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There is much debate in the '''scientific inquiries into chiropractic care'''. Since its inception, ] has been the subject of controversy. Criticism has also come from philosophical conflicts within the profession and critics outside the profession. The conflicts within the profession comes from the differing schools of thought. There are four main varying groups of chiropractors: "traditional straights", "objective straights", "mixers", and "reform".<ref name="choose a chiropractic"> | |||
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|quote=}}</ref><ref name="chiropractic overview"> | |||
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|title=NCAHF Position Paper on Chiropractic — The Reformers | |||
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|quote=}}</ref> All groups, except reform, treat patients using a subluxation-based system. Differences are based on the philosophy for adjusting, claims made about the effects of those adjustments, and additional treatments provided with the adjustment. Chiropractic has received critiques from the scientic community. Historically, these have indirectly led to the scientific investigation of chiropractic. As a result of this criticism, as well as the relative dissatisfaction with its medical counterpart, the chiropractic philosophy is still evolving toward more scientific practices. | |||
Throughout its history, ] has been the subject of internal and external controversy and criticism.<ref name=Kaptchuk-Eisenberg>{{cite journal |pmid=9818801 |date=November 1998 |last1=Kaptchuk |first1=TJ |last2=Eisenberg |title=Chiropractic: origins, controversies, and contributions |volume=158 |issue=20 |pages=2215–24 |issn=0003-9926 |journal=Archives of Internal Medicine |doi=10.1001/archinte.158.20.2215 |first2=DM|doi-access=free }}</ref><ref name=Jaroff>{{cite magazine |last=Jaroff |first=Leon |title=Back Off, Chiropractors! |url=http://content.time.com/time/health/article/0,8599,213482,00.html |date=27 February 2002 |magazine=] |access-date=7 June 2009}}</ref> According to ] ], the founder of chiropractic, "]" was the sole cause of all diseases and manipulation was the cure for all disease.<ref name=Ernst-eval>{{cite journal |pmid=18280103 |date=May 2008 |last1=Ernst |first1=E |title=Chiropractic: a critical evaluation |volume=35 |issue=5 |pages=544–62 |issn=0885-3924 |doi=10.1016/j.jpainsymman.2007.07.004 |journal=]|doi-access=free }}</ref><ref name=":0">{{Cite journal |last1=Kaptchuk |first1=Ted J. |last2=Eisenberg |first2=David M. |date=1998-11-09 |title=Chiropractic: Origins, Controversies, and Contributions |url=http://archinte.jamanetwork.com/article.aspx?doi=10.1001/archinte.158.20.2215 |journal=Archives of Internal Medicine |language=en |volume=158 |issue=20 |pages=2215–2224 |doi=10.1001/archinte.158.20.2215 |pmid=9818801 |issn=0003-9926}}</ref> Internal divisions between "straights," who adhere strictly to Palmer’s original philosophy, and "mixers," who incorporate broader medical practices, have further complicated the profession’s identity.<ref name=":0" /> A 2003 profession-wide survey found "most chiropractors (whether 'straights' or 'mixers') still hold views of Innate Intelligence and of the cause and cure of disease (not just back pain) consistent with those of the Palmers".<ref name=Brown2014>{{cite news|first=Candy|last=Gunther Brown|title=Chiropractic: Is it Nature, Medicine or Religion?|url=http://www.huffingtonpost.com/candy-gunther-brown-phd/chiropractic-is-it-nature_b_5559654.html|work=]|date=July 7, 2014}}</ref> A critical evaluation stated "Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today."<ref name=Ernst-eval/> Chiropractors, including D.D. Palmer, were ]ed for ].<ref name=Ernst-eval/> D.D. Palmer considered establishing chiropractic as a ] to resolve this problem.<ref name=Palmer_religion>{{Citation |last=Palmer |first=Daniel |date=May 4, 1911 |title=D. D. Palmer's Religion of Chiropractic |publisher=The Chiropractic Resource Organization |url=http://www.chiro.org/Plus/History/Persons/PalmerDD/PalmerDD%27s_Religion-of-Chiro.pdf |access-date=February 22, 2015 }}</ref> For most of its existence, chiropractic has battled with ], sustained by ] and ] ideas such as vertebral subluxation.<ref name=History-Primer>{{cite web |title= Chiropractic history: a primer |author1=Keating JC Jr |author2=Cleveland CS III |author3=Menke M |url=http://www.historyofchiropractic.org/books/primer/ |format=PDF |year=2005 |access-date=2008-06-16 |publisher= Association for the History of Chiropractic |quote=A significant and continuing barrier to scientific progress within chiropractic are the anti-scientific and pseudo-scientific ideas (Keating 1997b) which have sustained the profession throughout a century of intense struggle with political medicine. Chiropractors' tendency to assert the meaningfulness of various theories and methods as a counterpoint to allopathic charges of quackery has created a defensiveness which can make critical examination of chiropractic concepts difficult (Keating and Mootz 1989). One example of this conundrum is the continuing controversy about the presumptive target of DCs' adjustive interventions: subluxation (Gatterman 1995; Leach 1994).}}</ref> | |||
== Research == | |||
Chiropractic researchers have documented that fraud, abuse and ] are more prevalent in chiropractic than in other health care professions.<ref name=Murphy-pod>{{cite journal |pmid=18759966 |doi=10.1186/1746-1340-16-10 |date=August 2008 |last1=Murphy |first1=DR |last2=Schneider |last3=Seaman |last4=Perle |last5=Nelson |title=How can chiropractic become a respected mainstream profession? The example of podiatry |volume=16 |page=10 |journal=Chiropractic & Osteopathy |first2=MJ |first3=DR |first4=SM |first5=CF |pmc=2538524 |doi-access=free }}</ref> Unsubstantiated claims about the efficacy of chiropractic have continued to be made by individual chiropractors and chiropractic associations.<ref name=Ernst-eval/> The core concept of traditional chiropractic, vertebral subluxation, is not based on ].<ref name=Ernst-eval/> Collectively, ]s have not demonstrated that ], the main treatment method employed by chiropractors, was ] for any medical condition, with the possible exception of treatment for ].<ref name=Ernst-eval/> Spinal manipulation, particularly of the upper spine, can cause complications in adults and children that can cause permanent disability or death.<ref name="WHO-guidelines" /><ref name="Ernst-adverse">{{cite journal |last1=Ernst |first1=E |date=July 2007 |title=Adverse effects of spinal manipulation: a systematic review |journal=Journal of the Royal Society of Medicine |volume=100 |issue=7 |pages=330–38 |doi=10.1177/014107680710000716 |issn=0141-0768 |pmc=1905885 |pmid=17606755}} | |||
Chiropractic researchers Robert Mootz and Reed Phillips suggest that, in chiropractic's early years, influences from both straight and mixer concepts were incorporated into its construct. They conclude that chiropractic has both ] qualities that lend themselves to scientific investigation and ] qualities that do not (Table 1). | |||
* {{cite web |author=Christian Nordqvist |date=2007-07-02 |title=Spinal Manipulation Should Not Be Routinely Used, New Study Warns |url=http://www.medicalnewstoday.com/articles/75754.php |website=Med News Today}}</ref><ref name="Vohra">{{cite journal |last1=Vohra |first1=S |last2=Johnston |first2=BC |last3=Cramer |first3=K |last4=Humphreys |first4=K |date=January 2007 |title=Adverse events associated with pediatric spinal manipulation: a systematic review |url=http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=17178922 |journal=Pediatrics |volume=119 |issue=1 |pages=e275–83 |doi=10.1542/peds.2006-1392 |issn=0031-4005 |pmid=17178922 |s2cid=43683198}}</ref> Scientific studies have generally found limited evidence for chiropractic efficacy beyond back pain, and concerns about patient safety, particularly with neck manipulations, have been raised.<ref>{{Cite journal |last1=Kaminskyj |first1=Adrienne |last2=Frazier |first2=Michelle |last3=Johnstone |first3=Kyle |last4=Gleberzon |first4=Brian J. |date=March 2010 |title=Chiropractic care for patients with asthma: A systematic review of the literature |journal=The Journal of the Canadian Chiropractic Association |volume=54 |issue=1 |pages=24–32 |issn=1715-6181 |pmc=2829683 |pmid=20195423}}</ref><ref>{{Cite journal |last1=Chen |first1=W.-L. |last2=Chern |first2=C.-H. |last3=Wu |first3=Y.-L. |last4=Lee |first4=C.-H. |date=January 2006 |title=Vertebral artery dissection and cerebellar infarction following chiropractic manipulation |journal=Emergency Medicine Journal: EMJ |volume=23 |issue=1 |pages=e1 |doi=10.1136/emj.2004.015636 |issn=1472-0213 |pmc=2564146 |pmid=16373786}}</ref><ref>{{Cite journal |last1=Jones |first1=Jeremy |last2=Jones |first2=Catherine |last3=Nugent |first3=Kenneth |date=January 2015 |title=Vertebral artery dissection after a chiropractor neck manipulation |journal=Proceedings (Baylor University. Medical Center) |volume=28 |issue=1 |pages=88–90 |doi=10.1080/08998280.2015.11929202 |issn=0899-8280 |pmc=4264725 |pmid=25552813}}</ref> | |||
With relatively little federal funding, academic research in chiropractic has only recently become established in the USA. In 1994 and 1995, half of all grant funding to chiropractic researchers was from the US Health Resources and Services Administration (7 grants totaling $2.3 million). The Foundation for Chiropractic Education and Research (11 grants, $881,000) and the Consortium for Chiropractic Research (4 grants, $519,000) accounted for most of the rest. By 1997, there were 14 peer-reviewed chiropractic journals in English that encouraged the publication of chiropractic research, including ''The Journal of Manipulative and Physiological Therapeutics (JMPT)'', ''Topics in Clinical Chiropractic'', and the ''Journal of Chiropractic Humanities''. However, of these, only ''JMPT'' is included in '']''. Research into chiropractic, whether from Universities or chiropractic colleges, is however often published in many other scientific journals.<ref>Chirofind.com </ref> | |||
Legal battles, including the landmark Wilk v. AMA case and Simon Singh’s libel suit, highlight tensions between chiropractors and mainstream medicine.<ref>{{Cite journal |last1=Johnson |first1=Claire D. |last2=Green |first2=Bart N. |date=2021-09-01 |title=Looking back at the lawsuit that transformed the chiropractic profession part 1: Origins of the conflict |url=https://meridian.allenpress.com/jce/article/35/S1/9/470443/Looking-back-at-the-lawsuit-that-transformed-the |journal=Journal of Chiropractic Education |language=en |volume=35 |issue=S1 |pages=9–24 |doi=10.7899/JCE-21-22 |issn=2374-250X |pmc=8493520 |pmid=34544156}}</ref><ref>{{Cite journal |last=Dyer |first=C. |date=2010-04-01 |title=Appeal court judges say scientific controversies must be settled by science not law |url=https://www.bmj.com/lookup/doi/10.1136/bmj.c1895 |journal=BMJ |language=en |volume=340 |issue=apr01 2 |pages=c1895 |doi=10.1136/bmj.c1895 |issn=0959-8138}}</ref><ref>{{Cite journal |last=Dyer |first=C. |date=2010-04-15 |title=Chiropractors drop their libel action against science writer Simon Singh |url=https://www.bmj.com/lookup/doi/10.1136/bmj.c2086 |journal=BMJ |language=en |volume=340 |issue=apr15 3 |pages=c2086 |doi=10.1136/bmj.c2086 |issn=0959-8138}}</ref> Ethical issues, such as misleading advertising and opposition to vaccination, continue to draw criticism. Despite efforts to modernize, chiropractic remains controversial within both the medical community and the public sphere. In 2008, ] was sued for ] by the ] (BCA) for criticizing their activities in a column in '']''.<ref name=Eden>{{cite news | url =https://www.telegraph.co.uk/news/newstopics/mandrake/2570744/Doctors-take-Simon-Singh-to-court.html | title = Doctors take Simon Singh to court |last=Eden |first=R | date=16 August 2008 | work = ]|access-date=16 August 2008 | location=London}}</ref> A ] took place at the ] in front of judge ]. The judge held that merely using the phrase "happily promotes bogus treatments" meant that he was stating, as a matter of fact, that the British Chiropractic Association was being consciously dishonest in promoting chiropractic for treating the children's ailments in question.<ref name="guardianeurope">{{cite news|url=https://www.theguardian.com/society/2009/may/13/simon-singh-british-chiropractic-association|title=Science writer accused of libel may take fight to European court|last=Boseley|first=Sarah|date=14 May 2009|publisher=The Guardian (UK)|access-date=2009-05-19|location=London}}</ref> An editorial in ''Nature'' has suggested that the BCA may be trying to suppress debate and that this use of British libel law is a burden on the right to freedom of expression, which is protected by the ].<ref>{{cite journal |title=Unjust burdens of proof |journal=Nature|volume=459 |issue=7248 |page=751 |date=June 2009 |pmid=19516290|doi=10.1038/459751a|bibcode=2009Natur.459Q.751.|doi-access=free }}</ref> The libel case ended with the BCA withdrawing its suit in 2010.<ref>{{cite news|title=Case dropped against Simon Singh|author=Pallab Ghosh |url=http://news.bbc.co.uk/1/hi/sci/tech/8621880.stm|work=BBC News|date=2010-04-15}}</ref><ref>{{cite news|newspaper=Times Online|url=http://business.timesonline.co.uk/tol/business/law/article7098157.ece|archive-url=https://web.archive.org/web/20110611200255/http://business.timesonline.co.uk/tol/business/law/article7098157.ece|url-status=dead|archive-date=June 11, 2011|title=Science writer Simon Singh wins bitter libel battle|author=Mark Henderson|location=London|date=2010-04-16}}</ref> | |||
While there is still debate about the effectiveness of chiropractic for the many conditions in which it is applied, chiropractic seems to be most effective for acute low back pain and tension headaches.<ref name =Duke>McCrory DC, et al. (2001) ''Evidence Report: Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache''. Duke University Evidence-Based Practice Center, Durham, North Carolina (] format) | |||
</ref> When testing the efficacy of health treatments, ] studies are considered acceptable scientific rigor. These are designed so that neither the patient nor the doctor knows whether they are using the actual treatment or a placebo (or "sham") treatment. However, chiropractic treatment involves a ]; "sham" procedures cannot be easily devised for this, and even if the patient is unaware whether the treatment is a real or sham procedure, the doctor cannot be unaware. Thus there may be "observer bias" - the tendency to see what you expect to see, and the potential for the patient to wish to report benefits to "please" the doctor. Similarly, it is often difficult to devise a sham procedure for surgical procedures, but it is not impossible. It is also a problem in evaluating treatments; even when there are objective outcome measures, the ] can be very substantial. Thus, DCs have historically relied mostly on their own clinical experience and the shared experience of their colleagues, as reported in ], to direct their treatment methods. In this, they are not different to the practice in much of conventional medicine. {{Or|date=October 2007}}. Consequently there has been a call to increase ] studies which can better examine the whole chiropractic clinical encouter. | |||
Chiropractors historically were strongly opposed to ] based on their belief that all diseases were traceable to causes in the spine, and therefore could not be affected by vaccines.<ref name="Busse-JW">{{cite journal |doi=10.1016/j.jmpt.2005.04.011 |pmid=15965414 |date=June 2005 |last1=Busse |first1=JW |last2=Morgan |last3=Campbell |title=Chiropractic antivaccination arguments |volume=28 |issue=5 |pages=367–73 |issn=0161-4754 |journal=Journal of Manipulative and Physiological Therapeutics |first2=L |first3=JB |url= http://jmptonline.org/article/S0161-4754(05)00111-9/fulltext}}</ref> Some chiropractors continue to be opposed to vaccination.<ref name=Nelson>{{cite news|last=F. Nelson |first=Craig |title=Spinal Manipulation and Chiropractic: Views of a Reformist Chiropractor |url=http://www.acsh.org/healthissues/newsID.656/healthissue_detail.asp |date=1 April 1999 |publisher=American Council on Science and Health |access-date=7 June 2009 |url-status=dead |archive-url=https://web.archive.org/web/20090409071958/http://www.acsh.org/healthissues/newsID.656/healthissue_detail.asp |archive-date=April 9, 2009 }}</ref> Early opposition to water fluoridation included chiropractors in the U.S. Some chiropractors opposed ] as being incompatible with chiropractic philosophy and an infringement of personal freedom.<!-- <ref name="Mormann"/> --> More recently, other chiropractors have actively promoted fluoridation, and several chiropractic organizations have endorsed scientific principles of public health.<ref name="Mormann">{{cite journal |pmid=2782512 |pmc=1350185 |doi=10.2105/AJPH.79.10.1405 |date=October 1989 |last1=Jones |first1=RB |last2=Mormann |last3=Durtsche |title=Fluoridation referendum in La Crosse, Wisconsin: contributing factors to success |volume=79 |issue=10 |pages=1405–08 |issn=0090-0036 |journal=American Journal of Public Health |first2=DN |first3=TB}}</ref> | |||
There is evidence that ] is effective for the treatment of acute low back pain, tension headaches and some musculoskeletal issues, but not all studies support this conclusion.<ref name =Duke>McCrory DC, et al. ''Evidence Report: Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache''. Duke University Evidence-Based Practice Center, Durham, North Carolina, January 2001 (] format)</ref> A systematic review of systematic reviews in 2006 by ] and P.H. Canter concluded that no data "demonstrate that spinal manipulation is an effective intervention for any condition. Given the possibility of adverse effects, this review does not suggest that spinal manipulation is a recommendable treatment."<ref name="Ernst E">Ernst E (2006) A systematic review of systematic reviews of spinal manipulation'' J R Soc Med'' 99:192-6 </ref> In 2007, Ernst performed another review, drawing similar findings which concluded: "Spinal manipulation, particularly when performed on the upper spine, is frequently associated with mild to moderate adverse effects. It can also result in serious complications such as vertebral artery dissection followed by stroke. Currently, the incidence of such events is not known. In the interest of patient safety we should reconsider our policy towards the routine use of spinal manipulation."<ref name="Ernest E 2007">E Ernst ''J R Soc Med'' 2007;100:330-338</ref> A commentary from a chiropractic and osteopathic journal disputed Ernst and Canter's conclusion as, "..definitely not based on an acceptable quality review of systematic reviews and should be interpreted very critically by the scientific community, clinicians, patients, and health policy makers. Their conclusions are certainly not valid enough to discredit the large body of professionals utilizing spinal manipulation."<ref>G Bronfort, M Haas, ''Review conclusions by Ernst and Canter regarding spinal manipulation refuted'', Chiropr Osteopat. 2006; 14: 14. </ref> | |||
One controlled trial showed a lowering of blood pressure in hypertensive patients similar to taking two blood-pressure lowering drugs at once<ref name=Bakrus>Bakris, G. (2007) Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study. ''Journal of Human Hypertension 2007 (May);21 (5):347–352 </ref> after alignment of the atlas vertebra. | |||
== Historical controversy and critical elements == | |||
Sociologist Leslie Biggs interviewed 600 Canadian DCs in 1997: while 86% felt that chiropractic methods needed to be validated, 74% did not believe that controlled clinical trials were the best way to evaluate chiropractic. Moreover, 68% believed that "most diseases are caused by spinal malalignment", although only 30% agreed that "subluxation was the cause of many diseases".<ref>Biggs L (2002) ''Measuring philosophy: | |||
{{Main|History of chiropractic}} | |||
''a philosophy index'''' </ref> | |||
]]] | |||
The birth of chiropractic was on September 18, 1895. There is controversy over what happened with several different accounts. Daniel D. Palmer later claimed that on that day he manipulated the spine of ], a man who was nearly deaf, allegedly curing him of deafness. Palmer said "there was nothing accidental about this, as it was accomplished with an object in view, and the expected result was obtained. There was nothing 'crude' about this adjustment; it was specific so much so that no chiropractor has equaled it."<ref> {{webarchive|url=https://web.archive.org/web/20101230074905/http://collections.ic.gc.ca/heirloom_series/volume5/130-133.htm |date=2010-12-30 }}</ref> | |||
However, this version was disputed by Lillard's daughter, Valdeenia Lillard Simons. She said that her father told her that he was telling jokes to a friend in the hall outside Palmer's office and Palmer, who had been reading, joined them. When Lillard reached the punch line, Palmer, laughing heartily, slapped Lillard on the back with the hand holding the heavy book he had been reading. A few days later, Lillard told Palmer that his hearing seemed better. Palmer then decided to explore manipulation as an expansion of his magnetic healing practice. Simons said "the compact was that if they can make it, then they both would share. But, it didn't happen."<ref name="Westbrooks">{{cite journal |author= Westbrooks B |year=1982 |title= The troubled legacy of Harvey Lillard: the black experience in chiropractic |journal= Chiropr Hist |volume=2 |issue=1 |pages=47–53 |pmid=11611211}}</ref> | |||
Even when a valid mechanism of action is not determined, it is generally thought sufficient to present evidence showing benefit for the claims made. There is wide agreement that, where applicable, an ] framework should be used to assess health outcomes, and that systematic reviews with strict protocols are important for objectively evaluating treatments. Where evidence from such reviews is lacking, this does not necessarily mean that the treatment is ineffective, only that the case for a benefit of treatment may not have been rigorously established. | |||
In spite of the fact that Lillard could hear well enough to tell jokes, ] claimed under sworn testimony that Lillard had been "thoroughly deaf".<ref name=BJPalmerTestimony>{{Cite web |url=http://www.chirobase.org/05RB/BCC/07.html |title=B.J. Palmer's testimony in State of Wisconsin vs. S. R. Jansheski, December, 1910 |access-date=2009-11-30 |archive-url=https://web.archive.org/web/20121020162249/http://chirobase.org/05RB/BCC/07.html |archive-date=2012-10-20 |url-status=dead }}</ref> Since 1895, the story of Palmer's curing a man of deafness has been a part of chiropractic tradition. Palmer's account differs significantly from what actually happened, in that, according to Lillard's daughter, his improved hearing was likely caused by an accidentally fortuitous jarring of Lillard's body and not, as claimed by D.D. Palmer, caused by a "specific" adjustment. It was after this event that Palmer began to experiment with manipulation. He also claimed that his second patient, a man with heart disease, was also cured by spinal manipulation. | |||
A 2005 editorial in ''JMPT'', "The ]: is it relevant for doctors of chiropractic?"<ref>{{cite journal | author = French S, Green S | title = The Cochrane Collaboration: is it relevant for doctors of chiropractic? | journal = J Manip Physiol Ther | volume = 28 | pages = 641-2 | year = | id = PMID 16326231}}</ref> proposed that involvement in Cochrane collaboration would be a way for chiropractic to gain greater acceptance within medicine. The collaboration has 11,500 contributors from more than 90 countries organized in 50 review groups. For chiropractic, relevant review groups include the Back Group; the Bone, Joint, and Muscle Trauma Group; the Musculoskeletal Group; and the Neuromuscular Disease Group. The editorial states that, for example, "a chiropractor may provide conservative care supported by a Cochrane review to a patient with carpal tunnel syndrome. If the patient's symptoms become progressive, the doctor may consider referring the patient for surgery using a recent Cochrane review that examined new surgical techniques compared with traditional open surgery..." | |||
Chiropractic included vitalistic ideas of Innate Intelligence with religious attributes of Universal Intelligence as substitutes for science.<ref name=Ernst-eval/> Evidence suggests that D.D. Palmer had acquired knowledge of manipulative techniques from ], the founder of ].<ref name=Ernst-eval/> Although D.D. Palmer combined ] to give chiropractic its method, and "]" for the theory, he acknowledged a special relation to magnetic healing when he wrote, "chiropractic was not evolved from medicine or any other method, except that of magnetic."<ref name=Kaptchuk-Eisenberg/> He also "claimed that his profession had nothing to do with medicine, that he healed by the laying on of hands;... He also said that he had a diploma from no earthly school but from High Heaven."<ref name=Keating_lifeline>{{Citation |last=Keating Jr. |first=Joseph |date=April 13, 1998 |title=D.D. Palmer's Lifeline |publisher=The Chiropractic Resource Organization |url=http://www.chiro.org/Plus/History/Persons/PalmerDD/PalmerDD%27s-Lifeline-chrono.pdf |access-date=February 22, 2015 }}</ref> | |||
The Cochrane Collaboration did not find enough evidence to support or refute the claim that manual therapy (including, but not limited to, chiropractic) is beneficial for . trials have not shown benefit from diuretics, non-steroidal anti-inflammatory drugs, magnets, laser acupuncture, exercise or chiropractic and there is not enough evidence to show the effects of spinal ] (including, but not limited to, chiropractic) for | |||
] found limited evidence that spinal manipulative therapy (including, but not limited to, chiropractic) might reduce the frequency and intensity of migraine attacks, but the evidence that spinal ] is better than amitriptyline, or adds to the effects of amitriptyline, is insubstantial for the treatment of , although "spinal manipulative therapy might be worth trying for some patients with migraine or tension headaches." | |||
According to Bandolier, a systematic review of a small, poor quality set of trials provided no convincing evidence for long-term benefits of chiropractic interventions for acute or chronic low back pain, despite some positive overall findings<ref></ref> but there might be some short-term pain relief, especially in patients with acute pain.<ref>{{cite journal | author = Assendelft WJJ ''et al.''| title = The effectiveness of chiropractic for treatment of low back pain: an update and attempt at statistical pooling| journal = J Manip Physiol Ther | volume = 19 | pages = 499-507 | year = 1996| id = PMID 16326231}}</ref> However, the ] noted in a study on long-term low-back problems "...improvement in all patients at three years was about 29% more in those treated by chiropractors than in those treated by the hospitals. The beneficial effect of chiropractic on pain was particularly clear."<ref>{{cite journal | author = Meade ''et al.''| title = The effectiveness of chiropractic for treatment of low back pain: an update and attempt at statistical pooling| journal = Brit Med J | volume = | pages = | year = 1995| id = PMID 16326231}}</ref> | |||
A 1994 study by the U.S. Agency for Health Care Policy and Research (AHCPR) and the U.S. Department of Health and Human Services endorses spinal ] for acute low back pain in adults in its Clinical Practice Guideline. | |||
The first significant recognition of the appropriateness of spinal ] for low back pain was performed by the ] Corporation. This meta-analysis concluded that some forms of spinal ] were successful in treating certain types of lower back pain. Some chiropractors claimed these results as proof of chiropractic hypotheses, but RAND's studies were about spinal ], not ] specifically, and dealt with appropriateness, which is a measure of net benefit and harms; the efficacy of chiropractic and other treatments were not explicitly compared. In 1993, Dr Shekelle rebuked some DCs for their exaggerated claims: ...we have become aware of numerous instances where our results have been seriously misrepresented by chiropractors writing for their local paper or writing letters to the editor....<ref>Shekelle PM (1993) RAND misquoted. ''ACA J Chir'' 30:59–63</ref> | |||
According to D.D. Palmer, subluxation was the sole cause of all diseases and manipulation was the cure for all diseases of the human race.<ref name=Ernst-eval/> A 2003 profession-wide survey found:<ref name=Brown2014/><blockquote>most chiropractors (whether "straights" or "mixers") still hold views of Innate and of the cause and cure of disease (not just back pain) consistent with those of the Palmers. On one hand, modern promotional brochures make a bid for medical legitimacy by describing Innate and adjustments using more scientific-sounding terms such as "inherent" and "nerve force."</blockquote>Chiropractic has had a strong salesmanship element since it was started by D.D. Palmer. His son, B.J. Palmer, asserted that their chiropractic school was founded on "...a business, not a professional basis. We manufacture chiropractors. We teach them the idea and then we show them how to sell it".<ref name=pmid18670469>{{cite journal|pmid=18670469 |url=http://www.nzma.org.nz/journal/121-1278/3158/ |date=July 2008 |last1=Colquhoun |first1=D |title=Doctor Who? Inappropriate use of titles by some alternative "medicine" practitioners |volume=121 |issue=1278 |pages=6–10 |issn=0028-8446 |journal=The New Zealand Medical Journal |url-status=dead |archive-url=https://web.archive.org/web/20090615040740/http://www.nzma.org.nz/journal/121-1278/3158/ |archive-date=June 15, 2009 }}</ref> D.D. Palmer established a magnetic healing facility in Davenport, Iowa, styling himself 'doctor'. Not everyone was convinced, as a local paper in 1894 wrote about him:<ref name="pmid18670469" /><blockquote>A crank on magnetism has a crazy notion that he can cure the sick and crippled with his magnetic hands. His victims are the weak-minded, ignorant and superstitious, those foolish people who have been sick for years and have become tired of the regular physician and want health by the short-cut method... he has certainly profited by the ignorance of his victims... His increase in business shows what can be done in Davenport, even by a quack.</blockquote>Before adopting the term "chiropractic" in about 1896, his advertising used the term "magnetic". In 1891–92, a city business directory stated: "Dr. Palmer can cure with his Magnetic Hands Diseases of the Head, Throat, Heart, Lungs, Stomach, Liver, Spleen, Kidneys, Nerves, and Muscles, ten times quicker than any one can with medicines."<ref name=Keating_lifeline/> | |||
There is conflict in the results of chiropractic research. For instance, many DCs claim to treat . According to a 1999 survey, 46% of chiropractors in Ontario treated children for ].<ref name="Verhoef">Verhoef MJ, Costa Papadopoulos C. ''Survey of Canadian chiropractors’ involvement in the treatment of patients under the age of 18''. </ref> In 1999 a Danish randomized controlled clinical trial with a blinded observer suggested that there is evidence that spinal manipulation might help infantile colic.<ref name="Wiberg">Wiberg JMM ''et al.'' (1999) The short-term effect of spinal manipulation in the treatment of infantile colic: A randomized controlled clinical trial with a blinded observer. ''J Manip Physiol Ther'' 22:517-22</ref> However, in 2001, a Norwegian blinded study concluded that chiropractic spinal ] was no more effective than placebo for treating infantile colic.<ref name="Olafsdottir">Olafsdottir E ''et al.'' (2001) Randomised controlled trial of infantile colic treated with chiropractic spinal ].'' Arch Dis Child'' 84:138-141. </ref> | |||
: Give me a simple mind that thinks along single tracts, give me 30 days to instruct him, and that individual can go forth on the highways and byways and get more sick people well than the best, most complete, all around, unlimited medical education of any medical man who ever lived.<ref name=Ernst-eval/> | |||
In 1997, historian Joseph Keating Jr described chiropractic as a "science, antiscience and pseudoscience", and said "Although available scientific data support chiropractic's principle intervention method (the manipulation of patients with lower back pain), the doubting, skeptical attitudes of science do not predominate in chiropractic education or among practitioners". He argued that chiropractic's culture has nurtured antiscientific attitudes and activities, and that "a combination of uncritical rationalism and uncritical empiricism has been bolstered by the proliferation of pseudoscience journals of chiropractic wherein poor quality research and exuberant over-interpretation of results masquerade as science and provide false confidence about the value of various chiropractic techniques". However, in 1998, after reviewing the articles published in the ''JMPT'' from 1989-1996, he concluded, | |||
:"substantial increases in scholarly activities within the chiropractic profession are suggested by the growth in scholarly products published in the discipline's most distinguished periodical (JMPT). Increases in controlled outcome studies, collaboration among chiropractic institutions, contributions from nonchiropractors, contributions from nonchiropractic institutions and funding for research suggest a degree of professional maturation and growing interest in the content of the discipline."<ref>{{cite journal | author = Keating J ''et al.'' | title = A descriptive analysis of the Journal of Manipulative and Physiological Therapeutics, 1989-1996 | journal = J Manip Physiol Ther | volume = 21 | pages = 539-52 | year = 1998 | id = PMID 9798183}}</ref> | |||
Chiropractic was rooted in ], leading to internal conflicts between straights and mixers which still persist.<ref name=Ernst-eval/> It has two main groups: "straights", now the minority, emphasize ], innate intelligence and ]s, 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 ].<ref name=Kaptchuk-Eisenberg/> The straights adhere religiously to the gospel of its founders while mixers are more open.<ref name=Ernst-eval/> There is a lack of uniformity and consensus among chiropractors in regard to their role. Depending upon whose point of view, chiropractors are, for example, subluxation-correctors, ]s, neuromusculoskeletal specialists, or holistic health specialists.<ref name="chiroandosteo.com">{{cite journal |pmid=16000175 |date=July 2005 |last1=Nelson |first1=CF |last2=Lawrence |last3=Triano |last4=Bronfort |last5=Perle |last6=Metz |last7=Hegetschweiler |last8=Labrot |title=Chiropractic as spine care: a model for the profession |volume=13 |page=9 |doi=10.1186/1746-1340-13-9 |journal=Chiropractic & Osteopathy |first2=DJ |first3=JJ |first4=G |first5=SM |first6=RD |first7=K |first8=T |pmc=1185558 |doi-access=free }}</ref> Straights have claimed mixers are not real chiropractors because they do not acknowledge Palmer's foundation of chiropractic therapy.<ref name="Trick or Treatment">{{cite book |pages=145–90 |chapter= The truth about chiropractic therapy |title= Trick or Treatment: The Undeniable Facts about Alternative Medicine |vauthors=Singh S, Ernst E |year=2008 |publisher= W.W. Norton |isbn=978-0-393-06661-6}}</ref> | |||
Joseph C. Keating, Jr. and researchers argued: "The dogma of subluxation is perhaps the greatest single barrier to professional development for chiropractors. It skews the practice of the art in directions that bring ridicule from the scientific community and uncertainty among the public. Failure to challenge subluxation dogma perpetuates a marketing tradition that inevitably prompts charges of quackery. Subluxation dogma leads to legal and political strategies that may amount to a house of cards and warp the profession's sense of self and of mission. Commitment to this dogma undermines the motivation for scientific investigation of subluxation as hypothesis, and so perpetuates the cycle." | |||
In 1906, D.D. Palmer was the first of hundreds of chiropractors who went to ].<ref>{{cite journal |pmid=11620299 |date=June 1998 |last1=Kimbrough |first1=ML |title=Jailed chiropractors: those who blazed the trail |volume=18 |issue=1 |pages=79–100 |issn=0736-4377 |journal=Chiropractic History}}</ref> Chiropractors were jailed for ].<ref name=Ernst-eval/> In the 1920s hundreds of unlicensed chiropractors chose jail rather than fines.<ref>{{cite journal |pmid=11613404 |date=December 1995 |last1=Callender |first1=A |title=Buckeye chiropractic: turbulence in a limited branch of medicine, 1915-1975 |volume=15 |issue=2 |pages=78–89 |issn=0736-4377 |journal=Chiropractic History}}</ref> Herbert Reaver was the most jailed chiropractor in the U.S.<ref name=Reaver>, ''The Chiropractic Journal'', December 1997 {{webarchive |url=https://web.archive.org/web/20041222012552/http://www.worldchiropracticalliance.org/tcj/1997/dec/dec1997a.htm |date=December 22, 2004 }}</ref> Chiropractors were charged with not complying with the medical practice act. California chiropractors adopted the motto, "Go to jail for chiropractic." 450 chiropractors were jailed in a single year at the peak of the controversy. Many chiropractors treated fellow prisoners and visiting patients while in jail.<ref name=Kaptchuk-Eisenberg/> | |||
Dr. Craig F. Nelson states, "The chiropractic profession has crusaded against one of the most effective public health measures of all time¬vaccination¬and many of its members publicly scoff at the germ theory of disease. Even today some chiropractors are openly opposed to vaccination. Some practice "muscle testing"¬for example, manually, subjectively appraising the muscle strength of a patient with a vitamin pill in his or her hand as a means of diagnosing nutritional deficiencies." | |||
Chiropractors, including Palmer, faced frequent legal battles, leading to efforts to reframe chiropractic as a religious practice to circumvent medical licensing laws.<ref>{{Cite journal |last=Valdivia |first=Joaquin |date=July 1, 2017 |title=The Last Ten Years of D.D. Palmer, "As I See It" |url=https://web-p-ebscohost-com.foyer.swmed.edu/ehost/pdfviewer/pdfviewer?vid=1&sid=3928b64b-5b90-4ba4-8bb1-dee983edfd6c%40redis |journal=Chiropractic History |volume=37 |issue=2 |pages=29–51 |via=EBSCO |url-access=subscription}}</ref> D.D. Palmer defined chiropractic as "a science of healing without drugs" and considered establishing chiropractic as a ] as a means to use ] to resolve legal difficulties presented by restrictive "chiro laws". In 1911, he stated (emphasis in original):<ref name="Palmer_religion" /><!-- <ref name=Ernst-eval/> --><blockquote>You ask, what I think will be the <u>final outcome</u> of our law getting. It will be that we will have to build a boat similar to Christian Science and hoist a religious flag. I have received chiropractic from the other world, similar as did Mrs. Eddy. No other one has laid claim to that, <u>NOT EVEN B.J</u>. | |||
== Reports and studies== | |||
Exemption clauses instead of chiro laws by all means, and LET THAT EXEMPTION BE <u>THE RIGHT TO PRACTICE OUR RELIGION</u>. But we must have a religious head, one who is the founder, as did Christ, Mohamed, Jo. Smith, Mrs. Eddy, Martin Luther and others who have founded religions. I am the fountain head. I am the founder of chiropractic in its science, in its art, in its philosophy and in its religious phase. Now, if chiropractors desire to claim me as their head, their leader, the way is clear. My writings have been gradually steering in that direction until now it is time to assume that we have the same right to as has Christian Scientists.</blockquote> | |||
==== The Manga Report ==== | |||
Chiropractors have struggled with survival and identity during its formative years, including internal struggles between its leaders and colleges.<ref>{{cite journal |author=Johnson C |title=Reflecting on 115 years: the chiropractic profession's philosophical path |journal=Journal of Chiropractic Humanities |volume=17 |issue=1 |pages=1–5 |date=December 2010 |pmid=22693471 |pmc=3342796 |doi=10.1016/j.echu.2010.11.001}}</ref> For much of the history of the chiropractic profession chiropractors showed little interest in scientific research and regarded their principles and practices as valid.<ref name=Nelson/> Despite heavy opposition by mainstream medicine, by the 1930s chiropractic was the largest alternative healing profession in the U.S.<ref>{{cite journal |pmid=11623404 |date=October 1993 |last1=Martin |first1=SC |title=Chiropractic and the social context of medical technology, 1895–1925 |volume=34 |issue=4 |pages=808–34 |issn=0040-165X |journal=Technology and Culture |doi=10.2307/3106416 |jstor=3106416|s2cid=23423922 }}</ref> Long-standing ] (AMA) policies against chiropractic contributed to a lack of acceptance within mainstream public health.<ref name=Chiro-PH/> The AMA created the Committee on Quackery "to contain and eliminate chiropractic." Using the Committee on Quackery, efforts were made to prevent the participation of chiropractic in organized health care. In 1966 a policy passed by the AMA House of Delegates stating:<ref name=Chiro-PH/>{{blockquote|It is the position of the medical profession that chiropractic is an unscientific cult whose practitioners lack the necessary training and background to diagnose and treat human disease. Chiropractic constitutes a hazard to rational health care in the United States because of its substandard and unscientific education of its practitioners and their rigid adherence to an irrational, unscientific approach to disease causation.}}The longstanding feud between chiropractors and ]s continued for decades. The AMA labeled chiropractic an "unscientific ]" in 1966,<ref name="Chiro-PH">{{cite journal |pmid=18722194 |date=July 2008 |last1=Johnson |first1=C |last2=Baird |last3=Dougherty |last4=Globe |last5=Green |last6=Haneline |last7=Hawk |last8=Injeyan |last9=Killinger | display-authors = 8|title=Chiropractic and public health: current state and future vision |volume=31 |issue=6 |pages=397–410 |issn=0161-4754 |doi=10.1016/j.jmpt.2008.07.001 |journal=Journal of Manipulative and Physiological Therapeutics |first2=R |first3=PE |first4=G |first5=BN |first6=M |first7=C |first8=HS |first9=L|doi-access=free }}</ref> and until 1980 held that it was unethical for medical doctors to associate with "unscientific practitioners".<ref>{{cite journal |pmid=2817179 |date=November 1989 |last1=Cherkin |first1=D |title=AMA policy on chiropractic |volume=79 |issue=11 |pages=1569–70 |issn=0090-0036 |journal=American Journal of Public Health |doi=10.2105/AJPH.79.11.1569-a |pmc=1349822}}</ref> This culminated in a landmark 1987 decision, ], 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.<ref>{{cite journal |pmid=12669653 |year=2003 |last1=Cooper |first1=RA |last2=Mckee |title=Chiropractic in the United States: trends and issues |volume=81 |issue=1 |pages=107–38, table of contents |issn=0887-378X |journal=The Milbank Quarterly |doi=10.1111/1468-0009.00040 |first2=HJ |pmc=2690192}}</ref> The rivalry was not solely with conventional medicine; many osteopaths proclaimed that chiropractic was a bastardized form of osteopathy.<ref name="Ernst-eval" /> | |||
The Manga Report was an outcomes-study funded by the Ontario Ministry of Health and conducted by three health economists led by Professor ]. The Report supported the scientific validity, safety, efficacy, and cost-effectiveness of chiropractic for low-back pain, and found that chiropractic care had higher patient satisfaction levels than conventional alternatives. The report states that "The literature clearly and consistently shows that the major savings from chiropractic management come from fewer and lower costs of auxiliary services, fewer hospitalizations, and a highly significant reduction in chronic problems, as well as in levels and duration of disability."<ref>Manga P, Angus D. (1998) Enhanced Chiropractic Coverage Under OHIP as a Means of Reducing Health Care Costs, Attaining Better Health Outcomes and Achieving Equitable Access to Health Services. Retrieved 08 29 2006, from </ref> | |||
Serious research to test chiropractic theories did not begin until the 1970s,<!-- <ref name=History-Primer/> --> and is continuing to be hampered by ] and ] ideas that sustained the profession in its long battle with organized medicine.<!-- <ref name=History-Primer/> --> 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.<ref name=History-Primer/> Some people believe chiropractic has little more than a placebo effect, while some randomized trials of spinal manipulation have supported its effectiveness for the treatment of (specifically) low back pain.<ref name="DeVocht-JW">{{cite journal |journal=Clin Orthop Relat Res |year=2006 |volume=444 |pages=243–49 |title=History and overview of theories and methods of chiropractic: a counterpoint |author=DeVocht JW |doi=10.1097/01.blo.0000203460.89887.8d |pmid=16523145 }}</ref> There are several barriers between primary care physicians and chiropractors for having positive referral relationships which includes a lack of good communication.<ref>{{cite journal |pmid=17873667 |date=October 2007 |last1=Allareddy |first1=V |last2=Greene |last3=Smith |last4=Haas |last5=Liao |title=Facilitators and barriers to improving interprofessional referral relationships between primary care physicians and chiropractors |volume=30 |issue=4 |pages=347–54 |issn=0148-9917 |doi=10.1097/01.JAC.0000290404.96907.e3 |journal=The Journal of Ambulatory Care Management |first2=BR |first3=M |first4=M |first5=J|s2cid=20575186 }}</ref> The medical establishment has not entirely accepted chiropractic care as mainstream.<ref>{{cite journal |pmid=11827498 |date=February 2002 |last1=Meeker |first1=WC |last2=Haldeman |title=Chiropractic: a profession at the crossroads of mainstream and alternative medicine |volume=136 |issue=3 |pages=216–27 |issn=0003-4819 |journal=Annals of Internal Medicine |first2=S |doi=10.7326/0003-4819-136-3-200202050-00010|citeseerx=10.1.1.694.4126 |s2cid=16782086 }}</ref> After 100 years, the chiropractic profession has failed to define a message that is understandable, credible, and scientifically valid.<ref name="chiroandosteo.com"/> The future of chiropractic is uncertain due to the economic struggles and restrictions of the science and methods in chiropractic.<ref>{{cite journal |first1=Samuel |last1=Homola |year=2006 |title=Can Chiropractors and Evidence-Based Manual Therapists Work Together? An Opinion From a Veteran Chiropractor |journal=The Journal of Manual & Manipulative Therapy |volume=14 |issue=2 |pages=E14–E18 |url=http://jmmtonline.com/documents/HomolaV14N2E.pdf |doi=10.1179/jmt.2006.14.2.14e |citeseerx=10.1.1.366.2817 |s2cid=71826135 |access-date=July 18, 2009 |archive-date=July 10, 2007 |archive-url=https://web.archive.org/web/20070710071140/http://jmmtonline.com/documents/HomolaV14N2E.pdf |url-status=dead }}</ref> | |||
==== Workers' Compensation studies ==== | |||
Chiropractic has seen considerable controversy within the profession over its philosophy.<ref>{{cite book |first=Wayne B. |last=Jonas |chapter=Foreword – Chiropractic: the return of philosophy to medicine? |chapter-url=https://books.google.com/books?id=zsY8dwHl54YC&pg=PR9 |pages=ix–xii |editor=Ian D. Coulter |title=Chiropractic: a philosophy for alternative health care |year=1999 |publisher=Elsevier Health Sciences |isbn=978-0-7506-4006-0 |url-access=registration |url=https://archive.org/details/chiropracticphil00coul }}</ref> In connection with a controversial and divisive 2015 organizational split in the Australian chiropractic community, an article described the profession's long standing and current problems:<ref name="Alexander">Alexander, Harriet. '']'', July 11, 2015</ref><blockquote>The chiropractic profession is notorious for its infighting, with quarrels over the value of vaccination, the evidence or lack thereof to support the theory of subluxation and whether spinal adjustments should be performed on children.</blockquote> | |||
In 1998, a study of 10,652 Florida workers' compensation cases was conducted by Steve Wolk. He concluded that "a claimant with a back-related injury, when initially treated by a chiropractor versus a medical doctor, is less likely to become temporarily disabled, or if disabled, remains disabled for a shorter period of time; and claimants treated by medical doctors were hospitalized at a much higher rate than claimants treated by chiropractors."<ref>Wolk S. (1988) An analysis of Florida workers' compensation medical claims for back-related injuries. ''J Amer Chir Ass'' 27:50-59</ref> Similarly, a 1991 study of Oregon Workers' Compensation Claims examined 201 randomly selected workers' compensation cases that involved disabling low-back injuries: when individuals with similar injuries were compared, those who visited DCs generally missed fewer days of work than those who visited MDs.<ref>Nyiendo J. (1991) Disability low back Oregon workers' compensation claims. Part II: Time loss. ''J Manip Physiol Ther'' 14:231-239</ref> | |||
=== Allegations of patricide connected with the death of D.D. Palmer === | |||
A 1989 study analyzed data on Iowa state records from individuals who filed claims for back or neck injuries. The study compared benefits and the cost of care from MDs, DCs and DOs, focusing on individuals who had missed days of work and who had received compensation for their injuries. Individuals who visited DCs missed on average 2.3 fewer days than those who visited MDs, and 3.8 fewer days than those who saw DOs, and accordingly, less money was dispersed as employment compensation on average for individuals who visited DCs.<ref>Johnson M. (1989) A comparison of chiropractic, medical and osteopathic care for work-related sprains/strains. ''J Manip Physiol Ther'' 12:335-344</ref> | |||
The 2008 book '']'' states that in 1913 B.J. Palmer ran over his father, D.D. Palmer, during a homecoming parade at the Palmer School of Chiropractic.<!-- <ref name="Trick or Treatment"/> --> Weeks later D.D. Palmer died.<!-- <ref name="Trick or Treatment"/> --> The official cause of death was recorded as ].<!-- <ref name="Trick or Treatment"/> --> The book ''Trick or Treatment'' indicated "it seems more likely that his death was a direct result of injuries caused by his son.<!-- <ref name="Trick or Treatment"/> --> Indeed there is speculation that this was not an accident, but rather a case of patricide."<ref name="Trick or Treatment"/> A 1999 documentary study suggests D.D. Palmer's widow may have also played a role in the ] controversy.<ref name="Siordia L-Keating JC"/> D.D. Palmer's attending ]s were persuaded to change their ]s about the main cause of death.<ref name="Siordia L-Keating JC">{{cite journal |journal= Chiropr Hist |year=1999 |volume=19 |issue=1 |pages=23–31 |title= Laid to uneasy rest: D. D. Palmer, 1913 |vauthors=Siordia L, Keating JC |pmid=11624037}}</ref> Chiropractic historian ] has described the attempted patricide of D.D. Palmer as a "myth" and "absurd on its face" and cites an eyewitness who recalled that D.D. was not struck by B.J.'s car, but rather, had stumbled.<ref name="dispell"/> He also says that "Joy Loban, DC, executor of D. D.'s estate, voluntarily withdrew a civil suit claiming damages against B.J. Palmer, and that several grand juries repeatedly refused to bring criminal charges against the son."<ref name="dispell">{{cite news|url=http://www.chiroweb.com/mpacms/dc/article.php?id=42251|title=Dispelling Some Myths About Old Dad Chiro|last=Keating|first=Joseph|date=April 23, 1993|publisher=]}}</ref> A 1969 article stated that in July 1913 at the Palmer School of Chiropractic B.J. Palmer:<ref name="Ralph Lee Smith">{{cite news |url=http://www.chirobase.org/05RB/AYOR/01.html |title=At Your Own Risk: The Case Against Chiropractic – The Iowa Grocer's Dream |author1=Stephen Barrett |author2=Samuel Homola |year=1969 |work=] |access-date=2010-04-10 |archive-url=https://web.archive.org/web/20100323015116/http://www.chirobase.org/05RB/AYOR/01.html |archive-date=2010-03-23 |url-status=dead }}</ref>{{blockquote|insisted on leading the alumni procession, but was prohibited from doing so by the marshal of the parade, who was a student at the school. An altercation ensued. B.J. drove up in his automobile. Words passed between father and son. What happened after that depends on whom you believe. Daniel David claimed that B.J. struck him with his automobile, and D.D.'s friends and allies later produced affidavits of witnesses to prove it. B.J. flatly denied it, and produced many more affidavits to this effect than D.D.'s cohorts were able to muster.}} | |||
In 1989, a survey by Cherkin ''et al.'' concluded that patients receiving care from health maintenance organizations in the state of Washington were three times as likely to report satisfaction with care from DCs as they were with care from other physicians. The patients were also more likely to believe that their chiropractor was concerned about them.<ref>Cherkin CD, MacCornack FA, Berg AO (1988) ''West J Med'' 149:475–480</ref> | |||
== Ethics and claims == | |||
==== American Medical Association (AMA) ==== | |||
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This section is in need of division into logical subsections. A better, all-inclusive, heading might also be a good idea. Any ideas are welcome. | |||
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A study of California disciplinary statistics during 1997–2000 reported 4.5 disciplinary actions per 1000 chiropractors per year, compared to 2.27 for medical doctors, and the incident rate for fraud was 9 times greater among chiropractors (1.99 per 1000 chiropractors per year) than among medical doctors (0.20).<ref name=Foreman>{{cite journal |pmid=15389179 |doi=10.1016/j.jmpt.2004.06.006 |date=September 2004 |last1=Foreman |first1=SM |last2=Stahl |title=Chiropractors disciplined by a state chiropractic board and a comparison with disciplined medical physicians |volume=27 |issue=7 |pages=472–7 |issn=0161-4754 |journal=Journal of Manipulative and Physiological Therapeutics |first2=MJ}}</ref> Public trust in chiropractors remains mixed.<ref name=":4">{{Cite journal |last1=Weeks |first1=William B. |last2=Goertz |first2=Christine M. |last3=Meeker |first3=William C. |last4=Marchiori |first4=Dennis M. |date=March 2016 |title=Characteristics of US Adults Who Have Positive and Negative Perceptions of Doctors of Chiropractic and Chiropractic Care |url=https://linkinghub.elsevier.com/retrieve/pii/S0161475416000257 |journal=Journal of Manipulative and Physiological Therapeutics |language=en |volume=39 |issue=3 |pages=150–157 |doi=10.1016/j.jmpt.2016.02.001|pmid=26948180 |doi-access=free }}</ref> While many patients report positive experiences, surveys consistently rank chiropractors lower in perceived honesty and ethical standards compared to other healthcare providers.<ref name=":4" /> According to a 2006 Gallup Poll of U.S. adults, when asked how they would "rate the honesty and ethical standards of people in these different fields", chiropractic compared unfavorably with mainstream medicine.<ref name=":5" /> When chiropractic was rated, it "rated dead last amongst healthcare professions". While 84% of respondents considered nurses' ethics "very high" or "high", only 36% felt that way about chiropractors. Other healthcare professions ranged from 38% for psychiatrists, to 62% for dentists, 69% for other medical doctors, 71% for veterinarians, and 73% for druggists or pharmacists.<ref name=Murphy-pod/><ref name=":5">{{cite journal |journal=Dynamic Chiropractic |volume=25 |issue=3 |date=29 January 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=] |date=11 December 2006}}</ref><ref name=Gallup_chart></ref> Similar results were found in the 2003 Gallup Poll.<ref name=Gallup_2003>"". ], 2003</ref> Chiropractic authors have placed these results in perspective in articles, with one writing that "we were the least trusted and least believed health care discipline",<ref name=Andersen>G. Douglas Andersen, DC, DACBSP, CCN, "", '']'', February 12, 2007, Vol. 25, Issue 04</ref> and another writing that chiropractors who use unethical marketing methods "]" for others in the profession, and that they "might be responsible for the negative opinion people have about the ethics of the chiropractic profession."<ref name=Perle>Stephen M. Perle, DC, MS, "", '']'', April 24, 2006, Vol. 24, Issue 09</ref> Many chiropractors have sought to address their minor status within the U.S. medical community by attending practice-building seminars to assist chiropractors to persuade their patients of the efficacy of their treatments, increase their revenue, and boost their morale as unorthodox medical practitioners.<ref>{{cite journal |title=Practice-building seminars in chiropractic: a petit bourgeois response to biomedical domination |author=Baer HA |journal=Med Anthropol Q |year=1996 |volume=10 |issue=1 |pages=29–44 |pmid=8689442 |doi=10.1525/maq.1996.10.1.02a00050 }}</ref> | |||
In 1997, the following statement was adopted as policy of the AMA after a report on a number of alternative therapies.<ref></ref> | |||
Historically the profession has often been accused of ], with the profession often responding negatively to such accusations. In its early days, the accusation of quackery was voiced in a 1913 editorial in the '']'':<ref name="Smith-Cunnien">Susan L. Smith-Cunnien. | |||
Specifically about chiropractic it said, | |||
</ref> (p. 29)<blockquote>Chiropractic is a freak offshoot from osteopathy. Disease, say the chiropractors, is due to pressure on the spinal nerves; ergo it can be cured by 'adjusting' the spinal column. It is the sheerest quackery, and those who profess to teach it make their appeal to the cupidity of the ignorant. Its practice is in no sense a profession but a trade – and a trade that is potent for great harm. It is carried on almost exclusively by those of no education, ignorant of anatomy, ignorant even of the fundamental sciences on which the treatment of disease depends.</blockquote>The view that chiropractic was a trade, rather than a profession, was stated clearly by ], who asserted that chiropractic was founded on "a business, not a professional basis. "We manufacture chiropractors. We teach them the idea and then we show them how to sell it".<ref name=pmid18670469/> | |||
:"] has been shown to have a reasonably good degree of efficacy in ameliorating back pain, headache, and similar musculoskeletal complaints." | |||
In 1992, the AMA issued this statement: | |||
:"It is ethical for a physician to associate professionally with chiropractors provided that the physician believes that such association is in the best interests of his or her patient. A physician may refer a patient for diagnostic or therapeutic services to a chiropractor permitted by law to furnish such services whenever the physician believes that this may benefit his or her patient. Physicians may also ethically teach in recognized schools of chiropractic. (V, VI)"<ref></ref> | |||
In more modern times (1991), when the president of the ACA called accusations of quackery a "myth", chiropractic historian, ] responded by calling his comments "absurd" and stated:<ref name="Keating_quackery">], "", '']'', February 15, 1991, Vol. 09, Issue 04</ref><blockquote>The so-called 'quackery myth about chiropractic' is no myth ... the kernels of quackery (i.e., unsubstantiated and untested health remedies offered as "proven") are ubiquitous in this profession. I dare say that health misinformation (if not quackery) can be found in just about any issue of any chiropractic trade publication (and some of our research journals) and much of the promotional materials chiropractors disseminate to patients. The recent unsubstantiated claims of the ACA are exemplary '''' ... It escapes me entirely how Dr. Downing, the ACA, MPI, and Dynamic Chiropractic can suggest that there is no quackery in chiropractic. Either these groups and individuals do not read the chiropractic literature or have no crap-detectors. I urge a reconsideration of advertising and promotion policies in chiropractic.</blockquote>In an article on quackery, W. T. Jarvis has stated that "Non-scientific health care (e.g., acupuncture, ayurvedic medicine, chiropractic, homeopathy, naturopathy) is licensed by individual states. Practitioners use unscientific practices and deception on a public who, lacking complex health-care knowledge, must rely upon the trustworthiness of providers. Quackery not only harms people, it undermines the scientific enterprise and should be actively opposed by every scientist."<ref>{{cite journal |pmid=1643742 |date=August 1992 |last1=Jarvis |first1=WT |title=Quackery: a national scandal |volume=38 |issue=8B Pt 2 |pages=1574–86 |issn=0009-9147 |journal=Clinical Chemistry}}</ref> | |||
==== British Medical Association ==== | |||
In a 2008 commentary,<ref name=Murphy-pod/> the chiropractic authors proposed that "the chiropractic profession has an obligation to actively divorce itself from metaphysical explanations of health and disease as well as to actively regulate itself in refusing to tolerate fraud, abuse and ], which are more rampant<ref name=Foreman/> in our profession than in other healthcare professions", a situation which violates the ] between patients and physicians. Such self-regulation "will dramatically increase the level of trust in and respect for the profession from society at large."<ref name=Murphy-pod/> Another chiropractic study documented that the largest chiropractic associations in the U.S. and Canada distributed patient brochures which contained unsubstantiated claims.<ref name=Unsubstantiated>{{cite journal |pmid=11677551 |doi=10.1067/mmt.2001.118205 |date=October 2001 |last1=Grod |first1=JP |last2=Sikorski |last3=Keating |title=Unsubstantiated claims in patient brochures from the largest state, provincial, and national chiropractic associations and research agencies |volume=24 |issue=8 |pages=514–19 |issn=0161-4754 |journal=Journal of Manipulative and Physiological Therapeutics |first2=D |first3=JC}}</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 name="Trick or Treatment" /> 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/> In English-speaking countries the majority of chiropractors and their associations appear to make efficacy claims that are unsupported by scientific evidence. Claims not supported by solid evidence were made about asthma, ear infection, earache, otitis media, and neck pain.<ref>{{cite journal |pmid=20389316 |date=April 2010 |last1=Ernst |first1=E |title=Chiropractic claims in the English-speaking world |volume=123 |issue=1312 |pages=36–44 |journal=N Z Med J |last2=Gilbey |first2=A |url=http://journal.nzma.org.nz/journal/123-1312/4054/ |access-date=6 January 2012 |url-status=dead |archive-url=https://archive.today/20130414000948/http://journal.nzma.org.nz/journal/123-1312/4054/ |archive-date=14 April 2013 }}</ref> | |||
The British Medical Association notes that "There is also no problem with GPs referring patients to practitioners in osteopathy and chiropractic who are registered with the relevant statutory regulatory bodies, as a similar means of redress is available to the patient."<ref>British Medical Association, </ref> | |||
Despite the claim from some chiropractors that spinal manipulation could treat infant colic, a 2009 review of chiropractic spinal manipulation for ] stated "the current evidence... does not show that chiropractic spinal manipulation is an effective treatment for infant colic."<ref>{{cite journal |author=Ernst E |title=Chiropractic spinal manipulation for infant colic: a systematic review of randomised clinical trials |journal=Int J Clin Pract |volume=63 |issue=9 |pages=1351–53 |year=2009 |pmid=19691620 |doi=10.1111/j.1742-1241.2009.02133.x |doi-access=free }}</ref> | |||
==== WebMD ==== | |||
{{POV-section|date=February 2008}} | |||
] has published several studies that promote the efficacy of chiropractic adjustments. The first of these was published on October 12, 2004. This study showed that not only did Chiropractic cut the cost of treating back pain by 28%, it also reduced hospitilizations by 41%, back surgeries by 32%, and reduced the cost of medical imaging, such as X-rays or MRIs, by 37%. This was according to a study published in the Oct. 11 issue of Archives of Internal Medicine. Although the researchers did not look at patient satisfaction in this study, Metz says company studies show that 95% of chiropractic care patients are satisfied with the care they receive."<ref>Web MD, </ref> | |||
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.<ref name=Gilbey>{{cite journal |pmid=18670471 |date=July 2008 |last1=Gilbey |first1=A |title=Use of inappropriate titles by New Zealand practitioners of acupuncture, chiropractic, and osteopathy |volume=121 |issue=1278 |pages=15–20 |issn=0028-8446 |journal=The New Zealand Medical Journal}}</ref> In New Zealand, chiropractors are allowed to use the title 'doctor' when it is qualified to show that the title refers to their chiropractic role. A representative from the NZ Chiropractic Board states that entries in the Yellow Pages under the heading of "Chiropractors" fulfills this obligation when suitably qualified.<ref>{{cite journal|url=http://www.nzma.org.nz/journal/121-1280/3224/ |pmid=18791634 |date=August 2008 |last1=Bale |first1=K |title=Chiropractic Board New Zealand response to "Dr Who?" editorial |volume=121 |issue=1280 |pages=78–79 |issn=0028-8446 |journal=The New Zealand Medical Journal |url-status=dead |archive-url=https://archive.today/20120907215408/http://www.nzma.org.nz/journal/121-1280/3224/ |archive-date=September 7, 2012 }}</ref> If a chiropractor is not a registered medical practitioner, then the misuse of the title "Doctor" while working in healthcare will not comply with the ].<ref name=Gilbey/> | |||
== Critics == | |||
UK chiropractic organizations and their members make numerous claims which are not supported by scientific evidence. Many chiropractors adhere to ideas which are against science and most seemingly violate important principles of ethical behavior on a regular basis. The advice chiropractors gave to their patients is often misleading and dangerous.<ref>{{cite journal |pmid=19541879 |date=July 2009 |last1=Ernst |first1=E |title=UK chiropractic: regulated but unruly |volume=14 |issue=3 |pages=186–87 |issn=1355-8196 |doi=10.1258/jhsrp.2009.008183 |journal=Journal of Health Services Research & Policy|s2cid=43404682 }}</ref> This situation, coupled with a ] to the ], has inspired the filing of formal complaints of false advertising against more than 500 individual chiropractors within one 24-hour period,<ref name=withdraw>{{cite web |url=http://blogs.nature.com/news/thegreatbeyond/2009/06/chiropractic_group_advises_mem_1.html |title=The Great Beyond: Chiropractic group advises members to 'withdraw from the battleground' |publisher=Nature.com |author=Lucas Laursen |access-date=20 June 2009}}</ref><ref>{{cite web |url=http://blogs.nature.com/news/thegreatbeyond/2009/06/chiropractic_complainers_ident.html |title=The Great Beyond: Complaints converge on chiropractors |publisher=Nature.com |author=Lucas Laursen |access-date=20 June 2009}}</ref> prompting the McTimoney Chiropractic Association to write to its members advising them to remove leaflets that make claims about whiplash and colic from their practice, to be wary of new patients and telephone inquiries, and telling their members: "If you have a website, take it down ''now''" and "Finally, we strongly suggest you do ''not'' discuss this with others, especially patients."<ref name=withdraw/> | |||
] of ] wrote, "the claim that chiropractors are generally qualified to be "primary-care providers" is absurd." | |||
], which has published this button in his favor.<ref name=SAScience/>]] | |||
William T. Jarvis, Ph.D. stated: "Chiropractic is a controversial health-care system that has been legalized throughout the United States and in several other countries. In the United States in 1984, roughly 10.7 million people made 163 million office visits to 30,000 chiropractors. More than three fourths of the states require insurance companies to include chiropractic services in health and accident policies. The federal government pays for limited chiropractic services under Medicare, Medicaid, and its vocational rehabilitation program, and the Internal Revenue Service allows a medical deduction for chiropractic services. Chiropractors cite such facts as evidence of "recognition." However, these are merely business statistics and legal arrangements that have nothing to do with chiropractic's scientific validity." | |||
On 19 April 2008, ] wrote a cautionary article about chiropractic therapies in '']'',<ref name=beware>{{cite news |url=https://www.theguardian.com/commentisfree/2008/apr/19/controversiesinscience-health |title=Beware the spinal trap |last=Singh |first=Simon |author-link=Simon Singh |date=19 April 2008 |work=] |access-date=7 May 2017}}</ref> which resulted in him being sued for libel by the ]. Singh wrote in ''The Guardian'' criticizing the claims made by chiropractors about the efficacy of spinal manipulation in treating childhood ailments, among other things. He suggested there was "not a jot" of evidence to support such interventions for these ailments, and argued that the British Chiropractic Association "happily promotes bogus treatments".<ref name=":6">{{cite journal |pmid=19493953 |date=June 2009 |last1=Harris |first1=E |title=Science in court |volume=338 |page=b2254 |issn=0959-8138 |journal=BMJ (Clinical Research Ed.) |doi=10.1136/bmj.b2254|s2cid=27412292 }}</ref> Singh stated that he would "contest the action vigorously… There is an important issue of freedom of speech at stake."<ref name=Eden/> The article developed the theme of Singh's published book '']'', making various claims about the usefulness of ].<ref name=beware/> Commentators suggested this ruling could set a precedent to restrict ] to criticize ].<ref>{{cite news |url=https://www.newscientist.com/article/mg20227083.000-chiropractic-critic-loses-first-round-in-libel-fight.html |title=Chiropractic critic loses first round in libel fight |date=15 May 2009 |work=New Scientist |access-date=19 May 2009}}</ref><ref>{{cite news |url=https://www.newscientist.com/article/mg20227086.200-comment-dont-criticise-or-well-sue.html |title=Comment: Don't criticise, or we'll sue |last=Green |first=David Allen |date=13 May 2009 |work=New Scientist |access-date=19 May 2009}}</ref> The charity ] launched a campaign<ref name=SAScience>{{cite press release |title=The campaign at a glance |publisher=] |date=29 November 2009 |url=http://www.senseaboutscience.org.uk/index.php/site/project/375/ |access-date=29 November 2009 |archive-url=https://web.archive.org/web/20110504025109/http://www.senseaboutscience.org.uk/index.php/site/project/375 |archive-date=4 May 2011 |url-status=dead }}</ref> to draw attention to this particular case. They issued a statement entitled "The law has no place in scientific disputes",<ref name=Statement>{{cite web |title=The law has no place in scientific disputes |publisher=] |date=10 August 2009 |url=http://www.senseaboutscience.org.uk/index.php/site/project/334/ |access-date=11 September 2009}}</ref> which was signed by myriad signers representing science, journalism, publishing, arts, humanities, entertainment, skeptics, campaign groups and law. {{As of|2010|04|16|df=US}}, over 50,000 had signed.<ref name=SAScience/> On April 1, 2010, in '']'' Singh won his court appeal for the right to rely on the defense of fair comment. On April 15, 2010, the BCA officially withdrew its lawsuit, thus ending the case.<ref>{{cite web|url=http://www.elyplace.com/index.aspx?p=1&articleId=208 |publisher=Ely Place |title=British Chiropractic Association v Singh – BCA admits defeat |access-date=2010-04-15 |url-status=dead |archive-url=https://web.archive.org/web/20100420201251/http://www.elyplace.com/index.aspx?p=1 |archive-date=April 20, 2010 }}</ref> The Wilk v. AMA case marked a turning point for chiropractic, with the court ruling that the AMA’s efforts to undermine the profession constituted an unlawful restraint of trade.<ref name=":6" /> The decision helped chiropractors gain greater acceptance in healthcare systems. | |||
Lon Morgan, DC, a reform chiropractor, expressed his view of ] this way: "Innate Intelligence clearly has its origins in borrowed mystical and occult practices of a bygone era. It remains untestable and unverifiable and has an unacceptably high penalty/benefit ratio for the chiropractic profession. The chiropractic concept of Innate Intelligence is an anachronistic holdover from a time when insufficient scientific understanding existed to explain human physiological processes. It is clearly religious in nature and must be considered harmful to normal scientific activity."<ref name="Morgan L">Morgan L (1998) J Can Chiropr Assoc 1998; 42(1):35-41</ref> | |||
== Evidence for safety and efficacy == | |||
According to Williams, writer of the ], "today, ] is one of the ideas that form the basis for many pseudoscientific health systems that claim that illnesses are caused by a disturbance or imbalance of the body's vital force." "Vitalists claim to be scientific, but in fact they reject the scientific method with its basic postulates of cause and effect and of provability. They often regard subjective experience to be more valid than objective material reality."<ref name="Williams">Williams.W. (2000) '']. From Alien Abductions to Zone Therapy''. Facts on File inc. Contributors: Drs D.Conway, L.Dalton, R.Dolby, R.Duval, H.Farrell, J.Frazier, J.McMillan, J.Melton, T.O'Niell, R.Shepherd, S.Utley, W.Williams. ISBN 0-8160-3351-X</ref> | |||
Evidence-based research into the efficacy of chiropractic techniques is motivated by concerns that are antithetical to its vitalistic origins.<ref name=Villanueva-Russell>{{cite journal |journal= ] |year=2005 |volume=60 |issue=3 |pages=545–61 |title= Evidence-based medicine and its implications for the profession of chiropractic |author= Villanueva-Russell Y |doi=10.1016/j.socscimed.2004.05.017 |pmid=15550303}}</ref> Not all the criticism, however, has origins in the medical profession. Some chiropractors are cautiously calling for reform.<ref name=Jaroff/> Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs ] reasoning and unsubstantiated claims<ref name=History-Primer/><ref name="chiroandosteo.com"/><ref name=Keating-subluxation/><ref>Science, antiscience, materialism and vitalism: | |||
*{{cite journal |author= Keating JC Jr |journal= ] |volume=21 |issue=4 |pages=37–43 |title= Chiropractic: science and antiscience and pseudoscience side by side |year=1997}} | |||
*{{cite book |author= Phillips RB |chapter= The evolution of vitalism and materialism and its impact on philosophy |pages=65–76 |title= Principles and Practice of Chiropractic |edition=3rd |editor1=Haldeman S |editor2=Dagenais S |editor3=Budgell B |display-editors=etal |publisher=] |year=2005 |isbn=978-0-07-137534-4}}</ref> that are ethically suspect when they let practitioners maintain their beliefs to patients' detriment.<ref name="chiroandosteo.com"/> | |||
It is widely held that chiropractic extends into areas of medicine beyond the limits of its efficacy. In the opinion of ], "A good chiropractor can do a lot to help you when you have mechanical-type back pain and other musculoskeletal problems. But until the chiropractic profession cleans up its act, and its colleges uniformly graduate properly limited chiropractors who specialize in neuromusculoskeletal problems, you'll have to exercise caution and informed judgment when seeking chiropractic care."<ref name=Homola_bad_good>Samuel Homola, DC. "", reprinted (with slight modification) from the January/February 2001 issue of '']'', ]</ref> ] is critical of chiropractic. Its founder, ], has written that it is "absurd" to think that chiropractors are qualified to be primary care providers<ref name=fool_you>Stephen Barrett, M.D., "</ref> and considers ] to be pseudoscience.<ref name="Quackwatch-AK">{{cite web|url=http://www.quackwatch.org/01QuackeryRelatedTopics/Tests/ak.html|title=Applied Kinesiology: Phony Muscle-Testing for "Allergies" and "Nutrient Deficiencies"|author-link=Stephen Barrett|first=Stephen|last=Barrett|date=23 August 2014}}</ref> | |||
] emphasizes the commercial, rather than professional, nature of chiropractic:<ref name=Jarvis>{{cite web|author=William T. Jarvis, Ph.D.|url=http://www.chirobase.org/01General/controversy.html|title=Why Chiropractic Is Controversial|year=1990}}</ref>{{blockquote|Chiropractic is a controversial health-care system that has been legalized throughout the United States and in several other countries. In the United States in 1984, roughly 10.7 million people made 163 million office visits to 30,000 chiropractors. More than three fourths of the states require insurance companies to include chiropractic services in health and accident policies. The US federal government pays for limited chiropractic services under Medicare, Medicaid, and its vocational rehabilitation program, and the Internal Revenue Service allows a medical deduction for chiropractic services. Chiropractors cite such facts as evidence of "recognition." However, these are merely business statistics and legal arrangements that have nothing to do with chiropractic's scientific validity.}} | |||
=== Spinal manipulation === | |||
The efficacy and safety of spinal manipulation are uncertain.<ref name=Ernst-eval/><ref>{{cite web|author=Edzard Ernst|title=The alchemists of alternative medicine – part 5: pseudo-systematic reviews|publisher=Edzard Ernst|date= February 8, 2014|url=http://edzardernst.com/2014/02/the-alchemists-of-alternative-medicine-part-5-pseudo-systematic-reviews/}}</ref> A 2008 review found that with the possible exception of chronic ], chiropractic manipulation has not been shown to be ] for any medical condition.<ref name=Ernst-eval/><ref name=":1">{{Cite journal |last1=Kaminskyj |first1=Adrienne |last2=Frazier |first2=Michelle |last3=Johnstone |first3=Kyle |last4=Gleberzon |first4=Brian J. |date=March 2010 |title=Chiropractic care for patients with asthma: A systematic review of the literature |journal=The Journal of the Canadian Chiropractic Association |volume=54 |issue=1 |pages=24–32 |issn=1715-6181 |pmc=2829683 |pmid=20195423}}</ref><ref name=":2">{{Cite journal |last1=Chen |first1=W.-L. |last2=Chern |first2=C.-H. |last3=Wu |first3=Y.-L. |last4=Lee |first4=C.-H. |date=January 2006 |title=Vertebral artery dissection and cerebellar infarction following chiropractic manipulation |journal=Emergency Medicine Journal: EMJ |volume=23 |issue=1 |pages=e1 |doi=10.1136/emj.2004.015636 |issn=1472-0213 |pmc=2564146 |pmid=16373786}}</ref><ref name=":3">{{Cite journal |last1=Jones |first1=Jeremy |last2=Jones |first2=Catherine |last3=Nugent |first3=Kenneth |date=January 2015 |title=Vertebral artery dissection after a chiropractor neck manipulation |journal=Proceedings (Baylor University. Medical Center) |volume=28 |issue=1 |pages=88–90 |doi=10.1080/08998280.2015.11929202 |issn=0899-8280 |pmc=4264725 |pmid=25552813}}</ref> The efficacy and safety of chiropractic for children are particularly doubtful. A 2009 review found that "the best evidence available to date fails to demonstrate clinically relevant benefits of chiropractic for paediatric patients, and some evidence even suggests that chiropractors can cause serious harm to children".<ref>{{cite journal |pmid=19460920 |doi=10.1136/adc.2009.158170 |date=June 2009 |last1=Ernst |first1=E |title=Chiropractic manipulation, with a deliberate "double entendre" |volume=94 |issue=6 |page=411 |issn=0003-9888 |journal=Archives of Disease in Childhood|s2cid=13324088 }}</ref> According to ], chiropractic is no more effective than conventional treatment at its best, has a disadvantage of being "surrounded by gobbledygook about 'subluxations{{'"}}, and, more seriously, it does kill patients occasionally.<ref name=pmid18670469/> Some reformist chiropractors advocate for evidence-based practices, distancing themselves from the subluxation theory and focusing on musculoskeletal care.<ref>{{Cite journal |last=Homola |first=Samuel |date=December 2010 |title=Real orthopaedic subluxations versus imaginary chiropractic subluxations |url=https://onlinelibrary.wiley.com/doi/10.1111/j.2042-7166.2010.01053.x |journal=Focus on Alternative and Complementary Therapies |language=en |volume=15 |issue=4 |pages=284–287 |doi=10.1111/j.2042-7166.2010.01053.x |issn=1465-3753}}</ref><ref>{{Cite journal |last=Simpson |first=J Keith |date=December 2012 |title=The Five Eras of Chiropractic & the future of chiropractic as seen through the eyes of a participant observer |journal=Chiropractic & Manual Therapies |language=en |volume=20 |issue=1 |page=1 |doi=10.1186/2045-709X-20-1 |doi-access=free |issn=2045-709X |pmc=3299614 |pmid=22260381}}</ref><ref>{{Cite journal |last1=Marcon |first1=Alessandro R. |last2=Murdoch |first2=Blake |last3=Caulfield |first3=Timothy |date=December 2019 |title=The "subluxation" issue: an analysis of chiropractic clinic websites |journal=Archives of Physiotherapy |language=en |volume=9 |issue=1 |page=11 |doi=10.1186/s40945-019-0064-5 |doi-access=free |issn=2057-0082 |pmc=6854675 |pmid=31754460}}</ref> | |||
A 2009 defense of chiropractic, written by chiropractor Alan Breen, stated there is consistent evidence that manual therapies such as chiropractic manipulations are "helpful and generally produce moderate but significant and sustained improvement for back pain"<ref name=Breen2009/> and dismissed the suggestion that chiropractic does more harm than good as "specious". The author admitted, however, the possibility that chiropractic manipulation can cause strokes and even death.<ref name=Breen2009>{{cite journal |pmid=19541880 |doi=10.1258/jhsrp.2009.009025 |date=July 2009 |last1=Breen |first1=A |title=In praise of chiropractic |volume=14 |issue=3 |pages=188–89 |issn=1355-8196 |journal=Journal of Health Services Research & Policy|s2cid=11348276 }}</ref> | |||
Although rare,<ref name=WHO-guidelines>{{cite web|url=https://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf|title=WHO guidelines on basic training and safety in chiropractic – 2005|access-date=2022-07-06|archive-date=2022-03-13|archive-url=https://web.archive.org/web/20220313162309/https://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf|url-status=bot: unknown}}</ref> spinal manipulation, particularly of the neck, can result in complications that lead to permanent disability or death.<ref>{{cite journal |pmid=19444054 |date=May 2009 |last1=Gouveia |first1=LO |last2=Castanho |last3=Ferreira |title=Safety of chiropractic interventions: a systematic review |volume=34 |issue=11 |pages=E405–13 |issn=0362-2436 |doi=10.1097/BRS.0b013e3181a16d63 |journal=Spine |first2=P |first3=JJ|s2cid=21279308 }}</ref><ref name=Dirty_secret>{{cite web|author-link=Stephen Barrett|first=Stephen|last=Barrett|url=http://www.quackwatch.org/01QuackeryRelatedTopics/chirostroke.html|title=Chiropractic's Dirty Secret: Neck Manipulation and Strokes|date=26 November 2016}}</ref> These events can occur in both adults<ref name=Ernst-adverse/> and children.<ref name=Vohra/> A 2010 systematic review found that numerous deaths since 1934 have been recorded after chiropractic neck manipulation typically associated with ].<ref name="Ernst-death">{{cite journal|quote="Some chiropractic proponents seem to think that a critical evaluation of the research is tantamount to a 'scare story' or to 'puffing up (the evidence) out of all proportion'... A reasonable approach to serious risk from chiropractic therapy, however, requires an open examination."|journal= Int J Clin Pract |year=2010 |volume=64 |issue= 8 |pages=1162–65 |title= Deaths after chiropractic: a review of published cases |author= E Ernst |pmid=20642715 |doi=10.1111/j.1742-1241.2010.02352.x|s2cid= 45225661 |doi-access=free }}</ref><ref name=":1" /><ref name=":2" /><ref name=":3" /> A growing number of chiropractors advocate for aligning the profession with scientific standards, focusing on neuromusculoskeletal care and collaborating with mainstream healthcare providers. | |||
=== X-ray procedures === | |||
Singh's 2008 book '']'' states that:<ref name="Trick or Treatment"/>{{blockquote|chiropractors may X-ray the same patient several times a year, even though there is no clear evidence that X-rays will help the therapist treat the patient. X-rays can reveal neither the subluxations nor the innate intelligence associated with chiropractic philosophy, because they do not exist. There is no conceivable reason at all why X-raying the spine should help a straight chiropractor treat an ear infection, asthma or period pains. Most worrying of all, chiropractors generally require a full spine X-ray, which delivers a significant higher radiation dose than most other X-ray procedures.}}Practice guidelines aim to reduce unnecessary radiation exposure,<ref name="Bussieres">{{cite journal |vauthors=Bussières AE, Taylor JA, Peterson C |title=Diagnostic imaging practice guidelines for musculoskeletal complaints in adults—an evidence-based approach—part 3: spinal disorders |journal=J Manipulative Physiol Ther |volume=31 |issue=1 |pages=33–88 |year=2008 |pmid=18308153 |doi=10.1016/j.jmpt.2007.11.003 |url=http://jmptonline.org/article/S0161-4754(07)00314-4/fulltext }}</ref> which increases cancer risk unnecessarily.<ref>{{cite book |author=] |title=Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2 |publisher=The National Academies Press |location=Washington, DC |year=2006 |isbn=978-0-309-09156-5 |doi=10.17226/11340 }}</ref> Research suggests that radiology instruction given at chiropractic schools worldwide is evidence-based, but that radiography is overused for low back pain.<ref name="Ammendolia">{{Cite journal | pmid = 18722195| year = 2008| last1 = Ammendolia| first1 = C| last2 = Taylor| first2 = J. A.| last3 = Pennick| first3 = V| last4 = Côté| first4 = P| last5 = Hogg-Johnson| first5 = S| last6 = Bombardier| first6 = C| title = Adherence to radiography guidelines for low back pain: A survey of chiropractic schools worldwide| volume = 31| issue = 6| pages = 412–18| doi = 10.1016/j.jmpt.2008.06.010| journal = Journal of Manipulative and Physiological Therapeutics}}</ref> | |||
] | |||
=== Vertebral subluxation === | |||
], the core concept of chiropractic, based on both physical science and metaphysical concepts.<ref name=Ernst-eval/> The concept of subluxation is subject to new and emerging research, and has been the subject of a debate about whether to keep it in the chiropractic paradigm that has lasted for decades.<ref name=Keating-subluxation>{{cite journal |doi=10.1186/1746-1340-13-17 |pmid=16092955 |date=August 2005 |last1=Keating Jc |first1=Jr |last2=Charlton |last3=Grod |last4=Perle |last5=Sikorski |last6=Winterstein |title=Subluxation: dogma or science? |volume=13 |page=17 |journal=Chiropractic & Osteopathy |first2=KH |first3=JP |first4=SM |first5=D |first6=JF |pmc=1208927 |issue=1 |doi-access=free }}</ref> It has been argued that dogmatic commitment to subluxation is a significant barrier to chiropractic as a profession: it brings ridicule from the scientific community and perpetuates a marketing tradition in chiropractic that leads to charges of quackery.<ref name=Keating-subluxation/> | |||
=== Innate intelligence === | |||
Lon Morgan, DC, a reform chiropractor, expressed his view of Innate Intelligence this way: "Innate Intelligence clearly has its origins in borrowed mystical and occult practices of a bygone era. It remains untestable and unverifiable and has an unacceptably high penalty/benefit ratio for the chiropractic profession. The chiropractic concept of Innate Intelligence is an anachronistic holdover from a time when insufficient scientific understanding existed to explain human physiological processes. It is clearly religious in nature and must be considered harmful to normal scientific activity."<ref name=pmc2485333>{{cite journal |first1=Lon |last1=Morgan |date=March 1998 |title=Innate intelligence: its origins and problems |journal=The Journal of the Canadian Chiropractic Association |volume=41 |issue=1 |pages=35–41 |pmc=2485333 }}</ref> | |||
Chiropractic historian ] articulated that "So long as we propound the "One cause, one cure" rhetoric of Innate, we should expect to be met by ridicule from the wider health science community. Chiropractors can't have it both ways. Our theories cannot be both dogmatically held vitalistic constructs and be scientific at the same time. The purposiveness, consciousness and rigidity of the Palmers' Innate should be rejected."<ref name=pmc2505097>{{cite journal |first1=Joseph C. |last1=Keating |date=March 2002 |title=The Meanings of Innate |url=http://www.cliniquetag.com/wp-content/uploads/2015/03/the-meanings-of-innate.pdf |journal=The Journal of the Canadian Chiropractic Association |volume=46 |issue=1 |pages=4–10 |pmc=2505097 }}</ref> | |||
== Vaccination and water fluoridation == | |||
{{see also|Anti-vaccinationism in chiropractic}} | |||
Many forms of ] are based on philosophies that ] and have practitioners who voice their opposition.<ref name=Ernst/> These include some elements of the chiropractic community.<ref name=Ernst>{{cite journal |journal=Vaccine |year=2001 |volume=20 |issue= Suppl 1 |pages=S89–93 |title= Rise in popularity of complementary and alternative medicine: reasons and consequences for vaccination |author= Ernst E |doi=10.1016/S0264-410X(01)00290-0 |pmid=11587822}}</ref> The reasons for this negative vaccination view are complicated and rest, at least in part, on the early philosophies which shape the foundation of these professions.<ref name=Ernst/> Chiropractors historically were strongly opposed to ] based on their belief that all diseases were traceable to causes in the spine, and therefore could not be affected by vaccines; D.D. Palmer wrote, "It is the very height of absurdity to strive to 'protect' any person from smallpox or any other malady by inoculating them with a filthy animal poison."<ref name="Busse-JW"/> Some chiropractors continue to be opposed to vaccination, one of the most effective public health measures in history.<ref name=Nelson/> Many deny the eradication of ] and believed it was renamed ].<ref name="Busse-JW"/> | |||
Some chiropractic groups still oppose attempts to limit or eliminate nonmedical exemptions to vaccination. In March 2015, the Oregon Chiropractic Association invited ], a discredited former doctor and chief author of a ], to testify against Senate Bill 442,<ref name=Yoo>{{Citation |last=Yoo |first=Saerom |date=February 24, 2015 |title=Vaccine researcher Wakefield to testify in Oregon |publisher=] |url=http://www.statesmanjournal.com/story/news/health/2015/02/24/andrew-wakefield-vaccine-oregon/23967797/ |access-date=March 3, 2015 }}</ref> "a bill that would eliminate nonmedical exemptions from Oregon's school immunization law."<ref name=Yoo_canceled>{{Citation |last=Yoo |first=Saerom |date=February 26, 2015 |title=Meeting on vaccine mandate bill canceled |publisher=] |url=http://www.statesmanjournal.com/story/news/health/2015/02/25/meeting-vaccine-mandate-bill-canceled/24020213/ |access-date=March 3, 2015 }}</ref> The California Chiropractic Association lobbied against a 2015 bill ending belief exemptions for vaccines. They had also opposed a 2012 bill related to vaccination exemptions.<ref name=Mason>{{Citation |last=Mason |first=Melanie |date=March 5, 2015 |title=Chiropractors lobby against bill ending belief exemptions for vaccines |work=] |url=http://www.latimes.com/local/political/la-me-pc-vaccine-bill-chiropractors-20150305-story.html |access-date=March 6, 2015 }}</ref> On April 24, 2015, Wakefield received two standing ovations from the students at ] when he told them to oppose Senate Bill SB277, a bill which proposes limits on non-medical vaccine exemptions. Responding to his critics, he stated that "t doesn't matter if I go to the grave discredited. I don't care what they say about me. In fact, I have nothing to lose now. This is such an important issue."<ref name=Allday >{{Citation |last=Allday |first=Erin |date=April 25, 2015 |title=Anti-vaccine leader tells parents to fight immunization bill |publisher=] |url=http://www.sfchronicle.com/health/article/Former-doc-who-linked-vaccines-to-autism-tells-6222613.php |access-date=April 25, 2015 }}</ref> Wakefield had previously been a featured speaker at a 2014 "California Jam" gathering of chiropractors,<ref name=Collins >{{Citation |last=Collins |first=Caitlin |title=''Lifelines'', Winter 2014: Cal Jam in Review |publisher=] |url=http://lifewest.edu/wp-content/uploads/2014/03/Winter2014-2.pdf |access-date=April 25, 2015 |archive-url=https://web.archive.org/web/20180924184907/http://lifewest.edu/wp-content/uploads/2014/03/Winter2014-2.pdf |archive-date=September 24, 2018 |url-status=dead }}</ref> as well as a 2015 "California Jam" seminar, with ] credits, sponsored by Life Chiropractic College West.<ref name=California_Jam_2015 >{{Citation |title=California Jam (March 2015 CA) |url=http://pr.mo.gov/chiropractors-ceu-course-schedule.asp?detail=3014 |access-date=April 25, 2015 }}</ref> | |||
In response to threatening activities by anti-vaccination activists, the ] (CMA) sent a warning letter to California Chiropractic Association President Brian Stenzler, whom they could document had encouraged the ] of lobbyists who supported Senate Bill SB277. The CMA also filed a police report.<ref name=White >{{Citation |last=White |first=Jeremy |date=May 19, 2015 |title='Stalking' of pro-vaccine lobbyists prompts warning from doctors' group |newspaper=] |url=http://www.sacbee.com/news/politics-government/capitol-alert/article21421539.html |access-date=May 30, 2015 }}</ref> | |||
Early opposition to water fluoridation included chiropractors in the U.S. Some chiropractors oppose ] as being incompatible with chiropractic philosophy and an infringement of personal freedom. More recently, other chiropractors have actively promoted fluoridation, and several chiropractic organizations have endorsed scientific principles of public health.<ref name="Mormann"/> | |||
== Ownership of spinal manipulation == | |||
While no single profession "owns" spinal manipulation (SM), and there is little consensus as to which profession should administer SM, chiropractors have expressed concern that orthodox medical physicians and physical therapists could "steal" SM procedures from chiropractors. Chiropractors regularly introduce bills into state legislatures to further prohibit non-chiropractors from performing SM, and they are opposed by physical therapist organizations.<ref>{{cite journal |journal= DePaul J Health Care Law |year=2004 |volume=8 |issue=1 |pages=237–61 |title= State practice acts of licensed health professions: scope of practice |vauthors=Hilliard JW, Johnson ME }}</ref> Two U.S. states (Washington and Arkansas) prohibit physical therapists from performing SM,<ref>{{cite news |last=Anderson |first=Chantal |title=Physical therapists, chiropractors square off over bill |url=http://blog.seattletimes.nwsource.com/politicsnorthwest/2009/01/22/the_campus_is_heating_up.html |date=2009-01-22 |work=The Seattle Times |access-date=2010-09-23 |url-status=dead |archive-url=https://web.archive.org/web/20100922091855/http://blog.seattletimes.nwsource.com/politicsnorthwest/2009/01/22/the_campus_is_heating_up.html |archive-date=2010-09-22 }}</ref> while some states allow them to do it only if they have completed advanced training in SM. In the most restrictive states, SM is limited to chiropractors and medical physicians. | |||
== Notable incidents and lawsuits == | |||
* ], 45, an American musician, died during a chiropractic visit on February 28, 1986, when an "intentional whiplash" experiment caused blood vessels in his neck to rupture, leading to a fatal stroke.<ref name="wcp070706">{{cite news | title = The Cosmos Club |url = http://www.washingtoncitypaper.com/cover/2006/cover0707.html?navEdit | date = July 7, 2006 | publisher = ] |archiveurl = https://web.archive.org/web/20080627200714/http://www.washingtoncitypaper.com/cover/2006/cover0707.html?navEdit |archivedate = June 27, 2008}}</ref> | |||
* Lana Dale Lewis, of ], Canada, died on September 12, 1996, following a neck manipulation. The coroner's jury found that "receiving an upper cervical neck manipulation from a chiropractor could injure the arteries in your neck."<ref name =GayAbbate></ref> | |||
* Laurie Jean Mathiason, of ], Canada, had a massive stroke while undergoing chiropractic treatment, and died three days later, on February 4, 1998. A coroner's jury concluded that neck manipulation caused the stroke.<ref name =GayAbbate/> | |||
* Kimberly Lee Strohecker, 30, of ], United States, died after a series of seizures left her unable to drink or walk and caused the contents of her stomach to aspirate into her lungs, causing ]. Strohecker, an ], had been advised by her chiropractor, Joanne M. Gallagher of Life Expression Chiropractic Center of ], to stop taking her ] medication if she wished to cure herself. When Strohecker began experiencing seizures every 10 to 15 minutes, Gallagher reassured her that she was fine and told her to not visit a hospital as they would treat her with anticonvulsants, which could kill her. Strohecker died on April 29, 1999, and her family filed suit against Gallagher. Gallagher plead guilty to one count ], stemming from an attempt to bill ] for treatment that supposedly took place after Strohecker's death, agreed to pay the family $500,000 in restitution. She was fined $9,100 and sentenced to 18 months in prison. Gallagher attempted to appeal the revocation of her license 2005 but was unsuccessful. In 2012, she was twice denied a license to practice massage in the state of Pennsylvania. She was later able to resume work with Life Expression Chiropractic Center as a Registered Craniosacral Therapist, with the website stating that Gallagher "transitioned" from chiropractic care to craniosacral therapy, with no mention of her criminal history or her involvement in Strohecker's death. She is still working in the field as of September 2022.<ref>{{Cite web |last=kreidler |first=Marc |date=2016-09-01 |title=Bizarre Therapy Leads to Patient's Death {{!}} Quackwatch |url=https://quackwatch.org/chiropractic/victims/gallagher/ |access-date=2022-09-26 |language=en-US}}</ref><ref>{{Cite web |title=Joanne M. Gallagher, RCST ® |url=http://lifeexpressionwellness.com/team/joanne-m-gallagher-rcst/ |access-date=2022-09-26 |website=Life Expression Wellness Center}}</ref><ref>{{Cite web |last=Archivist |first=Times Leader |date=2004-03-09 |title=Chiropractor Gets 18 Months Joanne M. Gallagher, 44, Was Sentenced To Federal Prison For Defrauding Medicaid In Connection With Patient's Death In 1999. |url=https://www.timesleader.com/archive/1056168/chiropractor-gets-18-months-joanne-m-gallagher-44-was-sentenced-to-federal-prison-for-defraudingmedicaid-in-connection-with-patients-death-in-1999 |access-date=2022-09-28 |website=Times Leader |language=en-US}}</ref><ref>{{Cite web |last=DeJesus |first=Ivey |date=2012-08-15 |title=Former chiropractor who pleaded guilty in death of patient tells licensing board she is a changed woman |url=https://www.pennlive.com/midstate/2012/08/former_chiropractor_who_pleade.html |access-date=2022-09-28 |website=pennlive |language=en}}</ref><ref>{{Cite web |last=Patriot-News |first=The |date=2012-08-14 |title=Chiropractor pleaded guilty to fraud: July 2003 |url=https://www.pennlive.com/midstate/2012/08/chiropractor_pleads_guilty_to.html |access-date=2022-09-28 |website=pennlive |language=en}}</ref> | |||
* James Turner, 11, of Ontario, Canada, was left with lower body paralysis, muscle weakness, and ] after having his neck adjusted by chiropractor V. Gary Dyck. Dyck performed two adjustments on Turner, the first on July 24, 2000, and the second on July 25, 2000, and caused the ] of a ], a benign spinal tumor. Turner underwent emergency surgery at the Royal Victoria Hospital in ], Ontario. The lawsuit, brought by Turner's parents, Alan and Jill Turner, claimed that Dyck had shown negligence in that he did not perform X-rays to determine if the adjustments would resolve Turner's initial complaints of neck pain and that had he done so, Dyck would have noticed the tumor. Dyck died in 2017.<ref>{{Cite web |last=kreidler |first=Marc |date=2001-10-18 |title=Canadian Chiropractor Sued after Child Is Paralyzed {{!}} Quackwatch |url=https://quackwatch.org/chiropractic/turner/ |access-date=2022-09-26 |language=en-US}}</ref><ref>{{Cite web |date=2015-07-06 |title=Remembering Gary Dyck {{!}} Obituaries |url=https://www.adamsfuneralhome.ca/obituaries/gary-dyck/29408/ |access-date=2022-09-26 |website=Adams Funeral Home and Cremation Services Ltd {{!}} Barrie, ON |language=en-US}}</ref> | |||
* ], 22, an ] from ], Canada, suffered ] after her chiropractor, based in ], over-rotated her neck during an adjustment. The injury had a devastating effect on her performance at the ] in ], China, as the injury left her unable to eat or train for five weeks.<ref>{{Cite web |date=2008-06-01 |title=Canada's BMX medal hope Cools turns in gallant effort in China |url=https://www.thestar.com/sports/olympics/2008/06/01/canadas_bmx_medal_hope_cools_turns_in_gallant_effort_in_china.html |access-date=2022-09-26 |website=thestar.com |language=en}}</ref> | |||
* Jeremy Lynn Youngblood, 30, an employee of the city of ], United States, died on June 11, 2011, from complications of an acute cerebellar stroke. The injuries were determined by the ] to have been caused by a neck adjustment performed by an unnamed chiropractor employed by Power Chiropractic Clinic. Authorities did not comment on whether charges of negligence would be filed against Power Chiropractic Clinic or not. According to Assistant Police Chief Carl Allen, Youngblood complained of disorientation and began vomiting in the minutes following the adjustment and clinic staff did not call 911. Youngblood was driven to Valley View Regional Hospital, now Mercy Hospital Ada, by his father and died two days later.<ref>{{Cite web |date=2014-11-08 |title=30-year-old dies after routine visit to the chiropractor |url=https://www.q13fox.com/news/30-year-old-dies-after-routine-visit-to-the-chiropractor |access-date=2022-09-26 |website=FOX13 News {{!}} Seattle & Western Washington {{!}} Formerly Q13 News |language=en-US}}</ref><ref>{{Cite web |title=Ada man, 29, dies of stroke after chiropractic treatment |url=https://www.oklahoman.com/story/lifestyle/health-fitness/2011/06/23/ada-man-29-dies-of-stroke-after-chiropractic-treatment/61154746007/ |access-date=2022-09-26 |website=The Oklahoman |language=en-US}}</ref><ref>{{Cite news |title=Valley View Regional Hospital becomes Mercy Hospital Ada |url=https://www.theadanews.com/news/local_news/valley-view-regional-hospital-becomes-mercy-hospital-ada/article_c88f96d3-6eeb-5381-bd59-e1a2b2a092b8.html |access-date=2022-09-26 |website=The Ada News |language=en}}</ref><ref>{{Cite web |title=Chiropractic Stroke Awareness Group, LLC |url=https://chiropracticstroke.com/victims.jeremy.php |access-date=2022-09-26 |website=chiropracticstroke.com}}</ref> | |||
* In 2019, a video appeared online of Andrew Arnold, a chiropractor from ], Australia, holding a 2-week-old baby upside down surfaced online, sparking outrage. Arnold gave an undertaking not to provide chiropractic treatment to children under the age of 12 after a video of him pending a review of his practice. He is the owner of Cranbourne Family Chiropractic.<ref>{{Cite web |agency=Australian Associated Press |date=2019-02-21 |title=Chiropractor who manipulated baby's spine banned from treating children under 12 |url=http://www.theguardian.com/australia-news/2019/feb/21/melbourne-chiropractor-who-manipulated-babys-spine-to-be-investigated |access-date=2022-09-28 |website=the Guardian |language=en}}</ref> | |||
* Caitlin Jensen, 28, a student at ], visited chiropractor T. J. Harpham, of Richmond Hill Family Chiropractic in ], United States, on June 16, 2022, to have her neck adjusted following complaints of stiffness. During the adjustment, four arteries in Jensen's neck were dissected, resulting in ], a ], and a ]. She was reportedly without a pulse for 10 minutes until she could be revived. She was left with almost full-body ], capable of only blinking her eyes and moving her left thumb. Her injuries also subsequently removed her ability to eat and breathe on her own, resulting in doctors forming ] and ] tubes in her stomach and neck areas respectively.<ref>{{Cite web |date=2022-09-08 |title=Georgia woman moved to rehab after being left paralyzed from routine chiropractor visit |url=https://nypost.com/2022/09/07/georgia-woman-caitlin-jensen-moved-to-rehab-after-being-left-paralyzed-from-routine-chiropractor-visit/ |access-date=2022-09-26 |website=New York Post |language=en-US}}</ref><ref>{{Citation |title=Woman Paralyzed After Chiropractor Visit | date=July 14, 2022 |url=https://www.youtube.com/watch?v=k7rB25rWwX0 |language=en |access-date=2022-09-26}}</ref><ref>{{Cite web |last=McNulty |first=Matthew |date=2022-07-19 |title=(Update) Family Of Woman Paralyzed During Chiropractor Visit Considering Lawsuit For Botched Adjustment |url=https://theshaderoom.com/update-family-of-woman-paralyzed-during-chiropractor-visit-considering-lawsuit-for-botched-adjustment/ |access-date=2022-09-26 |website=The Shade Room |language=en-US}}</ref> | |||
==See also== | |||
* ] | |||
== References == | == References == | ||
{{Reflist}} | {{Reflist|30em}} | ||
== External links == | == External links == | ||
=== Internal criticism === | |||
* | |||
* – ] | |||
* | |||
* – ] (commented in ) | |||
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* – Samuel Homola, (book review at ) | |||
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* – Christopher Kent, DC president of the Council on Chiropractic Practice | |||
=== External criticism === | |||
* – '']'' | |||
* – ], '']'' | |||
* '' ''– Paul Benedetti, Wayne MacPhail | |||
*{{Scientific American Frontiers |12 |10 |url=https://www.pbs.org/saf/1210/features/spine.htm Keeping Your Spine In Line |and=https://www.pbs.org/saf/1210/segments/1210-3.htm |name= Adjusting the Joints |Video=https://www.pbs.org/saf/1210/video/watchonline.htm ]}} | |||
* – ], MD, and Samuel Homola, DC | |||
{{Chiropractic}} | |||
{{DEFAULTSORT:Chiropractic Controversy And Criticism}} | |||
] | ] |
Latest revision as of 04:25, 9 December 2024
Throughout its history, chiropractic has been the subject of internal and external controversy and criticism. According to magnetic healer Daniel D. Palmer, the founder of chiropractic, "vertebral subluxation" was the sole cause of all diseases and manipulation was the cure for all disease. Internal divisions between "straights," who adhere strictly to Palmer’s original philosophy, and "mixers," who incorporate broader medical practices, have further complicated the profession’s identity. A 2003 profession-wide survey found "most chiropractors (whether 'straights' or 'mixers') still hold views of Innate Intelligence and of the cause and cure of disease (not just back pain) consistent with those of the Palmers". A critical evaluation stated "Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today." Chiropractors, including D.D. Palmer, were jailed for practicing medicine without a license. D.D. Palmer considered establishing chiropractic as a religion to resolve this problem. For most of its existence, chiropractic has battled with mainstream medicine, sustained by antiscientific and pseudoscientific ideas such as vertebral subluxation.
Chiropractic researchers have documented that fraud, abuse and quackery are more prevalent in chiropractic than in other health care professions. Unsubstantiated claims about the efficacy of chiropractic have continued to be made by individual chiropractors and chiropractic associations. The core concept of traditional chiropractic, vertebral subluxation, is not based on sound science. Collectively, systematic reviews have not demonstrated that spinal manipulation, the main treatment method employed by chiropractors, was effective for any medical condition, with the possible exception of treatment for back pain. Spinal manipulation, particularly of the upper spine, can cause complications in adults and children that can cause permanent disability or death. Scientific studies have generally found limited evidence for chiropractic efficacy beyond back pain, and concerns about patient safety, particularly with neck manipulations, have been raised.
Legal battles, including the landmark Wilk v. AMA case and Simon Singh’s libel suit, highlight tensions between chiropractors and mainstream medicine. Ethical issues, such as misleading advertising and opposition to vaccination, continue to draw criticism. Despite efforts to modernize, chiropractic remains controversial within both the medical community and the public sphere. In 2008, Simon Singh was sued for libel by the British Chiropractic Association (BCA) for criticizing their activities in a column in The Guardian. A preliminary hearing took place at the Royal Courts of Justice in front of judge David Eady. The judge held that merely using the phrase "happily promotes bogus treatments" meant that he was stating, as a matter of fact, that the British Chiropractic Association was being consciously dishonest in promoting chiropractic for treating the children's ailments in question. An editorial in Nature has suggested that the BCA may be trying to suppress debate and that this use of British libel law is a burden on the right to freedom of expression, which is protected by the European Convention on Human Rights. The libel case ended with the BCA withdrawing its suit in 2010.
Chiropractors historically were strongly opposed to vaccination based on their belief that all diseases were traceable to causes in the spine, and therefore could not be affected by vaccines. Some chiropractors continue to be opposed to vaccination. Early opposition to water fluoridation included chiropractors in the U.S. Some chiropractors opposed water fluoridation as being incompatible with chiropractic philosophy and an infringement of personal freedom. More recently, other chiropractors have actively promoted fluoridation, and several chiropractic organizations have endorsed scientific principles of public health.
Historical controversy and critical elements
Main article: History of chiropracticThe birth of chiropractic was on September 18, 1895. There is controversy over what happened with several different accounts. Daniel D. Palmer later claimed that on that day he manipulated the spine of Harvey Lillard, a man who was nearly deaf, allegedly curing him of deafness. Palmer said "there was nothing accidental about this, as it was accomplished with an object in view, and the expected result was obtained. There was nothing 'crude' about this adjustment; it was specific so much so that no chiropractor has equaled it."
However, this version was disputed by Lillard's daughter, Valdeenia Lillard Simons. She said that her father told her that he was telling jokes to a friend in the hall outside Palmer's office and Palmer, who had been reading, joined them. When Lillard reached the punch line, Palmer, laughing heartily, slapped Lillard on the back with the hand holding the heavy book he had been reading. A few days later, Lillard told Palmer that his hearing seemed better. Palmer then decided to explore manipulation as an expansion of his magnetic healing practice. Simons said "the compact was that if they can make it, then they both would share. But, it didn't happen."
In spite of the fact that Lillard could hear well enough to tell jokes, B.J. Palmer claimed under sworn testimony that Lillard had been "thoroughly deaf". Since 1895, the story of Palmer's curing a man of deafness has been a part of chiropractic tradition. Palmer's account differs significantly from what actually happened, in that, according to Lillard's daughter, his improved hearing was likely caused by an accidentally fortuitous jarring of Lillard's body and not, as claimed by D.D. Palmer, caused by a "specific" adjustment. It was after this event that Palmer began to experiment with manipulation. He also claimed that his second patient, a man with heart disease, was also cured by spinal manipulation.
Chiropractic included vitalistic ideas of Innate Intelligence with religious attributes of Universal Intelligence as substitutes for science. Evidence suggests that D.D. Palmer had acquired knowledge of manipulative techniques from Andrew Taylor Still, the founder of osteopathy. Although D.D. Palmer combined bonesetting to give chiropractic its method, and "magnetic healing" for the theory, he acknowledged a special relation to magnetic healing when he wrote, "chiropractic was not evolved from medicine or any other method, except that of magnetic." He also "claimed that his profession had nothing to do with medicine, that he healed by the laying on of hands;... He also said that he had a diploma from no earthly school but from High Heaven."
According to D.D. Palmer, subluxation was the sole cause of all diseases and manipulation was the cure for all diseases of the human race. A 2003 profession-wide survey found:
most chiropractors (whether "straights" or "mixers") still hold views of Innate and of the cause and cure of disease (not just back pain) consistent with those of the Palmers. On one hand, modern promotional brochures make a bid for medical legitimacy by describing Innate and adjustments using more scientific-sounding terms such as "inherent" and "nerve force."
Chiropractic has had a strong salesmanship element since it was started by D.D. Palmer. His son, B.J. Palmer, asserted that their chiropractic school was founded on "...a business, not a professional basis. We manufacture chiropractors. We teach them the idea and then we show them how to sell it". D.D. Palmer established a magnetic healing facility in Davenport, Iowa, styling himself 'doctor'. Not everyone was convinced, as a local paper in 1894 wrote about him:
A crank on magnetism has a crazy notion that he can cure the sick and crippled with his magnetic hands. His victims are the weak-minded, ignorant and superstitious, those foolish people who have been sick for years and have become tired of the regular physician and want health by the short-cut method... he has certainly profited by the ignorance of his victims... His increase in business shows what can be done in Davenport, even by a quack.
Before adopting the term "chiropractic" in about 1896, his advertising used the term "magnetic". In 1891–92, a city business directory stated: "Dr. Palmer can cure with his Magnetic Hands Diseases of the Head, Throat, Heart, Lungs, Stomach, Liver, Spleen, Kidneys, Nerves, and Muscles, ten times quicker than any one can with medicines."
- Give me a simple mind that thinks along single tracts, give me 30 days to instruct him, and that individual can go forth on the highways and byways and get more sick people well than the best, most complete, all around, unlimited medical education of any medical man who ever lived.
Chiropractic was rooted in mystical concepts, leading to internal conflicts between straights and mixers which still persist. 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. The straights adhere religiously to the gospel of its founders while mixers are more open. There is a lack of uniformity and consensus among chiropractors in regard to their role. Depending upon whose point of view, chiropractors are, for example, subluxation-correctors, primary care physicians, neuromusculoskeletal specialists, or holistic health specialists. Straights have claimed mixers are not real chiropractors because they do not acknowledge Palmer's foundation of chiropractic therapy.
In 1906, D.D. Palmer was the first of hundreds of chiropractors who went to jail. Chiropractors were jailed for practicing medicine without a license. In the 1920s hundreds of unlicensed chiropractors chose jail rather than fines. Herbert Reaver was the most jailed chiropractor in the U.S. Chiropractors were charged with not complying with the medical practice act. California chiropractors adopted the motto, "Go to jail for chiropractic." 450 chiropractors were jailed in a single year at the peak of the controversy. Many chiropractors treated fellow prisoners and visiting patients while in jail.
Chiropractors, including Palmer, faced frequent legal battles, leading to efforts to reframe chiropractic as a religious practice to circumvent medical licensing laws. D.D. Palmer defined chiropractic as "a science of healing without drugs" and considered establishing chiropractic as a religion as a means to use religious "exemption clauses" to resolve legal difficulties presented by restrictive "chiro laws". In 1911, he stated (emphasis in original):
You ask, what I think will be the final outcome of our law getting. It will be that we will have to build a boat similar to Christian Science and hoist a religious flag. I have received chiropractic from the other world, similar as did Mrs. Eddy. No other one has laid claim to that, NOT EVEN B.J. Exemption clauses instead of chiro laws by all means, and LET THAT EXEMPTION BE THE RIGHT TO PRACTICE OUR RELIGION. But we must have a religious head, one who is the founder, as did Christ, Mohamed, Jo. Smith, Mrs. Eddy, Martin Luther and others who have founded religions. I am the fountain head. I am the founder of chiropractic in its science, in its art, in its philosophy and in its religious phase. Now, if chiropractors desire to claim me as their head, their leader, the way is clear. My writings have been gradually steering in that direction until now it is time to assume that we have the same right to as has Christian Scientists.
Chiropractors have struggled with survival and identity during its formative years, including internal struggles between its leaders and colleges. For much of the history of the chiropractic profession chiropractors showed little interest in scientific research and 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. Long-standing American Medical Association (AMA) policies against chiropractic contributed to a lack of acceptance within mainstream public health. The AMA created the Committee on Quackery "to contain and eliminate chiropractic." Using the Committee on Quackery, efforts were made to prevent the participation of chiropractic in organized health care. In 1966 a policy passed by the AMA House of Delegates stating:
It is the position of the medical profession that chiropractic is an unscientific cult whose practitioners lack the necessary training and background to diagnose and treat human disease. Chiropractic constitutes a hazard to rational health care in the United States because of its substandard and unscientific education of its practitioners and their rigid adherence to an irrational, unscientific approach to disease causation.
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. The rivalry was not solely with conventional medicine; many osteopaths proclaimed that chiropractic was a bastardized form of osteopathy.
Serious research to test chiropractic theories did not begin until the 1970s, and is continuing to be hampered by 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. Some people believe chiropractic has little more than a placebo effect, while some randomized trials of spinal manipulation have supported its effectiveness for the treatment of (specifically) low back pain. There are several barriers between primary care physicians and chiropractors for having positive referral relationships which includes a lack of good communication. The medical establishment has not entirely accepted chiropractic care as mainstream. After 100 years, the chiropractic profession has failed to define a message that is understandable, credible, and scientifically valid. The future of chiropractic is uncertain due to the economic struggles and restrictions of the science and methods in chiropractic.
Chiropractic has seen considerable controversy within the profession over its philosophy. In connection with a controversial and divisive 2015 organizational split in the Australian chiropractic community, an article described the profession's long standing and current problems:
The chiropractic profession is notorious for its infighting, with quarrels over the value of vaccination, the evidence or lack thereof to support the theory of subluxation and whether spinal adjustments should be performed on children.
Allegations of patricide connected with the death of D.D. Palmer
The 2008 book Trick or Treatment states that in 1913 B.J. Palmer ran over his father, D.D. Palmer, during a homecoming parade at the Palmer School of Chiropractic. Weeks later D.D. Palmer died. The official cause of death was recorded as typhoid. The book Trick or Treatment indicated "it seems more likely that his death was a direct result of injuries caused by his son. Indeed there is speculation that this was not an accident, but rather a case of patricide." A 1999 documentary study suggests D.D. Palmer's widow may have also played a role in the patricide controversy. D.D. Palmer's attending physicians were persuaded to change their opinions about the main cause of death. Chiropractic historian Joseph C. Keating Jr. has described the attempted patricide of D.D. Palmer as a "myth" and "absurd on its face" and cites an eyewitness who recalled that D.D. was not struck by B.J.'s car, but rather, had stumbled. He also says that "Joy Loban, DC, executor of D. D.'s estate, voluntarily withdrew a civil suit claiming damages against B.J. Palmer, and that several grand juries repeatedly refused to bring criminal charges against the son." A 1969 article stated that in July 1913 at the Palmer School of Chiropractic B.J. Palmer:
insisted on leading the alumni procession, but was prohibited from doing so by the marshal of the parade, who was a student at the school. An altercation ensued. B.J. drove up in his automobile. Words passed between father and son. What happened after that depends on whom you believe. Daniel David claimed that B.J. struck him with his automobile, and D.D.'s friends and allies later produced affidavits of witnesses to prove it. B.J. flatly denied it, and produced many more affidavits to this effect than D.D.'s cohorts were able to muster.
Ethics and claims
A study of California disciplinary statistics during 1997–2000 reported 4.5 disciplinary actions per 1000 chiropractors per year, compared to 2.27 for medical doctors, and the incident rate for fraud was 9 times greater among chiropractors (1.99 per 1000 chiropractors per year) than among medical doctors (0.20). Public trust in chiropractors remains mixed. While many patients report positive experiences, surveys consistently rank chiropractors lower in perceived honesty and ethical standards compared to other healthcare providers. According to a 2006 Gallup Poll of U.S. adults, when asked how they would "rate the honesty and ethical standards of people in these different fields", chiropractic compared unfavorably with mainstream medicine. When chiropractic was rated, it "rated dead last amongst healthcare professions". While 84% of respondents considered nurses' ethics "very high" or "high", only 36% felt that way about chiropractors. Other healthcare professions ranged from 38% for psychiatrists, to 62% for dentists, 69% for other medical doctors, 71% for veterinarians, and 73% for druggists or pharmacists. Similar results were found in the 2003 Gallup Poll. Chiropractic authors have placed these results in perspective in articles, with one writing that "we were the least trusted and least believed health care discipline", and another writing that chiropractors who use unethical marketing methods "poison the well" for others in the profession, and that they "might be responsible for the negative opinion people have about the ethics of the chiropractic profession." Many chiropractors have sought to address their minor status within the U.S. medical community by attending practice-building seminars to assist chiropractors to persuade their patients of the efficacy of their treatments, increase their revenue, and boost their morale as unorthodox medical practitioners.
Historically the profession has often been accused of quackery, with the profession often responding negatively to such accusations. In its early days, the accusation of quackery was voiced in a 1913 editorial in the Journal of the American Medical Association: (p. 29)
Chiropractic is a freak offshoot from osteopathy. Disease, say the chiropractors, is due to pressure on the spinal nerves; ergo it can be cured by 'adjusting' the spinal column. It is the sheerest quackery, and those who profess to teach it make their appeal to the cupidity of the ignorant. Its practice is in no sense a profession but a trade – and a trade that is potent for great harm. It is carried on almost exclusively by those of no education, ignorant of anatomy, ignorant even of the fundamental sciences on which the treatment of disease depends.
The view that chiropractic was a trade, rather than a profession, was stated clearly by B.J. Palmer, who asserted that chiropractic was founded on "a business, not a professional basis. "We manufacture chiropractors. We teach them the idea and then we show them how to sell it". In more modern times (1991), when the president of the ACA called accusations of quackery a "myth", chiropractic historian, Joseph C. Keating Jr. responded by calling his comments "absurd" and stated:
The so-called 'quackery myth about chiropractic' is no myth ... the kernels of quackery (i.e., unsubstantiated and untested health remedies offered as "proven") are ubiquitous in this profession. I dare say that health misinformation (if not quackery) can be found in just about any issue of any chiropractic trade publication (and some of our research journals) and much of the promotional materials chiropractors disseminate to patients. The recent unsubstantiated claims of the ACA are exemplary ... It escapes me entirely how Dr. Downing, the ACA, MPI, and Dynamic Chiropractic can suggest that there is no quackery in chiropractic. Either these groups and individuals do not read the chiropractic literature or have no crap-detectors. I urge a reconsideration of advertising and promotion policies in chiropractic.
In an article on quackery, W. T. Jarvis has stated that "Non-scientific health care (e.g., acupuncture, ayurvedic medicine, chiropractic, homeopathy, naturopathy) is licensed by individual states. Practitioners use unscientific practices and deception on a public who, lacking complex health-care knowledge, must rely upon the trustworthiness of providers. Quackery not only harms people, it undermines the scientific enterprise and should be actively opposed by every scientist."
In a 2008 commentary, the chiropractic authors proposed that "the chiropractic profession has an obligation to actively divorce itself from metaphysical explanations of health and disease as well as to actively regulate itself in refusing to tolerate fraud, abuse and quackery, which are more rampant in our profession than in other healthcare professions", a situation which violates the social contract between patients and physicians. Such self-regulation "will dramatically increase the level of trust in and respect for the profession from society at large." Another chiropractic study documented that 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. In English-speaking countries the majority of chiropractors and their associations appear to make efficacy claims that are unsupported by scientific evidence. Claims not supported by solid evidence were made about asthma, ear infection, earache, otitis media, and neck pain.
Despite the claim from some chiropractors that spinal manipulation could treat infant colic, a 2009 review of chiropractic spinal manipulation for infant colic stated "the current evidence... does not show that chiropractic spinal manipulation is an effective treatment for infant colic."
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. In New Zealand, chiropractors are allowed to use the title 'doctor' when it is qualified to show that the title refers to their chiropractic role. A representative from the NZ Chiropractic Board states that entries in the Yellow Pages under the heading of "Chiropractors" fulfills this obligation when suitably qualified. If a chiropractor is not a registered medical practitioner, then the misuse of the title "Doctor" while working in healthcare will not comply with the Health Practitioners Competence Assurance Act 2003.
UK chiropractic organizations and their members make numerous claims which are not supported by scientific evidence. Many chiropractors adhere to ideas which are against science and most seemingly violate important principles of ethical behavior on a regular basis. The advice chiropractors gave to their patients is often misleading and dangerous. This situation, coupled with a backlash to the libel suit filed against Simon Singh, has inspired the filing of formal complaints of false advertising against more than 500 individual chiropractors within one 24-hour period, prompting the McTimoney Chiropractic Association to write to its members advising them to remove leaflets that make claims about whiplash and colic from their practice, to be wary of new patients and telephone inquiries, and telling their members: "If you have a website, take it down now" and "Finally, we strongly suggest you do not discuss this with others, especially patients."
On 19 April 2008, Simon Singh wrote a cautionary article about chiropractic therapies in The Guardian, which resulted in him being sued for libel by the British Chiropractic Association. Singh wrote in The Guardian criticizing the claims made by chiropractors about the efficacy of spinal manipulation in treating childhood ailments, among other things. He suggested there was "not a jot" of evidence to support such interventions for these ailments, and argued that the British Chiropractic Association "happily promotes bogus treatments". Singh stated that he would "contest the action vigorously… There is an important issue of freedom of speech at stake." The article developed the theme of Singh's published book Trick or Treatment? Alternative Medicine on Trial, making various claims about the usefulness of chiropractic. Commentators suggested this ruling could set a precedent to restrict freedom of speech to criticize alternative medicine. The charity Sense about Science launched a campaign to draw attention to this particular case. They issued a statement entitled "The law has no place in scientific disputes", which was signed by myriad signers representing science, journalism, publishing, arts, humanities, entertainment, skeptics, campaign groups and law. As of April 16, 2010, over 50,000 had signed. On April 1, 2010, in British Chiropractic Association v Singh Singh won his court appeal for the right to rely on the defense of fair comment. On April 15, 2010, the BCA officially withdrew its lawsuit, thus ending the case. The Wilk v. AMA case marked a turning point for chiropractic, with the court ruling that the AMA’s efforts to undermine the profession constituted an unlawful restraint of trade. The decision helped chiropractors gain greater acceptance in healthcare systems.
Evidence for safety and efficacy
Evidence-based research into the efficacy of chiropractic techniques is motivated by concerns that are antithetical to its vitalistic origins. Not all the criticism, however, has origins 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 antiscientific reasoning and unsubstantiated claims that are ethically suspect when they let practitioners maintain their beliefs to patients' detriment.
It is widely held that chiropractic extends into areas of medicine beyond the limits of its efficacy. In the opinion of Samuel Homola, "A good chiropractor can do a lot to help you when you have mechanical-type back pain and other musculoskeletal problems. But until the chiropractic profession cleans up its act, and its colleges uniformly graduate properly limited chiropractors who specialize in neuromusculoskeletal problems, you'll have to exercise caution and informed judgment when seeking chiropractic care." Quackwatch is critical of chiropractic. Its founder, Stephen Barrett, has written that it is "absurd" to think that chiropractors are qualified to be primary care providers and considers applied kinesiology to be pseudoscience.
William T. Jarvis emphasizes the commercial, rather than professional, nature of chiropractic:
Chiropractic is a controversial health-care system that has been legalized throughout the United States and in several other countries. In the United States in 1984, roughly 10.7 million people made 163 million office visits to 30,000 chiropractors. More than three fourths of the states require insurance companies to include chiropractic services in health and accident policies. The US federal government pays for limited chiropractic services under Medicare, Medicaid, and its vocational rehabilitation program, and the Internal Revenue Service allows a medical deduction for chiropractic services. Chiropractors cite such facts as evidence of "recognition." However, these are merely business statistics and legal arrangements that have nothing to do with chiropractic's scientific validity.
Spinal manipulation
The efficacy and safety of spinal manipulation are uncertain. A 2008 review found that with the possible exception of chronic back pain, chiropractic manipulation has not been shown to be effective for any medical condition. The efficacy and safety of chiropractic for children are particularly doubtful. A 2009 review found that "the best evidence available to date fails to demonstrate clinically relevant benefits of chiropractic for paediatric patients, and some evidence even suggests that chiropractors can cause serious harm to children". According to David Colquhoun, chiropractic is no more effective than conventional treatment at its best, has a disadvantage of being "surrounded by gobbledygook about 'subluxations'", and, more seriously, it does kill patients occasionally. Some reformist chiropractors advocate for evidence-based practices, distancing themselves from the subluxation theory and focusing on musculoskeletal care.
A 2009 defense of chiropractic, written by chiropractor Alan Breen, stated there is consistent evidence that manual therapies such as chiropractic manipulations are "helpful and generally produce moderate but significant and sustained improvement for back pain" and dismissed the suggestion that chiropractic does more harm than good as "specious". The author admitted, however, the possibility that chiropractic manipulation can cause strokes and even death.
Although rare, spinal manipulation, particularly of the neck, can result in complications that lead to permanent disability or death. These events can occur in both adults and children. A 2010 systematic review found that numerous deaths since 1934 have been recorded after chiropractic neck manipulation typically associated with vertebral artery dissection. A growing number of chiropractors advocate for aligning the profession with scientific standards, focusing on neuromusculoskeletal care and collaborating with mainstream healthcare providers.
X-ray procedures
Singh's 2008 book Trick or Treatment states that:
chiropractors may X-ray the same patient several times a year, even though there is no clear evidence that X-rays will help the therapist treat the patient. X-rays can reveal neither the subluxations nor the innate intelligence associated with chiropractic philosophy, because they do not exist. There is no conceivable reason at all why X-raying the spine should help a straight chiropractor treat an ear infection, asthma or period pains. Most worrying of all, chiropractors generally require a full spine X-ray, which delivers a significant higher radiation dose than most other X-ray procedures.
Practice guidelines aim to reduce unnecessary radiation exposure, which increases cancer risk unnecessarily. Research suggests that radiology instruction given at chiropractic schools worldwide is evidence-based, but that radiography is overused for low back pain.
Vertebral subluxation
Vertebral subluxation, the core concept of chiropractic, based on both physical science and metaphysical concepts. The concept of subluxation is subject to new and emerging research, and has been the subject of a debate about whether to keep it in the chiropractic paradigm that has lasted for decades. It has been argued that dogmatic commitment to subluxation is a significant barrier to chiropractic as a profession: it brings ridicule from the scientific community and perpetuates a marketing tradition in chiropractic that leads to charges of quackery.
Innate intelligence
Lon Morgan, DC, a reform chiropractor, expressed his view of Innate Intelligence this way: "Innate Intelligence clearly has its origins in borrowed mystical and occult practices of a bygone era. It remains untestable and unverifiable and has an unacceptably high penalty/benefit ratio for the chiropractic profession. The chiropractic concept of Innate Intelligence is an anachronistic holdover from a time when insufficient scientific understanding existed to explain human physiological processes. It is clearly religious in nature and must be considered harmful to normal scientific activity."
Chiropractic historian Joseph C. Keating Jr. articulated that "So long as we propound the "One cause, one cure" rhetoric of Innate, we should expect to be met by ridicule from the wider health science community. Chiropractors can't have it both ways. Our theories cannot be both dogmatically held vitalistic constructs and be scientific at the same time. The purposiveness, consciousness and rigidity of the Palmers' Innate should be rejected."
Vaccination and water fluoridation
See also: Anti-vaccinationism in chiropracticMany forms of alternative medicine are based on philosophies that oppose vaccination and have practitioners who voice their opposition. These include some elements of the chiropractic community. The reasons for this negative vaccination view are complicated and rest, at least in part, on the early philosophies which shape the foundation of these professions. Chiropractors historically were strongly opposed to vaccination based on their belief that all diseases were traceable to causes in the spine, and therefore could not be affected by vaccines; D.D. Palmer wrote, "It is the very height of absurdity to strive to 'protect' any person from smallpox or any other malady by inoculating them with a filthy animal poison." Some chiropractors continue to be opposed to vaccination, one of the most effective public health measures in history. Many deny the eradication of smallpox and believed it was renamed monkeypox.
Some chiropractic groups still oppose attempts to limit or eliminate nonmedical exemptions to vaccination. In March 2015, the Oregon Chiropractic Association invited Andrew Wakefield, a discredited former doctor and chief author of a fraudulent research paper, to testify against Senate Bill 442, "a bill that would eliminate nonmedical exemptions from Oregon's school immunization law." The California Chiropractic Association lobbied against a 2015 bill ending belief exemptions for vaccines. They had also opposed a 2012 bill related to vaccination exemptions. On April 24, 2015, Wakefield received two standing ovations from the students at Life Chiropractic College West when he told them to oppose Senate Bill SB277, a bill which proposes limits on non-medical vaccine exemptions. Responding to his critics, he stated that "t doesn't matter if I go to the grave discredited. I don't care what they say about me. In fact, I have nothing to lose now. This is such an important issue." Wakefield had previously been a featured speaker at a 2014 "California Jam" gathering of chiropractors, as well as a 2015 "California Jam" seminar, with continuing education credits, sponsored by Life Chiropractic College West.
In response to threatening activities by anti-vaccination activists, the California Medical Association (CMA) sent a warning letter to California Chiropractic Association President Brian Stenzler, whom they could document had encouraged the stalking of lobbyists who supported Senate Bill SB277. The CMA also filed a police report.
Early opposition to water fluoridation included chiropractors in the U.S. Some chiropractors oppose water fluoridation as being incompatible with chiropractic philosophy and an infringement of personal freedom. More recently, other chiropractors have actively promoted fluoridation, and several chiropractic organizations have endorsed scientific principles of public health.
Ownership of spinal manipulation
While no single profession "owns" spinal manipulation (SM), and there is little consensus as to which profession should administer SM, chiropractors have expressed concern that orthodox medical physicians and physical therapists could "steal" SM procedures from chiropractors. Chiropractors regularly introduce bills into state legislatures to further prohibit non-chiropractors from performing SM, and they are opposed by physical therapist organizations. Two U.S. states (Washington and Arkansas) prohibit physical therapists from performing SM, while some states allow them to do it only if they have completed advanced training in SM. In the most restrictive states, SM is limited to chiropractors and medical physicians.
Notable incidents and lawsuits
- Robbie Basho, 45, an American musician, died during a chiropractic visit on February 28, 1986, when an "intentional whiplash" experiment caused blood vessels in his neck to rupture, leading to a fatal stroke.
- Lana Dale Lewis, of Ontario, Canada, died on September 12, 1996, following a neck manipulation. The coroner's jury found that "receiving an upper cervical neck manipulation from a chiropractor could injure the arteries in your neck."
- Laurie Jean Mathiason, of Saskatchewan, Canada, had a massive stroke while undergoing chiropractic treatment, and died three days later, on February 4, 1998. A coroner's jury concluded that neck manipulation caused the stroke.
- Kimberly Lee Strohecker, 30, of Pennsylvania, United States, died after a series of seizures left her unable to drink or walk and caused the contents of her stomach to aspirate into her lungs, causing pneumonia. Strohecker, an epileptic, had been advised by her chiropractor, Joanne M. Gallagher of Life Expression Chiropractic Center of Sugarloaf, Pennsylvania, to stop taking her anticonvulsant medication if she wished to cure herself. When Strohecker began experiencing seizures every 10 to 15 minutes, Gallagher reassured her that she was fine and told her to not visit a hospital as they would treat her with anticonvulsants, which could kill her. Strohecker died on April 29, 1999, and her family filed suit against Gallagher. Gallagher plead guilty to one count mail fraud, stemming from an attempt to bill Medicaid for treatment that supposedly took place after Strohecker's death, agreed to pay the family $500,000 in restitution. She was fined $9,100 and sentenced to 18 months in prison. Gallagher attempted to appeal the revocation of her license 2005 but was unsuccessful. In 2012, she was twice denied a license to practice massage in the state of Pennsylvania. She was later able to resume work with Life Expression Chiropractic Center as a Registered Craniosacral Therapist, with the website stating that Gallagher "transitioned" from chiropractic care to craniosacral therapy, with no mention of her criminal history or her involvement in Strohecker's death. She is still working in the field as of September 2022.
- James Turner, 11, of Ontario, Canada, was left with lower body paralysis, muscle weakness, and fecal incontinence after having his neck adjusted by chiropractor V. Gary Dyck. Dyck performed two adjustments on Turner, the first on July 24, 2000, and the second on July 25, 2000, and caused the infarction of a ganglioglioma, a benign spinal tumor. Turner underwent emergency surgery at the Royal Victoria Hospital in Barrie, Ontario. The lawsuit, brought by Turner's parents, Alan and Jill Turner, claimed that Dyck had shown negligence in that he did not perform X-rays to determine if the adjustments would resolve Turner's initial complaints of neck pain and that had he done so, Dyck would have noticed the tumor. Dyck died in 2017.
- Samantha Cools, 22, an Olympic athlete from Alberta, Canada, suffered ruptured tendons after her chiropractor, based in Switzerland, over-rotated her neck during an adjustment. The injury had a devastating effect on her performance at the 2008 Summer Olympics in Beijing, China, as the injury left her unable to eat or train for five weeks.
- Jeremy Lynn Youngblood, 30, an employee of the city of Ada, Oklahoma, United States, died on June 11, 2011, from complications of an acute cerebellar stroke. The injuries were determined by the coroner to have been caused by a neck adjustment performed by an unnamed chiropractor employed by Power Chiropractic Clinic. Authorities did not comment on whether charges of negligence would be filed against Power Chiropractic Clinic or not. According to Assistant Police Chief Carl Allen, Youngblood complained of disorientation and began vomiting in the minutes following the adjustment and clinic staff did not call 911. Youngblood was driven to Valley View Regional Hospital, now Mercy Hospital Ada, by his father and died two days later.
- In 2019, a video appeared online of Andrew Arnold, a chiropractor from Victoria, Australia, holding a 2-week-old baby upside down surfaced online, sparking outrage. Arnold gave an undertaking not to provide chiropractic treatment to children under the age of 12 after a video of him pending a review of his practice. He is the owner of Cranbourne Family Chiropractic.
- Caitlin Jensen, 28, a student at Georgia Southern University, visited chiropractor T. J. Harpham, of Richmond Hill Family Chiropractic in Georgia, United States, on June 16, 2022, to have her neck adjusted following complaints of stiffness. During the adjustment, four arteries in Jensen's neck were dissected, resulting in cardiac arrest, a stroke, and a traumatic brain injury. She was reportedly without a pulse for 10 minutes until she could be revived. She was left with almost full-body paralysis, capable of only blinking her eyes and moving her left thumb. Her injuries also subsequently removed her ability to eat and breathe on her own, resulting in doctors forming gastrostomy and tracheotomy tubes in her stomach and neck areas respectively.
See also
References
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- "The Cosmos Club". Washington City Paper. July 7, 2006. Archived from the original on June 27, 2008.
- ^ Gay Abbate, "Chiropractic neck manipulation linked to woman's death," Globe and Mail, January 17, 1994.
- kreidler, Marc (September 1, 2016). "Bizarre Therapy Leads to Patient's Death | Quackwatch". Retrieved September 26, 2022.
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External links
Internal criticism
- Faulty Logic and Non-skeptical Arguments in Chiropractic – Joseph C. Keating Jr.
- Open Letter to the Profession – George P. McAndrews (commented in Chiroweb)
- Chiropractic, Bonesetting, and Cultism – Samuel Homola, (book review at Chiroweb)
- Critical thinking – Christopher Kent, DC president of the Council on Chiropractic Practice
External criticism
- Chiropractic – Skeptic's Dictionary
- Chiropractic – H. L. Mencken, Baltimore Evening Sun
- Spin Doctors: The Chiropractic Industry Under Examination – Paul Benedetti, Wayne MacPhail
- "Adjusting the Joints, on season 12 , episode 10". Scientific American Frontiers. Chedd-Angier Production Company. 2001–2002. PBS. Archived from the original on January 1, 2006.
- Chirobase: Skeptical guide to chiropractic history, theories, and current practices – Stephen Barrett, MD, and Samuel Homola, DC
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