Why I Quit Chiropractic
Although I have a chiropractic degree from Life University in Marietta, Georgia, I do not encourage students to enter the profession. It took me a long time to learn the extent to which chiropractic is riddled with problems. Students and prospective students may not realize this because the schools and many practitioners paint an overly optimistic picture of what awaits new chiropractic graduates in the real world.
At the time I attended, Life encouraged its alumni to recruit prospective students from their practices. Successful alumni were given rewards such as a white distinctive blazer with the school's crest. My own chiropractor was one of these supporters. She told me that chiropractic was based on legitimate scientific principles and that I would receive the best chiropractic education at Life. Admissions materials from the school described it as providing a thorough education in the diagnosis and care of patients so that their health would be improved by removing nerve interference. These assertions were all false.
My Chiropractic School Experience
During my college years, the only negative information I encountered about chiropractic was Ralph Lee Smith's book At Your Own Risk: The Case Against Chiropractic in the local library. But my chiropractor advised me to disregard it because it was inspired by a "witch hunt" against chiropractic by the American Medical Association. She also said that a recent verdict in an antitrust suit against the AMA had proved this was true. Years later, I learned that this was completely untrue and that the judge had actually remarked that the AMA had had legitimate grounds to attack improper chiropractic practices.
Career almanacs and handbooks favorably describe chiropractic as a promising career and do not mention any negative information. Because I encountered almost no negative information and trusted the fact that the college was accredited, I did not think to question the validity of chiropractic theory. Later I learned that most of the information in these career guides originates from chiropractic organizations themselves and portrays the profession in an unrealistically positive light.
Students at Life University (and many other chiropractic schools and postgraduate programs) get an intense indoctrination into the chiropractic belief system. They are exposed to contradictory chiropractic systems and are encouraged to find one that they can support even if they disbelieve the others. My instructors taught that all the techniques were effective and encouraged us to use whatever method we liked, based on personal preference and patient responses measured with chiropractic assessments. Whether or not methods were evidence-based was irrelevant.
Accreditation standards say that one objective of chiropractic education is to acquire the ability to critically evaluate research. However, I have observed just the opposite. For example, after taking several postgraduate seminars, I realized that several commonly used chiropractic analysis procedures had been proven unreliable. But when I tried to share this information with my classmates, they immediately discounted all negative research as fraudulent. Instructors at the college actually taught them how to do this in chiropractic philosophy indoctrination classes. Before long, my well-intentioned discussions resulted in excommunication as a heretic by many of my classmates.
My program at Life program seemed like that of any other school and I had no major problems until about halfway into the curriculum. During the eighth quarter of the 14-quarter system, the program became much more adversarial as we entered the outpatient clinic. This was our internship, where we were supposed to gain our clinical experience by treating the public. In earlier quarters, the school had taken extra effort to make us feel welcome. We were treated to free lunches, guided tours of the campus by friendly enthusiastic students, and free lodging when touring the campus. The clinic atmosphere was different. The instructors made it very clear that unless a long list of rules was followed, we would face suspension from the clinic and possible failure of that quarter's clinical internship. Infractions were outlined in a student handbook. Violations would result in either a warning or a suspension—known as a "pink slip." This system was unbelievably harsh. Students could find themselves suspended from clinic for such minor mistakes as forgetting to empty a cup of urine, not filling out a form completely, missing an appointment because of a miscommunication with a patient about the appointment date, or even wearing casual slacks rather than dress slacks.
In addition to this harsh system of rules, students were kept constantly busy by the demands of the clinic, academic classes, and national boards. My typical day would be to arise at 6 am, arrive early in the clinic in order to secure a place on a walk-in list for new patients. After doing this I would sit on a stool at one of four telephone stations where I and up to three other students would take turns answering the clinic's one telephone with the hope of finding new patients to treat.
Students who were not recruiting enough patients to pass the course became desperate. A large wooden sign hung in the hallway with carved letters that read "Whatever It Takes." Instructors advised us to use direct solicitation. They encouraged us to visit drugstores and to target people in pain. This approach was often difficult, because many local residents had been solicited so often that Life students were regarded as desperate and fanatical. Successful students targeted faculty and families with young children who could receive care at discounted rates. Many students paid their patients' clinic fees out of desperation.
In retrospect, this system of strict rules and harsh punishments resembles descriptions of how cults operate. Since students were kept busy, they had little time to question the teachings of the group; and the Draconian punishments encouraged conformity. Up to 30% of students failed this class and had to pay to retake it.
Like many other students, I was unable to find enough patients to pass that first clinic and was very frustrated. This problem, combined with the school president's prohibition against many common treatment methods that I wanted to learn, led me to consider transferring to the Los Angeles College of Chiropractic. I found, however, that despite having excellent grades, I would lose an entire year of school if I did that. Wishing to keep expenses to a minimum, I decided to finish the program.
As I reached my final terms, I wondered why, despite being in the upper part of my class, I found the diagnosis sections of the National Boards difficult. Ten months after graduation I was shocked when—despite graduating Magna Cum Laude and spending eight months studying—I failed Part IV of final national board exams, a requirement for practice in most states. After completing a review course, I retook and passed the test and began seeking employment, expecting to work with chiropractors skilled in rehabilitation and gain valuable clinical experience to compensate for the limited training I had received in school. Unfortunately, this proved incorrect, because the chiropractors who hired me misrepresented themselves.
My Work Experience
The first chiropractor I worked for —also a Life graduate—used me and other new graduates as a front to bilk insurance companies out of millions of dollars. He never told me that the guidelines he had us follow for treating auto accident patients were illegal. It must have been a lucrative scam for him, because the state board investigators told me that he caused the licenses of two associates to be revoked for fraudulent billing. Luckily, I stayed in close contact with the board and his license ended up being revoked, not mine.
I subsequently worked for two other chiropractors. One was a Scientologist who tried to get me to join Scientology in Los Angeles. This man told patients that chiropractic adjustments could cure multiple sclerosis, acne, and heart disease. The board revoked his license after learning that he had tried to conceal a license revocation in another state. The other chiropractor, who ran a clinic for patients with chronic back pain, ordered me to overutilize expensive nerve-conduction tests to boost the clinic income. When I balked at ordering unnecessary tests, I was fired. The Kentucky chiropractic licensing board was not interested in prosecuting him.
I once believed that I could teach myself differential diagnosis and follow scientific treatment guidelines. Later I learned that this was not possible without exposure to expert faculty and actual patients. Refusing to be a quack or a thief, I had serious doubts about whether to remain a chiropractor. In 2003, I gave it one more try by accepting a position with a graduate of National University of Health Sciences (one of the better chiropractic schools) who was certified in "chiropractic sports medicine." But I soon learned that:
- He routinely used scare tactics, such as warnings about "subluxations" and "nerve interference," to promote lifetime maintenance care, even for small children.
- Everything he said to patients was carefully scripted to induce compliance.
- He falsely coded patient records so he could be paid for treatment that insurance companies considered unnecessary.
- His x-ray films were of poor quality.
His office manager told me that the chiropractor had failed to identify the cause of her mother's back pain, which turned out to be a cancer that caused her death. I suspect that better-quality x-rays might have revealed that the pain had been caused by metastatic tumor. So, despite this chiropractor's training at a more academically inclined school, he performed no better than the rest. Disgusted with his unethical conduct, my own lack of training in differential diagnosis, and the anti-science orientation of the field, I resigned and quit the profession for good.
Further Observations and Beliefs
While reflecting on my experiences, I remembered the glowing claims from the admissions materials that Life had initially sent me and decided to revisit them. I now believe that the school was training unknowing students to engage in practices that were unethical and dangerous. Life University has been teaching that chiropractors should not perform differential diagnosis (listing possible medical conditions and doing what is necessary to determine whether they are present)—a policy that places patients at considerable risk. Concerned about this problem, I encouraged students to seek corrective action. One article I posted on Chirobase encouraged graduates to challenge these problems with a class-action lawsuit. This caused quite a commotion at the college and encouraged faculty and students to speak out against policies of Sid E. Williams, D.C., the school's president. Life's heavy-handed response triggered complaints to the school's accreditor, the Council on Chiropractic Education (CCE), which performed a site visit and revoked Life's accreditation status. Unfortunately, in 2002, Life claimed unfair treatment and sued the accreditor for $100 million dollars. The suit ended in a confidential settlement where Life's accreditation was restored and the accreditation agency claimed that all of the problems had been corrected for later classes.
At the time of Life's 2002 accreditation troubles, I submitted my own complaints which illustrated how the same problems existed as early as 1992 when I began classes. I estimated that 8,000 Life graduates were inadequately trained in diagnosis, posing a serious threat to their patients because they might not refer patients to medical practitioners in a timely manner. As students, these chiropractors were also taught to take unnecessary x-rays of pain-free areas (to find "subluxations") and to advise patients to discontinue prescription medications.
The handling of my complaints provides a lesson in how ineffective the current regulatory system is. My initial complaint to Life went unaddressed. A follow-up complaint to the CCE regarding Life's lack of action was stonewalled for months. My subsequent complaint to the U.S. Department of Education (DOE) regarding CCE's excessive stonewalling, which violated DOE's guidelines, forced CCE to verify that my complaints against Life were valid and produced a statement that they had corrected the problems in the present. Alarmed that past graduates were not warned that they would be held personally liable for malpractice, I asked DOE to have CCE retroactively strip the accreditation of the program for the affected students and offer some kind of remediation. DOE responded that they do not require accreditation agencies to do such things. The end result is that the CCE and the DOE have covered up the fact that thousands of Life graduates have entered practice without even a rudimentary knowledge of how to diagnose properly.
The Bottom Line
Having personally observed the activities of scores of chiropractors and their organizations, I am convinced that:
- Chiropractic's legitimate scope of practice is too limited and its adherence to pseudoscience is too entrenched to promote optimal physical medicine
- Many chiropractic institutions encourage (or fail to discourage) unethical practices.
- Despite years of education, most chiropractors lack the knowledge and ability to provide quality care and many have enormous student loan debts. (Chiropractic graduates have the highest student loan default rate among the health professions, with Life's graduates having the highest number of defaulters and the highest total amount.)
For these reasons—and more—students who are interested in manual medicine would be much wiser to pursue physiatry, osteopathy, or physical therapy as as career.
Dr. Botnick attended Life College from 1992 to 1996. His article about the school's assemblies provides a vivid description of the school's atmosphere. His Chirotalk Forum contains additional views about whether chiropractic should be abandoned.
This page was revised on December 30, 2007.