Chiropractic Controversy and Criticism - Efficacy

Efficacy

Not all criticism originated from critics in the medical profession. Some chiropractors are cautiously calling for reform. Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs antiscientific reasoning and unsubstantiated claims, that are ethically suspect when they let practitioners maintain their beliefs to patients' detriment. Samuel Homola writes that the bottom line is "A good chiropractor can do a lot to help you when you have mechanical-type back pain and other musculoskeletal problems. But until the chiropractic profession cleans up its act, and its colleges uniformly graduate properly limited chiropractors who specialize in neuromusculoskeletal problems, you'll have to exercise caution and informed judgment when seeking chiropractic care."

Vertebral subluxation, the core concept of chiropractic, is not based on solid science. A 2010 review found that manual therapies commonly used by chiropractors are effective for the treatment of low back pain, neck pain, some kinds of headaches and a number of extremity joint conditions. A 2008 review found that with the possible exception of back pain, chiropractic manipulation has not been shown to be effective for any medical condition. The concept of subluxation remains unsubstantiated and largely untested, and has been debated about whether to keep it in the chiropractic paradigm for decades. The dogma of subluxation is the biggest single barrier to professional development for chiropractors. Vertebral subluxation skews the practice of legitimacy in ways that bring ridicule from the scientific community and uncertainty among the general public. Commitment to the subluxation dogma undermines the desire for scientific investigation of subluxation as hypothesis, and further perpetuates a cycle of a marketing tradition, inevitably bringing charges of quackery. The cost, effectiveness, and safety, of spinal manipulation are uncertain. Edzard Ernst stated "the best evidence available to date fails to demonstrate clinically relevant benefits of chiropractic for paediatric patients, and some evidence even suggests that chiropractors can cause serious harm to children". A 2007 survey of Alberta chiropractors found that they do not consistently apply research in practice, which may have resulted from a lack of research education and skills though the chiropractic profession has research-focused professional training encouraged by professional association incentives which provide time and support for research. According to David Colquhoun, chiropractic is no more effective than conventional treatment at its best, and has a disadvantage of being "surrounded by gobbledygook about 'subluxations'", and, more seriously, it does kill patients occasionally. He states that chiropractic manipulation is the number one cause of stroke under the age of 45. Neck spinal manipulation has a risk of stroke or death. Although rare, spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death; these can occur in adults and children. Most of the adverse events were benign, however, there are complications that were life threatening. A 2010 systematic review found that numerous deaths since 1934 have been recorded after chiropractic neck manipulation typically associated with vertebral artery dissection. Some chiropractic proponents seem to think that a critical evaluation of the research is tantamount to a 'scare story' or to 'puffing up (the evidence) out of all proportion'. A reasonable approach to serious risk from chiropractic therapy, however, requires an open examination.

The 2008 book Trick or Treatment states that "chiropractors may X-ray the same patient several times a year, even though there is no clear evidence that X-rays will help the therapist treat the patient. X-rays can reveal neither the subluxations nor the innate intelligence associated with chiropractic philosophy, because they do not exist. There is no conceivable reason at all why X-raying the spine should help a straight chiropractor treat an ear infection, asthma or period pains. Most worrying of all, chiropractors generally require a full spine X-ray, which delivers a significant higher radiation dose than most other X-ray procedures". Recent research suggests that most chiropractors in Canada are taught and follow stringent radiography guidelines, which were developed to reduce unnecessary radiography.

Quackwatch is critical of chiropractic; its founder, Stephen Barrett, has written that it is "absurd" to think that chiropractors are qualified to be primary care providers and considers applied kinesiology to be a "term most commonly used to identify a pseudoscientific system of muscle-testing and therapy".

A 2009 perspective stated there is consistent evidence that manual therapies such as chiropractic manipulations are "helpful and generally produce moderate but significant and sustained improvement for back pain in populations" and writes that the suggestion that chiropractic does more harm than good as "specious". The author went on to write that the more serious suggestion is that chiropractic treatment can kill people, and it is often claimed that chiropractic manipulation causes strokes. Common sense suggests that these people were most likely to be in the prodrome of a stroke when they sought help. The author writes "To portray only part of the relevant information in a critique is itself pseudoscience."

Lon Morgan, DC, a reform chiropractor, expressed his view of Innate Intelligence this way: "Innate Intelligence clearly has its origins in borrowed mystical and occult practices of a bygone era. It remains untestable and unverifiable and has an unacceptably high penalty/benefit ratio for the chiropractic profession. The chiropractic concept of Innate Intelligence is an anachronistic holdover from a time when insufficient scientific understanding existed to explain human physiological processes. It is clearly religious in nature and must be considered harmful to normal scientific activity."

Chiropractic historian, Joseph C. Keating, Jr., articulated that "So long as we propound the "One cause, one cure" rhetoric of Innate, we should expect to be met by ridicule from the wider health science community. Chiropractors can’t have it both ways. Our theories cannot be both dogmatically held vitalistic constructs and be scientific at the same time. The purposiveness, consciousness and rigidity of the Palmers' Innate should be rejected."

William T. Jarvis, Ph.D. has stated: "Chiropractic is a controversial health-care system that has been legalized throughout the United States and in several other countries. In the United States in 1984, roughly 10.7 million people made 163 million office visits to 30,000 chiropractors. More than three fourths of the states require insurance companies to include chiropractic services in health and accident policies. The federal government pays for limited chiropractic services under Medicare, Medicaid, and its vocational rehabilitation program, and the Internal Revenue Service allows a medical deduction for chiropractic services. Chiropractors cite such facts as evidence of "recognition." However, these are merely business statistics and legal arrangements that have nothing to do with chiropractic's scientific validity."