Last week I wrote part 1 of “No, no, no, no, no.  Chiropractors are still quacks”.  In that article, I wrote about a paper in the Journal of the American Medical Association (JAMA) entitled “Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis” by Paige et. al.” (If you can’t get a copy of the paper and want to read it, DM me).  That paper concluded, based on a meta-analysis, that spinal manipulation therapy (SMT) had some small beneficial effects on treating back pain.  Though I’m skeptical of that conclusion and you can read an in depth article about the weaknesses of the study over here at sciencebasedmedicine.org.  Basically, they have the same conclusion that I have to the question of does SMT help relieve back pain?  The answer is I don’t know.  It might or it might not.  But the evidence that is does actually help is very weak to put it kindly.  I’m not saying the SMT definitely does not work, I’m simply saying I don’t know because the evidence simply isn’t there. And if you look at the actual wording of the guidelines put forth by the American College of Physicians they also seem a bit skeptical [emphasis added]:  

RECOMMENDATION 1:

Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation).

RECOMMENDATION 2:

For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence). (Grade: strong recommendation).

Notice that each time they mention spinal manipulation it is followed parenthetically by the phrase “low-quality evidence”.  None of the other treatments are followed by this caveat.  That’s important to note.  But chiropractors seem to have a way of taking any non-negative mention of chiropractic and further proof that it’s true while conveniently ignoring any research that shows chiropractic is basically an elaborate placebo.  Now expect chiropractors to present evidence that their field is true (clearly they are biased), but the way the media covers this stuff really makes me cringe.

I first heard about this from my wife when NPR did a story on this piece.  Here is how NPR covered it.  They actually seem to do a fair job with the story.  They are focusing on SMT in their headline and most of the article.  They then note that this therapy is performed by a wide array of practitioners including practitioners.  This seems fair to me based on what the actual JAMA article is claiming (though I still think the claim in the JAMA article are dubious).  But then there is the way the New York Times covered the story.

Take a look at this:

No, no, no, no, no.  The JAMA article is about one specific therapy (i.e. SMT) performed by a wide variety of practitioners (including, but not limited, to chiropractors) and its effects on a specific kind of back pain.  (Between this chiro article and their pseudo-science climate change garbage, I have cancelled by subscription to the NY Times.)

Here are some excerpts from that article (emphasis added):

Physicians are traditionally wary of spinal manipulation (applying pressure on bones and joints), in part because the practitioners are often not doctors and also because a few chiropractors have claimed they can address conditions that have little to do with the spine.

Still, there is no merit to many other claims about spinal manipulation — that it has been proved to work for things like infantile colic, painful periods, asthma, gastrointestinal problems, and more. For most conditions, the therapy lacks a good evidence base.

Along these same lines, Dr. Richard Deyo says in his response to the JAMA meta-analysis [emphasis added]:

Spinal manipulative therapy (SMT) is a controversial treatment option for low back pain, perhaps in part because it is most frequently administered by chiropractors. Chiropractic therapy is not widely accepted by some traditional health care practitioners. This may be, at least in part, because some early practitioners of chiropractic care rejected the germ theory, immunizations, and other scientific advances.

and this:

Concerns also exist about claims of exceptional benefit from some chiropractors. For example, there is no biological evidence to support spinal manipulation as an effective therapy for diabetes, heart failure, or thyroid disease.

A “few chiropractors”?  “lacks a good evidence base”?  The author of the NY times article is talking about these things as if they are afterthoughts.  Like yeah chiropractors might claim to be able to treat 100 different conditions with absolutely no evidence to support their claims, but let’s ignore that because there is low-quality evidence that they can help with back pain.

Deyo talks about “early practitioners” rejecting some sound scientific principles including immunization.  Well, there still appears to be a sizeable portion of chiropractors that don’t believe in immunizations.  This article, published in a chiropractic journal in 1994, found that “One-third agree that there is no scientific proof that immunization prevents disease, that vaccinations cause more disease than they prevent, and that contracting an infectious disease is safer than immunization.”  This is insane.

For me these aren’t afterthoughts, they are the whole point: Chiropractors make wild claims about being able to treat a wide array of conditions through spinal manipulation and treating subluxations.  And, with the exception of some types of back pain, there is basically zero evidence that chiropractic does anything for any of these other conditions.

And it’s not just a “few chiropractors” or “early practitioners” who are making the crazy claims.  Take ChiroOne for instance (you may have seen them trying to sign you up for chiropractic care on a street corner, art festival, or a whole foods if you lie in Chicago).  They have over 40 locations in the Chicago area.  Here is a list of conditions that they claim to be able to treat with chiropractic care: 

Some of these are in the realm of possibility like sciatica and scoliosis.  Others are absolutely ridiculous like ADD/ADHD, high blood pressure, cold, flu, and virus symptoms, Crohns disease, and diabetes.  Though I think the most absolutely appalling thing listed here is “Newborns and Chiropractic care”.  For F*$&%^ sake, do not take your newborn in for a spinal manipulation!

So what I’m saying is, this isn’t the fringes of the chiropractic community.  This is mainstream stuff in their world.  Finally, I’ll end this post with a quote from a different JAMA article by David J. Fugazzotto, MD from 1970:

It continues to amaze me that, with all the evidence against the value of chiropractic, it still exists in our society today.

That was 47 years ago.  And somehow the quackery still persists.  My goal is that in another 47 years as a society we can look back on the scam that was chiropractic and just shake out heads in disbelief.

Cheers.