cat-chiropractic-variousconcerns"…we surely stick out like a sore thumb among professions which claim to be scientifically based by our unrelenting commitment to vitalism. 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."

Joseph Keating Jr, 'The Meanings of Innate', Journal of the Canadian Chiropractic Association, 46,1 (2002), p.10.


This page was last updated on 16th November 2013.

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Chiropractic for back pain? Perhaps we should think again

"In view of the cost of chiropractic spinal manipulation and the uncertainty about its safety, I would probably not rate this approach as the treatment of choice but would consider the current Cochrane review which concludes that "high quality evidence suggests that there is no clinically relevant difference between spinal manipulation and other interventions for reducing pain and improving function in patients with chronic low-back pain" Personally, I think it is more prudent to recommend exercise, back school, massage or perhaps even yoga to cLBP-sufferers." Professor Edzard Ernst (12th November 2013)

Australian Spinal Research Foundation: it's time to drop the pretence

"The Australian Spinal Research Foundation (ASRF) has just released their Annual Report detailing financial activity for 2012-2013. Net revenue for this period was $1,697,097. The amount of money spent or allocated to research grants was $52,029. This amounts to 3.07% of all monies generated...Conversely, $605,956 was spent on salaries or wages during this same period. This seems somewhat disproportionate. So, in this post The Rogue Chiropractor will look deep into the history of ASRF revenue and research grant expenditure...perhaps the ASRF needs a name change – Australian Subluxation Marketing Fund, so that chiropractors who have moved on from the vertebral subluxation complex can easily identify that this might not be where they want to direct their donations and those that want to contribute to VSC research can do so." The Rogue Chiropractor blogspot (9th October 2013)

Subluxations officially manifesting in New South Wales chiropractic courses

"Today, in The Australian newspaper, it was revealed that "Central Queensland University [CQU] will next year offer [chiropractic] courses in Brisbane and Sydney alongside its Mackay courses". The Chiropractors' Association of Australia [CAA] has been working hard since Macquarie University decided to dump its chiropractic course due, diplomatically, to its status of, shall we say, research unencumbrance... [According to] the CAA 2012 President's report, some expenses are for the employment of a political lobbyist, and the employment of a public relations firm. Evidence? No way, chirostars. It's all about protecting the public image from questions regarding evidence. It's not about providing evidence. It's about holding back-slapping conferences of mutual admiration, selling each others' wares, and promoting each others' beliefs. It's about attacking and denigrating people who ask for evidence. It's about not being crystal clear about your anti-vaccinationism, and your belief in the invisible. It's about avoiding public scrutiny, so you can privately affect the health choices of others, without having pesky regulations and codes of ethics intrude upon your love-circle. Then it's about demanding respect in the public sphere, whilst threatening legal action against those who would ask legitimate questions. Then you claim it's about the research..." Reasonable Hank blogspot (6th August 2013)

ABC's Catalyst covers the cringe of chiropractic

"...the excellent [Australian] science program Catalyst covered [here] the growing problem of non-evidence-based chiropractic. It is a good thing that the fly-boys of the Chiropractors' Association of Australia are getting more exposure to the light." Reasonable Hank blogspot (12 July 2013)

Chiropractors: struggling to find the subluxation

"...if DD Palmer was able to cure deafness in 1895, then modern chiropractors should be able to do this as well...According to my checks, there is little evidence that this trick hasn't been performed since. Why not? DD Palmer did it, so why aren't chiropractors curing deaf people world wide? Surely that should be the first therapy taught to young chiropractors! If you want [another] reason to doubt the concept, then what about high quadriplegics, like Christopher Reeve, who had perfect hearing, but a non-functioning spinal cord. Not malaligned or subluxed – not functioning at all. So when you hear someone tell you this story, just remember that you're hearing it without using your spinal cord. Some chiropractors insist that adjusting the spine can, indeed, fix your hearing, your diabetes, your child's autism and asthma, and "enhance" your immune system. They invented the concept of "innate intelligence" to explain it, which is some sort of life force that cannot be seen, does not follow nerve pathways, yet can somehow be manipulated and adjusted by cracking a person's neck or back. How is it that something, that cannot be seen or touched or imaged, be "adjusted"? How can you know that the supposed "adjustment" is being performed correctly, healing the "innate", when it cannot even be measured? You'll need to ask a chiropractor that. It's a convenient and intuitive concept, but completely without evidence. None. And much evidence to the contrary. It's a fairy tale, designed to make people believe...Let's be honest, if your chiropractor mentions the words innate or subluxation, or attempts to provide you treatment that isn't directly related to spinal complaints, then you're dealing with a non-evidence based practitioner." John Cunningham, MD - Spinal orthopaedic surgeon specialising in cervical and lumbar spinal degeneration and trauma (10th July 2013)

Pseudoscience in the use of manipulation by chiropractors

"While spinal manipulation is an acceptable modality in the treatment of back pain, it is used inappropriately by some chiropractors who use manipulation as a treatment for disease by 'adjusting vertebral subluxations.' Defined by the subluxation theory that gave it birth, the core of the chiropractic profession continues to cling to a modified version of the theory, despite rejection by the scientific community. Philosophical differences between the various factions in chiropractic, ranging from some who have renounced subluxation theory to those who are subluxation-based, keep the profession divided and marginal." Samuel Homola DC, Focus on Alternative and Complementary Therapies [FACT] (June 2013)

Research in chiropractic seems in a dismal state

"...what does this tiny investigation suggest? Not a lot, I have to admit, but I think it supports the hypothesis that research into chiropractic is not very active, nor high quality, nor does it address the most urgent questions."  Edzard Ernst (1st February 2013)

The DC as PCP? The battle continues

Chiropractors are trying to rebrand themselves as primary care physicians...they are seeking the expansion of their scope of practice, via the magic of legislative alchemy, to include the prescription and administration of drugs.  Not drugs that any self-respecting M.D. would use, but drugs nonetheless.  That effort succeeded to an extent in New Mexico.  Recently Colorado got into the act.  Other states have followed suit.  One of the main obstacles in their way is the lack of authority to prescribe drugs.  Colorado chiropractors recently attempted an end run around the time-consuming and expensive process of lobbying the state legislature and getting their practice act amended to include prescription privileges.  Perhaps they were aware of certain snafus (which we'll get to soon) bedeviling New Mexico chiropractors in their quest for practice expansion.  The Colorado Board of Chiropractic Examiners' solution was to bypass the legislature altogether by simply passing a rule giving chiropractors the authority to administer and prescribe certain drugs.  Never mind the fact that this was totally beyond the authority the Colorado Legislature gave the Board...Meanwhile, in New Mexico, the battle over chiropractic prescribing continues.  As reported in a previous post, the legislature amended the chiropractic practice act to create a new iteration of chiropractor, an "advanced practice" version, which takes all of 90 hours of additional training plus passing a test.  The New Mexico Chiropractic Association describes part of this training on its website [capitalization and punctuation as in original]: Routes of administration [for 'naturally derived' substances], of course, are oral, topical and rectal, which we may already do but new to us here are intravenous (IV) and intramuscular (IM) administration. Doctors completing the certification will be prepared to do: IM injections (B12, homeopathic, magnesium, trigger point, etc.), neural therapy injections Intravenous procedures (meyer's cocktails, H2O2, chelation, ascorbates, amino acids, minerals, etc.), emergency procedures Laboratory testing and diagnosis. In other words, a veritable pantry full of quack remedies, now conveniently available via an IV...The Arizona Association of Chiropractic has filed an application with the state legislature for an expansion of chiropractic scope of practice to include the use of natural substances, homeopathic medication and orthomolecular therapy as an opportunity to enhance care for their patients.  According to the petition, these "services" are currently available to chiropractic patients in Oklahoma, Utah, Alaska, Oregon and Idaho, as well as New Mexico and Colorado.  Ten other states are in the process of considering legislation.  We'll return to these unfortunate developments in a future post."   Jann Bellamy, Science Based Medicine (24th January 2012)

Review of the chiropractic Activator device

“In conclusion, while uncontrolled case studies have shown that the Activator maybe effective at reducing back pain without any firm proof (such as a well designed RCT study), I would agree with Prof Ernst’s view that this type of intervention has no sound scientific bases and is “at best, an expensive placebo”.” Prof Richard Appleyard, Australian School of Advanced Medicine, Macquarie University. Friends of Science in Medicine (October 2012) [pdf]

Following the guidelines of science: A chiropractic dilemma

"All things considered, with the status and the future of chiropractic in doubt, I would not think that any well informed person following the guidelines of science today would choose to be a Doctor of Chiropractic rather than a Doctor of Physical Therapy."  Samuel Homola, DC, Science Based Medicine (26th October 2012)

The war against chiropractors

A critical review of J.C. Smith’s book, The Medical War Against Chiropractors: The Untold Story from Persecution to Vindication: “Nowhere does he mention chiropractors like Sam Homola, who have criticized chiropractic from within. Nowhere does he mention that half of chiropractors are still undermining public health by discouraging immunizations. Nowhere does he acknowledge or respond to the arguments against chiropractic, for instance the wealth of material on Quackwatch’s Chirobase, Homola’s numerous books and articles, and magazine and blog articles by me, Steven Novella, David Gorski, and many others. Nowhere does he acknowledge the critiques of the Cassidy stroke study and the other studies he cites, [and] throughout, he confuses chiropractic with spinal manipulation.” Harriet Hall MD, Science Based Medicine (23rd October 2012)

The DC as PCP? Revisited

“There is a disturbing effort afoot to rebrand chiropractors as primary care physicians… Part of this effort includes convincing state legislatures to grant prescription privileges to chiropractors, an effort that succeeded in New Mexico…The attempt to rebrand chiropractors as primary care physicians is bad enough, but giving them the legal authority to prescribe is beyond the pale. New Mexico’s ill-conceived legislation has turned into a debacle, with the pharmacy and medical boards having to haul the chiropractic board into court to comply with the law. And once they got limited privileges, chiropractors lobbied for increasing privileges to the point of wanting to prescribe controlled substances and dangerous drugs without any oversight and the right to practice surgery to boot. If you think this can’t happen in your state, think again. Remember that chiropractors got all 50 state legislatures to grant them the privilege of “detecting” and “correcting” the imaginary “subluxation.”” Jann Bellamy, Science Based Medicine (6th September 2012)

The Pseudoscience of Veterinary Chiropractic

“…the only convincing evidence that has emerged to support chiropractic treatment is in the care of humans with lower back pain, in which chiropractic is about as effective as conventional care. This does not justify the application of chiropractic for any other medical condition or the use of chiropractic in non-human animals without appropriate research to justify this.” The Skeptvet (19th August 2012)

Chiropractic gimmickry

“One of the most disturbing complaints I hear comes from chiropractic patients who have paid thousands of dollars in advance for a course of treatment lasting several months─after succumbing to a high-pressure sales pitch involving scare tactics. These patients have usually opted to discontinue treatment because symptoms have either worsened or disappeared. Most have signed a contract, however, that does not allow a refund, even if the treatment regimen was not completed. Some have used a chiropractic ‘health care credit card’ to borrow the advance payment from a loan company, leaving the patient legally bound to repay the loan. It’s never a good idea to pay for chiropractic services in advance. Treatment should be discontinued if symptoms have worsened after one week of treatment or have not improved after two to four weeks of treatment. In many cases of neck or back pain, symptoms will often resolve after a few weeks, eliminating the need for further treatment. Patients who have signed a contract for discounted long-term treatment that involves correction of vertebral subluxations, however, may be told that subluxation-detection instruments indicate that they still have subluxations that need to be corrected to prevent a recurrence of symptoms. Treatment may then be continued as a preventive-maintenance measure, even in the absence of symptoms ─ all in keeping with subluxation theory which proposes that correction of vertebral subluxations will ‘restore and maintain health’. Such unnecessary treatment is a needless expense, and it poses a risk that outweighs benefit, especially in the case of neck manipulation which is potentially dangerous. It is generally considered to be unethical to ask for contracted payment in advance for long-term treatment of a health problem, since such an agreement is tantamount to a guarantee that the treatment will be effective. There is no way to determine if chiropractic treatment might be effective or how many treatments might be needed. I generally advise chiropractic patients to pay for treatment per visit on an as-needed basis and only for treatment of mechanical-type back pain and related problems. A ‘free exam’ or a request for payment in advance should raise a red flag. Few consumers are aware that a diagnosis of ‘subluxations’ in a chiropractor’s office is in itself a red flag.” Samuel Homola DC, Science Based Medicine (17 August 2012)

Chiropractic Strokes Again: An Update

“Provocative testing before cervical manipulation is widely recommended in the chiropractic literature. The validity of such testing is questionable, and at any rate the HVLA maneuver is not part of the provocative test and it is the likely culprit. Regardless of the magnitude of risk, the existence of a risk is undeniable and patients should know there is a risk before they agree to treatment. The Association of Chiropractic Colleges suggests informed consent but does not mandate it...any degree of risk is unacceptable when there is no benefit. A Cochrane systematic review has shown that HVLA manipulations are no more effective for neck pain than gentle mobilization and that neither is effective unless used in conjunction with an exercise program. And there is even less evidence for benefit in non-neck-related conditions. NUCCA practitioners and other chiropractors who manipulate necks for almost any complaint are clearly out of line.” Harriet Hall, MD, Science Based Medicine (14th August 2012)

NCCAM manipulates spinal manipulation

“Some chiropractors employ manipulation in the same way physical therapists, M.D.s and D.O.s do – as a physical therapy for patients with back or neck pain who have been conventionally diagnosed and found to be appropriate candidates for this therapy. However, chiropractors also use the term “spinal manipulation” as a synonym for “spinal adjustment” which, in their unique vocabulary, is a treatment for the ubiquitous and nonexistent subluxation. Only chiropractors use the term in this manner because only chiropractors believe the chiropractic version of the subluxation exists…Not surprisingly, chiropractors cannot agree on a definition for their subluxation, how to diagnose one, or its clinical significance. They can’t even agree on a name for it – it’s variously called the vertebral subluxation complex, manipulable lesion, spinal lesion, joint dysfunction, and so on. Nor can they agree on its role in chiropractic – large and unremitting intramural battles have been fought over the subject. Nevertheless, chiropractors daily tell patients that they are suffering from subluxations which must be corrected at the risk of ill health. Again, one means of correction is the chiropractic “adjustment,” which chiropractors also refer to as “manipulation.” If chiropractors are this confused, then one can well understand how the writers and editors of NCCAM’s [National Center for Complementary and Alternative Medicine] website could be confused, but it’s time to set the record straight. The correction of subluxations via a spinal adjustment/manipulation is not the same as the use of spinal manipulation by physical therapists and other health care providers as a means of alleviating back or neck pain. While it is true that a chiropractor might “find” a subluxation and claim it is the cause of a patient’s pain, this is not a legitimate diagnostic method nor is its correction via an adjustment/manipulation a legitimate therapy for the patient’s pain. NCCAM does its readers a real disservice in failing to explain this critical difference. As it stands, readers may be left with the incorrect assumption that a chiropractor’s use of adjustments/manipulations to correct subluxations is a useful therapy for neck or back pain. This is especially important because some chiropractors have intentionally tried to exploit the efficacy of manipulation for back pain as proof that chiropractic “works.” They have also falsely claimed that they are more proficient at, and safer in performing, spinal manipulation than other practitioners, to the point of trying to use the political process to prohibit physical therapists from employing manipulation.”  Jann Bellamy, Science Based Medicine (26th July 2012)

A chiropractor strikes back

…I came across a hilariously paranoid post by a chiropractor calling himself J. C. Smith (JCS), who runs a website called Chiropractors for Fair Journalism…The article starts with the typical canards laid down by chiropractors about how horrible the American Medical Association is and how it supposedly tried to shut down chiropractic (as though that were a bad thing), referring to the AMA as a “medical mob” and referred to Morris Fishbein, MD, former director of the AMA as a “longtime medical godfather” and the “medical Mussolini.” JCS then equates opposition to the pseudoscience and quackery that underlie chiropractic with “bigotry”…Never mind that chiropractic is unscientific. Never mind that there is no such thing as a subluxation. Never mind that it’s nonsense that chiropractic is superior to medical care for spinal disorders…” Orac at Respectful Insolence (3 July 2012)

Part 2:  A chiropractor strikes back at the Institute for Science in Medicine…again

“In the end, this followup post attacking ISM is risible in the extreme, relying primarily on tu quoque arguments, emphasizing harm that conventional medicine can cause while not balancing it with the good, personally attacking people…and in general using the same old fallacies favored by cranks and quacks.”  Orac at Respectful Insolence (20th July 2012) [Includes a critical assessmement of ‘death by medicine’]

Debate over risk from spinal manipulation

“…experts debated the safety and effectiveness of spinal manipulation for neck pain in the pages of the British Medical Journal [BMJ 2012;344:e3679].  The debate featured academics, some of whom said that spinal manipulation should be abandoned as a treatment for neck pain, and some who disagreed saying that it is a valid treatment that patients like…

Should we abandon cervical spine manipulation for mechanical neck pain? Yes  [Full text PDF]

Given the equivalence in outcome with other forms of therapy, manipulation seems to be clinically unnecessary. The potential for catastrophic events and the clear absence of unique benefit lead to the inevitable conclusion that manipulation of the cervical spine should be abandoned as part of conservative care for neck pain. In the interests of patient safety, the regulatory and professional bodies associated with professions that use manual therapy should consider adopting this as a formal policy.

Benedict M Wand, Peter J Heine, Neil E O’Connell.

Should we abandon cervical spine manipulation for mechanical neck pain? No  [Full text PDF]

…when risk, benefit, and patient preference are considered, there is currently no preferred firstline therapy, and no evidence that mobilisation is safer or more effective than manipulation. Thus, the identification of safe and effective interventions for neck pain remains a high priority. We say no to abandoning manipulation and yes to more rigorous research on the benefits and harms of this and other common interventions for neck pain.

J David Cassidy, Gert Bronfort, Jan Hartvigsen.

…Both articles are based on the professional opinion of the authors, who each presented evidence supporting their viewpoints. They are not systematic reviews and it is unclear whether all evidence relevant to spinal manipulation has been considered. No firm conclusions for or against spinal manipulation can be made based on these opinions alone…People with persistent neck pain should consult their doctor and discuss the treatment options that would be appropriate for them...The debate, although loosely defined, appears to focus on spinal manipulation of the neck by chiropractors, rather than by osteopaths or both…These articles were designed to stimulate debate in a controversial area rather than to offer conclusions.”

NHS Choices review (8th June 2012)

Dangers of chiropractic treatments under-reported, study finds

"We only see what is being published and that can only be the tip of the iceberg," said (Edzard) Ernst. "Some neurologist sees a stroke and he finds out that this was associated with chiropractic – in 99.9% of cases he won't publish that." Ernst said the under-reporting of adverse effects meant decisions about the best course of treatment for a patient would be made difficult. "Therapeutic decisions ought to be taken not on considering the effectiveness alone but also you have to have effectiveness as a balance with the potential for harm. You have to do a risk-benefit analysis. When you under-report risk, this cannot possibly be done robustly." Alok Jha, The Guardian (14th May 2012)

Chiropractic: a treatment for neck pain or a pain in the neck?

"Within hours of the publication of this new US study [Bronfort G, Evans R, Anderson AV, Svendsen KH, Bracha Y, Grimm RH. Spinal manipulation, medication or home exercise with advice for acute and subacute neck pain. A randomised trial. Ann Intern Med 2012; 156:1-10], the world of chiropractic celebrated it as a vindication of chiropractic spinal manipulation. Its aim was to “to determine the relative efficacy of spinal manipulation therapy (SMT), medication, and home exercise with advice (HEA) for acute and subacute neck pain in both the short and long term”. Because neck pain is such a common problem which is often difficult to treat, this study did indeed seem important…At first glance, this seems to be a rigorous piece of research. At closer scrutiny, however, the flaws of this study become fairly obvious…I therefore fear that this study merely shows that TLC and non-specific effects can strongly influence symptoms such as pain. If we consider the high costs of regular SMT versus the negligible expense of HEA, the latter would probably turn out to be preferable. If we finally factor in the potential for harm, the balance decidedly tilts towards HEA. Exercise is virtually risk-free, whereas SMT results in transient adverse effects in about 50% of all patients; in addition, it is associated with several hundred severe complications including deaths." Edzard Ernst, The 21st Floor (1st May 2012)

Chiropractic manipulation of the spine may cause strokes and even death

A study by American neurosurgeons adds to evidence suggesting chiropractic can damage arteries supplying the brain...The conclusions of the American neurosurgeons in their recent paper speak for themselves: “Chiropractic manipulation of the cervical spine can produce dissections of the cranial and cervical segments of the vertebral and carotid arteries. Given the popularity of chiropractic treatment, the incidence of this phenomenon is most likely underreported. These arterial injuries can be severe, producing adverse neurological sequelae and even death (including 31% of patients in this series). Consequently, aggressive endovascular and surgical techniques may be required to restore vessel patency and to preserve neurological function." Professor Edzard Ernst, The Guardian (27th April 2012)

An Appraisal of Courses in Veterinary Chiropractic

Conclusion: Animal chiropractic and the veterinary chiropractic courses scrutinized here mix science, pseudoscience and fantasy and make no visible effort to show which is which. They give biased information and refer to more or less irrelevant articles to make the courses look serious and credible. Many of the methods taught lack evidence as well as plausibility and are clearly outside the realm of medical science. We found no evidence for the use of animal chiropractic in veterinary medicine. Ragnvi E. Kjellin, DVM, and Olle Kjellin, MD, PhD, Science Based Medicine (16th March 2012) [NOTE: This article was submitted to a series of veterinary journals, but none of them wanted to publish it.] 

‘The Medical War Against Chiropractors: The Untold Story from Persecution to Vindication’

Author: Smith JC. REVIEW: "This book is focused on the unfortunate legal battle between the American Medical Association (AMA) and the US chiropractic profession. It could be an interesting historical exposé but, unfortunately, JC Smith spoils it thoroughly by his entirely one-sided, biased view and inflammatory language. Smith goes not one but several steps too far and thus loses all credibility. For instance, he repeatedly compares the ‘medical lynch mob’ to Nazis and extreme racists: ‘Just as the Nazis used the Big Lie to undermine the image of Jews, so did the AMA use its own version of the Big Lie to defame the chiropractors’ (p. 132). Elsewhere, Smith states that the actions of some medical professionals in Florida were ‘clearly reminiscent of the days of racial desegregation in the South’ (p. 179). This is a great shame, not least because the tensions between the two professions would deserve a scholarly evaluation. I suspect that a sober analysis would have put the clinical evidence in the centre; an aspect that Smith avoids almost entirely. The tensions, I fear, are not between two groups fighting over the same patients, but between one group believing in science and evidence and the other having very little more than aggressive promotion. As it turns out, this book is not an analysis of a 130-year-old conflict but provides a wealth of misguided concepts; it is also a rich source for rampantly paranoid ideas that sadly still exist in the chiropractic profession.” Edzard Ernst, Focus on Alternative and Complementary Therapies [FACT] (March 2012)

Credibility of chiropractic tribunals questioned

“A chiropractor who defends a device condemned by doctors as nothing more than ‘a stick that goes click’ [an Activator instrument] sits on the tribunal that is supposed to protect the public from shonky operators. The revelation is a further blow to the credibility of the chiropractic industry and its highest professional bodies, says the Friends of Science in Medicine — a lobby group of more than 400 doctors, medical researchers and scientists.” Australian Doctor (21st February 2012)

The Five Eras of Chiropractic and the future of chiropractic as seen through the eyes of a participant observer

“Chiropractic’s problem is that subluxation based chiropractors are not only deluding themselves, they are indoctrinating patients into believing in a purportedly dangerous mythical entity, and that without regular adjustments, patients will not only fail to reach their full potential, they will likely suffer serious health problems…Escaping from the dogma house will require extraordinary cooperation amongst all aspects of the profession. Organizations such as the World Federation of Chiropractic and all major chiropractic associations will need to agree upon and adopt a position statement identifying the chiropractic subluxation as an historical construct that remains a hypothesis, which cannot form the basis for patient care until and unless there is a body of scientific evidence to support it…The position statement will need to be backed up by these organizations incorporating and enforcing appropriate statements into their ethical codes. Further, educational accrediting bodies will have to modify their standards to clearly state that subluxation is not a concept upon which to base patient care. From this, it follows that chiropractic teaching institutions will be required to restructure their curricula accordingly. These moves will need to be reinforced by the actions of registration boards to deal harshly with the misleading and deceptive advertising on the part of subluxation based chiropractors and the unconscionable conduct that typically occurs therewith. Specifically, registration boards must prohibit the common practice whereby potential clients present to a chiropractor for a musculoskeletal complaint, only to be convinced that they are in fact suffering from subluxation related disorders and require prolonged chiropractic care. Insurance providers will need to alter their rebate guidelines to only provide payment for evidence-based care and to strike from their registers subluxation-based chiropractors. All of this must happen and the public must be informed along the way. Last, but by no means least, it will require each and every chiropractor to be intolerant of the nonsense that is out there. The contract that the profession has with society and its patients is such that, in exchange for a significant degree of autonomy over education, licensing and credentialing, members of the profession are expected to maintain high standards of competence and moral responsibility and interest. If the profession is to gain the trust of the consuming public it must, of necessity, become truly self-policing. Only in this way will chiropractic generate the cultural authority required for recognition as a group worthy of the title ‘profession’. No longer can we cast a blind eye. By our silence we are giving consent.” J Keith Simpson, Chiropractic & Manual Therapies (January 2012) [pdf]

Chiropractic: Concussion Craziness

“Chiropractic may have reached a new low. A practice in Nova Scotia has started advertising concussion screening for sports teams...This entire process is completely outside the realm of chiropractic. Any patient who is brought to a chiropractor instead of an emergency room for a suspected concussion is at increased risk of death due to delayed onset of treatment and possible misdiagnosis.” Dr. Robert, Skeptical Health (6th January 2012)

Chiropractic: An Indefensible Profession

“It is the author’s position that chiropractic is an indefensible profession. It is inherently unscientific. The supposed cause of disease, subluxations, do not exist. And the scientific evidence overwhelmingly finds that spinal manipulation is dangerous and ineffective for practically every application.” Critical review by Dr Robert, Skeptical Health (2nd January 2011)

Chiropractic Inquiry

A medical doctor puts four questions to chiropractors based on the following evidence: “1. In 2010, a risk-benefit analysis of chiropractic manipulation of the neck found that the risk of any manipulation to the neck is not worth any possible benefit. (Ernst 2010); 2. In 2009, scholarly chiropractors found there is no evidence to support the idea of vertebral subluxation, which is the entire foundation of chiropractic manipulation. (Mirtz 2009); 3. As of now, the best evidence says that chiropractic manipulation, in its entirety, is only effective for certain types of chronic lower back pain, and it’s only as effective as some medical treatment with exercise. (Rubinstein 2011); 4. No systematic reviews have ever found cervical manipulation of the neck to be effective for the treatment of any disease; 5. Systematic reviews have found that “regular” or “preventative” chiropractic manipulation does not promote or in any way improve health, and have found that given the risks associated with chiropractic manipulation, there is no reason to recommend it to any patient. (Ernst 2009); 6. Children do not have fully ossified bones.” Skeptical Health (25th December 2011)

Chiropractic: crackers now, and crackers way back when

“Recently there was an excellent, and much read, article on The Conversation entitled There’s no place for pseudo-scientific chiropractic in Australian universities which made the case against chiropractic “medicine” all too well. Dodgy doctors are dodgy wherever they live and are trained…The article, by John Dwyer of the University of New South Wales [see below], made me reflect that in 1998 Dr Bessie Borwein – whom among her many other attributes is my mother – had been involved in a similar, and largely successful battle to stop such bogus or unvetted programs becoming ensconced in Canadian Universities…let me reproduce my mother’s letter – dated April 17, 1998 – when she was an Assistant Dean of Research at the University of Western Ontario – one of Canada’s top medical schools…” Jon Borwein, Professor of Mathematics at the University of Newcastle, New South Wales, The Conversation (23rd December 2011)

There’s no place for pseudo-scientific chiropractic in Australian universities

“It’s difficult enough to counter the massive amount of misleading information provided to consumers through the media and online. But the task becomes much harder when tertiary institutes give an undeserved imprimatur to pseudo disciplines by offering them as courses. Central Queensland University (CQU) is the latest to do so, announcing it will offer a Bachelor of Science degree (Chiropractic) from 2012. I’m one of thirty-four doctors, scientists and clinical academics who, in an attempt to protect health-care consumers from the dangers associated with unscientific clinical practices, have today written to the science deans at CQU urging them, as fellow academics, to reconsider this decision…Some chiropractors limit their clinical activities to treat musculo-skeletal problems that cause back pain. There is evidence that shows these manipulations are marginally effective, though they’re unlikely to deliver lasting results, regardless of whether the practitioners are physiotherapists, osteopaths or chiropractors. But a practice limited to spinal area musculo-skeletal discomfort is not what modern chiropractic is all about. Most chiropractors believe and teach that spinal area “adjustment” can be used to treat the vast majority of medical problems.” John Dwyer, Emeritus Professor at University of New South Wales, The Conversation (6th December 2011)

Chiropractic degree condemned

Australian Medical Association president, Steve Hambleton, has condemned the University of Central Queensland for allowing the teaching of what he and his colleagues describe as pseudo disciplines which ignore evidence and could harm patients: “This course [the new chiropractic degree] puts pseudo science next to science. It actually uses the imprimatur of a university to actually add something to this area of subluxation theory which really isn't supported by evidence which claims that there is innate intelligence which controls all normal body functions and there is guiding energy and some of those people are actually treating children for all sorts of things including bed wetting, asthma, attention deficit disorder. It is very disturbing…there is no doubt that patients will be harmed if they don't get access to the best evidence and the best evidence-based therapy and this is a way of diverting them away from that.” Professor Phillip Ebrall, who is running the course, says the university's critics are basing their argument on ignorance: “Subluxation theory will be taught because it is an emerging theory that is developing an amazing amount of evidence at new levels in support of some of its underlying principles but I am also the first person to say that we still do not understand that fully enough…We don't deal with conditions. We deal about optimising health and wellness…I think it is absolutely fantastic that people know what the university is doing - that the university is open and honest and is presenting what it’s doing with integrity.” Report by Michael Atkin, ABC Today (5th December 2011)

Blind-Spot Mapping, Cortical Function, and Chiropractic Manipulation

“The evidence for a high incidence of enlarged blind spots is unconvincing. There is no evidence that blind-spot mapping reflects cortical function or that manipulation can affect the size of the blind spot by altering brain function.” Harriet Hall MD, Science Based Medicine (29th November 2011)

Chiropractic Neurology

“Chiropractic neurology appears to me to be the very definition of pseudoscience – it has all the trappings of a legitimate profession, with a complex set of beliefs and practices, but there is no underlying scientific basis for any of it.” Steven Novella MD, Science Based Medicine (16th November 2011)

Spinal Fusion: Chiropractic and Subluxation

“Subluxation-based chiropractic remains an integral part of chiropractic practice in North America and Australia, as demonstrated by the uncritical acceptance of articles discussing its implausible diagnostic methods and treatments in peer-reviewed chiropractic journals, its presence in surveys of chiropractic practice in peer-reviewed chiropractic literature, as well as the aforementioned inclusion in chiropractic education.” Jann Bellamy, Science Based Medicine (3rd November 2011)

Stay away from chiropractic neck manipulation

“The evidence in the literature is quite clear: vertebral artery dissection (VAD), a type of stroke, is associated with chiropractic neck manipulation. It is not a common outcome, perhaps 1.5/100,000 manipulations, but it happens. What’s left is a somewhat subjective decision regarding the risks vs. benefits of the procedure…VAD is an uncommon type of stroke that affects the back of the brain. Rather than go into the details, I think we can all agree that strokes are a bad outcome, and that if a procedure carries that risk, it better have a lot of benefit…The best literature has failed to show a significant benefit of chiropractic neck manipulation vs. more conservative therapy for the treatment of neck pain. What we have here is an intervention that carries a small but real risk of a catastrophic complication, whose benefits are unclear at best.” Peter Lipson MD, Whitecoat Underground (30th September 2011)

Follow up: 2nd October 2011 Supporting the unsupportable

“…when it comes to risk, there is a small but definite association between chiropractic neck manipulation and the rare form of stroke known as vertebral artery dissection. This correlation is most clearly seen in young patients, those who would not normally suffer from strokes. Given the lack of superiority of chiropractic, and the small but real association with VAD, I stand by my advice that one should not allow a chiropractor near the neck.”

Recent Controversies in Chiropractic and RMIT Courses/Clinic

“Is chiropractic at RMIT [Royal Melbourne Institute of Technology] really worthy of government (read: tax-payer’s dollars) support?...RMIT has been publicly criticised for opening a Chiropractic Paediatric Clinic, along with a public call from Loretta Marron for this clinic to be shut down. You may think that this doesn’t sound like much to complain about, the reason is: There is zero scientific evidence that chiropractic is effective for any specific childhood condition …Chiropractic treatment is not without risks, thus children are being treated with chiropractic ‘therapy’, without any conclusive evidence that the treatment being performed is effective. From a totally objective, mathematical, non-emotional risk/benefit point of view, if there’s no benefit from treatment the child only gets the risks associated with the treatment.” Mal Vickers, Victoria Skeptics (29th September 2011)

Follow up: 3rd October 2011 RMIT (Not So) Open Day

“And so it was, I went along to RMIT’s Open Day on August 14, 2011, with my camera, voice recorder and some prepared questions. As any good skeptical researcher would do, I went searching for the evidence and for the experts that might help me find it. Surely, if there is any up-to-date science behind chiropractic the leaders of chiropractic teaching in Australia would know? Would I be the one to eat humble pie and change my mind if the science had come of age?...I found a quiet moment to approach Tom [Molyneux] and engage in polite conversation. I introduced myself as a blog writer from the Australian Skeptics and asked Tom if he’d be willing to be interviewed. Tom was polite but firm in his answer, which was ‘no’…”

Does chiropractic truly understand research?

Highlights the problem of chiropractors’ fear of the consequences from negative results of good quality research. Journal of the Canadian Chiropractic Association (September 2011)

Chiropractor code of ethics: the importance of setting a good example

Our quick and somewhat informal review of the World Wide Web (www) pages of the NZCA [New Zealand Chiropractic Association] and the NZCC [New Zealand College of Chiropractic] suggests that those ideally placed to set an example by complying fully with the NZ chiropractor code of ethics are falling short, at least insofar as their compliance with Section 2.3. We therefore urge the NZCB to ensure that compliance with the code is effectively enforced, given its role in protecting both patient and practitioner. Andrew Gilbey, Jose Perezgonzalez, New Zealand Medical Journal (12th August 2011)

Consumer Reports gives bad advice about chiropractors

The September 2011 issue of Consumer Reports has inappropriately endorsed chiropractic treatment by reporting that subscribers who answered its annual survey said that chiropractic treatment had been more helpful to them than various other treatments for back and neck pain. The article acknowledges that the survey data might not represent the experiences of the general population and should not be compared to the results of clinical trials. However, it fails to place the survey's findings in proper perspective. In 1975 and 1994, Consumer Reports thoroughly debunked chiropractic's subluxation concept and warned very clearly about bad chiropractic advice and overselling. The September 2011 report provides no such warnings, shows a subluxation-based chiropractor giving an "adjustment," and recommends using the American Chiropractic Association to help find a chiropractor. The article gives similar uncritical advice about acupuncture and massage therapy.
Barrett, S., Chirobase (7th August 2011)

Chiropractic president of the U.S. National University of Health Sciences appears to support chiropractor prescription rights only to boost chiropractors' incomes

“"I see that our graduates have a more and more difficult time making a living because the third party payers continue to cut reimbursement to them. One way to increase reimbursement ethically is for the DC to have a broader scope...," says Winterstein; in effect, admitting the obvious fact that financial gain is an ultimate motivation for seeking prescriptive rights.” Chiropractic media report (3rd August 2011)

Are healthy people being manipulated into becoming chiropractic clients?

“A number of concerns around chiropractic practice have been raised recently. Another concern is the use of unproven diagnostic techniques which can produce false diagnoses for which patients are told that they require often lengthy courses of treatment. Such practices have been described recently by a former president of the Chiropractors Registration Board of Victoria (in Australia), who said that some chiropractors misuse equipment such as thermography, and "phrases such as ...'attract new patients' and 'keep your patients longer in care', are common enticements for chiropractors to attend technique and practice management seminars.”… this case describes the use of an unproven diagnostic technique, leading to an incorrect diagnosis of a musculoskeletal problem in an asymptomatic individual resulting in worry, unnecessary cost, and in all likelihood, unnecessary X-rays and a prolonged course of a treatment that is not only unnecessary but also could lead to life-threatening adverse effects. Patients rightly assume that any diagnoses made by healthcare professionals, particularly those who call themselves doctors, are accurate and that any recommended treatments are supported by clinical research evidence, have a positive benefit/risk profile, and are, above all, necessary. The motive behind this practice appears to be to generate clients from healthy individuals."  Professor Shaun Holt, Adjunct Professor of Biological Sciences, Victoria University of Wellington, Journal of the New Zealand Medical Association, Vol 124 No 1339 (29th July 2011) [Subscription]

An update on spinal manipulation science

"BMJ Clinical Evidence — an excellent organization that publishes EBM reviews (much like the World HQ for EBM, The Cochrane Collaboration) — updated their acute low back pain review recently. Here’s what they had to say about spinal manipulative therapy:    One systematic review (149 people) and one subsequent RCT (101 people) added at this update. The review and RCT found no significant difference between spinal manipulation and placebo or usual care in pain. One further study added in harms which reports on adverse effects after spinal manipulation. Categorization of spinal manipulation changed from ‘Likely to be beneficial’ to ‘Unknown effectiveness’.    This is nothing new to anyone who has actually been following the SMT evidence: scientific optimism about spinal manipulative therapy has been steadily eroding for a decade. There was never any evidence of serious efficacy (it always failed the “impress me” test), and larger and better experiments have conclusively shown that it is either completely ineffective, or so unreliable and trivially effective on average that it really just doesn’t deserve to be an expensive therapy with a good reputation any more. It just isn’t all it’s cracked up to be."  Paul Ingraham, Skeptic North blogspot (11th July 2011)

The prevalence of the term subluxation in North American English-Language Doctor of Chiropractic Programs

"Despite the controversies and paucity of evidence the term subluxation is still found often within the chiropractic curricula of most North American chiropractic programs…The recent uproar about the U.S. Council on Chiropractic Education’s new accreditation standards and General Chiropractic Council of the UK’s position on the subluxation shows how much resistance there is to dropping the term.” Timothy A Mirtz and Stephen M Perle, Chiropractic & Manual Therapies (17th June 2011)

Chiropractic at the crossroads or are we just going around in circles?

“The future of chiropractic in Australia is at a crossroads. For the profession to move forward it must base its future on science and not ideological dogma. The push by some for it to become a unique and all encompassing alternative system of healthcare is both misguided and irrational.” John Reggars, DC, Chiropractic & Osteopathy, (21st May 2011)

Chiropractic at a crossroad

“…in an unprecedented attack, John Reggars, a former president of the Chiropractors Registration Board of Victoria, said elements within the Chiropractors’ Association of Australia (CAA) had brought the profession to a crossroads, where it had to choose between science and pseudoscientific dogma...He claimed the CAA’s active promotion of so-called vertebral subluxation complex (VSC) — an unproven theory that spinal misalignments affect the “expression of innate intelligence”, resulting in ill health — was damaging the profession’s credibility… “Chiropractic trade publications and so-called educational seminar promotion material often abound with advertisements of how practitioners can effectively sell the vertebral subluxation complex to an ignorant public,” Mr Reggars said. “Phrases such as ‘double your income’, ‘attract new patients’ and ‘keep your patients longer in care’, are common enticements for chiropractors to attend technique and practice management seminars…Selling such concepts as lifetime chiropractic care, the use of contracts of care, the misuse of diagnostic equipment such as thermography and surface electromyography and the X-raying of every new patient, all contribute to our poor reputation, public distrust and official complaints.” “For the true believer, the naive practitioner or undergraduate chiropractic student who accepts in good faith the propaganda and pseudoscience peddled by the VSC teachers, mentors and professional organisations, the result is the same, a sense of belonging and an unshakable and unwavering faith in their ideology.” Mr Reggars said both the Chiropractic Board of Australia and the Australian Competition and Consumer Commission needed to take “clear and decisive action” against the promotion of VSC as a cause of ill health…He talks about some clinics churning through hundreds of patients a day, the package deals where patients pay up-front for fixed numbers of chiropractic sessions, the family deals where the kids are treated alongside mum and dad. None of this looks pretty. Paul Smith, Australian press (13th May 2011) [pdf]

The chiropractic subluxation is a myth

“Traditionally chiropractic was almost entirely based on the notion that 'subluxations' of the spine need to be 'adjusted' by spinal manipulation – if not, illness would be the inevitable outcome. We all know this is not true, some might say ridiculous, yet the chiropractic profession has been slow to doubt this gospel…Why? The answer, in my view is simple. If you take the basic concept of 'subluxation' away from chiropractic, what remains? The answer, I fear, is not a lot!” Professor Edzard Ernst, Pulse (9th May 2011) [Free registration]

The crossroads of science vs. subluxation

Transcript of an interview between Brett Kinsler, DC, and John Reggars, DC, an Australian skeptical chiropractor. On The Other Hand Podcast (7th May 2011)    [PDF]   Click here for the link to the original podcast.

Loretta Marron: Cracking the chiropractic case

“Someone had to document chiropractic claims, so I decided that it may as well be me…An intriguing finding from my research was that nearly every Australian chiropractic website makes similar claims. I concluded that the 19th century teachings of chiropractic in universities including the RMIT University in Melbourne, Macquarie University in Sydney and Murdoch University in Perth might be part of the problem…When I noticed that the RMIT ran a paediatric chiropractic clinic, I realised that it was probably promoting inappropriate and potentially harmful treatments. Armed with more evidence and additional research, I asked professors of medicine, psychology and science in Australia and the UK to support a report to Federal Health Minister Nicola Roxon, requesting that this clinic be shut down. From both sides of the planet, the response was overwhelming. As more letters continue to head for Canberra, and more support comes in from around the world, I can only hope that our transatlantic efforts will stop this blatant exploitation of our precious children.” Medical Journal of Australia (4th April 2011)

The Image of Chiropractic: Consensus Based On Belief

“If the chiropractic profession does not take steps to eliminate the nonsense in chiropractic, it may be difficult for ethical, science-based chiropractors to separate themselves from questionable treatment methods that have been traditionally supported by chiropractic subluxation theory. The practice-centered approach of chiropractors who disseminate misinformation, whether they are true believers or not, hurts the public as well as the profession…the niche for a back-pain specialty remains unfilled. With changes, chiropractic could have filled this niche (specializing like optometry or chiropody), but instead chose to be defined as a form of alternative medicine with a limited treatment method and an unlimited scope of practice…Since physical therapy as a sub-specialty of medicine is now incorporating use of science-based manipulation in an armamentarium designed for treatment of neck and back pain and other musculoskeletal problems, it might be too late for the chiropractic profession to establish itself as a preferred back-pain specialty or sub-specialty.” Samuel Homola, DC, Science Based Medicine (28th March 2011)

The Battle Within Chiropractic Over Science

“As part of the transition to the new Australian Health Practitioner Regulatory Agency (AHPRA) the regulated professions have been asked to sign up to Codes of Conduct proposed by the new Boards which have been created. A split appears to be looming between the Chiropractic Board of Australia (CBA) and a number of the major professional organizations over the Code of Conduct for registered chiropractors,,,particularly in the areas of public health, informed financial consent and the use of x-rays…It will make for an interesting and no doubt challenging few months as the chiropractic profession attempts to unite behind a Code of Conduct which accords even in general terms with the other AHPRA Boards.” Skepticbros (20th March 2011)

Chiropractic: The More We Look, the Less We Find

“…the best we can say is that spinal manipulation alone has a small, short-term impact on back pain, probably not enough to matter to patients and certainly no better than conventional therapy. Combined or “holistic” chiropractic care does no better. So the research evidence, after more than a hundred years of study since chiropractic was invented, clearly shows no benefit for any problem other than uncomplicated lower back pain. And even for this indication, the benefit is small, possibly no greater than placebo and certainly no greater than conventional therapy. So is this benefit worth being exposed to the rampant pseudoscience promulgated by so many chiropractors, the aggressive marketing of “preventative” chiropractic treatment, and all the other nonsense that so often accompanies most chiropractic treatment?” The Skeptvet (20th March 2011)

Spinal manipulative therapy damned with faint praise (again)

“If there are certain kinds of SMT that work extremely well on certain kinds of patients, it sure does not show in this data, and this review considered all the best studies that have ever been done…Indeed — and this is the clincher — there is no individual study that I know of that shows any significant benefit. If any specific flavour of SMT works especially well for any particular type of patient, that combination was not studied in any of the 26 experiments covered by this Cochrane review.” Paul Ingraham, Save Yourself blog, (16th March 2011)

Maintenance spinal manipulation: The cherry-pickers quandary

“The email from the industry was effusive. In a cock-a-hoop, caps lock-happy frenzy it bellowed “ALL MANUAL MEDICINE PROVIDERS SHOULD BE AWARE OF THIS STUDY”. The study in question, soon to be published in the journal “Spine” is a RCT that specifically looks at whether patients with chronic back pain benefit from a sustained period of “maintenance spinal manipulation” following their initial treatment period and concludes that SMT is indeed effective but that “maintenance manipulations” add benefit after the initial intensive therapy has concluded…The message from this one back pain trial might seem appealing and I can see why the email was so enthusiastic. But by focusing on one particular cherry that seems so ripe and juicy we might miss the bigger picture from the rest of the tree. And there is always the chance that the tastiest cherries contain a few artificial sweeteners. Personally I would lay off the caps lock for now. Neil O'Connell , Body in Mind blog (10th March 2011)

Certificate honouring chiropractic dropouts

“Chirotalk (the skeptical chiropractic discussion forum) want to officially recognize those courageous former chiropractic students who left chiropractic programs before graduating after learning about the poor career prospects and systemic problems of the field. Every student who leaves is like a beacon of light shining the way for other students to leave the field. Every student deprives manipulative chiropractic schools of funding that they use to deceive other students, eventually to the detriment of the public. Congratulations! We'd like to email or fax you an official Chirotalk Meritorious Conduct Award certificate that you can print out and display on your wall.”  (February 2011)

The Vitalism of New Zealand College of Chiropractic (NZCC) 2011

Dynamic Chiropractic reports in ‘Dr. Eric Russell to Assume Presidency of New Zealand College of Chiropractic’: New Zealand College of Chiropractic: Dr. Eric G. Russell is the new president of the New Zealand College of Chiropractic, becoming the first Chiropractic Philosophy diplomate to be named president of a chiropractic college. He is a 1996 graduate of Palmer College of Chiropractic [...] “the New Zealand College of Chiropractic has a great reputation for supporting vitalism throughout the curriculum, rigorous and innovative academic instruction, and progressive subluxation-based research,” said Dr. Russell.  Note: So, NZCC is vitalistic in context just like naturopathy. I'm not sure it's so great to be associated with an idea that is LONG-GONE from science. Of course, the science-ejected nature of vitalistic figmentation is never communicated to the public, and, in that sense, they are abused. How can you consent in an informed manner when opacity is the overall sCAM mode?”   Naturocrit - a whistle-blower's skeptical analysis of the absurdity known as naturopathy / naturopathic medicine / natural medicine -- 'from the inside' (19th January 2011)

International web survey of chiropractic students about evidence-based practice: a pilot study

"Among an estimated 7,142 student recipients of invitation letters, 674 participated in the survey for an estimated response rate of 9.4%. Most respondents reported having access to medical/healthcare literature through the internet, but only 11% read literature every week and 21% did not read literature at all...Respondents generally agreed that the use of research evidence in chiropractic was important. Although 76% of respondents found it easy to understand research evidence and 81% had some level of confidence assessing the general worth of research articles, 71% felt they needed more training in EBP to be able to apply evidence in chiropractic care."  Ryunosuke BanzaiDustin DerbyCynthia LongMaria Hondras, Chiropractic & Manual Therapies (2011, 19:6)

An independent review of NCCAM-funded studies of chiropractic

“Ten RCTs were included, mostly related to chiropractic spinal manipulation for musculoskeletal problems. Their quality was frequently questionable. Several RCTs failed to report adverse effects and the majority was not described in sufficient detail to allow replication. The criticism repeatedly aimed at NCCAM seems justified, as far as their RCTs of chiropractic is concerned. It seems questionable whether such research is worthwhile.” Ernst E, Posadzki P, Clinical Rheumatology (January 2011)

Real orthopaedic subluxations versus imaginary chiropractic subluxations

“The chiropractic vertebral subluxation theory has confused the definition of the word ‘subluxation’; a common medical term. Unlike the mysterious, undetectable chiropractic ‘vertebral subluxation complex’ alleged to be a cause of disease, a real vertebral subluxation can be a cause of mechanical and neuromusculoskeletal symptoms, but has never been shown to be a cause of organic disease…Until chiropractic schools and associations draw a line, and take a stand on the side of science as a properly limited specialty, uniformly defining and limiting chiropractic in state laws, the credibility and the status of chiropractors will remain low. Physicians will continue to refer their patients to physical therapists, physiatrists and orthopaedic surgeons rather than risk a bad outcome with inappropriate treatment provided by a chiropractor.” Samuel Homola, DC, Focus on Alternative and Complementary Therapies (December 2010)

Humpty Dumpty chiropractic

“…the time is fast approaching when chiropractic will have to decide whether it is informed by 19th century metaphysics or by 21st century science. If it chooses wrongly, then it may not be possible for all the king’s horses and all the king’s men to effect a repair.” Martin Young, Editor, Clinical Chiropractic (2010) 13, 197—198) [pdf]

NOTE: Rather than pushing for universal chiropractic reform, this editorial appears to be proposing simply renaming the chiropractic subluxation as ‘segmental spinal dysfunction’.

Back pain: It ain’t what you do it’s ….?

A paper recently turned up in the journal Rheumatology by Majid Artus and his colleagues at Keele University. They performed a systematic review that aimed to assess not the effectiveness of interventions but instead the overall pattern of symptom development over time of back pain sufferers who take part in clinical trials and how it might vary between different types of intervention…It is interesting that the placebo treatment/waiting list control/no treatment group didn’t differ from the treatment groups.” Neil O’Connell, researcher in the Centre for Research in Rehabilitation, Brunel University. (Body In Mind blog, 22nd November 2010)

Who Has the Backbone to Stop This?

Chiropractors should not promote their services as an alternative to vaccination or treat children for conditions like autism and asthma.  I would like the relevant authorities to take the follow actions:

• prohibit chiropractors from using the honorific “Dr” and from referring to themselves as doctors;
• discourage health insurers from providing benefits for chiropractic care, other than for treatment of lower back pain;
• provide educational material to the public advising of the limitations of chiropractic and the dangers of some chiropractic procedures;
• prosecute chiropractors who claim to be able to treat conditions that are not plausibly amenable to spinal manipulation, such as autism and ADHD; and
• prohibit chiropractors from treating young children for any reason.

Peter Bowditch, Immediate Past President of Australian Skeptics Inc., Australasian Science Magazine             (November 2010)

NOTE: The Chiropractors Association of Australia (CAA) took exception to the content of the above article and decided to make a formal complaint to the Australasian Science Magazine. Peter Bowditch's response to the CAA’s concerns can be read here

The DC as PCP?

Subluxation-free chiropractic?

“...Stephen P. Welsh, DC, Fellow of the ICA [International Chiropractors Association], saw right through NUHS [National University of Health Sciences] and its grandiose plans:

…The goal of the advocates of these changes is to practice primary care medicine, without fully qualifying at the appropriate standard to do so.

Couldn’t have said it better myself.”

Jann Bellamy, Science Based Medicine (18th November 2010)

Attitudes of non-practicing chiropractors: a pilot survey concerning factors related to attrition

“A total of 70 valid responses were received for analysis. A majority of respondents were male with 66% being in non-practice status for 3 to 5 years and less with 43% indicating that they had graduated since the year 2000. Most respondents were employed either in other healthcare professions and non-chiropractic education. A majority of NPCs believed that business ethics in chiropractic were questionable and that overhead expense and student loans were factors in practice success. A majority of NPCs were in associate practice at one time with many believing that associates were encouraged to prolong the care of patients and that associate salaries were not fair. Most NPCs surveyed believed that chiropractic was not a good career choice and would not recommend someone to become a chiropractor.” Timothy A Mirtz, Jeffrey J Hebert, Lawrence H Wyatt, Chiropractic & Osteopathy (November 2010) [pdf]

World Health Organisation (WHO) says that the consequences of the chiropractic subluxation are ‘hypothesized’

It is hypothesized that significant neurophysiological consequences may occur as a result of mechanical spinal functional disturbances, described by chiropractors as subluxation and the vertebral subluxation complex       (9, 10:169-170, 11).”   (Skeptic Barista blogspot, 24th October 2010)

(A hypothesis is something put forward to explain a set of events or conditions and whilst it may offer grounds for further investigation, it is not in itself proof.)  Further, the WHO’s 2003 bulletin on Lower Back Pain mentions chiropractic and the reasons people turn to it:

“People with low back pain often turn to medical consultations and drug therapies, but they also use a variety of alternative approaches. Regardless of the treatment, most cases of acute back pain improve. At the time, people in such cases may credit the improvement to the interventions some of which clearly are more popular and even seemingly more effective than others (e.g. chiropractic and other manipulative treatments in which the laying on of hands and the person-to-person interaction during the treatment may account for some of the salutary results).”

and that:

“The spread of chiropractic and other manipulative treatments worldwide has won many adherents to this treatment, who perceive that it works better than others. This hypothesis was recently put to the test (25) and, although the respondents still favoured such approaches (chiropractic adjustment, osteopathic manipulation, and physical therapy) perhaps because of the time spent and the laying on of hands meta-analysis cannot confirm the superiority of manipulative treatments (or, for that matter, of acupuncture and massage (26)) over other forms of therapy, or even time as a healer (25), which substantiates the contentions of WHO’s document (1). In most instances, manipulative treatments are more expensive than others (apart from surgery) and not more helpful to outcome (26).”

2010: Major chiropractic survey updated, but less comprehensively than in previous years

The (US) National Board of Chiropractic Examiners has published the results of its periodic survey to which 2,371 randomly selected chiropractors responded last year. Previous surveys, reported under the title Job Analysis of Chiropractic, were performed in 1991, 1998-99, and 2003. The reports are interesting because they provide a basis to assess the minimum extent of irrational practices among chiropractors. The 2003 survey, for example, found that 37.6% used applied kinesiology muscle testing, 69.9% of respondents used activator methods, 38% used "cranial" techniques, 49.6% used sacrooccipital technique, 28% used Logan basic, and 25.7% used Palmer upper cervical, and 15.1% used the meric system. However, unlike the previous versions, the 2009 survey questionnaire did not ask about the use of applied kinesiology or any of the subluxation-based "adjustive procedures" that place chiropractic in an unfavorable light. The 2009 survey found that 38.6% of respondents said they prescribe homeopathic remedies, 13% use acupuncture/meridian therapy with needles, and 41.1% use acupuncture/meridian therapy without needles (acupressure), which it defines as "applying digital pressure to stimulate certain sites on the skin to affect distant functional mechanisms of the body . . . . based on the belief that these sites are organized along meridians that carry life force." The 2009 survey also found that 94.4% of respondents said they offer "nutritional/dietary recommendations," but the number does not indicate the extent to which the recommendations include unnecessary or irrational products.

Chiropractic Vertebral Subluxations: Science vs. Pseudoscience

“Unlike the mysterious, undetectable and asymptomatic chiropractic ‘vertebral subluxation complex’ alleged to be a cause of disease, a real vertebral subluxation, that is, an orthopedic subluxation, can be a cause of mechanical and neuromusculoskeletal symptoms but has never been associated with organic disease….

A largely ignored landmark review of the literature by a Ph.D. and a chiropractor (Nansel and Szlazak), published in 1995, concluded that there is not a single appropriately controlled study to indicate that any dysfunction in structures of the spinal column is a cause of organic disease…

Unfortunately, the chiropractic profession in the United States continues to be defined by subluxation theory. Too few chiropractors are willing to ‘step out of line’ and announce that the theory (more accurately defined as a belief) is scientifically indefensible and should be dumped… the British Chiropractic Association advised its members to “refrain from making any reference to Vertebral Subluxation Complex in media to which their patients or the general public may have access,” adding that “this advice has no bearing on scope of practice”…

Without some identifying label or degree that distinguishes science-based chiropractors from subluxation-based chiropractors, medical physicians will continue to be reluctant to refer a patient to a chiropractor, lest they deliver a patient into the hands of a pseudoscientific practitioner whose philosophy embraces an anti-medical approach and endangers the patient...

It seems likely that subluxation-based chiropractic, like homeopathy and other belief systems, will be perpetuated to some degree by true believers…

Because the chiropractic profession seems unwilling to abandon these discredited concepts, reform of the state chiropractic practice acts to eliminate subluxation-based chiropractic practice may be the only viable solution to the perpetration of unscientific and unproved healthcare practices…

Good science-based chiropractors who do not subscribe to the vertebral subluxation theory and who use manipulation appropriately can offer a service of value. Unfortunately, such chiropractors are not easy to find.”

Samuel Homola DC, Science Based Medicine (1st October 2010)

Misinformed Consent? What not to tell a patient with back pain

“We just came across a fancy patient information form that was given to a patient after an assessment by a clinician. The form just blew our minds (but not in a good way) because it seemed to be the perfect clinical tool for generating ongoing pain and disability, and all by the simple process of ramping up the fear. So, just for fun, we thought we’d take you through it…Page 2 “Your nervous system controls everything”… The terrifying consequences of subluxations…The “Spinal Decay Report” Oh my goodness my spine is crumbling!...What is wrong with giving patients detailed information? Absolutely nothing but ultimately information should be accurate and empower the patient to make good decisions. The problems here are legion.” Neil O’Connell, Body In Mind blogspot (19th August 2010)

Why do chiropractors order so many X rays?

“Both anecdotal and quantitative studies have shown that chiropractors are very likely to order spine X rays. Given the inutility of these studies, and the radiation exposure, what reason could there be (aside from financial incentive) for chiropractors to order X rays?...X rays are a significant intervention. Anytime ionizing radiation is applied to a human being, there better be a good reason for it. If there is no evidence that the X ray will help in a meaningful way with diagnosis or treatment, then no X ray should be done. There is no clear reason any chiropractor should ever order an X ray.” PalMD, White Coat Underground blogspot (10th August 2010)

Not to worry! Chiropractic Board says stroke not a risk of cervical manipulation

“What does this ruling mean?

The Board’s declaration that there is no risk of cervical artery dissection and stroke following manipulation is a finding of fact and not binding on the courts. As is their ruling that informed consent does not require a warning. Under Connecticut law, whether a warning of risk is required is determined by the “reasonable patient” standard, that is, what would a reasonable patient consider important in making his decision whether to undergo a particular procedure. One of the very purposes of the reasonable patient standard is to prevent practitioners from setting low standards and then claiming they’ve abided by their profession’s standard of care. Imagine the chiropractor sued for failure to warn who erroneously thinks he’s been inoculated against malpractice claims by following the Board’s ruling. Surprise!

As a matter of fact, the hearing transcript and videotape are now in the hands of plaintiffs’ personal injury attorneys, who will mine it for useful information. A couple of years ago the American Justice Society (formerly known as the Association of Trial Lawyers of American) started a chiropractic interest group (that is, interest in suing chiropractors for personal injury). The section collects and distributes such information for AJS members.

The chiropractors may have won this battle, but they could be losing the war.”

Jann Bellamy, Science Based Medicine (2nd July 2010)

What do you get if you visit a chiropractor?

“A few months ago I visited a chiropractor just to see what would happen…He gave me the hard sell on the importance of regular chiropractic care to prevent degenerative disease. I listened and nodded politely then left and that, as far as I was concerned, was the end of the matter. But there’s apparently an old adage I didn’t know about until it was mentioned by someone on the Bad Science forum. It goes like this: Q: What do you get if you visit a chiropractor? A: Another appointment. Like everyone else, chiropractors have a living to earn. Of course, most of us don’t try to make a living delivering an unnecessary and scientifically unsupported therapy to people who don’t need it. But I guess those who do aren’t going to let anyone who’s already set foot on their premises, had both feet through the door, get away without at least one more attempt to lure them back.” Skepticat blogspot (10th June 2010)

Brief Note: The Chiropractic Subluxation is Dead

The General Chiropractic Council, a UK-wide statutory body with regulatory powers, has just published a new position statement on the chiropractic subluxation complex:

The chiropractic vertebral subluxation complex is an historical concept but it remains a theoretical model. It is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease or health concerns.

They remind chiropractors that they must make sure their own beliefs and values do not prejudice the patient’s care, and that they must provide evidence-based care. Unfortunately, they define evidence-based care as

clinical practice that incorporates the best available evidence from research, the preferences of the patient and the expertise of practitioners, including the individual chiropractor her/himself. [emphasis added]

This effectively allows “in my experience” and “the patient likes it” to be considered along with evidence, effectively negating the whole point of evidence-based medicine.

Harriet Hall MD, Science Based Medicine (29th May 2010) 

Cold Laser Therapy

“A popular therapy among chiropractors who treat pets is low level laser or “cold laser” treatment. It is an impressive bit of showmanship to pull out a complex-looking device and with a serious expression wave a beam of light over a patient, but the evidence to suggest it is anything more than showmanship is weak at best.” The SkeptVet (26th May 2010)

The Chiropractic Conundrum

“2010 is the 100th anniversary of the Flexner Report – essentially an expose on poor-scientific regulation of medical practices that led to a scientific revolution in mainstream medicine. Chiropractic is in major need of its own Flexner Report (an Ernst Report?). In my opinion they need to clean house if they want to become respected members of the evidence-based mainstream medical community. They are trying to achieve this through legislation, lobbying, and advertising rather than genuine quality control, and that is a shame. As Ernst writes – their failure to do so constitutes an ethical and public health issue.” Steven Novella MD, NeuroLogica blog (10th April 2010)

Chiropractic claims in the English-speaking world

“Conclusions The majority of chiropractors and their associations in the English-speaking world seem to make therapeutic claims that are not supported by sound evidence, whilst only 28% of chiropractor websites promote lower back pain, which is supported by some evidence. We suggest the ubiquity of the unsubstantiated claims constitutes an ethical and public health issue.” Edzard Ernst, Andrew Gilbey, Journal of the New Zealand Medical Association (9th April 2010) [pdf]

NOTE: In 2003, 69% of all UK chiropractors felt confident to treat visceral/organic conditions, currently this figure stands at 74%. In the US,“nearly 80% of chiropractors teach a relationship between subluxation and internal health”, 88% believe that subluxation contributes to over 60 % of all visceral ailments, and 90% feel that chiropractic treatments should not be limited to musculoskeletal conditions.

Spinal Decompression Machines

“The Canadian Broadcasting Company (CBC) show “Marketplace” does a scathing exposé of so-called nonsurgical spinal decompression treatment with machines like the DRX 9000 and of some of the unscrupulous practitioners who offer it. Between the hidden camera footage and the weasel words of the chiropractor they interview, it’s quite entertaining.” Harriet Hall, MD, Science Based Medicine (28th March 2010)

On Stroke Risks, Chiropractors Manipulate Us

“By a 4-1 vote, the board turned back a request for a "declaratory ruling" that would have mandated the state's chiropractors to warn patients that cervical manipulation of the spine can be dangerous. Medical doctors know this warning as "informed consent." I called board Chairman (and chiropractor) Matthew W. Scott to ask about the decision, which was made at a public meeting Tuesday morning. "I'm not allowed to talk about it," Scott said. There is one board member who isn't a chiropractor. She voted for requiring informed consent and was happy to talk." They see no risk of stroke from cervical manipulation," said Jean Rexford, the executive director of the Connecticut Center for Patient Safety. "They relied on one study. It's time to really take a close look at how all these boards are being run. We have way too many foxes watching the henhouse." Many chiropractors have been irate about the proposal, saying that evidence of a risk doesn't exist and that they are being singled out. Stroke victims, an increasingly outspoken group, say all they want is for patients to learn about the danger. The legislature, which passed the issue to the chiropractic examiners, might now take up the issue again. "It makes me wonder why we have a board at all," said Norm Pattis, lawyer for the stroke victims. "If the board won't do it and legislators won't, then we will go to the courts."” Rick Green, Hartford Courant (18th March 2010)

Science-Based Chiropractic: An Oxymoron?

“I spent 43 years in private practice as a “science-based” chiropractor and a critic of the chiropractic vertebral subluxation theory…If I had it to do over again, however, I would study physical therapy rather than chiropractic. Considering the controversy that continues to surround the practice of chiropractic, I would not recommend that anyone spend the time, effort, and money required to earn a degree in chiropractic. Physical therapy, which is now beginning to include spinal manipulation in its treatment armamentarium, may offer better opportunity for those interested in manual therapy. Properly-limited, science-based chiropractors are now essentially competing with physical therapists who use manual therapy. Unfortunately, only a few chiropractors have renounced the vertebral subluxation theory, making it difficult to find a “good chiropractor.” I consider physical therapy to be more progressive and more evidence based. For this reason, I generally recommend the manipulative services of a physical therapist rather than a chiropractor. There are some science-based chiropractors who use manipulation appropriately, but until the chiropractic profession abandons the implausible vertebral subluxation theory and is defined according to standards dictated by anatomy, physiology, and neurology, I would not describe it as a science-based profession.” Samuel Homola DC, Science Based Medicine (4th March 2010)

Inside the spine wizard’s den

“Until a few years ago I assumed, when I heard the words ‘Dr X, a chiropractor’, that they referred to a doctor of medicine who specialised in a fully recognised branch of medicine…The alarm bells only rang when I saw one of their stalls in a shopping centre one day, complete with chiros touting for business. I surely can’t be the only person who finds it utterly weird that people claiming to represent a serious health discipline behave so evangelically and hang around public places hustling, (though, come to think of it, D.D. Palmer did say something about possibly making chiropractic a religion). What I didn’t know until recently was how chiropractics use ‘bait and switch’ to gain respectability. At these public promotional events, they focus plausibly on muscular-skeletal conditions and give the impression they are something to do with physiotherapy. Given their low cost introductory offers, why wouldn’t anyone with a chronic ache or pain give them a go? Once they’ve lured people into the surgery they start talking nonsense about subluxations and how these cause all manner of conditions that have nothing to do with the spine. I didn’t give chiropractic another thought until the BCA took the momentously stupid decision to sue Simon Singh, thereby exposing the dearth of scientific evidence for claims blithely made by its members and inspiring thousands of open-minded and concerned people like myself to do some serious research.” SkepticatUK blogspot (3rd March 2010)

Chiropractic reform leader scolds chiropractors

The founder of Victims of Chiropractic Abuse, Inc. - a survivor of chiropractic stroke - testifies before the Connecticut State Board of Chiropractic Examiners on the need for Informed Consent prior to neck manipulation. Chiropractors in the audience heckled her during the presentation sparking an emotional response. (19th January 2010) [2:25 min video segment]

Chiropractic leader refuses to answer easy questions

The head of the Connecticut Chiropractic Council, a trade group, refuses to answer the question “What is neck manipulation” during testimony before the Connecticut State Board of Chiropractic Examiners on 19th January 2010. [3:32 mins video segment]

Chiropractors and Consent — Quacks and Risk

"I’ve had friends who complained of various ailments and bothers, some of whom swear that after visiting a chiropractor they felt 100% better…for awhile at least. I’ve always been of the opinion that everyone feels 100% better after a massage, a stretch and what passes for professional attention. The thing about chiropracty is that, when you look at the evidence, it’s really no better than sugar pills and rest…and in some ways it’s very much worse. Chiropractors are dangerous, make outrageous and unsubstantiated claims about the effectiveness of their “treatment”, and now one group of these charlatans wants permission to NOT advise their patients that cervical manipulation might cause a stroke." Cousinavi blog (9th January 2010)

The end of chiropractic

"An article written by 3 chiropractors and a PhD in physical education and published on December 2, 2009 in the journal Chiropractic and Osteopathy may have sounded the death knell for chiropractic… The chiropractic emperor has no clothes, and now even some chiropractors have realized that. This study should mark the beginning of the end for chiropractic, but it won't. Superstition never dies, particularly when it is essential to livelihood." Article by Harriet Hall, MD, Science Based Medicine (11th December 2009)

Fatal Adjustments: How Chiropractic Kills

"There is no medically proven benefit whatsoever to chiropractic manipulation of the cervical spine… As practiced today, chiropractic is a threat to public health. In an age where phenomenal medical discoveries have improved the health and extended average longevity to almost 80 years, chiropractic remains a holdover from the days of the snake oil salesmen. Every year trusting and naïve Americans suffer needless injury and death due to dangerous cervical spine manipulation." Article by J. D. Haines, MD, Skeptic Magazine (21st October 2009)

No Vaccine Against Greed

"One of the things that's always puzzled me about the anti-vax movement is why people are motivated to rail against something with so much supportive evidence. Sure, there are legions of misinformed parents who think they're helping society by decrying the vaccination conspiracy, and there are certainly those that have experienced personal loss due to the very, very, rare negative side effects of vaccination. But Chiropractor Dr. Chad Rohlfsen illustrates in abundance what I think might be the primary motive for anti-vaccine rhetoric, and that is pure, simple, banal greed." Jeff Wagg, James Randi Educational Foundation (30th September 2009)

Disappointing advertisement

"I was disappointed to see a full-page advertisement for the Ontario Chiropractic Association in the July 2009 edition of Canadian Family Physician. In spite of their attempts over the decades to legitimize themselves, the overwhelming majority of chiropractors do not practise scientifically based health care, and chiropractic care remains more of a faith-based cult than a legitimate alternative to medical care." Tim McDowell, MD CCFP, in a letter to Canadian Family Physician (9th September 2009)

The Problem with Chiropractic NUCCA

"Members of the National Upper Cervical Chiropractic Association (NUCCA) specialize in adjustment of the atlas, using the procedure as an exclusive treatment for a great variety of ailments…The NUCCA approach to treating human ailments received unexpected support recently when a pilot study published in a legitimate medical journal suggested that correcting atlas misalignment would reduce early high blood pressure…The minor atlas subluxations routinely found by NUCCA chiropractors have not been proven to be significant. I would be surprised if a legitimate properly controlled study offered proof that upper neck manipulation would permanently lower blood pressure that has an organic origin. The claim by NUCCA practitioners that a painless slightly misaligned atlas is a cause of high blood pressure does not have enough supporting evidence to warrant the risk of manipulating the necks of patients suffering from high blood pressure, risking injury to vertebrobasilar arteries." Article by Sam Homola, DC, Science Based Medicine (7th August 2009)

Chiropractic's Answer to Swine Flu: Get Adjusted

"Instead of helping the public reduce their risk of infection, they are trying to boost their business and spread misinformation…" Article by Harriet Hall, MD, James Randi Educational Foundation (30th April 2009)

Chiropractic's Pathetic Response to Stroke Concerns

"If chiropractors really wanted to understand the risks [of chiropractic neck adjustments] and minimize them, here's what they could do. They could establish a database of every patient who received neck manipulations, listing their presenting symptoms, specifying exactly which type of neck manipulations were done, and following each patient up with phone calls to determine whether symptoms of stroke had developed after treatment. That would (1) establish the true incidence of stroke following neck adjustments, (2) determine whether strokes were more common with certain specific types of adjustments, and (3) determine whether patients were seeking "inappropriate" care for pre-existing symptoms of CAD. This could be done at little expense and would answer clinically significant questions." Article by Harriet Hall, MD, Science Based Medicine (10th February 2009)

Is Chiropractic X-raying Illegal?

"Given that chiropractic is founded on pseudoscientific notions of health and that the concept of spinal subluxations has never been empirically validated, just what are chiropractors looking for in X-rays? And since chiropractic treatment cannot demonstrate efficacy to a reasonable standard, how will X-raying a patient lead to a therapeutic benefit? In addition, since the positive effects seen for some sort of back pain are only comparable to conventional treatment where no X-ray is required, surely there is always an alternative treatment plan that does not involve exposing the patient to the risk of ionising radiation?" The Quackometer (29th January 2009)

Chiropractic Folly and the Nature of Evidence

"If we are to accept evidence for chiropractic efficacy we need a little more than stories. It is also worth pointing out that chiropractic treatment for anything that is not to do with muscles and bones is implausible in the extreme. Chiropractors believe they can cure many other things because the trade was founded on the idea that subluxations (chiropractors mysterious bodily malfunctions) were the cause of most (if not all) illness. Thus, by crunching bones you can clear subluxations and get the 'vital forces' moving again. Yes, chiropractic is founded on pre-scientific views of biology and medicine and thus any claims it makes must be subject to the highest forms of evidence." The Quackometer (11th November 2008)

The Bait and Switch of Unscientific Medicine

"Chiropractic is perhaps the most common and egregious example of the bait and switch in medicine…..someone may go to see a chiropractor and think they will be seeing a medical professional who will treat their musculoskeletal symptoms, but in reality they will see the practitioner of a cult philosophy of energy healing…The bait — claims that chiropractors are medical practitioners with expertise in the musculoskeletal system. The switch — practitioners of discredited pseudosciences that have nothing to do with the musculoskeletal system…..A more subtle form of the bait and switch among chiropractors is the treatment of musculoskeletal symptoms with standard physical therapy or sports medicine practices under the name of chiropractic manipulation. Ironically, the more honest and scientific practitioners among chiropractors are most likely to commit this subtle deception. The problem comes not from the treatment itself but the claim that such treatments are 'chiropractic'…. But by doing so and calling it 'chiropractic' it legitimizes the pseudoscientific practices that are very common within the profession — like treating non-existent 'subluxations' in order to free up the flow of innate intelligence." Article by Steven Novella, MD, Science Based Medicine (2nd July 2008)

Chiropractic Lawsuit (Canada)

"The risks of neck manipulation are not trivial. The primary risk is that aggressive neck manipulation may cause a tear (called a dissection) in one of the four arteries that feed the brain — two carotids to the front of the brain and two vertebrals to the back. If a tear forms in one of these arteries then a clot (called a thrombus) can form around that tear, blocking off flow through the artery and causing a stroke. It is also possible that the thrombus may break lose and flow downstream and then lodge in and completely block off an artery — when a clot moves it is called an embolus. This is apparently what happened to Sandra Nette…this case should be a wake up call. The government cannot continue to license nonsense and call it medicine. The public deserves better. I also think that public awareness about the risks of neck manipulation needs to be raised, and more importantly this practice needs to simply stop. Watch how the government and chiropractors respond to this law suit. It will be very telling." Steven Novella, MD, NeuroLogica Blog (17th June 2008)

Consent: Its Practices and Implications in United Kingdom and United States Chiropractic Practice

Results from this survey suggest a patient's autonomy and right to self-determination may be compromised when seeking chiropractic care. Difficulties and omissions in the implementation of valid consent processes appear common, particularly in relation to risk. Langworthy JM, and Cambron J, Institute for Musculoskeletal Research and Clinical Implementation, [AECC], Bournemouth, UK (July-August 2007)

Chiropractic, Cervical Spine Manipulation, and Stroke

“There is evidence to indicate that upper cervical manipulation can cause stroke by injuring vertebrobasilar arteries. Many chiropractors routinely manipulate the neck as part of a treatment regimen designed to improve health by adjusting ‘vertebral subluxations’. Physical therapy practitioners may occasionally use cervical spine manipulation in the treatment of a problem related to loss of mobility. Although stroke caused by neck manipulation is rare, it happens most often among chiropractic patients who may be subjected to unnecessary manipulation based upon untenable guidelines.” This review, written by a retired chiropractor, offers some insight into problems associated with chiropractic neck manipulation. Samuel Homola DC, The Scientific Review of Alternative Medicine (2007)

Can Chiropractors and Evidence-Based Manual Therapists Work Together? An Opinion From a Veteran Chiropractor

"The words 'manipulation' and 'subluxation' in a chiropractic context have meanings that are different from the meanings in evidence-based literature… The reasons for use of manipulation/mobilization by an evidence-based manual therapist are not the same as the reason for use of adjustment/manipulation by most chiropractors." Article by Samuel Homola, DC, The Journal of Manual & Manipulative Therapy, Vol.14 No.2 (2006) E14-E18 [pdf]

Subluxation: dogma or science?

"Subluxation syndrome is a legitimate, potentially testable, theoretical construct for which there is little experimental evidence… Failure to challenge subluxation dogma perpetuates a marketing tradition that inevitably prompts charges of quackery… We lament efforts to generate unity within the profession through consensus statements concerning subluxation dogma and believe that cultural authority will continue to elude us so long as we assert dogma as though it were validated clinical theory." Josepth C. Keating Jr, Keith H. Charlton, Jaroslaw P. Grod, Stephen M. Perle, David Sikorski and James F. Winterstein, Chiropractic & Osteopathy (10th August 2005)

'Unanimous Agreement on Identity of the Profession'

In June 2005, following "two years intensive work", the World Federation of Chiropractic (WFC) finally reached agreement on "the most appropriate public identity" for the chiropractic profession: "The spinal health care experts in the health care system". However, as this new identity appears to make provision for the continued use of a number of pseudoscientific chiropractic practices, including vitalistic subluxation-based practices, is it likely to convey anything meaningful or reassuring to the public? NOTE: In order to make fully informed choices about their health care consumers have the right to be told that the practice of real chiropractic is built on the belief of a fictional lesion — the chiropractic subluxation — and its unproven deterimental effects on human health. Further, consumers have a right to be told that, even when unstated or denied, the concept of subluxation is still very much fundamental to the practices of many chiropractors in the UK and elsewhere.

'WHO guidelines on basic training and safety in chiropractic'

The World Health Organisation (WHO) Consultation on Chiropractic, from which the 2005 guidelines contained in this link evolved, took place in Milan, Italy, on 2-4 December 2004. Of the 27 listed participants, 18 appear to be professionally involved with either chiropractic or Complementary and Alternative Medicine (CAM). Under the heading 'Philosophy and basic theories of chiropractic' (Section 1.2) it is stated: "A majority of practitioners within the profession would maintain that the philosophy of chiropractic includes, but is not limited to, holism, vitalism, naturalism… Significant neurophysiological consequences may occur as a result of mechanical spinal functional disturbances, described by chiropractors as subluxation and the Vertebral Subluxation Complex". [pdf]

A Chiropractic License is a Social Contract: Are You Serving the Public Interest?

"The profession is clouded by uncontrolled commercialism and self-interest which endangers the fiduciary relationship with the patient. There is a major conflict between the culture of business and the culture of clinical delivery… Diagnostic and treatment services that exceed clinical necessity are indicators of incompetence or intentional mistreatment — a violation of public trust that requires remediation." Presentation to the Federation of Chiropractic Licensing Boards by Richard E. Vincent, DC, FICC, Past-President, FCLB and NBCE (2005) [pdf]

A chiropractic school at FSU: Unanswered questions

An opinion from Samuel Homola, D.C., regarding the proposed new chiropractic school at Florida State University in the United States. [UPDATE: On 27th January 2005 the Florida Board of Governors voted to deny the approval of a chiropractic program at Florida State University]

Analysis of a misleading chiropractic article in a major medical journal

"Modern chiropractic theory, if it exists, is double-talk that attempts to cling to "subluxation" theory while pretending to have abandoned it. The actual reality is that chiropractors cannot agree among themselves about what they believe or should believe." Analysis by Stephen Barrett, MD (Chirobase)

Unsubstantiated claims in patient brochures from the largest state, provincial, and national chiropractic associations and research agencies (USA and Canada)

"The largest professional associations in the United States and Canada distribute patient brochures that make claims for the clinical art of chiropractic that are not currently justified by available scientific evidence or that are intrinsically untestable. These assertions are self-defeating because they reinforce an image of the chiropractic profession as functioning outside the boundaries of scientific behavior." Grod JP, Sikorski D, Keating JC Jr, Journal of Manipulative and Physiological Therapeutics (2001)

Chiropractors' use of X-rays

"The validity of chiropractors' X-ray diagnoses is not well established. Small vertebral displacements or malalignments have no proven clinical relevance, dynamic studies have no proven value, and plain radiographs yield little relevant biomechanical information… In conclusion, the current, albeit incomplete, data suggest an overuse of spinal radiography by the chiropractic profession." E. Ernst, MD, PhD, The British Journal of Radiology [pdf]

Balanced judgements on complementary/alternative medicine. Is informed consent necessary?

“Consider a woman consulting a chiropractor for neck pain, which is a common reason for people to seek chiropractic care, and chiropractors claim that it can be effectively treated with spinal manipulation. The relevant facts regarding such a case are as follows:
• Treatment would be elective, i.e. the patient could, without serious risks, postpone her treatment decision.
• Other treatments exist, some of which, like exercise, are virtually risk-free [5].
• The risk of not having any treatment at all is minimal.
• Chiropractic treatment of neck pain has not been demonstrated to be effective or more effective than competing therapies [6].
Manipulation of the upper spine is associated with material and significant risks. About half of all patients will experience transient discomfort or pain, and in a (probably small but essentially unknown) number of cases, it may cause arterial dissection with potentially serious sequelae [7]. ‘A significantly more thorough standard of disclosure is needed where the treatment is elective and … the law may require disclosure of all known risks …’ [8]. Thus chiropractors must advise patients with neck pain that the risk–benefit balance of upper spinal manipulation is not demonstrably in favour of this approach and that other, less risky and effective treatments (e.g. exercise) exist [9]. Many patients would be alarmed by these facts and decline treatment. As most chiropractors are self-employed, full informed consent is overtly against their own financial interest. Consequently chiropractors might rarely provide such information (to date no data are available). Yet the mere fact that the patient might become upset by hearing the information, or might refuse treatment, is not sufficient to act as a justification for non-disclosure of information [3]. ‘Therapeutic privilege’ could be the solution and, in fact, seems to be current clinical practice. It means that chiropractors limit disclosure of risks in the belief that this is in the patient’s best interest. However, therapeutic privilege only applies where ‘treatment is so necessary to maintain the life or health of the patient and the consequences of failing to carry it out are so clearly disadvantageous’ [8].”

Edzard Ernst, letter to Rheumatology, (2004)

Informed Consent: A Potential Dilemma for Complementary Medicine

"The dilemma that emerges seems clear: informed consent compels chiropractors to tell neck pain patients firstly that the benefit of chiropractic spinal manipulation is uncertain, secondly that its risks are not negligible, and thirdly that other therapeutic options are not associated with harm. Such information is likely to deter patients from choosing chiropractic treatment. Thus, informed consent can work against the financial interests of CM (Complementary Medicine) practitioners, most of who are privately paid by their patients." Edzard Ernst, MD, PhD, Journal of Manipulative and Physiological Therapeutics (July-August 2004) [This article has recently become subscription-only]

Chiropractic: The Victims Perspective

Foreword to George Magner's book written by William T. Jarvis, PhD. (Quackwatch) NOTE: On the issue of informed choice, George Magner writes on page 178 of his book that "If relevant information is withheld (a covert lie), or if false information is supplied (an overt lie), there is deception. Under such conditions, treatment is administered under false pretences. Deceived patients are not able to choose freely. Only an informed choice is a free choice. Chiropractors who preempt their patients' ability to choose betray their trust and set them up for possible physical and psychological catastrophe."

Chiropractic: A Profession Seeking Identity

"The chiropractic profession is resisting changes that will establish it as a back-pain specialty while seeking an identity that will continue to allow chiropractors to treat a broad scope of health problems." Article by Samuel Homala, DC, Skeptical Inquirer (Jan/Feb 2008)

Amani Oakley's closing in the Lana Dale Lewis Inquest

Bearing in mind that the requirement to explain risks to patients has the potential to affect a chiropractor's income, it is interesting to note a revealing comment which was made at an inquest in Canada which involved a chiropractor who had allegedly caused a patient to suffer a stroke through neck manipulation. When pressed as to why he wasn't telling his patients about the 'potentially catastrophic injuries and death' which may result from neck manipulation, he said that if he were to tell patients that "I can kill you", then "half of them would walk out". (Chirowatch) [Use 'Edit' then 'Find on This Page' to locate quote]

The Dangers in Chiropractic

"We do not know if chiropractic is anything positive for our health and negative indicators are growing." Article by Howard Fienberg, STATS (Statistical Assessment Service — a non-profit, non-partisan organisation which monitors the media to expose the abuse of science and statistics before people are misled and public policy is distorted)

PBS Broadcast Angers Chiropractors

"Chiropractors almost never accept or react constructively to criticism. When specific wrongdoings are exposed, they typically claim that their critics are biased, the criticism is unbalanced, and that the medical profession does things that are much worse." Here, a well-reasoned criticism of chiropractic quackery triggers an angry response from the profession. (The response from the programme's producers is also included.) By Stephen Barrett, MD, National Council Against Health Fraud (NCAHF)

Watch the PBS broadcast (Scientific American Frontiers’ documentary called 'Adjusting the joints).  It features an ex-chiropractor, John Badanes, who challenges the claims of his former colleagues. (Scroll to 3rd link down)  Also available to view on YouTube here.

Read responses to some of the questions from viewers forwarded to John Badanes by the producers of A Different Way to Heal? after the show aired nationally in the United States in June of 2002.  [Background: John Badanes trained as a chiropractor at Life Chiropractic College West (LCCW) in San Lorenzo, California, and graduated summa cum laude in 1984. He is now committed to science-based intervention and has sharpened his criticism of the arbitrary diagnostic and therapeutic methods that proliferate within the chiropractic profession and characterise ‘alternative’ medicine.]

Does Chiropractic 'Add Years to Life'?

In a survey examining the longevity of chiropractors vs. general population vs. MDs the lifespans of chiropractors turned out to be the lowest of the three groups. Lon Morgan, DC, DABCO, Journal of the Canadian Chiropractic Association [PDF]

Bonesetting, Chiropractic and Cultism

A critical study of chiropractic (its history and methods) in its relationship with past and present-day medical science, along with analyses, conclusions, and speculation regarding its status and its future. Updated in 2000 with a postscript 'Chiropractic Today' which concludes "Patients seeking chiropractic manipulation for back pain will have to learn how to make an informed choice if they are to avoid inappropriate treatment by chiropractors". Book by Samuel Homola, DC (Chirobase)

NCAHF Position Paper on Chiropractic

"NCAHF believes that a health care delivery system as confused and poorly regulated as is chiropractic constitutes a major consumer health problem." The paper concludes with an extensive range of recommendations. (National Council Against Health Fraud)

Proliferation of Clinical Myths

" has [also] been shown that patients are very pleased and satisfied with chiropractic care whether they get better or not....Furthermore, it has been said that chiropractic's greatest contribution to health care has been the development of a solid doctor-patient relationship. So, let's not kid ourselves. It may not be what we say.....but simply the way in which we say it that stimulates some measurable change in patient's general health care status. Some studies support this view." Views of David Byfield, Susan King and Peter McCarthy, chiropractic staff members at the University of Glamorgan, UK.

Chiropractic; osteopathy; massage

Part of the “A Scientific Look at Alternative Medicine," course given by Thomas J. Wheeler, PhD, to students at the University of Louisville School of Medicine. Also includes a critical look at the anti-vaccination movement. [PDF]  Handout    Reading   [HTML] 

COMTA Guidelines

How to recognise safe and scientific manual therapy. Guidelines from the Canadian Orthopractic Manual Therapy Association