Part II: This Page
Disclaimer: Little in this series of posts rises above personal opinion. I'm not a medical expert and I don't plan to talk about medical research in detail. I've had medically-trained friends explain some of this research to me, but I'm not qualified to discuss it in detail and there are other bloggers who are. I am trying to make a series of posts for non-medically-trained readers (like myself) outlining the historic ideas behind modern chiropractic, and also voicing my concerns about the recent BSA decision against Dr Shaun Holt. For discussion of research into modern chiropractic therapies, I'll provide links at the end.
I'm moving slow on these because it is taking some research, and of course work and living will always trump blogging. In my previous post, I discussed the folk medicine that chiropractic emerged from: A vague hodge-podge of pseudo-scientific terminology and spiritual metaphor. Just because the practice is not founded in scientitic thought does not mean it does not work. It does not seem controversial to say that modern chiropractic, however muddled its origins, helps ease back pain in some people. How chiropractic eases back pain is a subject of great argument, and experts also debate whether it is any more effective than physiotherapy, massage or even placebo. The prevailing theory among chiropractors is that chiropractic subluxation (as opposed to the medical concept of subluxation) causes many conditions, a theory that originated from chiropractic founder D D Palmers' pseudo-scientific ideas about a vital force or 'innate intelligence' flowing through the nervous system.
Now, an anonymous chiropractic supporter has warned me that chiropractic subluxation theory is too complicated to be outlined on a blog, that any attempt to do so will lead to 'misunderstandings'. However the blogosphere houses lots of science communicators dispersing quite complex information about their disciplines, so I'm quite sceptical of this claim. That said, I've spent well over a week reading articles, blogs, full-text journal articles, public relations websites, medical journal editorials and listening to podcasts from the chiropractic industry and I still have no clear understanding of any chiropractic theories. I can only conclude one of three things: (A) Chiropractic theories are as shallow and superficial as they sound (B) Chiropractors are generally very poor communicators (C) Chiropractic is so profound it can't be understood on any level by anyone who isn't trained in it. One thing is abundantly clear, whether subluxations of the spine exist or not, chiropractors cannot describe them in physical terms. I'm going to outline and examine some of the claims and explanations I've encountered thus far. The best place to start is with Doug Blackbourn, the chiropractor who appeared on TVNZ's Breakfast in response to Dr Shaun Holt.
Dr Doug Blackbourn on Breakfast
I've discussed the historic basis for chiropractic - D D Palmer's theories of an innate intelligence that is fed to all the body via the nervous system - but I also noted it would be specious to dismiss modern chiropractic on the basis of its pseudoscientific history. A lot of pre-scientific beliefs have been vindicated by scientific analysis, because a lot of pre-scientific beliefs were determined by observing material facts (a good move) and then taking a wild-ass guess as to the mechanisms involved (a rather bad move). Palmer's theories were just such a wild-ass guess, and many of his inaccurate assumptions are still core to modern chiropractice. We can see one of these assumptions nested in Blackbourn's discussion above: The idea that the human body refers to some sort of perfectly functioning blueprint. This idea conflicts with modern understandings of biology. There are no perfect beings, and organisms survive not by being perfect models of functionality, but just by functioning well enough that they don't die out given the factors acting against their population. It would be a surprise if our bodies were as efficient and easy to correct as a lot of chiropractic theory assumes.
Palmer was a theist who rejected the idea that biology was mechanistic in any sense analogous to machinery. To Palmer, biology was a spiritual affair, and the body a perfect system of interconnected organs put there by a deity to work in a certain way. It is this background that plays into Blackbourn's innocuous-sounding truism: 'The body has the ability to heal, it's something that, inherently, we are born with.' It's certainly a true statement, in a general sense. The body has an ability to heal, but Blackborn neglects to contextualise it, or to hint that this ability has clear physical limits. The body would struggle to recover from severe pneumonia or an axe-wound, obviously, without medical intervention. The body's defenses against illness and injury are very complex, it heals itself to the best of its abilities, and not all afflictions are healed in the same way. Bacterial infections are, obviously, caused by bacteria, not spinal subluxations. We've observed bacteria, we know a lot about them, including how to help the body counter them. It's very hard to understand how subluxations (a term I'll deal with shortly) play any role at all in aiding this sort of illness.
Blackbourn, obviously a friendly man, is extremely careful to say that chiropractors don't treat conditions, they just ensure there is no 'interference' with messages traveling along the spine. All the chiropractors I've spoken to while researching this post have insisted very firmly that they don't 'cure', although they can help the body to cure itself. Spinal adjustments are, to them, simply bodily maintenance - a tune up - to ensure that your nervous system is still pumping health around. But there is an internecine quality to Blackbourn's claims. He says that some asthma patients get healthier with manipulation, but that not all asthma sufferers respond because there are different causes for their discomfit. If he is talking at the level of treating causes of a condition, it sounds a lot like he could mean to cure that condition.
Blackbourn keeps the conversation at an anecdotal level - this patient or that (all presumably believing in chiropractic and paying for it voluntarily) reported a healthier feeling after an adjustment. As a kid I went to chiropractors, and I felt better afterward, but everyone had assured me that I would. This sort of reaction could as easily be explained by being in a warm room on a cold day while someone sympathetic gives you a massage of sorts. My mother also took me when my back pain was at its worst, and more than likely the pain subsided all by itself. But back then we would attribute the relief to the chiropractor.
What is Subluxation?
Firstly, chiropractic subluxation is very different to medical subluxation. In medicine, subluxation of the vertebrae consists of a partly dislocated spine. It's quite a dramatic injury, and it's usually very painful. Like any dislocation, it can entail a lot of inflamed and bruised tissue. It's not the sort of injury that a specialist could miss on an x-ray.
Chiropractic subluxation is the theory that small dislocations of the spine and joints restrict nerve flow. Chiropractors, as Blackbourn states, believe that the nervous system is the absolute control centre for the body. This is, quite simply, wrong. The nervous system is a principal control centre, a very import communications system for the body, but it is one of several control systems that are not necessarily entirely integrated. It should go without saying that different systems of the body can function independently of one another to some degree, otherwise how would the organs of people with severe spinal injuries remain functioning. The endocrine system, which ferries messages around our bloodstream via hormones, etc, is equally as essential as the nervous system. There are lots of functions in our body that happen quite independently of the nervous system. The kidneys, the heart, and liver all continue to work fine without input from the nervous system.
The NZ Chiropractors' Association describes chiropractic thusly:
Chiropractic is not a 'treatment' as such for any particular symptom or disease, but rather a method of helping to ensure optimal joint function and nerve communication and is thus able to effectively assist the body in healing a wide array of symptoms and conditions.
Once again, it's a very vague explanation. The spine houses nerves. A poorly adjusted spine impedes nerve flow, but how? Not in the medical sense, not in the sense of painful pinched nerves, because chiropractic subluxations are allegedly often asymptomatic. The most frustrating thing about chiropractic is how chiropractors talk down to their customers, using vastly over-simplified distortions of anatomy (such as trumpeting the total primacy of the nervous system), and seldom if ever do they discuss actual anatomical complexes. Customers (and perhaps chiropractors) have no clue as what the alleged physical occurrences responsible for their ailments actually are. To the average unqualified reader, chiropractic can sound plausible, especially when it builds itself out distorting real medical terms and misrepresenting real medical research. When we start investigating the anatomy of the spine, asymptomatic chiropractic subluxation quickly lose plausibility. The neurons passing through the spine that do affect organs pass through the same junctures as those neurons that affect skeletal muscle, if a subluxation is affecting organ performance it will almost certainly cause major upsets (even pain) in a patient's muscles. This is what we see in medical pinched nerves. Real subluxation is a painful affair, quite detectable on an x-ray. The WHO's Guidelines on Basic Training and Safety in Chiropractic notes that medical subluxation is a 'significant structural displacement, and therefore visible on static imaging studies.' Contrast this very tangible description of quite a major complex with the WHO's description of chiropractic subluxation, 'A lesion or dysfunction in a joint or motion segment in which alignment, movement integrity and/or physiological function are altered, although contact between joint surfaces remains intact. It is essentially a functional entity, which may influence biomechanical and neural integrity.' A lesion should be very detectable, I'm surprised that across the past few weeks not a single chiropractic body has presented me with documentation of a lesion on the spine constituting vertebral subluxation. A dysfunction could be anything, structurally-speaking, and how could anyone miss that word 'may' in such a description? The is nothing solid here. I constantly find more questions to ask, and so far I haven't found a single coherent answer to any of them in chiropractic literature. I will simply have to learn more about anatomy (it's a good thing I learned a lot of skeletal structure through life-drawing!) and get some chiropractic books out. It does, seem however, that chiropractic has grown from the ridiculous ideas of Palmer into an much more elaborate, hard-to-pin-down implausibility. A pseudoscience that looks squarely across at medicine and says, 'We are equal paradigms, look, I'm using the same words', yet can't produce the physical data to support itself the way that medicine can.
I've been working on this one post for far too long, against a background of insomnia, work, and family illness. Weeks, in fact, and haven't used even a quarter of my links and scribblings here, but I think I'm going to call this post done for now. I feel bad that I'm not being more thorough. There is much more to come. I'm especially concerned, given that I work with radio and television, at the BSA decision's implications for the role of expertise in the media. I'd also love to post on chiropractor's use of the word 'doctor', and the chiropractic industry's fascinating rhetoric on this conflict (almost all the discussion I've found among chiropractors centres funding litigation and not on funding research). Next up, at any rate, I'll discuss ear infections - what causes them, and how totally implausible it is that chiropractic might provide relief for them.
Links - Blogs on Holt vs BSA
- Natural Remedies that Work, Dr Shaun Holt's blog.
- Broadcasting Substandards on MacDoctor
- New Zealand Chiropractors in New Complaint on Stuff and Nonsense
- Two lawyers and two journalists squash criticism of chiropractic on TV on DC's Improbable Science
- a rather strange decision on BioBlog
- BSA backs chiropractic quackery on Not PC
- Medical researcher gets it in the neck, by Jodi Yeats of nzdoctor.co.nz
- Bay research slams television complaint ruling in Bay of Plenty Times