Three recent news items about chiropractic have particularly irritated me.
(1) General Halstead has become a spokesperson for The Foundation for Chiropractic Progress, a nonprofit organization dedicated to increasing public awareness of chiropractic. Her quoted comments boil down to
- I like the personal attention and caring I get from my chiropractor.
- Chiropractic advice about healthy lifestyle is essential
- Chiropractic care prevents more serious health concerns
- Chiropractic is essential for assisting in recovery from minor injuries.
- Chiropractors don’t mask the problem with drugs and all their side effects.
- Chiropractors are holistic and involve the patient in her own care.
- “Listening appears to be a major tool.”
This is nothing but opinion based on personal experience and scientific ignorance. She offers no evidence that chiropractic theory is true, that chiropractic adjustments are effective, or that a chiropractor has any advantage over a science-based medical doctor who also spends time listening to patients, is interested in the whole patient, advises about healthy lifestyle, and avoids unnecessary use of drugs. Caring clinicians can be found in chiropractic, in homeopathy, in every kind of quackery, and in scientific medicine, with the advantage that the scientific clinician can also provide effective evidence-based treatments.
As a woman and a retired Air Force colonel, I am doubly ashamed that this high-ranking military woman has prostituted herself by becoming a spokesperson for pseudoscience. I hope they are paying her well.
(2) The “research,” reported in the Journal of Pediatric, Maternal & Family Health – Chiropractic, is not really what I would call research. It describes a case of a child with cerebellar ataxia whose problems completely resolved following four chiropractic adjustments. The report speculates that
the increase in the diagnosis of such disorders as ADHD, pervasive developmental disorder, Tourette’s Syndrome, obsessive compulsive disorder and other neurodevelopmental disorders, have their root in abnormal spinal development. Children’s nervous systems need the constant stimulation of movement in order to develop and function properly. Abnormal position or movement of the spinal vertebra can develop and this can lead to nerve interference. It is this interference, called vertebral subluxations, that chiropractors correct.
Maybe, but these subluxations have never been shown to exist outside the imagination of chiropractors, and the alleged nerve interference has never been demonstrated.
I couldn’t access the entire article without paying $50, but the abstract raised a lot of questions. A seven year old girl “presented for chiropractic care and cerebellar ataxia was noted.” Was this an incidental observation by the chiropractor, or had the child been previously diagnosed with documented ataxia? The chiropractor’s exam “isolated the location of trans-neuronal dysfunction to the right cerebellum.” How? What does “trans-neuronal dysfunction” even mean? Even the grammar is faulty: “Chiropractic analysis of static and motion palpation were used to examine the spine for subluxations.” The wording makes it unclear what the treatment was: adjustments were given “in either the cervical, thoracic, lumbar and/or pelvic region as needed. Neuro-rehabilitative exercises were given either at home and/or during the office visit.” “Within four visits there was marked improvement of gait patterns and resolution of the ataxia.” Really? Or did the chiropractor and parents simply convince themselves they saw improvement? Was cerebellar ataxia really there in the first place? Did a medical doctor confirm the diagnosis? Was there any long-term followup?
The abstract’s conclusion is propaganda, not a conclusion based on the study. It consists of speculation that is in no way justified by the data.
Understanding and applying foundational neurological principles via a patient specific, individually tailored, chiropractic management plan is essential. Assessing and optimizing asymmetrical neurological indicators should be part of screening and management procedures. In this case, addressing the dysfunction concerning the central integrative state of the cerebellum was necessary for optimum functioning of this seven-year-old female.
This is a case report, little more than a testimonial. I hope the body of the article clarifies some of the questions the abstract raises, but I have seen many, many similar chiropractic case reports that are poorly documented, that mix treatments so it is impossible to determine what caused the improvement, and that are eminently unconvincing. The value of case reports is that they can help guide future research. This seldom happens in chiropractic; there is no progress over time, and reports like this do not build into a coherent body of knowledge.
The author, Nicoleta Borcean, has no articles listed either on PubMed or in the Index to Chiropractic Literature. The journal this article was published in is a brand-new one, and I question both its concept and its editorial board. Why do we need a journal of “Pediatric, Maternal & Family Health- Chiropractic”? There is no evidence that chiropractic has any role in pediatric or maternal health, and the attempt of some chiropractors to become “family doctors” is misguided. The editor in chief is a professor at Life University, a scandal-ridden school that was denied recertification in 2002 because it offered substandard education. One editorial board member is Barbara Loe Fisher, Co-Founder & President of the National Vaccine Information Center – an anti-vaccine organization. Other board members are associated with the Academy of Chiropractic Family Practice and the International Chiropractic Pediatric Association, organizations whose raison d’être is questionable.
I’m not making an ad hominem argument. I’m not saying these individuals couldn’t produce a high-quality journal. But in this case, they haven’t; and their background helps explain why. The abstracts in the current issue are all case reports similar to the ataxia one. “I treated a patient and he got better” is meaningless unless you can show that you’re not making a post hoc ergo propter hoc error. The journal appears to be more interested in finding evidence to support chiropractic claims than in doing good science to test whether chiropractic claims are true. Pseudoscience tries to show “that” a treatment works; real science asks “if” it really works.
(3) Chiropractors were among the first alternative providers to jump on the Swine Flu bandwagon. I already wrote about this for the JREF’s Swift, but I’ll repeat it here. Their handout boils down to 6 recommendations:
- Build your immune system by getting adjusted.
- Limit the amount of sugar in your diet because sugar depresses the immune system.
- Avoid alcohol and white flour products.
- Drink more water
- Wash your hands frequently.
- Disinfect your rooms by spraying them with a solution of essential oils (4 drops to one cup of water).
Hey! One out of six isn’t bad. Handwashing is a good idea. The rest of this advice is useless for preventing infection.
They tell us “Studies show that being adjusted twice a week can increase your immune system function by up to 400%.” No they don’t. I couldn’t find even one such study. I did find a reference to “preliminary research” – apparently not published – that allegedly showed that patients who had received long term chiropractic care had 200% greater immune competence than patients who had not received chiropractic care and 400% greater than those who had cancer. This is uninterpretable because we are not told how the data were collected nor how “immune competence” was measured. Maybe sicker people are already seeing MDs and are less likely to see chiropractors. Besides which, the damage from flu is due to the immune response, and it’s conceivable that increasing immune competence might be harmful.
There is NO credible evidence that chiropractic adjustments decrease the risk of catching ANYTHING. Ditto sugar, white flour and alcohol (unless perhaps indirectly due to secondary effects of overindulgence). Drinking more water? No evidence. And spraying dilute essential oils is probably as effective as having a witch doctor wave a bone and chant.
Chiropractic may help some people with musculoskeletal pain, but reading news items like these doesn’t help my blood pressure!
This article was originally published in the Science-Based Medicine Blog.