Chiropractic

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Chiropractic, or chiropractic care, is a complementary and alternative medicine health profession concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, and the effects of these disorders on the function of the nervous system and general health. It emphasizes the body's own natural ability to regulate itself and attempts to remove obstructions to the healing process by adjusting subluxations of the spine and/or extremities. There is an emphasis on manual treatments including spinal manipulations termed adjustments. Evidence suggests benefits in patients with tension headache and low back pain. There is also evidence that spinal manipulation may help infantile colic.

Introduction

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DD Palmer

Chiropractic was founded in 1895 by Daniel David Palmer, and was based on the belief that all health problems could be prevented and treated using "adjustments" of the spine, and sometimes other joints, to correct what he termed "subluxations". He and later his son BJ Palmer, postulated that these subluxations were misaligned vertebrae which caused nerve compression that "interfered" with the transmission of what he termed "Innate Intelligence". This interference interrupted the proper flow of Innate Intelligence from "above, down, inside, and out" to the organ to which it travelled. As a result, the human body would experience "dis-ease" or disharmony which would result in a loss of health. He compared this process to a "pinched hose" that slowed the transmission of water.

While the "pinched hose theory" has mostly been abandoned, it is still used in a modified form by some chiropractors. However, the concept of the subluxation, for which there is no scientific evidence, remains an integral part of the typical chiropractic practice. Nevertheless, in 2003 90% of chiropractors believed the vertebral subluxation complex played a significant role in all or most diseases, and practiced accordingly. The remainder limited their practices to the care of musculoskeletal problems.

Today there are 17 [10] accredited chiropractic colleges in the US and two in Canada, and over 70,000 chiropractors(DC's) licensed and practicing throughout the world. In the U.S. and Canada, licensed individuals who practice chiropractic are commonly referred to as "chiropractors," "doctors of chiropractic," or "chiropractic physicians." The vast majority of patients that visit a chiropractor do so initially because of symptoms arising from musculoskeletal disorders, especially low back and neck pain, although most chiropractors say they concern themselves with the overall health of the patient.

The initial chiropractic technique was manipulation of the spine (called "adjustment") and remains the primary technique. The chiropractic adjustment differs from other manipulative techniques in its precision and accuracy in correcting vertebral subluxations. Today's chiropractor may continue to adhere to the strict tenets of Palmer and use only spinal adjustments or he/she may also include a broad range of methods, short of drugs and surgery, that are directed at "correcting" subluxations and/or relieving musculoskeletal pain. Some doctors of chiropractic employ chiropractic assistants to work as office staff and perform therapeutic activities and may also employ massage and physiotherapists as adjuncts to chiropractic care. According to a 2002 survey released in 2004 by the National Center for Complementary and Alternative Medicine, chiropractic was the fourth most commonly used complementary and alternative medicine therapy among adults in the United States (7.5%). It is now practiced in hundreds of different ways. The U.S. Department of Labor's Occupational Outlook Handbook said:

Because chiropractors emphasize the importance of healthy lifestyles and do not prescribe drugs or perform surgery, chiropractic care is appealing to many health-conscious Americans. Chiropractic treatment of the back, neck, extremities, and joints has become more accepted as a result of research and changing attitudes about alternative, noninvasive health care practices. [11]

Spinal adjustments, chiropractic's primary technique, may provide short-term relief of certain forms of back and neck pain, headaches, and other spine-related conditions, but studies show conflicting results. For example, a systematic review (1997) noted "Strong evidence was found for the effectiveness of spinal manipulation, back schools and exercise therapy, especially for short-term effects." However, a more recent (2006) systematic review concluded "Collectively these data do not demonstrate that spinal manipulation is an effective intervention for any condition. Given the possibility of adverse effects, this review does not suggest that spinal manipulation is a recommendable treatment."

Chiropractic may be able to show it can be a partner in today's cost conscious healthcare environment. A 2005 study stated that "the inclusion of a chiropractic benefit resulted in a reduction in the rates of surgery, advanced imaging, inpatient care, and plain-film radiographs."

Chiropractic is also used by some professional athletes. The U.S. Olympic Medical Services Staff includes doctors of chiropractic who work with medical doctors for the benefit of the athletes. [12]

It should be noted that there are two main groups of Chiropractors. Those, who chose to limit their practice to musculoskeletal disturbances (mechanistic approach), and those who strive to improve the overall health and wellbeing of the patient (Vitalistic Approach). Mechanistic Chiropractors focus primarily on palliative treatments in order to overcome pain associated with the spine and extremities. Vitalistic Chiropractors on the other hand, view the vertebral subluxation as a spinal lesion which interferes with the nervous system´s regulation of bodily processes. In the presence of vertebral subluxations the human body enters into disharmony which reduces the person's adaptive range and decreases the person's health potential. Left uncorrected, subluxations will eventually weaken the body until symptoms or disease processes ensue. The Chiropractic adjustment is not administered in order to treat any symptom or disease, but to reduce subluxation and allow the body to regain balance and function at a higher level.

Although chiropractic has gained more acceptance in the last 40 years as an appropriate treatment for certain back, neck and other spine-related problems, resulting in increased usage, statistics in the later years have shown some variations from these trends: student enrollments fell 39.9% between 1996 and 2002, and the percentage of the adult population that uses chiropractic fell by 25% from 1997 to 2002. The statistics for student enrollments seem to be rising again, while patient use statistics are still uncertain.

History

In 1885 the world was well into the second industrial revolution, marked by innovation and creativity. Health care was no exception consisting of competing treatments including scientific medicine, vitalism, herbalism, magnetism and leeches, lances, tinctures and patent medicines. Neither consumers nor many practitioners had much knowledge of either the causes of, or cures for, illnesses. Allopathy, fueled by Louis Pasteur's refutal of the centuries old spontaneous generation theory in 1859, was growing rapidly. German bacteriologist, Robert Koch formulated his postulates bringing some much-needed scientific clarity to what was then a very confused field.[13] Drugs, medicines and quack cures were becoming more prevalent and were mostly unregulated. MD Andrew Taylor Still [14], ventured into magnetic healing (meaning hypnotism then) and bonesetting in 1875. He opened the American School of Osteopathy (ASO) in Kirksville, Missouri in 1892.[15] Daniel David Palmer (DD Palmer), a teacher, grocer turned magnetic healer opened his office of magnetic healing in Davenport, Iowa in 1886. After nine successful years, DD Palmer gave the first chiropractic adjustment to a deaf janitor, Harvey Lillard, on September 18,1895.

Conflicting accounts of the first Chiropractic adjustment

Palmer and his patient Harvey Lillard gave differing accounts of when and how Palmer began to experiment with spinal manipulation. Palmer recalled an incident in 1895 when he was investigating the medical history of a deaf janitor, Harvey Lillard. Lillard informed Palmer that while working in a cramped area seventeen years earlier, he felt a 'pop' in his back, and had been nearly deaf ever since. Palmer’s examination found a sore lump which indicated spinal misalignment and a possible cause of Lillard's deafness. Palmer corrected the misalignment, and Lillard could then hear the wheels of the horse-drawn carts in the street below. 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 equalled it.[16]

Palmer's 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."

Palmer said he "received chiropractic from the other world" during a seance, from a deceased physician named Dr. Jim Atkinson.

He regarded chiropractic as partly religious in nature, and in a letter of May 4, 1911 he said: "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."

Keating et al writing for the Association for the History of Chiropractic said D.D. Palmer

"introduced the concept of Innate Intelligence circa 1904. Innate, he believed, was an intelligent entity which directed all the functions of the body, and used the nervous system to exert its influence. (Donahue 1986, 1987)."

Palmer’s son B. J. Palmer initiated research, development and promotion of chiropractic.

DD Palmer's effort to find a single cause for all disease led him to say:

A subluxated vertebra . . . is the cause of 95 percent of all diseases. . . . The other five percent is caused by displaced joints other than those of the vertebral column. (From: Palmer D.D. The Science, Art and Philosophy of Chiropractic. Portland, Oregon: Portland Printing House Company, 1910.)

The term chiropractic originated when Palmer asked a patient - Rev. Samuel Weed - to come up with a name from the Greek language to describe his practice. Weed suggested combining the words chiros and praktikos (meaning "done by hand") to describe the adjustment of a vertebra in the spinal column.

Wilk et al. vs The American Medical Association

Before 1980, Principle 3 of the American Medical Association Principles of Medical Ethics stated: "A physician should practice a method of healing founded on a scientific basis; and he should not voluntarily professionally associate with anyone who violates this principle." Until 1983, the AMA held that it was unethical for medical doctors to associate with an "unscientific practitioner," and labeled chiropractic "an unscientific cult."

As a result of this policy, an antitrust suit was brought against the AMA and other medical associations in 1976 - Wilk et al v. American Medical Association et al - by Wilk and other chiropractors. The landmark lawsuit ended in 1987 when the Federal Appeals Court found the AMA guilty of conspiracy and restraint of trade; the Joint Council on Accreditation of Hospitals and the American College of Physicians were exonerated. The court recognized that the AMA had to show its concern for patients, but was not persuaded that this objective could not have been satisfied in a manner less restrictive of competition, for instance by public education campaigns. The AMA then lost its appeal to the Supreme Court and had to allow its members to collaborate with chiropractors. ^{PDF of key transcripts}

The judge in the Wilk case said that the AMA had covered up research on the effectiveness of chiropractic for back pain. She then said that chiropractors clearly wanted "a judicial pronouncement that chiropractic is a valid. efficacious, even scientific health care service." She said no "well designed, controlled, scientific study" had been done, and concluded "I decline to pronounce chiropractic valid or invalid on anecdotal evidence." ^{PDF of key transcripts}

Chiropractic subluxation

Palmer imbued the term "subluxation" with a metaphysical and philosophical meaning. He held that certain dislocations of bones interfered with the "innate intelligence", a kind of spiritual energy or life force dependent upon a Universal Intelligence that connects the brain to the rest of the body. Palmer claimed that subluxations interfered with the proper communication of this innate intelligence with the rest of the body, and that, by fixing them, 100% of all diseases could be treated.

In 1998, Lon Morgan, D.C., wrote, in the Journal of the Canadian Chiropractic Association,

"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." [17]

In the mid-1990's, the Association of Chiropractic Colleges redefined a subluxation as a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system and general health. In 1997 the Foundation for Chiropractic Education and Research defined a subluxation as a joint problem (whether a problem with the way the joint is functioning, a physical problem with the joint, or a combination of any of these) that affects the function of nerves and therefore affects the body's organs and general health.

Today, chiropractors use the concept of Innate Intelligence to describe the body's self-healing physiology; accordingly, they hold that healthcare interventions should consider the person as a whole and that conservative (non-invasive) treatment approaches should be used where possible.

Philosophy of the subluxation

Both chiropractic and mainstream medicine hold that much of the body is controlled by nerve impulses sent to and from the brain along the spinal cord. Whether the brain commanding the foot to move, the foot signaling the brain that it is in pain, or even a simple patellar reflex, the spinal cord is involved. Outgoing impulses from the brain pass down the spinal cord and exit through the appropriate spinal nerve branch held between the vertebrae on either side of the spinal cord. There are 31 pairs of spinal nerves that emerge from the spinal cord; all of which are housed by vertebrae. If the vertebrae are misaligned (subluxated), chiropractic doctors believe that a spinal nerve can be squeezed or pinched and therefore message flow can be compromised. By aligning the vertebrae and removing restrictions on the spinal nerves, chiropractic claims to allow the spinal cord to more effectively relay messages to and from the brain; thus promoting better health.

Science and chiropractic

Chiropractic is controversial because of the lack of scientific evidence for some of the claims made by chiropractors (see [18]). There is scientific agreement that, wherever applicable, an evidence based medicine framework should be used to assess health outcomes, and that systematic reviews with strict protocols are an important part of objectively evaluating the efficacy of treatments. Where evidence from such reviews is lacking, this does not necessarily mean that the treatment is ineffective, only that the case for a benefit of treatment may not have been rigorously established. Organisations such as the Cochrane Collaboration and Bandolier publish such reviews. An editorial in The Journal of Manipulative and Physiological Therapeutics in 2005, The Cochrane Collaboration: is it relevant for doctors of chiropractic?, proposed that involvement in Cochrane collaboration would be a way for chiropractic to gain greater acceptance within medicine. The collaboration has 11,500 contributors from more than 90 countries organised in 50 review groups. For chiropractic, relevant review groups include the Back Group; the Bone, Joint, and Muscle Trauma Group; the Musculoskeletal Group; and the Neuromuscular Disease Group. The editorial states:

"For example, a chiropractor may provide conservative care supported by a Cochrane review to a patient with carpal tunnel syndrome. If the patient's symptoms become progressive, the doctor may consider referring the patient for surgery using a recent Cochrane review that examined new surgical techniques compared with traditional open surgery for the said condition.”"

The Cochrane Collaboration found insufficient evidence that chiropractic is beneficial for asthma, carpal tunnel syndrome, and painful menstrual periods. Bandolier found insufficient evidence that chiropractic is beneficial for migraine, chronic low back pain and menopausal symptoms .

University of Saskatchewan sociologist Leslie Biggs interviewed 600 Canadian chiropractors in 1997, and found that 74.3% of them did not believe that controlled clinical trials were the best way to evaluate chiropractic, and 68.1% believed that most diseases are caused by spinal malalignment. [19]

Many chiropractors [20] claim to treat infantile colic. According to a 1999 survey of the Ontario Chiropractic Association (representing 83% of chiropractors in Ontario), 46% treated children for colic. [21]. In 2001, a Norwegian double-blind study said “Chiropractic spinal manipulation is no more effective than placebo in the treatment of infantile colic.”[22].

Meta-analysis

A 2006 meta-analysis in the Journal of the Royal Society of Medicine found "these data do not demonstrate that spinal manipulation is an effective intervention for any condition. Given the possibility of adverse effects, this review does not suggest that spinal manipulation is a recommendable treatment." The study confirmed other studies in also concluding "The evidence from the other systematic reviews of SM for non-spinal pain, dysmenorrhoea, infantile colic, asthma, cervicogenic dizziness and any condition is uniformly negative."[[23]]

American Medical Association

In 1997, the following statement was adopted as policy of the American Medical Association (AMA) after a report on a number of alternative therapies:[24]

"There is little evidence to confirm the safety or efficacy of most alternative therapies. Much of the information currently known about these therapies makes it clear that many have not been shown to be efficacious. Well-designed, stringently controlled research should be done to evaluate the efficacy of alternative therapies."

Safety

As with all interventions, risks may be associated with spinal manipulation. These risks, although rare, include vertebrobasilar accidents, strokes, disc herniations, vertebral fracture, and cauda equina syndrome, according to Harrison's. Most serious complications occur after cervical (the 7 bones in the upper third of the spine) manipulation. The practice of greatest concern is the rotary neck movement, sometimes called "master cervical" or "rotary break", which may be linked to trauma, paralysis, strokes, and death.

Nothing more than a temporal relationship has ever been established in relation to severe complications and chiropractic intervention. Chiropractic continues to be one of the safest health care professions and Chiropractors benefit from some of the lowest malpractice insurance premiums among the health care industry.

Documented serious complications after manipulation of the cervical spine are very rare (1 in 3-4 million manipulations or fewer). This estimate is based on international studies of millions of chiropractic cervical adjustments from 1965 to the present day. The "one in a million" estimate is echoed in an extensive review of spinal manipulation performed by the RAND corporation. However, in another study, Dvorak cites figures of 1 in 400,000, while Jaskoviak reported approximately 5 million cervical manipulations from 1965 to 1980 at The National College of Chiropractic Clinic in Chicago, without a single case of vertebral artery stroke or serious injury [25]. Less conservative treatments such as neck surgery are also often used for conditions similar to the conditions chiropractors treat using spinal adjustments. Cervical spine surgery has a 3-4% rate of complication and 4,000-10,000 deaths per million neck surgeries.

With studies of this nature it is difficult to determine what percentage of incidents are reported. The RAND study, for example, assumed that only 1 in 10 cases would have been reported. Dr Edzard Ernst surveyed neurologists in Britain for cases of serious neurological complication occurring within 24 hours of cervical spinal manipulation during the past year. 35 cases had been seen by the 24 who responded, and none of those had been reported. His survey led him to conclude that underreporting was closer to 100%, rendering estimates "nonsensical." [26]

A 2001 study in the medical journal Stroke found that vertebrobasilar accidents (VBAs) are five times more likely in those aged <45 years who had visited a chiropractor in the week before the VBA, compared to controls who had not visited a chiropractor. [27]

Chiropractors cite a New Zealand Commission report as supporting the safety of chiropractic. The report said "We are satisfied that chiropractic treatment in New Zealand is remarkably safe." (Report of the Commission of Inquiry Into Chiropractic 1979:p 77). But this was disputed by the judge in the Wilk v. American Medical Association case; on safety, this report was found to be "unsatisfactory", and a review of the New Zealand report by the United States Congress' Office of Technology Assessment found 'serious problems' in the report's treatment of safety and efficacy issues. It concluded that the New Zealand report's review of the safety issue was 'unsatisfactory.' [28]

It should be noted that most studies performed that deal with the stroke issue and cervical manipulation do not take into account the difference between "manipulation" and the "Chiropractic adjustment". Chiropractic adjustments are set apart from manipulation due to their precision and specificity. It should also be noted that there are nearly 200 different chiropractic techniques, which vary considerably in their application; such differences have never been taken into account in relation to safety issues.

Chiropractic education, licensing, and regulation

United States

In the United States, graduates of chiropractic school receive the degree Doctor of Chiropractic (D.C.), are referred to as "doctor", and are eligible to seek licensure in all jurisdictions. The Council on Chiropractic Education [29] (CCE) sets minimum guidelines for chiropractic colleges, but additional requirements may be needed for a license depending on the jurisdiction where a chiropractor chooses to practice. Currently all 19 chiropractic institutions in the USA are accredited by the CCE.

Students often enter chiropractic school with a Bachelor's degree, or with three years of post-secondary education in the sciences and other appropriate coursework. However, in 2005 only one chiropractic college required a baccalaureate degree as an admission requirement. [30] The minimum prerequisite for enrollment in a chiropractic college set forth by the CCE is 90 semester hours, and the minimum cumulative GPA for a student entering is 2.50. Commonly required classes include: psychology, biology, organic and inorganic chemistry, and physics. Other common medical classes are: anatomy or embryology, physiology, microbiology, diagnosis, neurology, x-ray, orthopedics, obstetrics/gynecology, histology, and pathology.

In the U.S., chiropractic programs require at least 4,200 hours of combined classroom, laboratory, and clinical experience. The last 2 years stress courses in manipulation and spinal adjustment and provide clinical experience in physical and laboratory diagnosis, orthopedics, neurology, geriatrics, physiotherapy, and nutrition. Graduates must complete 5 years of schooling and pass 4 national board exams to complete their education. To qualify for licensure, graduates must sit for State examination; most State boards require at least 2 years of undergraduate education, and an increasing number require a 4-year bachelor’s degree. All boards require the completion of a 4-year program at an accredited college leading to the Doctor of Chiropractic degree. Once licensed, most States require chiropractors to attend 12-48 hours of continuing education annually.

Chiropractic colleges also offer Postdoctoral training in neurology, orthopedics, sports injuries, nutrition, rehabilitation, industrial consulting, radiology, family practice, pediatrics, and applied chiropractic sciences. After such training, chiropractors may take exams leading to "diplomate" status in a given specialty including orthopedics, neurology and radiology.

Australia

In Australia, chiropractic is taught at three universities: RMIT in Melbourne, Murdoch University in Perth and Macquarie University in Sydney. To be registered by various state Chiropractic Registration Boards, a Bachelor of Chiropractic Science, a Bachelor of Science or health-related degree, plus the successful completion of a full-fee paying postgraduate qualifying program for the Master of Chiropractic is required.

Practice styles and schools of thought

Contemporary chiropractic is divided into three schools of thought - straight, mixer, and reform - which differ in their approaches to patient care. All chiropractic approaches are based on non-invasive, non-medication approaches, with many based on the use of manipulation as a treatment for mechanical musculoskeletal dysfunction of the spine and extremities. The three schools of thought do not correspond exactly to existing membership organizations, but adherents tend to favor certain organizations.

1. Straight chiropractors primarily concern themselves with vertebral subluxation correction. Practitioners often use varying vertebral manipulation techniques known as "adjustments" for the purpose of preventive medicine and pain relief. Straight chiropractors hold that only the body can cure the body. By aligning the vertebrae, straight chiropractors believe that they are clearing nerve impulse restrictions and therefore providing a more efficient dialogue between the brain and the rest of the body's systems, thus putting the body in a better position to cure (or heal) itself. Straight chiropractors are a minority, and tend to be members of the International Chiropractors Association (ICA), and the World Chiropractic Alliance (WCA).
2. Mixing chiropractors combine contemporary medical diagnosis and treatment with chiropractic adjustments. Mixing style practitioners use adjustments to treat chiropractic subluxations, as well as nutrition and naturopathic style remedies for other disorders. Methods used include ultrasound, TENS, rehabilitation or the use of other diagnostic methods such as Applied Kinesiology (AK). Mixing chiropractic is itself divided into conservative and liberal groupsTemplate:Fn. Many mixers are members of the American Chiropractic Association (ACA), but there are also many exceptions.
3. Reform chiropractors are oriented at mainstream medicine, advocating a very limited use of chiropractic primarily for treatment of musculoskeletal conditions.

Most universities teaching chiropractic, including Palmer in Davenport Iowa, use rehabilitation methods, exercise, physiological therapeutics and nutrition. The National College (now University) incorporated physical therapy in 1912, even before there was a profession bearing its name. The profession in the U.S. continues to be divided only into specialities. Some do spine-only, others prefer to do sports and rehabilitation. There are musculoskeletal foci and those who co-manage people with organic problems, MS or cancer along with their regular medical approaches.

See also

• Applied kinesiology
• Manipulative therapy
• Naprapathy
• Osteopathy
• Physical therapy
• Reflexology

External links

Advocacy

Chiropractic organizations

• American Chiropractic Association (ACA)
• British Chiropractic Association (BCA)
• Canadian Chiropractic Association (CCA)
• Japanese Association of Chiropractors (JAC)
• International Chiropractors Association (ICA)
• National Association for Chiropractic Medicine
• World Chiropractic Alliance (WCA)
• World Federation of Chiropractic (WFC)
• Foundation for Chiropractic Education and Research (FCER)

Descriptions of chiropractic procedures

• Chiropractic treatments for back pain by Spine-health.com
• Glossary of Chiropractic Terms

Other resources

• The Chirotalk Skeptical Chiropractic Discussion Forum -- The #1 ranked chiropractic discussion forum on the internet.
• 3D Spine Simulator -- Interactive nerve chart, body posture and subluxation / degeneration models
• Mercola -- alternative health website with many articles about chiropractic treatment
• Chiropractic Resource Organization
• Dynamic Chiropractic Online (ChiroWeb)
• Planet Chiropractic -- More than 1000 Chiropractic related articles
• Today's Chiropractic magazine
• National Upper Cervical Chiropractic Association
• Directory of Chiropractors in the United States
• The Chiropractic Profession and Its Research and Education Programs
• The Future of Chiropractic Revisited: 2005 to 2015

Other

• Cherkin, Daniel C.; Mootz, Robert D. (1997) Chiropractic in the United States: Training, Practice, and Research, available online
• Healey, James W. (1990) "It's Where You Put the Period", Dynamic Chiropractic, Volume 08, Issue 21 (October 10, 1990) available online

Critiques

• Chirobase -- A Skeptical Guide to Chiropractic History, Theories, and Practices, Stephen Barrett
• A Different Way To Heal? -- PBS - Scientific American Frontiers, Web Feature
• Chiropractic, Bonesetting, and Cultism -- Samuel Homola, DC (entire book on-line)
• Chiropractic: science and antiscience and pseudoscience side by side -- Joseph C. Keating, Jr, PhD
• Commentary: The Specter of Dogma -- Joseph C. Keating, Jr., PhD
• Faulty Logic and Non-skeptical Arguments in Chiropractic -- Joseph C. Keating Jr, PhD