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At Your Own Risk:
The Case Against Chiropractic

Chapter 8: X Ray -- The Chiropractor's Toy
© 1969, Ralph Lee Smith

The principal menace to public health posed by chiropractic is that it removes sick persons from scientific treatment, and thus endangers their health and sometimes their lives. But there are at least two other dangers that cannot be ignored, and these will be discussed in the following two chapters. The first of these dangers is the use of X ray by chiropractors.

Within the past few years there has been increasing concern within the medical and scientific communities about the amount of radiation to which the public is exposed by diagnostic X ray. No one minimizes the dangers; no one denies that X-radiation from any source is basically damaging; all agree that unnecessary exposure should be avoided-except some chiropractors: see the Parker seminar Textbook's recommendations on what chiropractors should say if the patient evinces concern on this subject, quoted here on page 46.

In September, 1967, the Senate Commerce Committee, chaired by Senator E. L. Bartlett (D., Alaska), opened a series of hearings on ionizing radiation hazards of electronic products. Among the witnesses was Dr. Karl Z. Morgan, director of health physics at Oak Ridge National Laboratory and a pioneer in radiation protection research. Dr. Morgan told the committee that there was an urgent need for improvement in diagnostic X ray. Continued use of X rays at the present rate in a population of the nation's current size, he said, could lead to as many as 27,000 deaths a year from genetic defects, 1,100 from leukemia, and a non-specific life-shortening effect on 1,000 persons. He set forth a series of sixty-three recommendations for improving the diagnostic value of X rays while reducing the exposure of patients-and doctors-to radiation.

There is some disagreement among scientists regarding the magnitude and immediacy of the dangers posed by the use of diagnostic X ray. But reduction of the use of X ray in diagnosis to an absolute minimum, and continuing refinement of technique to cut down the amount of radiation to which the patient is exposed when diagnostic X ray is unavoidable, are unanimous objectives of modem scientific medicine.

A number of chiropractors take a different tack. They use their machines liberally in pursuit of a medically false theory of disease-and use them for public relations as much as for medical purposes. Chiropractic X ray is now probably the largest source of totally gratuitous radiation of the United States public.

No figures on actual usage are available, but the recommendations are clear:

"In my ten years of practice," the Parker Textbook suggests that chiropractors tell their patients, "75% have been fully X-rayed, 15% partially X-rayed, and 10% required no X ray at all." By contrast, X rays are used in only 3% of cases under medical supervision at Johns Hopkins Hospital.

Chiropractors call their X-ray technique "spinography." It consists of taking a picture 36 inches high and 14 inches wide, of the entire vertebral column, as was done to me when I visited the Palmer College of Chiropractic Clinic as a "patient." Chiropractic spinography was discussed in detail by the Quebec College of Physicians and Surgeons in a Brief prepared in 1963 for submission to the Quebec legislature, which was considering holding hearings on a bill to license chiropractors:

This film is obtained with a very wide stream of radiation, which blankets almost the whole trunk of the body as it penetrates from the front to the film at the back. It is unusual for the chiropractor to take a side view, since the technical difficulties are great and the resulting film even less satisfactory than the anteroposterior view.

[As the reader will recall, the Palmer clinic took two 14-by-36 plates of me, one a front and one a side view. To the extent that this may have become standard chiropractic practice since the Quebec College prepared its 1963 Brief, the radiation exposure of chiropractic patients has been doubled, and the problem has become twice as urgent.]

This large plate gives the chiropractor a handsome full view of his chosen turf, the spine, which he can show to his patient. The chiropractor mounts it on a fluorescent screen and sections it off with two-inch squares drawn on the negative with radio-opaque ink. (The Parker Chiropractic Research Foundation also recommends that the chiropractor give the patient a "Polaroid reproduction of his spinal X ray with the doctor's stamp on back.-- "Give it in a neat printed folder," a foundation instructor suggests. "People will show it to others.") "In theory," says the Brief, "the purpose of these squares is to help visualize disturbances in the longitudinal alignment of the vertebral column. This technical detail [sectioning the picture in two-inch squares] does not really provide a better demonstration of possible changes in vertebral structure, external or internal; on the contrary, it may interfere with visibility."

This, however, is a minor point. A more important issue is that "large films of this type, taken in the antero-posterior view only, have very limited diagnostic value."

In a full spine picture "the curvatures [normal or abnormal] of the vertebral column cause some degree of superimposition of the shadows of adjacent vertebrae the one on the other. The oblique direction of the X rays in relation to these curvatures causes only certain vertebrae to be clearly distinguished from their neighbors above and below; and indeed, focusing on a small area with careful aim is essential for the proper study of the outline and internal structure of each bone and of its relations to contiguous anatomical elements."

Physicians therefore do not usually use these oversize plates for evaluation of spinal conditions. "Small sectional views are of much more diagnostic value than a single broad picture, since they provide a more accurate perspective of architectural relationships; they allow the photographic density to be adjusted for each region; and they require less scatter of X rays, thereby giving a better quality of film and reducing the risk of genetic effects." In connection with the Jerry R. England case in Louisiana in 1965, described in Chapter Six, medical specialists in many fields made affidavits regarding the relationship of the current state of knowledge in their fields to the theory and practice of chiropractic. One was Dr. Seymour F. Ochsner, associate professor of radiology at Tulane University School of Medicine, a member of the executive council of the American Roentgenary Society, chancellor of the American College of Radiology, and a member of the Louisiana Board of Nuclear Energy. Dr. Ochsner discussed chiropractic spinograph and X-ray techniques:

One of the most important contributions recent advances have made for the safety of the patient is the use of smaller fields of exposure of the human body rather than larger fields of exposure. The radiologist tries to focus X rays on the specific area of specific interest. By doing this, he protects other parts from unnecessary radiation exposure. At times, of course, one does need to obtain one or more views of particularly susceptible parts of the body, for instance the human pelvis or genital organs, but every effort is made to shield these areas from radiation exposure and the use of excessively large fields for diagnosis of local condition is usually considered improper use of X rays for diagnosis. The broad field X ray is bad because it unnecessarily exposes a sensitive part of the body and the information obtained is not worth the hazards to the patient.

The average chiropractor is largely without the type of training in the use of X ray that many scientists regard as indispensable for achieving the three goals of taking meaningful pictures, interpreting them correctly, and providing protection for the patient.

"If an individual is going to set himself up as particularly knowledgeable about the use of X rays and diagnosis of disease," says Dr. Ochsner, I think he should have at least three more years' intensive training (beyond the medical school curriculum) devoted almost entirely to the use of X rays and this includes a study of how X rays are produced, what effect they have on the human body, how they produce a readable X-ray film in various diseases, and also, of course, a study of the effect of X ray on human tissue, and even more specifically a study of and consideration of possible dangers of radiation to tissues. Ifs extremely important, I think, in doing anything to a human being in order to achieve a diagnosis to be certain that one does not injure a human being. So, the study of the possible ill effects and understanding the dangers of the use of the X ray are very important. This, I think, will take at least three years of intensive training in an individual who already knows a lot about disease and a lot about anatomy, physiology, and pathology."

The ignorance of many chiropractors about this sophisticated equipment was highlighted in a 1961 lawsuit in which the Chiropractic Association of New York, on behalf of itself, its individual members, and a chiropractor named Ernest E. Quatro, sought to force the New York State Public Health Commissioner to permit chiropractors to use X-ray machines. The practice of chiropractic was at that time not licensed in New York State. In his decision upholding the State Public Health Commission's refusal to permit chiropractic use of X ray, the judge listed 152 Findings of Fact. They included:

The plaintiff Quatro used no cone on his X-ray machine nor did he use any other instrumentality or device for the purpose of shielding or protecting the patient from the primary X-ray beam or from scatter.

The plaintiff Quatro as of the time he was exposing the lumbar and sacral areas of the spine of his patients to ionizing radiation was not aware of the very great danger to the reproductive organs of the male and female resulting from such exposure.

In the following year New York State passed a law licensing chiropractors and permitting their use of X rays. Alone among the states, New York also passed, in 1966, a law requiring all X-ray machine operators to be licensed and to pass an examination to show at least minimum proficiency in operation of the equipment. It seems likely that in the other forty-nine states of the Union there are many chiropractors-busy irradiating their patients who have no greater knowledge of their equipment than that displayed by Dr. Quatro in his 1961 testimony.

Once the chiropractor has his X-ray plate marked and mounted, be almost always finds "subluxations" of one or more vertebrae of his patients, which radiologists, neurologists, orthopedists, rheumatologists, and psychiatrists, are somehow unable to see or do not know how to see. One explanation may be that the chiropractor's knowledge of medicine exceeds that of such specialists, but that seems unlikely. Another possibility is suggested by the Quebec College Brief: "The 'subluxations' to which they refer are not the same as those defined in classical medical terms."

If the chiropractor chooses to designate any deviation from complete symmetry as a "subluxation," the Brief makes it clear that he will have no problems, since a perfectly symmetrical picture of the spine would probably be difficult to take. Any slight deviation of the patient's posture from the perfect vertical as the X-ray picture is taken will show on the film as "displacements of articular surfaces one upon the other." Although these are phenomena of normal movement, the patient can be told that they are pathological conditions when they are caught on film by the X-ray candid camera. Since the chiropractor regards subluxations as being, by definition, extremely minute variations, it would probably be a rare X-ray plate on which he was not home free.

For patients beyond the first blush of youth the chiropractor does not even have to depend on normal body movement to get his subluxations. Dr. James M. Morris, assistant professor of orthopedic surgery at the University of California Medical Center, says that changes 'in spinal discs "due to degeneration begin at about twenty years of age and increase progressively throughout life."

"After the age of forty," says the Quebec College Brief, "perfectly normal vertebral columns become rapidly rarer. It is unusual after that age to see spines without X-ray evidence of aging, including thinning of the discs and thinning and slipping of articular surfaces.... The longer a man lives the more impressive the radiologic changes in his vertebral column become."

And, of course, even this fails to reach the ultimate question. Where is the proof that these spinal "subluxations," real or imaginary, are pinching nerves? The Brief comments succinctly:

"Over and above all this is the undeniable fact that 'spinography,' i.e., the single X ray of the whole spine on which chiropractors rely, has never demonstrated the pinching of a nerve, since nerves are not visible on X-ray films and can only be demonstrated by the injection of liquid or gaseous contrast media . . .' in many more serious and extensive diseases of the vertebral column, it is necessary to inject into the spinal canal a substance opaque to X ray [a technique which chiropractors do not use] so that a highly trained specialist may achieve an accurate diagnosis of the location of the pathologic process. Chiropractors, with lesser means, claim a greater precision of diagnosis. But here again, no scientific proof supports the claim."

The results obtained by chiropractors through this method of analyzing illness are not scientifically viable. Dr. Ochsner, commenting on a chiropractic textbook that teaches the techniques and uses of spinography, states:

The chiropractic manual entitled Textbook of Logan Basic Methods, edited from the original manuscript of Hugh B. Logan, D.C., by Vinton F. Logan and Fern F. Murray, illustrates some of the so-called "spinograph" films apparently used by chiropractors for diagnosis or "analysis." These films purport to be "before and after" X rays relative to various diseases such as appendicitis, asthma, back injury, constipation, diabetes, irregular menses, nervous breakdown, "disabled by pain," prostate disorder, sciatica, sciatic rheumatism, migraine headaches, heart condition, ear and throat abscesses, pain in kidneys, and lumbago and sciatica. The only comment that radiologists could make about these films is that the quality is very poor and the apparent diagnoses made on the basis of the films are completely ridiculous.

Actually, more than just medical considerations seem to be involved in the use of X ray by some chiropractors. In some instances, X ray is apparently used as the keystone of a program to update their public image and assume the appearance of practicing scientific healing.

Chiropractic literature on the subject includes a book called Modern X-Ray Practice and Chiropractic Spinography by P. A. Remier, listed in the 1965-1966 catalog of the Palmer College of Chiropractic as professor of X ray and chairman of the department of X ray. in addition to the alleged usefulness of X ray for chiropractic analysis, the text says that "reasons why the chiropractor should spinograph every case" include:

The Parker Seminar Textbook agrees. Reasons for doing a full-spine X ray, the book says, include "Psychological," "Financial,' "Reputation."

Practitioners of scientific medicine use X ray only when no other method of examination will reveal problems or pathology. "The thesis on which we operate," said a medical expert in the Quatro court action, "is [that] radiation is undesirable and hence the clinical indications for the taking of a film or series of films must be established beforehand." By contrast, the Parker-system chiropractor X-rays the patient as soon as he consents to an examination, and before any examination of the patient has been made; the very first thing that happens to a patient who says "yes" is that he gets a 14-by-36-inch dose.

The chiropractor following the Parker technique not only X-rays early, he X-rays often. During the period of the first ten adjustments, discussed in an earlier chapter, the Parker Textbook advises the chiropractor to "Take small comparative X ray for some particular problem that's not progressing exactly as it should and perhaps make no charge." After that, he should "Re-X-ray if necessary (active patients, every three months; once-a-month patients, once each year)." It seems likely that the chiropractor will find it necessary. The Textbook presumes that more pictures will be taken. "Talk enthusiastically about the results you are getting," it says. "Show evidence of results. Show before and after heart graphs, X rays, etc." "There isn't a spine that shouldn't be X-rayed once a year," Parker told the seminar.

The chiropractor is advised to use his X-ray machine in his campaign to keep current patients and get new ones. The Textbook suggests that he print up handsome little cards-"Lifetime X-ray cards, three-year X-ray cards, one-year X-ray cards," entitling the bearers to free X rays during the period designated on the card. The cards are then judiciously distributed: "Give current satisfied patients an annual X-ray card with the name of a friend or loved one on it as a quick referral stimulus."

In the author's opinion, the use of X ray in pursuit of the chiropractic theory of disease should be banned in every state in the Union, for reasons of public safety and public health.

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