Inside the spine wizard’s den
The first thing that struck me, when I visited a chiropractor recently, was that the surgery looked almost exactly like a normal doctors’ surgery. The only difference was a folder full of glowing customer testimonials sitting on a low table in the waiting room, together with a supply of the General Chiropractic Council’s Patient Information Leaflet – the one that was the subject of a successful complaint to the Advertising Standars Authority (ASA). The leaflet was in Polish but that hasn’t stopped it finding its way to the ASA.
I’ll call the chiropractor I was booked to see ‘Jim’. He called himself ‘Dr Jim’ and that’s also how he was referred to by surgery staff.
That some chiros should misrepresent themselves as doctors is altogether in keeping with the clumsy word that is ‘chiropractic’. In Classical Greek cheiro means ‘hand’ and praktic means ‘action’. Ignoring the rules of declension of Greek nouns, D.D. Palmer slammed these two words together to forge a name he felt accurately represented his therapy and, as a bonus, gave it an aura of ancient wisdom and culture. Nice idea, D.D., but as a name it sucks. ‘Hand action’ could just as easily apply to reiki, reflexology or any other um…manual activity.
Until a few years ago I assumed, when I heard the words ‘Dr X, a chiropractor’, that they referred to a doctor of medicine who specialised in a fully recognised branch of medicine. The closest I had ever got to a chiropractor was when a friend was referred to one by her GP, to treat her sciatica. The treatment she received didn’t help at all and she was peeved but I didn’t think anything of it. No therapy has a 100% success rate and there was no reason to think she hadn’t seen a medical specialist. If I’d thought about it at all, the GP referral would have reassured me that chiropractic is a fully established medical specialty like dermatology or rheumatology.
The alarm bells only rang when I saw one of their stalls in a shopping centre one day, complete with chiros touting for business. I surely can’t be the only person who finds it utterly weird that people claiming to represent a serious health discipline behave so evangelically and hang around public places hustling, though, come to think of it, D.D. Palmer did say something about possibly making chiropractic a religion. What I didn’t know until recently was how chiropractics use ‘bait and switch’ to gain respectability. At these public promotional events, they focus plausibly on muscular-skeletal conditions and give the impression they are something to do with physiotherapy. Given their low cost introductory offers, why wouldn’t anyone with a chronic ache or pain give them a go? Once they’ve lured people into the surgery they start talking nonsense about subluxations and how these cause all manner of conditions that have nothing to do with the spine.
I didn’t give chiropractic another thought until the BCA took the momentously stupid decision to sue Simon Singh, thereby exposing the dearth of scientific evidence for claims blithely made by its members and inspiring thousands of open-minded and concerned people like myself to do some serious research.
It was in that spirit that I submitted to a free spinal check by a chiro outside Sainsburys a few months ago and was told that treating the ache in my shoulder (which I knew was caused by my poor posture while using my laptop) would probably need a series of expensive appointments. I turned down the special offer of a £30 introductory appointment and bought a £15 lap top table instead. The ache soon went away but I kind of regretted not taking advantage of the offer just to see what they did. So, when I saw a different bunch of chiropractors offering an even cheaper deal in another shopping centre recently, I jumped at the chance to broaden my understanding of chiropractic.
‘Dr Jim’ is handsome and charismatic, if somewhat inarticulate when answering unsolicited questions about chiropractic. Nevertheless, he delivered his well-rehearsed spiel with charm and confidence and I’m sure that, if I hadn’t known he was talking crap, I would have believed every word of it. I tried to be as convincing in my own role as a potential customer but it wasn’t easy, given that there was nothing whatever wrong with me. Overall, I was impressed at the thoroughness of Jim’s questioning and the checks he did on my flexibility which, as he acknowledged, is extremely good. I am in my fifties with an athletic build and a healthy weight. I can effortlessly place my hands flat on the floor without bending my knees while standing, for example. He was similarly impressed by my blood pressure reading and with my reflexes. (Edit: I have since been examined by a neurologist and now realise Jim’s testing of my reflexes were very limited in comparison to the real doctor’s).
I asked him about the “lump” in my neck his colleague had found at the initial check in the shopping mall. He said my neck felt good but there was some tension in my occiput. He guessed that I spent long hours in front of the computer and said something about the dangers of degenerative disease if problems are left untreated. However, he was less concerned about my neck than about the “occasional lower backache when standing for a long time,” which I’d invented as a cover story just to see what he’d say about it. It was easy to describe because I used to get it fairly regularly until I was liberated by the menopause.
Jim wanted me to have two x-rays – one from the front and one from the side – so he could “see what’s going on”. I asked him what he’d be looking for and he replied with a clumsy explanation of how stiff joints in the lower back resulted in nutrient loss to the invertebral discs and this could lead to osteoarthritis.
Jim conceded he couldn’t actually feel anything that alarmed him but he wanted x-rays to check the state of the discs for signs of injury or wear. “If we can catch it at an early stage we can slow down or halt the degeneration”. He’d also be looking for any “misalignments”. He would see if there were “any curves or twists or rotations” because he could “make corrections” to those.
On the wall of his large surgery was a poster featuring a picture of a spine with a ‘subluxation’ circled in red. The text read,
A subluxation. The silent killer. Chiropractors correct subluxations.
Dr Jim – bless him – earnestly explained how the nerves in the spinal column control everything and send messages to other parts of the body. A subluxation, he said, is a misaligned joint or area of inflammation around the joint that stop the nerves doing their job properly. Thus, “any irritation or damage to the middle part of the spine can send a message to the digestive system to not work so well.”
I imagine any chiros reading this will be nodding sagely in agreement with Dr Jim, while any skeptics will be snorting at the preposterous notion that adjusting the spine will cure a digestive problem. So it seems a good place to post a link to a recently-published epidemiological study on the chiropractic subluxation. Three of the four-strong team of researchers are chiropractors, the fourth is an associate professor of physical education.
From the conclusion:
No supportive evidence is found for the chiropractic subluxation being associated with any disease process or of creating suboptimal health conditions requiring intervention. Regardless of popular appeal this leaves the subluxation construct in the realm of unsupported speculation. The lack of supportive evidence suggests the subluxation construct has no valid clinical applicability.
I guess Dr Jim hasn’t seen that one yet.
I refused the x-rays. Jim made reassuring noises about both the cost – I was entitled to one free one as part of the special offer – and the low dosage of radiation. He suggested I talk it through with my husband (who was in the waiting room inspecting leaflets) and do some internet research on radiation. He very kindly said that he would keep the special offer open for a while in case I changed my mind. “Just call the surgery and ask to speak to Dr Jim,” he said, soothingly.
Trying to keep intact my cover as a naïve but curious shopper, who’d been lured by the special price introductory appointment, meant I had to be careful about what I said. One thing I had to bite my tongue over was his repeated use of the ‘Dr’ title. I believe chiros use this ‘courtesy title’ duplicitously to give the impression that chiropractic is an established branch of medicine but I wasn’t about to destroy our comfortable rapport by telling him that.
Nor did I question the ethics of his trying to persuade me to have x-rays simply on a report of an occasional lower back pain that I’d said was causing low-level nuisance – especially when he said he’d felt nothing untoward and I was obviously in good condition overall. I don’t know how relevant any family history of osteoarthritis would be but I’d already told him there’d been nothing like that in my extended family.
And I decided not to mention the report of the RCT by Hancock et al on lower back pain, which concluded:
Neither diclofenac nor spinal manipulative therapy gave clinically useful effects on the primary outcome of time to recovery.
This study was cited by the GCC Review but I don’t suppose Jim was familiar with it.
Instead, I inquired amiably about one of the posters on the wall, which indicated that chiropractic was suitable for babies.
It was the claims that chiropractic can treat various childhood ailments – including colic and ear infections – that were challenged by Simon Singh in the Guardian back in April 2008, resulting in a libel action by the British Chiropractic Association. The BCA claimed there was a “plethora of evidence” for the claims but they turned down the Guardian‘s offer of a 500-word reply, preferring instead to resort to the law to try to shut Simon up. To their dismay, Simon is defending the action. At an Appeal Court hearing last week, I sat behind Richard Brown of the BCA and observed the tension build up in his occiput as he helplessly watched his counsel take a battering from the Lord Chief Justice himself. His Lordship proclaimed he was “baffled” that, since the BCA were so concerned about the effect Simon’s article had on their reputation, they hadn’t taken up the offer of a reply at the time. His Lordship was ostensibly unaware that the supposed “plethora of evidence” has already been comprehensively demolished outside the courtroom.
Nevertheless, a poster on the wall of Jim’s room quoted extensively from two studies to the effect that chiropractic cured a range of conditions in babies. Here’s a sample:
Subluxations were found to be the cause of several health problems, including tonsillitis, vomiting, hyperactivity, sleepiness, lower resistance to infections especially ear, nose and throat infections.
Subluxations: a serious interference with normal communication from the brain to the body. This interference may cause sickness and disease. No-one, especially a child, should have to live with subluxations. Have your family checked for subluxations frequently.
Refs: Hendricks, C.; Larkin-Thier, S Otitis Media in Young Children Chiro: The J of Chiro Res & Clin Invest 1989; 2 (1): 9–13 J Am Osteopath Assoc. 1966 May;65(9):964-72. Manipulative therapy of upper respiratory infections in children.
Anyway, at the mention of babies, Jim began animatedly telling me that he’d been “adjusting” his baby daughter since the second day of her life to keep her spinal function and nervous system working properly. He said chiropractors saw many colicky babies and this was often related to stomach problems and was the consequence of subluxations caused through prolonged labour or the birth process. He also saw many kids with ear infections and chest infections.
“Can you actually treat ear infections? I asked.
He replied that it depended on the cause and whether there is pressure on the nervous system because there are “other things in the body that can create those symptoms” and that’s why a detailed examination is necessary. “Children are resiliant,” he added, “They bounce back really quickly and we tend to see changes in kids very fast.”
I asked him how he knew the chiropractic was benefitting them and they weren’t just getting better anyway,
“…or is that a silly question?” I added, sheepishly, for effect.
“No, it’s a good question,” he reassured me.
He didn’t answer it, though. Instead, he launched into some irrelevant anecdote about a kid he’d treated who’d got better, which proved nothing either way. In full kamikaze mode, he went on to say how problems in older people that have been there a while are harder to shift. In other words, he can successfully treat healthily growing children who’d probably get better anyway but frail, ageing people who probably won’t get better anyway are more difficult. Sounds about right.
Yet another poster on the wall of Jim’s room had a picture of two x-rayed spines. One was a 49-year-old spine and the other was 75 (allegedly). I couldn’t see a difference between them but the text helpfully explained that the younger one was suffering “loss of curve and spinal decay” while the 75 year-old had benefitted from years of maintenance care. “Preventive chiropractic care can help with many types of health problem,” read the text.
Sure enough, the appointment ended with Jim giving me the hard sell about the usefulness of regular chiropractic and emphasising that they didn’t just want people to come in when they were in pain but also when they didn’t so he could teach them how to take care of themselves.
In conclusion, chiropractors are fake doctors practising a questionable therapy with a pretentious name that was chosen to enhance its brand appeal while proselytising to the hapless public. In common with other alternative therapists, chiropractors encourage people who are perfectly well to part with cash for unnecessary treatment in order to keep perfectly well. Oh…and they may be successful in treating self-limiting conditions.
I’m not saying that everything every chiropractic does to anyone is worthless, I’m saying that the theory of chiropractic, which seems to have evolved only slightly from D.D. Palmer’s time, is nonsense and the fact that chiropractics may have picked up some useful techniques in treating muscular-skeletal problems along the way, doesn’t make the ‘subluxations cause ear infections/digestive problems/whatever and these can be cured by adjustments’ hypothesis any less unhinged nor those who promote it as if it were a scientific truth, any less irresponsible.
Finally, I recommend as a more reliable source of information than any chiropractor’s website I’ve seen, the newly set-up Discover Chiropractic website.
- Updated 4.3.10: I recommend this fascinating article by a retired chiropractor. I wish I’d seen it before I wrote the above. Science based chiropractic: an oxymoron?