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| #REDIRECT ] | |||
| Since its inception in ], ''']''' has been the subject of '''controversy''' and '''criticism'''. | |||
| Chiropractic is rooted in mystical concepts which led to internal conflict within the profession.<ref name=Ernst-eval/> For most of its existence, chiropractic has battled with ], sustained by ] and ] ideas such as subluxation.<ref name=History-Primer/> The core concepts of chiropractic, ] and ], is not based on sound science.<ref name=Ernst-eval/> | |||
| == History == | |||
| {{main|Chiropractic history}} | |||
| According to ], the founder of chiropractic, subluxation is the sole cause of disease and manipulation is the cure of all disease for the human race.<ref name=Ernst-eval>{{cite journal |journal= ] |date=2008 |volume=35 |issue=5 |pages=544–62 |title= Chiropractic: a critical evaluation |author= Ernst E |doi=10.1016/j.jpainsymman.2007.07.004 |pmid=18280103}}</ref> Chiropractic is rooted in ], leading to internal conflicts between straights and mixers which continue to this day.<ref name=Ernst-eval/> It has two main groups: "straights", now the minority, emphasize ], ] 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>{{cite journal |journal= ] |date=1998 |volume=158 |issue=20 |pages=2215–24 |title= Chiropractic: origins, controversies, and contributions |author= Kaptchuk TJ, Eisenberg DM |pmid=9818801 |url=http://archinte.ama-assn.org/cgi/content/full/158/20/2215 |doi= 10.1001/archinte.158.20.2215}}</ref> | |||
| Despite heavy opposition by mainstream medicine, by the 1930s chiropractic was the largest alternative healing profession in the U.S.<ref>{{cite journal |journal= ] |author= Martin SC |date=1993 |volume=34 |issue=4 |pages=808–34 |title= Chiropractic and the social context of medical technology, 1895–1925 |doi=10.2307/3106416 |pmid=11623404}}</ref> The longstanding feud between chiropractors and ]s continued for decades. The AMA labeled chiropractic an "unscientific ]" in 1966,<ref name=Chiro-PH>{{cite journal |journal= J Manipulative Physiol Ther |date=2008 |volume=31 |issue=6 |pages=397–410 |title= Chiropractic and public health: current state and future vision |author= Johnson C, Baird R, Dougherty PE ''et al.'' |doi=10.1016/j.jmpt.2008.07.001 |pmid=18722194 |url=http://jmptonline.org/article/PIIS0161475408001784/fulltext}}</ref> and until 1980 held that it was unethical for medical doctors to associate with "unscientific practitioners".<ref>{{cite journal |journal= ] |date=1989 |volume=79 |issue=11 |pages=1569–70 |title= AMA policy on chiropractic |author= Cherkin D |pmid=2817179 |pmc=1349822 |doi= 10.2105/AJPH.79.11.1569-a}}</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 |journal= ] |date=2003 |volume=81 |issue=1 |pages=107–38 |title= Chiropractic in the United States: trends and issues |author= Cooper RA, McKee HJ |doi=10.1111/1468-0009.00040 |pmid=12669653}}</ref> | |||
| Serious research to test chiropractic theories did not begin until the 1970s, 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>{{cite web |title= Chiropractic history: a primer |author= Keating JC Jr, Cleveland CS III, Menke M |url=http://data.memberclicks.com/site/ahc/ChiroHistoryPrimer.pdf |format=PDF |date=2005 |accessdate=2008-06-16 |publisher= Association for the History of Chiropractic}}</ref> | |||
| == Ethics and claims == | |||
| Chiropractic does not have the same level of mainstream credibility as other healthcare professions.<!-- <ref name=Murphy-pod/> --> Public perception of chiropractic compares unfavorably with mainstream medicine with regard to ethics and honesty: in a 2006 ] of U.S. adults, chiropractors rated last among seven health care professions for being very high or high in honesty and ethical standards, with 36% of poll respondents rating chiropractors very high or high; the corresponding ratings for other professions ranged from 62% for dentists to 84% for nurses.<ref name=Murphy-pod>{{cite journal |author= Murphy DR, Schneider MJ, Seaman DR, Perle SM, Nelson CF |title= How can chiropractic become a respected mainstream profession? the example of podiatry |journal= Chiropr Osteopat |volume=16 |pages=10 |year=2008 |pmid=18759966 |doi=10.1186/1746-1340-16-10 |url=http://chiroandosteo.com/content/pdf/1746-1340-16-10.pdf |format=PDF}}</ref><ref>{{cite journal |journal= Dyn Chiropr |volume=25 |issue=3 |date=2007 |title= Gallup Poll: Americans have low opinion of chiropractors' honesty and ethics |url=http://dynamicchiropractic.com/mpacms/dc/article.php?id=52038}}</ref><ref>{{cite news |title= USA TODAY/Gallup poll |url=http://usatoday.com/news/polls/tables/live/2006-12-11-ethics.htm |work= USA Today |date=2006-12-11}}</ref> | |||
| A 2008 commentary proposed that the chiropractic profession actively regulate itself to combat abuse, fraud, and ], which are more prevalent in chiropractic than in other health care professions, violating the ] between patients and physicians.<ref name=Murphy-pod/> Unsubstantiated claims about the efficacy of chiropractic have continued to be made by individual chiropractors and chiropractic associations.<ref name=Ernst-eval/> The largest chiropractic associations in the U.S. and Canada distributed patient brochures which contained unsubstantiated claims.<ref>{{cite journal |author= Grod JP, Sikorski D, Keating JC |title= Unsubstantiated claims in patient brochures from the largest state, provincial, and national chiropractic associations and research agencies |journal= J Manipulative Physiol Ther |volume=24 |issue=8 |pages=514–9 |year=2001 |pmid=11677551 |doi=10.1067/mmt.2001.118205}}</ref> Chiropractors, especially in America, have a reputation for unnecessarily treating patients. In many circumstances the focus seems to be put on economics instead of health care.<ref>{{cite book |pages=145–90 |chapter= The truth about chiropractic therapy |title= ] |author= Singh S, Ernst E |year=2008 |publisher= W.W. Norton |isbn=978-0-393-06661-6}}</ref> Sustained chiropractic care is promoted as a preventative tool but unnecessary manipulation could possibly present a risk to patients. Some chiropractors are concerned by the routine unjustified claims chiropractors have made.<ref name=Ernst-eval/> A study of California disciplinary statistics during 1997–2000 reported 4.5 disciplinary actions per 1000 chiropractors per year, compared to 2.27 for MDs; the incident rate for fraud was 9 times greater among chiropractors (1.99 per 1000 chiropractors per year) than among MDs (0.20).<ref>{{cite journal |author= Foreman SM, Stahl MJ |title= Chiropractors disciplined by a state chiropractic board and a comparison with disciplined medical physicians |journal= J Manipulative Physiol Ther |volume=27 |issue=7 |pages=472–7 |year=2004 |pmid=15389179 |doi=10.1016/j.jmpt.2004.06.006}}</ref> | |||
| 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>{{cite journal |journal=N Z Med J |year=2008 |volume=121 |issue=1278 |pages=15-20 |title=Use of inappropriate titles by New Zealand practitioners of acupuncture, chiropractic, and osteopathy |author=Gilbey A |pmid=18670471 |url=http://www.ncbi.nlm.nih.gov/pubmed/18670471}}</ref> | |||
| == Efficacy == | |||
| Not all criticism originated from critics in the medical profession. Some chiropractors are cautiously calling for reform.<ref>{{cite news|last=Jaroff|first=Leon|title=Back Off, Chiropractors!|url=http://www.time.com/time/columnist/jaroff/article/0,9565,213482,00.htm | |||
| |date=February 27, 2002|work=]|publisher=]|accessdate=2009-06-07}}</ref> Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs ] reasoning and unsubstantiated claims,<ref name=Nelson>{{cite journal |journal= Chiropr Osteopat |date=2005 |volume=13 |pages=9 |title= Chiropractic as spine care: a model for the profession |author= Nelson CF, Lawrence DJ, Triano JJ ''et al.'' |doi=10.1186/1746-1340-13-9 |pmid=16000175 |url=http://chiroandosteo.com/content/13/1/9}}</ref><ref name=Keating-subluxation/><ref name=History-Primer/><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 |date=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 |editor= Haldeman S, Dagenais S, Budgell B ''et al.'' (eds.) |publisher=] |date=2005 |isbn=0-07-137534-1}}</ref> that are ethically suspect when they let practitioners maintain their beliefs to patients' detriment.<ref>{{cite journal |journal= Chiropr Osteopat |date=2005 |volume=13 |pages=9 |title= Chiropractic as spine care: a model for the profession |author= Nelson CF, Lawrence DJ, Triano JJ ''et al.'' |doi=10.1186/1746-1340-13-9 |pmid=16000175 |url=http://chiroandosteo.com/content/13/1/9}}</ref> | |||
| Vertebral subluxation and spinal manipulation, the core concepts of chiropractic, is not based on solid science.<ref name=Ernst-eval/> The dogma of subluxation is the biggest single barrier to professional development for chiropractors.<ref></ref> The concept of subluxation remains unsubstantiated and largely untested, and has been debated about whether to keep it in the chiropractic paradigm for decades.<ref name=Keating-subluxation>{{cite journal |journal= ] |date=2005 |volume=13 |pages=17 |title= Subluxation: dogma or science? |author= Keating JC Jr, Charlton KH, Grod JP, Perle SM, Sikorski D, Winterstein JF |doi=10.1186/1746-1340-13-17 |pmid=16092955 |url=http://chiroandosteo.com/content/13/1/17}}</ref> The cost, effectiveness, and safety, of spinal manipulation are uncertain.<ref name=Ernst-eval/> A 2007 survey of ] chiropractors found that they do not consistently apply research in practice, which may have resulted from a lack of research education and skills.<ref>{{cite journal |journal= J Manipulative Physiol Ther |year=2007 |volume=30 |issue=2 |pages=109–15 |title= How important is research-based practice to chiropractors and massage therapists? |author= Suter E, Vanderheyden LC, Trojan LS, Verhoef MJ, Armitage GD |doi=10.1016/j.jmpt.2006.12.013 |pmid=17320731}}</ref> | |||
| Some chiropractors are opposed to ], one of the most effective public health measures in history.<ref>Craig F. Nelson. (1999) , ''American Council on Science and Health''.</ref> Some chiropractors oppose ] as being incompatible with chiropractic philosophy and an infringement of personal freedom.<ref>{{cite journal |journal= Am J Public Health |date=1989 |volume=79 |issue=10 |pages=1405–8 |title= Fluoridation referendum in La Crosse, Wisconsin: contributing factors to success |author= Jones RB, Mormann DN, Durtsche TB |pmid=2782512 |pmc=1350185 |url=http://www.ajph.org/cgi/reprint/79/10/1405.pdf |format=PDF |doi= 10.2105/AJPH.79.10.1405}}</ref> | |||
| == References == | |||
| {{Reflist}} | |||
| == External links == | |||
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