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Tuesday, June 02, 2009

The Truth About Chiropractic

Fifteen years ago, my faculty association (union) negotiated some increased coverage to our health plan. They added visits to the chiropractor and increased the rates that we all pay for this extra coverage. At the meeting where this addition was ratified, every single scientist on our Governing Council opposed the extension on the grounds that most visits to the chiropractor were ineffective. What this means is that we are paying for our non-scientific colleagues to support quacks.

The general public seems completely unaware of the fact that chiropractic is "alternative medicine." In other words it is not evidence-based medicine.

Read "What you should know about chiropractic" in this week's issue of New Scientist to learn more.
FOR many people, chiropractic appears almost mainstream. Some chiropractors even call themselves "doctor". In the UK, chiropractors are regulated by statute, and in the US they like to be seen as primary care physicians. It is therefore understandable if people hardly ever question the evidential basis on which this profession rests.

The origins of chiropractic are surprising and rather spectacular. On 18 September 1895 Daniel Palmer, a "magnetic healer" practising in the American Midwest, manipulated the spine of Harvey Lillard, a janitor who had been partially deaf since feeling "something give in his back". The manipulation apparently cured Lillard of his deafness. Palmer's second patient suffered from heart disease, and again spinal manipulation is said to have effected a cure. Within a year or so, Palmer had opened a school, the first of many, and the term he coined, "chiropractic", was well on its way to becoming a household name.

The only true cure

Palmer convinced himself he had discovered something fundamental about human illness and its treatment. According to Palmer, a vital force - he called it the "Innate" - enables our body to heal itself. If our vertebrae are not perfectly aligned, the flow of the Innate is blocked and we fall ill. Chiropractors speak of these misalignments as "subluxations" (in conventional medicine, a subluxation means merely a partial dislocation). The only true cure is to realign the vertebrae by manipulating the spine, and in the logic of chiropractic it follows that all human illness must be treated with spinal manipulations. Many chiropractors also assert that we need regular "maintenance care" even when we are not ill so that subluxations can be realigned before they cause a disease. In the words of Palmer "95 per cent of all diseases are caused by displaced vertebrae, the remainder by luxations of other joints".
It's true that there are some chiropractors who don't believe all this nonsense. They concentrate on relieving back pain and stay away from all the quackery associated with most chiropractic. Those chiropractors exist, but you'll have a hard time finding them.

So, the key question is whether chiropractic works. Is there any evidence to support the claims of chiropractors? The short answer is no. There's some evidence that chiropractic helps relieve back pain but that's it. Here's how Edzard Ernst describes it in his New Scientist article.
In the book I co-wrote with Simon Singh, Trick or Treatment? Alternative medicine on trial, we dedicate a chapter to chiropractic. After weighing all the evidence, our conclusions were not flattering: "Warning: this treatment carries the risk of stroke and death if spinal manipulation is applied to the neck. Elsewhere on the spine, therapy is relatively safe. It has shown some evidence of benefit in the treatment of back pain, but conventional treatments are usually equally effective and much cheaper. In the treatment of all other conditions chiropractic therapy is ineffective except that it might act as a placebo."
It's nice to hear a voice of reason from time to time.

As you might expect, the chiropractors aren't happy. In fact, they are so unhappy that they're using the British legal system to silence their critics.
Simon later wrote an article in The Guardian newspaper about chiropractic. In it, he quoted from the website of the British Chiropractic Association which, at the time, made fairly clear claims that chiropractors can effectively treat a whole range of childhood diseases, including asthma. The evidence for treatment of this condition is less than weak: no fewer than three controlled trials have found that chiropractic spinal manipulation has no beneficial effect. The best of these studies, published in The New England Journal of Medicine, concluded that "the addition of chiropractic spinal manipulation to usual medical care provided no benefit".

Not supported

For alerting the public to all of this, and possibly preventing harm to unsuspecting children, Simon deserves much credit. Instead, he is being sued for libel by the British Chiropractic Association. I think this is a serious issue that raises two crucial questions. Is it acceptable that scientists and journalists are restricted in their criticism by the legal muscle of those who are being criticised? And is it acceptable that professional bodies, such as the British Chiropractic Association - or indeed any other organisation - are able to make therapeutic claims that are not supported by scientific data? I leave it to the reader to decide.
The preliminary judgment has gone against Singh as reported in New Scientist a few weeks ago [Chiropractic critic loses first round in libel fight].
IF YOU have ever been tempted to call alternative medicine "bogus", choose your words with care. You could be sued for defamation. That's the message from a ruling in the High Court in London that censured science writer Simon Singh for claiming that the British Chiropractic Association (BCA) promoted "bogus" treatments.

Chiropractic is a system of alternative and complementary medicine that treats illnesses by manipulating the spine. Singh made the comment in an article in London newspaper The Guardian in April 2008. The BCA asked him to retract the statement, which it said was wrong and damaging to its reputation. Singh refused, so the BCA sued him for libel.

In a pre-trial hearing last week, the judge ruled that Singh was saying the BCA had knowingly made false claims. He rejected Singh's defence that it was fair comment. "The judge has given us a meaning [of bogus] that is very extreme and that I never intended," Singh told New Scientist.
You know we're in trouble when the courts stifle science in favor of quackery.


kerstin said...

Do check out this blog for updates on the case...He is one of the lawyers advising on this case...

SLC said...

Relative to quackipractors, perhaps Prof. Moran should concern himself with the current Canadian Minister for Science and Technology before concerning himself with Dr. Francis Collins

pip said...


Why not concern himself with both?

Nevertheless, your point is worth noting. As well as having a chiropractor as Minister for Science and Technology, the Liberal party of Canada have Dr. Ruby Dhalla, chiropractor and one time Critic for Health for the Official Opposition.

Just imagine if a chiropractor were Minister of Health one day.

I can't decide if that would be incrementally worse than giving a chiropractor the science brief, or a whole step change of wrongness.

SLC said...

Re pip

I was unaware of the presence of yet another quackipractor as at least a potential minister for a science related ministry in the Canadian Parliament. I find this to be amazing. What the hell is going on in Canada which is supposed to be a forward looking, scientifically literate nation? Is the influence of unscientific America now affecting its neighbors as well?

pip said...


Politicians don't get the problem with chiropractic. I think it would be fair to say a lot of the public don't either: Chiro is where you go if you have a bad back.

It also doesn't help that chiros in Ontario can call themselves 'Dr', as Ruby Dhalla does every chance she gets. GPs refer patients to chiropractors in Canada, and health insurers cover their services.

How did this happen? Chiropractors are exceptionally good at protecting and promoting their own interests, and the medical community in North America is probably shy to challenge them after the AMA lost in the Supreme Court in 1987 (for anti-competitive practices, if you can believe it).

Add that to the general ignorance of what chiropractors really do, and you have our current situation: chiropractors promoted to positions of influence in the Canadian government.

Anonymous said...

You know you are an idiot!!! I received my PhD from the University of Pittsburgh in the area of molecular biophysics with an emphasis on the effects that closed system bio-mechanics has on cell function. You should check the AMA's statistical data in 2009 alone there were ~ 500,000 iatrogenic deaths in North America . But you and your minimal neuronal connections seem to focus on a mode of treatment that poses a 1 in a million chance of VAI....or stroke to the uneducated. Its clear that you have a huge ego and a small compassion for human suffering. If its possible to give patients relief without the aid of Pharmaceutical or surgical intervention why the hell not!!!! And no I'm not a chiropractor Ive just dedicated my life's work to studying other ways of healing the sick......I guess you don't support acupuncture either.....I have a colleague at Harvard that's on the cutting edge of research in this area. You should really do your Degree a favor and read more literature before you blog.

Larry Moran said...

Anonymous rants,

If its possible to give patients relief without the aid of Pharmaceutical or surgical intervention why the hell not!!!!

Nobody could possibly object to a procedure that is known to work. How do we know that a procedure actually works? We subject it to rigorous scientific tests.

Chiropractic fails on all the claims that are made by a typical practitioner.

Was that your point?

And no I'm not a chiropractor Ive just dedicated my life's work to studying other ways of healing the sick......I guess you don't support acupuncture either...

That's right. The latest scientific studies indicate that acupuncture is nothing more than an elaborate placebo effect. Do you believe what's reported in the scientific literature or does your life's work rely on some other way of knowing?

..I have a colleague at Harvard that's on the cutting edge of research in this area. You should really do your Degree a favor and read more literature before you blog.

You have a colleague at Harvard? Well, I guess that settles it. I bow down to your superior intellect and promise to do at least as much intelligent reading as you seem to have done.

(Wow! A colleague at Harvard. I'm so glad you told me. I just can't stop thinking about what that must mean to you.)

Anonymous said...

Last time I checked...nobody is getting "better" with scientifc methods" Larry. Interpret the data anyway you want. We are't "curing" anything and no, people aren't "healthier" today then they used to be. Writing a blog to the masses might fool some, and make you pound your chest as a champion to the "poor unedcated souls" but if you want to get the brass knuckles out be careful. I have a feeling even if the scientific method supported Chiropractic or it didn't, your mind is already made up. Perhaps you should go to work for the pharmaceutical industry, thats usually how their scientific method works too!

Larry Moran said...

Anonymous says,

I have a feeling even if the scientific method supported Chiropractic or it didn't, your mind is already made up.

Oh, dear. I think you are mistaking me for a chiropractor.

Anonymous said...

I'm glad you brought up the AMA statistical data because you won't find chiropractic care in there, because they refuse to be apart of the medical association.

Unknown said...

Thanks for sharing this information. I would agree with you for the most part, except I went to a chiropractor in Mississauga, and after I left, the pain that I was having up my spine had decreased immensely and has been that way ever since.

Unknown said...

I didn't actually know this. I like it though. I don't have much information on any chiropractor, considering I don't live up with my cousin in Scarborough, and we hardly ever talk. So its nice to get a little insight.

Unknown said...

I find it interesting that you had difficulty finding any positive research for chiropractic. I will admit that there are a number of chiropractors that make unsubstantiated claims (such as in the UK), however, there is certainly quality evidence to 'back up' (pardon the pun) chiropractic care.
I'm not sure what your previous experiences with chiropractors have been like, or maybe people you know went to a 'bad' chiropractor, but it seems like you may have had some bad experiences or information that taint what chiropractic really is or does.
Essentially, conservative care is the name of the game for musculoskeletal and some neural (for example, a disc problem pushing on a nerve) issues is the bread and butter of chiropractic, mostly the back (hence being known as a back doctor by many). Chiro also looks to prevent issues from coming back or happening in the first place with prescribing rehab exercises and lifestyle changes, and a huge one – education (both to decrease the exacerbating factor(s) and increase activity that helps) Also, as a ‘primary’ health care professional, good advice regarding general health and fitness is also quite well received from chiropractors, which also takes some of this load off of already oversaturated medical offices. Every patient and every back and condition is different, and therefore, should be treated differently.
Chiropractors also have multiple tools in the belt, since not every therapy works for every person or problem, which completely makes sense. Providing manipulation to a joint that already moves too much will actually make someone's problem worse. The trick is finding the problem and correcting it. Even so, manipulation has good evidence across the board, even with individual variation.
For spinal manipulation therapy (which physiotherapists now often provide as well) there is no paucity of evidence. For example neck pain: the neck pain task force (multidisciplinary team of Canadian researchers); low back pain: multiple international clinical practice guidelines (such as Canada, NZ, many European guidelines, etc.).
I agree that chiropractors are not "doctors" in the medical sense (M.D.), but the title of doctor is also used for dentists, optometrists, etc. The hours and years of schooling however, are all similar for these professions that gain the title of "doctor."
Hopefully this gives a bit more of a balanced perspective. And if your back/joints ever give you any trouble, you may find that chiropractic could gain a place in your good books. All the best.

Larry Moran said...

Please email me the URL for the website of any chiropractor who practices simple chiropractic using only scientifically proven methods. I will glady post it and apologize for maligning the entire profession.