Mark Hoofnagle has a MD and PhD in physiology from the University of Virginia, and is now a general surgery resident. His interest in denialism concerns the use of denialist tactics to confuse public understanding of scientific knowledge.
As you may have read earlier, the only thing chriopractic has ever really been shown to do is to help low back pain about as well as conventional therapy. That doesn't stop chiropractors from doing whatever they want. It sure seems harmless enough, though---you back or neck hurts, some guy moves it around, and you feel better---and all without drugs! What could it hurt, right?
With any medical or physical intervention, things can go wrong, sometimes horribly wrong. For example, when I treat someone with an ACE inhibitor, I run the risk of causing a serious drug reaction. But the benefits far outweigh the risks. Also, I know what problems to look for, and how to treat them. These drugs save kidneys, hearts, and lives, so the payoff is worth the small risk.
What of chiropractic? Well, Harriet Hall over at sciencebasedmedicine.com just saved me a lot of time. Vertebral artery dissection (VAD), a rare type of stroke, has been linked to chiropractic neck manipulation. It's hard to count precisely, but the Canadian literature has some decent reports. What the reports show is that there is a clear link between VAD and chiropractic. How many of these strokes are caused by neck manipulation is less clear, and that's where some serious crankery comes in.
Some chiropractors will tell you that if there is a risk, it is quite small, so why worry? But about 10% of people with VAD die. That's DIE. And they are often young (average early 40s).
There is no proven benefit to chiropractic manipulation of the neck. It is associated with a rare and very dangerous type of stroke. In judging the risk/benefit ratio, the answer here is clear---don't let a chiro touch your neck---never, never, never.
Medicine & Health
Comments
I'm looking right now at the back page of my local paper which has a full page ad for a chain of Chiropractic clinics. They suggest that Chiropractic may be the answer for a number of ailments including: Asthma, Digestive problems, ear infections, headaches, high blood pressure, numbness in limbs, neck pain ... I'm amazed that something so irresponsible can be advertised in this way. Still, despite the seriousness I can't help but laugh at the claim "Twenty-first century technology makes chiropractic both scientific and safe"!
Posted by: Stu | April 30, 2008 5:16 AM
A couple months ago, the chiro magazine (Dynamic Chiropractic) ran an article lamenting those chiros who advertise that do not perform the stroke-inducing neck-snap. Normally, I note that 90+% of chiros make the rest look bad; this is a case where 1% of chiros show the rest are bad.
Posted by: Joe | April 30, 2008 8:10 AM
Chripractic is the greatest medical fraud ever perpetrated on the American public.
Posted by: Science Avenger | April 30, 2008 9:43 AM
PalMD, could you do a short entry, please, on exactly what kind of school chiropractors attend that they can call themselves "doctors," "physicians," and "medical directors?" Two years study, I think, is roughly the equivalent of a community college degree, no? What courses do they take? Are these courses "medical" in any mainstream sense of the layman's understanding of the term? When they get a license to practice, do they have to pass "state boards?" Perform internships? Residencies? Carry malpractice insurance? In short, apart from submitting themselves to brainwashing into a faith-based system, what actual training do they undergo? Thanks for any light you can shed on "schools" of chiropractic.
Posted by: Old Word Wolf | April 30, 2008 10:50 AM
Old World Wolf:
See the "chiropractic education" section here:
http://www.chirobase.org/
Posted by: Manduca | April 30, 2008 11:37 AM
Thanks! I had, indeed, forgotten to check Stephen Barrett's resource before asking that question!
Posted by: Old Word Wolf | April 30, 2008 2:10 PM
LOL. Yeah, chiropractic as a discipline even rejects the germ theory of disease, and nobody yet has come up with a consistent definition of what in the world a 'subluxation' is.
HOWEVER. Every once in a while I'll be doing something involving upper body strength, and I'll feel a little "thump" between my shoulder blades. Happens about every two years, give or take a year between. Suddenly it hurts to breath, to move my arms, you name it. My Doctor's solution? Take flexeril and wait three to four weeks. I go to my chiro, he thumps and crunches my back, and by the next morning I'm all good again, with no hangover.
I think that Chiro is a case study in someone developing bullshit explanations to explain why something worked (spinal manipulation). Orthopedic doctors will tell you your spine isn't misaligned, or you'd be paralyzed (I have, in fact, been told that by the doctor writing me a scrip for Flexeril).
Chiro "science" is undoubtedly woo of the first water, but spinal manipulation works for some things.
Posted by: Steve | May 1, 2008 1:17 PM
@Steve, "Chiro "science" is undoubtedly woo of the first water, but spinal manipulation works for some things."
Spinal manipulation is not chiro- chiro is "adjustment" of imaginary subluxations. "Manipulation" is the province of masseurs and some health professionals (e.g., PTs). Your chiro is a masseur, with delusions of grandeur.
Posted by: Joe | May 1, 2008 3:34 PM
I agree that chiropractors offer little beside placebo benefit and do have the potential to do harm, but you minimize the negative side of allopathic medicine.
There is much that is done with more conventional therapy that is also of questionable or no benefit and at a minimum is costly for the patient or causes injury or death. For example, the misuse of antibiotics, steroids or the inappropriate use of drugs for a given patient or interact adversely with each other. As far as procedures are concerned, there are certainly plenty of surgeries that are done that are of questionable benefit. These may include at times orthopedic surgery, coronary surgery,tonsillectomies, hysterectomies, c-sections. Although difficult to get accurate information, it is likely than tens of thousands of procedures fall into the area of unnecessary or without demonstrated efficacy.
When commenting about chiropractors, allopathic physicians should be honest about their own deficiencies.
Posted by: ron field | May 1, 2008 5:24 PM
Um, Ron, that's kind of what evidence-based medicine is all about.
Just a quick look at current journals shows that these questions are being asked every day.
For example:
this looks at complication and success rates of various treatments for heart disease.
this examines harm vs benefit of certain prostate cancer treatments.
EBM is all about looking for evidence for how to approach prevention and illness. These concerns you raise are the basis of medical research.
Find me a chiropractor who studies complications.
Posted by: PalMD
| May 1, 2008 6:05 PM
Ron, that's terribly dishonest. None of the medical procedures you mentioned are "placebos at best," so your comparison is total crap. "Placebo with potential to do harm" is completely different from "helpful with potential for misuse."
No one would ever argue that conventional medicine is occasionally practiced incorrectly. A perfect diagnosis isn't always possible, sure. But to lump real medicine with those potentially-damaging placebos is a false comparison, and an irresponsible one.
Posted by: Brian | May 3, 2008 11:32 PM
I have a question to ask about one chiropractor in particular.
This chiro, Paul Whitcomb (http://stopfibro.com/), says the cause of Fibromyalgia is "an upper cervical spinal stenosis, which is actually a choking off of the spinal cord structures -- but not so much of the spinal cord as the meninges, the coverings of the spinal cord itself." (To see this opinion on Whitcomb's site you have to log in and give info I certainly would rather he not have about me, but you can see it in an interview here: http://www.naturalnews.com/008526.html.)
So, what Whitcomb actually says on his site (yeah, I lied to get this) as of today, July 13, 2008, is:
"Cause and Effects of Fibromyalgia
"A pulling on the meninges by way of encroachment or torquing appears to cause Fibromyalgia. This intrusion could indicate a tumor or other malformation, but we find that it is most often due to a change in alignment between the Occipital and the Atlas (C-1), which can reduce or distort the space through which the spinal cord and meninges must traverse the foramen magnum.
"The foramen magnum, which is the opening in the skull that the spinal cord passes through, must line up precisely with the first vertebra in order for the spinal nerves to function properly. If there is a rotation or subluxation that compromises this precise alignment, it may impede that delicate process and cause a misfiring of normal impulses to the brain.
"Any tugging on the meninges (remember the meninges attaches to the spinal nerve roots and the cranial nerves) can have devastating effects on this critical and sensitive nerve action, which in turn can produce a galaxy of undesirable symptoms."
And
""The Whitcomb Technique"
"We do not claim to treat Fibromyalgia. We are moving on the premise that it is a condition of the cervical spine causing an uncontrolled firing of the nervous system. The aim of The Whitcomb Technique is simply to reduce the subluxation that causes the symptoms we know as "Fibromyalgia."
"The procedure involves the movement of the atlas (the first cervical vertebra) in relationship to the occipital (the back and underside of the skull). Actually it is not one technique; it is a series of techniques that are applied at the appropriate times. Some of these are modifications of standard techniques and some we have developed. Those we use today are quite different from those used even one year ago. It has taken five years to develop this treatment and it is still being refined.
"Our objective is to free up the neurological structures that are being encroached upon, thus allowing the brain and spinal cord to return to normal function. In most cases, there is little or no pain associated with this procedure. Where there has been severe trauma and many years in which to develop arthritis in the neck, the adjustments may be more painful, but not intolerable. Any pain associated with the treatment usually lasts only seconds. If there is fibrosis or scar tissue in the affected joints there can be some mild soreness after the first two or three days of initial treatments.
"The typical three-times-a-week treatment the average chiropractic patient receives is not sufficient to accomplish this for Fibromyalgia patients, and response is limited. While the length of treatment for most people is generally two or three times a day over a period of eight to ten weeks (eight weeks usually works the best and is the standard for most patients), the treatment schedule often needs personal customization to meet individual conditions. The longer time period we used at first has been refined and shortened by using a more intensive treatment schedule of two or three treatments a day. This is simply because it is in the nature of Fibromyalgia and its causative mechanisms for the atlas to quickly return to the abnormal state where it has been for so long. And so it becomes of the utmost importance to hold the correction completely in place while the affected ligaments adjust and the body attempts to maintain this new position."
So, my question is, knowing what we know about cervical chiropractic adjustment, why oh why is this guy allowed to do this to people at least 112 times in an 8 week period (2x7=14, 14x8=112)?
My other reason for posting a comment here is the hope that someone besides me will be inspired to write about this quack. Preferably someone with actual medical training. Yeah, he will threaten to sue.
Posted by: Sherril | July 13, 2008 6:26 PM
Sherril wrote "So, my question is, knowing what we know about cervical chiropractic adjustment, why oh why is this guy allowed to do this to people ..."
The first consideration is that chiro is not really regulated, and they are free to make stuff up. As long as their licensing board (the inmates in charge of the asylum) says they are practicing within their standards of practice, they are immune to criminal sanctions. That is the fault of our legislators.
This guy is probably a NUCCA nut who thinks everything revolves around the Atlas vertebra (in the neck). The Logan technique says everything depends on the other end (and they skirt sexual assault claims). They are protected by legislation and board certification.
You may like to see
http://www.sciencebasedmedicine.org/?p=152
and see what else they have to say about chiro.
Also www,chirobase.org
PalMD has written about this here and at his archived site, you can search them as well.
Posted by: Joe | July 13, 2008 7:48 PM
"their licensing board (the inmates in charge of the asylum)"--You got that right. Thanks for the link. I wonder when a lawsuit like this one is going to happen in the U.S. Seems way overdue.
Posted by: Sherril | July 14, 2008 12:23 PM
Sherril, I'd never seen that lovely quote. Thanks.
Posted by: PalMD
| July 14, 2008 12:26 PM