Chiropractic Controversy and Criticism - Ethics and Claims

Ethics and Claims

A study of California disciplinary statistics during 1997–2000 reported 4.5 disciplinary actions per 1000 chiropractors per year, compared to 2.27 for medical Doctors, and the incident rate for fraud was 9 times greater among chiropractors (1.99 per 1000 chiropractors per year) than among medical Doctors (0.20). According to a 2006 Gallup Poll of U.S. adults, when asked how they would "rate the honesty and ethical standards of people in these different fields", chiropractic compared unfavorably with mainstream medicine. When chiropractic was rated, it "rated dead last amongst healthcare professions". While 84% of respondents considered nurses' ethics "very high" or "high," only 36% felt that way about chiropractors. Other healthcare professions ranged from 38% for psychiatrists, to 62% for dentists, 69% for medical doctors, 71% for veterinarians, and 73% for druggists or pharmacists. Similar results were found in the 2003 Gallup Poll. Chiropractic authors have placed these results in perspective in articles, with one writing that "we were the least trusted and least believed health care discipline", and another writing that chiropractors who use unethical marketing methods "poison the well" for others in the profession, and that they "might be responsible for the negative opinion people have about the ethics of the chiropractic profession." Many chiropractors have sought to address their minor status within the U.S. medical community by attending practice-building seminars to assist chiropractors to persuade their patients of the efficacy of their treatments, increase their revenue, and boost their morale as unorthodox medical practitioners.

Historically the profession has often been accused of quackery, with the profession often responding negatively to such accusations. In its early days, the accusation of quackery was voiced in a 1913 editorial in the Journal of the American Medical Association:

"Chiropractic is a freak offshoot from osteopathy. Disease, say the chiropractors, is due to pressure on the spinal nerves; ergo it can be cured by "adjusting" the spinal column. It is the sheerest quackery, and those who profess to teach it make their appeal to the cupidity of the ignorant. Its practice is in no sense a profession but a trade - and a trade that is potent for great harm. It is carried on almost exclusively by those of no education, ignorant of anatomy, ignorant even of the fundamental sciences on which the treatment of disease depends." (p. 29)

The view that chiropractic was a trade, rather than a profession, was stated clearly by B.J. Palmer, who asserted that chiropractic was founded on "…a business, not a professional basis. We manufacture chiropractors. We teach them the idea and then we show them how to sell it".

In more modern times (1991), when the president of the ACA called accusations of quackery a "myth", chiropractic historian, Joseph C. Keating, Jr. responded by calling his comments "absurd" and stated:

"The so-called 'quackery myth about chiropractic' is no myth.....the kernels of quackery (i.e., unsubstantiated and untested health remedies offered as "proven") are ubiquitous in this profession. I dare say that health misinformation (if not quackery) can be found in just about any issue of any chiropractic trade publication (and some of our research journals) and much of the promotional materials chiropractors disseminate to patients. The recent unsubstantiated claims of the ACA are exemplary ...It escapes me entirely how Dr. Downing, the ACA, MPI, and Dynamic Chiropractic can suggest that there is no quackery in chiropractic. Either these groups and individuals do not read the chiropractic literature or have no crap-detectors. I urge a reconsideration of advertising and promotion policies in chiropractic."

In an article on quackery, W.T. Jarvis has stated that "Non-scientific health care (e.g., acupuncture, ayurvedic medicine, chiropractic, homeopathy, naturopathy) is licensed by individual states. Practitioners use unscientific practices and deception on a public who, lacking complex health-care knowledge, must rely upon the trustworthiness of providers. Quackery not only harms people, it undermines the scientific enterprise and should be actively opposed by every scientist."

In a 2008 commentary, the chiropractic authors proposed that "the chiropractic profession has an obligation to actively divorce itself from metaphysical explanations of health and disease as well as to actively regulate itself in refusing to tolerate fraud, abuse and quackery, which are more rampant in our profession than in other healthcare professions," a situation which violates the social contract between patients and physicians. Such self-regulation "will dramatically increase the level of trust in and respect for the profession from society at large." Another chiropractic study documented that the largest chiropractic associations in the U.S. and Canada distributed patient brochures which contained unsubstantiated claims. Chiropractors, especially in America, have a reputation for unnecessarily treating patients. Sustained chiropractic care is promoted as a preventative tool but unnecessary manipulation could possibly present a risk to patients. Some chiropractors are concerned by the routine unjustified claims chiropractors have made. In English speaking countries the majority of chiropractors and their associations appear to make efficacy claims that are unsupported by scientific evidence. Claims not supported by solid evidence were made about asthma, ear infection, earache, otitis media, and neck pain.

A 2009 chiropractic spinal manipulation review for infant colic stated "Some chiropractors claim that spinal manipulation is an effective treatment for infant colic but the "evidence fails to demonstrate the effectiveness of this treatment. It is concluded that the above claim is not based on convincing data from rigorous clinical trials."

Some New Zealand chiropractors appeared to have used the title 'Doctor' in a New Zealand Yellow pages telephone directory in a way that implied they are registered medical practitioners, when no evidence was presented it was true. In New Zealand, chiropractors are allowed to use the title 'doctor' when it is qualified to show that the title refers to their chiropractic role. A representative from the NZ Chiropractic Board states that entries in the Yellow Pages under the heading of 'Chiropractors' fulfills this obligation when suitably qualified. If a chiropractor is not a registered medical practitioner, then the misuse of the title 'Doctor' while working in healthcare will not comply with the Health Practitioners Competence Assurance Act 2003.

UK chiropractic organizations and their members make numerous claims which are not supported by scientific evidence. Many chiropractors adhere to ideas which are against science and most seemingly violate important principles of ethical behaviour on a regular basis. The advice chiropractors gave to their patients is often misleading and dangerous. This situation, coupled with a backlash to the libel suit filed against Simon Singh, has inspired the filing of formal complaints of false advertising against more than 500 individual chiropractors within one 24 hour period, prompting the McTimoney Chiropractic Association to write to its members advising them to remove leaflets that make claims about whiplash and colic from their practice, to be wary of new patients and telephone inquiries, and telling their members: "If you have a website, take it down NOW." and "Finally, we strongly suggest you do NOT discuss this with others, especially patients."

On 19 April 2008, Simon Singh wrote a cautionary article about chiropractic therapies in The Guardian which resulted in him being sued for libel by the British Chiropractic Association. Singh wrote in The Guardian criticising the claims made by chiropractors about the efficacy of spinal manipulation in treating childhood ailments, among other things. He suggested there was "not a jot" of evidence to support such interventions for these ailments, and argued that the British Chiropractic Association "happily promotes bogus treatments". Singh stating that he will "contest the action vigorously… There is an important issue of freedom of speech at stake." The article developed the theme of Singh's recently published book Trick or Treatment? Alternative Medicine on Trial, making various claims about the usefulness of chiropractic. Commentators suggest this ruling could set a precedent to restrict freedom of speech to criticise alternative medicine. The charity Sense About Science has launched a campaign to draw attention to this particular case. They have issued a statement entitled "The law has no place in scientific disputes", which has been signed by myriad signers representing science, journalism, publishing, arts, humanities, entertainment, skeptics, campaign groups and law. As of April 16, 2010 (2010-04-16), over 50,000 have signed. On 1 April 2010, Simon Singh won his court appeal for the right to rely on the defence of fair comment. On 15 April 2010, the BCA officially withdrew its lawsuit, thus ending the case.