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I have studied the activities of chiropractors for nearly thirty years. I became interested while teaching health and physical education at a boarding school. As a gymnastics coach, I had noted that manipulative therapy seemed to help certain athletic injuries. In time, a neighborhood chiropractor began indoctrinating me. Although I had a master's degree in health education, my coursework had never covered chiropractic. I began reading everything I could find on the subject. The health-education literature was highly critical of chiropractic, but my mentor attributed this to prejudice. So I explored chiropractic literature to see what chiropractors said about themselves. What I saw convinced me that chiropractic was a cult whose participants were often victimized by their own misguided philosophy and training.
My doctoral dissertation, completed during the early 1970s, was based on a study assisted by nineteen chiropractors. My close association with these practitioners persuaded me that they were basically honest, hard-working, well-meaning individuals who believed that their treatment was effective even though no scientific studies had tested this belief. One of the chiropractors even acknowledged that the trouble with chiropractic was that it had never been proven scientifically. "What I do is treat patients the way I was taught," he said candidly. "Those who like it come back, those who don't like it do not. Enough people come back to keep me busy, so I must be helping them."
Many of these chiropractors proudly told me about patients who were almost miraculously relieved of their pain and dysfunction. When I asked whether they could tell which patients or conditions were likely to respond to their methods, all said they could not. How sad, I thought, that chiropractors had practiced for seventy-five years without determining what they can effectively do. Although nearly twenty-five more years have passed since that thought first occurred to me, chiropractic has still not made a single noteworthy contribution to the scientific knowledge of health care.
Chiropractic was founded on the delusion that spinal misalignments ("subluxations") have a profound effect upon bodily functions and that chiropractic "adjustments" may favorably alter these alleged conditions. Once this basic premise is accepted, it is easy to believe that nearly every patient will benefit from spinal manipulation. Chiropractic publications repeat and reinforce this mythology, distort scientific and government reports, and give credence to all sorts of pseudoscientific practices.
Many who choose chiropractic as a career have been misled by government policies and educational counseling materials that portray chiropractic as part of standard health care. Prospective students are lured by false promises of status and success. At most chiropractic colleges, students are exposed to cultlike indoctrination into a deviant belief system. They are taught false theories of disease and healing and persuaded to accept them as gospel. They are taught to disdain science and distrust medical doctors. A few reform-minded schools are trying to move away from teaching chiropractic philosophy as a substitute for science, but these are under attack as heretical.
Chiropractic students learn conversational medicine. This enables them to speak as if they know about disease and healing processes and creates the illusion that they understand medical science. Chiropractic literature, however, indicates that many chiropractors don't even understand the most basic concepts of disease etiology. Some chiropractic authors still attack the germ theory as erroneous, and speak of it as if it were scientific medicine's only theory of causation.
Many new graduates are dumped into the cold, hard world where survival values often displace ethics. Many discover that they are not in a true profession, but a guild of survivors who must sink or swim. A large percentage half, according to chiropractic sources fail in practice. This is one reason that chiropractors have the unhappy distinction of having the highest default rate of all who obtain Health Education Assistance Loans from the federal government. (Figures released in January 1998 showed that 817 chiropractors owed a total of $59 million. The current default list can be seen on the Health Resources & Services Administration Web site.)
One chiropractor told me how he had gone from practice to practice trying to find a job that did not violate his conscience. Nearly every chiropractor who interviewed or hired him wanted high-volume work. In other words, "Just pop those spines and move on to the next patient." These chiropractors encouraged patients to return frequently for manipulations, a practice that can stretch ligaments, make joints less stable, and lead to more frequent musculoskeletal problems. My informant's greatest concern was the chiropractors who insisted that patients be x-rayed during nearly every visit. In an office where he worked, one woman had been x-rayed more than seventy times in a year-and-a-half. The idea of that much radiation exposure to a patient's body frightened him and caused him to quit the practice.
Chiropractic encourages self-delusion. One of the saddest stories I have encountered is that of a young chiropractic student with breast cancer who was so enthused over chiropractic's possibilities that she decided to make herself a documented test case. She died an agonizing death from untreated cancer but never lost faith in chiropractic's basic principles.
Chiropractic has failed the most fundamental scientific requirements that it define itself, determine its clinical usefulness and limitations, and conduct basic research on its mechanisms of action. Yet its public-relations spin-doctors attempt to portray chiropractic on an equal plane with scientific medicine by stating that both have their place. They maintain that both medicine and chiropractic have failings (and therefore the two are equal). These comparisons remind me of an experience I had as a boy while ice-skating in Minnesota. At the rink that I frequented, novices would skate around the edge while Olympians practiced in the middle. When an elite figure-skater fell while trying to do a triple Lutz, an old man who was shuffling around on his skates said with a twinkle, "I also fall down when I try to do a triple Lutz!"
From time to time, I am contacted by chiropractic students and practitioners who realize they have become ensnared by a deviant health-care system. By the time they see through the smoke and mirrors, they have invested a substantial amount of time and money in pursuit of their career. In addition, most rightly believe that manipulative therapy is useful. When they ask what they should do, I reply that there are two options: run or fight. By run, I mean get out of chiropractic and chalk up their losses to experience. By fight, I mean stay in chiropractic and try to transform it into a science-based service that focuses on manipulative therapy for musculoskeletal problems, mainly back pain. The more experience I garner, the more inclined I am to recommend running away. I do, however, salute and try to help those who become reformists and face the inevitable animosity of their colleagues.
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