Chiropractic controversy and criticism
Throughout its history chiropractic has been the subject of internal and external controversy and criticism. According to magnetic healer Daniel D. Palmer, the founder of chiropractic, subluxation was the sole cause of all diseases and manipulation was the cure for all diseases of the human race. A 2003 profession-wide survey found "most chiropractors (whether "straights" or "mixers") still hold views of Innate and of the cause and cure of disease (not just back pain) consistent with those of the Palmers." A critical evaluation stated "Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today." Chiropractors, including D.D. Palmer, were jailed for practicing medicine without a license. D.D. Palmer considered establishing chiropractic as a religion to resolve this problem. For most of its existence, chiropractic has battled with mainstream medicine, sustained by antiscientific and pseudoscientific ideas such as subluxation. Chiropractic has been controversial, though to a lesser extent than in past years.
Chiropractic researchers have documented that fraud, abuse and quackery are more prevalent in chiropractic than in other health care professions. Unsubstantiated claims about the efficacy of chiropractic have continued to be made by individual chiropractors and chiropractic associations. The core concept of traditional chiropractic, vertebral subluxation, is not based on sound science. Collectively, systematic reviews have not demonstrated that spinal manipulation, the main treatment method employed by chiropractors, was effective for any medical condition, with the possible exception of treatment for back pain. Although rare, spinal manipulation, particularly of the upper spine, can also result in complications that can lead to permanent disability or death; these can occur in adults and children.
Chiropractors historically were strongly opposed to vaccination based on their belief that all diseases were traceable to causes in the spine, and therefore could not be affected by vaccines. Some chiropractors continue to be opposed to vaccination. Early opposition to water fluoridation included chiropractors in the U.S. Some chiropractors opposed water fluoridation as being incompatible with chiropractic philosophy and an infringement of personal freedom. Recently, other chiropractors have actively promoted fluoridation, and several chiropractic organizations have endorsed scientific principles of public health.
In 2008, Simon Singh was sued for libel by the British Chiropractic Association (BCA) for criticizing their activities in a column in The Guardian. A preliminary hearing took place at the Royal Courts of Justice in front of judge David Eady. The judge held that merely using the phrase "happily promotes bogus treatments" meant that he was stating, as a matter of fact, that the British Chiropractic Association was being consciously dishonest in promoting chiropractic for treating the children's ailments in question. An editorial in Nature has suggested that the BCA may be trying to suppress debate and that this use of British libel law is a burden on the right to freedom of expression, which is protected by the European Convention on Human Rights. The libel case ended with the BCA withdrawing its suit in 2010.
Historical controversy and critical elements
The birth of chiropractic was on September 18, 1895. There is controversy over what happened with several different accounts. Daniel D. Palmer later claimed that on that day he manipulated the spine of Harvey Lillard, a man who was nearly deaf, allegedly curing him of deafness. Palmer said "there was nothing accidental about this, as it was accomplished with an object in view, and the expected result was obtained. There was nothing 'crude' about this adjustment; it was specific so much so that no chiropractor has equaled it."
However, this version was disputed by Lillard's daughter, Valdeenia Lillard Simons. She said that her father told her that he was telling jokes to a friend in the hall outside Palmer's office and Palmer, who had been reading, joined them. When Lillard reached the punch line, Palmer, laughing heartily, slapped Lillard on the back with the hand holding the heavy book he had been reading. A few days later, Lillard told Palmer that his hearing seemed better. Palmer then decided to explore manipulation as an expansion of his magnetic healing practice. Simons said "the compact was that if they can make [something of] it, then they both would share. But, it didn't happen."
In spite of the fact that Lillard could hear well enough to tell jokes, B.J. Palmer claimed under sworn testimony that Lillard had been "thoroughly deaf". Since 1895, the story of Palmer's curing a man of deafness has been a part of chiropractic tradition. Palmer's account differs significantly from what actually happened, in that, according to Lillard's daughter, his improved hearing was likely caused by an accidentally fortuitous jarring of Lillard's body and not, as claimed by D.D. Palmer, caused by a "specific" adjustment. It was after this event that Palmer began to experiment with manipulation. He also claimed that his second patient, a man with heart disease, was also cured by spinal manipulation.
Chiropractic included vitalistic ideas of Innate Intelligence with religious attributes of Universal Intelligence as substitutes for science. Evidence suggests that D.D. Palmer had acquired knowledge of manipulative techniques from Andrew Taylor Still, the founder of osteopathy. Although D.D. Palmer combined bonesetting to give chiropractic its method, and "magnetic healing" for the theory, he acknowledged a special relation to magnetic healing when he wrote, "chiropractic was not evolved from medicine or any other method, except that of magnetic." He also "claimed that his profession had nothing to do with medicine, that he healed by the laying on of hands;... He also said that he had a diploma from no earthly school but from High Heaven."
According to D.D. Palmer, subluxation was the sole cause of all diseases and manipulation was the cure for all diseases of the human race. A 2003 profession-wide survey found "most chiropractors (whether "straights" or "mixers") still hold views of Innate and of the cause and cure of disease (not just back pain) consistent with those of the Palmers. On the one hand, modern promotional brochures make a bid for medical legitimacy by describing Innate and adjustments using more scientific-sounding terms such as "inherent" and "nerve force.""
Chiropractic has had a strong salesmanship element since it was started by D.D. Palmer. His son, B.J. Palmer, asserted that their chiropractic school 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". D.D. Palmer established a magnetic healing facility in Davenport, Iowa, styling himself ‘doctor’. Not everyone was convinced, as a local paper in 1894 wrote about him:
- "A crank on magnetism has a crazy notion that he can cure the sick and crippled with his magnetic hands. His victims are the weak-minded, ignorant and superstitious, those foolish people who have been sick for years and have become tired of the regular physician and want health by the short-cut method…he has certainly profited by the ignorance of his victims…His increase in business shows what can be done in Davenport, even by a quack."
Before adopting the term "chiropractic" in about 1896, his advertising used the term "magnetic". In 1891-92, a city business directory stated: "Dr. Palmer can cure with his Magnetic Hands Diseases of the Head, Throat, Heart, Lungs, Stomach, Liver, Spleen, Kidneys, Nerves, and Muscles, ten times quicker than any one can with medicines."
D.D. Palmer remarked that "Give me a simple mind that thinks along single tracts, give me 30 days to instruct him, and that individual can go forth on the highways and byways and get more sick people well than the best, most complete, all around, unlimited medical education of any medical man who ever lived."
Chiropractic has seen considerable controversy within the profession over its philosophy.
Chiropractic was rooted in mystical concepts, leading to internal conflicts between straights and mixers which continue to this day. It has two main groups: "straights", now the minority, emphasize vitalism, innate intelligence and spinal adjustments, and consider subluxations to be the leading cause of all disease; "mixers" are more open to mainstream and alternative medical techniques such as exercise, massage, nutritional supplements, and acupuncture. The straights adhere religiously to the gospel of its founders while mixers are more open. There is a lack of uniformity and consensus among chiropractors in regard to their role. Depending upon whose point of view, chiropractors are, for example, subluxation-correctors, primary care physicians, neuromusculoskeletal specialists, or holistic health specialists. Straights have claimed mixers are not real chiropractors because they do not acknowledge Palmer's foundation of chiropractic therapy.
In 1906, D.D. Palmer was the first of hundreds of chiropractors who went to jail. Chiropractors were jailed for practicing medicine without a license. In the 1920s hundreds of unlicensed chiropractors chose jail rather than fines. Herbert Reaver was the most jailed chiropractor in the U.S. Chiropractors were charged with not complying with the medical practice act. California chiropractors adopted the motto, "Go to jail for chiropractic." 450 chiropractors were jailed in a single year at the peak of the controversy. Many chiropractors treated fellow prisoners and visiting patients while in jail.
D.D. Palmer defined chiropractic as "a science of healing without drugs" and considered establishing chiropractic as a religion as a means to use religious "exemption clauses" to resolve legal difficulties presented by restrictive "chiro laws". In 1911, he stated:
- "You ask, what I think will be the final outcome of our law getting. It will be that we will have to build a boat similar to Christian Science and hoist a religious flag. I have received chiropractic from the other world, similar as did Mrs. Eddy. No other one has lad claim to that, NOT EVEN B.J.
- "Exemption clauses instead of chiro laws by all means, and LET THAT EXEMPTION BE THE RIGHT TO PRACTICE OUR RELIGION. But we must have a religious head, one who is the founder, as did Christ, Mohamed, Jo. Smith, Mrs. Eddy, Martin Luther and other who have founded religions. I am the fountain head. I am the founder of chiropractic in its science, in its art, in its philosophy and in its religious phase. Now, if chiorpractors desire to claim me as their head, their leader, the way is clear. My writings have been gradually steering in that direction until now it is time to assume that we have the same right to as has Christian Scientists."
Chiropractors have struggled with survival and identity during its formative years, including internal struggles between its leaders and colleges. For much of the history of the chiropractic profession chiropractors showed little interest in scientific research and regarded their principles and practices as valid. Despite heavy opposition by mainstream medicine, by the 1930s chiropractic was the largest alternative healing profession in the U.S. The lack of acceptance with mainstream public health was contributed to by the long-standing American Medical Association (AMA) policies against chiropractic. The AMA created the Committee on Quackery "to contain and eliminate chiropractic." Using the Committee on Quackery, efforts were made to prevent the participation of chiropractic in organized health care. In 1966 a policy passed by the AMA House of Delegates stating: "It is the position of the medical profession that chiropractic is an unscientific cult whose practitioners lack the necessary training and background to diagnose and treat human disease. Chiropractic constitutes a hazard to rational health care in the United States because of its substandard and unscientific education of its practitioners and their rigid adherence to an irrational, unscientific approach to disease causation." The longstanding feud between chiropractors and medical doctors continued for decades. The AMA labeled chiropractic an "unscientific cult" in 1966, and until 1980 held that it was unethical for medical doctors to associate with "unscientific practitioners". This culminated in a landmark 1987 decision, Wilk v. AMA, in which the court found that the AMA had engaged in unreasonable restraint of trade and conspiracy, and which ended the AMA's de facto boycott of chiropractic. The rivalry was not solely with conventional medicine; many osteopaths proclaimed that chiropractic was a bastardized form of osteopathy.
Serious research to test chiropractic theories did not begin until the 1970s, and is continuing to be hampered by antiscientific and pseudoscientific ideas that sustained the profession in its long battle with organized medicine. By the mid-1990s there was a growing scholarly interest in chiropractic, which helped efforts to improve service quality and establish clinical guidelines that recommended manual therapies for acute low back pain. Some people believe chiropractic has little more than a placebo effect, but there have been many satisfied patients and many randomized trials of spinal manipulation have verified its effectiveness for the treatment of low back pain. There are several barriers between primary care physicians and chiropractors for having positive referral relationships which includes a lack of good communication. The medical establishment has not entirely accepted chiropractic care as mainstream. After 100 years, the chiropractic profession has failed to define a message that is understandable, credible, and scientifically valid. The future of chiropractic is uncertain due to the economic struggles and restrictions of the science and methods in chiropractic. Chiropractic has been controversial, though to a lesser extent than in past years, and continues to be more controversial than indigenous medicine.
The 2008 book Trick or Treatment states that in 1913 B.J. Palmer ran over his father, D.D. Palmer, at a homecoming parade during the Palmer School of Chiropractic. Weeks later D.D. Palmer died. The official cause of death was recorded as typhoid. The book Trick or Treatment indicated "it seems more likely that his death was a direct result of injuries caused by his son. Indeed there is speculation that this was not an accident, but rather a case of patricide." A 1999 documentary study suggests D.D. Palmer's widow may have also played a role in the patricide controversy. D.D. Palmer's attending physicians were persuaded to change their opinions about the main cause of death. Chiropractic historian Joseph C. Keating, Jr. has described the attempted patricide of D.D. Palmer as a "myth" and "absurd on its face" and cites an eyewitness who recalled that D.D. was not struck by B.J.'s car, but rather, had stumbled. He also says that "Joy Loban, DC, executor of D.D.'s estate, voluntarily withdrew a civil suit claiming damages against B.J. Palmer, and that several grand juries repeatedly refused to bring criminal charges against the son." A 1969 article stated that in July 1913 at the Palmer School of Chiropractic B.J. Palmer "insisted on leading the alumni procession, but was prohibited from doing so by the marshal of the parade, who was a student at the school. An altercation ensued. B.J. drove up in his automobile. Words passed between father and son. What happened after that depends on whom you believe. Daniel David claimed that B.J. struck him with his automobile, and D.D's friends and allies later produced affidavits of witnesses to prove it. B.J. flatly denied it, and produced many more affidavits to this effect than D.D.'s cohorts were able to muster."
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 [examples provided]...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 stated that he would "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 suggested this ruling could set a precedent to restrict freedom of speech to criticise alternative medicine. The charity Sense About Science launched a campaign to draw attention to this particular case. They issued a statement entitled "The law has no place in scientific disputes", which was signed by myriad signers representing science, journalism, publishing, arts, humanities, entertainment, skeptics, campaign groups and law. As of April 16, 2010[update], over 50,000 had 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.
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 2008 review found that with the possible exception of back pain, chiropractic manipulation has not been shown to be effective for any medical condition. Commenting on a famous ‘systematic’ review by Bronfort et al., Edzard Ernst stated that it was a notorious example of a pseudo-systematic review that omitted evidence, for instance, of negative primary studies. 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 of 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". Practice guidelines aim to reduce unnecessary radiation exposure, which increases cancer risk in proportion to the amount of radiation received. Research suggests that radiology instruction given at chiropractic schools worldwide seem to be evidence-based. Although, there seems to be a disparity between some schools and available evidence regarding the aspect of radiography for patients with acute low back pain without an indication of a serious disease, which may contribute to chiropractic overuse of radiography for low back pain.
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.
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."
Vaccination and water fluoridation
Many forms of alternative medicine are based on philosophies that oppose vaccination and have practitioners who voice their opposition. These include some elements of the chiropractic community. The reasons for this negative vaccination view are complicated and rest, at least in part, on the early philosophies which shape the foundation of these professions. Chiropractors historically were strongly opposed to vaccination based on their belief that all diseases were traceable to causes in the spine, and therefore could not be affected by vaccines; D.D. Palmer wrote, "It is the very height of absurdity to strive to 'protect' any person from smallpox or any other malady by inoculating them with a filthy animal poison." Some chiropractors continue to be opposed to vaccination, one of the most effective public health measures in history.
Some chiropractic groups still oppose attempts to limit or eliminate nonmedical exemptions to vaccination. In March 2015, the Oregon Chiropractic Association invited Andrew Wakefield, chief author of a fraudulent research paper, to testify against Senate Bill 442, "a bill that would eliminate nonmedical exemptions from Oregon's school immunization law." The California Chiropractic Association lobbied against a 2015 bill ending belief exemptions for vaccines. They had also opposed a 2012 bill related to vaccination exemptions.
Early opposition to water fluoridation included chiropractors in the U.S. Some chiropractors oppose water fluoridation as being incompatible with chiropractic philosophy and an infringement of personal freedom. Recently, other chiropractors have actively promoted fluoridation, and several chiropractic organizations have endorsed scientific principles of public health.
Ownership of manipulation
No single profession "owns" spinal manipulation (SM) and there is little consensus as to which profession should administer SM, raising concerns by chiropractors that orthodox medical physicians could "steal" SM procedures from chiropractors. A focus on evidence-based SM research has also raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks. Two U.S. states (Washington and Arkansas) prohibit physical therapists from performing SM, some states allow them to do it only if they have completed advanced training in SM, and some states allow only chiropractors to perform SM, or only chiropractors and physicians. Bills to further prohibit non-chiropractors from performing SM are regularly introduced into state legislatures and are opposed by physical therapist organizations.
- Kaptchuk, TJ; Eisenberg, DM (Nov 1998). "Chiropractic: origins, controversies, and contributions". Archives of Internal Medicine 158 (20): 2215–24. doi:10.1001/archinte.158.20.2215. ISSN 0003-9926. PMID 9818801.
- Jaroff, Leon (27 February 2002). "Back Off, Chiropractors!". Time. Retrieved 7 June 2009.
- Ernst, E (May 2008). "Chiropractic: a critical evaluation". Journal of pain and symptom management 35 (5): 544–62. doi:10.1016/j.jpainsymman.2007.07.004. ISSN 0885-3924. PMID 18280103.
- Gunther Brown, Candy (July 7, 2014). "Chiropractic: Is it Nature, Medicine or Religion?". The Huffington Post.
- Palmer, Daniel (May 4, 1911), D.D. Palmer's Religion of Chiropractic, The Chiropractic Resource Organization, retrieved February 22, 2015
- Keating JC Jr, Cleveland CS III, Menke M (2005). "Chiropractic history: a primer" (PDF). Association for the History of Chiropractic. Retrieved 2008-06-16.
A significant and continuing barrier to scientific progress within chiropractic are the anti-scientific and pseudo-scientific ideas (Keating 1997b) which have sustained the profession throughout a century of intense struggle with political medicine. Chiropractors' tendency to assert the meaningfulness of various theories and methods as a counterpoint to allopathic charges of quackery has created a defensiveness which can make critical examination of chiropractic concepts difficult (Keating and Mootz 1989). One example of this conundrum is the continuing controversy about the presumptive target of DCs' adjustive interventions: subluxation (Gatterman 1995; Leach 1994).
- DeVocht JW (2006). "History and overview of theories and methods of chiropractic: a counterpoint". Clin Orthop Relat Res 444: 243–9. doi:10.1097/01.blo.0000203460.89887.8d. PMID 16523145.
- Murphy, DR; Schneider, MJ; Seaman, DR; Perle, SM; Nelson, CF (Aug 2008). "How can chiropractic become a respected mainstream profession? The example of podiatry". Chiropractic & osteopathy 16: 10. doi:10.1186/1746-1340-16-10. PMC 2538524. PMID 18759966.
- WHO guidelines on basic training and safety in chiropractic - 2005
- Ernst, E (Jul 2007). "Adverse effects of spinal manipulation: a systematic review". Journal of the Royal Society of Medicine 100 (7): 330–8. doi:10.1258/jrsm.100.7.330. ISSN 0141-0768. PMC 1905885. PMID 17606755. Lay summary – Med News Today (2 July 2007).
- Vohra, S; Johnston, BC; Cramer, K; Humphreys, K (Jan 2007). "Adverse events associated with pediatric spinal manipulation: a systematic review". Pediatrics 119 (1): e275–83. doi:10.1542/peds.2006-1392. ISSN 0031-4005. PMID 17178922.
- Busse, JW; Morgan, L; Campbell, JB (Jun 2005). "Chiropractic antivaccination arguments". Journal of manipulative and physiological therapeutics 28 (5): 367–73. doi:10.1016/j.jmpt.2005.04.011. ISSN 0161-4754. PMID 15965414.
- F. Nelson, Craig (1 April 1999). "Spinal Manipulation and Chiropractic: Views of a Reformist Chiropractor". American Council on Science and Health. Retrieved 7 June 2009.
- Jones, RB; Mormann, DN; Durtsche, TB (Oct 1989). "Fluoridation referendum in La Crosse, Wisconsin: contributing factors to success". American journal of public health 79 (10): 1405–8. doi:10.2105/AJPH.79.10.1405. ISSN 0090-0036. PMC 1350185. PMID 2782512.
- Eden, R (2008-08-16). "Doctors take Simon Singh to court". The Daily Telegraph (London). Retrieved 2008-12-12.
- Boseley, Sarah (14 May 2009). "Science writer accused of libel may take fight to European court". London: The Guardian (UK). Retrieved 2009-05-19.
- "Unjust burdens of proof". Nature 459 (7248): 751. June 2009. doi:10.1038/459751a. PMID 19516290.
- Pallab Ghosh (2010-04-15). "Case dropped against Simon Singh". BBC News.
- Mark Henderson (2010-04-16). "Science writer Simon Singh wins bitter libel battle". London: Times Online.
- Daniel David Palmer short history
- Westbrooks B (1982). "The troubled legacy of Harvey Lillard: the black experience in chiropractic". Chiropr Hist 2 (1): 47–53. PMID 11611211.
- B.J. Palmer's testimony in State of Wisconsin vs. S. R. Jansheski, December, 1910
- Keating, Jr., Joseph (April 13, 1998), D.D. Palmer's Lifeline, The Chiropractic Resource Organization, retrieved February 22, 2015
- Colquhoun, D (Jul 2008). "Doctor Who? Inappropriate use of titles by some alternative "medicine" practitioners". The New Zealand medical journal 121 (1278): 6–10. ISSN 0028-8446. PMID 18670469.
- Jonas, Wayne B. (1999). "Foreword – Chiropractic: the return of philosophy to medicine?". In Ian D. Coulter. Chiropractic: a philosophy for alternative health care. Elsevier Health Sciences. pp. ix–xii. ISBN 978-0-7506-4006-0.
- Nelson, CF; Lawrence, DJ; Triano, JJ; Bronfort, G; Perle, SM; Metz, RD; Hegetschweiler, K; Labrot, T (Jul 2005). "Chiropractic as spine care: a model for the profession". Chiropractic & osteopathy 13: 9. doi:10.1186/1746-1340-13-9. PMC 1185558. PMID 16000175.
- Singh S, Ernst E (2008). "The truth about chiropractic therapy". Trick or Treatment: The Undeniable Facts about Alternative Medicine. W.W. Norton. pp. 145–90. ISBN 978-0-393-06661-6.
- Kimbrough, ML (Jun 1998). "Jailed chiropractors: those who blazed the trail". Chiropractic history 18 (1): 79–100. ISSN 0736-4377. PMID 11620299.
- Callender, A (Dec 1995). "Buckeye chiropractic: turbulence in a limited branch of medicine, 1915-1975". Chiropractic history 15 (2): 78–89. ISSN 0736-4377. PMID 11613404.
- World Chiropractic Alliance gives 1997 awards, The Chiropractic Journal, Dec. 1997
- Johnson C (December 2010). "Reflecting on 115 years: the chiropractic profession's philosophical path". Journal of Chiropractic Humanities 17 (1): 1–5. doi:10.1016/j.echu.2010.11.001. PMC 3342796. PMID 22693471.
- Martin, SC (Oct 1993). "Chiropractic and the social context of medical technology, 1895-1925". Technology and culture 34 (4): 808–34. doi:10.2307/3106416. ISSN 0040-165X. JSTOR 3106416. PMID 11623404.
- Johnson, C; Baird, R; Dougherty, PE; Globe, G; Green, BN; Haneline, M; Hawk, C; Injeyan, HS et al. (Jul 2008). "Chiropractic and public health: current state and future vision". Journal of manipulative and physiological therapeutics 31 (6): 397–410. doi:10.1016/j.jmpt.2008.07.001. ISSN 0161-4754. PMID 18722194.
- Cherkin, D (Nov 1989). "AMA policy on chiropractic". American journal of public health 79 (11): 1569–70. doi:10.2105/AJPH.79.11.1569-a. ISSN 0090-0036. PMC 1349822. PMID 2817179.
- Cooper, RA; Mckee, HJ (2003). "Chiropractic in the United States: trends and issues". The Milbank quarterly 81 (1): 107–38, table of contents. doi:10.1111/1468-0009.00040. ISSN 0887-378X. PMC 2690192. PMID 12669653.
- Allareddy, V; Greene, BR; Smith, M; Haas, M; Liao, J (Oct 2007). "Facilitators and barriers to improving interprofessional referral relationships between primary care physicians and chiropractors". The Journal of ambulatory care management 30 (4): 347–54. doi:10.1097/01.JAC.0000290404.96907.e3 (inactive 2015-01-01). ISSN 0148-9917. PMID 17873667.
- Meeker, WC; Haldeman, S (Feb 2002). "Chiropractic: a profession at the crossroads of mainstream and alternative medicine". Annals of internal medicine 136 (3): 216–27. doi:10.7326/0003-4819-136-3-200202050-00010. ISSN 0003-4819. PMID 11827498.
- Homola, Samuel (2006). "Can Chiropractors and Evidence-Based Manual Therapists Work Together? An Opinion From a Veteran Chiropractor". The Journal of Manual & Manipulative Therapy 14 (2): E14–E18.
- Siordia L, Keating JC (1999). "Laid to uneasy rest: D.D. Palmer, 1913". Chiropr Hist 19 (1): 23–31. PMID 11624037.
- Keating, Joseph (April 23, 1993). "Dispelling Some Myths About Old Dad Chiro". Dynamic Chiropractic.
- Stephen Barrett, Samuel Homola (1969). "At Your Own Risk: The Case Against Chiropractic - The Iowa Grocer's Dream". Chirobase.
- Foreman, SM; Stahl, MJ (Sep 2004). "Chiropractors disciplined by a state chiropractic board and a comparison with disciplined medical physicians". Journal of manipulative and physiological therapeutics 27 (7): 472–7. doi:10.1016/j.jmpt.2004.06.006. ISSN 0161-4754. PMID 15389179.
- "Gallup Poll: Americans have low opinion of chiropractors' honesty and ethics". Dynamic Chiropractic 25 (3). 29 January 2007.
- "USA TODAY/Gallup poll". USA Today. 11 December 2006.
- Gallup chart
- "Public Rates Nursing as Most Honest and Ethical Profession." Gallup Poll, 2003
- G. Douglas Andersen, DC, DACBSP, CCN, "Food for Thought 2007: Trust", Dynamic Chiropractic, February 12, 2007, Vol. 25, Issue 04
- Stephen M. Perle, DC, MS, "Poisoning the Well", Dynamic Chiropractic, April 24, 2006, Vol. 24, Issue 09
- Baer HA (1996). "Practice-building seminars in chiropractic: a petit bourgeois response to biomedical domination". Med Anthropol Q 10 (1): 29–44. doi:10.1525/maq.1996.10.1.02a00050. PMID 8689442.
- Susan L. Smith-Cunnien. A profession of one's own: organized medicine's opposition to chiropractic
- Joseph C. Keating, Jr., "Quackery in Chiropractic", Dynamic Chiropractic, February 15, 1991, Vol. 09, Issue 04
- Jarvis, WT (Aug 1992). "Quackery: a national scandal". Clinical chemistry 38 (8B Pt 2): 1574–86. ISSN 0009-9147. PMID 1643742.
- Grod, JP; Sikorski, D; Keating, JC (Oct 2001). "Unsubstantiated claims in patient brochures from the largest state, provincial, and national chiropractic associations and research agencies". Journal of manipulative and physiological therapeutics 24 (8): 514–9. doi:10.1067/mmt.2001.118205. ISSN 0161-4754. PMID 11677551.
- Ernst, E; Gilbey, A (Apr 2010). "Chiropractic claims in the English-speaking world". N Z Med J 123 (1312): 36–44. PMID 20389316. Retrieved 6 January 2012.
- Ernst E (2009). "Chiropractic spinal manipulation for infant colic: a systematic review of randomised clinical trials". Int J Clin Pract 63 (9): 1351–3. doi:10.1111/j.1742-1241.2009.02133.x. PMID 19691620.
- Gilbey, A (Jul 2008). "Use of inappropriate titles by New Zealand practitioners of acupuncture, chiropractic, and osteopathy". The New Zealand medical journal 121 (1278): 15–20. ISSN 0028-8446. PMID 18670471.
- Bale, K (Aug 2008). "Chiropractic Board New Zealand response to "Dr Who?" editorial". The New Zealand medical journal 121 (1280): 78–9. ISSN 0028-8446. PMID 18791634.
- Ernst, E (Jul 2009). "UK chiropractic: regulated but unruly". Journal of health services research & policy 14 (3): 186–7. doi:10.1258/jhsrp.2009.008183. ISSN 1355-8196. PMID 19541879.
- Lucas Laursen. "The Great Beyond: Chiropractic group advises members to 'withdraw from the battleground'". Nature.com. Retrieved 20 June 2009.
- Lucas Laursen. "The Great Beyond: Complaints converge on chiropractors". Nature.com. Retrieved 20 June 2009.
- Sign up now to keep the libel laws out of science! Sense about Science
- Singh, Simon (19 April 2008). "Beware the spinal trap". The Guardian. Archived from the original on 13 November 2008. Retrieved 21 January 2009.
- Comment is Free, The Guardian
- Harris, E (Jun 2009). "Science in court". BMJ (Clinical research ed.) 338: b2254. doi:10.1136/bmj.b2254. ISSN 0959-8138. PMID 19493953.
- "Chiropractic critic loses first round in libel fight". New Scientist. 15 May 2009. Retrieved 19 May 2009.
- Green, David Allen (13 May 2009). "Comment: Don't criticise, or we'll sue". New Scientist. Retrieved 19 May 2009.
- "The law has no place in scientific disputes". Sense About Science. 10 August 2009. Retrieved 11 September 2009.
- "British Chiropractic Association v Singh - BCA admits defeat". Ely Place. Retrieved 2010-04-15.
- Nelson, CF; Lawrence, DJ; Triano, JJ; Bronfort, G; Perle, SM; Metz, RD; Hegetschweiler, K; Labrot, T (Jul 2005). "Chiropractic as spine care: a model for the profession". Chiropractic & osteopathy 13: 9. doi:10.1186/1746-1340-13-9. PMC 1185558. PMID 16000175.
- Keating Jc, Jr; Charlton, KH; Grod, JP; Perle, SM; Sikorski, D; Winterstein, JF (Aug 2005). "Subluxation: dogma or science?". Chiropractic & osteopathy 13 (1): 17. doi:10.1186/1746-1340-13-17. PMC 1208927. PMID 16092955.
- Science, antiscience, materialism and vitalism:
- Keating JC Jr (1997). "Chiropractic: science and antiscience and pseudoscience side by side". Skeptical Inquirer 21 (4): 37–43.
- Phillips RB (2005). "The evolution of vitalism and materialism and its impact on philosophy". In Haldeman S, Dagenais S, Budgell B et al. (eds.). Principles and Practice of Chiropractic (3rd ed.). McGraw-Hill. pp. 65–76. ISBN 0-07-137534-1.
- Samuel Homola, DC. "Chiropractic: Does the Bad Outweigh the Good?", reprinted (with slight modification) from the January/February 2001 issue of Skeptical Inquirer, Committee for Skeptical Inquiry
- Edzard Ernst (February 8, 2014). "The alchemists of alternative medicine – part 5: pseudo-systematic reviews". Edzard Ernst.
- Ernst, E (Jun 2009). "Chiropractic manipulation, with a deliberate "double entendre"". Archives of Disease in Childhood 94 (6): 411. doi:10.1136/adc.2009.158170. ISSN 0003-9888. PMID 19460920.
- Suter, E; Vanderheyden, LC; Trojan, LS; Verhoef, MJ; Armitage, GD (Feb 2007). "How important is research-based practice to chiropractors and massage therapists?". Journal of manipulative and physiological therapeutics 30 (2): 109–15. doi:10.1016/j.jmpt.2006.12.013. ISSN 0161-4754. PMID 17320731.
- David Colquhoun. "Doctor Who? Inappropriate use of titles by some alternative "medicine" practitioners", The New Zealand Medical Journal, 25-July-2008, Vol 121 No 1278
- Stephen Barrett, M.D., "Chiropractic's Dirty Secret: Neck Manipulation and Strokes"
- Gouveia, LO; Castanho, P; Ferreira, JJ (May 2009). "Safety of chiropractic interventions: a systematic review". Spine 34 (11): E405–13. doi:10.1097/BRS.0b013e3181a16d63. ISSN 0362-2436. PMID 19444054.
- E Ernst (2010). "Deaths after chiropractic: a review of published cases". Int J Clinical Practice 64 (8): 1162–1165. doi:10.1111/j.1742-1241.2010.02352.x. PMID 20642715.
- Bussières AE, Taylor JAM, Peterson C (2008). "Diagnostic imaging practice guidelines for musculoskeletal complaints in adults—an evidence-based approach—part 3: spinal disorders". J Manipulative Physiol Ther 31 (1): 33–88. doi:10.1016/j.jmpt.2007.11.003. PMID 18308153.
- Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation, Board on Radiation Effects Research, U.S. National Research Council (2006). Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2. Washington, DC: The National Academies Press. ISBN 0-309-09156-X.
- Ammendolia, C; Taylor, J. A.; Pennick, V; Côté, P; Hogg-Johnson, S; Bombardier, C (2008). "Adherence to radiography guidelines for low back pain: A survey of chiropractic schools worldwide". Journal of Manipulative and Physiological Therapeutics 31 (6): 412–8. doi:10.1016/j.jmpt.2008.06.010. PMID 18722195.
- Stephen Barrett, M.D., "Don't Let Chiropractors Fool You
- Applied Kinesiology: Phony Muscle-Testing for "Allergies" and "Nutrient Deficiencies", Stephen Barrett, MD
- Breen, A (Jul 2009). "In praise of chiropractic". Journal of health services research & policy 14 (3): 188–9. doi:10.1258/jhsrp.2009.009025. ISSN 1355-8196. PMID 19541880.
- Morgan, Lon (March 1998). "Innate intelligence: its origins and problems". The Journal of the Canadian Chiropractic Association 41 (1): 35–41. PMC 2485333.
- Keating, Joseph C. (March 2002). "The Meanings of Innate". The Journal of the Canadian Chiropractic Association 46 (1): 4–10. PMC 2505097.[dead link]
- William T. Jarvis, Ph.D., "Why Chiropractic Is Controversial (1990)
- Ernst E (2001). "Rise in popularity of complementary and alternative medicine: reasons and consequences for vaccination". Vaccine 20 (Suppl 1): S89–93. doi:10.1016/S0264-410X(01)00290-0. PMID 11587822.
- Yoo, Saerom (February 24, 2015), Vaccine researcher Wakefield to testify in Oregon, Statesman Journal, retrieved March 3, 2015
- Yoo, Saerom (February 26, 2015), Meeting on vaccine mandate bill canceled, Statesman Journal, retrieved March 3, 2015
- Mason, Melanie (March 5, 2015), Chiropractors lobby against bill ending belief exemptions for vaccines, Los Angeles Times, retrieved March 6, 2015
- Villanueva-Russell Y (2005). "Evidence-based medicine and its implications for the profession of chiropractic". Soc Sci Med 60 (3): 545–61. doi:10.1016/j.socscimed.2004.05.017. PMID 15550303.
- Anderson, Chantal (2009-01-22). "Physical therapists, chiropractors square off over bill". The Seattle Times. Retrieved 2010-09-23.
- Hilliard JW, Johnson ME (2004). "State practice acts of licensed health professions: scope of practice". DePaul J Health Care Law 8 (1): 237–61.
- Faulty Logic and Non-skeptical Arguments in Chiropractic. Joseph C. Keating, Jr.
- Open Letter to the Profession - George P. McAndrews (commented in Chiroweb)
- Chiropractic, Bonesetting, and Cultism. Samuel Homola, (book review at Chiroweb)
- Critical thinking. Christopher Kent, DC president of the Council on Chiropractic Practice
- Chiropractic, Skeptic’s Dictionary
- Critical views of chiropractic - Citizendium
- Chiropractic - H. L. Mencken, Baltimore Evening Sun
- Spin Doctors: The Chiropractic Industry Under Examination - Paul Benedetti, Wayne MacPhail
- Keeping Your Spine In Line, Adjusting the Joints, and Video - Alan Alda, PBS, Scientific American Frontiers
- Chirobase: Skeptical guide to chiropractic history, theories, and current practices - Stephen Barrett, MD, and Samuel Homola, DC