Unscientific Ideas and Practices

When members of the audience at a conference on the proposed affiliation of York University and the Canadian Memorial Chiropractic College confronted chiropractor panelists about the profession's use of unscientific and pseudoscientific practices they got what has become a standard response.

It goes something like this: Sure, some chiropractors use unproven treatments, but it's a small minority, a fringe element. You can't judge the profession on the behaviour of a few "bad apples".

When it was pointed out that many chiropractors in Ontario and in the rest of Canada used unconventional techniques in their day-to-day practices, Ian Coulter, former president of CMCC, said this faction was small in number. Besides, said Coulter, you can't blame the school for the behaviour of its graduates.

In a report to York University, CMCC president Jean Moss repeated the same defence. She says the number of chiropractors who hold anti-immunization views and use bogus therapies are "few in number". She said it's unfair to hold chiropractic to a higher standard than other professions whose members have unconventional beliefs and use unconventional procedures.

In its presentations to York, CMCC paints a picture of chiropractic as part of a team of science-based health-care professionals working within the biomedical model and in a defined scope of practice, publishing in scientific journals and conducting scientific research. Though it is accurate that CMCC is probably more science-based than most chiropractic colleges in North America, the picture presented to York is anything but accurate.

An investigation by CANOE has found that:

Subluxation

What's a subluxation?

Here's a simple definition. It's the thing, whatever it is, and whether it exists or not, which chiropractors claim to treat to help you get well.

That definition is both vague and accurate. Because, 100 years after D.D. Palmer invented the profession of chiropractic, chiropractors still can't agree on what a subluxation is. And, they still don't know if it really exists.

Now, if you had asked D.D. Palmer, what a subluxation is, he would have said it's just a "bone out of place", that is, a misaligned vertebra.

Palmer thought that if a mysterious force called Innate Intelligence could flow freely through the body, that body would stay in optimal health. A misaligned vertebra impinged nerves and somehow stifled the flow of Innate and, therefore, good health.

Chiropractors could bring the body back to its natural healthy state, Palmer taught, by racking the errant vertebra back into line.

Unfortunately for Palmer and chiropractic, there's no evidence that vertebra go "out of place" in a way that can be fixed by chiropractic adjustment. There's also no scientific evidence that wayward vertebra have any effect on general health at all. And, although he was influenced by popular 19th century notions like animal magnetism, Mesmerism and vitalism, Palmer just made up the idea of the subluxation and its relationship to disease all by himself.

Both he and his son B.J. Palmer were unwilling and unable to put the idea to a scientific test. And human anatomy just wasn't put together the way Palmer thought it was.

But, that didn't mean the idea of subluxation disappeared. The word just changed its meaning for chiropractors, and that meaning got more vague and more complex as the 20th century rolled on and neuroscience and anatomy got more clear on what nerves and the spine do and don't do.

In 1906 some chiropractors laid aside the "bone out of place" idea and decided that a subluxation was a vertebra that has "an altered field of motion". Others still held to the "bone out of place" idea.

In the 1920s B.J. Palmer, D.D. Palmer's son, had another idea. He said he knew what a subluxation was. It was nerve pressure that could only be detected with his new invention, the "neurocalometer" a hand-held, heat-seeking device that B.J. Palmer claimed could spot subluxations of the spine by detecting temperature variations. He said that any chiropractor that didn't use the neurocalometer shouldn't be practicing.

A lot of chiropractors ignored him and some even started their own schools and came up with their own ideas of what a subluxation was.

So did B.J. In 1930 he decided that by adjusting only the top vertebrae in the spine, subluxations in the rest of the spine would fall into place. He called this technique the Hole In One.

Unfortunately for chiropractic, none of the schools had any data to back up their theories. But, medical doctors had data to the contrary.

Twenty-five years ago Yale anatomist Edmund Crelin experimented on six human spines from cadavers and determined that the amount of force needed to twist and bend the spine so that nerves were impinged was enough to snap the spine itself.

The American Chiropractic Association ignored Crelin's experiment and stated, "nerve encroachment ... is a dynamic occurrence and cannot be reproduced in a dead body."

In the last couple of decades some chiropractors have looked for more complicated neurological and dynamic definitions of a subluxation.

Some theorized that a subluxation was a limited range of motion in all or part of the spine. That abnormal range of motion caused, according to some chiropractic theorists, nerve pressure. Others said it produced nerve interference. Still others said it caused nerve compression. But, in general, the idea was that through a complicated neurophysiological feedback process called subluxation complex, the subluxations caused all sorts of bodily problems called subluxation syndrome.

Things got pretty confusing. And, current definitions for this sort of subluxation are anything but elegant. Here's one drafted in 1996 by the Association of Chiropractic Colleges in the U.S.:

"A subluxation is a complex of functional and/or structural and/or pathological articular changes that compromise 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."

That definition, though, is just theoretical. Dr. Howard Vernon, in the CMCC text Foundations of Chiropractic - Subluxations, sums up the current state of affairs this way, "The profession, it seems, is either still 'fixated on' or feels more satisfied with its conceptual models and its elaborate speculative pictures than with pursuits of more basic scientists, who seek to depict or study subluxations as it really occurs." In the text, Vernon details 18 studies that attempted to create and test the effects of subluxations in animals.

He concludes that there have been no sustained lines of investigation in the studies, no replications and no clinical implications. No real proof, the blame for which Vernon lays squarely on the shoulders of chiropractic.

Another textbook that's required reading at the CMCC, The Chiropractic Theories, calls the subluxation a manipulable lesion. The book, written in 1994, asks these questions:

"Is there a manipulable lesion? Indeed, is there a specific, identifiable lesion that responds favourably to spinal manipulation or to chiropractic manipulation therapy ... Or, are there physiological and clinical effects of [chiropractic manipulation therapy] that can be reliably and reproducibly measured whether or not a lesion is detected? ... Tireless efforts to quantify and qualify the [subluxation] and to find a suitable outcome measure or measures capable of predicting manipulative effectiveness have met with mixed and often disappointing results."

A hundred years after the chiropractic profession was founded, there is no agreement on what a subluxation is, if it exists, no proof that manipulation of a subluxation does any good and no good answer to the question: what is a subluxation?

To appreciate the situation, imagine that doctors, 100 years after modern medicine came into existence, couldn't prove germs cause disease or that the human body contains DNA. That's the position chiropractors are in at the end of the 20th century.

Chiropractors Claim They Can Treat Ear Infections with Neck Manipulation

Pediatricians say they lack training, proof and authority

By Paul Benedetti and Wayne MacPhail

When babies and young children complain of earaches it's often due to a condition doctors call otitis media.

Pediatricians treat otitis media with antibiotics, or in some extreme cases, by surgically inserting tubes that drain the fluid. Left untreated, the condition can cause permanent hearing loss.

And, as of Nov. 18, the Chiropractic Canada Web site (which is endorsed by the Ontario Chiropractic Association) offers this advice to visitors worried about their child's ear infection:

Some children suffer from recurrent ear infections, revealing that the chronic ear infections are merely a symptom of a larger problem. Chiropractic adjustments to the neck and upper back can help eliminate the cause of chronic ear infections ...Chiropractic adjustments to the neck and upper back help restore proper motion to the vertebrae. Once proper joint motion is restored, elimination of nervous interference and drainage of the Eustachian tube can occur, allowing your body's immune system to effectively fight the infection ... If your children have ear infections, chances are they have nerve interference, and they need to have their neck examined by a chiropractor. Your chiropractor will be able to make additional recommendations to help your child and to promote better health.

Chiropractors and Vaccination

Despite sound medical evidence of the safety and benefit of immunizations, chiropractic, since its birth at the turn of the century, has been anything but friendly to vaccination. One of the founders of chiropractic, B.J. Palmer, called immunization a form of poisoning. In the late 1950s, in the midst of an epidemic, the U.S. National Chiropractic Association campaigned against the polio vaccine. Why do chiropractors feel so strongly about a medical breakthrough that has saved millions of lives worldwide? Because Chiropractic philosophy holds that a body with a spine free of subluxations, or misalignments, is capable of insuring its own health.

Applied Kinesiology

Applied kinesiology (AK) is a pseudo-scientific system of muscle testing invented in 1964 by Detroit chiropractor George J. Goodheart Jr. D.C. The system is based on the idea that every internal organ is connected by "energy pathways" to a specific muscle, so that testing the muscle's strength allows the practitioner to diagnose the organ problem.

Applied kinesiology should not be confused with kinesiology (biomechanics), which is the legitimate, scientific study of movement.

AK is used by some chiropractors, naturopaths, medical doctors, dentists, nutritional consultants, physical therapists and others. In 1991 a survey by the National Board of Chiropractic Examiners found that 37 per cent of full-time American chiropractors who responded used AK in their practice. A similar survey found 31 per cent in Canada, 60 per cent in Australia, and 72 per cent in New Zealand. Applied kinesiology proponents say that allergies, nutritional deficiencies and other physical problems can be detected by having the subject put a substance (food extract or vitamin) in their mouth while the practitioner pushes down on their extended arm.

Some practitioners simply have the patient hold the substance in their hand, or touch it to a body part. There are even cases of testing by proxy, in which a child will hold hands with his mother and the mother's arm will be tested to determine a weakness in the child's body.

Treatments based on the "findings" can include nutritional supplements, acupressure, special diets, and spinal manipulation. Though the concepts of applied kinesiology do not conform to scientific facts about the body or the causes and treatments of disease and are viewed as absurd by medical science, researchers have nonetheless tested AK in several well-designed controlled studies of AK.

The studies show no difference in muscle response from one substance to another, or no difference in test results between substances and placebos. In short, there is no scientific evidence to support AK.

Chelation Therapy

Chelation therapy is a series of intravenous injections of an animo acid complex called ethylenediamine tetraacetic acid, more commonly known as EDTA. Chelationists believe that the therapy is effective against coronary heart disease, vascular disease and atherosclerosis, or hardening of the arteries.

Supporters tout it as a cheaper, safer alternative to bypass surgery. Today, in the U.S. and Canada many people (about 500,000 in the U.S.) receive chelation therapy each year.

But does it work?

Chelation therapy is an accepted effective therapy for heavy metal poisoning. EDTA binds with mercury, copper, lead and other metals and removes them from the blood. Based on this, some doctors speculated that chelation could help remove calcium, one of the components, along with cholesterol, in the plaque that clogs arteries.

The doctors who deliver chelation therapy also claim that is effective for treating arthritis, MS, Parkinson's disease, Alzheimer's disease, diabetes, and can even slow the aging process.

Unfortunately, chelation theory is flawed because even if the process removed calcium, it is not the major problem in artery disease. Other theories proposed by chelationists - and there are many - remain unproven.

What is the evidence? Again, controlled studies show that chelation has no effect on diseased arteries, or any other disease. Even study patients who say they feel better show no objective improvement in blood flow in their arteries. There is a mountain of anecdotal evidence and testimonials from patients who say they feel better after chelation, but it is likely due to the placebo effect, the attention they receive from practitioners and other lifestyle improvements they make.

Despite the fact that therapists have chelated hundreds of thousands of people in the last 40 years, they have produced no solid evidence that their treatment is effective.