Robert Todd Carroll
The basic theory of chiropractic is that "subluxations" are the cause of most medical problems. A "subluxation" is a misalignment of the spine that allegedly interferes with nerve signals from the brain. Chiropractors think that by adjusting the misalignments they can thereby restore the nerve signals and cure health problems. This theory was first propounded in 1895 by D.D. Palmer, a grocer from Davenport, Iowa. There is little scientific evidence to support the theory. Most support for the theory comes from testimonials of people who claim to have been helped by chiropractic. Whether they were helped because nerves were "unblocked" is not always that clear. Most of these have been people with back pain that has been alleviated by spinal manipulation. This is not to say that chiropractors don't help people with aching backs, including people with chronic back problems. It is the theory of subluxations that has not been supported by scientific studies.
The theory of subluxations maintains that all health problems are due to "blockage" of nerves. It is true that nerves from the spine connect to the organs and tissues of the body and it is true that damage to those nerves affects whatever they connect to, e.g., severe the spinal cord and your brain can't communicate with your limbs, though your other organs can still continue to function. Chiropractic is often holistic and is based upon the belief that the body is basically self-healing. Hence, drugs and surgery are not recommended except in extreme cases. Spinal manipulation allegedly unblocks nerves so the body can heal itself. Chiropractic seems like a materialistic version of Chinese acupuncture used to unblock chi, or therapeutic touch to channel prana. The chiropractor's "needles" are his or her hands and fingers, manipulating nerves rather than the flow of chi. However, the chiropractic theory of subluxations seems to be empirically testable, unlike the metaphysical theory of acupuncture unblocking chi. Why, then, has traditional medicine opposed chiropractic for the most part? Chiropractors rarely are in joint practice with medical doctors, and they are almost never on staff at hospitals. Is there a conspiracy on the part of the American Medical Association (AMA), who fear chiropractors will dip into their profits, as many chiropractors maintain?
The AMA, of course, is partly responsible for chiropractic's reputation as quackery. For years, the AMA made no bones about their disapproval of chiropractic, which was featured in their Committee on Quackery. But the chiropractors fought back and won a significant lawsuit against the AMA in 1976 for restraint of trade. Today, the American College of Surgeons has issued a position paper on chiropractic which sees the two professions as working together. Privately, many battles continue between the medical profession and chiropractic, but publicly the AMA no longer attacks chiropractic. In fact, the AMA may have been shell shocked by the victory of the chiropractors in the courtroom. For, today numerous so-called "complementary medicine" techniques are being allowed to flourish in hospitals and medical clinics around the country without a word of protest from the AMA. The National Institutes of Health has a flourishing division for testing even the most unpromising of alternative health practices. Chiropractors and other "alternative" practitioners have learned one thing from the AMA: it pays to organize and to lobby Congress and state legislatures. The AMA is still the most powerful lobby among health care professionals, but it is no longer flying solo. Even so, the AMA's lobbying is not the only reason that chiropractic's public image has suffered.
For years chiropractors relied more on faith than on empirical evidence in the form of control studies to back up their claims about the wonders of nerve manipulation. This is changing and to some extent so is the relationship between the medical profession and chiropractic. There is a growing body of scientific evidence that chiropractic is effective in the treatment of many lower back ailments and neck injuries. There is some evidence that chiropractic is effective for the treatment of certain kinds of headaches and other pains. The chiropractor is one of the few alternative health practitioners that medical insurance will generally cover. However, the likelihood that diseases such as cancer, for example, will ever be attributed to nerve blockage seem extremely remote. Making extravagant claims about the wonders of chiropractic, or references to the flow of "life forces" which heal the body or to such notions as "bio-energetic synchronization," are not likely to contribute to the advancement of the discipline into mainstream medicine. Likewise, making claims such as that germ theory is wrong, a common chiropractic claim, does little to make chiropractors seem like advanced medical practitioners. To ignore bacteria and viruses, or to underestimate the role of microbes in infections, as chiropractors are wont to do, are not likely to advance their cause. Every misdiagnosis or mistreatment by a chiropractor undermines the whole profession, rather than only the individual malpractitioner, because of the contentious nature of the theory of subluxations.
There are, of course, horror stories featuring medical doctors. However, very few people take such stories as indictments of the entire profession. They are seen as aberrations, not typical. This is not likely due to the better lobbying efforts of the AMA or to a conspiracy to control the press. It is most likely due to the experiences most people have had with medical doctors and the generally positive effects of modern medicine. In many cases, medical doctors take much greater risks than any chiropractor ever will. Hence, failures by an M.D. can be disastrous or even fatal; rarely will that be the case for a chiropractor. Though this may well change if the current push by chiropractic to become primary care practitioners for infants and children is successful. Pediatrics is much riskier than manipulating the spine of an old man who is there because he doesn't want surgery and he wants to play golf that afternoon.
In short, chiropractic remains controversial, though not in all areas of its practice. It has firmly established itself as an effective treatment for lower back pain. It is attractive because there is no danger from side effects of drugs, since chiropractors don't generally recommend drugs to their patients. It is also attractive because it is seen as an alternative to surgery. And it is attractive because it is generally less expensive than treatment by a physician with drugs or surgery. Though, it should not be assumed that all medical doctors are quick to prescribe drugs or surgery. Many, like their chiropractic brothers and sisters, will recommend selected exercises for specific back problems.
See related entry on alternative health practices.
Jarvis, William. "Chiropractic: A Skeptical View," in The Hundredth Monkey, ed. Kendrick Frazier (Buffalo, N.Y.:Prometheus Books, 1991), pp. 262-270.
Magner, George. Chiropractic : the victim's perspective; edited by Stephen Barrett ; with a foreword by William T. Jarvis. (Amherst, N.Y.: Prometheus Books, 1995).
Smith, Ralph. At Your Own Risk: The Case Against Chiropractors, (New York: Simon and Shuster, 1984).
Consumer Reports (September 1995), article on lower back pain.
Robert Todd Carroll