The Truth About Chiropractic

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

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

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

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

The only true cure

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

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

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

Not supported

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

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

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

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