Chiropractic: The Greatest Hoax of the Century? Review | Quackwatch (original) (raw)

I have studied and tracked chiropractic for more than 30 years. My introduction to came by way of a local chiropractor who, wanting me to refer students his way, educated me in the 1960s about the topic when I was teaching high school health and physical education and coaching gymnastics. Like Dr. Chotkowski, despite having a degree in health education, I had never received a minute’s worth of information on chiropractic. However, sensing there was something—not quite right in the chiropractor’s physiological explanations, I never did recommend chiropractic care to my students.

In the late 1960s, I began reading articles on chiropractic that appeared in the health science literature because chiropractic had been reviewed and rejected by the U.S. Department of Health, Education, and Welfare during the establishment of Medicare. I also read the 1969 book At Your Own Risk: The Case Against Chiropractic [1], which has been bitterly attacked but never refuted by chiropractors. By then I was teaching college-level health education courses. One day a tabloid publication appeared on my doorstep declaring the wonders of chiropractic and the dangers of medical drugs and surgery. The testimonials and claims were so fantastic that I decided to order 50 copies and have my students read and discuss the contents. As a result of placing the large order, something only chiropractors normally do, I ended up on the mass mailing lists of chiropractic suppliers and trade associations listed as “Dr. William Jarvis.” I began subscribing to several chiropractic journals and it was by reading its own publications that I realized how perverse, bizarre, and dangerous chiropractic actually is.

Although my primary interest had always been health promotion, as I began my doctoral work I shifted my focus to consumer health education, and made chiropractic the topic of my doctoral dissertation. I worked directly with nineteen chiropractors and three physicians in the development of a programmed instruction course that presented an accurate, objective view of chiropractic on the hypothesis that the more health educators learned about chiropractic, the less favorable toward it they would become.

In 1978 I was visited by representatives of the New Zealand Physiotherapy Society, and was one of only three North Americans selected to testify against the inclusion of chiropractors in that country’s national health program. I was a key witness for defense in antitrust suit brought by chiropractors against fifteen different scientific medical organizations during the 1980s. In 1981 I testified on behalf of the American College of Radiology, and in 1987 on behalf of the American Medical Association. Despite the distortions of the outcome by public relations sources, the antitrust case did not validate chiropractic as a health-care system, a fact which Dr. Chotkowski covers in his book.

In 1977, I initiated the founding of what became the National Council Against Health Fraud, Inc. (NCAHF), a nonprofit, tax-exempt, all volunteer consumer protection agency incorporated in California. NCAHF’s 1985 Position Paper on Chiropractic has been heralded by a source that is highly respected by medical and chiropractic manipulation therapists as “a milestone contribution to the knowledge and understanding of those concerned about societal and community health issues as they related to chiropractic.” [2] In 1987, I helped organize a reform group of chiropractors who wished to preserve the useful aspects of manipulative therapy while discarding useless and dangerous practices. In 1991, I suggested to a victim of chiropractic, George Magner, that he establish a registry for people injured by chiropractors as a means of bringing the dangers of chiropractic before the public and legislative bodies. In 1995, Magner and Stephen Barrett published Chiropractic: The Victim’s Perspective, for which I wrote the foreword. I emphasized my belief that many chiropractors themselves are victims of the delusional world of chiropractic. Victimization begins with the recruitment of naive students who are told that chiropractic is a valid healthcare profession, continued by a proprietary pseudoeducational program, and perpetuated by chiropractic trade publications. I have since heard from numerous chiropractors who have acknowledged their victimization, swallowed huge educational debt, and gone on to honest employment elsewhere.

Dr. Chotkowski is a physician whose book title asks if chiropractic is “the greatest hoax of the century.” This question is difficult to answer because the competition for such a title is enormous, e.g., soviet communism, the Third Reich, scientology, UFOs, and the continued notion of human “royalty,” to name a few. If Dr. Chotkowski had limited his topic to health hoaxes, he then would still have to consider “organic” foods and farming, the health food industry, and exaggerated expectations for vitamins as worthy competitors for the title of “greatest health hoax of the century.” If he had limited his topic to “health care,” he would only have Freudian psychotherapy as a contender to the title “greatest health-care hoax of the century.” In any case, Dr. Chotkowski certainly is correct when he labels chiropractic a hoax of enormous magnitude.

Readers with only average knowledge about chiropractic are likely to judge Dr. Chotkowski’s book to be overly negative, exaggerated, and biased. After all, it is written by a physician. Reasonable people simply have a difficulty believing that lawmakers would legitimize a health-care guild as bereft of a scientific basis and as flawed in every way as is chiropractic. To have credibility with audiences, I have found it necessary to understate the facts about chiropractic, but Dr. Chotkowski tells the straight truth with the insight of a physician, and by doing so inherits the liability of the possible disbelief of his readers. The book is self-published and contains a number of minor errors-including the misspelling of my name-but these are forgivable and do not detract from its validity.

Dr. Chotkowski rightfully challenges the validity of chiropractic by focusing upon the questions of the absence of proof for its theoretical foundation-the spinal “subluxation,” and noting that chiropractic has never been found useful for a single one of the approximately 14,000 diseases that have been classified. Dr. Chotkowski describes encounters with chiropractic educators, practitioners, and apologists who have taken him on in writing. Confronted with the invalidity of its foundation, the chiropractors Dr. Chotkowski communicates with respond with venom and sarcasm. Each encounter he describes adds insight into chiropractic group-think and discloses to the reader just how perverse is the bizarre world of chiropractic. Science-minded readers will wonder why 50 states and federal government allow chiropractic to be licensed, paid for with tax dollars, and given official status as a health-care service.

Chiropractors learn snappy comebacks to employ when confronted with the scientific poverty of their guild. When asked what diseases chiropractor’s treat, they answer that chiropractors don’t treat disease, rather, they analyze and adjust the spine to eliminate the subluxations enabling the body to function properly to restore health and prevent disease. Unlike health-care subspecialties, all of which have a limited, rational scope of practice (e.g., dentists treat diseases of the oral cavity, podiatrists treat diseases of the foot, optometrists correct vision defects, and so forth), chiropractors have no limitations because any problem can be allegedly improved by removing interferences with the body’s innate, health-giving Life Force. The problem is, as Dr. Chotkowski explains again and again, subluxations do not exist, and chiropractic treatment does nothing to improve health.

In pointing out dangers, Dr. Chotkowski relates several cases of people deceived and harmed by chiropractic pseudoscience either directly or by delaying proper medical treatment. Andy Warhol gets a few minutes of fame as Dr. Chotkowski describes how Warhol’s faith in chiropractic contributed to his untimely death. Chiropractic manipulation of the neck can be disastrous. The most heartrending story is that of a former nurse and part-time ballet dancer who was made a quadriplegic by a neck manipulation. Fed by a tube, confined to bed or electric wheel chair, and abandoned by her family, who cannot stand to see her in such a condition, this poor woman resides in a netherworld one would not wish on one’s worst enemy. Chiropractic’s well rehearsed defense is that standard medicine also has its victims. Medications are dangerous, so are surgery and anesthesia, immunization and antibiotics. Medical treatments can cause great harm, but each of them can be judged on a benefit-risk ratio so it will more often do good, will be less harmful than the unchecked disease for which it is applied. Neck manipulation has no proven benefit for any disease but can maim and kill Further, medicine is a science that tracks adverse events while chiropractic is a self-serving guild that denies its dangers and covers up its adverse effects. Readers will read the retorts chiropractors are taught to use when under attack. Such are red herrings designed to throw critics off of the tra1L But, Dr. Chotkowski is not diverted. He stands up to the well-rehearsed chiropractic comebacks, including the personal insults one must endure when exposing the guild’s failings.

Dr. Chotkowski explains a dozen reasons why chiropractic succeeds in the marketplace. A careful reading will make readers aware that scientific aspects of health care are only a part of what enables a clinician to succeed in the health-care business. People who occupy the role of healers always have a following of believers, whether they are witch doctors, alternative practitioners, or evidence- based medical providers.

In a democracy, any guild with a constituency can expect to be heard. If they are contributors to politicians they can expect even more. Chiropractors are exceptional at currying political favoritism, and it has paid off for them. As of January 1, 2000, chiropractors have easier access to Medicare, the Congressional Budget Office has estimated chiropractors will be in line for more than 900million,andtheSenateestimatedthatthenewpolicywouldincreasechiropracticreimbursementby900 million, and the Senate estimated that the new policy would increase chiropractic reimbursement by 900million,andtheSenateestimatedthatthenewpolicywouldincreasechiropracticreimbursementby2 billion. This nearly killed the bill, but aggressive support from Orrin Hatch (R-UT), who has two sons-in-law who are chiropractors [3], and Charles Grassley (R-IA], whose state is the home of chiropractic) got it passed [4].

The facts are that most legislators are medically and scientifically illiterate. They play by the rules of politics, which is spelled c-o-m-p-r-o-m-i-s-e. When contentious issues arise, politicians accept money from both sides, and give each one a little of what they want. This generally works well enough in the everyday business world, but it has no place in patient care. In 1998, the editors of the New England Journal of Medicine stated the matter clearly:

There cannot be two kinds of medicine-conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that mayor may not work. Once a medicine has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted. But assertions, speculation, and testimonials do not substitute for evidence. Alternative treatments should be subjected to scientific testing no less rigorous than that required for conventional treatments [5].

Such is the case against chiropractic. In over 100 years of its existence, chiropractic has not made a single noteworthy contribution to the world’s body of healthcare knowledge. Chiropractors are quick to claim credit for positive reports on the value of spinal manipulation but, as Dr. Chotkowski reveals, most studies are done by medical manipulative therapists. Chiropractors have mostly built businesses by expropriating methods of manual therapists, trafficking in dubious fads, and pretending to be primary care “doctors.”

Dr. Chotkowski’s solution to the problem is for chiropractic schools to convert themselves to legitimate schools of medicine and to adopt science and professional ethics. That is precisely what osteopathy did, and it has worked out well for patients and practitioners. Like the osteopaths, chiropractors could still perform manipulative therapy if they wished. However, it is very likely that, like the osteopaths, manipulation would be used less and less as practitioners learned how to use more effective procedures. The problem I see with such a solution is that most of the clientele that currently are training as chiropractors could not qualify for a medical education. Thus, new, substandard schools would likely emerge to meet the market demand of below-par practitioners making the transition from chiropractic to chiromedicine.

It is clear that chiropractic is an enormous social problem that begs for a solution, but I have little confidence that legislators will ever do the right thing. After all, over the past eighty or so years, the legislatures of every state in the union have demonstrated their lack of competence in judging the validity of health care by passing practice acts enabling chiropractors to “analyze” the spine for “subluxations,” “adjust” the spine to “remove nerve interference” or to “maintain or restore normal health” without evidence that any of these things has a basis in reality. Thus, while chiropractic is a political problem that demands a political solution, politicians are simply not up to doing the job.

References

1. Smith RL. At Your Own Risk: The Case Against Chiropractic. New York: Pocket Books, 1969.
2. White A, Punjabi M. Clinical Biomechanics of the Spine. 2d ed. Philadelphia: Lippincott-Raven, 1990: 435.
3. Stechschulte P. U.S. Senator Orrin Hatch: soul of a statesman. Today’s Chiropractic, Jan-Feb 2000), p 78.
4. No more mandatory Medicare x-rays! Dynamic Chiropractic, Aug 25, 1997.
5. Angell M, Kassirer J. Alternative Medicine—The risks of untested and unregulated remedies. New England Journal of Medicine 339:839-841, 1998.

This review was originally published iin the Fall/Winter issue of the Scientific Review of Alternative Medicine. A revised second edition of the book was published in 2002 and republished in 2005.

This page was posted on December 23, 2007.