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Who has the backbone to stop this?

August 26, 2012

Australia has an excellent health system. Yes, many improvements could be made, but generally the mixture of public and private provision of health delivery and insurance together with regulatory oversight works to provide one of the best, if not the best, health care system in the world.

Alongside this system is a parallel system of "medicine", where science might receive lip service but superstition, tradition and faith provide the supposed evidence of efficacy and safety. This sector used to be called "Alternative Medicine" but now prefers to be referred to as "Complementary" in the hope that it can be seen as an adjunct to real, scientifically-based medicine.

In the grey area between these two forms of medicine sits Chiropractic.

There is a popular misconception that chiropractors are some sort of back pain specialists. If a chiropractor confines himself to treating lower back pain by massage and manipulation then he is not really doing chiropractic, he is doing physical therapy. The fundamental principle of chiropractic is that all dis-ease (note the hyphen) is the result of subluxations of the spine causing pressure on nerves and therefore inhibiting the transmission of the signals which allow the innate intelligence of the body to heal itself. Everything is caused by subluxations (which chiropractors have trouble reliably identifying on x-rays) and everything can be fixed by removing these annoying misalignments. Chiropractic rejects the "germ theory" of disease, preferring to see microorganisms as just inconvenient nuisances or perhaps even opportunistic scavengers that come along after disease is established.

Chiropractic was "discovered" by Daniel Palmer in 1895 when he cured someone's deafness by pressing on a bulge on the person's back. (Anatomists will say that the nerves between the ear and the brain don't go through the spine.) Palmer's son saw the commercial potential of chiropractic as well as training schools and colleges, and there is a thriving industry today teaching chiropractors how to attract and keep patients. Attempts to reform the profession and place it on a scientific basis have been strongly resisted, and chiropractors in the USA who have broken ranks have been subject to much vilification and abuse.

Examples of the promotion of inappropriate uses of chiropractic are easy to find. Almost any magazine aimed at new parents will contain advertisements for chiropractors who claim to treat autism, bed wetting, asthma, ADHD and colic. One highly promoted chiropractic treatment for children is for the ear inflammation otitis media. Not only are there no nerves passing from the spine to the ear, but the procedure exposes children to risk from sudden stress on the spine, particularly the neck.

One aspect of chiropractic which is often overlooked its declared opposition to vaccination. If everything is caused by vertebral subluxations then vaccination is unnecessary, but the opposition goes beyond that to claims that vaccination is harmful. At a recent trade fair in Sydney aimed at parents of young children a professional association of chiropractors was distributing brochures which contained serious misinformation about vaccines. In an extreme case, at the 2000 national conference of the Pediatrics Council of the US International Chiropractors' Association an award of Hero of Chiropractic was made to a man who was in prison for the murder of a ten-week old child. The award recognised that the killer was just as much a victim as the dead child, because a vaccine had really caused the intracranial bleeding and the broken ribs, not Shaken Baby Syndrome.

Outside of journals run by and for chiropractors there is little reliable and valid evidence that chiropractic is useful to treat any medical condition other than some forms of back pain. There is no scientific plausibility to the hypothesis that subluxations of the spine impair nerve function (except in the grossest cases, where the spinal damage far exceeds any definition of subluxation) or that this impairment affects the operation of the body's immune system. There are direct dangers from chiropractic treatments, particularly neck manipulation where there is a risk of stroke from sudden movement, and there is the indirect danger that people with serious illnesses will use chiropractors as primary care physicians (a term that chiropractors regularly attempt to appropriate) and consequently avoid medical treatment.

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 which are not plausibly amenable to spinal manipulation, such as autism and ADHD
  • Prohibit chiropractors from treating young children for any reason

(This article was published as the Naked Skeptic column in the November 2010 edition of Australasian Science)

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