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Chiropractic controversy and criticism

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The birth of chiropractic was 1895; it has been the subject of controversy and criticism.

Daniel D. Palmer, the founder of chiropractic, manipulated the spine of a deaf person, allegedly curing him of deafness. Chiropractic is rooted in mystical concepts which led to internal conflict within the profession. Chiropractors, including D.D. Palmer, were jailed for practicing medicine without a license. For most of its existence, chiropractic has battled with mainstream medicine, sustained by what are characterized as antiscientific and pseudoscientific ideas such as subluxation. Unsubstantiated claims about the efficacy of chiropractic have continued to be made by individual chiropractors and chiropractic associations. A core concept of chiropractic, vertebral subluxation, is not based on sound science. Research has not demonstrated that spinal manipulation is effective, with the possible exception of treatment of back pain.

History

Main article: Chiropractic history

The birth of chiropractic was on September 18, 1895. On this day, Daniel D. Palmer, manipulated the spine of a deaf janitor named Harvey Lillard, allegedly curing him of deafness. And his second patient, a man with heart disease was also cured. D.D. Palmer, the founder of chiropractic, defined chiropractic as "a science of healing without drugs" and considered establishing chiropractic as a religion. Chiropractic included vitalistic ideas of innate intelligence with religious attributes of universal intelligence to substitute 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." According to D.D. Palmer, subluxation is the sole cause of disease and manipulation is the cure of all disease for the human race.

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

Chiropractic has seen considerable controversy over its philosophy.

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.

For much of the history of the chiropractic profession chiropractors have shown little interest in scientific research and have regarded their principles and practices as valid. Despite heavy opposition by mainstream medicine, by the 1930s chiropractic was the largest alternative healing profession in the U.S. The lack of acceptance with mainstream public health was contributed to by the long standing American Medical Association (AMA) policies against chiropractic. 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 what are characterized as antiscientific and pseudoscientific ideas that sustained the profession in its long battle with organized medicine. By the mid 1990s there was a growing scholarly interest in chiropractic, which helped efforts to improve service quality and establish clinical guidelines that recommended manual therapies for acute low back pain. 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 a 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.

Ethics and claims

Chiropractic does not have the same level of mainstream credibility as other healthcare professions. A 2006 Gallup Poll of U.S. adults, chiropractors rated last among seven health care professions for being very high or high in honesty and ethical standards, with 36% of poll respondents rating chiropractors very high or high; the corresponding ratings for other professions ranged from 38% for psychiatrists, 62% for dentists, and 84% for nurses.

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

Some New Zealand chiropractors appeared to have used the title 'Doctor' in a New Zealand Yellow pages telephone directory in a way that implied they are registered medical practitioners, when no evidence was presented it was true. 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 claims that entries in the Yellow Pages under the heading of 'Chiropractors' fulfills this obligation. 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 behaviour on a regular basis. The advice chiropractors gave to their patients is often misleading and dangerous.

This article appears to be slanted towards recent events. Please try to keep recent events in historical perspective and add more content related to non-recent events. (July 2009)

On April 19, 2008, Simon Singh wrote an article in the The Guardian which resulted in him being sued for libel by the British Chiropractic Association. Singh wrote in The Guardian criticising 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". The suit is ongoing, with Singh stating that he will "contest the action vigorously... There is an important issue of freedom of speech at stake." The article developed the theme of Singh's recently published book Trick or Treatment? Alternative Medicine on Trial, making various claims about the usefulness of chiropractic. Commentators suggest this ruling could set a precedent to restrict freedom of speech to criticise alternative medicine. The charity Sense About Science has launched a campaign to draw attention to this particular case. They have issued a statement entitled "The law has no place in scientific disputes", which has been signed by myriad signers representing science, journalism, publishing, arts, humanities, entertainment, skeptics, campaign groups and law. As of June 13, 2009, over 10,000 have signed.

Efficacy

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

Vertebral subluxation, a core concept of chiropractic, is not based on solid science. Collectively, systematic reviews of this research have not demonstrated that spinal manipulation is effective, with the possible exception of treatment of back pain. The concept of subluxation remains unsubstantiated and largely untested, and has been debated about whether to keep it in the chiropractic paradigm for decades. The dogma of subluxation is the biggest single barrier to professional development for chiropractors. Vertebral subluxation skews the practice of legitimacy in ways that bring ridicule from the scientific community and uncertainty among the general public. Commitment to the subluxation dogma undermines the desire for scientific investigation of subluxation as hypothesis, and further perpetuates a cycle of a marketing tradition, inevitably bringing charges of quackery. The cost, effectiveness, and safety, of spinal manipulation are uncertain. Edzard Ernst stated "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". A 2007 survey of Alberta chiropractors found that they do not consistently apply research in practice, which may have resulted from a lack of research education and skills.

Chiropractic is no more effective than conventional treatment at its best, and has a disadvantage of being surrounded by subluxations and, more seriously, it does kill patients occasionaly. Chiropractic manipulation is the number one cause for humans suffering stroke under the age of 45. The chiropractors of Alberta, Canada and the Alberta Government are now at the center of a class-action lawsuit. Sandra Nette, formerly a healthy 41 year old, she is tetraplegic, now lead plaintiff. Immediately following neck manipulation by a chiropractor she had a major stroke as a result of a torn vertebral artery.

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 a "term most commonly used to identify a pseudoscientific system of muscle-testing and therapy".

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."

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."

Chiropractors historically are 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. 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. Recently, other chiropractors have actively promoted fluoridation, and several chiropractic organizations have endorsed scientific principles of public health.

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