oct 2012 at 11:06 pm
    Tgobbi- if you think RD’s are getting good credible information then you should check out #fnce on Twitter. The food and nutrition conference and expo took place in Philly a couple of weeks ago and guess who the major sponsors were? Coke. PepsiCo. McDonald’s. Corn refiners association of America. Hershey.

    Sponsoring an event means they footed part of the bill for the hotel rental. That is not the same as organizing the conference or determining the content of the speakers’ presentations. Furthermore, conferences are one of many ways to learn new stuff AFTER RD’s already got a proper education on the subject. It’s not like high school seniors walk into the conference and come out with a license. It is not logical to say that RD’s do not get good information because Pepsi bought ad space on the wall of a rented building.

  58. cloudskimmer says:

    Thank you Dr. Hall for an excellent post. And you even brought in a real chiropractor so I can ask some questions.
    Wolfring said “Not sure what you mean by naturopathy – focusing on getting people to eat a nutritious diet, manage their stress, and avoid unhealthy lifestyle behaviours?”
    If you don’t know what naturopathy is, why do you recommend it on website? i don’t think it’s another word for nutrition and lifestyle.
    Why are you ignoring the studies that indicate acupuncture doesn’t work?
    Do you perform neck manipulations as part of your practice? If so, what do you think of the correlation with stroke? And the evidence that they do no good?
    Have you ever abandoned a procedure because you found it to be ineffective?
    Wy did you choose chiropractic instead of physical therapy or a more well scientifically grounded field?
    Why do you sell vitamins in your office instead of directing patients to buy them somewhere else? That strikes me as mildly unethical. If you are working so hard, surely you don’t need the income.
    Are you going to take down the references on your website to naturopathy and acupuncture since they are dubious scientifically and outside the realm of your practice?
    I hope you will respond to Dr. Hal’s request for an adequate study about proper breathing stabilizing the spine. That contention alone would make me think you were not conducting your practice in a science based way.

  59. Jan Willem Nienhuys says:

    Suppose the chiropractors had any interest in proving that theirs is a scientific concept. Just hypothetically. To prove that subluxations exist, and can be adjusted, is easy. Here is how.
    1. Select a number of different test people.
    2. Select a number of chiropractors.
    3. Let each of them diagnose which places of the spines of the test people have a “subluxation”. Then compare.
    4. If they all agree in some decent statistical sense, then at least this diagnosis – whatever it really means – makes sense.
    (Of course, the chiros may all say ‘no subluxations’ or they may say ‘all vertebrae are subluxated’, then you have to think
    harder how to organise the test. The main problem of the test is to properly blind the chiros. In this case ‘blinding’ may be
    done in a literal way, because supposedly the subluxations are done by touch. So one can even try to present the same test person several times to the same blinded chiro.)

    5. Let the chiros adjust some of the subluxations, and let the others them determine which of the subluxations have been adjusted.
    Many setups are possible, for instance A diagnoses test person 1, the B diagnoses testperson 1, A adjusts a number of subluxations (to be determined by a random generator), and B rediagnoses. Ideally the first two diagnoses should be identical, and after the adjustment B should precisely indicate which subluxations are not there anymore.

    The outcome of an extensive series of experiments like the above should be published, and repeated. This experiment (properly blinded and radnoized of course) should be part of the basic training of chiropractors, just like measuring the local gravity (g) or checking gas laws or other basic physics experiments are part of the training of physicists.

    According to me such experiments haven’t been done or they have been done only a few times with negative results. On websites of chiropractors a positive outcome of such experiments is never mentioned. (Correct me if I am wrong.) If they had been done correctly with positive results chiropractic woule be taken seriously by regular medicine.

    So suppose chiropractors were serious about their claims. Then they would have done the experiments. But they haven’t. Hence the hypothesis that chiropractors are serious leads to a contradiction, in other words, the hypothesis is false. Actually, I guess they could earn Randi’s million by performing experiments like I described. But they don’t.

    It’s the same witth other SCAMs. Homeopathy, for example, rests on a ‘knowledge base’ of about one million combinations of an ultradiluted subtance given to healthy volunteers and subsequent symptoms. To homeopaths this proves beyond any doubt that ultradiluted stuff does something. Forget about rationalisations like memory of water and quantum mechanics and information and strange experiments with ultradiluted histamine in test tubes, or with crystal defects in frozen heavy water.

    If the homeopaths were serious, they would show that at least some of those million combinations consistently are reproducible in properly randomized and blinded trials. For example Sulphur 200C and an itchy feeling. Or Belladonna 30C and hot flashes or whatever. If the homeopaths prefer to settle on just the number of symptoms (in comparison with placebo) rather than specific symptoms, that’s fine for starters. But they don’t, even if you offer them large sums in case of a succesful test.

    It’s the same with lots of diagnostic systems such as electroacupuncture or muscle tests or diagnosis by pendulum or biotensor. If these systems worked, it would be easy to prove.

    In iridology actually many tests have been done. Iridology is just about the best refuted nonsense medical diagnosis. It doesn’t matter. The iridologists just go on. Just like the astrologers, in fact.

  60. Jan Willem Nienhuys says:

    PS. Oops. Forget to check properly blinded and randomized.

  61. marcus welby says:

    JW Nienhuys: I recall seeing one small published article in a chiropractic journal with a very small number of test subjects designed to evaluate just what you propose..I read the article in 2005, so it was published prior to that time. Australian chiropractors maybe associated with a chiro school there. Perhaps 10 or so test subjects. Totally negative results regarding detection of subluxations with interobserver reliability.

  62. windriven says:

    @Wolfring

    “Does that mean I’m not a chiropractor? Fine. I don’t need a label to know I can help people in pain.”

    Do you understand my difficulty with this? You are licensed as a chiropractor. But you eschew the foundational belief of chiropractic. It sounds to me as if you are practicing as a physical therapist rather than as a chiropractor. But then it would appear that you are not licensed as a physical therapist.

    The point of licensure is to assure the public that practitioners have been appropriately educated and tested and conform to the practice – and practice limits – under which they are licensed.

  63. Jan Willem Nienhuys says:

    Actually that is common phenomenon with SCAM. They do the same thing as religions: split off in different directions. Each man a sect of his own. And there is what is called the courtier’s reply (said to be called like that by PZ Myers who was thinking of the clever taylors in the Emperor’s New Clothes story). Some courtiers develop a very complicated and sophisticated abstract version of the truth, and when you protest you are hit with the argument that you haven’t understood the superduper hifalutin’ delicate concepts. So when you criticise a SCAM of type X (fill in any X you want), some Xer will come out of the woodwork and claim that you didn’t understand it at all and that s/he thinks ….. follows either that person’s personal version of X or some kind of highbrow gobbledygook pretending to be the real meaning of X.

  64. Cowy1 says:

    Wolfring: “diaphragm relates to spinal stability in that appropriate engagement of the diaphragm in conjunction with the pelvic floor, multifidi and transverse abdominus creates a stiffening effect for the spine at a segmental level”.

    Let’s sing along.

    The toe bone connected to the heel bone,
    The heel bone connected to the foot bone,
    The foot bone connected to the leg bone,
    The leg bone connected to the knee bone,
    The knee bone connected to the thigh bone,
    The thigh bone connected to the back bone,
    The back bone connected to the neck bone,
    The neck bone connected to the head bone!

  65. tgobbi says:

    Wolfring sells only one supplement in his office: vitamin D. He states “… My nutrition training came through a year of nutrition science as part of my school training, not afterwards.”

    I suspect the school where he was trained in nutrition was his chiropractic school. This makes me question the validity of the training since I’ve never encountered a DC who was schooled in mainstream nutrition science. Typical of the “nutrition” practiced by chiropractors is this example of an ad from a chiropractic website:

    FALL DETOX SPECIAL

    *1 BOTTLE HCG DROPS

    *6 BOTTLES DETOX DROPS

    *3 EB FOOT BATHS

    *6 VIBE PLATE EXERCISE SESSIONS

    $690 VALUE FOR $230

    Not a hint of science here! I’m not including the link because the “doctor” in question has made a threat against me in the past and I’m too old to get involved in a long legal action. But I do want to stress what generally passes as the chiropractic approach to nutrition.

    Wolfring, as so well stated by windriven, has a chiropractic degree and license; but he doesn’t appear to be practicing as a chiropractor. Kinda reminds me of “Pat,” the androgynous character from the Saturday Night Live TV show. We never learned Pat’s gender. Likewise, Wolfring obfuscates his chiropractic identity. Is he? Or isn’t he?

  66. nwtk2007 says:

    @windriven, a great deal of physical medicine is within the scope of practice of chiropractors. I am also not sure why you find it difficult to understand that a chiropractor would not adhere to the subluxation theory.

    It seems that a lot of anti-chiro folks want to pin chiro’s down into that category so they can continue to bash them. There is a refusal to acknowledge that chiro’s also do other physical medicine for which they are licensed.

  67. windriven says:

    @nwtk2007

    ” I am also not sure why you find it difficult to understand that a chiropractor would not adhere to the subluxation theory.”

    Subluxation theory is the foundational belief of chiropractic. Without it chiropractic is an empty shell.

    I’m not interested in pinning chiropractors anywhere; they’ve pinned themselves as chiropractors. If they wish instead to be physical therapists there are many fine credentialing programs available.

  68. nybgrus says:

    How apropos that this particular article came across my news feed.

    The AOA and ACGME are merging for a single unified standard to license and train DO’s and MD’s. From the article:

    This would provide physicians in the United States with a uniform path of preparation for practice. This approach would ensure that the evaluation and accountability for the competency of resident physicians are consistent across all programs

    Americans deserve a health care system where continuously improving the quality of care and the health of our patients is the driving force,” stressed AOA President Ray E. Stowers, D.O. “A unified accreditation system creates an opportunity to set universal standards for demonstrating competency with a focus on positive outcomes and the ability to share information on best practices

    Stephen C. Shannon, D.O., M.P.H., President of AACOM, adds that, “AACOM is undertaking this historic initiative because we believe that a unified accreditation system will improve the quality and efficiency of graduate medical education.”

    So why is it that the chiropractic schools have no interest in doing this? If they are so evidence based and the profession really is becoming legitimate and they really want to be part of the “mainstream” medicine, why have the DO’s been able to do it but the DC’s can’t get their $hit together? They’ve had basically the same amount of time in the same country with the same laws….

    So nobody is trying to pin anyone down and define chiros in a way that allows us to bash them. That whole argument is ridiculous. It would be like me saying that I am a Ku Klux Klan member because I like their political views on labor unions, immigration, foreign policy, and find flowing white robes to be fashionable and comfortable… but please! don’t lump me in with those psycho racist guys who also happen to call themselves Klansmen. I am nothing like them! Really, you don’t understand – there are plenty of us that don’t like the whole racism, anti-semitism, homophobia and violence aspect of it. We just like the sense of community and the other conservative political stances. Plus the meetings are fun. Never mind that the Grand Vizar still says we have to hate black people and teh gayz, things are changing and when I was a wee Klansmen I never once heard anyone around me mentioning such things.

    This is exactly analagous to the “defense” of chiropractic we keep seeing here. If you think there are legitimate points and aspects to chiro that is great – we here agree. But you have chosen to get DC after your name and thus are inextricably mired with the majority (and the leadership) who continue to espouse the basic tenets of chiropractic as the subluxation. You have schools known to be more quacky and some that are indeed less so. But just like I (in my hypothetical) could have chosen to be a Libertarian or a Republican for shared conservative views rather than be a Klansmen, you could have chosen to be a PT or OT instead of a DC.

    So yeah… change is coming! We keep hearing it… yet the DO’s are the ones actually doing it.

  69. zaphod says:

    I drive past this chiropractor every day on my way home from work so I could not resist checking out their website (just so I’m being non-judgemental when I shake my head at them)

    http://www.wellnesschiropractic.net.au/

    It’s quite clear the central theme of their practice is the subluxation so I feel vindicated that my initial reaction was that they were not science-based practitioners.

    Anyway I draw your attention to the special sealed section of their website “for sceptics only”. It’s hilariously full of all the common (= poor) arguments used by “alties” to defend their practice. Enough strawmen to take down Hadrian’s wall, armed to the teeth with false dichotomies, and mis-direction.

    My question is who exactly is this aimed at? How many sceptics would really be convinced by that?

  70. windriven says:

    “If you think there are legitimate points and aspects to chiro that is great – we here agree.”

    Some of we here agree. At least one of we has yet to see any convincing evidence that chiropractic is anything but a crock of dung. Yes, there is evidence that chiropractic can be efficacious in the treatment of lower back pain. So can massage. So can NSAIDs. Building a psuedo-profession around the idea that it is about as good as Advil isn’t that compelling an argument.

  71. nybgrus says:

    I was being gracious and generous. I certainly don’t consider it a compelling argument, but you are correct – from myriad angles and facets there is little justification for the existence of chiropractic (probably none, really, but I’m trying to be gracious and generous again ;-))

  72. windriven says:

    @nybgrus

    “I was being gracious and generous.”

    You were and you clearly showed more maturity than I. I will admit that this is an issue that just frosts my chaps. Medical doctors make huge investments of time, money and deferred gratification to earn the appelation doctor and the trust that accompanies it. Dickweeds who want the honorific without the sweat equity raise my ire.

    It doubly inflames me when they claim licensure under false pretenses: “I’m licensed as a chiropractor but we both know chiropractic is horse hockey so instead I’ll treat you with some ad hoc therapies that I’ve pieced together from the parts of chiro school that might not have been horse hockey and (wait for it …) my clinical experience. But wait, there’s more! I’ll also sell you some vitamins and let me show you this new detergent from Amway.”

    I could heave.

  73. nybgrus says:

    @windriven:

    No doubt. I am living that huge investment of time, money, and deferred gratification (well, not really that – I often feel very gratified at the things I get to do an learn and view the whole process as one lifelong journey rather than a certain endpoint of gratification… though I will admit I am starting to want that long coat more often these days…).

    There are also people called “doctor” who specialize in Australian horror films which I think is ludicrous to devote one’s life to, but meh.

    I do agree there is a difference in that the “doctors” of chiro attempt to practice some kind of medicine and conflate themselves as being on the same level as an actual medical doctor. I just try not to let anything frost my chaps. It has been a hard earned lesson(s) for me that it is invariably better to un-frosted, as gracious as possible, and then devastate opponents with warm, pink chaps. ;-)

    The thing is I would much rather see chiros actually change and find a way to bring them into the fold (we really do need more PT/OT people after all) than just erase them entirely (kind of like how I would rather see religious people view theism rationally rather than outlaw or erase theology entirely). The DO’s proved it can be done. I think the DC’s need to follow suit and put up or shut up.

  74. nybgrus says:

    Ah, Mr. Beeblebrox,

    Adelaide is a city I have not visited… but would like to when I am back in Aus next year.

    In any event I took a quick skim of the skeptics section. This caught my eye:

    Today’s chiropractor receives a much broader education. In fact, it’s quite comparable to that received by medical practitioners.

    Firstly, interesting that they refer to us as “medical practitioners” separate from them (i.e. they are not medical practitioners), but secondly I would love to see them take the USMLE and see how well they fare, if they are comparably educated. No need for a high score – just pass. Any of the Steps.

    He also goes on to say that infants and newborns need adjustment due to birth trauma with adjustments no more forceful “than that used to test the ripeness of a tomato” and that parents see immediate benefits.

    You also don’t need a referall! (This is something we skeptics are so often concerned about). Thankfully, they alleviate that fear and say no, a referall is not needed… but your money is.

    Ack. I won’t even touch the placebo section.

  75. The Dave says:

    nybgrus:

    “The thing is I would much rather see chiros actually change and find a way to bring them into the fold (we really do need more PT/OT people after all) than just erase them entirely… The DO’s proved it can be done. I think the DC’s need to follow suit and put up or shut up.”

    Very well said. They could be a valuable member of the healthcare team. And they already seem to have a quite large fanbase. I can’t even count how many people I know have gone to, or currently see, a chiro

  76. @nybgrus and windriven: I agree, this huge sacrifice of time is one of the reasons why MDs should have a modicum of trust (not to mention the existence of a code of deontology). Can we say the same about CAM practitioners? How long does it take for a chiropractor or an acupuncturist to go through their training program and get their licensure? Is this process consistent across countries? Because after all, the medical program is. There are of course variations from country to country, but overall, we can expect a doctor trained in the United States to have a level of knowledge and practice similar to that of a doctor trained in France, Germany or the UK.

  77. Quill says:

    There are of course variations from country to country, but overall, we can expect a doctor trained in the United States to have a level of knowledge and practice similar to that of a doctor trained in France, Germany or the UK.

    Exactly so and one can see this simply by comparing licensing examinations. Or if you want anecdotes, talk to the doctors in Médecins Sans Frontières/Doctors Without Borders. They have no trouble working with colleagues from just about any country, often having to do so at the last minute and with significant language barriers. Fortunately, medicine is medicine and they can do excellent work because of that.

    None of the same can be said for chiropractors. “Chiros Without Borders”? Impossible. The ones that post here can’t even agree on fundamental principles with practitioners in their same state let alone from another country. And the fact that current chiros are just fine with some schools abandoning the philosophical foundation of the whole enterprise should be enough to point out that it wasn’t much of a foundation to begin with.

    And I hope it should be obvious that one year plus 250 hours of anything does not an expert make. ;-)

  78. “Chiropracteurs sans frontières”, that’s a good one, Quill. It’s interesting to see that most CAM practitioners operate in first world countries. What does this say about those practices, I wonder.

  79. nybgrus says:

    Funny how I post an article about DO’s coming “into the fold” as Dr. Hall described, along with various solid criticisms of specific chiro “treatments” and suddenly the chiropractor who is proclaiming a scientific basis of practice and that indeed the “profession” is changing disappears.

  80. Harriet Hall says:

    @nybgrus,

    A suggested explanation of your observation: DOs were willing to do whatever it took to meet the MD standards and come into the fold as equals; DCs want to be accepted into the fold on their own terms. DOs realized their education was substandard and they revamped it; DCs think their education about musculoskeletal conditions is superior to that of doctors, and some of them imagine their education has prepared them to be family doctors. DOs wanted to be doctors providing complete medical care including surgery and inpatient care of serious illness; DCs are still arguing among themselves about what they want to be.

  81. nybgrus says:

    I appreciate the devil’s advocate argument, Dr. Hall.

    And I am sure that they all actually are correct depending on which sub-population of each group you look at.

    But Wolfring here made specific claims that the field was already changing, made claims about therapies that have no basis in evidence or physiological understanding, and claimed that chiropractic was already scientifically based.

    My comment was brief for three reasons – 1)it was, to a degree, rhetorical, 2) I was in clinic between patients writing, and 3)I have been trying to learn from you to make points more briefly :-D

    The intent was to point out – and hopefully get Wolfring or any of our resident DC’s to respond – that the standard MO seems to be:

    1) Angrily protest that [X] was taken out of context
    2) Assert the scientific basis of chiropractic (whilst simultaneously stating the “just wait till science proves me right” gambit)
    3) Minimize the amount of quackery in DC schools, licensing exams, and practice
    4) Claim that MDs are just “out to get them and anyone they see as competition”
    5) Get refuted with solidly referenced evidence
    6) Make poor rebuttal arguments most oftenly repeating what they’ve already said, burning straw men, or a complete non-sequiter
    7) Disappear (+/- calling us meanings before exiting, stage left)

    Which is very much reminiscent of how those who blindly and doggedly defend an ideology or belief system tend to act.

  82. William M. London says:

    Dr. Hall,

    I think you made a strong case that this obscure book deserves its obscurity. I hope your post does not generate paradoxical interest in the book.

    You wrote: “Smith is irate because under Fishbein the AMA accepted advertising from tobacco companies, even touting the supposed health benefits of cigarettes. But they didn’t know any better. As soon as they did know better, in the 1950s, when evidence of harm mounted, they stopped accepting tobacco ads, well before the first Surgeon General’s Report was published.”

    I’m not sure that Fishbein and the AMA were as responsive to science as you seem to be suggesting.

    I recently looked over a book I have with a 1956 copyright by Peter J. Steincrohn, M.D., F.A.C.P. titled LIVE LONGER AND ENJOY IT! The book has a blurb on the cover by Fishbein that includes these sentences about Steincrohn: “He is aware of the new discoveries in medicine and he adapts them in the advice he gives… This book is replete with good advice and those who take it will have happier and longer lives.” On the inside front cover flap, is this blurb by W. W. Bauer, M.D., Director, Bureau of Health Education, AMA: “Dr. Steincrohn has done it again. …To a dull and inherently uninteresting topic, health, he brings a sparkle. But he never sacrifices the important fundamentals.”

    But on page 190 of the book, Steincrohn admits to being a smoker and wrote:

    “Being a doctor, wouldn’t I be stupid to smoke if I were sure tobacco is harmful? But I am not sure!

    “In spite of the recent storm of condemnation blanketing all cigarette smoking as an invitation to doom, I am yet to be convinced. And when I am, I shall be one of the first to forswear all smoking. The recent statistical data of the causal relationship b between cigarettes and lung cancer are not sufficiently overpowering.” (p. 190-191)

    At the bottom of p. 191, is a section with this heading: Go Ahead and Smoke–If You’re Healthy. (The section discusses how doctors should not be moralists and people should live their lives the way they want.)

  83. Harriet Hall says:

    @William London,

    I agree that the medical establishment was slower than it should have been to acknowledge the dangers of smoking, and I can think of a number of possible reasons. Nevertheless, the AMA did stop accepting tobacco advertising, and Smith’s condemnation is unreasonable and fails to recognize the historical milieu.

Comments are closed.