There’s a perpetual problem when discussing chiropractic: It’s difficult to fully differentiate between the charlatans and the real physicians. If someone complains about the Palmerist* loons, someone else comes in to defend the genuine chiropractors because they helped his chronic back pain. That defense then benefits the Palmerist frauds, simply because both the real doctors and the phonies are called chiropractors.
So, what can the legitimate chiropractors do to prevent themselves from being lumped in with the Palmerist charlatans? Is there any legal way they can say “We’re the real chiropractors, we have the valid degrees, and we are being materially damaged by association with known frauds”?
*(Palmerism is the correct term for what Palmer was selling. ‘Chiropractic’ has come to mean a legitimate field that can be studied and improved just like cardiology and podiatry, regardless of its early history.)
Why are chiropractors necessary at all? You don’t need a special field of medicine to address manipulation of the spine, because real doctors already specialize in fields like spinal medicine and physical therapy.
Chiropractors are exactly as legitimate as acupuncturists. Both practices are based on theoretical foundations that are provably false, but some people say they make them feel better. That’s fine, but there’s no way to bring these practices into line with real medicine based on real knowledge.
Except why then do specialists in spinal medicine and physical therapy seem unable to address problems that chiropractors can? Years ago my wife was in a car crash that left her with severe pain from a neck injury. After a couple of years of revolving door treatment, the conventional doctors told her that she had a permanent injury that would never get better, and she would have to go on a pain-managment regimen. My wife then went to a chiropractor who adjusted her cervical vertebrae with an audible crack, and then she was fine.
Chiropractors are experts in spinal manipulation. When the problem is one that can actually be solved by spinal manipulation, they are useful. The Palmerists simply believed that everything could be solved by spinal manipulation.
This seems sort of a response to Cecil’s Column: Is chiropractic for real or just quackery?, so it might arguably be moved to the forum for Comments on Cecil’s Column, but since this seems to be a separate discussion, I’m going to leave it here.
Studies have found that sticking needles in at random points has exactly the same effect as “proper” accupuncture. So it’s entirely possible that any effects detected during a trial might simply be down to placebo.
IIRC, the placebo effect was taken into account for these studies, and acupuncture performed better than placebo for long-term relief.
Interestingly, the same positive result was not demonstrated for other modalities, including physical therapy, chiropracty, medications, bedrest, or exercises.
Acupuncture used to be pretty widely derided, but then it was found to be effective in some cases, and now it’s becoming more widely accepted. That’s the path that legitimate chiropractors are going to have to take–show that what they do works, let the medical establishment know about it, and they’ll start to be accepted.
The term “reform chiropractic” might sound like a misnomer, but there are actually chiropractors (in the minority, unfortunately) who stick to musculoskeletal conditions for which there’s evidence they can be helpful, and reject the “subluxation-causes-all-ills” nonsense that afflicts they rest of their profession.
Unfortunately, there’s a lot of competition for the patients with back and joint pain, including physical therapists, massage specialists and orthopedic physicians, many of whom can do an equally good or better job, and so there doesn’t seem to be enough well-paying work for all the chiropractors out there.
New chiropractors typically come out of school with substantial debt, so there’s temptation to promote the same sort of expensive gadgetry and nonsensical treatments for non-musculoskeletal conditions that have given chiropractic its dubious reputation.
When the evidence-based chiros become influential and respected enough to help weed out those practitioners who go around “adjusting” newborn infants and treating infectious diseases, chiropractic will finally overcome its quackery-laden heritage.
I just don’t see that happening anytime soon. Even the reformers (a couple of whom used to contribute regularly to a health fraud e-mail list I’m on) tend to have a circle-the-wagons mentality when their profession is cricitized, and it’s difficult to be heard when your major professional organizations like the American Chiropractic Association put out alerts advising chiros how to sucessfully bill Medicare for fixing “subluxations” (and other groups like the World Chiropractic Association are far deeper into bizarro-land).
I tell everyone I can who inquires about Chiropractors (and have done so at least three times on this board in the past) that if they see or hear the word “subluxation” anywhere in the office or ads, run like hell.
What else are all those Sports Medicine graduates supposed to do with their time?
When I drive around and see all of the chiropractor offices around, it’s just amazing that there are so many of them. The ones I pass by most frequently are usually ghost towns, with very little business. No small surprise that the less ethical ones resort to quackery to increase their revenue stream.
Or when the Medical Profession in general steps up and get the Feds involved, there just might be some legal reforms. If the FDA or equivalent Federal Agency were to investigate “subluxation” and rule it quackery, followed by the FDA barring any use of the word and idea by medical practitioners, then we might see a bit of an exodus from the field as all the pure quacks were busted out.
Fighting quackery has not been as big a priority as it should be for major medical organizations. But in the case of chiropractic, there’s also legal precedent that makes it risky to wage a comprehensive battle. In the Wilk decision, the A.M.A. lost in its efforts to prohibit chiropractors from gaining access to mainstream medical affiliations and facilities:
“In 1987, federal court judge Susan Getzendanner concluded that during the 1960s “there was a lot of material available to the AMA Committee on Quackery that supported its belief that all chiropractic was unscientific and deleterious.” The judge also noted that chiropractors still took too many x-rays. However, she ruled that the AMA had engaged in an illegal boycott. She concluded that the dominant reason for the AMA’s antichiropractic campaign was the belief that chiropractic was not in the best interest of patients. But she ruled that this did not justify attempting to contain and eliminate an entire licensed profession without first demonstrating that a less restrictive campaign could not succeed in protecting the public.”
Chiropractors have trumpeted this decision as vindicating their profession, but it was actually not a referendum on chiropractic itself.
Still, physicians are wary of more legal action, plus a minority have concluded that it makes business sense to associate with chiros (one would hope that this excludes the quacky aspects, but that doesn’t seem to always be the case). Chiros are politically well entrenched and have allies in government, so antiquackery actions (even assuming the FDA had enough money and authority to take on all of the subluxation-associated weirdness) are a difficult proposition.
Public education, efforts to target the sleaziest practices and action at the statewide level (for instance, to mandate better disclosure to patients of the risks of permanent neurologic damage in the case of high neck manipulation or to ban the practice altogether) are the best bet at this point.
