Twisted Logic: The Complicated Debate About Chiropractors

Are they miracle workers or complete quacks? The answer might be somewhere in between.

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Do you want to be a part of your health care, or not?

On his DVD stand-up show Dress to Kill, British comedian Eddie Izzard has a great routine in which he discusses going to a chiropractor in New York. “They crack your bones, that’s what they do,” Izzard says of the specialists. “In the end, you trust them, you just trust them. They could have their fingers in your nostrils, one foot on the back of your underpants, and they’re pushing your spine away with a broom…’What’s this one all about?'” Izzard, pretending to be the hapless patient, says as he demonstrates the position to the guffawing audience. His imagined chiropractor responds, “I have no idea.” Izzard then releases his “patient,” grimacing as he lands on a far-off target as if he were an arrow shot from a bow. “Wherever he falls, there shall he be buried,” Izzard deadpans. It’s a hilarious routine, but it also reveals a lot of the fear and misunderstanding that still surrounds chiropractors. Even to this day, people mostly think that all chiropractors do is “crack your bones.”

It is not based on neurology, anatomy, and physiology; it’s based on a myth.

But the reality of chiropractic—the noun form for the kind of pain relief and healing that chiropractors study—is, for better or worse, much more complicated. “I think at one time, there was a lot of misinformation [about chiropractors] for various reasons,” says Scott Bautch, a doctor of chiropractic and president of the American Chiropractic Association’s Council on Occupational Health. “One reason was largely word of mouth: if you have a good experience, you tell one person, but if you have a bad experience, you tell a room of people.” Bautch, who has been practicing at his current location since 1985, believes some of the uneasiness about chiropractors in the public consciousness is starting to fade. “The public in general is starting to demand active engagement in their health care—how people are paying for it, how they’re thinking about it…they’re taking more control,” he says. “Seventy percent of Americans want a drug-free option for pain relief, and we’re the largest drug-free profession.”

A Brief History of Chiropractic

“Chiropractic” is a late 19th-century word combining the Greek words chiro (hand) and praktikos (practical), meaning “do.” It’s a form of alternative, or complementary, medicine based on the diagnosis and manipulative treatment of the joints and spine to address musculoskeletal pain. Most patients see chiropractors for head, neck, and back pain, although some go for other reasons as well. Bautch touts the profession’s holistic approach to pain relief. “If you go in a medical direction [for pain], most of what you get is care for the symptom,” he says. “Medical doctors don’t have much training to diagnose other [problems].” A chiropractor, on the other hand, is “not treating the effect, but the cause. For instance, if a patient has back pain, we address how do you sit properly, how do you eat properly? So [doctors] can treat the pain only, but how can you prevent the pain from being ongoing?” As a profession, chiropractic has had an uphill battle in earning its legitimacy in the eyes of the world. For most of its existence, the practice has been viewed with suspicion. It doesn’t help that its founder, Daniel David Palmer, viewed chiropractic as a religion he “received from the other world.” He regularly engaged in séances to connect with long-dead doctor Jim Atkinson—in his posthumously released book The Chiropractor, Palmer wrote, “The method by which I obtained an explanation of certain physical phenomena, from an intelligence in the spiritual world, is known in biblical language as inspiration.” In a 1911 letter comparing himself to Mary Baker Eddy, the founder of Christian Science, he said: “I occupy in chiropractic a similar position as did Mrs. Eddy in Christian Science. Mrs. Eddy claimed to receive her ideas from the other world and so do I. She founded theron a religioin (sic), so may I. I am THE ONLY ONE IN CHIROPRACTIC WHO CAN DO SO.” This stigma of chiropractic as hokum followed practitioners of it for decades. In the 1960s, the American Medical Association created a Committee on Quackery specifically to stop the spread of the profession. In 1966, a policy passed by the AMA House of Delegates stated, “It is the position of the medical profession that chiropractic is an unscientific cult whose practitioners lack the necessary training and background to diagnose and treat human disease.” This and other policies did much to delegitimize chiropractors in the public sphere. Some speculated that the AMA was trying to eliminate economic competition from chiropractors. Whatever their motive, as recently as 1987, a suit brought against the association ruled they were in violation of antitrust laws. They were ordered to cease and desist in their efforts to block the advancement of chiropractic. Since then, the profession has enjoyed a steady increase in patients now willing to embrace the once-taboo practice. The fact that chiropractors don’t prescribe medication is a particularly salient reason Dr. Bautch believes the practice is gaining popularity. “[Americans] are 5% of the world’s population, and we’re on 80% of the world’s painkillers,” he says. Nervousness about the opioid crisis and other addiction fears have spurred people on to other solutions. “Chiropractic is going to be the drug-free approach to pain relief, and your chiropractor is going to want you to be a participant in your health care, rather than a passive member,” Bautch says.

Does it work?

One major adherent of chiropractic is Janet Juounie, a patient of Dr. Bautch’s. But she had to be converted. “[Dr. Bautch] caused more arguments in our married life than I care to mention,” Juounie says. After growing up in a household where her father openly ridiculed the practice, Juounie was horrified when her husband started going to see Bautch. He went for 10-15 years, and “every time a bill came and he went to pay it, I’d ask him, ‘Why do you go to this quack?’” But when Juounie started getting excruciating pain in her legs—“Like having six or seven Charlie horses all at the same time,”—her husband persuaded her to go to the chiropractor before getting surgery. “I went in, and [Dr. Bautch] had me lie on my back, and he put tape on my legs in the shape of a Y,” she says. “I thought, ‘Wow, he’s really a quack. He’s crazy.’” But when he had her get up and walk, there was almost no pain. “I didn’t believe it,” she says. Now, at 71, Juounie says she can do things like cross her legs and walk to the end of the driveway without stopping— things she hasn’t been able to do in 20 years. She goes to see Dr. Bautch three times a week and says she adores him even more than her husband does. “I would never believe I’d suggest going to a chiropractor,” she says. “I swear by them.” For his part, Bautch says he’s seen plenty of patients like Juounie come and go. “A typical case for me is a patient who’s had 2-3 episodes of pain, but they’ve held off coming in because they didn’t understand [chiropractic].” In all that time, he says, “I’ve never had someone say, ‘I wish I’d waited’… they always say, ‘I wish I’d come sooner.’”

There’s ongoing skepticism.

If Juounie’s testimony is enough to persuade you to make a chiropractor appointment, not so fast, says Dr. Harriet Hall. As the “The SkepDoc,” Hall, a retired family physician and former Air Force flight surgeon, has devoted herself to exposing the truths behind complementary and alternative medicine and quackery.

Chiropractors don’t do anything a good physical therapist can’t do without any quackery.

“Of course [chiropractic] is popular,” Hall says. “People get better without treatment. If they have seen a chiropractor, they give him the credit. They can go to a chiropractor immediately rather than waiting for a doctor’s appointment. And the culture presents chiropractic as the best way to treat back pain.” For Hall, part of the problem is that most medical doctors don’t really understand what chiropractic is. “Science-based doctors who understand it, like Edzard Ernst, are very critical of chiropractic,” she says. Ernst is a Emeritus Professor at the University of Exeter, the editor in chief of two medical journals, and a medical doctor with training in acupuncture, homeopathy, herbalism, spinal manipulation and more. For 25 years, he has focused his research on “the critical evaluation of all aspects of alternative medicine.” He regularly writes about alternative medicine, including chiropractic, on his blog; he concluded a July 2017 rebuttal to a chiropractor by saying, “‘Dr’ Braccio is using very tired pseudo-arguments which have all been addressed and invalidated hundreds of times. My advice to him: book yourself urgently on a course of critical thinking.” Like Ernst, most science-based doctors are decidedly not fans of chiropractic. In her own series of lectures on YouTube, Hall devotes over 35 minutes to deconstructing chiropractic. “Chiropractors are not medical doctors,” she says. “They can say they’re doctors, because they hold the DC degree—Doctor of Chiropractic…some people don’t even know there’s a difference. They think chiropractors are just M.D.s that specialize in the back. Most customers go to chiropractors for treatment of back pain, but some people go to chiropractors for all their health needs and health maintenance and prevention. That’s a mistake.” Hall calls chiropractic a “pre-scientific belief system,” and says “It is not based on neurology, anatomy, and physiology; it’s based on a myth…the myth of the so-called ‘chiropractic subluxation.’…Subluxation is the idea that displacement of bones is the root of all disease.”

Book yourself urgently on a course of critical thinking.

Hall herself isn’t against all practice of chiropractic. “I don’t tell patients not to see a chiropractor, but I give advice on how to choose one who is less likely to be a quack,” she says. “If a chiropractor offers to provide short-term treatment of musculoskeletal problems, he may not be a quack. If he offers to ‘adjust your subluxations’ or offers quack treatments and quack diagnostic tests like applied kinesiology [he may be].” Hall concludes, “Chiropractors don’t do anything a good physical therapist can’t do without any quackery.”

The choice is yours.

Whatever your perceptions of chiropractic, if you’re planning to go to one, do your research. Talk to other patients, your medical doctor, and a chiropractor or two before beginning treatment. To hear Bautch tell it, though, chiropractors will only continue to gain popularity. Since 1985, he says he hasn’t grown his patient base by advertising. It’s all been through positive word of mouth. And that word of mouth, he says, is due to people asking, “Do you want to be a part of your health care, or not?” “The passive approach [to pain care] has proved to be a great failure,” he says. As a society, we “don’t engage people along with the pain habits.” But ultimately, whether or not you go to a chiropractor is up to you. “You have to look at what your health belief system is,” he says. “Do you understand we can relieve your pain? Do you think we’ll only hurt your back? [Or] do you want to minimize the risk of getting pain under control?”