This year sees the centenary celebration of D.D. Palmer’s great work entitled, The Science, Art and Philosophy of Chiropractic, in which he claimed that “A subluxated vertebra… is the cause of 95 percent of all diseases… The other five percent is caused by displaced joints other than those of the vertebral column”. Not that I’ve noticed any chiropractors celebrating.
A few months ago I visited a chiropractor just to see what would happen. I blogged the whole episode here but, in a nutshell, I told him I had come out of curiosity, taking advantage of a special offer £20 introductory appointment, which was being touted in a shopping centre on a busy Saturday. As a cover story I mentioned I had occasional lower backache but it wasn’t really a problem, I was just curious to see if he could explain it. He asked a lot of questions and wanted me to have a couple of x-rays. I declined. He gave me the hard sell on the importance of regular chiropractic care to prevent degenerative disease. I listened and nodded politely then left and that, as far as I was concerned, was the end of the matter.
But there’s apparently an old adage I didn’t know about until it was mentioned by someone on the Bad Science forum. It goes like this:
Q: What do you get if you visit a chiropractor?
A: Another appointment.
Like everyone else, chiropractors have a living to earn. Of course, most of us don’t try to make a living delivering an unnecessary and scientifically unsupported therapy to people who don’t need it. But I guess those who do aren’t going to let anyone who’s already set foot on their premises had both feet through the door get away without at least one more attempt to lure them back.
Here’s a letter I received from the Clinic Director.
I have recently reviewed your case records and it appears that you have discontinued your care programme. Of course I sincerely hope that you are doing well and will not suffer any setbacks.
We feel a responsibility to every patient that consults and I am therefore concerned that your symptoms may reappear or your condition may become chronic due to your not visiting the clinic for care. I would be happy to discuss your case with you if you so wish either by telephone or in person if you would prefer to pop into the clinic. If you choose the latter simply call the Front Desk to schedule some time. They will be happy to help you.
Whatever your decision I want you to know that we stand ready to be of assistance to you at any time in the future.
How caring and concerned they are! Introductory appointments at that place cost £95 a go. Subsequent appointments are likely to be cheaper and will no doubt seem like a bargain in comparison.
I toyed with the idea of ringing her up to ‘discuss my case’ just to see if she would continue to give me the hard sell or whether she’d do the decent thing and say, “Well, if you’re not suffering any symptoms or problems, there’s no need to come back” but I couldn’t be arsed. These are people who give up their Saturdays to harangue shoppers into submitting to having their spines “checked” (i.e. poked and prodded through several layers of clothing) and then do their damndest to get you to make an appointment at their clinic. If she’d actually read my case notes, she shouldn’t have sent the letter in the first place. The fact that she did is enough to persuade me that the primary concern here is not getting people well but getting them to part with their cash.
So I responded with an email:
“Thank you for your recent letter soliciting my further custom.
I was surprised to receive this given that I had only had one initial appointment, which I booked as a result of the special offer you had been promoting in Brent Cross shopping centre the previous week. I booked this appointment more out of curiosity than anything else and I had not started any ‘care programme’.
However, I welcome this opportunity to raise a couple of concerns with you.
When I visited your premises for an appointment with Jim, I noted a number of posters on the wall of his room containing what appeared to be misinformation about ‘subluxations’.
One of them said:
“A subluxation. The silent killer. Chiropractors correct subluxations.”
“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 interence 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.”
Yet another claimed that, “Preventive chiropractic care can help with many types of health problem.”
Jim’s responses to my various questions were in keeping with the hypothesis that so-called subluxations can cause all manner of ailments.
However, the most recent research on the subject of subluxations concludes:
“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. This lack of supportive evidence suggests the subluxation construct has no valid clinical applicability.”
Ref: Mirtz et al, Chiropractic & Osteopathy 2009, 17:13doi:10.1186/1746-1340-17-13
As I’m sure you are aware, the General Chiropractic Council recently issued guidance to members:
>>GUIDANCE ON CLAIMS MADE FOR THE CHIROPRACTIC VERTEBRAL SUBLUXATION COMPLEX
The chiropractic vertebral subluxation complex is an historical concept but it remains a theoretical model. It is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease or health concerns.
Chiropractors are reminded that
* they must make sure their own beliefs and values do not prejudice the patients’ care (GCC Code of Practice section A3)
* they must provide evidence based care, which is clinical practice that incorporates the best available evidence from research, the preferences of the patient and the expertise of practitioners, including the individual chiropractor her/himself (GCC Standard of Proficiency section A2.3 and the glossary)
* any advertised claims for chiropractic care must be based only on best research of the highest standard (GCC Guidance on Advertising issued March 2010)<<
In light of this guidance, I trust the posters will be binned.
(Jim isn’t his real name).
The news that the subluxation was dead in the water emerged a few weeks ago in a correspondence between the GCC and Skeptic Barrista, who very helpfully blogged about it here. Zeno wrote a comprehensive obituary here.
D D Palmer, inventor of the original subluxation, was a snake oil salesman. He based his invention on an idea that we know now to be wrong: that all bodily functions are controlled by the nerves. He thought he could feel bones out of place in the spine and decided for no good reason that these so-called misalignments — which he decided to call subluxations — were the cause of most cases of disease. Funnily enough, these chiropractic subluxations, didn’t show up in x-rays, an inconvenience chiropractors addressed by changing the definition of subluxation from the partial dislocation that Palmer imagined to
A lesion or dysfunction in a joint or motion segment in which alignment, movement integrity and/or physiological function are altered, although contact between joint surfaces remains intact. It is essentially a functional entity, which may influence biomechanical and neural integrity.
Source: The World Health Organisation quoted by Wiki.
But that was a long time ago — well before the BCA’s libel action against Simon Singh forced the spotlight onto what chiroquacks have been getting away with and the subsequent campaign to get them to clean up their acts.
How are chiropractors responding to the news of the old subby’s demise? The answer is ‘predictably’. This is the response I got to my email:
Thank you for your email. We have indeed received the information from the GCC regarding the use of the term subluxation until more research supports the concept. Of course we have already removed the posters, as I am sure many other clinics will be, to make sure we are in compliance of all GCC regulations.
I take this to mean that the chiros at this particular practice will stop using the word and quite right too. But I am not reassured that they won’t do what other chiropractors have been doing for a long time and use any number of synonyms: “joint misalignment, joint dysfunction, facet syndrome and articular derangement” are the examples helpfully provided by the GCC to mean pretty much the same thing, even though the correspondence from the GCC to Skeptic Barista makes it clear that there is no clinical research evidence to support the concept whatever it is called. Understandably, the writer of the email to me is ostenisbly optimistic that one day there will be evidence that supports the concept and maybe there will be. Give them time. They’ve only had 100 years so far.