Chiroquackery?

One of my martial arts instructors is an addict. Not to drugs, alcohol or even gambling mind you, he's addicted to chiropractic therapy. This has brought back memories of my college days when my running partner (we were training for the marathon) was trying to convince my to quit college, get certified and join his chiropractic practice. He was doing about $250K annually by himself (this was in 1980 mind you) and he wanted to expand this growing business.

Whatever else it may be, chiropractic has become big business. How big is hard to say, because no one seems to keep accurate statistics, but a 1998 survey gives us some indication. At that time, about 11% of the American population were making some 192 million visits to a chiropractor during the course of the year. Today, there are over 60,000 licensed chiropractors in the country. Dozens of hospitals have on-site chiropractic departments. Over 75% of private medical plans and more than half of all HMOs offer chiropractic coverage.

This evidence of chiropractic's stunning popularity might lead one to believe that it has become a recognized part of the medical mainstream. Yet it hasn't. It continues to struggle for an acceptance it has sought for over a hundred years.

Spinal manipulative therapy (SMT), practiced today by medical specialists known as physiatrists, has been employed for millennia in the treatment of human ills. Manipulations seem to be going on in cave paintings in southern France that date back to 17,500 B.C. Hippocrates himself was a believer, counseling his followers in about 400 B.C. to "Get knowledge of the spine, for this is the requisite for many diseases."

Modern chiropractic, though, originated with Daniel David Palmer, a transplanted Canadian businessman who settled in Iowa in 1880. Palmer, a layman self-educated in all things medical, had long been fascinated with phrenology, spiritualism, and alternative therapies such as magnetic healing, osteopathy, and vertebral manipulation. After studying them for years, he concluded that he could synthesize everything into a single, unified model of human health.
95% of all disease, Palmer taught, was caused by spinal "subluxations" (partial dislocations of the bones) and the other 5% by "luxated bones elsewhere in the body." He theorized that these subluxations impinged upon spinal nerves, causing them to function improperly, and that this led to all known ailments. Thus he disdained traditional medicine--dismissing it as too symptom-focused--and had no use for drugs or surgery. Instead, he proposed realignment of the spine as the engine of recovery. Simply freeing up the body's own natural healing forces, he said, was all that need be done to restore full health to anyone.

Palmer's own conception of what he accomplished is even more grandiose: "I created the art of adjusting vertebrae, using the spinous and transverse processes as levers, and named the mental act of accumulating knowledge, the cumulative function, corresponding to the physical vegetative function--growth of intellectual and physical, together, with the science, art and philosophy--Chiropractic. . . It was I who combined the science and art and developed the principles thereof. I have answered the question--what is life?" No shrinking violet, he.

Trouble is, no such single-source theory has ever been shown to have a validity that would stand up to even the most basic scrutiny. There is no way to demonstrate the "nerve flow" whose impingement Palmer placed at the center of his belief system. Worse yet, when Dr. Edmund Crelin, a Yale University anatomist, subjected the spines of young and adult cadavers to pressure from a drill press in order to displace the bones, he was unable to force any interference with the spinal nervous system at all, short of producing what would be a completely disabling injury in a live person. Those vital nerves are very well protected.

As for the supposed subluxations, several studies have shown that they can be damnably difficult to find. James Deely, health insurance director of the National Association of Letter Carriers, made the point in an address to the organization's national convention in 1996: "At our invitation, representatives of both ACA [American Chiropractic Assn.] and ICA [International Chiropractors Assn.] met in our office with one of the most reputable radiologists in the area, whom we had engaged on a temporary consultant basis. Our doctor (medical) presented 20 sets of X-rays that had been submitted by chiropractors. Each film was purported to show a subluxation; in several instances, four to six subluxations had been diagnosed in a single X-ray.

One after another, each film was placed in the view box. The chiropractic representatives, including a radiologist of their own selection, were invited to point out the subluxations. Not a single one was identified." Chiropractors often respond to experimental failures like this by saying that their detection of subluxations is "subjective."

In fairness, many present-day chiropractors--such as those belonging to the reform group, National Association for Chiropractic Medicine--have disavowed Palmer's original theories, and practice only SMT work, the treatment of back and neck problems, an area in which they have occasional success, or at least do no harm.

Which is not to say that chiropractic is entirely risk-free. A coroner's jury in Ontario in 1996 was convinced that a neck adjustment was the cause of a woman's death from stroke six days later, and in their verdict the jurors recommended passage of legislation requiring that all chiropractic patients "be provided with an information sheet outlining the possible risk of stroke and/or injury."

Few incidences of injury or death that might be attributed to chiropractic treatment are reported in a given year, thus any individual's chances of a profoundly negative outcome are likely to be small. Yet anyone considering this course of action should, in our opinion, take a few simple precautions:

Have your primary care physician first rule out serious underlying illness, and keep your doctor informed of what you're doing; do not submit to long-term care, discontinue treatment if you don't experience significant relief within a couple of weeks; have any recommended X-rays done by a trained radiologist, not the chiropractor; recognize that the full-spine X-rays routinely ordered by chiropractors involve significant doses of radiation that can pose their own health risks; avoid chiropractors who purport to be able to cure a wide range of illnesses, who seem cultist in manner, or who prescribe herbs and dietary supplements that they themselves sell; and remember that chiropractic treatment is not appropriate for children.

Someday, perhaps, there will be a true science of spinal manipulation. Just not today.