Chiropractors—Knocking At Your Door?
Stephen Barrett, M.D.
Reprinted from Private Practice Magazine
What if a chiropractor refers a patient to a physician? What if he wants a report, a lab test or an X-ray examination? What if a patient wants his records sent to a chiropractor? What should you do?
Today's chiropractors claim they can determine what lies within their scope of treatment and the rest they refer to other practitioners. They back these claims, not with scientific evidence, but with the specter of legal action against anyone who gets in their way.
The Nature of Chiropractic
The "discovery" of chiropractic is attributed to Daniel David Palmer, an Iowa grocer and "magnetic healer." In 1895, so the story goes, Palmer restored the hearing of a deaf Janitor by "adjusting" a bump on his spine. After further study, Palmer theorized that the basic cause of disease is nerve Interference caused by misaligned spinal bones. The basic treatment was, therefore, adjustment of the spine—by hand. The word chiropractic is derived from the Greek words cheir (hand) and prakttkos (effective).
Because Palmer's theory is utter nonsense, medical doctors have traditionally regarded chiropractic as an unscientific cult. Today's chiropractors claim they have gone far beyond Palmer's theory: but many chiropractic documents suggest otherwise:
- Pamphlets currently sold by the Iowa chiropractic Institution Palmer College, claim an Important role for chiropractic in a wide variety of illnesses, including appendicitis, bronchitis, tonsillitis, epilepsy, liver disease, kidney disease and diabetes. The liver pamphlet states that "Chiropractic is the only science which seeks to find the basic cause producing the abnormally functioning liver." The gallstone pamphlet suggests, "The best approach to a permanent solution to gallstones or any other health problem is to see your chiropractor regularly." The kidney pamphlet concludes: "If you are suffering from kidney disease. the logical course is to visit your chiropractor. He will examine your spine to see where your trouble exists. A chiropractic adjustment will have you feeling better in no time."
- ln 1979, I supervised a survey of local chiropractic offices which found that 28 out of 35 were using pamphlets. Twelve used the ones sold by Palmer College; eleven used equally outlandish ones from other sources; and five used pamphlets which are more subdued but still exaggerate what chiropractors can treat.
- A Bethlehem, Pennsylvania chiropractor is now being prosecuted for advertising that "intense, fearful constricting chest pain" and "blurred vision" are reasons to see a chiropractor. Other ads in the case claim that "pinched nerves" can cause abnormal blood pressure, hay fever, sinus trouble, arthritis, pleurisy, glandular trouble, goiter, bronchitis and colds, as well as stomach, liver, kidney, and gallbladder problems. At a preliminary hearing, a medical cardiologist testified that severe chest pain could represent a heart attack requiring emergency care and that delay in getting such care could be fatal. Seven chiropractors testified in support of the advertising claims. The testimony of one of them:
Q. Sir, if somebody came to you complaining of blurred vision, would you examine the eye?
A. I would examine the spine. I examine everyone's spine.
Q. If someone came to you complaining of goiter, would you examine the goiter?
A. I would examine their spine again.
Q. If someone came to you complaining of intense pain in the chest radiating down the left arm, would you examine, or would you attempt to examine, the heart by using an electrocardiogram machine?
A. I only check the spine for vertebral subluxations.
Q. Would you use a stethoscope to check the heart pain at that point if somebody came to you with their complaint?
A. We don't use a stethoscope in checking the pain. We only check the spine for subluxations.
At a subsequent hearing, the chairman of the Pennsylvania State Board of Chiropractic Examiners and faculty members from three of the nation's 16 chiropractic schools endorsed the ads as accurate and representative of what is taught in chiropractic schools.
- According to a recent survey, the required dermatology textbook at Los Angeles College of Chiropractic is "Dermatology for Chiropractic Physicians," written in 1962 by the director of the department of diagnosis of Northwestern College of Chiropractic. The book (which contains no pictures) recommends spinal manipulation for about 100 skin conditions including acne, scleroderma, disseminated lupus erythematosus, pemphigus neonatorum, folliculitis, and carbuncles.
- Sid E. Williams, D.C., founder and president of Life Chiropractic College, is chiropractic's equivalent of Oral Roberts. Four times a year, he runs an inspirational practice-building seminar that attracts over a thousand participants. Ads for the seminar boast that top instructors see 200-400 patients in their daily practices. One of its textbooks describes how, years ago, God told Williams "in very clear language" to commence the meetings. Another text outlines a systematic plan to persuade all comers to have monthly spinal exams.
- "Touch for Health," currently sold by the Texas Chiropractic College bookstore, describes "applied kinesiology," a healing system used by many chiropractors. According to the book. "muscle weakness" is the cause of a wide variety of diseases which should be treated by massage, acupressure, and food supplements.
- A chart which claims that more than 100 ailments are caused by misaligned spinal vertebrae is used by many chiropractors. A brocure containing the chart was distributed recently at a New York Chiropractic College clinic.
- Some chiropractors are so backward that last year the Journal of the American Chiropractic Association published a statement from its malpractice Insurance company that said:
It has been mentioned in various locations of the country that some chiropractors diagnose and treat patients through their clothing. Following discussion with legal counsel . . . it was determined . . . that legal defense of this kind of case was more difficult and, therefore, more costly to our company. A frequent basis for claims against our Insureds is failure to properly diagnose the patient's condition. A diagnosis or treatment should not be made through the patient's clothing if this will interfere in any way with giving proper care, We recommend that careful discretion concerning this procedure be exercised by all.
During the past 10 years, I have collected chiropractic journals and textbooks. listened to chiropractic lectures, spoken and corresponded with hundreds of chiropractors. Interviewed many of their patients and conducted a variety of clinical research projects. As far as I can tell, chiropractors are unable to agree among themselves about whether to diagnose, how to diagnose, what to treat, how to treat. when to treat, when not to treat. how long to treat. when to make a referral, when to take an X-ray. how to take an X-ray, how to read an X-ray or how their treatments work. It is hardly surprising that most physicians want nothing to do with chiropractors.
A Legal Cloud
In the real world, however, strange things can happen. In 1976. chiropractors began a series of lawsuits against the AMA other prominent professional organizations and several individual critics. charging that all had conspired to deprive chiropractors of their legal rights. Because chiropractors are licensed, the litigants reason, conspiring against them is a violation of antitrust laws.
In the wake of these lawsuits. the AMA softened its official position last summer by removing the label of "unscientific cult" and permitting association with chiropractors when it is in the best Interest of the patient. While many physicians regard the new AMA position as a cowardly retreat, chiropractors hail it as "recognition." Actually, it is neither. Physicians do not shun chiropractors out of fear of harassment by colleagues. They do so out of lack o! respect for chiropractic. The new AMA position was suggested by attorneys who think that defense of the antitrust suits will be simpler if name-calling is stopped.
There has been a more serious side-effect of the suits. Some defense attorneys have also advised their clients to curtail anti-chiropractic activities until the suits are resolved. As a result. many physicians who want advice on dealing with chiropractors are not getting it from their professional organizations. They are being told to think for themselves.
About a third of the nation's 21,000 chiropractors still cling firmly to D.D. Palmer's basic doctrine. Most of the rest acknowledge that factors such as germs and hormones play a role in disease. but still view spinal problems as the underlying cause. A few chiropractors—probably fewer than 100—are free of delusion, practice a conservative form of physical therapy, do not pretend to be primary providers, and refer quickly when they sense that a problem is outside their scope. Medical cooperation with this type of chiropractor may well be in the public interest—and indeed, it has been taking place for years in many communities. When a medical facility cooperates with a chiropractor who is delusional. however, the effect is likely to be political rather than medical. One chiropractor I know maintains a separate file of "referred patients" to demonstrate that he is "working closely with medical colleagues."
What Should You Do?
What are the best policies for dealing with chiropractors? I suggest the following:
- Unless you have personal knowledge that the chiropractor is nondelusional, requests for laboratory tests or X-ray examinations should be Ignored. There ls little reason to believe that giving medical information to a confused practitioner will enhance the patient's chances of getting appropriate care.
- Referrals for treatment should be accepted. If acknowledgements are given, they should be done by telephone.
- If a patient asks that existing reports be sent to a chiropractor, the reports should be offered to the patient. Patients have a legal right to see their records. Seeing a negative X-ray report may even protect the patient from a chiropractor who wishes to treat non-existent spinal problems.
- If a chiropractor wishes to discuss an X-ray he has taken such consultation should be provided only if the chiropractor agrees in advance that a report be sent to the patient's medical doctor if medical care is Indicated.
Will following these policies get you sued? I think not. There is no law that says you must take orders from a chiropractor. Until the antitrust suits are resolved. there may be legal risk for large health organizations to join forces against chiropractic. But independent action by individual physicians cannot create grounds for an antitrust suit. Despite the belligerent reputation of chiropractors, lawsuits against individual physicians are extremely rare. As far as I know, none has ever been successful.
If you need further Information on this subject, please feel free to contact me.
This article was posted on January 27, 2018.