Issues Magazine

“Rational Investigation” and Chiropractic

By Dennis Richards

The Chiropractors’ Association of Australia rejects the SA Skeptics’ view of chiropractic.

Chiropractic has more than a 100-year record of helping people around the world with health problems. It is recognised by government legislation in numerous countries, including all Australian states and territories, and its practitioners are educated in three government universities in Australia. It is interesting that the Skeptics Association of South Australia (Skeptics SA), which claims to investigate pseudoscience and the paranormal from a responsible scientific viewpoint, has criticised such a profession.

History of Chiropractic

Skeptics SA claims that D.D. Palmer, the founder of chiropractic, “had no medical training”. Whether or not Palmer had medical training is irrelevant because he did not practise medicine. It is clear from Palmer’s second book (The Chiropractor’s Adjustor, 1910) that he had broad and detailed knowledge of clinical sciences relevant to his area of interest.

The statement, “Palmer believed that the body requires an unobstructed flow through the nervous system of an ethereal substance called Innate Intelligence” is not substantiated by Skeptics SA. We are not aware of Palmer describing innate intelligence as a substance, ethereal or otherwise. He made it clear that the principles of chiropractic, such as universal and innate intelligence, came from the ancient Greeks. These philosophical tenets played a significant role in Hellenic thought from Pythagoras through Aristotle, and were most fully embodied in the thought of Plato. What is the Skeptics’ evidence for the claim that Palmer described it as a substance?

Skeptics SA paints an extremely uninformed picture of modern chiropractic practice. This is primarily done by using a grossly misinformed view of the “history” of the profession as the basis for its portrayal of chiropractic practice today.

It is true that a conflict did exist between the newly established chiropractic profession and medicine, a conflict that many argue lasted for 75 years. However, it is important to understand the environment in which the profession operated during its inception, something the Skeptics SA article fails to do.

David Chapman Smith, in The Chiropractic Profession (2000, pp.12–13), provides an overview of the early conflict between chiropractic and the medical profession:

Frankly speaking, both medicine and chiropractic set themselves up for a fight – and history suggests it benefited them both. Chiropractors claimed to have an alternative and superior fundamental approach to health. Medical doctors, they charged, merely treated symptoms with the remedy of the day. Chiropractors understood the real cause of most ill health – malpositioned spinal vertebrae interfering with the nervous system and thereby obstructing the body’s own natural innate healing power. Patients should abandon drugs, surgery, and medical doctors and get all of their primary health care from chiropractors. Medical doctors, in their turn, needed targets to build their credibility, unity and the economic and political control of health care in the early twentieth century.

The 1970s were indeed a time of change for the chiropractic profession. However, the reasons provided by Skeptics SA for chiropractic’s increasing acceptance into mainstream health care are unsubstantiated and grossly incorrect. Simply claiming that chiropractic joined a “chorus of criticism” and conveniently abandoned its heritage to appeal to a “receptive audience” ignores the significant reform and maturity achieved by the profession.

By the late 1970s, many signs of maturity and imminent change were evident in the chiropractic profession:

  • 1974: The US government formally recognised the Council on Chiropractic Education (CCE) as the accrediting agency for chiropractic educational institutions.
  • 1975: Chiropractic researchers were invited to the first US federally funded research conference on chiropractic and spinal manipulation.
  • 1979: The first major interdisciplinary text with chiropractic and medical authors was released.
  • 1979: The first peer-reviewed chiropractic journal, the Journal of Manipulative and Physiological Therapeutics, began publication.
  • 1977 (Australia) and 1979 (New Zealand): The first comprehensive government commissions of inquiry into chiropractic delivered independent findings strongly supportive of the contemporary chiropractic profession, and calling for close cooperation between chiropractic and medicine in education and practice in the public interest.

“Us Versus Them” Mentality

Reference by Skeptics SA to an “us vs them” mentality against orthodox medicine implies that this mindset is in full existence today throughout all circles of health care. Such a statement ignores the advancements made by the chiropractic and medical professions in developing common ground and building mutually beneficial relationships over time.

A mainstream proliferation of such a mentality would not have resulted in an expansion of Medicare’s Enhanced Primary Care program (EPC) in Australia in 2004. Since its expansion in 2004, EPC has provided general practitioners, other referrers and patients with an increased level of choice and access to chiropractic care at affordable prices.

As outlined in a 2008 article by John Kron in the Journal of Complementary Medicine, this increased level of access is “reflected in the substantial growth in the number of chiropractic and osteopathy EPC items, at around 80% a year”. This increase outpaced other allied health professional and general practitioner items. It is vitally important to note that patients under the EPC must receive a referral from a general practitioner. The fact that chiropractic EPC referrals are growing at a substantial rate demonstrates the healthy modern relationship between chiropractic and orthodox medicine.

According to the most recent National Health Survey by the Australian Bureau of Statistics (2006), over 215,000 Australians visit a chiropractor each week. Today, chiropractic receives wide public acceptance and is considered a part of mainstream health care. Further, an international study by John Astin, published in the Journal of the American Medical Association in 1998, confirmed that chiropractic patients generally use both chiropractic and medical services and want cooperation between their chosen health providers.

Education and the Content and Character of Chiropractic

Through their extensive 5-year university training, chiropractors are uniquely positioned to help patients lead healthy lifestyles using drug-free preventative care. Developments in chiropractic education have enabled chiropractors to deliver the highest levels of care to patients. Chiropractors, through their extensive university training, are equipped to provide their patients with an extremely versatile form of care that calls on a variety of disciplines.

These courses are of similar length and depth as medical courses, but focus on promoting healthier lifestyles via better body function rather than on drugs and surgery. Accordingly, chiropractic education involves a special emphasis on anatomy, physiology, pathology, neurology, biomechanics, X-ray, spinal adjustment techniques and related subjects.

This demanding curriculum enables chiropractors to care for people with a range of health conditions, and to help individuals on the path to overall wellness. The diverse skill sets obtained by chiropractors result in increased choice for the patient – if a patient prefers to utilise a chiropractor solely for back pain they can exercise this right. Alternatively, should a patient wish to visit a chiropractor for wellness care, this option is also available to them. It remains to be seen how advancements to chiropractic education, which have subsequently resulted in increased patient choice and levels of care, call the content and character of the profession into question.

Claims About the Superiority of Specific Chiropractic Manipulation

The Skeptics SA article voices an opinion about claims made about specific chiropractic manipulations, and states: “at present, such claims are unproven”. This unsubstantiated opinion is made despite claiming to have relied upon “available evidence” regarding specific chiropractic manipulations. A small look at some of the available information on chiropractic manipulation shows the following evidence:

  • For acute and chronic pain, patients with chronic lower-back pain treated by chiropractors showed greater improvement and satisfaction at 1 month than patients treated by family physicians, according to Joanne Nyiendo and colleagues (Journal of Manipulative and Physiological Therapeutics, 2000).
  • Mitchell Haas and others found that, in comparison with other treatment alternatives, acute and chronic chiropractic patients experienced better outcomes in pain, functional disability and patient satisfaction, and clinically important differences in pain and disability improvement were found for chronic patients (Journal of Manipulative and Physiological Therapeutics, 2005).
  • Cervical spine manipulation was found by Jesper Wiberg and colleagues to be associated with significant improvement in headache outcomes in trials involving patients with neck pain and/or neck dysfunction and headache (Journal of Manipulative and Physiological Therapeutics, 1999).

Chiropractic Science and Research

According to the Skeptics SA article:

Instead they examined and treated patients and argued, as many still do today, that the results of their clinical treatments constituted scientific proof.

In modern chiropractic practice, chiropractors are not required to attempt to justify the effectiveness of their care through individual clinical treatments. A vast array of literature exists supporting the effectiveness of chiropractic care, particularly for the treatment of lower back pain, neck pain and headaches.

Secondly, there is insufficient evidence to support the claim that chiropractic is useful in the management of “visceral conditions”.

It is incorrect to portray the chiropractic profession on the whole as advocating an all-encompassing form of care. The chiropractic profession does not assert that its treatment is effective for visceral conditions. Whatever the patient’s condition, chiropractors fundamentally see themselves as diagnosing and caring for dysfunctions in the neuromusculoskeletal system, including the spine and joints. In doing so, this could potentially have corresponding effects in the nervous system that may impact on the patient’s general health and well-being. These outcomes may be experienced in addition to the patient’s primary complaint or reason for consultation.

Illustrating this, a 1999 study by Jesper Wiberg and colleagues in the Journal of Manipulative and Physiological Therapeutics showed that spinal manipulation has a positive effect on infantile colic. However, only babies with evidence of spinal joint restriction were accepted. Babies medically diagnosed with infantile colic were not. The underlying point to consider is that the patients cared for received treatment adhering to chiropractic’s fundamental approach: the diagnosis and treatment for underlying joint and soft tissue dysfunction.

Skeptics SA refers to “a number of scientific reviews that have included an assessment of the evidence for and against chiropractic”. They state that they have reviewed these, draw certain conclusions and make recommendations regarding chiropractic and chiropractors. To judge the credibility and validity of these reviews conclusions and recommendations, it would be necessary to know the:

  • identity of those conducting the reviews;
  • reviewers’ relevant qualifications and experience;
  • review methods used; and
  • exact documents reviewed.

None of this information is available. In fact, the vast majority of claims made against chiropractic in the Skeptics SA article are unsubstantiated, unreferenced or simply incorrect. As a result, it is not possible to assess the credibility and validity of the claims made against chiropractic.