Why Chiropractic is Moot

There are a lot of alternative medicines out there.  Chiropractic is one of the most popular that people flock to, regardless of the fact that there is no supporting scientific evidence.  The reason I initially ventured into researching Chiropractic is simply because I wanted to know if it was reliable.  I thought that, like any other person, you would want to look into the credibility of a service before paying money to it.  Turns out I was wrong.  Millions of people give away money to a service which has absolutely no supporting evidence at all.  However, don’t let my opinion do the talking, I’ll share with you what brought me to this conclusion.

Origin of Chiropractic

Firstly, Chiropractic was founded by DD Palmer in the 1890’s.  DD Palmer was from Pickering, Ontario.  This may come to a surprise to many people, but DD Palmer claims that he was taught the ways of Chiropractic from a deceased doctor, Dr. Jim Atkinson, from the afterlife.  He claims that Dr. Jim Atkins is an intellectual spirit who taught him how to heal.  To further this, Palmer related the healing ability with hands to that of Christ.  This is where the word “Chiropractic” comes from.  The Greek letters X and P are, respectively, Chi and Rho.  This is Christ.  This is the symbol you commonly see in religious context to represent Christ.  Chiropractic literally translates to Christ-practice; practicing the art of Christ.

+ D.D. Palmer. (1914). The Chriopractor. Health Research Books.

– http://books.google.com/books?id=EmsyM–srdwC&q=religious#v=snippet

The Basics of Chiropractic

Further in time, Chiropractic received a lot of attention and a lot of efforts to support it’s science.  The crux of Chiropractic lays within two parties:

* Straights: Focusing on spinal adjustments and innate intelligence

Spine and Organ Associations

* Mixers: Focusing on integrating spinal adjustments with other mediums such as nutritional supplements, acupuncture, etc.

In both cases, the reasoning behind the effectiveness of spinal adjustments lays within subluxations or vertebral luxations.  In short, subluxations are the symptoms caused by mis-alignment in the spine.  Many Chiropractors will argue that a significant majority (DD Palamer quoted at 95%) of all biological pathology lays within the spine.  Even more, they argue that the remaining percentage is joint and limb mis-alignments.

That’s it.  Everything else is methods on re-aligning the spine.  Now, my question was, “Is there any evidence?”.  Of course, I’d like to know for certain that it has been proven effective before ever venturing to have someone manipulate my spine.  So, I looked into the scientific research.

The Evidence

Subluxations

The World Federation of Chiropractic defines subluxations as:

Chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on the subluxation. A subluxation is a complex of functional

and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health. A subluxation is evaluated, diagnosed, and managed through the use of chiropractic procedures based on the best available rational and empirical evidence.

http://books.google.com/books?id=x7hrs-7YJx0C

Considering the very nature of the definition, the most commonly held argument is that, if the center of attention is on neural integrity, we ought to be able to see the mis-alignments within x-rays.  However, this is not the case and you will find that Chiropractors will not dispute this.  This is a cause of alarm for credibility.  However, the nature of the rebuttal is that we cannot specifically see vulgar mis-alignments but more detailed and specific integrity issues within the spinal cord.  It’s very disconcerting that the definition has changed over time (the above definition being instated in 1996).  However, it creates the problem of proving the existence of subluxations.  There is no definitive evidence of subluxations.  Instead, there are alternative words like somatic dysfunction.  In a study by Brantingham, JW., they founded the term somatic dysfunction instead of subluxation as the term simply did not define the findings.  The purpose of a definition is to be globally acceptable, not selectively.  However, somatic dysfuntion suits the purpose of explaining why some neural problems can be identified, but not always specifically because of the spine.

http://www.ncbi.nlm.nih.gov/pubmed/3290374

With all this said, we can’t really make any definitive decision on whether or not subluxations really exist.  There are far too many edits made to it’s definition and the specifics are vague to the point of generalities.

Chart of Spinal Misalignments

Does it work..?

Even if we can’t define it’s crucial variables, perhaps we can prove that it still works.  For this, I looked at comparisons between Chiropractic and other forms of therapy.  The most commonly held comparisons is between Chiropractic, Physiotherapy, and exercise booklets.  I will try to focus on the central conclusions, but provide the sources to eliminate cause for edits.

For patients with low back pain … chiropractic manipulation had similar effects and costs, and patients receiving these treatments had only marginally better outcomes than those receiving the minimal intervention of an educational booklet. Whether the limited benefits of these treatments are worth the additional costs is open to question.

http://www.ncbi.nlm.nih.gov/pubmed/9761803

The effectiveness and total costs of chiropractic or physiotherapy as primary treatment were similar to reach the same result after treatment and after 6 months.

http://journals.lww.com/spinejournal/Abstract/1997/09150/Cost__and_Effectiveness_Analysis_of_Chiropractic.15.aspx

With this, the studies show that Chiropractic is no more effective than an exercise booklet.  The other problem is that most studies have inconclusive results due to possible bias.  Far too often people will vouch for Chiropractic or otherwise in favour of them.  Considering that there is no real definition of subluxations, there is not really a way of proving whether one is truly more effective than the other.  This is why the most popular for of evidence is testimony.

Testimonies

The most commonly thing said is, “I know lot’s of people who do it and it works for them.”  There’s a few problems with this:

Ad populum fallacy

It is illogical to believe something is true simply because many people believe it to be so.  We can easily go back to the times of antiquity and show how they believed that the Earth was the center of the universe.  However, in time, they were proven wrong.  All wrong.  But, you couldn’t convince anyone otherwise then!  It was the opinion of the majority, and this is a powerful thing.  However, it is not factual evidence.  You can also have a group of people believe that smoking was good for you.  In the past, people would advocate smoking as a form of release and catharsis.  It was good to smoke.  This too was proven wrong.  This reasoning comes from another fallacy within.

Post hoc, ergo propter hoc

“After this, therefore, because of this.”  This is the belief that, Y happened after X happened.  Therefore, X caused Y.  However, this is not true.  For example, say someone just moved into the house with you, renting the house.  Then, the next day, the house burns down when no one is home.  It is easily natural for people to be suspicious of the person moving in before considering the faulty furnace.  This is related to Chiropractic because people will believe (or convince) that they had a good feeling after leaving the Chiropractor.  However, that does not mean it was because of what they did.  There is no evidence to say it was not a placebo effect (your own volition).

Conclusion

At length, there is not enough support to justify Chiropractic to me.  I would need a specific, functioning definition to work by in its methodology.  A definition that can be proven and demonstrated is one that holds credibility and reliability.  However, using vagaries and changing your methodology only perpetuates it’s descent into pseudo-science, if not outright lie.  Not too forget that it’s roots are founded by an apparent intellectual being from the afterlife.  How can we prove such a thing in that case?!

I should also mention what it takes to become a Chiropractic.  You require a high school education, three years of university education (within a science), and then 2 years of Chiropractic schooling.  That is all.  You do not even need to finish University.  You can see for yourself, along with many other details, in the handbook for Chiropractors from the World Health Organization (WHO):

http://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf

What do you think…?
~

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10 thoughts on “Why Chiropractic is Moot

  1. “In the U.S., chiropractic is the largest alternative medical profession,[8] and is the third largest doctored profession, behind medicine and dentistry.[11] In the U.S., chiropractors perform over 90% of all manipulative treatments.[93] The percentage of the population that utilizes chiropractic care at any given time generally falls into a range from 6% to 12% in the U.S. and Canada,[13] with a global high of 20% in Alberta.[94] Chiropractors are the most common CAM providers for children and adolescents, who consume up to 14% of all visits to chiropractors.[95] The vast majority who seek chiropractic care do so for relief from back and neck pain and other neuromusculoskeletal complaints;[96] most do so specifically for low back pain. Practitioners such as chiropractors are often used as a complementary form of care to primary medical intervention.[13] Satisfaction rates are typically higher for chiropractic care compared to medical care, with a 1998 U.S. survey reporting 83% of respondents satisfied or very satisfied with their care; quality of communication seems to be a consistent predictor of patient satisfaction with chiropractors.[97]”

    Also: http://youtu.be/s68Yr38-lAQ

    And finally, here is some research done by objective third parties:

    Low back pain

    Low back pain is the most commonly treated condition in the chiropractic profession, accounting for over 65% of patient complaints. Numerous studies confirm that chiropractic care is an effective form of low back pain management.

    In 1995, a study published in the British Medical Journal compared the ongoing chiropractic and hospital outpatient management for over 700 patients with low back pain. After three years, those treated by a chiropractor showed an improvement rate nearly 30% higher than those treated in a hospital. Similarly, in 1993 the Government of Ontario commissioned a report into the safety and effectiveness of chiropractic treatment of lower back pain that concluded overwhelmingly in its favor. The following year, that report was endorsed by government-sponsored practice guidelines in the US and the UK.
    References:
    Journals

    Hurwitz, E., et al. “Use of chiropractic services from 1985 through 1991 in the United States and Canada.” American Journal of Public Health, Vol. 8 (1998): 771-776.

    Meade, T., et al. “Randomized comparison of chiropractic and hospital outpatient management for low back pain: results from extended follow up.” British Medical Journal, Vol. 311 (1995): 349-351.

    Manga, P., et al. “The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low Back Pain.” Ottawa, Ontario: Pran Manga and Associates, 1993.
    Books

    Chapman-Smith, D. The Chiropractic Profession. West Des Moines: NCMIC Group Inc., 2000.
    Neck pain

    In recent years, chiropractic treatment of the neck has received a lot of negative attention. However, in the past five years, three major studies have concluded that neck manipulation and mobilization are safe and effective methods of treatment for patients with neck pain. The “Quebec Task Force Report”, the “RAND Corporation Report” and the “Cochrane Collaboration Systematic Review” have all produced evidence that neck pain is more effectively managed by chiropractic manipulation than treatments commonly administered by medical professionals.
    References:

    Coulter, I., et al. “The appropriateness of manipulation and mobilization of the cervical spine.” Santa Monica, California: RAND, 1996.

    Aker, P., et al. “Conservative management of mechanical neck pain: systematic overview and meta-analysis.” British Medical Journal, Vol. 313 (1996): 1291-1296.

    Spitzer, W., et al. “Scientific monograph of the Quebec task force on whiplash-associated disorders: redefining whiplash and its management.” Spine, Vol. 20 (1995): 85.
    Headaches

    There are several types of headaches, including migraine, tension and cervicogenic (arising from the cervical spine). Numerous controlled trials now support the effectiveness of chiropractic treatment for all three. In a controlled trial conducted by Macquarie University in Australia, for example, 172 migraine sufferers were treated with spinal manipulation therapy (SMT) for a six-month period. Results showed that over 20% of participants reported a dramatic reduction in the number of migraines experienced after only two months of therapy. Likewise, the majority of participants reported a marked improvement in the severity of their migraine episodes.
    References:

    Bonello, R., et al. “A Randomized Controlled Trial of Chiropractic Spinal Manipulation Therapy for Migraine.” Proceedings of the 5th Biennial Congress of the World Federation of Chiropractic (1999): 183-184.

    Bronfort, G., et al. “The Efficacy of Spinal Manipulation, Amitriptyline and the Combination of Both Therapies for the Prophylaxis of Migraine Headache.” The Journal of Manipulative and Physiological Therapeutics, Vol. 21 (1998): 511-519.

    Christensen, H.W., et al. “The Effect of Spinal Manipulation in the Treatment of Cervicogenic Headache.” The Journal of Manipulative and Physiological Therapeutics, Vol. 20 (1997): 326-330.

    Boline, P., et al. “Spinal Manipulation vs Amitriptyline for the Treatment of Chronic Tension-Type Headaches.” The Journal of Manipulative and Physiological Therapeutics, Vol. 18 (1995): 148-154.

    Parker G.B., et al. “Why Does Migraine Improve during a Clinical Trial? Further Results from a Trial of Cervical Manipulation for Migraine.” Australian and New Zealand Journal of Medicine, Vol. 10 (1980): 192-198.

    Parker G., et al. “A Controlled Trial of Cervical Manipulation for Migraine.” Australian and New Zealand Journal of Medicine, Vol. 8 (1978): 589-593.
    Colic

    Studies suggest that infantile colic, a persistent crying in otherwise healthy babies, may be attributed to problems in the spine. In a study conducted in Denmark of 316 infants with both colic and some form of spinal disturbance (i.e. limited movement of the back), chiropractic treatment over the course of two weeks resulted in a 94% success rate. In 60% of the infants, the symptoms stopped completely; 34% of infants showed significant improvement. In a more recent study, researchers compared the treatment results of two groups of colicky babies, with one group being treated by spinal manipulation and the other by the drug dimethicone. Outcomes were measured in the number of hours the babies cried, as recorded in a diary. During trial days four to seven, babies being treated with spinal manipulation cried 1.4 hours less than those being treated by dimethicone. On days eight through 11, this number increased to 1.7 hours. The study concluded that spinal manipulation can be an effective treatment in relieving infantile colic.
    References:

    Wiberg, J.M.M., et al. “The Short-Term Effect of Spinal Manipulation in the Treatment of Infantile Colic: A Randomized Controlled Clinical Trial with a Blinded Observer.” Journal of Manipulative and Physiological Therapeutics, Vol. 22, No. 8 (1999).

    Klougar, N., et al. “Infantile Colic Treated by Chiropractors: A Prospective Study of 316 Cases.” Journal of Manipulative and Physiological Therapeutics, Vol. 12 (1989): 281-288.
    Asthma

    The 1979 New Zealand Commission of Inquiry into Chiropractic found that chiropractic treatment, paired with medical care, can be an effective way of managing asthma. The inquiry cites the case of a two-year-old asthmatic whose condition had not been improving under the care of a medical specialist. Upon examination by a chiropractor, it was suggested that the child may have fallen and injured his neck. The chiropractor adjusted the patient’s back and his symptoms diminished significantly. Since then, studies have shown mixed results in the effectiveness of chiropractic treatment in asthmatic children with some form of spinal dysfunction. While patients have reported relief from symptoms and decreased dependency on medication, rates of peak airflow have shown less improvement.
    References:

    Balon, J., et al. “A Comparision of Active and Simulated Chiropractic Manipulation as Adjunctive Treatment for Childhood Asthma.” New England Journal of Medicine, Vol. 339 (1998): 1013-1020.

    Bronfort, G. “Asthma and Chiropractic.” European Journal of Chiropractic, Vol. 44 (1996): 1-7.

    Hviid, C. “A Comparison of the Effect of Chiropractic Treatment on Respiratory Function in Patients with Respiratory Distress Symptoms and Patients without.” Bulletin of the European Chiropractic Union, Vol. 26 (1978): 17-34.
    Enuresis (bed-wetting)

    Twenty percent of children between the ages of four and five suffer from bed-wetting. While the causes are not entirely known, chiropractors have reported successful treatment in bed wetters with some form of spinal dysfunction. In an Australian study of 171 children between the ages of four and 15, chiropractic treatment alone was found to be more effective than psychotherapy, but less effective than dry bed training methods. Chiropractors believe that combining chiropractic care with other treatment methods, such as fluid restriction, would improve these results significantly.
    References:

    LeBoeuf-Yde, C., et al. “Chiropractic Care of Children with Nocturnal Enuresis: A Prospective Outcome Study.” The Journal of Manipulative and Physiological Therapeutics, Vol. 14 (1991): 110-115.
    Otitis media (middle ear infection)

    Otitis media (OM) is an inflammation of the middle ear caused by complications of colds, sore throats and sinusitis. While chiropractic treatment is not advised for the treatment of OM, in some cases it has been known to prevent chronic cases. A 1992 US study examined a two-year-old girl suffering from chronic OM in both ears, despite several routine treatments with antibiotics. After six months without results, her parents consulted a chiropractor. The first chiropractic examination found that the girl’s spine was out of alignment and after an initial treatment to restore the normal range of motion, there was a significant reduction in pain and ear discharge; further treatment brought total relief. Any recurrences over the next six months were alleviated after chiropractic care and today the girl is free of symptoms. The likely explanation for these results is that chiropractic manipulation restores motion in the spine, which alters the nervous system and therefore improves the drainage of the ear’s eustachian tubes. Further studies are now underway to determine whether medical treatment, chiropractic treatment or a combination of both is the most effective method of treatment for patients with OM.
    References:

    Fallon, J.M. “The Role of Chiropractic Adjustment in the Care and Treatment of 332 Children with Otitis Media.” Journal of Clinical Chiropractic Pediatrics, Vol. 2 (1997): 167-183.

    Froehle, R.M. “Ear Infection: A Retrospective Study Examining Improvement from Chiropractic Care and Analyzing for Influencing Factors.” Journal of Manipulative and Physiology Therapeutics, Vol. 19, No. 3 (March-April 1996): 169-177.

    Phillips, N.J. “Vertebral Subluxation and Otitis Media: A Case Study, Chiropractic.” Journal Chiropractic Research and Clinical Investigation, Vol. 8 (1992): 38-39.
    Pelvic disorders and dysmenorrhea (Painful Menstruation)

    In a study published in The Journal of Manipulative and Physiological Therapeutics, it was found that a variety of gynecological, sexual and bowel disorders may be successfully managed under chiropractic care. The most detailed report cited the case of a 41-year-old woman who had experienced several years of low back and pelvic disorders, including difficulty in urination. After chiropractic examination, it was determined that the woman had a disk herniation in the low back. Adjustment by a chiropractor brought relief from the pain and an end to her urinary problems. Likewise, a study done by the National College of Chiropractic found that chiropractic care has provided relief in patients suffering from dysmenorrhea (painful menstruation). Further research on this subject is underway.
    References:

    Browning, J.E. “Chiropractic Distractive Decompression in the Treatment of Pelvic Pain and Organic Dysfunction in Patients with Evidence of Lower Sacral Nerve Root Compression.” The Journal of Manipulative and Physiological Therapeutics, Vol. 11 (1998): 436-442.

    Kokjohn, K., et al. “The Effect of Spinal Manipulation on Pain and Prostaglandin Levels in Primary Dysmenorrhea.” The Journal of Manipulative and Physiological Therapeutics, Vol. 15 (1992): 279-285.
    Cost-effectiveness

    A 1997 study conducted by Miron Stano at Michigan’s Oakland University compared the costs of health care for patients of medicine and patients of chiropractic. By reviewing the insurance claims paid by patients, Stano found that those receiving chiropractic treatment, either by itself or with medical care, had health-care costs averaging $1,000 less than those receiving medical care alone. Furthermore, patients receiving only chiropractic care paid 30% less in total insurance costs than those under the care of a medical doctor. Similarly, numerous studies show that patients with low back pain who are treated by a chiropractor often avoid thousands of dollars in medical expenses, such as surgery and medication.
    References:
    Journals

    Smith, M. and M. Stano. “Costs and Recurrences of Chiropractic and Medical Episodes of Low-Back Care.” The Journal of Manipulative and Physiological Therapeutics, Vol. 20, No. 1 (1997): 5-12.
    Books

    Chapman-Smith, D. The Chiropractic Profession. West Des Moines: NCMIC Group Inc., 2000.
    Patient Satisfaction

    A 1989 survey conducted by Dr. Daniel Cherkin and Dr. Frederick MacCornack found that patients receiving care from health maintenance organizations (HMOs) in the state of Washington were three times as likely to report satisfaction with chiropractic care than they were from other health-care providers. Early in the 1990s, a similar study conducted by the Gallup Organization found that 90% of chiropractic patients felt their care was effective. Over 80% were satisfied with their care, and close to 75% felt that their expectations had been met.
    References:

    Cherkin, D.C. and F.A. MacCornack. “Patient Evaluations of Low Back Pain from Family Physicians and Chiropractors.” Western Journal of Medicine, Vol. 151, No. 1 (July 1989): 83-84.

  2. Firstly, we must sift through the reliable sources you are citing. We cannot truly accept evidence with an obvious bias. You say you are citing objective third parties, but then you cite several journals which are funded by chiropractic organizations. If the very foundation of those funding the research depends on the truth of their results, the bias is blatantly obvious to the point of vulgarity. There is in no possible way that any responsible academic or intellectual person would accept evidence or support in such a position.

    Secondly, we also cannot accept evidence that utilizes fallacies. While it is nice to know that a study shows that people are satisfied with the results of a service, this does not negate the possibility of placebo or bias. Testimonies are not evidence. Opinions are not evidence.

    I will now review your citations consecutively:

    Your first reference points to chiropractic vs hospital care. However, you will find that I have cited evidence showing that chiropractic care is no more effective than a home pamphlet outlining physical activities. Furthermore, it is also not significantly more effective than physiotherapy.

    While I may agree that hospital care is not effective for lower back pain, I don’t agree that chiropractic care is more effective than physiotherapy.

    Your references for neck pain is easily nullified by their own journals. I found contrary evidence to your citations by your very own referenced journals in more recent entries. When it comes to neck pain, it is clearly an issue and evident. Here I quote science direct and, as you did, Spine. While you may report that neck pains are manageable, I contend that it is the case that the evidence shows a more diligent guide to avoiding the adverse effects produced by the service rather than rectifying original symptoms.
    + http://www.sciencedirect.com/science/article/pii/S0161475403001817
    + http://journals.lww.com/spinejournal/Abstract/1997/02150/Frequency_and_Characteristics_of_Side_Effects_of.17.aspx

    Your headaches section is almost entirely cited by blatantly bias sources, contrary to you saying that they are objective third parties. They are beyond unacceptable.

    However, your citations of the Australian and New Zealand Journal of Medicine is reliable. The problem is that they are old. More recent studies show that what you are claiming is unfounded and needs more research. There is no clear evidence supporting that chiropractic remedies headaches:
    + http://onlinelibrary.wiley.com/doi/10.1046/j.1468-2982.2002.00423.x/full
    + http://www.ncbi.nlm.nih.gov/pubmed/8775024

    Both your references for colic efficacy is clearly bias again. I would supply contrary substantial evidence, but you have yet to present any that deserves it.

    You reference, again, two bias sources for asthma. However, one reliable one. Even worse, the article you cited by the reliable source (New England Journal of Medicine) actually states that chiropractic has, “…no benefit”
    + http://www.nejm.org/doi/full/10.1056/NEJM199810083391501

    Your bed-wetting reference is bias and once you provide reliable evidence, I will consider it.

    This is the same for otitis.

    And painful mesntruation.

    And cost effectiveness. Also, note that I provided reliable evidence above that shows that the cost-effectiveness is actually the worst when considering chiropractic.

    Finally, your patient satisfaction reference is reliable, however fallible. Testimonies are not a form of evidence. Furthermore, there is more recent evidence clearly demonstrating that patient satisfaction of chiropractic is a subjective matter:
    + http://www.sciencedirect.com/science/article/pii/S0167487097000147

    I find it grossly disrespectful that you state you are providing objective third-party evidence and then consistently provide references to the same bias source.

    In addition, your one source you cited to support chiropractic was actually contrary to what you were saying. You misrepresented the citation and presented intellectual dishonesty.

    I am curious if you can come back with more substantial and honest citations.
    ~

  3. I want to note now that I have posted twice on CircleChiro’s website with civil discussion and they have deleted both. I am a bit disappointed that they are not continuing the discussion as they gave an initial respective standpoint; one that was willing to discuss things, not preach.
    ~

  4. Its such as you learn my mind! You seem to understand a lot about this, such as you wrote the e-book in it or something. I feel that you just could do with some p.c. to power the message home a little bit, but instead of that, this is wonderful blog. A great read. I will definitely be back.

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