Chiropractic: The Greatest Hoax of the Century? L.A. Chotkowski, MD, FACP Second Edition © 2002, 2005 ISBN 0-9657855-2-1 Edited by Stephen Barrett, MD New England Novelty Books P.O. Box 1747 Allentown, PA 18105 (610) 437-1795 Contents About the Author . v Dedication . .vi About the Editor . .vi Acknowledgement . .vi Part I: Overview 1 Why I Consider Chiropractic a Hoax . 3 2 The Hoax in Action: Three Cases . 7 3 NCAHF Fact Sheet on Chiropractic (2001) . 15 Part II: What Others Have Said 4 H.L. Mencken Debunks Chiropractic (1924) . 35 5 At Your Own Risk: The Case Against Chiropractic (1969) . 43 6 The Views of Consumer Reports (1975, 1994) . 55 7 Smart Money Hits a Raw Nerve (1996) . 61 8 The Lemmon/Matthau Takeoff . 67 Part III: My Own Investigations 9 The Crippling of Linda Solsbury . 71 10 Visits to Two Chiropractic Colleges . 83 11 Visit with an Alaskan Chiropractor . 99 12 A Chiropractic Lecture on Headache . 105 13 Additional Opinions about Chiropractic . 111 14 Reactions to the First Edition of This Book . 129 15 More Dialogue and Debate on the Internet . 139 iii Part IV: Additional Perspectives 16 Why People Go to Chiropractors . 149 17 The Chiropractic Antitrust Suit . 159 18 The AHCPR Guideline . 171 19 Some Notes on a Leading Chiropractic Textbook . 175 20 Complaints against Chiropractors . 179 21 Recent Studies on Tension Headaches, Low Back Pain, Asthma, and Colic . 183 22 Final Comments . 185 Part V: Appendices A Glossary . 191 B Where to Get Additional Information . 197 Index . 199 iv About the Author Ludmil Adam Chotkowski, MD, FACP, is a board-certified specialist in internal medicine who retired in 1986 after practic- ing medicine for 41 years. Born in Berlin, Connecticut, he was valedictorian of his high school class, graduated from Trinity College and Yale University School of Medicine, and completed his residency training at Hartford Hospital in Hartford, Connecti- cut. He then practiced privately for 25 years in Berlin, during which, at various times, he also served as a school physician, medical examiner, health director, medical staff president at New Britain Memorial Hospital, and an instructor at the University of Connecticut Medical School. In his later years, Dr. Chotkowski served as Chief of Medicine at the Rocky Hill Veterans Home and Hospital and Medical Director of Connecticut State Mental Hospital. He is the author of several scientific medical articles published in the New England Journal of Medicine, the Journal of the American Medical Association, and Connecticut Medicine. He wrote a syndicated weekly newspaper column called “What’s New in Medicine” for more than 30 years and in 1991 authored a book with the same name that won a Mosby book award. He also wrote a section on advances in medicine for the Encyclopedia Americana. In 1980, he received an American Cancer Society award for “excellence in communicating about cancer.” He is a member of the American Medical Association and the Connecticut State Medical Society and is a Fellow of the American College of Physicians (an honor awarded for his contributions to the practice of medicine). v Author’s Dedication This book is dedicated to the memory of my dear wife, Emily, who finally succumbed to an operation intended to mend the ravages of rheumatic heart disease on her mitral valve. She had a full life, sustained by a previous heart operation and the tender care of her doctors. I also wish to pay tribute to the men and women who have made the scientific medical discoveries that enable people to lead healthier, happier, and longer lives. About the Editor Stephen Barrett, MD, a retired psychiatrist who resides in Al- lentown, Pennsylvania, is a nationally renowned author, editor, and consumer advocate. He has been collecting information about chiropractic for more than 30 years. He is board chairman of Quackwatch, Inc.; vice president of the National Council Against Health Fraud; and editor of Consumer Health Digest, a free weekly e-mail newsletter. His 49 books include The Health Robbers: A Close Look at Quackery in America; Reader’s Guide to “Alternative” Health Methods; and six editions of the college textbook Consumer Health: A Guide to Intelligent Decisions. He operates Quackwatch (www.quackwatch.org), Chirobase (www.chirobase.org), and 15 other Web sites. He can be reached at [email protected] or (610) 437-1795. Acknowledgment The author gives special thanks to freelance editor Sarah E. Fike, of Belleville, Illinois, who did a superb job of copy editing. vi Part I Overview Why I Consider Chiropractic a Hoax The Hoax in Action: Three Cases NCAHF Fact Sheet on Chiropractic (2001) 1 Why I Consider Chiropractic a Hoax Chiropractic is based on a century-old notion that spinal prob- lems (“subluxations”) are the cause or underlying cause of ill health. According to this notion: (a) vertebral “subluxations” press on spinal nerves and interfere with the passage of energy down those nerves to various organs, causing the organs to be- come diseased, and (b) spinal manipulation (“adjustments”) can remedy these problems. Since this “discovery”—made by a gro- cer and “magnetic healer” in 1895—an entire profession has evolved, with some practitioners clinging to the original no- tion, some denouncing it, and others adopting a loosely defined middle ground. I consider these ideas, in all of their many forms, to be a hoax. “Modern” Chiropractic Chiropractic’s most recent and “authoritative” description was formalized in 1996 by a consensus of the presidents of the 16 colleges forming the Association of Chiropractic Colleges (ACC). The resultant position paper stated the following, which I have slightly condensed: ACC Position on Chiropractic Chiropractic is a health care discipline which empha- sizes the inherent recuperative power of the body to heal itself without the use of drugs or surgery. The practice of chiropractic focuses on the relation- ship between structure (primarily the spine) and func- tion (as coordinated by the nervous system) and how 3 4 Part I: Overview that relationship affects the preservation and restoration of health. In addition, Doctors of Chiropractic recog- nize the value and responsibility of working in coop- eration with other health care practitioners when in the best interest of the patient. The Chiropractic Paradigm The purpose of chiropractic is to optimize health. The body’s innate recuperative power is affected by and integrated through the nervous system. The practice of chiropractic includes: •Establishing a diagnosis; • Facilitating neurological and biomechanical integrity through appropriate chiropractic case management; and •Promoting health. The foundation of chiropractic includes philosophy, science, art, knowledge, and clinical experience. The Subluxation Chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on the subluxation. A subluxation is a complex of functional and/or struc- tural and/or pathological articular changes that compro- mise neural integrity and may influence organ system function and general health. A subluxation is evaluated, diagnosed, and managed through the use of chiropractic procedures based on the best available rational and empirical evidence. Although the preceding statements are deliberately vague, they convey two themes that should be considered the basis of chiropractic today: (1) vertebral “subluxations” influ- ence organ function and general health, and (2) managing them can preserve and restore health. These ideas clash with the body of basic knowledge of health, disease, and health care that sci- entists have developed through centuries of study. Chapter 1. Why I Consider Chiropractic a Hoax 5 Vertebrae Areas & Parts of Body Possible Symptoms This chart falsely suggests that misaligned spinal bones are the cause or underlying cause of earaches, gallbladder problems, liver problems, hardening of the arteries, pneumonia, crossed eyes, and scores of other health problems. Its listing in a recent catalog from chiropractic’s leading supply house indicates that many chiropractors still exaggerate what spinal manipulation can do. (The details are intentionally blurred to avoid violating the publisher’s copyright.) My interest in chiropractic began during my childhood, as described in Chapter 2. During more than 40 years of 6 Part I: Overview medical practice, I encountered many patients whom chiroprac- tors had mistreated for epilepsy, asthma, diabetes, cancer, and many other conditions for which they had nothing legitimate to offer. I eventually persuaded my state representative to intro- duce bills to the Connecticut legislature to prohibit or curtail certain chiropractic practices, including treatment of children, but these bills did not pass. The final straw was a TV infomercial showing a chiro- practor manipulating a newborn’s neck and stating, “As the twig is bent, so grows the tree.” This chiropractor advised mothers to have their babies’ neck “subluxations” adjusted immediately after birth and subsequently throughout childhood in order to stay healthy. The chiropractor also advised against vaccinations. In my view, these activities amounted to a form of child abuse that should be challenged for what it is. During my investiga- tion, I visited two chiropractic colleges, interviewed several chiropractors in depth, and sent and received correspondence from many more. This book, the first such work written by a medical doc- tor, exposes fairly and honestly chiropractic’s failure to prove that “adjusting” the spine can cure disease or maintain “wellness” or health in any way. The effectiveness of modern medicine against disease is well documented in standard medical texts. In contrast, no scientific proof exists for the claims that are cen- tral to chiropractic practice. 2 The Hoax in Action: Three Cases Many years ago, a 16-year-old high school student developed nausea that was accompanied by unusual abdominal pains. Her mother took her to the office of Dr. “X,” whom a friend had recommended as particularly knowledgeable about female medi- cal problems. Dr. “X” treated the girl with abdominal massage and vigorous spinal manipulations.