Healers Or Quacks? Part1: the 80-Year War with Science Part2: How Chiropractors Can Help-Or Harm

May 1976

er Reports consum t from A reprin CHIROPRACTORS HEALERS OR QUACKS? PART1: THE 80-YEAR WAR WITH SCIENCE PART2: HOW CHIROPRACTORS CAN HELP-OR HARM

Pennsylvania Medicine, May 1976 45 CHIROPRACTORS HEALERS OR QUACKS?

Can the chiropractor serve some of your health care needs? Pointing to the more than 5,000,000 persons who visit .chiropractors in the United States and Canada each year, the chiropractic profession insists it offers an important health ser vice. Its critics in medicine and science think other wise, however, and assert that chiropractic is a danger to patients. In this first of a two-part series, CU explores the reasons for that controversy and examines some of the theories and practices of chiropractic, a system of therapy that claims to / restore or maintain health by spinal manipulation. PART 1: THE 80-YEAR WAR WITH SCIENCE In a voice charged with emotion. Dr. Joseph Janse, presi fostered by agencies like the NIH. In turn, medical and gov dent of the National College of Chiropractic, was addressing ernment officials have generally branded chiropractic as "an the hushed audience in the conference room. unscientific cult " or "a significant hazard to the public." "For me to stand here and exclaim or explain that I and This time, however, the planning commission for the meet my people, or those who preceded me, have never indulged ing-which was held in response to a Congressional mandate in mishap or overclaim ... would be dishonest. -included three chiropractors among its eight members. " ... I am not, and we are not, necessarily proud of those The arrival of chiropractic in such a prestigious strong that we are responsible for, and have to live with. But I do hold of science marked the latest in a series of developments hope ... this workshop will not deny the people of my pro that would appear to lend support to the chiropractor's de fession the privilege of progress and ethics." mand for general recognition as a legitimate practitioner of As on many previous occasions, Dr.Janse was responding the healing arts. to a challenge to chiropractic. But this occasion last Febru Despite opposition from organized medicine and the U.S. ary was different from the rest. Public Health Service, chiropractors in 1973 won the right The conference, a "Workshop on the Research Status of to render some services under both Medicare and Medicaid. Spinal Manipulative Therapy," was taking place in Be Soon after, they achieved licensure in Louisiana and Mis thesda, Md., at the National Institutes of Health (NIH). sissippi, the last two holdouts among the 50 states. (The period saw similar chiropractic gains in Canada.) Never before had chiropractors participated in an inter same national scientific conference in the United States, much The crowning triumph for American chiropractors came less at the NIH. one of the world's foremost medical and in August 1974, when the U.S. Commissioner of Education biological research organizations. recognized an accrediting agency for chiropractic colleges. Throughout its 80-year history, in fact, chiropractic has Now colleges accredited by the Council on Chiropractic Ed largely rejected or ignored advances in medical science ucation have official national standing. Previously, degrees

46 Pennsylvania Medicine, May 1976 conferred by such institutions-such as the "Doctor of who specializes in medical and environmental reporting. Chiropractic" degree (D.C.)-were listed as "spurious" by The investigation included an extensive review of chiro the U.S. Office of Education. Recognition also meant that practic and medical literature, as well as the findings of accredited chiropractic schools would be eligible for finan pertinent national, state, and provincial government studies cial assistance under a variety of Federal funding programs. conducted in the U.S. and Canada over the last decade. CU Chiropractic, in short, has made undeniable progress in visited three chiropractic colleges-Palmer, National, and professional status and access to government-funded pro Canadian Memorial-and also interviewed officials of the grams. Whether those gains mean equivalent progress for principal chiropractic associations, whose memberships in health care, however, is another question. In CU's view, the clude virtually all of the 15,000 U.S. chiropractors in active answer depends on whether chiropractic is a valid method practice and some 1400 chiropractors in Canada. CU also of treatment or, as its critics contend, a form of quackery. conducted interviews with American Medical Association To explore that question, CU studied the current claims representatives and with medical practitioners in ortho and practices of the profession to determine what chiroprac pedics, physical medicine, neurosurgery, radiology, and tic is and what potential benefits or harm a patient might other specialties. In the interest of objectivity, the assistance experience. Our report is based on a six-month investigation of CU's medical consultants was sought only for clarifying by Joseph R. Botta, a Senior Editor of CONSUMER REPORTS medical terminology or practices.

Chiropractic, which literally means been a common practice, in fact, to apply chanical disturbances of the nervous sys "done by hand," originates from the theo leeches, irritants, or even hot irons to tem are what impair the body's defenses. ries of Daniel David Palmer, a tradesman tender sites along the spine as a treatment According to this theory, minor "off-cen who operated a "magnetic healing" studio for various disorders. terings" of the vertebrae or pelvis might in Davenport, Iowa, late in the 19th By the end of the 19th century, how disturb nerve function and lower the century. According to Palmer's writings, ever, such practices had waned. The sci body's resistance to germs. Structural mis one of the passions of his life had been to entific revolution that would shatter the alignments, say chiropractors, may also discover the ultimate cause of disease boundaries of medicine in the 20th cen disturb nerve impulses to the visceral -why one person should be ill while tury had already begun. organs, allegedly causing or aggravating another, "eating at the same table, work Osteopathy, which emerged a few years such illnesses as heart disease, stomach ing in the same shop," was spared. "This before chiropractic, adapted to the change. ulcers, and diabetes. question," said Palmer, "had worried While retaining a separate identity-partly "While many factors impair man's thousands for centuries and was answered because of its use of manipulative therapy health, disturbances of the nervous system in September 1895." and its emphasis on the muscles and skel are among the most important," asserts the American Chiropractic Association. The answer occurred to him, wrote etal system--0steopathy gradually adop According to the association, almost any Palmer, after treating a janitor he claimed ted the concepts and practices of orthodox medical science as well. Osteopathic stu thing can cause a mechanical subluxation was deaf. Palmer alleged that he restored dents now receive training similar to that that might trigger nerve disturbances: the man's hearing by adjusting one of his of medical students and earn a Doctor of gravitational strains, asymmetrical activi vertebrae, the bony segments of the spine. Osteopathy (D.O.) degree. In contrast, ties and efforts, developmental defects, or Apparently unaware that the nerves of chiropractic maintained its allegiance to other mechanical, chemical, or psychic hearing are entirely in the skull, Palmer the 19th-century focus on the spine. irritations. "Once produced," claims the theorized that he had relieved pressure association, "the lesion becomes a focus on a spinal nerve that affected hearing. CHIROPRACTICTHEORY NOW of sustained pathological irritation." Adjusting the vertebrae, he decided, had Some chiropractors still cling strictly to removed interference with the nerve sup Palmer's theory that misalignments of THECHIROPRACTIC ADJUSTMENT ply and thereby allowed the body's "In the vertebrae--0r "subluxations"-are the While Palmer's theory of disease has nate Intelligence" to effect a cure. Innate principal cause of disease. Such practition been modified, the primary chiropractic Intelligence, according to Palmer, was the ers tend to advertise that chiropractic is treatment for all human illness remains "Soul, Spirit or Spark of Life," which he crucial to good health. One recent ad, for the same as in 1895: spinal adjustment. believed expressed itself through the instance, called vertebral subluxation "a Chiropractic adjustment is a specific nervous system to control the healing killer of millions of people yearly." form of spinal manipulation. The tech process. By supposedly impeding that ex In the main, however, chiropractic now nique, which is also used occasionally by pression, misaligned vertebrae were judged recognizes other factors in illness. It osteopaths, physical therapists, and some by Palmer as the cause of most disease. tends to assign bacteria and viruses a back medical doctors, is distinguished by the In 1895, Palmer's emphasis on the seat, but it no longer ignores their exis suddenness or speed of the maneuver, spine raised fewer eyebrows among med tence. Essentially, it has modified Palm which prevents any control by the patient. ical practitioners than it does today. Louis er's theories to accommodate some basic By comparison, a patient can voluntarily Pasteur had only recently demonstrated scientific realities. resist-and therefore control-a manipu the plausibility of the germ theory of For example, modern chiropractic lation when the therapist does it slowly or disease. And little more than a generation agrees with medicine that germs are fac rhythmically. If there is pain, for example, separated Palmer from many eminent tors in disease and that the body has in the patient can physically prevent further physicians who had viewed the spine as herent defense mechanisms against them. movement or advise the therapist accord the seat of iMumerable human ills. It had However, chiropractic stresses that me- ingly. The latter technique, which is gen-

Pennsylvania Medicine, May 1976 47 erally called "mobilization," is the most ailments. The new science of bacteriology The types of treatment are often similar common type of joint manipulation used held immense promise for treating other to some used by physicians or physical by physical therapists. wise fatal illnesses, as did other develop therapists (although the purpose or appli In contrast, chiropractors emphasize the ments in diagnosis and surgery. Hence, cation may not always be the same). In sudden maneuver, which they call a "dy medical efforts in the first third of this addition to exercise programs, such mea namic thrust." It may be done gently or century focused on infectious disease and sures may include the use of braces or forcefully, but always with a quick move similarly urgent problems. Backaches casts, whirlpool baths, hot or cold packs, ment. The maneuver often produces a could wait. Not until the 1930's did the ultrasound, diathermy machines, and click-like sound in the manipulated joint. medical profession start paying much at other devices. Medical and osteopathic practitioners tention to physical medicine and rehabili Chiropractic, in short, is seldom lim who use the technique agree that it is tation. In the interim, chiropractic seemed ited to spinal adjustment alone. Chiro sometimes effective for treating certain to offer hope in an area that medicine had practors often can, and do, make use of joint abnormalities or pain originating in largely ignored. common measures for treating muscle or the back or neck. There is disagreement Even today, many physicians find little joint complaints. And some limit their among them, however, about what con satisfaction in treating back ailments. practice almost exclusively to such com ditions it helps and exactly how it does so. Chronic pain may often be influenced by plaints, frankly dismissing Palmer's disease One prominent theory is that the ma psychological problems or physical habits theory as "cultism" or "chiroquackery." nipulation essentially restores joint mobil that patients are unable or unwilling to An undetermined number also try to ity, including a measure of "joint play" change. Exact diagnosis can be elusive cooperate with local physicians, referring that isn't apparent in voluntary move and expensive, and follow-up treatment patients who appear to need medical care ments. Another is that the technique may can be time-consuming for the doctor. and occasionally receiving a referral in displace a small fragment of a spinal disk Specialists in physical medicine and ortho turn. Last April, for example, Medical that may be pressing against adjacent tis pedics interviewed by CU asserted that, Economics, a magazine distributed to sue. Others suggest that the sudden force too often, treatment by some physicians physicians, reported the response of more may stretch a contracted muscle or tear simply meant prescribing a l'ainkiller, than 1000 office-based M.D.'s to a survey adhesions, possibly relieving a local pain muscle relaxant, or tranquilizer rather it conducted of referral relationships with causing spasm. Some manipulators sub than taking the time and effort such ail chiropractors. More than 20 per cent scribe to one theory while others believe ments might demand. stated that they received some referrals several are possible. As yet, there's no from chiropractors. Almost 5 per cent of proof that any is correct. STEPPINGINTO THEGAP the respondents said they sometimes re The chiropractic explanation is that the Chiropractors, meanwhile, have usually ferred patients to chiropractors. maneuver corrects subluxations. However, been ready and willing to see patients re On the basis of CU's investigation, the current chiropractic definition of sub peatedly and provide active treatment however, such instances of cooperation, luxation is so broad that it takes in virtu manipulation, exercise programs, heat ap or of chiropractic willingness to limit its ally any mechanical or functional de plication, and the like. In CU's opinion, scope of practice, tend to be the exception rangement of the spine-or, as one such accommodation has probably rein rather than the rule. Chiropractic officials speaker at the NIH workshop put it, "any forced the belief that chiropractors spe and educators invariably told CU that the variance from the normalcy of a newborn cialize in back ailments. Indeed, a survey chiropractor's role was that of a primary child." As a result, the chiropractic view conducted several years ago by the Uni physician, not a muscle-and-joint practi does not reject any of the other theories. versity of Kentucky College of Medicine tioner. They emphasized that chiroprac: A locked joint or offending disk fragment revealed that most of the people in the tors should serve as one of the "portals would simply be labeled a subluxation. study who visited chiropractors believed of entry" to the health-care system, func Thus, most manipulators believe that that a chiropractor has more specialized tioning essentially as family doctors and their action affects some local condition, training in musculoskeletal back and joint referring patients, when appropriate, to whatever it may be. The real quarrel arises problems than a physician has. Actually, other health professions. when chiropractors claim that their ma chiropractors usually have more training Such a role assumes that chiropractors, nipulation also influences the nervous sys than medical doctors in only one area: despite much less diagnostic training than tem and helps prevent or cure disease, an manipulative t>herapy. M.D.'s or D.O.'s, will recognize when to issue we will discuss later in this report. Chiropractors who belong to the Inter treat a patient and when to refer one to national Chiropractors Association (about a physician. It's on this point-and on the BIRTHOF A "BACK SPECIALIST" 37 per cent of practitioners) often confine question of scientific validity-that chiro Despite chiropractic's origin and all-em their treatment solely to manipulation. Be practic clashes most seriously with organ bracing theory of disease, many persons sides spinal adjustment, treatment may ized medicine. tend to view chiropractors as specialists include various "soft-tissue" manipula in muscle or joint problems, particularly tions, such as massaging muscles or apply TOO MUCH COMPETITION? those of the back. ing sustained pressure to ligaments. But For years, chiropractic spokesmen have Part of the reason, of course, is that the basic approach is "hands only." argued that medical or scientific opposi chiropractic manipulation focuses on the Most other chiropractors, however, use tion to chiropractic is largely a business spine. Whatever its ultimate intent, the a variety of treatment techniques. The quarrel. According to the charge, organ therapy involves direct, physical action on scope generally depends on what's permit ized medicine is a monopoly concerned the back. So people may conclude that ted by state or provincial law. Chiroprac primarily with aggrandizement of physi that's what the treatment is for. tors may not practice surgery or order cians, and the American Medical Associ But there are other reasons as well for prescription drugs. hut many jurisdictions ation is just trying to keep out the com this traditional association. For one thing, allow them to use physiotherapy and to petition. The book "Chiropractic: A the medical contemporary of the early recommend various nutritional supple Modern Way To Health," which was chiropractor gave little priority to back ments, such as vitamins and minerals. recommended to CU by chiropractic offi-

48 Pennsylvania Medicine, May 1976 cials, typically points the accusing finger is that of trying to teach at the post-college Lombard, Ill., and at Canadian Memorial at the AMA: professional level students who for the College of Chiropractic in Toronto al ". . . the AMA is a private group of most part have not gone beyond high ready have college degrees. men and women with a common private school, and who in high school were not The change in the academic background business interest, namely the practice of in the upper half of their classes. For of students is perhaps most dramatic at medicine," writes the author, Julius Din many of them a professional college Palmer College of Chiropractic in Daven tenfass, D.C., a charter member of the course is too difficult to master." port, Iowa, which is by far the world's New York State Board of Chiropractic The result, said Dr. Anderson, was to largest chiropractic school (Palmer trains Examiners. "Despite their vaunted con downgrade instruction so that students about one-third of all chiropractors). Its cern for the public health and welfare, the could pass the courses. January 1975 enrollment still included medical sachems act toward chiropractic A comprehensive study of chiropractic about 550 students whose previous edu as any collection of businessmen being conducted in 1965 for the government of cation was limited to high school or an threa,tened by a rival concern which seems Quebec reached similar conclusions. Stu equivalency program. However, virtually to have the kind of merchandise that cus dent admission requirements were termed all were seniors scheduled to graduate this tomers prefer." "too liberal, and inadequate," and the year. The rest of Palmer's 2100 students When CU discussed the allegation with training required of teachers was judged had one or more years of college; 416 of chiropractic officials, we expected to find "definitely inferior" to that demanded them held college degrees. wide agreement with it. We didn't. either by medical schools or by university Academic requirements for faculty "It's not true," said Richard C. Schafer, science departments. "A great number of members have also been upgraded. In D.C., director of public affairs for the these teachers are chiropractors who have creasingly, instructors in basic science sub American Chiropractic Association. "The received training in basic sciences of very jects must have recognized qualifications average medical doctor has more patients little value," said the Quebec study. in their disciplines, and the colleges are than he can handle," Dr. Schafer said. Landmark studies of chiropractic by giving preference to candidates with grad "They're not afraid of competition." the U.S. Department of Health, Educa uate degrees. Why, then, does organized medicine tion, and Welfare in 1968 and Ontario's Insistence on advanced qualifications oppose chiropractic? Committee on the Healing Arts in 1970 tends to be most pronounced at National CU got several answers from AMA expressed similarly critical findings. In ad College. Instructors in basic sciences must representatives and other critics. They in dition to poorly qualified teachers, inferior generally have a graduate degree in their volved charges of inferior education and basic science courses, and notably low specialty, and the college says it will not training, rejection of medical science, and admission requirements, both reports hire a teacher with only a master's degree abuses or hazards arising from the prac criticized the lack of any emphasis on re unless the candidate's department already tice of chiropractic. search. The HEW report also noted the includes a Ph.D. A D.C. degree is still Since those allegations have serious absence of inpatient hospital training and acceptable, though, for instructors in chi implications for patient care and safety, a poor ratio of faculty to students. At the ropractic or clinical courses. CU investigated them in detail. time of HEW's study, chiropractic schools In short, chiropractors are no longer averaged about one faculty member for teaching all subjects. And the colleges CHIROPRACTICEDUCATION each 19 students, compared to one per 1.7 have also narrowed the ratio of faculty There is virtually no denial that educa students in medical schools. (Both figures to students. Canadian Memorial, for ex tional standards for chiropractors in the include part-time instructors with admin ample, has roughly one teacher for every past were often little short of appalling. istrative duties or outside practices.) eight students. Instructors are still spread As late as 1942, according to Medical "The scope and quality of chiropractic fairly thin at Palmer, with one per 30 Economics, it was still possible to get a education do not prepare the practitioner students. But that's an improvement mail-order Doctor of Chiropractic degree to make an adequate diagnosis and pro over its one-to-45 ratio of a few years ago. from a Chicago college for $127.50. vide appropriate treatment," the HEW Library facilities have also been ex Although standards later improved, report concluded. The Ontario committee panded, and National College, for one, glaring deficiencies prevailed until recent endorsed HEW's findings on education has initiated a modest research project years. The scope of the problem was out and judged the chiropractor's diagnostic with a Federal agency. lined in a thorough evaluation of chiro ability as "very limited at best." practic schools conducted in 1964 by A study conducted for the state of Wis DIAGNOSTICTRAINING Dewey Anderson, Ph.D., who was then consin in 1972 found conditions largely Despite improvements in other areas, director of education for the American unchanged, While commending the "sin education in diagnosis remains a stepchild Chiropractic Association. Some of the in cerity and dedication" of both students -especially in comparison to the training adequacies mentioned in Dr. Anderson's and faculty, the Wisconsin study commit received by physicians. Part of the prob report were: "Too many instructors tee concluded that "the deficiencies are lem is historical. Traditionally, chiroprac teaching the basic sciences without having too pervasive to permit an adequate edu tors believed it wasn't important to had any advanced or graduate training in cational experience." "name" the disease. The important thing these sciences. Too many instructors not Since the early 1970's, chiropractic was to find and correct the subluxation trained or qualified as teachers nor mas schools have actively sought to raise their allegedly causing it. It made little differ ters of their fields, resulting in slavish educational standards. This was evident ence, for example, if a liver disorder in devotion to textbook teaching and instruc at the colleges CU visited. They still re volved congestion, cirrhosis, or cancer; the tion considerably below the level of post quire only a "C" average for admission, object was to relieve nervous-system dis college professional education." but entering students must now have two turbances that were supposedly respon The academic credentials of the stu years of college or the equivalent, includ sible for the disorder. dents, Dr. Anderson noted, were similarly ing courses in biology and chemistry. Ac Accordingly, that approach placed little deficient. tually, about half of the current entrants or no emphasis on making a differential "One of the most serious handicaps ... at National College of Chiropractic in diagnosis-that is, one that considers pos-

Pennsylvania Medicine, May 1976 49 sible causes of a pat1enrs symptoms and with patients. Chiropractors, in compari to accept, though, is chiropractic's singu establishes probable as well as alternative son, generally work alone. lar concept of the nervous system itself. diagnoses. While differential diagnosis is Clearly, the scope, quality, and length According to that view, the nervous fundamental to the practice of medicine, of chiropractic education cannot provide system is the overall master of all body chiropractors generally shunned it, pre the depth of diagnostic training a physi functions, regulating everything from ma ferring to call their approach "spinal cian receives. Even more fundamental, jor organs to intricate cellular activities. analysis" rather than diagnosis. Even to however, is the validity of what the chiro A typical statement of this concept ap day, some practitioners insist that medical practor learns. If it's unsound, more train pears in the current pamphlet, "How diagnosis is out of place in chiropractic. ing might only compound the error. The Chiropractic Heals," one of many such "It is a trap for the unwary in this pro crucial question, therefore, is whether pamphlets for patients distributed by fession," wrote William D. Harper, D.C., chiropractic theory is true or false. chiropractors. president of Texas Chiropractic College, "None of the body functions 'just hap recently in The Digest of Chiropractic THE CONFLICT WITH SCIENCE pen'," says the pamphlet. "Your heart Economics. "We waste too much time in The belief that minor interference with doesn't just happen to beat. Your lungs our curriculum on medical diagnosis." the spinal nerves can cause or aggravate don't just happen to inhale and exhale. Many chiropractic officials and educa disease is the cornerstone of chiropractic Your stomach doesn't just happen to di tors disagree with that sentiment, how theory. It is also the focus of scientific gest your dinner. A II doctors know that ever. And diagnostic training is now an objections. A few anatomical facts may your brain and nerve system coordinate integral part of the curriculum at most help to explain why. these functions which make for life in chiropractic colleges. Yet most of the peo There are 26 pairs of nerves that exit stead of death, ;,ealth instead of sickness." ple leachin~ diagnosis are the very same from mobile segments of the spine. Those Actually, all doctors know no such chiropractors who were trained in the are the only part of the nervous system thing. The heart just does happen to beat. I 960's and earlier, when educational stan conceivably accessible to manipulation. It will beat for a period of time even if dards-and attitudes toward diagnosis Twelve pairs of cranial nerves, which exit removed from the body and cut off from were far from ideal. Those instructors, through openings in the base of the skull all nerve impulses, so long as it's sur moreover, labor under a burden common and bypass the spine, are out of reach of rounded by a nutrient fluid. Transplanted, to all chiropractors-the lack of inpatient manipulation. So, too, are five pairs exit it is capable of sustaining life in another hospital training. ing from the sacrum, a solid bone formed human being without any immediate con "The medical doctor has the benefit of by the fusion of five vertebrae in the lower nection to the brain or nervous tissue. The patient exposure that we do not have," spine. The spinal cord (which is sur heart has an intrinsic rhythm of its own says Andries M. Kleynhans, D.C., director rounded by spinal fluid as well as by pro and thus can function automatically. of clinical sciences at National College. tective layers of tissue) and the brain it Similarly, the stomach digests automat Because of the lack of chiropractic hospi self-with all its interconnecting nerve ically. There are inherent processes that tals, chiropractors seldom see or treat dis pathways-are likewise out of reach. govern the functions of organs as impor eases that the medical doctor does. That Thus, the chiropractor's action is ex tant as the heart, stomach, intestines, gap, Dr. Kleynhans told CU, places chiro erted on only a limited part of the nervous blood vessels, and the like. Their function practors at a disadvantage in their diag system. It excludes, for example, the doesn't depend entirely on the nervous nostic training. nerves of sight, hearing, taste, and smell, system. In addition, chiropractors cannot use and the entire parasympathetic nervous A paraplegic woman, for example, may many of the sophisticated diagnostic tech system. The latter, along with the sym conceive, carry her pregnancy to term, niques available to the physician. This is pathetic nervous system, form the balanc and give birth to a normal baby-despite true even for some major diagnostic aids ing halves of the autonomic, or "involun severe injury to her spinal cord. Except involving the spine. A herniated spinal tary," nervous system, which serves the for bladder and bowel problems, internal disk, for example, isn't visible on a simple vital organs. organs of a quadriplegic still continue to X-ray. If it's necessary to confirm the disk Scientists, of course, accept the impor function, even though the spinal nerves protrusion, a physician may order a myel tance of the nervous system in body func are useless from the neck down. In short, ogram, an X-ray technique that involves tions. What they reject, however, is the life goes on-despite even massive "in injecting an opaque dye into the space assertion that manipulation directed at a terference" with nerve impulses. surrounding the spinal cord. Chiroprac limited part of this intricate system can That doesn't mean the spinal nerves tors are neither trained to use myelograms prevent or cure disease. aren't important. But their importance nor permitted to do so. In the first place, there's no scientific doesn't render other fundamental life Nor do they have the benefit of the evidence that minor off-centerings of the processes trivial. more extensive education and training re vertebrae impinge on spinal nerves. One The immunological defense system, for quired of physicians. In contrast to the study in 1973, which tested fresh cadaver instance, can work independent of nerve chiropractor's two years of college (now) spines, suggested that impingement does impulses. Artificially cultured white blood and four years of professional school, the not occur even when the spine is twisted cells will continue to engulf germs even physician must have four years of college, into extreme positions or abnormal forces though entirely divorced from nerve in four years of medical school, and usually are applied to the vertebrae. fluence. At the cellular level, to which three or more years of hospital residency. Secondly, if such a partial block could chiropractic claims to extend, the same Moreover, the physician's subsequent af occur, its effect would be nil. Research autonomy has been documented. Molecu filiation with a hospital provides a center by neurophysiologists shows that a nerve lar research has become so precise that it for continuing education. At the hospital, impulse travels more slowly in a zone of can sometimes pinpoint which portion of the physician's medical knowledge is rein partial compression but resumes its flow a molecule is responsible for a particular forced and expanded through conferences, immediately thereafter. The impulse disease. These biochemical life processes discussions, and association with col transmitted is normal in all respects. are fundamental-and completely inde leagues, as well as through experiences What is perhaps hardest for scientists pendent of the nervous system.

50 Pennsylvania Medicine, May 1976 Not a single scientific study in the 80- "Does chiropractic treat the following chart. The former lists numerous disor year existence of chiropractic or the entire successfully? Neoplasms, tumors of the ders purportedly helped by chiropractic history of medicine shows that manipula adrenal gland, calculi, hydronephrosis, treatment and gives the percentage of tion can affect any of these basic life tuberculosis, nonspecific infections .... "success" for each. The nerve chart shows processes. But a vast amount of evidence "Are you telling the people that we can a picture of the spine and specifies the suggests it cannot. treat such pathologies? If you are, then diseases supposedly caused by misalign In 1895, neither Palmer nor his con we deserve the title of quack and cultists!" ments at each level. temporaries could foresee that research. "Many within the profession, I'm sure, Neither chart has any scientific validity In 1975, however, there's no excuse for may agree with your comments," an ACA or any acceptable evidence to support its ignoring it. Unless most medical research official replied. However, he noted, others claims. Because of such advertising, the in the 20th century is wrong, Palmer's might want to utilize the tract in their Canadian Chiropractic Association re disease theory belongs in the pages of 19th practices. "This tract, in one version or fuses to release its mailing list to the century history, along with bleeding, purg another, has been a stock item for over 40 Parker organization. ing, and other blind alleys of medicine. years and has been redesigned to meet Another of the most successful practice the sustained needs of the interested mem builders is Clinic Masters, which claims a MEDICINEOF THEABSURD bership." membership of about 12 per cent of all When chiropractic theory is put into Most chiropractic officials interviewed U.S. and Canadian chiropractors in active practice, its efforts can sometimes border by CU frankly admitted the problem of practice. According to its membership on the ludicrous. Several chiropractic over-claiming. "We as a profession have contract, a chiropractor who "desires to pamphlets that have been used in Canada, claimed too much without valid proof," have the Clinic Masters System revealed for example, tout spinal manipulation as said Donald C. Sutherland, D.C., execu to him" must agree to pay $10,000 and a cure for childhood bed-wetting. Actu tive director of the Canadian Chiropractic not "divulge or share, directly or indi ally, the nerves to the bladder emerge Association. He indicated that the Cana rectly," any portion of the system with from the rigid bone of the sacrum. There dian organization was actively trying to anyone other than a Clinic Masters client. is no way to manipulate them. Further, a limit chiropractic's scope of practice. Nei Clinic Masters teaches a variety of spe true nerve defect would cause constant ther in Canada nor the U.S., however, cific income-building techniques and pro bladder problems, not just bed-wetting. could CU find concrete evidence that motes the idea that higher income means Spinal manipulation is also promoted abuses in the field were abating. greater service to patients. Some ways of frequently for patients with high blood At the Sherman College of Chiropractic providing such service include: multiple pressure. A typical pamphlet obtained in Spartanburg, S.C., for example, the cri billing, which means charging for each from the sales department at Palmer Col teria for accepting a patient are liberal spinal adjustment or other unit of treat lege suggests that the ailment may be indeed. According to an editorial by ment rather than accepting a flat office treated through "proper adjustment by Douglas Gates, a dean of the college, re fee; a "case basis" approach, which in hand." quirements for a "chiropractic case" are volves charging by the case (like a sur While the basic causes of high blood threefold: Does the patient have a spinal geon) rather than by number of visits; pressure in most patients are still unknown, column? Does the patient have a nervous and "intensive day care," which adds the portion of the nervous system involved system? Is the patient alive? room or ward fees to the bill. in lowering blood pressure is well identi In recognition of their "service to hu fied-the parasympathetic nervous system. BUILDINGA PRACTICE manity," clients earn membership ranks It is fed by the cranial and sacral nerves. For some chiropractors, economics in one of 12 Clinic Masters clubs. The and, as noted earlier, is entirely inacces probably plays a large part in the range of lowest is the "Leviathan" club, for those sible to manipulation. illnesses treated. A limited scope of prac earning $4000 to $8000 a month. The Another pamphlet from Palmer, titled tice can often mean fewer patients. And highest is the "Purple & White Medallion" "Eye Trouble," suggests that manipulation those who confine themselves to muscu club, which was recently added for mem may be applicable to some eye problems. loskeletal problems-sprains, strains, and bers earning $50,000 or more a month. The optic nerves are completely self-con back or neck ailments-tend to cut their According to the major chiropractic tained in the skull. There is no conceivable income potential. associations, none of the billing practices way to reach them manually. According to the American Chiroprac mentioned above is considered "a reason Other pamphlets obtained from Palmer tic Association, U.S. chiropractors earn an able and customary procedure" in the tout manipulation for conditions ranging average income of about $31,000 annu profession. But criticism has been stifled from acne and appendicitis to stomach ally. Canadian practitioners average somewhat by Clinic Masters' threat to sue trouble and tonsillitis. There isn't a shred roughly the same. Often contributing to those whose remarks it judges to be libel of scientific evidence showing that those the a_ttainment of that income are various ous. It offers a $ I 0,000 reward to anyone ailments respond to manipulation. practice-building organizations that seem who is first to report and substantiate Such unproved claims have bedeviled to abound within the profession. "disparaging statements about Clinic Ma3- some chiropractors for years. In an Au Among the oldest of such groups is the ters" that lead to a successful lawsuit. gust 1974 letter, Herbert W. E. Poinsett, a Parker Chiropractic Research Founda Despite the excesses of some practi Florida chiropractor, took the American tion, which offers a comprehensive, hard tioners and chiropractic's rejection of Chiropractic Association to task for one sell approach for attracting patients and science, the profession nevertheless serves of its pamphlets. keeping them coming back. Over the last more than 5,000,000 patients annually in "The new ACA tract on the kidneys is 20 years, several thousand chiropractors the U.S. and Canada. And many of those a disgrace to this profession," wrote Dr. or their assistants have attended the patients claim to be helped by chiroprac Poinsett. "The statement, 'Your doctor of Parker courses. tic treatment. Next month, CU will dis chiropractic treats many kidney disor Parker encourages practitioners to ad cuss the reasons why people might experi ders,' is pure nonsense! I ask you, what vertise and stresses the use of a "Chiro ence such benefits and some of the hazards disorders? practic Research Chart" and a "nerve" they face in the process.

Pennsylvania Medicine, May 1976 51 CHIROPRACTORS HEALERSOR QUACKS?

In last month's issue, CU explained that chiroprac tic is based on a mistaken 19th-century theory that conflicts with modern science. Yet many persons sincerely believe that chiropractors help them that those practitioners are a good deal more than common quacks. This month CU discusses how patients may sometimes benefit from chiropractic treatment-and the risks they face in the process. PART2: HOW CHIROPRACTORS CAN HELP-OR HARM

Years ago some surgeons thought they had developed a promising cure for angina, the chest pains associated with coronary heart disease. Tying off an artery in the chest appeared to offer relief. The cure was short-lived, however. Subsequent research showed that a sham operation, consisting of just a superficial incision on the chest wall, was equally successful. That experiment, like countless others, demonstrated the broad in fluence of the "placebo effect," a psychological reaction to a medication or procedure that results in improvement or cure of symptoms. Because of it, a sham operation may ease anginal pain _or a dummy pill relieve the nausea of pregnancy. It matters little whether the treatment is surgery, drugs, manipulation, or incantations. The key factors in the placebo effect are the patient's confidence in the healer and the healer's faith in the therapy-especially when that faith is communicated to the patient. Throughout much of medical history, the placebo effect was frequently all any healer could offer. Indeed, a patient was often fortunate if the actual treatment was of psychological value, or even merely worthless, rather than harmful or fatal. Today, despite all the acumen and para phernalia of modern medicine, such psychological effects are still an im portant factor in therapy. And they frequently account for some of the benefits obtained from the most skilled of physicians. They also explain, in part, why chiropractors can sometimes help people.

52 Pennsylvania Medicine, May 1976 Physicians have long recognized the potent commented Fletcher McDowell, M.D., of nature of various illnesses. But some favor psychological effect of the "laying on of Cornell University, to the NIH conference able results can be ascribed directly to hands." Chiropractors at a National Insti participants. "If it were less than 50 per manipulation itself. tutes of Health (NIH) conference last Feb cent, we'd either all be out of work or in Government studies in the U.S. and ruary also acknowledged its role in treat jail, I'm not sure which." Canada have judged manipulation to be a ment. In fact, one prominent chiropractic Even some chronic disorders, such as potentially useful technique for certain speaker, Dr. Scott Haldeman of Vancou rheumatoid arthritis or multiple sclerosis, conditions, such as the loss of joint mobil ver, B.C., felt that such placebo effects have spontaneous remissions. The symp ity. Research in manipulation is still mea should be considered an advantage of toms may disappear regardless of treat ger, and controlled clinical studies are rare. manipulation. ment for months or more, affording tem But chiropractors and other practitioners "Clinicians who practice spinal manip porary or, at times, long-term relief. If the who use manipulative therapy agree it can ulations often become very defensive when patient happens to be under treatment at help some muscle or joint problems. their detractors derisively state that all re the time, the practitioner and the type of Treatment of tension headaches by mas sults can be explained on the basis of psy therapy may get credit for such relief. sage, for example, is well recognized. chological effects," Dr. Haldeman said. Most back problems will also resolve Those headaches can stem from tense mus "However, there are very few therapies themselves. Several studies show that cles in the neck, and proper massage may that have the advantages of laying on of about 60 per cent of patients with back relieve the symptoms. Some practitioners hands, relaxing tense muscles, causing a pain get well within three weeks and at also report that a stiff joint in the neck sensation in the area of pain, the click or least 90 per cent recover within two may sometimes cause headache pain that pop of the adjustment, and a clinician who months-regardless of the type of treat can be treated by manipulation. has complete confidence in his therapy. It ment received. Only about 2 per cent even In general, back or neck pain that might is a pity that this possibility has been con tually undergo surgery, usually for serious arise from restricted movement in a spinal sidered a criticism of the therapeutic pro bone or disk problems. joint may respond to manipulation. Such cedure instead of one of its advantages." Although physicians and chiropractors pain is usually localized in the area of the Numerous studies show that placebo emphasize different methods of treatment joint. However, the pain may sometimes treatment in many disorders helps about in common back problems, a recent study be referred to another part of the body, one-third of patients. Temporary relief of comparing both groups showed essentially such as the chest. Such referred pain may pain or other symptoms has been demon no difference in the outcome of therapy. occasionally mimic the symptoms of other strated, for example, in arthritis, hay fever, Both the physicians and the chiropractors disorders, such as angina. headache, cough, high blood pressure, pep achieved satisfactory results with more "Thus we find a perfectly reasonable tic ulcer, and even cancer. than 90 per cent of patients suffering from basis in fact for the somewhat bizarre The psychological aspects of many dis back or neck ailments. stories of miraculous cures by spinal ma orders also work to the healer's advan Perhaps the most interesting part of the nipulation," says John McM. Mennell, tage. According to CU's interviews with study, which was conducted by research M.D., an authority on manipulative ther specialists in internal medicine, one-third ers at the University of Utah College of apy. "Almost invariably the basis of these to one-half of the complaints patients pre Medicine, was the reaction of patients to stories is that the patient has been told a sent in routine office visits either have ob their respective practitioners. The chiro diagnosis which he believes and remem vious psychological origins or do not arise practic patients were significantly more bers," writes Dr. Mennell in his book, from organic disease. Hence, treatment satisfied with the explanations they re "Back Pain." "If his symptoms are then offering some psychological benefit can ceived about their problems and the degree unrelieved by orthodox treatment, but are often be helpful. A sympathetic ear for to which they were made to feel welcome. later cured by a manipulator, it is not sur the patient's complaints or firm, authori Reporting their findings in The Lancet, prising that the patient claims to have been tative reassurance that no serious disease a British medical journal, in June 1974, cured of the visceral disease." Many chiro is involved can prove therapeutic in itself. the authors stressed the implications of practors and other manipulators share Dr. One of the most important factors, sug the patients' reactions: Mennell's view. gested a physician at the NIH conference, "On the basis of our study and others, it There are, in short, a variety of possible is that patients are relieved of the respon appears that the chiropractor may be more reasons why patients may experience ben sibility of their illness and suffering when attuned to the total needs of the patient efits from chiropractic treatment. That they hand that burden over to the healer. than is his medical counterpart. The chiro may not be all they experience, however. 'That silent act," he asserted, "is probably practor does not seem hurried. He uses The Chiropractic Study Committee for the ... as important as anything else that goes language patients can understand. He gives State of Wisconsin in 1972 underscored a on, and often many of the things that we them sympathy, and he is patient with critical issue surrounding chiropractic: do after that point we get by with rather them. He does not take a superior attitude "It is beyond question that substantial than being effective with." toward them. In summary, it is an egali number~ of people believe themselves to tarian relationship rather than a superordi have been helped by chiropractic treat SELF-LIMITING ILLNESSES nate/subordinate relationship." ment," said the committee report. "It is Beyond psychological influences in Their findings, the authors concluded, also beyond question that if they feel bet treatment, there are also the recuperative "underscore the powerful potential for the ter, for whatever reason, they have, in powers of the body itself. Medical scien doctor-patient relationship in effective some sense, been helped. There is, how tists estimate that about two-thirds of hu treatment, whether in chiropractic or tra ever, a balancing factor that screams to man illness is self-limiting. Regardless of ditional medicine." be considered. That, of course, is the po what type of outside intervention or treat tential hazard of treatment that ignores ment is used, the patients eventually get CAN MANIPULATION WORK? established scientific knowledge." well by themselves. Many positive responses to chiropractic On the basis of CU's investigation, there "If it were more than that figure ... I treatment undoubtedly stem from the doc are several major areas for concern. suspect there'd be no need for any of us," tor-patient relationship or the self-limiting Since many human illnesses are self-

Pennsylvania Medicine, May 1976 53 resolving, any intervention by a practi applications, CU concludes, any risk of vitamin preparations, are widely recom tioner should avoid exposing a patient to injury is unwarranted. mended and sold in chiropractic practice. unnecessary risks. The maxim, as a medi In CU's opinion, that distinction can be a cal aphorism puts it, is primum non no HAZARDS OF DRUG ADVICE dangerous one. A substance is defined as cere: "First of all, do no harm." Unlike physicians, chiropractors receive a drug by its use, not by arbitrary cate no education or training in pharmacology gories. In medicine, a drug is any substance EXPOSURE TO INJURY or drug therapy. What they learn about used as medication for a disease. Water The American Chiropractic Association drugs is often self-taught. That lack of prescribed for a dehydrated patient can (ACA) states that spinal manipulation is scientific background or experience in be defined as a drug. Ordering vitamins for ·•a painless and safe procedure." However, drug therapy may well contribute to whitt a deficiency disease is prescribing a drug. a review of chiropractic and medical liter CU views as a dangerous approach to For the patient's safety, any prescriber ature by CU indicates that manipulation is drugs by many chiropractors. Specifically, should have sufficient training to know not without hazard. The adverse effects re it involves undermining the use of ac when and why a specific drug is indicated. ported range from minor sprains and sore cepted drug therapies and espousing the Chiropractors have no such training. In ness to serious complications and death. use of unproven ones. CU's view, a brief course in nutrition at Serious complications included fracture, Various chiropractic pamphlets for the a chiropractic school is no substitute for spinal disk rupture, paraplegia, and stroke. public employ direct scare tactics against years of training in drug therapy. Yet Chiropractors say that such catastrophic drugs. Such titles as "Drug-Caused Dis chiropractors sometimes presume they can consequences of manipulation as stroke eases" and "Drugs-Dangerous Whether treat complex illnesses with vitamin pills. are relatively rare; and, indeed, CU's in Pushed or Prescribed" are typical. One An article in the March 1975 issue of vestigation uncovered only 12 documented published by the American Chiropractic The ACA Journal of Chiropractic, for cases of severe stroke from chiropractic Association, "Beware of Overuse of example, espouses high-dose vitamins for manipulation since 1947. Drugs," lists scores of possible adverse re treating schizophrenia, a complex and However, the exact incidence of injury actions to such drugs as antibiotics, oral sometimes crippling mental illness. The is virtually impossible to determine. Un contraceptives, and medicines for high author notes that "there is a great deal of like medical reports, none of the many blood pressure. The pamphlet then asserts controversy" surrounding such treatment, chiropractic surveys or journals that CU that chiropractors use no drugs, "thus but he concludes that "the megavitamin reviewed gave any statistics on complica avoiding drug-induced illnesses and dan approach is a practical alternative" for tions. The only data are from isolated gerous side effects often more serious than treating schizophrenia. The approach, he medical studies by a few physicians. the condition being treated." There's no says, "should be considered by chiroprac In an attempt to fill that gap, a study mention that some of those drugs may be tic as an adjunct to spinal manipulation." published in Clinical Orthopaedics and Re life-saving for patients who need them. Indeed, there once was "a great deal of lated Research in 1971 reported the in A common tactic is to link drug-taking controversy" about megavitamin therapy juries from chiropractic manipulation re with drug abuse. "Don't be a pill popper," for schizophrenia. But that was before corded by one physician over a three-year says the headline of an ad put out by several carefully controlled studies showed period. The physician reported that 172 of the American Chiropractic Association. it to have no therapeutic benefit. On the the patients he examined in his practice "Drugging your pains and your problems contrary, the findings suggested potentially had previously undergone chiropractic ma is not your answer to good health." Ac adverse effects, including longer hospitali nipulation. Seven of those, or 4 per cent, cording to the ad, "drugs and medications zation, increased need for other drugs, and had suffered direct injuries, ranging from only mask the pain and dull the symptoms poorer adjustment to home and commu aggravation of pain to serious nerve dam of a health problem." nity life after patients left the hospital. age. "Injury associated with spinal manip The consequences of such advice can Overall, the treatment was judged inferior ulation," he concluded, "appears more be tragic. These are typical of the cases to a placebo. Thus, the chiropractic au frequent than the present North American CU has come across: thor is recommending that a complicated medical literature suggests." ■ Under chiropractic care, an elderly mental disorder be treated with a drug less Therapy often involves risks. The ques woman with high blood pressure was ad effective than a dummy pill. tion is whether those risks are warranted. vised to stop medication. Her blood pres Many surgical procedures and drugs used sure rose sharply, and after a month she THE DANGER OF DELAY in medical practice are hazardous. Ac suffered a stroke. One of the worst dangers of chiropractic cordingly, physicians will weigh such risks treatment, say its critics, is that it might ■ A diabetic patient gave up insulin on against the proven value of treatment so divert the patient from seeking appropri instruction of a chiropractor. An infection that patients will not be endangered un ate medical attention in time. The result, necessarily. While an individual physi held in check by good control of the dia they contend, may have serious or even cian's judgment may be faulty, the em betes with insulin then spread and caused fatal consequences that might otherwise phasis of medicine on proven therapy the patient's death. have been avoided. tends to increase the average patient's ■ Parents of a six-yea.--ol<' epileptic girl Part of the problem is the confusing chances of genuine therapeutic benefits for stopped anticonvulsive therapy on the ad nature of back pain. Most patients who the risks taken. vice of a chiropractor. Until then, the child visit chiropractors go initially because of If spinal manipulation were a proven had been doing well and was seizure-free. back troubles. But back pain can arise form of universal therapy, there would be Without the medication, she had a pro from a variety of conditions, from a sim no reason to restrict it to muscle or joint longed seizure that resulted in brain dam ple sprain to heart disease. It may be mus disorders, even if it involved some risk. age and subsequent mental retardation. cular or skeletal in origin, or a symptom But as CU pointed out last month, chiro Chiropractic antipathy to medication, of ulcers, cancer, or disorders of the practic use of manipulation in other ill however, appears limited to prescription uterus or ovaries. It can also be caused by nesses contradicts much of the basic medi drugs-which chiropractors may not le diseases of the lungs, kidneys, liver, blad cal research of the 20th century. In such gally order. Other medications, such as der, intestines, or other organs.

54 Pennsylvania Medicine, May 1976 When a disorder of the internal organs correct therapy being started, which might absence of any other safeguards repre is suspected, many chiropractors will re aftect the child for the rest of his life." sents, in CU's opinion, a tragic negligence fer the patient to a physician. But the The report also decried earlier opposi on the part of legislators of both countries. chiropractor's limited diagnostic training tion of chiropractic authorities to immuni presents a major handicap to early recog zation. Jf those principles had been ac GRATUITOUSRADIATION nition of such illnesses. And some chiro cepted, said the report, "then this world Chiropractors use X-rays to diagnose a practors will continue to treat a patient would now be filled with smallpox, people disease process that doesn't exist. Even if regardless of any diagnoi:is, apparently paralyzed [or] dead from -tetanus, chil it did, though, X-rays would hardly help. convinced by chiropractic theory that they dren choking to death from diphtheria, Unlike bone, nerve tissue can't be seen are relieving the true cause of the disease. the uncontrolled spread of typhoid . . . on X-rays; nor do other fine details of soft Meanwhile, the illness may grow worse. and innocent children living in iron lungs tissues stand out. Hence, what chiroprac There is relatively little information because of polio." tors actually look for on X-rays are curva available about the type or frequency of According to a survey conducted by the tures of the spine and departures from serious consequences resulting from such American Chiropractic Association in postural symmetry, however minor. Those delays. According to American Medical August 1973, about 81 per cent of its are supposed to imply the presence of Association officials, physicians are usually members reported that they treat chil "subluxations," which allegedly disturb reluctant to report such instances for fear dren. Those chiropractors saw an average nerve impulses. of lawsuits. The court cases that CU is of 93 children annually, about 30 per cent However, structural variations in a nor aware of, however, show that delays in of whom were of preschool age. Respira mal spine-and any movement or shift proper treatment have resulted in mental tory ailments, allergies, and nervous-sys from a perfectly straight posture just be retardation, paralysis, and deaths from tem disorders were among the five most fore the X-ray-will also produce depar tuberculosis, spinal meningitis, and cancer. frequently treated conditions. tures from symmetry. And those ordinary, In most of those cases, the victims were Each of the major chiropractic associa inconsequential variations can look much young children. The most bitter criticism tions in the United States and Canada the same as chiropractic "misalignments." of chiropractic that CU encountered, in publishes pamphlets promoting chiroprac Generally, the variations identified as mis fact, was from pediatric hospitals. Some tic care for children. None of the current alignments by chiropractors are judged of the reasons why were underscored in a ones that CU reviewed makes claims entirely normal by radiologists, who have report issued jointly in 1972 by the about treating infectious diseases, nor do much more extensive training in X-ray Montreal Children's Hospital and the St. they argue against immunization of chil interpretation than chiropractors have. Justine Hospital for Children. dren. But the alarm expressed in 1972 by Thus, the chiropractor's X-ray diagnosis is The report described pamphlets distrib the two Canadian children's hospitals ap twice removed from reality: It depends uted by chiropractors to patients in Que pears to us to be no less justified today. on unscientific appraisal of a nonexistent bec. The pamphlets claimed that chiro Of particular concern, in our view, is disease. practors could treat epilepsy, croup, advice published in the October 1974 issue X-rays can, of course, show true bone cross-eye, rheumatic fever, bronchitis, of The ACA Journal of Chiropractic. An abnormalities, such as a fracture or tumor. pneumonia, appendicitis, leukemia, and article titled "Pediatrics" recommends However, the 14-by-36-inch film fre other illnesses affecting children. Such chiropractic treatment for children with quently used by chiropractors for examin claims, said the report, constituted "a real infectious diseases, digestive disorders, res ing posture does not produce good bone and direct danger" to children. "This is piratory illnesses, heart problems, genito detail. So, unless the chiropractor takes a especially so in that many childhood ill urinary disorders, and other illnesses. smaller and more detailed view as well, nesses are of an acute nature and require "The infectious diseases usually respond abnormalities that would preclude manip diagnosis and treatment without delay." well to chiropractic care," says the author, ulation may be missed. For example, one pamphlet then in cir William A. Nelson, D.C., a charter mem Many chiropractors agree that the large culation, entitled "Chiropractic for Chil ber of the American Chiropractic Associ film gives too little detail and too much dren," advised spinal manipulation for ation. The "so-called viral diseases," he radiation exposure. Indeed, one chiroprac croup. "Jn actual fact," said the report of states, "follow the same general rule," tor quoted in the March 1975 issue of The the children's hospitals, "croup is an acute with chiropractors deciding which chil ACA Journal of Chiropractic contended infectious disease involving the voice-box dren to refer to physicians. "We must not that "the doctor who takes such films just ar!!a of the throat. It often requires lose sight of the fact that ... our therapy does it to impress the patient." prompt medical attention which at times is preeminent in reestablishing normal Critics of chiropractic concur in that may he lifesaving." Cross-eye, too, should physiology where such is possible." sentiment and often charge that chiro be treated at a relatively early age, or Aq:ording to Dr. Nelson, chiropractors practic X-rays are a promotional gimmick blindness may result in the affected eye, can also evaluate heart problems in chil rather than a diagnostic aid. Some chiro said the report. dren. "If not an acute emergency," he practic writings lend support to that alle advises, "the easiest way may well be a gation. A bald example appears in the 'A FALSEIMAGE' short period of trial treatment." The only 1947 edition of "Modern X-Ray Practice Parents faced with a desperate situa conditions for which he stresses medical and Chiropractic Spinography," by P. A. tion, such as a child with leukemia, need referral among children or adolescents Remier, who in the mid-1960's was chair balanced and mature advice, the report are acute poisoning and venereal disease. man of the X-ray department at Palmer stressed. "By calling himself a 'doctor'; by To CU's knowledge, there is only one College of Chiropractic. According to taking x-rays; by pretending to be quali U.S. or Canadian statute that recognizes Remier, some of the reasons why chiro fied, the chiropractor creates a false im any specific need to protect children under practors should X-ray "every case" were: age as to his ability to deal with pediatric chiropractic treatment. That is a New "Jt promotes confidence. It creates interest problems. This leads directly to delay in York State law prohibiting chiropractors among patients. Jt procures business. It the proper diagnosis being made and the from X-raying anyone under age 18. The attracts a better class of patients. Jt adds

Pennsylvania Medicine, May 1976 55 prestige in your community. It builds a stomach ulcers. A psychologist doesn't ments used their licensing powers and their reliable reputation." order medication for a heart condition. power of the purse to restrict the chiro Today, such an attitude toward radiation An optometrist doesn't treat epilepsy. But practor's scope of practice more effec no longer prevails at Palmer College nor chiropractors may often do all three. And tively. Specifically, we think that licensing at the other two chiropractic schools CU they are permitted to offer treatment in laws and Federal health-insurance pro visited. In general, the X-ray departments specialties ranging from pediatrics to psy grams should limit chiropractic treatment of those colleges appeared to teach and chiatry-without having scientific training to appropriate musculoskeletal complaints encourage techniques for reducing radia in any of them. Chiropractors have won and ban all chiropractic use of X-rays and tion exposure. But such improvements fail that freedom without engaging in research drugs, including nutritional supplements, to get to the heart of the problem. The or demonstrating professional capability in for the purported treatment of disease. fact is that chiropractic X-rays for detect those fields. They have won it by one Above all, we would urge that chiroprac ing "subluxations" do not serve a scien method alone: political action. tors be prohibited from treating children: tifically valid purpose. In CU's opinion all For years, grass-roots politics has been children do not have the freedom to reject such radiation is unwarranted. the lifeblood of chiropractic. By marshal unscientific therapy that their parents may Although current figures are not avail ing the support of chiropractic patients, the mistakenly turn to in a crisis. able, a 1971 survey by The Journal of profession has often achieved an effective If you've been considering a chiroprac Clinical Chiropractic indicates that more political voice in legislation affecting its tor for the first time, we think you'd be than 10,000,000 X-rays were being taken licensure and services. And that voice has safer to reconsider. Even if you are dis by U.S. and Canadian chiropractors annu been its protection against science. Oppo satisfied with your physician's treatment ally. At least 2,000,000 of those were the nents of chiropractic come to legislative of a back problem, you can ask for a con 14-by-36-inch type, which irradiates the hearings with information, with scientific sultation with another physician, such as body from the skull to the thigh, including studies, and with the official endorsements an orthopedist or physiatrist ( a specialist the lens of the eye, the thyroid gland, bone of national organizations. Chiropractors iri physical medicine). Then, if manipula marrow, and the reproductive organs come armed with votes. tive treatment were indicated, it could be four areas considered among the most The recent inclusion of chiropractic ser performed by that specialist or by a susceptible to radiation damage. Evidence vices under Medicare, after a seven-year physical therapist. shows that exposure to large amounts of campaign by chiropractors and their sup Despite that recommendation, we rec X-ray increases the likelihood of cataracts, porters, provides a classic example. ognize that some persons will decide to thyroid cancer, leukemia, and reproduc Against the combined opposition of the use the services of a chiropractor. For tive-cell damage. Public-health officials are American Medical Association, the U.S. those who do, and who wish to avoid some particularly concerned about the radiation Department of Health, Education, and of the dubious practices that occur, we dose to reproductive organs, since damage Welfare, the National Council of Senior think some advice given to CU by chiro to the genetic material is a potential source Citizens, and numerous other groups, the practic officials themselves may be helpful. of harm to future generations. chiropractic lobby emphasized one pri ■ A void any practitioner who makes "On the average, 3 per cent of people in mary weapon: the mailbox. Congres claims about cures, either orally or in ad a medical practice are X-rayed," says the sional aides were reportedly astonished vertising. Anyone who implies or prom Montreal children's hospitals' report. "For over the sacks of prochiropractic mail, ises guaranteed results from treatment the chiropractor, the figure is over 90 per which never seemed to diminish. It got should be held suspect. cent." In addition, 14-by-36 full-trunk the message across. ■ Beware of chiropractors who ask you to X-rays account for less than one in every In its 80-year war with science, chiro sign a contract for services. A written 10,000 hospital X-rays, and the great ma practic has won the major battles. Its agreement is not customary practice. jority of hospitals do not take full-trunk next goal is the inclusion of chiropractic ■ Reject anyone advertising free X-rays. X-rays at all. In contrast, about one in under a national health-insurance pro Radiation should not be used as a lure. five chiropractic X-rays is of this type. gram. In the past, the public's freedom to ■ Ask whether the chiropractor refers According to a report prepared last May choose among health practitioners has for the Canadian Association of Radiolo been honored in legislation affecting chiro patients to other health professions. If the gists, chiropractic use of full-trunk X-rays practors. CU believes that principle will answer is 'No'--or if the chiropractor is the greatest source of unnecessary be sustained if a national health-insurance disparages other professions or accepted gonadal radiation in Canada ( especially bill emerges. Before such services are in treatment-walk out. for women, whose reproductive organs cluded, however, we think that public ■ Don't make advance payments. Most cannot be shielded from the primary X-ray safety demands a searching review and chiropractors have a flat office fee and beam). And chiropractic X-rays were thorough reform of chiropractic practices don't offer "discounts" for prepayment. judged second only to medical and dental by appropriate state and Federal agendes. Nor is it accepted practice to charge extra X-rays as the leading sources of man-made for "units of treatment," such as manipu radiation exposure in North America to RECOMMENDATIONS lation, heat therapy, and the like. That day. In CU's view, that is an extremely Overall, CU believes that chiropractic should be included in the office fee. high risk to take for placebo medicine. is a significant hazard to many patients. ■ Don't be pressured by scare tactics, Current licensing laws, in our opinion, such as threats of "irreversible damage" if THE ROLE OF POLITICS lend an aura of legitimacy to unscientific treatment isn't begun promptly. And Despite the dangers of unscientific treat practices and serve to protect the chiro watch out for talk about a "patch-up job" ment, chiropractors today enjoy wider lee practor rather than the public. In effect, as opposed to "intensive ·treatment." The way in their scope of practice than any those laws allow persons with limited intensive treatment may apply to your other health practitioner except the physi qualifications to practice medicine under bank account. cian. By comparison, other independent another name. CU would add one more precaution: health-care providers must practice within We believe the public health would be. See a physician as well and find out what far stricter limits. A dentist doesn't treat better served if state and Federal govern- he or she· has to say about the problem.

56 Pennsylvania Medicine, May 1976