PZ Myers. 2005 Jan 04. Chiroquackery. <http://pharyngula.org/index/weblog/chiroquackery/>. Accessed 2008 Dec 01.
Posted on M00o93H7pQ09L8X1t49cHY01Z5j4TT91fGfr on Tuesday, January 04, 2005
Chiroquackery
Radagast has a fine skeptical article dissecting chiropractic. My father went through years of chiropractic 'treatment' for chronic back pain, and it never did a scrap of good. A single anecdote does not make a case against the discipline, but it made me suspicious, and I dug deeper—and discovered this whole foundation of quackery and pseudoscience, subluxations and magnetic medicine. One great resource for learning more about the faulty basis and poor practice of chiropractic is Chirobase; I'm convinced and will never go to a chiropractor. While there is some virtue to some of what they do, I think that if I need physical therapy, I should see a physical therapist.
Code Blue Blog has more.
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While I think there's some actual benefit to be had--I've visited one a few times, and, well, it feels neat, and my insurance covers it--I read up on the pseudoscience and was very wary when I sought out a chiropractor for the first time. However, the one I went with assured me that he couldn't cure anything, offered to work closely with my real doctor and send over all the X-rays and whatnot, nags me to do stretches in the morning before I start typing, and the word "subluximation" has never come up.
The cool bit, I think, is just that your entire spine gets popped. And sort've like how you can feel the pressure building up in your knuckles, and then pop them, and then you don't feel the pressure any more, it feels like there's a lot of pressures that you're not really aware of that build up in your back--and then you pop it, and you don't feel the pressure any more, so for a while it's like you don't feel your back at all. If that makes any sense. (This is an analogy, not an analysis, I hasten to add.)
However, I think it's more like a massage than anything else--feels neat, probably has some value, but run if they get out the crystals. -
I'm no expert, but, when I hurt my back several years ago, the chiropractor was able to put me back to rights. Every time I went to her for treatment, at the end of the session, I'd be in severe pain, but then I'd wake up the next morning and feel great. After several visits, my back was in great shape, if not quite as good as new (hint: do not attempt to pick up objects as heavy as you are unless you know how to do this properly).
That being said, the nature of my injury was that I had mis-aligned my spine, which is something that a chiropractor can treat. I'm sure that there are lots of people who go to chiropractors because their back hurts, but don't have a problem that the chiropractor is able to treat effectively. I'm sure that there are also plenty of unscrupulous chiropractors who are more than willing to take your money, even if they know there is not much they can do to help your particular problem, but then, the same is true of doctors.
Allen#: Posted by on 01/04 at 08:21 AM -
Chiropractors are charlatans, pure and simple. But like most large groups they include a few reprobates who understand their limitations and minister only to those with conditions they can realistically treat—which means ailments that respond to massage.
I've had chronic back trouble for more than forty years. I've seen orthopods and other specialists, whose best analysis was that our skeleton wasn't designed for bipedalism but for running about on all fours. Since he and I agreed that running around on all fours is not the solution, I sleep on a level bed, do stretching exercises every morning and in general try not to twist my back into unusual shapes. Once when I felt desparate I did see a chiropractor. He x-rayed my back, "manipulated" my spine, gave me a pep talk (at about the level of a junior high shcool kid's understanding of the body) about how I should come in weekly for "manipulation", and promised he could cure anything. I was no better upon leaving his office, nor was I any better the next morning. Realizing his ineptitude and that his promised "manipulation" most likely referred to my wallet, I never returned. I haven't missed his ministrations.
My personal experience aside, every independent analysis of the benefits of chiropractic, whatever the source, has concluded that at best they are neutral and at worst harmful—with the latter prognosis most common if the chiropractor promises cures for all kinds of ailments. What give chiropractic staying power is probably the few chiropractors who understand their limitations, like the one who ministered to UrsulaV, and practice accordingly. But for everyone one of those, there are at least a dozen who are charlatans. I'd never recommend one consult a chiropractor, but if one feels compelled to, then do so only after taking a healthy dose of skepticism first.
By the way, the website PZ recommended, http://www.chirobase.org, is a subset of a larger website, Quackwatch which is at http://www.quackwatch.org/. Both are most enlightening about fake nostrums and panaceas peddled by the unscrupulous on an ignorant public.#: Posted by on 01/04 at 09:03 AM -
The point of my last sentence was simply that there is some good chiropractors can do. Massage, working joints, easing muscle pain, etc., but that's all stuff that qualified physical therapists also do...and they aren't carrying around all this other nonsensical baggage, and know exactly what their limitations are. Chiropractors (mostly) don't. The root of chiropractic theory is that 95% of all ailments are caused by "subluxations", and can can be cured by manipulating the spine.
That's scary. -
I've had trouble convincing fellow analysts who run simulations that it doesn't matter whether you get the right answer if you do the calculations the wrong way. It's just luck. There's no guarantee you'll get the right answer the next time, and it's a better bet that you'll get the wrong answer. Chiropractors start out with the wrong foundation for treatment. If they help, it's just luck.
#: Posted by on 01/04 at 09:27 AM
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UrsalaV wrote:
And sort’ve like how you can feel the pressure building up in your knuckles, and then pop them, and then you don’t feel the pressure any more...
And what happens about 10 minutes later?
Yep, the pressure returns - often at a greater level than before the popping.
I crack my knuckles quite frequently. And, it is relieving to know that everytime I need a "re-crack", I don't have to set up another appointment and shell out $350.
That being said, I do know some people whose chronic pain has been greatly diminished with the aid of a chiropractor.
Whether it's physical therapy, luck, or placebo - I'm not sure.
I wouldn't tell anyone to NEVER go to a chiropractor, but I would tell them to not expect any miracles, and to at least be skeptical of any promises made (see common sense).#: Posted by on 01/04 at 10:29 AM -
Chiropratic has the same success level as conventional medicine. The last stats I read have US doctors (MDs) killing about 90,000 people a year thru malpractice. Like a good MD, a good chiropractor is hard to find, but worth his weight in gold.
I had my first adjustment when I was 17 and had to practically crawl in tears to the car. I walked out of the office a new man. I've also had charlatans and hucksters and weaklings and some fabulous healers across the globe and the nation.
My worst mistake was thinking that they could always fix my back, and I pushed it too hard, too long and smooshed the disks. Even a damned good chiro can't do squat when the disks are gone, but they know that.#: Posted by on 01/04 at 10:31 AM -
Myself, I think a good back rub every now and then is a good thing. But paying some dude with a psuedo-scientific background to do it? I think not. Anyway, that's what women folk are for, anyhow.
Myers, you should stop picking on the low hanging fruit and expose the endemic fraud and quackery of the pharmaceutical industry and the impotent, clueless and coopted FDA who allows them boys to run wild. Merck/Vioxx would be a good start.#: Posted by on 01/04 at 10:54 AM -
I've been wary of chiropractors since I read about it in Martin Gardner's Fads and Fallacies, long ago (still in Dover print, I believe - a great book).
One possible benefit of going to a "weak" chiropractor (i.e. one who doesn't believe in subluxions, or whatever) is that it's much easier to find a chiropractor than a physiotherapist. And a back massage feels good. OTOH, a spine is a complex and somewhat fragile thing, and having an essentially untrained person bashing at it could do serious injury.
My Brother recommends a Turkish sauna (as in, one in Turkey). They have some giant guy who squeezes you after you have one, and he says his back has never felt better after that. Can't be any worse than a chiropractor.#: Posted by on 01/04 at 10:55 AM -
Hobnob: Being squeezed by a giant, sweating Turk somehow escapes my "must do" list, but hey, it might be just the ticket.
#: Posted by on 01/04 at 11:34 AM
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The risk of chiropractic isn't just limited to getting fleeced. They can kill you with one of those feel-good back massages.
I should say that 20 years ago I had a very bad case of carpal tunnel syndrome which nearly prevented me from working - hell, it kept me from <style. Whether that's a result of them shoving bones into the right places or a simple application of the <i>post hoc ergo propter hoc</i> fallacy I dunno. It's certainly anecdotal, non-double-blind evidence.#: Posted by Chris Clarke on 01/04 at 11:36 AM -
don't know why your comments function ate half my comment, PZ. went back to look and there was nothing wrong with the html that I could see.
here's the excised portion:
I should say that 20 years ago I had a very bad case of carpal tunnel syndrome which nearly prevented me from working - hell, it kept me from driving. Out of desperation, I went to see a chiro, and after about two months of adjustments the RSD has been nothing more than a minor, periodic annoyance for two decades - and I have a keyboard-heavy lifestyle. Whether that's a result of them shoving bones into the right places or a simple application of the post hoc ergo propter hoc fallacy I dunno. It's certainly anecdotal, non-double-blind evidence.#: Posted by Chris Clarke on 01/04 at 11:39 AM -
Part of the problem may be that, in the USA, chiropractic is a profession (or maybe pseudo-profession). Over here, it's not; but chiropractic is common enough for all that. It's viewed not as a profession but as a technique. And, while there might for all I know be some sort of non-medical practitioners who use it, I have only ever heard of it being used by physicians (orthopedists; but here that is simply one speciality of 'regular' physicians, whereas in the US I think it's a sort of alternative medical degree).
I am cursed with a more than usually bad back, and when I've gone to my orthopedist, sometimes (it depends on the complaint) he twists my spine into a pretzel-shape. (It's a one-off thing; no weeks and weeks of treatment.) I was sceptical at first, but I've found that the problem goes away much more quickly when this is done (less than 24 hours, as opposed to up to a week). Of course, he also uses lots of other things, like anti-inflammatories and painkillers, and (when needed) surgery.
I've had physical therapy, BTW (prescribed by the orthopedist), and it is nothing like chiropractic. (Nothing like massage therapy either, alas -- it was more like legal torture, but it too helped.)
The 'theory' behind US-style chiropractic is certainly bizarre. That doesn't mean it can't work. Acupuncture seems to do some good in cases of intractable pain that do not respond well to other treatment; this doesn't mean that all that mumbo-jumbo about chi meridians or whatever isn't nonsense. I see no problem with the technique if practiced by somebody (doctor or not) who is adequately trained to use it. The problem is that, if the practitioner sees it as something more than one relatively simple technique among many, he's likely to advise patients to rely on it for complaints for which it is plainly inappropriate (not to mention milking them by requiring them to come in several times a week for months on end).#: Posted by Mrs Tilton on 01/04 at 12:00 PM - Another excellent resource about quackery in all its forms (which is run by the same person who runs Chirobase) is http://www.quackwatch.org. I refer to it frequently and use its reference lists to find primary sources whenever someone starts parroting quackery or medical pseudoscience to me. I recommend it highly.
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Do you mean those Enzite commercials are not documentary in nature? And here I thought it was just stress keeping all that fat on my tummy. Cancel my check!
#: Posted by on 01/04 at 01:55 PM
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The historical foundations of chiropractic may be goofy, isolationist, and generally nutty, but they don't seem to bear much relationship to what chiropractors actually do these days in my experience. In particular, I think that in this age of "complementary medicine" you'd see chiropractors much more willing to work with other medical people.
Yet another anecdote: I was knocked out of a crosswalk by a van a few years ago, snapping off some of my tailbone and causing all sorts of bodily havoc. Like Mrs. Tilton, I was skeptical at first, but chiropractic work did seem to do a lot to remove the hitch from my git-along. And my chiropractors were not shy about recommending that I see other specialists -- a PT, a good LMT experienced in medical massage. They also encouraged/pestered me into some better habits.
As far as quackery goes, I've actually had more quackery from a run-of-the-mill general practitioner than from the woo-woo alternative-medicine crowd. (Of course, I do pick my woo-woo crowd with great care. Then again, I thought I was picking the GP with great care.) I have a moderately unusual chronic illness, and I've been prescribed drugs for it that not only have not been shown to work for this condition, but have been shown rather clearly not to work. Twice. Imagine my delight. I presume the MD was kept too busy to look up any research.
At this point, I think a healthy dose of skepticism is a good idea when visiting any medical professional, alternative or otherwise. -
Anecdotes cut both ways with this sort of thing. My father had terrible pain from sciatica through much of my late childhood and adolescence, and it all came to a happy end when, with all other avenues eventually exhausted, he threw his skepticism to the winds and went to see a chiropractor who had been recommended by the sort of people whose advice he didn't generally take.
Maybe the pain just would have stopped by itself, but it didn't; it stopped when he was in the chair, and it stayed stopped. So make of it what you will, but when it works it's fine medicine. -
The fact remains that chiropractic is based on a goofy idea. When chiropractors-in-training go to school, don't they learn the true belief? If they choose not to follow it when they get out of school, are they still chiropractors? Anecdotal evidence is generally not evidence of much of anything. You can find people who swear they were healed by prayer. But I won't believe in chiropractic or prayer until I see a good, scientific study that is repeated at least once.
#: Posted by on 01/04 at 04:42 PM
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"The fact remains that chiropractic is based on a goofy idea. When chiropractors-in-training go to school, don’t they learn the true belief?"
Actually, Mark, apparently not. I don't know much about the field, but after a quick check in the Wiki it looks like there are two schools, which we can call for utility's sake the "Wacky" school and the "Less Wacky" school (a.k.a. "straight" or "wacky" chiropractic, and "chiropractic medicine").
As an uneducated browser, I may be falling for the fatuous when I check out the site for the National Association for Chiropractic Medicine and see their early statement that "The first and foremost requirement for membership in the NACM is that a Doctor of Chiropractic Medicine renounce the chiropractic hypothesis and/or philosophy; that is, the tenets upon which their scope of practice is based."
It does look to me like there are some out there who are trying to use the lawnmower to mow the lawn, rather than cure cancer. But as I say, I don't know one way or the other, so I'll defer to people who are familiar with the field. -
Richard said: "Chiropratic has the same success level as conventional medicine. The last stats I read have US doctors (MDs) killing about 90,000 people a year thru malpractice."
If you look through my post (that PZ links to above) you'll notice that the only area where chiropractic comes close to conventional medicine in effectiveness is treating lower back pain, and even there it's a difficult topic to quantify and study (placebo effects are rampant). There are virtually no data to support the idea that chiropractors can treat any other ailments (possible exceptions are headaches and neck pain, but again those are difficult topics to work on).
Even if MDs kill 90,000 people a year due to malpractice, that does not say anything about the relative safety or efficacy of chiropractors. Based on the papers I cite, there are currently no solid data regarding the prevalence of life-threatening or otherwise severe complications due to chiropractic manipulations (though one study looking at cervical manipulations calculated a possible rate of 1 irreversible complication in every 850 patients undergoing cervical spinal manipulation). Thus, implying that chiropractic is safer than conventional medical treatments is completely inappropriate. -
How timely. While in my corner of the Sunshine State, Florida Atlantic University plays host to YEC biology PhD candidates and chemistry professors, Florida State faculty members are playing hardball with the school's intention to open a chiropractic school: http://www.sptimes.com/2005/01/04/State/Chiropractic_school_s.shtml
#: Posted by Duddits Cavell on 01/05 at 12:02 AM
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I've never been to a chiropractor, but I once ferried a friend back and forth while he had his back worked on. I sat in the waiting room and read the scores of brochures touting the benefits of chiropractic for a long, long list of ailments. I remember bedwetting was one of them. I'm still kinda agog at that.
There's something behind stuff like this (chiropractic) that gets talked about too seldom: Once you poison the communal well with the acceptability of mysticism, by allowing and/or pushing religion on people from earliest childhood, every lie that follows is more easily accepted.
People who can't think well are virtually defenseless against the unstoppable flood of nonsense -- everything from chiropractic, palm reading, and aromatherapy to state-sponsored lotteries and "A Diamond is Forever" ... and on to adventures in Iraq (where our soldiers are still not being greeted with flowers by a happily-liberated population).
Too many of us see good in some particular practice or philosophy which is, at base, bad thinking, and there are too few places where people can learn how to think better. And that's really where something like chiropractic should get stopped -- with the thinking individual.
Teaching young people to think critically and well is the ultimate bottom line practice of democracy.
That's the one main reason these assholes want to poison education with creationism and ID. They want victims. Prey. More and more who can critically examine less and less.#: Posted by on 01/05 at 12:58 AM -
"The first and foremost requirement for membership in the NACM is that a Doctor of Chiropractic Medicine renounce the chiropractic hypothesis and/or philosophy; that is, the tenets upon which their scope of practice is based."
I just don't get that. If these so-called chiropractors don't believe in the basis of chiropractic, why don't they become, say, physical therapists instead? Is it because it's easier to become whatever counts as fully educated in chiropractic? I'm sure such people are well-intentioned, but they may be falling into risky self-deception.#: Posted by on 01/05 at 03:39 AM -
Vasha,
well, as I said, where I live there is chiropractic, but no 'chiropractic hypothesis'. (No chiropractors - sensu stricto - either, for that matter.) Manipulation is just one technique of many that physicians use/prescribe, along with drugs, physical therapy, surgery and plain old exercise. I have never heard any physician talk about 'subluxation' or whatever it is that 'classical' chiropractors go on about. I suspect the physicians would find the 'theory' quaint, along the lines of the Four Bodily Humours.
I suppose US chiropractors who do not subscribe to the mumbo-jumbo could obtain licences as physical therapists. If they do not, this might be down more to history than anything else, i.e., practitioners calling themselves physical therapists have not ordinarily used the techniques used by practitioners calling thmselves chiropractors. I don't know what is considered 'physical therapy' in the US, but I have had physical therapy in Europe and it is not remotely like the chiropractic technique that my orthopedist used. (My physical therapist was, I am certain, rejected as a Marine Corps drill instructor on grounds of excessive cruelty.) But it would seem to make sense for chiropractors who are adept at the technique but do not buy the quack theory to go on and gain certification in other techniques as well. Even if one doesn't reject the idea of chiropractic as a technique out of hand, it is a low-level therapy good for only a limited number of things. Surely a practitioner who could do other things as well would be able to help a broader range of clients with a broader range of complaints.
As for the data cited above: it certainly is at best a very lukewarm endorsement. Still, and recognising that 'data' is not the plural of 'anecdote', chiropractic has helped me on a number of occasions, and I am hesitant to ascribe this to a placebo effect. Something definitely physical seemed to be going on, and my complaint began to clear up within hours and was gone the next day. Left untreated (or treated only with paracetamol and a hot pad at night), the same thing usually takes anywhere from four days to over a week to disappear.#: Posted by Mrs Tilton on 01/05 at 06:56 AM - Our outgoing trackback isn't working, so I'll just ping you with a comment. I've done a post called See Me Feel Me Touch Me Heal Me over on Pepper of the Earth which draws from this one.
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Another data point of anecdotal evidence (which means little, as we all know): the chiropractor my mother unfortunately goes to once "treated" my cousin. He had been complaining of head troubles, and I suggested he get checked out for a sinus infection. Well, he went to the chiropractor who told him that the hemispheres of his brain were in conflict with each other. After eventually going to the physician, he learned he did indeed have a sinus infection. When my sister went to this chiropractor, she was told that her legs were of different length and required shoe inserts, another common chiropractic myth. I wish my relatives wouldn't go to him, but he's their hero.
Here's the PBS program on chiropractic. Go down to the "Adjusting the Joints" link to view.
This journal article says that spinal manipulation is cost effective at reducing lower back pain.#: Posted by on 01/06 at 02:09 PM -
I spent 15 minutes with a post and when I didn't type in the "name" below I lost everything. The website removes the comments if the back button is used?
Too bad--your loss--it was a good post.#: Posted by on 01/06 at 07:20 PM -
I have fully read all the commentary stated on this site, and frankly am a little bitter about what people have to say. After being angry concerning some of the commentary made regarding me and my profession, I decided it is not my job to change the opinion of others. However, I would like to pass along some much needed information regarding this great profession. Now, you all may think that I am biased, because this is my profession, but I will let you know that chiropractors go through just as much training and education as mainstream medical doctors. We just so happend to take 2x the number of credits in half the time. This should disprove the "psuedoscience" you all talk about. It is well known and published anatomy that we base our profession upon. Any anatomist will tell you that misalignments of the spine can, and DO affect the internal workings of the body. The entire body is run by the central nervous system, which consists of the brain and spinal cord, which is housed in the bones of the back, the spinal column, the bones which we adjust. Any misalignment of the bones of the spinal column causes loss of integrity to the nervous system, and therefore causes malfunctioning of the internal organs of the body...Look it up in Gray's Anatomy...its all there! As for the recommendation of patients returning for multiple appointments, daily activities cause microtraumas in the spine and will affect the functioning of the spine over time, in order to correct malfunction due to malposition, it takes just as much, if not more, time to correct as it does to cause the misalignment. One of the principles of chiropractic states "Every process requires time" Also am important statement regarding modern day healthcare...symptoms are the last to show up and the first to go away when you are dealing with any underlying pathology, including spinal misalignment, of the body. I thank you for reading this, and hope that if I educated ONE single person, or struck curiosity to do more research, then my time writing this statement was not in vain.
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