76 It Works, It Works, It Works!
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Dynamic Chiropractic – September 25, 1992, Vol. 10, Issue 20

It Works, It Works, It Works!

By Joseph Keating Jr., PhD
In a recent editorial,1 Attorney George McAndrews, chief counsel to the plaintiff chiropractors in the Wilk et al. case, reported on the undermining of the potential benefits to be derived from the recently ended, 14-year-old lawsuit. In contrast to his own favorable communication to the medical profession in the pages of the American Medical News (AMN) on January 13, 1992, the February 17 issue of AMN reviewed recent advertising which claimed that chiropractic care favorably influences the immune system and that untreated subluxations carry the risk of death. McAndrews1 notes the outrage of "chiropractors across the land," not only at the DCs who released these unsubstantiated claims, but at AMN and the medical authors who brought the material to the attention of the medical profession. McAndrews objects to the reported tactic of placing such ads "on hospital bulletin boards as characteristic of the unscientific nature of chiropractic," but warns that the chiropractor-perpetrators of such "unsubstantiated ads" are doing the profession "enormous damage."

Are claims about adjustive benefits for the immune system and about killer subluxations truly uncharacteristic of chiropractic marketing? Yes and no. A willingness to discuss killer subluxations is probably limited to a fringe component of the profession, but what about claims for the immune system? One can easily document widespread unsubstantiated claims of this sort. For example, just a few years ago the ICA circulated a patient brochure suggesting that chiropractic care was indicated for AIDS patients. The brochure acknowledged that there was no scientific validation for adjustive benefits in AIDS patients, and was withdrawn following criticisms from the scientific community2 within the profession. One has to wonder, however, about the attitudes (and the pervasiveness of attitudes) of those who would produce this sort of promotional material in the first place. Similarly, the American Chiropractic Association (ACA) has been circulating patient brochures as part of its anti-steroid publicity campaign. Despite the absence of experimental validation, the pamphlets assert the "proven" value of chiropractic care in increasing athletic performance:

---Chiropractic procedure not only corrects athletic injury but also enables your body to operate at peak efficiency without the use of drugs or medicine,3 ...

and:

---chiropractic is a drugless, non-surgical method of procedure which has been proven effective for improving performance4 ...

Not to be outdone, the Foundation for Chiropractic Education & Research (FCER), which is the science funding arm of the ACA, has recently released a "patient awareness" pamphlet5 indicating that:

"Chiropractic Works! Research Proves It: Chiropractic Works! Now, thanks to mounting research-based evidence, chiropractic is proud to claim -- scientifically -- what doctors and patients have known all along: Chiropractic Works!"

The pamphlet then proceeds to describe the significance of spinal misalignment, subluxation, and nerve inflammation, and winds up by misrepresenting a number of studies. For instance, the RAND reports6,7 are offered as confirmatory "research" (rather than as critical reviews of available literature by an expert panel) and the Foundation's self-published "Florida Study," an interesting but uncontrolled cost-effectiveness comparison of medical vs. chiropractic care for work-related injuries, is also offered as "proof" of "what doctors and patients have known all along: Chiropractic Works!" The brochure fails to specify which chiropractic methods may be helpful for which patients, with which sorts of health problems, but does mention that "spinal mechanics plays a primary role in the health of the whole body." This is not exactly a mention of the immune system, but it is a broad enough claim to take in the immune system and everything else. In an apparent lapse of consciousness, the pamphlet also seems to assert that chiropractic care causes the sort of injury it is intended to relieve:

"...the professional chiropractor skillfully applies pressure to an area of the spine that is out of alignment, causing nerve inflammation and pain. ..."

The FCER brochure also perpetuates the traditional attitude among many chiropractors that the scientific community is some amorphous body external to the chiropractic profession; the FCER apparently does not recognize that when chiropractors engage in and publish scientific studies, then chiropractors are the scientific community. Instead, FCER tells us:

"... research is convincing the scientific community of the ..."

These examples of advertising by national professional organizations suggest that the attitudes portrayed by the ads noted in AMN are different only in degree, not in kind, from those common throughout the profession. Indeed, the profession seems to suffer from a psychiatric disorder, what might be called Trabajitis Chiropracticus (It Works, It Works, It Works!) The condition is characterized by a hardening of the categories, a lock of critical assessment of causation, a tendency to substitute marketing slogans for data, and a swelling of the neural tracts between the cortex and the tongue. The growing experimental evidence in support of the analgesic value of spinal manipulation for low back pain patients is being inflated ad absurdum to suggest the "truth" of so-called "chiropractic principles." Ironically, as greater scientific support for chiropractic procedures becomes available, many in the profession seem determined to prove that chiropractors are generally unable to critically evaluate this new information.

Will Mr. McAndrews' warning1 against unsubstantiated claims be heard in chiropractic? Perhaps not so long as a majority of chiropractors continue to perceive "philosophy" (and marketing) as defensive crutches against the historic assault by organized medicine,8 and as substitutes for hard core scientific information. The anti-scientific traditions9,10 in the profession are very strong, and although blatant anti-competitive activities by AMA et al. have been ruled illegal,11 criticism of the chiropractic profession (and posting of killer subluxation advertisements on hospital bulletin boards) are clearly within the free speech prerogatives of any would-be critics. The more we stretch the available scientific data to support "what we always knew was true," the more we can expect to be held up to ridicule. The chiropractic profession dearly needs an attitude adjustment.

There are signs that some of the profession's leadership have grown more sensitive to the need for greater research, more aware that research findings must precede rather than follow claims of effectiveness, and more ready to challenge unsubstantiated claims-making in the profession. The process and results of the Mercy Center conference on clinical guidelines bears witness to a greater scientific consciousness and willingness to restrain claims in some corners of the political arena. A formidable challenge for this new breed of politician will be to bring the rest of the chiropractic establishment and the profession up to speed. They deserve the support of all who realize what is at stake: the professionalization (and perhaps the survival) of chiropractic.

As a non-therapeutical remedy, we offer a new, highly scientific technique: the calcaneus is positioned on the frontal bone just superior to the bridge of the nose, and a high velocity, low amplitude thrust is administered. Naturally (all naturally), It Works, It Works, It Works!

References

  1. McAndrews G: Open letter to the profession. Dynamic Chiropractic, p1,17, March 27, 1992.

     

  2. Keating JC, Lawrence DJ: Letter to the Editor re: AIDS pamphlet. ICA Review, 77:March/April 1990.

     

  3. American Chiropractic Association, patient brochure #ST-3, 1990.

     

  4. American Chiropractic Association, patient brochure #ST-4, 1990.

     

  5. Chiropractic Works! Foundation for Chiropractic Education & Research, 1991, pamphlet #9116.

     

  6. Shekelle PG, Adams AH, Chassin MR, Hurwitz EL, Phillips RB, Brook RH: The appropriateness of spinal manipulation for low back pain: project overview and literature review. 1991a, RAND Corporation, Santa Monica, California (Document #R-4025/1-CCR/FCER).

     

  7. Shekelle PG, Adams AH, Chassin MR, Hurwitz EL, Park RE, Phillips RB, Brook RH: The appropriateness of spinal manipulation for low back pain: indications and ratings by a multidisciplinary expert panel. 1991b, RAND Corporation, Santa Monica, California (Document #R-4025/2-CCR/FCER.

     

  8. Keating JC, Mootz RD: The influence of political medicine on chiropractic dogma: implications for scientific development. Journal of Manipulative & Physiological Therapeutics, 12(5):393-8, Oct. 1989.

     

  9. Keating JC, Editorial: Making claims. Journal of Manipulative & Physiological Therapeutics. 11(2):75-7, April 1988.

     

  10. Keating JC: Traditional barriers to standard of knowledge production in chiropractic. Chiropractic Technique, 2(3):78-85, August 1990.

     

  11. Getzendanner S (U.S. District Judge, Northern District of Illinois, Eastern Division): Memorandum opinion and order. Wilk et al., vs. American Medical Association et al., August 27, 1987.

Joseph C. Keating Jr., Ph.D.
Thomas F. Bergmann, D.C.

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