Enjoy the nice criticism of medical woo.
-
Sid Schwab takes on the credulity of believers in alternative medicine, like chiropractic.
Pharyngula
Evolution, development, and random biological ejaculations from a godless liberal
Enjoy the nice criticism of medical woo.
Sid Schwab takes on the credulity of believers in alternative medicine, like chiropractic.
i have some experience of chiropractic – my sister-in-law is an american-trained chiropractor who set up a successful practice here in ireland, which, while historically a strongly catholic country, is also paradoxically home to one of the most sceptical, some would say cynical, populations on earth. (thankfully it looks very much like this scepticism, coupled with a neverending stream of scandals, is finally beginning to erode the power of the church here).
i have witnessed the benefits of the work my sister-in-law carried out, on the life of my cousin, born with severe scoliosis; on the life of a female patient who had to be helped in the door on her first visit, but ended up driving herself to appointments; on the lives of patients who reported feeling more energetic, sleeping better, improvements in their skin, suffering fewer migraines – generally feeling healthier in a variety of different ways.
i’ve read only the linked post on surgeonblog, but i think the blogger might accept that chiropractic could have legitimately helped my cousin, or the woman with severe back-pain, but not those patients who experienced improvements in their general health. he seems to feel the idea that children may experience such improvements to be especially ludicrous – but the spectrum of health surely consists of more than “childhood cardiac arrest” on the unhealthy side and “no childhood cardiac arrest” on the healthy side?
i feel the reason for this view might be revealed in the blogger’s rather weak effort at explaining the theory behind chiropractic, consisting as it does of a picture of a turd, clearly from a cow with a colon in the shape a vodka bottle, which i feel may miss some of the subtler nuances of what a good chiropractor tries to do.
as i understand it, chiropractic is concerned with relieving such interference with the central nervous system as is caused by misalignment of vertebrae in the spine. by removing the pressure of misalignments, the nervous system works better, which allows the body as a whole to function better. chiropractors do not ‘heal’, they help the body to heal itself.
chiropractic is not a cure for cancer, and any chiropractor who claims it is is either a moron or a particularly evil crook. to return to my own experience, my sister-in-law regularly requested her clients refer to their gp, or go get x-rays taken, and never suggested they stop taking prescribed medicine. when she got sick, she went to the doctor. for her, chiropractic was not alternative medicine, but complimentary medicine. perhaps this is because she was neither stupid nor uncaring nor lunatic, but then according to surgeonsblog, this means that she doesn’t exist.
#1: ‘…my cousin, born with severe scoliosis; on the life of a female patient who had to be helped in the door on her first visit, but ended up driving herself to appointments; on the lives of patients who reported feeling more energetic, sleeping better, improvements in their skin, suffering fewer migraines…’
Well! That sounds magic, doesn’t it! Any chance you can prove any of that was caused by the chiropractic, or was it a) a placebo effect or b) other changes to their lives they made simultaneously? Improvements in their SKIN? From spinal manipulation? Oh, come on.
Check this out as well. It cites a fairly recent meta-analysis showing chiropractic is no better than ‘cheaper alternatives, such as exercise’. Also has some fairly scary stuff about spinal manipulation and strokes.
http://www.skepticreport.com/medicalquackery/strokespinal.htm
When people start saying miracle therapy changed their life in as many ways as you just described, you should be VERY, VERY wary.
Gotta say, I’m another one who isn’t prepared to lump chiropractic in with obvious nonsense such as homeopathy. I’ve benefited from it myself and I’ve seen far too many dramatic improvements in people with severe back pain to dismiss it so readily.
When I was in my twenties I was foolish enough to try to one-hand my heavy old Vox AC30 guitar amp out of the back seat of my car. I’d say the resulting back damage was maybe the third most painful thing I’ve experienced in my life. We’re not talking a twinge or a pulled muscle here. I couldn’t move. I had to be helped into the house and every step was blinding agony. Somehow my ex-wife got me to her chiropractor. I was willing to try anything. After that one treatment I was still in pain, but I could walk again. After two more treatments I could run, jump and sing for joy.
I weakened one area of my spine pretty permanently with that injury and while most of the time I’m perfectly fine, every so often my back will “go out” again. I have tried the usual “non-alternative” recommendations (even in pain my scientific curiosity was piqued) and the result was weeks of sleep-depriving pain and severely hampered mobility. Yet every time – every single time – I have gone straight to the chiro, I see an unquestionable improvement after the first treatment and I’m back to normal after two or three.
If it were just my story I’d still be skeptical, but I know many, many broadly similar tales. The aforementioned ex used to be a rower at college and she ruptured a disc. Once, three days before we’d planned a trip to Crete, she re-ruptured it and was rendered almost totally immobile as a result. We desperately organised an intensive bunch of chiropractic treatments. When we boarded the plane she was walking gingerly, but adequately. Two days later we both hiked the Samaria Gorge.
There is something about those few, apparently simple chiropractic adjustments which really works. Now it is true that chiropractors tend to recommend too much “maintenance”. I don’t buy that: it seems too obviously a case of them needing to maintain their living rather than my back. But I simply cannot deny the dramatic effects the treatment has when you actually have a back injury. And they are dramatic – we’re not talking “feeling a bit better” here. We’re talking almost post Jesus-like “I CAN WALK AGAIN!”.
#3, Again: Placebo effect, show me some scientific evidence, etc. And I mean scientific evidence that doesn’t just test chiropractic on its own, but actually uses placebos and controls.
Stuart, I hear you. I can only restate that it is very, very hard for me – the guy who personally experienced the transitions from immense, crippling pain to relative ease and mobility – to ascribe this to mere placebo effect. Why did I not get a similar placebo effect when I attended my regular doctor – a practice I assure you I am far more inclined to put my faith in?
Please understand that I am a hardline atheist, rationalist and skeptic. My strong instinct when faced with non-standard medical techniques and medicines is a curled lip and a sneered “Yeah, yeah: prove it.” I would not be so foolish as to claim my personal experience, and that of the people I know, proves anything beyond “it works for us”. But there is a danger in simply lumping every non-standard procedure together in a big bag called “alternative woo” and dismissing it out of hand. It risks throwing babies out with bathwater.
When the chiropractor explained to me exactly what his spinal manipulations were doing (or what he claimed they were doing, sure) it did not seem unreasonable or “magic” that it might alleviate my problem. I would love to see a proper scientific study done on chiropractic, but on the basis of my own and all the other experiences I am aware of it would be irrational and close-minded of me to reject the idea that it may offer a purely naturalistic and rational means of helping certain types of injury.
Scientific testing and skepticism issues aside: I hope you never have severe, spine-related back pain but if you do, give chiro a shot. You may surprise yourself.
http://www.rand.org/publications/randreview/issues/rr.winter98.9/back.html
I did a bit of Googling and found that this RAND study actually supports the idea that lower back pain can be helped by chiropractic. I will say that almost all the anecdotal stories I am familiar with of people experiencing striking benefit from chiropractic manipulation (including my own) involve lower back pain. Interesting.
I certainly don’t buy some of the more wild and wacky “explanations” of how chiropractic is supposed to work (“subluxations” and all that rot): it seems more likely to me to be about appropriate spinal manipulation, but I can’t deny that it can be startlingly effective – to a degree whcih makes it silly for me not to use it when I’m laid low with my back issue. And that would be the case even if it could be shown to be entirely down to placebo effect.
I have lots of experience with chiropractic. My father swore by it, my sister swears by it, and my wife swore by it. It is with great disbelief how otherwise smart people accept this as medicine, even many doctors do. But there is a difference between feeling better and begin better.
1) very often ( may go so far as to say ‘most often’ if there isn’t actual disk or bone failure) back pain goes away by itself with rest and treatments of cold and heat, to reduce swelling. This even includes during initial disc deterioration
2) chiropractic does nothing for scoliosis (my entire PhD was on scoliosis treatment). How do I know? Well external bracing was tried to correct scoliosis, all it did was help somehwat in the prevention of further curvature (in some cases). That is constant pressure on the spine. That doesn’t work and a quick crack now and then does? gimme a break. The forces that inflict a scoliotic spine are rather large, far larger than a simple crack and release would.
3) ask a chirpractor how it works, then you can safely put it on your list of quackery
4) as proof, ask your chiropractor to show you an x-ray of your spine before adjustment and then after. Ask him to point out the things that are different.
I myself saw a chiropractor for the same pain you guys are talking about (at the advice of my sister, mother and wife). I couldn’t get out of bed. pain shooting down my legs. Problems in my lumbar regions. The good advice that a chiropractor will give you has nothing to do with the chiropractic method (rest, heat/cold, stretching, exercise), but while these things will help, any actual improvement still gets applied to the cracking for some reason.
Got back problems? Rest, see an orthopedist. Have him document issues with your back. use available drugs to reduce pain and to get swelling down until you can walk again. Then exercise for god sakes. you can do wonders in preventing future back failures with a good set of stomach and back muscles.
There is nothing to do with a failing disk until it fails. Just because there is no mechanical treatment for a failing disk, doesnt mean a nonsense treatment works.
Jack, that’s fair enough – but if we’re going by anecdotal evidence, my father had severe back pain recently and his GP recommeded chiropractic (yeah, I know) to sort it. He spent a lot (and I mean a LOT) of money on this, and do you know what? Nothing happened.
Oh, and there’s nothing ‘mere’ about the placebo effect. We don’t really udnerstand it yet (properly, anyway) so there may be loads of complex reasons why your doctor didn’t cause it but a chiropractor did.
techskeptic – all I can say is, good call!
Chiropractic does seem to help some back problems. As further anecdotal evidence, my wife finds it gives her relief from a chronic back problem.
But so might a good back massage.
The problem here is selective reporting. We hear all the heart-warming stories about where chiropractic seems to have worked. We don’t get to hear all the stories of where it didn’t. People tend not to write in about that.
No need to feel bad about it, though. The same thing happens in science. It’s known as the “file drawer effect”.
The thing to remember is that chiropractic is not as safe as people like to think, either. It doesn’t hurt to check out the broader picture.
Just to be on the safe side.
“Well! That sounds magic, doesn’t it! Any chance you can prove any of that was caused by the chiropractic, or was it a) a placebo effect or b) other changes to their lives they made simultaneously? Improvements in their SKIN? From spinal manipulation? Oh, come on.”
i wouldn’t call it magic, or miraculous. some of the cases were certainly dramatic, but it really isn’t difficult to understand how a therapy that improves general health can produce results as diverse as clearing up a skin condition, or relieving migraine.
in the case of my cousin, i can’t imagine what possible changes she could have coincidentally made in her life to achieve the relief she and her family attributed to chiropractic care – smoking crack maybe. nor do i believe that the placebo effect was responsible, given that she didn’t really think it was going to work when she first started going for treatment.
your demand for scientific evidence is perfectly reasonable – although there are difficulties with carrying out placebo-controlled trials: what is the chiropractic equivalent of a sugar-pill? nevertheless, this page (http://www.med.nyu.edu/patientcare/library/article.html?ChunkIID=37431) contains an interesting collection of trials, some of which even come down on the side of chiropractic. i’m not a chiropractor, or a doctor, so i can’t speak for the validity of any of these trials.
Chiropractic relies on the fact that chronic back pain is both common and variable. Yes, getting on a table and having someone stretch and manipulate your back feels good and can temporarily relieve symptoms…but the question is, does it do anything substantive? Does it actually fix anything? And the answer is no.
My father was a laborer, and had chronic back pain all of his life — he also regularly went to a chiropractor. He’d feel better for a little while…but I just told you, he had chronic back pain all of his life.
I had a back spasm, in my teens. Pretty bizarre, pretty scary, having never had one, before. Wound up pretty much immobile, in nothing flat… if you’ll pardon the expression.
My father had occasionally had the same issue. He was in the habit of going to a chiropractor for this, and my parents simply set up the same treatment. I’d never heard of any of the issues with chiropractors, at this point.
Guy who handled it, I have to give credit to. What he did indeed did loosen the spasm, get me mobile again… But then, it’s pretty clear in retrospect the way he did it was logical enough, and actually had nothing to do with ‘spinal manipulations’ of any kind. He just massaged the hell out of the general area with one of those big thumping machines, until everything loosened up. I stood up, thanked him, walked out, quite gratefully.
I do recall the manipulation, too… I think. It was a long time ago. But that weird bone crunching thing, yeah, rings a bell. Rather expect, by then, the real work was done, but y’know, this is expected, at a chiropractor’s office. He also, I believe I recall, explained this was probably about muscle tone, and if I wanted to avoid this in the future, I should probably do some calisthenics, get those back muscles in better shape.
Went on my merry way, … then, had another such spasm, sometime in my early university years.
Thinkin’, well, this worked last time, I went to another such practitioner:
We went through the same physical regimen, more or less. It also worked, perfectly well, but this time, there was more: a video: why all your problems in your life are due to spinal misalignment… And then there were the pamphlets. He wanted me to come back regularly. Long term therapy. Oh, your insurance will partially cover this? Great… So you get headaches? It’s your spine. Tired, now and then? That’s your spine, too.
Chicks don’t dig you?* Yep. Spine.
It did sound more than a bit like woo, yep. But I was still quite naive about this stuff. Wasn’t until I mentioned it to someone else, and they said: y’know, chiropractors, they do say that sort of thing–and they may well be entirely full of it up to here–that I thought to call him back, say, okay, no thanks.
Anyway.
Always wondered about that dichotomy, in retrospect. Was it just that I was younger before, not as much of a mark financially? Or were there, at one point, chiropractors who themselves did not buy and sell the woo… or, at least, not quite so entirely? Did they get, at least, that making back joints crunch around a bit probably doesn’t really do anything for, say, fatigue?
Anyway. I guess it’s moot. Last time I strained a back muscle shovelling snow, a GP introduced me to the wonders of over the counter muscle relaxants. And rest. And, again, exercise, thereafter.
Kinda sad for the chiropractors, actually, tho’. Because actually, I’d have been happy to have a guy just thump the hell out of it again to get it mobile. Costs a bit more, sure, but don’t really dig how those relaxants make ya feel–kinda dopey and sloppy for half a few hours, anyway. Hell, I’ll slip ya an extra $10 not to do the manipulation, and no one has to tell your chiropractic colleagues… But if the thumping has to come with a quack video, too, and a schmuck pedalling a six month regimen of snake oil to correct problems you didn’t even know you had, that quite makes up my mind there. No thanks, pass.
*Relative measure, of course. I mean, relative to how much I’d have liked them to, y’know.
@#11: Does a treatment have to fix a problem to be a proper treatment? Pain pills don’t get rid of pain, after all, since it will jus tbe back the next day. I understand that chiropractors claiming to clear up pimples is nonsense, but why can’t they be accepted even as super-masseurs?
Hell, if homeopathists only claimed to quench thirst with their super diluted remedies, I wouldn’t have a problem with them, either.
1) Neither my wife nor I believe in any of the ‘miracle’ claims made by some chiropractors.
2) Since a car accident a few years ago my wife gets severe neck pain that induce bad headaches.
3) Our chiropractor successfully alleviates the neck pain. He doesn’t claim to work miracles, cure cancer, or any of the rest of the quackary often associated with chiropractors. He adjusts her spine. Period.
4) Yes. The pain comes back, but only if my wife neglects the neck exercises that the chiropractor recommended. He also recommends the use of a heating pad.
5) As to PZ’s father, I would suggest that not being in pain for a while, even if the pain comes back later, is in itself a success. “Temporary relief of symptoms” is the entire basis of pain medication. Ready to toss asprin into the pile of woo, just because it didn’t actually permanently cure his back, either?
#10: ‘what is the chiropractic equivalent of a sugar-pill?’
In this you’re either implicitly admitting chiropractic does nothing, or you’re confused.
If chiropractors actually make a physical difference to your spine or indeed the ‘subluxations’ in it (whatever they are), or its alignment, or whatever, then for a placebo you could do a trial where patients are given sham spinal manipulation that does not follow the rules of chiropractic. As long as it wasn’t anything dangerous, and you made the patients THINK they were getting chiropractic, that would probably serve as an adequate placebo. I’ve seen something similar done for acupuncture, where they stick the needles in random places, not around the ‘meridians’ of Traditional Chinese Medicine.
Just a second! Here we are!
http://news.bbc.co.uk/1/hi/health/7084644.stm
#14: Aspirin doesn’t claim to change your life permanently. You should SEE some of the adverts chiropractors have in their surgeries – implying that if you get spinal manipulation, you’ll automatically become healthy, wealthy and, well, the less said about wise the better probably.
A good massage, or various other remedies, would probably alleviate your wife’s neck pain just as well as chiropractic.
I threw out my back on two different occasions;
Tried two different methods to fix it.
The first time, I tried chiropractic, because
The guy said it works–ipse dixit.
The next time I just let it heal on its own
And avoided the chiro technique;
The first time, he cured me! It took seven days,
But the second time took a whole week!
AJ hits the nail on the head for prevention of some back problems: exercise. Between the fact that many don’t exercise and the ab-centric spin in the media that ignores the other half of our core, I’m surprised that we don’t have more problems.
As a former federal prosecutor of health fraud cases, and also of antitrust, I offer some observations.
One should focus on specific treatments and whether they have been substantiated by the scientific method, e.g., double blinded clinical studies. It is not helpful analytically to paint any profession with a broad brush. Graduates of medical schools are my preferred service providers, but if one keeps up with current medical literature, one finds “medically accepted” treatments being shelved all the time, replaced by better (hopefully) ones. So at a point in time, a medical treatment may in fact be harmful, or non-efficacious.
Good physicians rely on some treatments some may find “alternative”, and insurance companies will pay for them. (A good, focused massage may be more efficacious than a cortisone shot.) The booklet that comes with a medical plan will detail some of them.
The medical profession is not 100% perfect by any means, and must rely on a clinical testing process which is difficult, expensive, and limited. Often, many years must pass before long-term treatment results become apparent. The advantage the medical profession has going for it is its willingness to look at evidence, and reevaluate that evidence over time. (Cold medicines for young kids? Out the window.)
Here is why I am suspicious of branding an entire profession as quackery. The history of medicine in this country must include a chapter on how certain specialties and certain license holders have tried to denigrate other providers. Battles have included obstetricians versus nurse-midwives, ophthalmologists versus optometrists, podiatrists versus orthopedists. My antitrust practice included handling antitrust cases where the “in” group tried to drive the “out” group out of business, e.g., orthopedists would band together to try to keep podiatrists (who can be very good foot surgeons)out of hospital operating rooms.
When I worked at the Federal Trade Commission, such disputes would be resolved by requiring parties to demonstrate their reliance on the scientific method. Sometimes the FTC would hire its own experts and conduct tests or surveys.
Nor is it helpful to use the broad brush of “natural” remedies, e.g., herbal remedies, versus “medicine.” Many pharmaceuticals are herbally based, but their efficacy has been shown through the scientific method. (On the other hand, personally I’d never set foot in those mega-vitamin stores one finds at the mall, unless you like having expensive urine.)
So in each case, I would ask — fine, your doctor, shaman, guru, etc. recommended it? Where is the scientific evidence? (My own doctor is so good that he is often way ahead of the curve on how the evidence is trending; he told me some years ago about cold medicines and is dismissive of some popular prescription drugs because the shown positive effects are so limited.)
In areas such as how mental processes affect physical processes, and vice versa, scientific knowledge is only now beginning to accumulate. Developments in this area of inquiry may affect how we view treatments that are now seen as “alternative.”
Excuse my blabbing. To sum up — I would focus on whether a treatment — whoever advances it — has been scrutinized under the clear light of clinical testing. I would avoid heavy handed characterizations, and realize that even professional groups sometimes care more about excluding rivals than legitimate treatment concerns. (Also, there’s the little matter of the profit motive and pharmaceutical testing — too long to discuss here.)
I do not want to seem as coming down too hard on the established medical profession. I just had gall bladder surgery and regard my treatment as amazingly simple and pain free, so I am currently worshipping at that profession’s altar. But I also know (through my own testing) that a few minutes of cranial massage can relieve terrible head congestion as well as medicine. (My wife and I perform this “magic” all the time with friends.)
Stuart Ritchie, #16: You are correct. Many, many chiropractors are using the air of medical respectability given to them as cover for massive quackary that is clearly nothing but snake oil.
You are also quite possibly correct that a really good neck massage by someone who knew what they are doing would achieve the same goal of pain relief for my wife.
But for the very limitted thing my wife needs (pain relief from a neck injury), it clearly works for her and is not terribly expensive (perhaps $80 once every few months, paid for by insurance). But that is all I need from it. Anything more than that need and we go to our regular doctor.
Just thought I’d throw osteopathy into the mix — medical doctors further schooled in manipulation. This seems like a balanced review of that branch of the medical profession:
http://www.intelihealth.com/IH/ihtIH/WSIHW000/8513/34968/358839.html?d=dmtContent
(the said article was reviewed by Harvard Medical School, which means it is 100% correct, right?)
If you think things are bad in the USA, we had a guest researcher in our department (of MEDICINE!) who reported on government funded research in her country. One study that particularly jarred: Homeopathic medicine–applied to CATTLE! I could only conclude that in Scandanavia, the farm animals are more credulous as well. *sighs*
I did say in my post that I acknowledge a role for manipulation in certain situations. And whereas there might be many “honest” chiropracters in some sense of the word, as far as I’m concerned all you really need to know is that at every county fair I’ve ever been to there are at least two chiropractic booths, offering complimentary analyses. And I’ve seen xrays that those folks take in their offices, and the marks they make on them. The mind reels.
Sorry for babbling on today, but after reading comments regarding chiropractic, I must interject (having done a tiny bit of research in this area) the medical profession has done itself no favors in the area of back pain treatment. Too often doctors will recommend surgery, which really has no better (and sometimes MUCH worse) outcomes than exercise.
Now I really must go off and yell at some people for taking Airborne…
PZ – you’re reporting one anecdotal example against those I and others have reported which indicate contrary results. We both know that neither proves anything substantive about chiropractic, and that research is needed. Not everyone responds to scientifically respected drugs but we do not take those people as proof that the drugs are completely without worth, do we?
I provided one example of some research which appears to give some support for the claim that chiropractic can achieve statistically significant benefits in the treatment of lower back pain. Of course that is not enough but I do not think you’re justified in making a statement as absolute as “Does it actually fix anything? And the answer is no”, any more than I am justified in saying chiropractic definitely provides relief above and beyond the placebo effect.
The examples given by you and others here of instances where chiropractic has not helped a back pain sufferer are interesting to me, because I can honestly say that of the fifteen or twenty people I have known who have used chiropractors, all reported not only “feeling better” but feeling much better, very quickly. Again, this does not prove that chiropractic achieves a physical healing in a statistically significant quantity of those who try it but I do think it should make us a little more careful before completely dismissing it.
I hear about all these magical back pain cures and I think to myself: “pain is there for a reason, it’s probably NOT a good idea to run and jump so soon after rupturing a disc!”. Do chiropractors recommend a return to normal (e.g. hiking in Crete days after ruturing a disc)? If so, they are completely irresponsible. Just because you feel better doesn’t mean you are better.
That’s “rupturing”. Sorry
John Mac…it’s called a “shift” key. It makes lower-case letters into capital letters. You should try it. Come on are you really THAT lazy?
I have a cousin who, as we speak, is lingering on the edge of death. Last time I saw her she was an active, healthy nurse in her 50s. Recently, she had an odd pain that she described as a pain “in the bone behind her ear.”
I’m not sure what route or reasoning led her to a chiropractor, but she did in fact visit one.
If all you have is a hammer, you treat everything like a nail. If you are a chiropractor, you treat everything as treatable by an “adjustment.”
The “adjustment” ruptured an artery. Half her brain seems to be dead. She is not on life support, and there is the possibility of recovery. Her doctors (doctors tend to be optimistic when speaking to family members) are giving her a 50-50 chance of being alive in a week or two, and if she is alive, they are not being especially optimistic about return of function.
I am not a person with one bad story about chiropractors. I’m a person who knows one person (a couple, actually) who swear by them, and about a dozen people who have been hurt by them. The example I give here is by far the worst I personally know.
I knew the first volley of comments would be anecdotal support for chiropractic and the “not so fast there” mentality.
Here’s why we should be very suspicious that chiropractic as a specific discipline is a crock of nonsense (done without reading the link’s approach):
– The historical basis of it is nonsense.
– The proposed mechanism (“subluxations”) is nonsense.
– The studies for its efficacy are weak or none.
– Anecdotal “evidence” counts for nothing.
– The spine did not evolve to be a Rubik’s Snake; it is
not meant to be able to be “adjusted”. What is being
adjusted? There are no linkages which are meant to
“hold” that adjustment.
– There are very similar treatments available called
“massage” which do not claim or charge for any medical
expertise.
– Some methods used are easily shown to be nonsense (like
clickers and comparing leg lengths).
– Some methods used are damn dangerous (quick neck manips)
– Back pain is a self-resolving condition anyway.
Chiropractic is some weak gruel.
I’ve been reading on alt med for a while, and my understanding is that there are basically two schools of chiropractry. One of them, the original, more traditional “Palmer” school, is based on a belief in vitalism and is full of woo. The other offshoot has evolved into doing nothing but physical therapy for back pain, and plenty of studies show this kind of chiropractic manipulation is as effective as going to a Physical Therapist. It often works. And what these chiropractors do here is considered part of mainstream medicine, not “alternative.” There’s nothing woo about it.
So — it depends on what kind of chiropractor you happen to find. Same thing with nutritionists and herbalists. One of the major tactics alties use to gain credibility is calling normal, reasonable, noncontroversial forms of health care “alternative medicine,” and then try to let the nonsense sneak in.
Just like with religion. Find something somewhere in a holy book which makes sense, and then act as if the entire system has now been established as true.
It’s strange how some of the normally hard-headed rationalists on this blog can be turned into woo-lovers because a few people they know claim to have benefitted from therapy based on a bizarre, untested, 19th-Century hypothesis.
Nobody’s perfect, I suppose.
People need to divorce some aspects of Chiropractic from others before they claim the stuff really works. At its heart Chiropractic was grafted on top of spinal manipulation, which actually has some genuine benefits for back problems, especially when combined with heat and massage. Where Chiropractic becomes pure quackery is the claim adjusting your back can affect more than your back, there’s no science behind “subluxations” and high neck manipulations can kill you, the field has contributed nothing new to medicine since its creation. Chiropractic is essentially a whole lot of woo added to an actual medical practice, the fact the base medical practice is real doesn’t change the fact that Chiropractic is quackery. You’d be much better off seeing a genuine medical back specialist, who at least won’t attempt a high neck manipulation.
But here’s the kicker that keeps Chiropractic in business, its a whole lot cheaper, you go in primarily for a back issue and they may offer you some temporary relief, but you pay a fraction of the amount you would to a real doctor. And of course Chiropractic doesn’t kill all that many people in a year…
I’m sure most people entering the field mean well and genuinely want to help people, and there’s always been this thin veneer of respectability, but in reality much of Chiropractic has about the same value as those people selling high colonics.
Jack Rawlinson’s comments elicited sympathy from me; I once had similar symptoms from a similar source and have never known such pain (and I’ve had broken bones, a crushed testicle, an infected tooth* etc which are all very painful).
I went to an MD, who gave me painkillers and an anti-inflammatory and rested. My lower back got better in a few days, and I’ve been very careful of how I lift since.
Anectote: For several years one of my work colleagues went to the chiropractor every few weeks. She was sure it worked, I didn’t have the heart to tell her that, were the treatments working, she wouldn’t have to keep going!
I’ve since left that job, but I suspect she’s still going.
*Trismus is no fun at all.
A friend of mine, an otherwise smart and reasonable person, once told me that her chiropractor “finally figured out what’s wrong with me. The right and left sides of my brain have reversed themselves!” This quack also had my friend believing that whatever “manipulations” they had done had corrected this alleged problem.
As a practitioner of evidence-based medicine, I can accept — maybe — that certain chiropractic techniques might temporarily relieve certain types of back pain. (though the reports of strokes have been enough to scare me away forever. I’m a fan of an ice pack and a good massage, personally, for my occasional neck spasms.) My problem with chiropractors is that they claim to treat a laundry list of ailments that would impress a patent medicine salesman from the 19th century. A good rule of thumb is: the more different diseases and symptoms they claim to be able to treat, the more suspicious you should be.
And if they invent a completely preposterous, imaginary “ailment” for you, and then claim that they’ve cured it, you should run away.
pedant – break free of the conventions of punctuation! we have to do what we’re told often enough, it’s important every now and then to throw protocol out the window and breathe free air! you can take my body, but you’ll never take my lower-case uniformity! also, i am that lazy.
stuart ritchie – you fear i am confused – i am, but only as to why you thinks i must be. finding an adequate placebo for chiropractic is not as easy as in your example of acupuncture. the sham acupuncture technique involved putting needles in the wrong place, but the pin-ee still felt the needle go in. if you tried to convince them they’d received a treatment by, say, prodding them with a ruler, you’d have a much harder time of it. if you’d ever had your spine manipulated, you’d understand why it’s difficult to convince someone you’ve done it when you haven’t.
that said, i’d love to see a good trial exploring chiropractic. one thing that’s clear from these comments, and from my own limited experience, is that there are many different kinds of chiropractor. certainly there are some less than honest, and some less than competent, and some downright dangerous. more investigation, and perhaps more regulation, is needed.
Another negative anecdote:
I was having terrible neck pain after a traffic accident, so I was sure that was the cause. I had no relief from the chiropractor, even though he was one of the gentler ones that didn’t do the woo bit. Turns out that the cause of my neck pain was looking at computer monitors above my head height through my bifocals. Rearranging the lab solved that problem. The chiropractor never asked me what my job was or how I performed it. It was an ergonomic problem.
The second time I went to one was after I popped a muscle in my lower back moving heavy furniture into a new house – I felt the pop and the immediate pain. This chiropractor was full of woo and wanted me to schedule appointments for a full year. He took an x-ray of my back and then showed me an x-ray of someone else’s back with such a severe curvature that that person should have been in a wheelchair. I walked into his office, gingerly, and couldn’t walk out after the manipulation. A days rest and careful walking for a couple of days and the pain went away. Learning how to lift with one’s legs is a valuable lesson.
I gotta say, I’m as skeptical as the next guy, or more so. But I had some serious back issues due to slouching as a kid, and my local chiropractor fixed my up but good. My back used to get so bad, I couldn’t stand up. I still get a little pain now and then, but after four visits to the chiropractor, I have next to zero problems. I know I don’t have any scientific proof, and this post is an argument through personal experience, but damn. Chiropracty didn’t change my life, but it sure helped me stand up on a reliable basis.
That is truly an excellent, well written article on homeopathy by Ben Goldacre.
LTerminus, my story is similar to yours:
I gotta say, I’m as skeptical as the next guy, or more so. But I had some serious back issues due to slouching as a kid, and
my local chiropractorsimply growing older fixed me up but good. Later in life, my back used to get so bad, I couldn’t stand up. I still get a little pain now and then, but afterfour visits to the chiropractorwaiting and doing nothing special, I have next to zero problems. I know I don’t have any scientific proof, and this post is an argument through personal experience, but damn.ChiropractyWaiting and taking it easy for a few days didn’t change my life, but it sure helped me stand up on a reliable basis.#36 – john mac – Ah, what if you did the sham manipulation to people who had never had chiropractic before, so didn’t already know what if felt like?
There must be a reliable way to do it, as they did so in that Lancet study I linked to via the BBC News website.
Oh man,
I’m going to get nailed to the wall for this buuuut here goes.
I’m always a little upset when people totally discount alternative medicines. I have an undergraduate degree in Biology, so I’m going to put it forward right now that my qualifications aren’t amazing. However, one of the things that really disillusioned me about biological research is that things with no money behind them don’t get research. In biology of Invertebrates, there were so many cool organisms where it was like “well, we don’t know anything about this worm, but over here we have these barnacles that we know a sh’load about because barnacles are/were a threat to the shipping industry”. Where am I going with this? There’s a possibility that some alternative remedies actually do work, but are so mundane and common as to be non-profitable. There’s probably a lot of preventative traditional remedies that work as well, but then no one ever made a dollar on prevention.
I’m very skeptical about alternative medicine. I think at best, 25% is gold and 75% is BS. But I also know enough not to trust blindly in the infalibility of pharmaceutical companies where priority is determined by profitability, and where lifestyle drugs and remedies for imaginary diseases get priority over less common but more severe ailments.
scrabcake :
1:3 is hardly very skeptical. I consider that as mildly skeptical.
BTW, is that 1 in 4 of woo modalities you consider “gold”, or do you refer to 1/4 of each modality?
By the way, isn’t alternative [to] medicine by definition non-medicine?
You’re really claiming 25% of non-medicine is “gold”. Wow.
#41 – stuart ritchie – perhaps chiro-virgins would be easier to convince, but they’d still know that you were supposed to be manipulating their spine, and would surely get suspicious when that didn’t happen. i’m not saying it’s impossible, just complicated.
To those claiming that back pain “just goes away given enough time and rest”–it’s not always true, not by a long shot. Chronic back pain does exist, of the kind that can make exercise impossible; heat and rest don’t necessarily help it.
I’m not saying chiropractic really helps anything, either; at most, it can alleviate symptoms for a while. I can achieve the same result with a pair of taped-together tennis balls, the weight of my body, and a hard floor to push back the twisted-around vertebrae, plus a good dose of NSAID and a hot water bottle. In my particular case, I have no doubt that stronger back muscles would be a great help, but this problem is chronic–I should exercise *every day*, with any lapse paid for with a return of the pain. Meaning that exercise is not a cure either, just a method for alleviating the symptoms. The only difference with painkillers (medicine’s response) or chiropractic (the alternative response) it that exercise is free, and my tennis balls don’t charge me $100 per use.
I guess all I’m saying is that we’re still pretty much clueless when it comes to chronic injury or illness.