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Faulty Logic and Non-sceptical Arguments in Chiropracticby Joseph C Keating Jr, PhD
Chirobase— Skeptical Guide to Chiropractic History, Theories, and Practices
Though edited for style and content, much of the information in this article came from Chiropractic on Wikipedia.com.
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The following article was written from a pro-chiropractic stance. It does not mention diabetes, but contains solid information about chiropractic care and the qualifications required to become a practitioner (in addition to the author's opinions). Courtesy of Wikipedia.com
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Chiropractic, also known as chiropractic care, is a health care discipline that purports to prevent and treat health problems by using spinal adjustments to correct spinal dysfunction, or subluxations. The basic premise for chiropractic is that the brain and nervous system control and coordinate all the body's functions in part through nerve branches that exit from the spinal cord between the vertebrae. Some Chiropractors infer a causal relationship between nerve interference or compression at the spine and subsequent problems in more distant body parts or organ systems regulated by the nerve.
Practitioners of chiropractic are called chiropractors or chiropractic physicians. In the United States chiropractors earn the degree Doctor of Chiropractic, (D.C.) and are referred to as doctor. Chiropractors are required to be licensed in the United States as well as in many other countries throughout the world.
History of Chiropractic
The roots of chiropractic care can be traced all the way back to the beginning of recorded time. Writings from China and Greece written in 2700 B.C. and 1500 B.C. mention spinal manipulation and the maneuvering of the lower extremities to ease low back pain. Hippocrates, the Greek physician, who lived from 460 to 357 B.C., also published texts detailing the importance of spinal manipulation. In one of his writings he declares: Get knowledge of the spine, for this is the requisite for many diseases.
Chiropractic was founded by Daniel David Palmer in Davenport, Iowa, USA. Palmer was born in Pickering, Ontario, and moved to the United States in 1865. Referred to by some historians as a "fish monger" because he sold fish commercially, Palmer practiced magnetic healing beginning in the mid-1880s in Burlington, Iowa. Palmer was well-read in medical journals of his time and had great knowledge of the developments that were occurring throughout the world regarding anatomy and physiology.
During this time he tried to find a single cause for 100% of all diseases. He reached a point where he even claimed to have succeeded in this mission:
In 1895, Palmer was investigating the medical history of a deaf janitor, Harvey Lillard. Lillard informed Palmer that while working in a cramped area seventeen years prior, he felt a pop in his back and had been nearly deaf ever since. Upon examination, Palmer found what he described as a lump that was sore to the touch. He concluded that this lump was a misalignment in the spine and a possible cause of Lillard's deafness. After Palmer supposedly corrected this misalignment, Lillard could reportedly hear the wheels of the horse-drawn carts in the street below.
Palmer's version of this event has always been disputed by Lillard's daughter, Valdeenia Lillard Simons. She says that her father told her that he was telling jokes to a friend in the hall outside Palmer's office and, Palmer, who had been reading, joined them. When Lillard reached the punch line, Palmer, laughing heartily, slapped Lillard on the back with the hand holding the heavy book he had been reading. A few days later, Lillard told Palmer that his hearing seemed better. Palmer then decided to explore manipulation as an expansion of his magnetic healing practice. Simons said "the compact was that if they can make [something of] it, then they both would share. But, it didn't happen."
The term chiropractic originated when Palmer asked a patient - Rev. Samuel Weed - to come up with a name from the Greek language to describe his practice. Of the several names submitted to him, Palmer accepted one which combined the words chiros and praktikos (meaning "done by hand") to describe his adjustment of a vertebra in the spinal column.
Palmer imbued the term "subluxation" with a metaphysical and philosophical meaning. He held that certain dislocations of bones interfered with the "innate intelligence," a kind of spiritual energy or life force dependent upon God that connects the brain to the rest of the body. Palmer claimed that subluxations interfered with the proper communication of this innate intelligence with the rest of the body, and that by fixing them 95% of diseases could be treated.
In the mid-1990s the Association of Chiropractic Colleges redefined a subluxation as follows: "A subluxation is a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system and general health." In 1997 the Foundation for Chiropractic Education and Research defined a subluxation as "a joint problem (whether a problem with the way the joint is functioning, a physical problem with the joint, or a combination of any of these) that affects the function of nerves and therefore affects the body's organs and general health."
Philosophy of the Subluxation
Chiropractic philosophy holds that so much of the body is controlled by messages sent to and from the brain along the nervous system. The medical community agrees that all messages -- whether it is the brain commanding the foot to move or an organ telling the brain it is in need of repair -- pass through the spinal cord -- which acts as a kind of cerebral router.
An outgoing message from the brain passes down the spinal cord and through the appropriate spinal nerve branch held between the vertebrae on either side of the spinal cord. There are 31 pairs of spinal nerves that emerge from the spinal cord; all of which are housed by vertebrae. If the vertebrae are misaligned (subluxated), chiropractors believe that a spinal nerve can be squeezed or pinched and therefore message flow can be compromised. By aligning the vertebrae and removing restrictions on the spinal nerves, chiropractic claims to allow the spinal cord to more effectively relay messages to and from the brain; thus promoting better health.
Use and Acceptance of Chiropractic
According to a survey released in 2004 by the National Center for Complementary and Alternative Medicine, chiropractic was the fourth most commonly used complementary and alternative medicine therapy among adults in the United States (7.5%).
Chiropractic has gained general acceptance in the last 40 years as an appropriate treatment for certain back and neck problems. This was partly a result of the prolonged litigation between the powerful American Medical Association (AMA) and various chiropractors over the legitimacy of the field (see Wilk v. American Medical Association). The AMA is politically opposed to chiropractic as a healing discipline and disputes the concept of subluxation.
According to Harrison's Principles of Internal Medicine, a meta-analysis of nine studies found spinal manipulation to be effective in improving uncomplicated, acute back pain. The studies found no benefit to treating chronic pain or sciatic nerve irritation.
Chiropractic Licensure and Regulation
In the United States, the Council on Chiropractic Education (CCE) is in charge of setting minimum guidelines for chiropractic colleges; however, additional requirements may be needed for a license depending on the jurisdiction where a chiropractor chooses to practice.
Chiropractors often enter chiropractic school with a Bachelor's degree, or with three years of post-secondary education in the sciences and other appropriate coursework. The admissions requirements for chiropractic colleges in the United States are not as stringent as schools for other health care professions and the process of credentialing varies widely by country.
The curriculum in a chiropractic school is quite rigorous, resembling medical school at the basic course level; however, the timeframe to attain a degree itself in a chiropractic school is much less than that of a medical school. Coursework in Chiropractic school may include study in gross anatomy, biochemistry, embryology, microbiology, anatomy and physiology in the first half of formal schooling. The last half of formal education focuses on clinical patient care through clinical rounds in various settings. Graduates of chiropractic schools have to complete five years of schooling and pass four national board exams in order to complete their education.
In the United States, graduates of chiropractic schools must sit for State examination to qualify for licensure. Once licensed, most States require chiropractors to annually attend 12 to 48 hours of continuing education courses.
Philosophical schools of chiropractic
Contemporary chiropractic is generally divided into two basic schools, straight and mixer, which differ in their approaches to patient care. However, all chiropractic approaches are heavily based on the use of manipulation as a panacea for mechanical musculoskeletal dysfunction of the spine and extremities.
Straight chiropractic. In the traditional approach (known as straight chiropractic), is the
application of different manipulative techniques for the expressed intention of
removing any of a large number of problems that are all grouped under the
catchall name of subluxation, from misaligned bones to posture correction.
Straight chiropractors believe that medicine is flawed because it fails to
accept subluxations as a primary cause of disease; instead seeing them as
effects from other underlying problems that may or may not need to be treated.
Believing they are unimportant, straight chiropractors refuse to use the proven
diagnostic algorithms of traditional diagnosis and instead use often debunked or
at best questionable proprietary chiropractic methods on patients. Straight
chiropractic is supported by the fact that health insurance companies often
refuse to reimburse chiropractors for diagnostic testing and many states do not
allow chiropractors enough scope to perform the procedures necessary to do it.
The patients of straight chiropractic can generally expect to have undiagnosed
systems monitored for two weeks for improvement before being referred to a
medical doctor. Gonstead Technique: one of the benchmark techniques in
chiropractic. It is a highly specific, full-body approach to the restoration of
functionality of the spine.
Mixing chiropractic. This combines contemporary medical diagnosis and
treatment with manipulation. In this model, patient complaints are often diagnosed
accurately but subluxation is asserted to be a mechanical joint pain syndrome
while the underlying cause of patient complaints is often ignored. Mixing style
practioners utilize both adjustments to treat chiropractic subluxations as well
as naturopathic style remedies for other disorders. Methods used might include
ultrasound, TENS, rehabilitation or the use of other diagnostic methods such as
kinesiology. Mixing chiropractic is
itself divided into conservative and liberal groups.
Minority group oriented at mainstream science. The National Association for Chiropractic Medicine (NACM) represents a small group of chiropractors which advocates a highly limited use of chiropractic medicine. By openly rejecting some of the more controversial aspects of chiropractic, including the original chiropractic hypothesis that subluxations are the cause of disease, NACM members claim to receive mainstream approval more so than practitioners of straight or traditional chiropractic. The NACM is a private organization that does not release membership data of its members, however, one outside estimate reported membership to be in the "low hundreds."
Criticism of Chiropractic
Critics, including many mainstream medical doctors and scientists, often reject the claims of some chiropractic associations and schools as pseudoscience, quackery, or fraud. Advocates believe at least some of this criticism was encouraged by the American Medical Association during the 1970s and early 1980s in what they have labeled "anti-chiropractic prejudice." In 1985, The National Council Against Health Fraud (NCAHF), a non-profit healthcare watch-dog group, issued a position statement critical of chiropractic.
Still, whether criticism is partly politically-based or not, to date there is limited scientific evidence of the existence of subluxations in terms of quantifiable measures. Nerve conduction studies of human spinal nerves identified as being subluxed by chiropractors were shown to be normal by conventional scientific measures. Studies involving X-ray and CT scanning of the human spine before and after chiropractic manipulation show no changes in joint position as identified by radiologists. This lack of a clear definition of subluxation, supported by scientific evidence, is one of the major sources of chiropractic's struggle for acceptance within the traditional medical community.
Critics cite major medical risks associated with spinal manipulation in their opposition to the practice of chiropractic. These risks include vertebrobasilar accidents, disc herniations, vertebral fracture, spinal cord compression, and cauda equina syndrome, according to Harrison's. Most serious complications occur after cervical (neck) manipulation. The practice of greatest concern is the rotary neck movement, sometimes called "Master cervical" or "rotary break", which has led to trauma, paralysis, strokes, and death among patients. Although serious, these complications due to spinal manipulation remain very rare having been estimated at 1 in 3 or 4 million manipulations or less.
Highly specific treatment procedures have also been developed to address subluxation or misalignment of the high neck region (upper cervical) using x-ray imaging. A controlled, linear, low force adjustment is slowly applied to the top vertebra (Atlas), removing the need for more forceful, rapid manipulative procedures. Development of this upper cervical treatment technology by the National Upper Cervical Chiropractic Association in the U.S.A. first started in the 1960's in Monroe, Michigan by Dr. Ralph Gregory DC.
Note: Read Chiropractic: What You Should Know, a guide to techniques advised, considered a "waste" of money (x-ray is considered a "waste"), how you should determine if a chiropractic might help you, and the types of questions to ask.
Misuse of Science Reports
Some doctors who have submitted research backing up the medical benefits of limited forms of spinal manipulation have found their claims incorrectly applied to the entire field of chiropractic manipulation. Perhaps the most well-known case of this occurred in response to The RAND report on The Appropriateness of Spinal Manipulation for Lower-Back Pain. This study was a meta-analysis of 22 controlled experiments; the conclusion was that certain forms of spinal manipulation were successful in treating certain types of lower back pain. Many chiropractors seized upon these results as proof that chiropractic theory was sound and that chiropractic medicine had reliable results; in fact, the authors of the report said no such thing. Misuse of this report reached such an extent that the RAND report authors were forced to issue a public statement. In 1993 Dr. Paul Shekelle rebuked the chiropractic industry for making false claims about RAND's research:
Diabetes and Chiropractic
The following links (offered only for general information and not intended as an endorsement or recommendation) contain information from websites that promote a chiropractic role in diabetes management.
Question posted on Diabetes123.com (a known, reputable site for diabetes information): Is there any benefit to chiropractic care in helping to treat diabetes for my child? He has been seeing a diabetes specialist and endocrinologist and his numbers remain very high in spite of the suggested treatments of both his current medical advisors.
The Spine Salesman (1976) - A lengthy article containing some basic history and legal proceedings related to legitimizing chiropractic and several mentions of diabetes.
Page Updated 04/29/2006