White Coat Underground

Why chiropractic is patently ridiculous

Blogging on Peer-Reviewed ResearchI am often asked my opinion of chiropractic care. My usual answer (based on evidence) is that it can be somewhat helpful in the treatment of low back pain. That’s it. Any further claims are complete and utter bullshit. Many chiropractors practice ethically, and recognize the correct scope of their abilities…many do not.

Adapted from RationalWiki
Chiropractic is the theory and practice of correction of “vertebral subluxation processes” to treat and cure disease. It was developed in the late 19th century, just before the development of modern medical education in the United States.

Chiropractors subscribe to the theory of “vertebral subluxation”. This differs from the medical definition considerably. An orthopaedic (real) subluxation is a painful partial dislocation of a vertebral body. A “chiropractic subluxation” is an asymptomatic misalignment or a “vertebral subluxation complex” thought to be a cause of disease. The mechanism posited is usually the blocking of nerve impulses from spinal roots, or some such nonsense. Such a subluxation has never been proven to exist.

Lest you think that this unproved hypothesis has died away, in July 1996, the Association of Chiropractic Colleges issued a consensus statement that:

Chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on the subluxation. A subluxation is a complex of functional and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health.

This hypothesis has never been tested, and ignores significant anatomical reality, such as the fact that much of the nervous system does not pass through “subluxations” in any way. This especially applies to the autonomic nervous system that “influences organ system function”.

According to the American Chiropractic Association:

The ACA Master Plan, ratified by the House of Delegates in June 1964 (Amended June 1979, June 1989, July 1994 and September 2000), and will govern future policies of ACA as quoted:
“With regard to the core chiropractic principle, which holds that the relationship between structure and function in the human body is a significant health factor and that such relationships between the spinal column and the nervous system are highly significant because the normal transmission and expression of nerve energy are essential to the restoration and maintenance of health.

That’s basically a re-statement of subluxation theory without the “s” word. It’s also patent bullshit.

So the chiropractors haven’t given up the absurd theory behind their “profession”—but does it work despite the poor theory? After all, outcomes are what count.

For back pain, there is evidence that chiropractic therapy may be as effective back exercises plus anti-inflammatory medications. Chiropractic has also been found to be slightly more effective than simply handing a patient a book about back care. In some studies, chiropractic did cost more overall. Specifically, a study comparing outcomes of acute low back pain treated by orthopedic surgeons, primary care physicians (PCP), and chiropractors found similar outcomes, but less cost from PCPs.

While 50-60% of patients who seek chiropractic care do so for back or neck pain, a significant number are treated for other problems. There is no evidence to support the use of chiropractic outside the realm of minor musculoskeletal complaints. Chiropractors who make any claims beyond low back pain are either dishonest, ignorant, or both. There is some evidence that (rarely) chiropractic care can cause stroke, carotid artery dissection, and other life-threatening problems.

Chiropractic may have a place in the treatment of low back pain—or it may not. Chiropractors are basically glorified massage therapists—except many massage therapists have better training, and know the limits of their profession. Chiropractors who discourage real medical care, vaccinations, and medications, or sell herbs and other potions out of their offices should be ashamed of themselves.

But of course, they have no shame.

————

References

  • McDonald W (2003) How Chiropractors Think and Practice: The Survey of North American Chiropractors. Institute for Social Research, Ohio Northern University
  • Samuel Homola, DC,Chiropractic: History and Overview of Theories and Methods, CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, Number 444, pp. 236-242,2006.
  • Shekelle PG, What Role for Chiropractic in Health Care? N Engl J Med 339:1074, October 8, 1998 Editorial
  • Carey TS, Garrett J, Jackman A, McLaughlin C, Fryer J, Smucker DR. The Outcomes and Costs of Care for Acute Low Back Pain among Patients Seen by Primary Care Practitioners, Chiropractors, and Orthopedic Surgeons, N Engl J Med 333:913, October 5, 1995 Special Article.
  • Balon J, Aker PD, Crowther ER, Danielson C, Cox PG, O’Shaughnessy D, Walker C, Goldsmith CH, Duku E, Sears MR A Comparison of Active and Simulated Chiropractic Manipulation as Adjunctive Treatment for Childhood Asthma. N Engl J Med 339:1013, October 8, 1998 Original Article.
  • Hufnagel A, Hammers A, Schonle P-W, Bohm K-D, Leonhardt G. Stroke following chiropractic manipulation of the cervical spine. J Neurol 1999;246:683-688.
  • Vickers A, Zollman C. The manipulative therapies: osteopathy and chiropractic. BMJ 1999;319:1176-1179.
  • Schievink WI, Mokri B, Piepgras D, Parisi J, Silbert P. Cervical artery dissections associated with chiropractic manipulation of the neck: the importance of preexisting arterial disease and injury. J Neurol 1996;243:Suppl 2:S92-S92.
  • Comments

    1. #1 Marc Weissman DC
      June 29, 2009

      A study in the May 2007 issue of the Journal of Manipulative and Physiological Therapeutics reports health plans that use Chiropractors as Primary Care Providers (PCPs) reduce their health care utilization costs significantly.

      The study covers the seven-year period from 1999 to 2005. Researchers compared costs and utilization data from an Independent Physicians Association (IPA) that uses Chiropractors as PCPs and a traditional HMO that doesn’t.

      The Chiropractic PCPs had 59 percent fewer hospitalizations, 62 percent fewer outpatient surgical cases and 85 percent lower drug costs compared with the HMO plans.

      The patients in the Chiropractic PCP group also reported higher satisfaction with their care than the HMO group. Over the seven-year period, Chiropractic patients consistently demonstrated a high degree of satisfaction with their care that ranged from 89 percent to 100 percent.

      Study co-author James Winterstein, D.C. says that patients using Chiropractic PCP health care groups “experienced fewer hospitalizations, underwent fewer surgeries and used considerably fewer pharmaceuticals than HMO patients who received traditional medical care.”

    2. #2 LanceR, JSG
      June 29, 2009

      And today’s prize for completely missing the point goes to…

      Marc Weissman, DC!! (YAY!)

      Way to completely ignore the valid criticism with a completely irrelevant study! And from a chiropractic journal? Wow. That won’t be a bit biased.

    3. #3 Daniel T Daly
      June 30, 2009

      Funny that the Balon et al study is cited. Have you read it? Terrible study. The control group was non existent. You might as well have “copied and pasted” a wikipedia article if you are going to use this RationalWiki article. Please don’t hide behind the guise of “evidence based medicine” while using no true evidence of your own to speak poorly of chiropractic.

      I like how your answer is “based on evidence.” What training do you have in chiropractic? Did you go to chiropractic school?

      Please don’t tell me that you know a chiropractor or you read a book. I know a lot of Internists, and I am not being unprofessional by bashing their lack of “evidence based” practice. It might be time to learn a bit more regarding the things about which you speak.

      Feel free to contact me and I can put you in touch with some of my patients to see if they have been helped with issues other than “back pain.” It would be great of you to tell them that it is all a bunch of “bullshit.”

      I look forward to hearing from you.

    4. #4 PalMD
      June 30, 2009

      To address the first point, i wrote the rationalwiki article, which is why i adapted it for the blog.

    5. #5 Richard Murray
      July 5, 2009

      Look, I’m no doctor or chiropractor, but patient satisfaction with the treatment doesn’t matter.

      If a “health care provider” offered a program of care involving an honour system drug prescription system for opiates or anything the patient believes they need, a relaxing massage, a couple shots of vodka, and some oral-genital stimulation, I’m going to bet that “patients” of this regimen are going to be pleased with the care they receive.

      Efficacy? Who knows so long as the patient believes that they’re getting good care, right, “Doctor” Marc? I mean, I can get plenty of anecdotal evidence regarding my Thai Massage regimen, though most of the patients would like to remain anonymous.

      Of COURSE people going to DCs and NDs and the like enjoy them more – they spend plenty of time with the patient, and there’s plenty of pseudoscientific words and phrases thrown out there to explain things.

      When was the last time a doctor explained the scientific actions of a drug they’re prescribing? They don’t typically explain because it takes too much back story, knowledge of chemistry and physiology, etc. However, when you make up your “science” as you go, an ND can easily explain how this magic herbal pill works to boost your immune system’s energy paths… no prior knowledge required.

      HMOs may be a problem with how doctors are required to work. This doesn’t have to mean that chiropractic is effective either.

    6. #6 Mark Campbell
      July 13, 2009

      I have been to many chiropractors all over the country (I was on tour for a year and a half). I have had several severe back issues over the years. The Chiropractors that I have seen have ranged from brilliant healers to utter quacks. But this ‘scientific refuting’ of chiropracty is also stupid because it completely ignores the simple fact that chiropractic treatment WORKS for many many people. Who cares why it works? According to Western Medicine Acupuncture is also bullshit. But as the years go by, more and more truth is being found in the practice (my father has a severe idiopathic blood disorder that is being kept in check by a combination of conventional western medicine, he is a retired doctor, and eastern medicines such as acupuncture.) Also, doctors are HUGE purveyors of theories and half-truths. Inbetween acting gigs I tempted off and on for four years for a major pharmaceutical company. If the general public knew how these ‘scientific studies’ proving the efficacy and safety of drugs were nerfed in the favor of the drug companies, heads would roll. My point here is not to say that all chiropractors are well-educated healers….but then again, many doctors are also not healers… Do I think a larger percentage of Doctors know what the hell they are doing then chiropractors…yes. But I also think a larger number of doctors believe they are infallable…which is, in my opinion, FAR more dangerous.

    7. #7 LanceR, JSG
      July 13, 2009

      False equivalence. “Most chiros are quacks, but some doctors are, too.”

      If chiro *really* worked, it would be mainstream. It has some benefit for lower back pain, about the same as a good massage, anything else is overpriced woo.

      So let’s compare: $100+ for chiro, vs @$50 for massage therapy. And let’s not forget; chiro kills.

      No real benefit + risk of stroke, paralysis, and death = crappy risk/benefit ratio.

    8. #8 the_lindsay
      August 4, 2009

      Good article PalMD – I admire your commitment in reading more than one chiropractic research article voluntarily.

      What my major malfunction with chiro is that any evidence (of varied quality) is coming in as an afterthought to a profession reaching it’s centenary. I’m comforted by reports that at least insurance companies are dismantling support for chiro for this reason.

      To Daniel T Daly (above): consider this table from the Centre for Evidence Based Medicine: http://www.cebm.net/index.aspx?o=1025, and note the lowly position of your expert opinion and case study-equivalent patients as a level of quality evidence.

      To Mark Campbell (above): knowledge of how therapies work is a cornerstone of medical science – it’s totally inadequate to accept a therapy with the mechanism remaining completely a mystery. Additionally, I’d say that uncertainty is a part of life – and the issue here is that at current it seems that the uncertainties surrounding chiropractice far outweight the evidence. While the same imbalance exists in medicine, it is possible to ask a physician why they have chosen a certain therapy, and at some point they could find the data to indicate that it is a reasonable assumption that the therapy would work in the majority of people. However in chiro, the same question put to a DC can only be answered in a quote: “because BJ said so”.

      That is all.

    9. #9 Anita
      October 15, 2009

      Lindsay, I am not sure I agree with your comment:

      “…it’s totally inadequate to accept a therapy with the mechanism remaining completely a mystery.”

      I believe many people do this- patients and doctors. Medicine (Western and otherwise) is (much to many people’s surprise and dismay) is as much as an art as well as a science. Talk to a psychiatrist on why they prescribe their therapies and how they titrate their patient’s doses. Talk to an oncologist on how they use their best knowledge to treat rare cancers or come up with a chemo regimen. Learn about how medical procedures and treatments were historically discovered and studied. Ask a patient how any of their drugs work. Ask millions of consumers why they buy peptobismal. Do you know that we still don’t know the mechanism of action for bismuth?? I find it hilarious!

      The more I learn about medicine in my program, the more I realize that we really haven’t elucidated mechanisms for a surprising number of things. We have standards of care and individualized care and careful monitoring to help us treat patients.

      Right?

    10. #10 Chris
      November 17, 2009

      Thanks for this article. My wife has had significant lower back pain and was considering going to a chiropractor. I wasn’t sure if they were complete bullshit (outrageous claims to cure anything and everything) or just partially (could it work for lower back pain?). Now I think we can make a more informed decision.

      Good luck dealing with all these other loons!

    11. #11 Philip Tan-Gatue, MD
      November 18, 2009

      The problem with chiropractic is that there are actually different styles – some which manipulate ONLY the muscles while others put pressure on the vertebrae themselves. There are obvious dangers in the latter method, particular in the osteoporotic, geriatric patients that seek chiro for low back pain relief.

    12. #12 d
      November 18, 2009

      to say subluxation is bull shit shows a lack of professionalism and a lack of acurate research on the subject.do your homewoek nwxt time

    13. #13 PalMD
      November 18, 2009

      Would you care to give some evidence to support your typographically challenged assertion?