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== Ethics and claims == == Ethics and claims ==


Chiropractic does not have the same level of mainstream credibility as other healthcare professions.<!-- <ref name=Murphy-pod/> --> <!--Public perception of chiropractic compares unfavorably with mainstream medicine with regard to ethics and honesty: in--> A 2006 ] of U.S. adults, chiropractors rated last among seven health care professions for being very high or high in honesty and ethical standards, with 36% of poll respondents rating chiropractors very high or high; the corresponding ratings for other professions ranged from 38% for psychiatrists to 84% for nurses.<ref name=Murphy-pod>{{cite journal |author= Murphy DR, Schneider MJ, Seaman DR, Perle SM, Nelson CF |title= How can chiropractic become a respected mainstream profession? the example of podiatry |journal= Chiropr Osteopat |volume=16 |pages=10 |year=2008 |pmid=18759966 |doi=10.1186/1746-1340-16-10 |url=http://chiroandosteo.com/content/pdf/1746-1340-16-10.pdf |format=PDF}}</ref><ref>{{cite journal |journal= Dyn Chiropr |volume=25 |issue=3 |date=2007 |title= Gallup Poll: Americans have low opinion of chiropractors' honesty and ethics |url=http://dynamicchiropractic.com/mpacms/dc/article.php?id=52038}}</ref><ref>{{cite news |title= USA TODAY/Gallup poll |url=http://usatoday.com/news/polls/tables/live/2006-12-11-ethics.htm |work= USA Today |date=2006-12-11}}</ref> Chiropractic does not have the same level of mainstream credibility as other healthcare professions.<!-- <ref name=Murphy-pod/> --> <!--Public perception of chiropractic compares unfavorably with mainstream medicine with regard to ethics and honesty: in--> A 2006 ] of U.S. adults, chiropractors rated last among seven health care professions for being very high or high in honesty and ethical standards, with 36% of poll respondents rating chiropractors very high or high; the corresponding ratings for other professions ranged from 62% for dentists to 84% for nurses.<ref name=Murphy-pod>{{cite journal |author= Murphy DR, Schneider MJ, Seaman DR, Perle SM, Nelson CF |title= How can chiropractic become a respected mainstream profession? the example of podiatry |journal= Chiropr Osteopat |volume=16 |pages=10 |year=2008 |pmid=18759966 |doi=10.1186/1746-1340-16-10 |url=http://chiroandosteo.com/content/pdf/1746-1340-16-10.pdf |format=PDF}}</ref><ref>{{cite journal |journal= Dyn Chiropr |volume=25 |issue=3 |date=2007 |title= Gallup Poll: Americans have low opinion of chiropractors' honesty and ethics |url=http://dynamicchiropractic.com/mpacms/dc/article.php?id=52038}}</ref><ref>{{cite news |title= USA TODAY/Gallup poll |url=http://usatoday.com/news/polls/tables/live/2006-12-11-ethics.htm |work= USA Today |date=2006-12-11}}</ref>


A 2008 commentary proposed that the chiropractic profession actively regulate itself to combat abuse, fraud, and ], which are more prevalent in chiropractic than in other health care professions, violating the ] between patients and physicians.<ref name=Murphy-pod/> <!--Unsubstantiated claims about the efficacy of chiropractic have continued to be made by individual chiropractors and chiropractic associations.<ref name=Ernst-eval/>--> The largest chiropractic associations in the U.S. and Canada distributed patient brochures which contained unsubstantiated claims.<ref>{{cite journal |author= Grod JP, Sikorski D, Keating JC |title= Unsubstantiated claims in patient brochures from the largest state, provincial, and national chiropractic associations and research agencies |journal= J Manipulative Physiol Ther |volume=24 |issue=8 |pages=514–9 |year=2001 |pmid=11677551 |doi=10.1067/mmt.2001.118205}}</ref> Chiropractors, especially in America, have a reputation for unnecessarily treating patients. <!--In many circumstances the focus seems to be put on economics instead of health care.--><ref>{{cite book |pages=145–90 |chapter= The truth about chiropractic therapy |title= Trick or Treatment: The Undeniable Facts about Alternative Medicine |author= Singh S, Ernst E |year=2008 |publisher= W.W. Norton |isbn=978-0-393-06661-6}}</ref> Sustained chiropractic care is promoted as a preventative tool but unnecessary manipulation could possibly present a risk to patients. Some chiropractors are concerned by the routine unjustified claims chiropractors have made.<ref name=Ernst-eval/> A study of California disciplinary statistics during 1997–2000 reported 4.5 disciplinary actions per 1000 chiropractors per year, compared to 2.27 for MDs; the incident rate for fraud was 9 times greater among chiropractors (1.99 per 1000 chiropractors per year) than among MDs (0.20).<ref>{{cite journal |author= Foreman SM, Stahl MJ |title= Chiropractors disciplined by a state chiropractic board and a comparison with disciplined medical physicians |journal= J Manipulative Physiol Ther |volume=27 |issue=7 |pages=472–7 |year=2004 |pmid=15389179 |doi=10.1016/j.jmpt.2004.06.006}}</ref> A 2008 commentary proposed that the chiropractic profession actively regulate itself to combat abuse, fraud, and ], which are more prevalent in chiropractic than in other health care professions, violating the ] between patients and physicians.<ref name=Murphy-pod/> <!--Unsubstantiated claims about the efficacy of chiropractic have continued to be made by individual chiropractors and chiropractic associations.<ref name=Ernst-eval/>--> The largest chiropractic associations in the U.S. and Canada distributed patient brochures which contained unsubstantiated claims.<ref>{{cite journal |author= Grod JP, Sikorski D, Keating JC |title= Unsubstantiated claims in patient brochures from the largest state, provincial, and national chiropractic associations and research agencies |journal= J Manipulative Physiol Ther |volume=24 |issue=8 |pages=514–9 |year=2001 |pmid=11677551 |doi=10.1067/mmt.2001.118205}}</ref> Chiropractors, especially in America, have a reputation for unnecessarily treating patients. <!--In many circumstances the focus seems to be put on economics instead of health care.--><ref>{{cite book |pages=145–90 |chapter= The truth about chiropractic therapy |title= Trick or Treatment: The Undeniable Facts about Alternative Medicine |author= Singh S, Ernst E |year=2008 |publisher= W.W. Norton |isbn=978-0-393-06661-6}}</ref> Sustained chiropractic care is promoted as a preventative tool but unnecessary manipulation could possibly present a risk to patients. Some chiropractors are concerned by the routine unjustified claims chiropractors have made.<ref name=Ernst-eval/> A study of California disciplinary statistics during 1997–2000 reported 4.5 disciplinary actions per 1000 chiropractors per year, compared to 2.27 for MDs; the incident rate for fraud was 9 times greater among chiropractors (1.99 per 1000 chiropractors per year) than among MDs (0.20).<ref>{{cite journal |author= Foreman SM, Stahl MJ |title= Chiropractors disciplined by a state chiropractic board and a comparison with disciplined medical physicians |journal= J Manipulative Physiol Ther |volume=27 |issue=7 |pages=472–7 |year=2004 |pmid=15389179 |doi=10.1016/j.jmpt.2004.06.006}}</ref>

Revision as of 16:59, 9 June 2009

Since its inception in 1895, chiropractic has been the subject of controversy and criticism.

Edzard Ernst has stated that chiropractic is rooted in mystical concepts which led to internal conflict within the profession. For most of its existence, chiropractic has battled with mainstream medicine, sustained by what are characterized as antiscientific and pseudoscientific ideas such as subluxation. The core concepts of chiropractic, vertebral subluxation and spinal manipulation, are not based on solid science.

History

Main article: Chiropractic history

According to D.D. Palmer, the founder of chiropractic, subluxation is the sole cause of disease and manipulation is the cure of all disease for the human race. Chiropractic is rooted in mystical concepts, leading to internal conflicts between straights and mixers which continue to this day. It has two main groups: "straights", now the minority, emphasize vitalism, innate intelligence and spinal adjustments, and consider subluxations to be the leading cause of all disease; "mixers" are more open to mainstream and alternative medical techniques such as exercise, massage, nutritional supplements, and acupuncture.

For much of the history of the chiropractic profession chiropractors shown little interest in scientific research and have regarded their principles and practices as valid. Despite heavy opposition by mainstream medicine, by the 1930s chiropractic was the largest alternative healing profession in the U.S. The longstanding feud between chiropractors and medical doctors continued for decades. The AMA labeled chiropractic an "unscientific cult" in 1966, and until 1980 held that it was unethical for medical doctors to associate with "unscientific practitioners". This culminated in a landmark 1987 decision, Wilk v. AMA, in which the court found that the AMA had engaged in unreasonable restraint of trade and conspiracy, and which ended the AMA's de facto boycott of chiropractic.

Serious research to test chiropractic theories did not begin until the 1970s, and is continuing to be hampered by what are characterized as antiscientific and pseudoscientific ideas that sustained the profession in its long battle with organized medicine. By the mid 1990s there was a growing scholarly interest in chiropractic, which helped efforts to improve service quality and establish clinical guidelines that recommended manual therapies for acute low back pain.

Ethics and claims

Chiropractic does not have the same level of mainstream credibility as other healthcare professions. A 2006 Gallup Poll of U.S. adults, chiropractors rated last among seven health care professions for being very high or high in honesty and ethical standards, with 36% of poll respondents rating chiropractors very high or high; the corresponding ratings for other professions ranged from 62% for dentists to 84% for nurses.

A 2008 commentary proposed that the chiropractic profession actively regulate itself to combat abuse, fraud, and quackery, which are more prevalent in chiropractic than in other health care professions, violating the social contract between patients and physicians. The largest chiropractic associations in the U.S. and Canada distributed patient brochures which contained unsubstantiated claims. Chiropractors, especially in America, have a reputation for unnecessarily treating patients. Sustained chiropractic care is promoted as a preventative tool but unnecessary manipulation could possibly present a risk to patients. Some chiropractors are concerned by the routine unjustified claims chiropractors have made. A study of California disciplinary statistics during 1997–2000 reported 4.5 disciplinary actions per 1000 chiropractors per year, compared to 2.27 for MDs; the incident rate for fraud was 9 times greater among chiropractors (1.99 per 1000 chiropractors per year) than among MDs (0.20).

Some New Zealand chiropractors appeared to have used the title 'Doctor' in a New Zealand Yellow pages telephone directory in a way that implied they are registered medical practitioners, when no evidence was presented it was true.

On 19 April 2008, Simon Singh wrote an article in the The Guardian. which resulted in him being sued for libel by the British Chiropractic Association. The suit is ongoing, with Singh stating that he will "contest the action vigorously... There is an important issue of freedom of speech at stake." The article developed the theme of Singh's recently published book Trick or Treatment? Alternative Medicine on Trial, making various claims about the usefulness of chiropractic. Commentators suggest this ruling could set a precedent to restrict freedom of speech to criticise alternative medicine.

Efficacy

Not all criticism originated from critics in the medical profession. Some chiropractors are cautiously calling for reform. Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs what is considered by many chiropractic researchers to be antiscientific reasoning and unsubstantiated claims, that are ethically suspect when they let practitioners maintain their beliefs to patients' detriment.

Vertebral subluxation and spinal manipulation, the core concepts of chiropractic, is not based on solid science. The dogma of subluxation is the biggest single barrier to professional development for chiropractors. The concept of subluxation remains unsubstantiated and largely untested, and has been debated about whether to keep it in the chiropractic paradigm for decades. The cost, effectiveness, and safety, of spinal manipulation are uncertain. A 2007 survey of Alberta chiropractors found that they do not consistently apply research in practice, which may have resulted from a lack of research education and skills.

A 1989 commentary in the American Journal of Public Health stated:

Chiropractors were among early opponents to fluoridation in the United States. Some continue to oppose flouridation in many areas as being an infringement of personal freedom, a dictate of organized medicine, and incompatible with chiropractic nutritional philosophy. More recently, some chiropractors are active as proponents to fluoridation and several chiropractic organizations are reaching out to the scientific community by endorsing the scientific principles of public health.

References

  1. ^ Ernst E (2008). "Chiropractic: a critical evaluation". J Pain Symptom Manage. 35 (5): 544–62. doi:10.1016/j.jpainsymman.2007.07.004. PMID 18280103.
  2. ^ Keating JC Jr, Cleveland CS III, Menke M (2005). "Chiropractic history: a primer" (PDF). Association for the History of Chiropractic. Retrieved 2008-06-16.{{cite web}}: CS1 maint: multiple names: authors list (link)
  3. Kaptchuk TJ, Eisenberg DM (1998). "Chiropractic: origins, controversies, and contributions". Arch Intern Med. 158 (20): 2215–24. doi:10.1001/archinte.158.20.2215. PMID 9818801.
  4. ^ Craig F. Nelson. (1999) Spinal Manipulation and Chiropractic: Views of a Reformist Chiropractor, American Council on Science and Health.
  5. Martin SC (1993). "Chiropractic and the social context of medical technology, 1895–1925". Technol Cult. 34 (4): 808–34. doi:10.2307/3106416. PMID 11623404.
  6. Johnson C, Baird R, Dougherty PE; et al. (2008). "Chiropractic and public health: current state and future vision". J Manipulative Physiol Ther. 31 (6): 397–410. doi:10.1016/j.jmpt.2008.07.001. PMID 18722194. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  7. Cherkin D (1989). "AMA policy on chiropractic". Am J Public Health. 79 (11): 1569–70. doi:10.2105/AJPH.79.11.1569-a. PMC 1349822. PMID 2817179.
  8. Cooper RA, McKee HJ (2003). "Chiropractic in the United States: trends and issues". Milbank Q. 81 (1): 107–38. doi:10.1111/1468-0009.00040. PMID 12669653.
  9. ^ Murphy DR, Schneider MJ, Seaman DR, Perle SM, Nelson CF (2008). "How can chiropractic become a respected mainstream profession? the example of podiatry" (PDF). Chiropr Osteopat. 16: 10. doi:10.1186/1746-1340-16-10. PMID 18759966.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
  10. "Gallup Poll: Americans have low opinion of chiropractors' honesty and ethics". Dyn Chiropr. 25 (3). 2007.
  11. "USA TODAY/Gallup poll". USA Today. 2006-12-11.
  12. Grod JP, Sikorski D, Keating JC (2001). "Unsubstantiated claims in patient brochures from the largest state, provincial, and national chiropractic associations and research agencies". J Manipulative Physiol Ther. 24 (8): 514–9. doi:10.1067/mmt.2001.118205. PMID 11677551.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  13. Singh S, Ernst E (2008). "The truth about chiropractic therapy". Trick or Treatment: The Undeniable Facts about Alternative Medicine. W.W. Norton. pp. 145–90. ISBN 978-0-393-06661-6.
  14. Foreman SM, Stahl MJ (2004). "Chiropractors disciplined by a state chiropractic board and a comparison with disciplined medical physicians". J Manipulative Physiol Ther. 27 (7): 472–7. doi:10.1016/j.jmpt.2004.06.006. PMID 15389179.
  15. Gilbey A (2008). "Use of inappropriate titles by New Zealand practitioners of acupuncture, chiropractic, and osteopathy". N Z Med J. 121 (1278): 15–20. PMID 18670471.
  16. ^ Singh, Simon (2008-04-19). "Beware the spinal trap". The Guardian. Archived from the original on 2008-11-13. Retrieved 2009-01-21.
  17. Comment is Free, The Guardian
  18. Eden, R (2008-08-16). "Doctors take Simon Singh to court". The Daily Telegraph. Retrieved 2008-12-12.
  19. "Chiropractic critic loses first round in libel fight". New Scientist. 15 May 2009. Retrieved 2009-05-19.
  20. Green, David Allen (13 May 2009). "Comment: Don't criticise, or we'll sue". New Scientist. Retrieved 2009-05-19.
  21. Jaroff, Leon (February 27, 2002). "Back Off, Chiropractors!". CNN. Time magazine. Retrieved 2009-06-07.
  22. Nelson CF, Lawrence DJ, Triano JJ; et al. (2005). "Chiropractic as spine care: a model for the profession". Chiropr Osteopat. 13: 9. doi:10.1186/1746-1340-13-9. PMID 16000175. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
  23. ^ Keating JC Jr, Charlton KH, Grod JP, Perle SM, Sikorski D, Winterstein JF (2005). "Subluxation: dogma or science?". Chiropr Osteopat. 13: 17. doi:10.1186/1746-1340-13-17. PMID 16092955.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
  24. Science, antiscience, materialism and vitalism:
    • Keating JC Jr (1997). "Chiropractic: science and antiscience and pseudoscience side by side". Skept Inq. 21 (4): 37–43.
    • Phillips RB (2005). "The evolution of vitalism and materialism and its impact on philosophy". In Haldeman S, Dagenais S, Budgell B et al. (eds.) (ed.). Principles and Practice of Chiropractic (3rd ed.). McGraw-Hill. pp. 65–76. ISBN 0-07-137534-1. {{cite book}}: |editor= has generic name (help)CS1 maint: multiple names: editors list (link)
  25. Nelson CF, Lawrence DJ, Triano JJ; et al. (2005). "Chiropractic as spine care: a model for the profession". Chiropr Osteopat. 13: 9. doi:10.1186/1746-1340-13-9. PMID 16000175. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
  26. Subluxation: dogma or science?
  27. Suter E, Vanderheyden LC, Trojan LS, Verhoef MJ, Armitage GD (2007). "How important is research-based practice to chiropractors and massage therapists?". J Manipulative Physiol Ther. 30 (2): 109–15. doi:10.1016/j.jmpt.2006.12.013. PMID 17320731.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  28. Jones RB, Mormann DN, Durtsche TB (1989). "Fluoridation referendum in La Crosse, Wisconsin: contributing factors to success" (PDF). Am J Public Health. 79 (10): 1405–8. doi:10.2105/AJPH.79.10.1405. PMC 1350185. PMID 2782512.{{cite journal}}: CS1 maint: multiple names: authors list (link)

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