[BPSDB] What is chiropractic anyway? The Wiki page on Chiropractic is OK and gives details of the history, philosophy, regulation and effectiveness (or otherwise) of chiropractic. Highlights include these gems: “Although vaccination is one of the most cost-effective forms of prevention against infectious disease, it remains controversial within the chiropractic community. Most chiropractic writings on vaccination focus on its negative aspects, claiming that it is hazardous or ineffective. Evidence-based chiropractors have embraced vaccination, but a minority of the profession rejects it, as original chiropractic philosophy traces diseases to causes in the spine and states that diseases cannot be affected by vaccines” [This strikes me as being both dogmatic and dangerously wrong. Some chiropractors are against vaccination because it goes against original chiropractic philosophy? That sounds quite similar to the homeopathy religion if you ask me – if it’s in the Organon, it must be true. And being opposed to the prevention of dangerous diseases because you believe all disease stems from spinal problems is nothing if not dangerously wrong];
“Straight chiropractors adhere to the philosophical principles set forth by D. D. and B. J. Palmer, and retain metaphysical definitions and vitalistic qualities” [Metaphysical and vitalistic? Hang on – vitalism is the belief in a magic ‘vital force’, that life cannot be explained by chemistry and physics but that another mysterious force is at work. It’s a bit Star Wars isn’t it? Anyway, I like Crick on vitalism – “When facts come in the door, vitalism flies out of the window”. And ‘metaphysical’ seems to have come to mean Esoteric these days – “knowledge which is only available to a narrow circle of “enlightened” people”. Like the Akashic records or those magic crystal skulls, special knowledge that only shamen may ‘access’];
The Wikipedia page also contains some links on the evidence for chiropractic. I have to say, it doesn’t look good. I looked at some Cochrane reviews in a previous post and I’ll reproduce that section here, as it has links to the reviews: This review of 33 trials did not favour manipulation or mobilisation done alone or in combination with various other physical medicine agents. It was unclear if manipulation and mobilisation performed in combination were beneficial, but when compared to one another, neither was superior. [For mechanical neck disorders]
There was weak evidence to support the use of hypnosis, psychotherapy, acupuncture and chiropractic but it was provided in each case by single small trials, some of dubious methodological rigour. Robust randomised trials are required with efficacy, cost-effectiveness and adverse effects carefully monitored.
[For nocturnal enuresis in children. It says there was ‘weak evidence to support the use of chiropractic’ and this was the absolute best I could find on Cochrane for Chiropractic – doesn’t exactly fill you with confidence does it?]
Apart from the Cochrane reviews, there are also some reviews on Pubmed. I had a look at the first five papers that came up on a search of reviews and meta-analyses. A recent paper, Chiropractic treatment of upper extremity conditions: a systematic review, concluded that:
There is a small amount of chiropractic research into upper limb conditions that is comprised mostly of case studies (level 4 evidence) and a small number of higher-level publications (level 1-3 evidence). Most treatments are multimodal in nature, which address both spinal and peripheral structures, with joint and soft tissue methods. There is a need for future research to be directed at higher-level evidence, in particular, randomized controlled trials for the chiropractic treatment of upper limb conditions. [PMID: 18328941]
Another review, The use of expertise-based randomized controlled trials to assess spinal manipulation and acupuncture for low back pain: a systematic review, had the following in the results and conclusions sections:
Of 12 eligible trials, none made use of an expertise-based randomized trial design […] Investigators designing acupuncture or spinal manipulation trials in which 2 or more active therapies are compared should consider expertise-based randomization to increase the validity and feasibility of their efforts. [PMID:18404113]
Of the other three papers in the first five, none were reviewing the efficacy of chiropractic but were instead looking at guidelines for use of diagnostic imaging and which outcome assessments were used in chiropractic [J Manipulative Physiol Ther. 2008 Jun; 31(5):355-75. PMID: 18558278, J Manipulative Physiol Ther. 2008 Jan;31(1):33-88. PMID: 18308153, and J Manipulative Physiol Ther. 2008 Jan;31(1):2-32. Review. PMID: 18308152]. The sixth paper was Edzard Ernst’s review Chiropractic: a critical evaluation. He runs through the same topics as the Wikipedia page: the history; the concepts; chiropractic practice and research; and he also looks at the efficacy, safety, and cost of chiropractic. [PMID: 18280103] The abstract includes this:
Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today. Currently, there are two types of chiropractors: those religiously adhering to the gospel of its founding fathers and those open to change. The core concepts of chiropractic, subluxation and spinal manipulation, are not based on sound science. Back and neck pain are the domains of chiropractic but many chiropractors treat conditions other than musculoskeletal problems. With the possible exception of back pain, chiropractic spinal manipulation has not been shown to be effective for any medical condition. Manipulation is associated with frequent mild adverse effects and with serious complications of unknown incidence. Its cost-effectiveness has not been demonstrated beyond reasonable doubt. The concepts of chiropractic are not based on solid science and its therapeutic value has not been demonstrated beyond reasonable doubt.
OK, so far it looks like the evidence for chiropractic is, at best, pretty weak. No benefits, then. What about costs? £20 for an examination and £32 for treatment for an adult – that’s £52 I’ve just saved by not booking an appointment, but I think it’s a total of Eighty Four Pounds at this practice. Here, prices range from £40-60, but… “the initial consultation may be offered free of charge. (If so it may not include a full examination in which case there may be a charge for the examination)” – so the free consultation is only free because you then have to have a paid-for examination if you are still interested in chiropractic treatment. There doesn’t seem to be any point to me in trying chiropractic and I can think of, ooh, around eight four reasons not to – they all have a lovely engraving of the Queen on one side and they are called pound coins. But at least it’s not harmful, right? Well, uh – maybe it is. Because some chiropractors like to claim that diseases all originate from the spine [remember – original chiropractic philosophy traces diseases to causes in the spine and states that diseases cannot be affected by vaccines], patients may be led to believe chiropractic can help whatever condition they have – and fail to seek proper medical attention from an appropriate source. There are also risks in spinal manipulation, which you would hope practitioners and patients would both be fully aware of – but this hasn’t prevented harm coming to some people who have tried chiropractic. Cases relating to both these potential risks are documented on whatstheharm.net. So… chiropractic is useless, costly and potentially dangerous.
More links: Quacksafe search, Improbable Science, HolfordWatch, Dr* T’s blog, an older Dr* post, Bad Science has a couple of posts that refer to chiropractic – one including this little gem from 2004: “the World Chiropractic Alliance’s ‘guidelines for straight chiropractic’ leave little room for discussion: a practitioner’s clinical assessment is ‘inviolable’ and their judgment is ‘the final authority'”. Here’s a link to a PDF of a response to some legal threats from Chiropractors. Which has been picked up on by twonilblankblank. More links to coverage of the legal shenanigans can be found in my earlier post here: more legal chill. Edit: Coracle has also now posted a response to the daffy legal threats – Weak minded, superstitious and ignorant. There’s more on this from Norbury as well. The Quackometer blog has a more holistic post on Chiropractors here.
BPSDB [Heh – I hope I’ve spelt it correctly this time]