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Throughout this book the author has quoted a number of scientific authorities on various specific aspects of chiropractic theory and practice. These statements, along with other material already set forth, may have amply convinced the reader that there is no scientific basis for chiropractic. Such a reader may skip this chapter, but is advised the keep the book around, and use the chapter later for arguments with friends or with chiropractors. On the other hand, chiropractors, their patients, and persons considering chiropractic treatment, should read on carefully.
There is no known human disease, not even a backache, that is caused by impingement of spinal nerves by subluxations. That is the verdict of science on the Iowa grocer's dream.
The scientific validity of chiropractic theory has been the subject of numerous studies and reports, a few of which will be discussed here.
In 1945 the Society of the State of New York issued a publication entitled Medicine Men and Men of Medicine, by Charles M. Bayer. According to this publication, in 1934 the Educational Department of the University of the State of New York addressed a set of four questions to one hundred nationally known specialists in anatomy, bacteriology, orthopedics, pathology, physiology, and roentgenology, whose names were chosen from the publication American Men of Science. These were the questions:
(1) In your experience, what "pains and illnesses of the human body" have you found to be caused by a subluxation or misalignment of the spinal vertebrae, other than those caused by trauma?
(2) In your experience, have you ever found the "foramina or apertures between the vertebrae, through which the nerve branches issue from the spinal cord," narrowed and causing pressure upon a nerve or nerves? If so, under what circumstances?
(3) In your judgment, is it possible to reduce a subluxation or misalignment of the vertebrae and thus relieve pressure upon nerve branches "by manipulation of the hand?"
(4) In general, what is your view of chiropractic both as a theory and as an alleged science?
A typical answer to the first question was that of Dr. C. Carl Huber, professor of anatomy and dean of the Graduate School of the University of Michigan: "There is no condition of subluxation or misalignment of the spinal vertebrae in the sense used by the chiropractic practitioner. If such conditions, by reason of accident or disease, actually are found, they require skilled surgery.
Replying to the second question, Dr. R. R. Bensley, Director of the Department of Anatomy of the University of Chicago, said, "In a period of twenty-nine years, during which time I have been Director of this Department we have never found in our dissecting rooms a single instance in which the foramen or aperture between the vertebrae through which the nerve branches issue from the spinal cord have been so narrowed as to cause pressure upon nerves."
On the third question, Dr. Dean Lewis, surgeon-in chief of Johns Hopkins Hospital, said, "In my judgment, it is not possible to reduce subluxations or misalignments of the vertebrae and thus relieve pressure of the nerve branches by manipulation of the hand." On the final question, Dr. Harvey Cushing, then one of the world's leading brain surgeons, wrote, "There is no logical basis whatever for the theory of chiropractic, and it is silly to allude to it as a science."
In the late 1940's, at the request of the Subcommittee on Cults of the Medical Society of the State of New York, a three-man commission made a study of chiropractic. Its members were Dr. Philip B. Armstrong, professor of anatomy, Syracuse University College of Medicine; Dr. Homer D. Keston, associate professor of pathology, Columbia University College of Physicians and Surgeons; and LeRoy L, Barnes, Ph.D., professor of biophysics, Cornell University. The commissions Report was published in 1948:
The fundamental tenet of chiropractic claims that all disease is due primarily to pressure on nerves. It should be emphasized at the very outset that nerve pressure as the primary cause of disease is only a belief. The chiropractors have not demonstrated its truth by scientific experimentation. They have assumed that it is true and, on this assumption, have instituted methods of treatment. There is, however, a large body of scientific fact which conclusively disproves the fundamental tenet of chiropractic.
The Report discussed in detail the question of pressure on nerves. It is a fact, says the document, that "pressure on these nerves of sufficient intensity can reduce or abolish their activity." But it does not follow that chiropractic theory and treatment of disease have any validity.
To begin with, as a simple physical fact, the nerves serving many areas of the body cannot be subject to impingement by vertebrae as they leave the spine, and these nerves are equally beyond the reach of any manual manipulation to relieve the nonexistent impingement.
"Many very important nerves leave the central nervous system through bony openings which are entirely rigid, formed of a solid ring of bone," the Report says. "This is true of all the nerves coming from the brain and also the lower spinal nerves. Those from the brain are distributed to all the structures in the face and one of them passes down through the neck and thorax into the abdomen, supplying the heart, lungs, stomach, liver, intestines and other important structures. The lower spinal nerves pass, out through the sacrum to the prostate, bladder, uterus, etc. These structures are frequently involved in disease which, according to the chiropractors, is due to pressure on their nerves. No amount of manipulation can change the rigid openings through which these nerves pass from the skull or sacrum."
Nerves serving other important bodily systems do not even pass through the spine, and are therefore equally beyond the chiropractor's reach. "Some of the glands of internal secretion which are so important in regulating various activities of the body are not under the control of the spinal nerves," the Report states. This includes the pituitary grand, "the so-called Master Gland of the body." Again, some tissues have no nerves at all. "The blood is subject to a variety of diseases but receives no nerves, not even in the bones where most of the blood cells are formed. . . . Where do the chiropractors manipulate to relieve a disease existing throughout the body in the blood, a tissue which receives no nerves? Pernicious anemia poses the same problem."
Other facts call into serious question the chiropractic premise that impaired nerve function somehow readers the areas of the body served by such nerves susceptible to disease. For example, skin areas with impaired or severed nerve function are not more susceptible to cancer. Again, many human maladies are helped, not aggravated, by the severing of nerves. "A number of nerve-cutting operations have been devised for the relief of a variety of conditions. Here we see that some disease conditions are relieved by abolishing nerve function which is diametrically opposed to fundamental chiropractic belief."
In 1963 a bill was introduced in the Quebec Legislature to license chiropractors and permit the practice of chiropractic in Quebec. A Royal Commission on Chiropractic was set up to collect information and make a report to the legislature. The commission, in turn, sought and received presentations from interested parties. The Quebec College of Physicians and Surgeons submitted the 64-page Brief to which we have referred in previous chapters.
The Brief noted the apparent complete indifference of chiropractic to the question of whether its doctrine is true. In common with everyone else who propounds a scientific theory, says the Brief, chiropractors have the "duty" and the "responsibility" of submitting their theories to at least the minimum exigencies of scientific proof" before applying them wholesale to matters involving health, sickness, life, and death. "Chiropractors have had every scientific method available to them," the Brief states. "Sixty-eight years constitute a sufficient period for the experimental proof of a limited number of facts." But chiropractors have never shown the slightest interest in experimental proof. Their posture is made all the more dubious by the fact that highly sophisticated means for conducting decisive experiments on their fundamental premises lie readily to hand.
Thus, the chiropractor claims that nervous impulses are some way disturbed or impaired by spinal subluxations. The obvious medical question is, what kind of disturbance? "No chiropractor has ever defined, either quantitatively or qualitatively, what chiropractic means by perturbation of nervous impulse," the Brief states. "Is it their number, their amplitude, their frequency, the speed of their propagation, or their wave patterns which are affected? All of these qualities can be identified, recorded, and studied. . . . Exceptionally sensitive apparatus is available to anyone wishing to use it."
Again, chiropractors claim that these impairments of nervous impulse cause disease. "By what experimental proof have they demonstrated a causative relationship between disturbance of nervous flow and the development of illnesses which they claim to cure? Here, again, absolutely none."
This indifference to scientific experiment contrasts sharply with chiropractic's enthusiasm for merchandising itself. "It is indeed astonishing," says the Brief, "that there has been such a lack of effort, or of concern for scientific truth, especially if one considers the effort that has gone into selling the theory to the general public-when the world to be convinced was the scientific world. Let the theory gain acceptance in the world of scholars, and all the troubles of the chiropractor will vanish."
The affidavits made by professors and medical experts, in connection with the Jerry R. England case in Louisiana in 1965 provide a wealth of scientific information on chiropractic.
Subluxations are discussed by Dr. Irvin Cahen, professor and head of the orthopedic department at Louisiana State University School of Medicine. A subluxation, he says, involves an alteration of the normally opposed surfaces of a joint,' as opposed to a luxation or dislocation, "in which the joint surfaces are completely separated." Subluxations, so defined, occur all the time in normal motion.
There is also such a thing as a "fixed subluxation," in which the surfaces do not return to normal opposition after movement. These "result only from pathology involving capsular or ligamental tears or alteration in the actual bony structure." Whether subluxations be those of normal movement, or fixed, they cannot and do not impinge on nerves. "It is my knowledge," he says, "that in chiropractic considerations the joints that are considered to be subluxed are those which we term facets, situated to the sides of the major body articulations. These joints cannot impinge upon a nerve root without major displacement."
There is such a thing as a pinched nerve, he says, resulting from such problems as a ruptured disc, displaced bone fragments, or tumefaction, but "in no instance has there been any scientific evidence that manipulation of a subluxed joint will correct these abnormalities." He also agrees with his fellow scientists that "the premise that an irritated nerve resulting from compression at an area is responsible for a disease has no scientific basis.'
Dr. Cahen and Dr. Solomon D. Winokur both stressed the dangers arising from the incomplete patterns of both diagnosis and treatment that are inherent in chiropractic theory and practice. This is true even for the treatment of back pains and spinal problems, to say nothing of the complete range of ills that chiropractors treat. "In order to be able to properly manipulate any area of the spine," says Dr. Winokur "it is first necessary and most important to make an accurate diagnosis. In order to make an accurate diagnosis it is essential that the person attempting to make such a diagnosis have a complete background in all of the normal and pathological conditions related to or around the vertebral structure." So-called back pains, pointed out, can be most deceptive. "For example, there are many times where a back pain is being, produced as a result of a prostatitis, acute appendix, acute gall bladder condition, and female disorders, tubal or ovarian, or retroverted uterus which produces low-back pain. Without a proper understanding of the surgical implication of these things a proper diagnosis is impossible."
Dr. Alton Ochsner, Sr., for thirty-one years chairman of the department and professor of surgery at Tulane University School of Medicine and now professor emeritus at Tulane, firmly denied in his affidavit the chiropractor's central belief that subluxations other than displacements due to normal movement are a prevalent or omnipresent phenomenon. He also stated that the chiropractor's claim to be able to feel subluxations comes close to being a physical impossibility: "Furthermore, it is almost impossible, and I think impossible, to feel any subluxation of any part of the spine below the cervical region because of the large mass of muscle overlying the vertebrae which makes it impossible for anyone to feel it."
Dr. George Nelson Ronstrom, professor of anatomy at Louisiana State University School of Medicine, bore down on another aspect of the matter that is by now familiar to the reader. "Anatomically," he said, "we find that forty-three pairs of nerve trunks carry the flow from the brain and spinal cord to various body structures or organs. However, the anatomist finds that only twenty-six pairs of spinal nerves are available to spinal manipulation. The brain and spinal cord from which the nerves originate, twelve pairs of cranial nerves, and five pairs of sacral nerves, simply are not available to manipulation because they pass through orifices made up of fused and immovable bones, and are therefore inaccessible to chiropractic manipulation." The inaccessible nerves include "various nerve supplies to the head, senses of smell, taste, hearing and sight, organs of the neck, respiratory apparatus, heart, stomach, small intestine, part of large intestine, pancreas, gall bladder, liver, spleen, kidneys, pelvic organs and part of lower limbs." Dr. Ronstrom then quietly, asks a blockbuster question. "This anatomical fact immediately raises the following question in the scientific mind: Why should the twenty-six pairs of spinal nerves accessible to spinal manipulation have such a great importance and the rest so little?"
Several of the experts had taken the time to read chiropractic writings and textbooks in the areas of their specialties. They found the books full of error and untruth. What impressed the experts is the way in which the chiropractic writers ignored whole mountains of material findings and evidence that have been produced by the vast labors of twentieth-century science."
Actually, this is probably easily explained. Modern medical knowledge demonstrates that chiropractic theory is false, and the chiropractor begins with the assumption that it is true. He must therefore necessarily discount or ignore whole areas of modern science and research. "The principles of chiropractic are just as solid today as when they were first promulgated in 1895," says Mortimer Levine, D.C., chairman of the department of chiropractic at the Chiropractic Institute of New York, in his book The Structural Approach to Chiropractic (Comet Press, 1964). In his preface to this book C. W. Weiant, dean emeritus of the Chiropractic Institute of New York, calls Dr. Levine "one of the truly great intellectuals of chiropractic history."
Dr. Andrew V. Friedrichs, assistant professor of pathology and bacteriology at Tulane, reacted with incredulity to a pamphlet called "The Chiropractor Looks at Infection," by J. R. Verner and C. W. Weiant. "To put it bluntly," Dr. Friedrichs says, "the chiropractors advocate in this pamphlet that all immunization and inoculation for polio, tetanus, typhoid, smallpox, diphtheria, to name a few, and many other diseases which are combated by immunization and inoculation, be discarded, to be replaced by manipulation of the spinal column, to normalize the flow of nerve impulses.... The authors advocate manipulation following trauma, where a fracture is present. Manipulation is the answer in acute infections, where an abscess has formed, or an acute appendix. Surgical procedures are completely ruled out." Dr. Friedrichs obviously had trouble believing what he was reading, and noted that the authors "even attempt to prove that their ridiculous conclusions are correct.' To Dr. Friedrichs, the pamphlet was "amusing" and "ludicrous."
Dr. Richard M. Paddison discussed in detail some sections of The Chiropractic Physician's Manual, by O. V. Allers, a faculty member of Lincoln Chiropractic College, that related to Dr. Paddison's specialty of neurology. On the subject of migraine headache, "the manual points out that the cause is unknown, which is not true." The book of course specifies chiropractic adjustments for treatment. "Such a concept denies the scientific data which have been accumulated so painstakingly and are well documented in the medical literature."
The Manual also recommends adjustments of subluxations for peripheral neuritis. Among other things, says Dr. Paddison, "there are peripheral neuropathies which affect the cranial nerves, which cannot be involved in subluxation." A theory that specifies subluxations as the cause of this malady "is a complete denial of what is known by modern medicine in terms of peripheral nerve function and diseases."
On polio, the Manual refers to a book called Taking the Terror Out of Polio by a Dr. Dunn, and recommends the treatment set forth in that book. It includes, says Dr. Paddison, "isolation of the patient, alternation of water and orange juice diet, general and specific adjustments, relaxing the muscles of the back with knifelike thrust correction of the paralysis of the neck, release of the spasm of the scapula by way of deep goading bilateral manipulation of the inguinal glands, release of the interosseus membranes in the legs, foot adjustments and manipulations of the abdominal viscera." Dr. Paddison reviews current scientific knowledge of this disease, and deals with the material in the Manual curtly: "The use of manipulative therapy in this disorder can only be condemned as 'quackery.'"
On epilepsy, the Manual says that there are many theories regarding the etiologies of the disease "which you should forget immediately." Brain damage during birth, injuries in childhood, and tumorous growths, the Manual says, are among the etiological theories that have never been proven. "These statements," says Dr. Paddison, "constitute a bold-faced prevarication of the available scientific data which have been accumulated in the past thirty-five years regarding epilepsy or convulsive disorders."
The Manual states that subluxations in the cervical and upper dorsal spine are commonly found in epileptic patients. "There is not a shred of scientific data in terms of the modern concept of epilepsy which allows us to even consider spinal subluxations and their adjustment in the causation of seizure states." Calling the information in the Manual "sheer and wanton quackery," Dr. Paddison goes on to say, "Patients are duped, misled and have their diagnosis and treatment either interfered with or delayed to the point of personal hazard because some seizure states can lead to what we call status epilepticus, a grave medical disorder which may lead to death or serious mental disability of a permanent nature."
The views of modern science on chiropractic are reflected in HEW's 1968 Report, which recommended against the inclusion of chiropractors in the Medicare program. "There is a body of basic scientific knowledge related to health, disease, and health care," the Report says. "Chiropractic practitioners ignore or take exception to much of this knowledge despite the fact that they have not undertaken adequate scientific research. . . . Chiropractic theory and practice are not based upon the body of basic knowledge related to health disease, and health care that has been widely accepted by the scientific community."
In the face of this overwhelming scientific testimony, what is one to make of the fact that many persons report that they feel better after being treated by a chiropractor? In some instances this may reflect psychological factors, as noted by Dr. Richard M. Paddison, or the self-limiting nature of most symptoms, as described by Dr. Milton Helpern and Dr. Robert W. Buck, in the preceding chapter. Others, of course, report feeling worse.
In his England case affidavit, Dr. Cahen discusses the relief from back complaints that some patients report after receiving chiropractic manipulations. "I would consider this temporary relief is entirely due to the application of heat or the massage of musculature or the stretching of sore muscles in the same overall concept that we apply physical therapy to the body as an adjunct to rehabilitation. I do not believe that such temporary relief is other than the effect of heat and massage."
Suggestive comment appears in HEW's Report. "The chiropractor attempts to move the vertebra with his hands so that it will not interfere with nerve function," says the Report. "It may be that the chiropractor, in this maneuver, is not affecting nerve function but actually is restoring the normal mobility of the joint. In this manner, the chiropractor may in many cases relieve pain and loss of function with the spinal adjustment. Referred pain to other parts of the body from joint dysfunction may be mistaken for a disease process, and when the spinal adjustment relieves the pain, this may be thought to be a cure of the 'disease.'" In its conclusions, the Report says, "Manipulation [including chiropractic manipulation] may be a valuable technique for relief of pain due to loss of mobility of joints. Research in this area is inadequate; therefore, it is suggested that research that is based upon the scientific method be undertaken with respect to manipulation."
The Report makes two things clear. First, such research was not reflected in the materials submitted by chiropractic associations to the HEW study group in support of the alleged scientific validity of chiropractic. "The little research that is done [by chiropractors] says the Report, "seems to be directed at proving that D. D. Palmer's teachings were right, rather than taking an objective look at all possible causes of disease." Second, if patients receive any benefit from chiropractic treatment, the benefits do not arise from the chiropractic theory. Chiropractors, the Report states, "believe that the subluxation is the most significant causal factor in disease, because they feel that it interferes with normal nerve function. However, no evidence has been found in the literature, nor has any information been submitted to this study, to prove that a subluxation, if it exists, is a cause of disease."
It hardly seems necessary to go on. The substance of the matter has been summarized in a statement on chiropractic issued by the McGill University faculty of medicine in 1963. "The theory which underlies chiropractic is false," the McGill faculty says. "Biology is probably the most complex and difficult of sciences and human biology its most important branch. To reduce it to one primary mechanical concept is simpleminded and dangerous." It is hard for the author of this book to imagine how any intelligent person, and even any intelligent chiropractor, could really believe otherwise.
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