In recent months, health care debates have dominated the news both in print and picture. Some claim that reform is necessary to preserve the United States’ role as a quality health care provider into the 21st century, others argue that reform legislation as currently proposed is tantamount to socialism. This particular debate will have to wait its turn, because reform (by either side of the political spectrum) will almost certainly not include a repudiation of the pseudoscience that has become standard fare in the medical community. Not that I seek to imply that the quality of medical care has not continued to improve in the western world year over year for centuries, but rather that many of the false claims that once dominated the industry still fester. One such malady, perhaps the most prolific and misunderstood, is chiropractic care.
Some will surely recoil at this presupposition. Many very smart people see chiropractors on a regular basis, and testify to the amazing healing effects of the practice. These people aren’t crazy. The consorted effort behind public education on chiropractics is immense, but is almost entirely driven by groups like the the American Chiropractic Association, whose Congressional lobby is amazingly well-armed. Alternative medicine (including chiropractics, acupuncture, homeopathy, and non-vitamin supplements) is a huge business, raking in nearly $34 billion last year. Numbers specific to chiropractics are harder to find, but that figure is somewhere in the neighborhood of $10 billion. Needless to say, it’s how lots of people spend their money. Even my employer’s insurance policy permits a dozen preventative care chiropractic visits a year at no additional cost. With all of this institutional support, it’s no surprise that most people consider chiropractic to be a legitimate medical practice with real, measurable health benefits.
Here’s the back story. Chiropractic was invented by Daniel David Palmer (a magnetic healer) in the late 1890’s. Palmer and his followers believed that the body coursed with innate intelligence, a divinely infused energy source critical to the health and wellbeing of the human body. Palmer claimed that interruptions in this mystical power were the causes of all disease (if you ever studied medieval medicine, this might sound familiar). Palmer and his protégé son, B.J. Palmer, were so convinced of the spiritual nature of their craft, that they strongly considered consolidating chiropractic as a religion. Instead, they aligned themselves with populist movements, and actively repudiated the value of intellectualism and traditional institutions such as the American Medical Association (anti-intellectual, anti-science populism poised against modernizing health care does sound eerily familiar). Palmer and son would later aggrandize the subluxation method (not to be confused with a real subluxation), which they claimed relieved spinal pressure on nerves, resulting in holistic wellness.
Eventually, chiropractic schismed into three branches, the same three that exist today: the straights, the reformers, and the mixers. Straights are the Palmer’s incarnate, entirely disregarding all medical science. These folks, like Palmer, tend to drastically exaggerate the benefits of their treatments (curing cancer, HIV, etc), and often find themselves on the wrong side of the law. Reformers are the so called doctors of chiropractic medicine (more on that later). Mixers are, as you probably guessed, some amalgamation of the two. In modern chiropractic, the vast majority of practitioners fall in the mixer category. As a rule of thumb, if a chiropractor shows you anatomical drawings or a human skeleton in the same breath as claiming that “adjustments” can boost your immunity and improve the disposition of your body’s core energy, he or she is a mixer. It’s a classic argument from authority, don’t be surprised if the chiropractor wears a lab coat or the like, especially when discussing the extent of your misalignment and necessary treatment. A doctor of chiropractic is not a medical doctor, but rather has obtained a first professional degree, the rough equivalent of a bachelor’s degree in anatomy or biology for an M.D. This, however, does not prevent a doctor of chiropractic from being considered a “primary care provider” in the United States and Canada (thus the insurance coverage). Doctors of chiropractic and their staff frequently perform basic physical therapy in addition to alignments and massage. A tangential, but equally important, point is that a chiropractor’s assistant requires no medical training whatsoever. Many such persons effectively avoid the considerable education, experience, and certification required to become physical therapists, while pretending to perform the same set of services.
So, what about the claims of pain relief? If you search around on the internet, you are likely to find as many scientific articles that claim no benefit as those that claim a small benefit for acute back pain. However, the mechanism of relief is always unclear. There is no scientific evidence that spinal adjustments (accounting for 94% of chiropractic treatments) cure anything. 
What has long been known, however, is that getting your joints popped releases a flood of endorphins, which act as the body’s temporary pain relievers, as well as a healthy heaping of dopamine as a result of being touched or massaged. Subsequently, the patient gets temporary relief from pain in combination with a light feeling of general euphoria. It’s no surprise then, that these two techniques (alignment and massage) are the cornerstones of nearly all reformist chiropractic. Let’s not discount the unbelievable power of the placebo effect. It doesn’t matter if you have a baby with colic, a sore back, or a learning disability, you are almost certain to get a massage and an alignment. Equally as often, your alignment will be pitched in association with some additional alternative medicine (see above – half of that $34 billion was spent on supplements).
The biggest problem with chiropractic lies in the concept of primum non nocere (first, do no harm). Since there is no evidence that chiropractic care provides anything more than what one would get from a little exercise (endorphins), massage (dopamine), or sex (both), the only way to rationalize the practice is if it hurts no one past the pocket-book. Unfortunately, that simply isn’t the case. There are countless instances of stroke associated with cervical spine manipulation. The American Chiropractic Association is quick to claim that fewer than one in 10 million manipulations result in stroke, however other sources with less monetary bias argue that injuries from such manipulations occur at around the rate of one in 750, with incidences of stroke within days of a cervical spine manipulation as high as one in 40,000. Anyone who claims that chiropractic is completely safe is lying to you. From personal experience as a young teenager (paid for and suggested by my genuinely well-intentioned parents), I got wicked nasty headaches following every neck manipulation. The chiropractor insisted on such adjustments, which led to me discontinuing my “therapy” (which was, ironically, designed to alleviate cluster headaches).
I am not suggesting that reformist chiropractic be made illegal, however it should be relegated to it’s proper place in pseudoscience. It should then be the job of every doctor and medical professional to dissuade their patients from relying on chiropractic for genuine medical care (as any responsible person would regarding homeopathy, reflexology, and other alternative medicines). If you have chronic back pain, see an orthopedist, and never let anyone pop your neck (don’t worry, a real doctor wouldn’t try it). We will never be able reform health care in this country until we are capable of honestly assessing what health care really is.
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