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"…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.

 

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“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)

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“…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)

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“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, Pain Science (1st July 2014)

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“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)

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“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)

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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)

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"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)

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“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)

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A March 2009 TV interview with New Zealand medical researcher, Dr Shaun Holt, regarding the small evidence base for chiropractic and its risks.  The following day, chiropractor Doug Blackbourn, defended the chiropractic profession against Dr Holt’s criticisms. (Note: Doug Blackbourn has previously been before a disciplinary panel for advising a patient she would need 100 treatments and taking payment for them in advance.)

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“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)

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“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)

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“…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’.

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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

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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)

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“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]

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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).”

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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.

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“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)
 

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“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)