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Chiropractic: A Fantasy and Delusion
It is an anachronism that an article titled, "Finding a Good Chiropractor"1 would appear in the January/February issue of the ARCHIVES.
This pseudoscience that has tried to make itself over has failed in its attempt. There never has been a double-blind placebo-controlled study that shows any benefit for this illogical unproved therapy. As a matter of fact, the few studies that have searched for the illusory "subluxations" on the old technology of plain films or even the newer imaging studies have never found any documented difference between the "before-and-after" studies.
The ARCHIVES demeans the science and art of medicine with the publication of such poorly researched articles. These types are parasites just as surely as the acupuncturists, naturopaths, astrologers, herbalists, and phrenologists that prey on the innocent—often at government expense.
That is not to say that a good massage or the technique of simple "touch" is not therapeutic. It does mean that we do not require an "adjustment" every 6 months for "chiropractic health."
The infamous RAND Corporation study was cited as proof of chiropractic utility. This particular study was merely a literature review and was lacking in many respects.
No physicians should ally themselves with this unscientific fringe. Merely because chiropractors have been licensed in most states does not make their nostrums and incantations blessed. They have spent heavily for their meager influence with some of the state legislatures.
The American Medical Association makes itself less meaningful to most of us when it launches an article with so much half-truth as this piece. I would appreciate a response.
Tad Lonergan, MD
Desert Hot Springs, Calif
1. Homola S. Finding a good chiropractor. Arch Fam Med. 1998;7:20-23.
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In reply
I felt I made it clear that there is no evidence supporting the chiropractic theory that vertebral subluxations can cause disease. And I tried to make it clear that I do not support the use of chiropractic adjustments as a method of restoring and maintaining health.
As Dr Lonergan said, and as I said in my article, the 1991 RAND Corporation study was a review of the literature, which supported the use of spinal manipulation for some types of back pain.1
The 1994 report on back pain by the Agency for Health Care Policy and Research was also a review of the literature, and it drew conclusions that were identical to those of RAND.
Both the RAND Corporation and the Agency for Health Care Policy and Research reports offered support for the use of spinal manipulation in the treatment of back pain but not for chiropractic adjustments as a method of treating illness.
Although the RAND study reported that "no evidence to date conclusively proves the effectiveness or lack thereof for the use of spinal manipulation to treat back pain," the report concluded that there is evidence to indicate that spinal manipulation can be a useful modality in the treatment of carefully selected back problems.2
Until spinal manipulation becomes more readily available in medical practice, there is nothing to be gained by denouncing efforts to limit chiropractors to appropriate use of spinal manipulation. Treating back pain with spinal manipulation should not be equated with the use of chiropractic adjustments as a treatment for disease.
I had hoped that my article on chiropractic would help physicians avoid the type of chiropractor Dr Lonergan describes while at the same time offering advice on how to find a properly limited chiropractor.
While I agree with Dr Lonergan's criticisms of the chiropractic theory, I do not think my article supported the use of "nostrums and incantations." His criticisms ignored the basic message of my article. Patients with back pain should not be denied treatment with spinal manipulation when it is indicated. But such treatment should be separated from adjustment of illusory chiropractic subluxations.
Samuel Homola, DC
Panama City, Fla
1. Shekelle PG, Adams AH, Chassin MR, Hurtwitz EL, Phillips RB, Brook RH. The Appropriateness of Spinal Manipulation for Low-Back Pain: Project Overview and Literature Review. Santa Monica, Calif: RAND Corp; 1991.
2. Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults. Rockville, Md: Agency for Health Care Policy and Research; 1994. AHCPR publication 95-0642.
Arch Fam Med. 1998;7:405-406.
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