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"…we surely stick out like a sore thumb among professions which claim to be scientifically based by our unrelenting commitment to vitalism. So long as we propound the 'one cause, one cure' rhetoric of Innate, we should expect to be met by ridicule from the wider health science community. Chiropractors can't have it both ways. Our theories cannot be both dogmatically held vitalistic constructs and be scientific at the same time."
Joseph Keating Jr, 'The Meanings of Innate', Journal of the Canadian Chiropractic Association, 46,1 (2002), p.10.
"I was disappointed to see a full-page advertisement for the Ontario Chiropractic Association in the July 2009 edition of Canadian Family Physician. In spite of their attempts over the decades to legitimize themselves, the overwhelming majority of chiropractors do not practise scientifically based health care, and chiropractic care remains more of a faith-based cult than a legitimate alternative to medical care." Tim McDowell, MD CCFP, in a letter to Canadian Family Physician (9th September 2009)
"Members of the National Upper Cervical Chiropractic Association (NUCCA) specialize in adjustment of the atlas, using the procedure as an exclusive treatment for a great variety of ailments…The NUCCA approach to treating human ailments received unexpected support recently when a pilot study published in a legitimate medical journal suggested that correcting atlas misalignment would reduce early high blood pressure…The minor atlas subluxations routinely found by NUCCA chiropractors have not been proven to be significant. I would be surprised if a legitimate properly controlled study offered proof that upper neck manipulation would permanently lower blood pressure that has an organic origin. The claim by NUCCA practitioners that a painless slightly misaligned atlas is a cause of high blood pressure does not have enough supporting evidence to warrant the risk of manipulating the necks of patients suffering from high blood pressure, risking injury to vertebrobasilar arteries." Article by Sam Homola, DC, Science Based Medicine (7th August 2009)
Conclusion: "…there remains room for considerable improvement to bring actual health behaviors closer in line with evidence-informed behavioural health practices." J. Manipulative Physiol Ther. (Jul-Aug 2009)
"Instead of helping the public reduce their risk of infection, they are trying to boost their business and spread misinformation…" Article by Harriet Hall, MD, James Randi Educational Foundation (30th April 2009)
"If chiropractors really wanted to understand the risks [of chiropractic neck adjustments] and minimize them, here's what they could do. They could establish a database of every patient who received neck manipulations, listing their presenting symptoms, specifying exactly which type of neck manipulations were done, and following each patient up with phone calls to determine whether symptoms of stroke had developed after treatment. That would (1) establish the true incidence of stroke following neck adjustments, (2) determine whether strokes were more common with certain specific types of adjustments, and (3) determine whether patients were seeking "inappropriate" care for pre-existing symptoms of CAD. This could be done at little expense and would answer clinically significant questions." Article by Harriet Hall, MD, Science Based Medicine (10th February 2009)
"Given that chiropractic is founded on pseudoscientific notions of health and that the concept of spinal subluxations has never been empirically validated, just what are chiropractors looking for in X-rays? And since chiropractic treatment cannot demonstrate efficacy to a reasonable standard, how will X-raying a patient lead to a therapeutic benefit? In addition, since the positive effects seen for some sort of back pain are only comparable to conventional treatment where no X-ray is required, surely there is always an alternative treatment plan that does not involve exposing the patient to the risk of ionising radiation?" The Quackometer (29th January 2009)
"If we are to accept evidence for chiropractic efficacy we need a little more than stories. It is also worth pointing out that chiropractic treatment for anything that is not to do with muscles and bones is implausible in the extreme. Chiropractors believe they can cure many other things because the trade was founded on the idea that subluxations (chiropractors mysterious bodily malfunctions) were the cause of most (if not all) illness. Thus, by crunching bones you can clear subluxations and get the 'vital forces' moving again. Yes, chiropractic is founded on pre-scientific views of biology and medicine and thus any claims it makes must be subject to the highest forms of evidence." The Quackometer (11th November 2008)
"Chiropractic is perhaps the most common and egregious example of the bait and switch in medicine…..someone may go to see a chiropractor and think they will be seeing a medical professional who will treat their musculoskeletal symptoms, but in reality they will see the practitioner of a cult philosophy of energy healing…The bait — claims that chiropractors are medical practitioners with expertise in the musculoskeletal system. The switch — practitioners of discredited pseudosciences that have nothing to do with the musculoskeletal system…..A more subtle form of the bait and switch among chiropractors is the treatment of musculoskeletal symptoms with standard physical therapy or sports medicine practices under the name of chiropractic manipulation. Ironically, the more honest and scientific practitioners among chiropractors are most likely to commit this subtle deception. The problem comes not from the treatment itself but the claim that such treatments are 'chiropractic'…. But by doing so and calling it 'chiropractic' it legitimizes the pseudoscientific practices that are very common within the profession — like treating non-existent 'subluxations' in order to free up the flow of innate intelligence." Article by Steven Novella, MD, Science Based Medicine (2nd July 2008)
"The risks of neck manipulation are not trivial. The primary risk is that aggressive neck manipulation may cause a tear (called a dissection) in one of the four arteries that feed the brain — two carotids to the front of the brain and two vertebrals to the back. If a tear forms in one of these arteries then a clot (called a thrombus) can form around that tear, blocking off flow through the artery and causing a stroke. It is also possible that the thrombus may break lose and flow downstream and then lodge in and completely block off an artery — when a clot moves it is called an embolus. This is apparently what happened to Sandra Nette…this case should be a wake up call. The government cannot continue to license nonsense and call it medicine. The public deserves better. I also think that public awareness about the risks of neck manipulation needs to be raised, and more importantly this practice needs to simply stop. Watch how the government and chiropractors respond to this law suit. It will be very telling." Steven Novella, MD, NeuroLogica Blog (17th June 2008)
"The chiropractic profession is resisting changes that will establish it as a back-pain specialty while seeking an identity that will continue to allow chiropractors to treat a broad scope of health problems." Article by Samuel Homala, DC, Skeptical Inquirer (Jan/Feb 2008)
Results from this survey suggest a patient's autonomy and right to self-determination may be compromised when seeking chiropractic care. Difficulties and omissions in the implementation of valid consent processes appear common, particularly in relation to risk. Langworthy JM, and Cambron J, Institute for Musculoskeletal Research and Clinical Implementation, [AECC], Bournemouth, UK (July-August 2007)
"The words 'manipulation' and 'subluxation' in a chiropractic context have meanings that are different from the meanings in evidence-based literature… The reasons for use of manipulation/mobilization by an evidence-based manual therapist are not the same as the reason for use of adjustment/manipulation by most chiropractors." Article by Samuel Homola, DC, The Journal of Manual & Manipulative Therapy, Vol.14 No.2 (2006) E14-E18 [pdf]
"Subluxation syndrome is a legitimate, potentially testable, theoretical construct for which there is little experimental evidence… Failure to challenge subluxation dogma perpetuates a marketing tradition that inevitably prompts charges of quackery… We lament efforts to generate unity within the profession through consensus statements concerning subluxation dogma and believe that cultural authority will continue to elude us so long as we assert dogma as though it were validated clinical theory." Josepth C. Keating Jr, Keith H. Charlton, Jaroslaw P. Grod, Stephen M. Perle, David Sikorski and James F. Winterstein, Chiropractic & Osteopathy (10th August 2005)
Article about chiropractic by Edzard Ernst, The Guardian (1st February 2005)
"The profession is clouded by uncontrolled commercialism and self-interest which endangers the fiduciary relationship with the patient. There is a major conflict between the culture of business and the culture of clinical delivery… Diagnostic and treatment services that exceed clinical necessity are indicators of incompetence or intentional mistreatment — a violation of public trust that requires remediation." Presentation to the Federation of Chiropractic Licensing Boards by Richard E. Vincent, DC, FICC, Past-President, FCLB and NBCE (2005) [pdf]
"The dilemma that emerges seems clear: informed consent compels chiropractors to tell neck pain patients firstly that the benefit of chiropractic spinal manipulation is uncertain, secondly that its risks are not negligible, and thirdly that other therapeutic options are not associated with harm. Such information is likely to deter patients from choosing chiropractic treatment. Thus, informed consent can work against the financial interests of CM (Complementary Medicine) practitioners, most of who are privately paid by their patients." Edzard Ernst, MD, PhD, Journal of Manipulative and Physiological Therapeutics (July-August 2004) [This article has recently become subscription-only]
Article by Edzard Ernst, The Guardian (27th July 2004) NOTE: In the UK, there appears to be no national system for reporting adverse events related to chiropractic treatment. Furthermore, the UK General Chiropractic Council's current promotional literature appears to make no mention of serious risks.
"The largest professional associations in the United States and Canada distribute patient brochures that make claims for the clinical art of chiropractic that are not currently justified by available scientific evidence or that are intrinsically untestable. These assertions are self-defeating because they reinforce an image of the chiropractic profession as functioning outside the boundaries of scientific behavior." Grod JP, Sikorski D, Keating JC Jr, Journal of Manipulative and Physiological Therapeutics (2001)