Part II: Some Modern Chiropractic Ideas
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.
Science changes. Scientific opinion shifts to account for new theories and new evidence, and medicine is a science. Egotism and dogma are threats to scientific progress, and some scientists refuse to abandon theories that have been debunked by evidence because they have invested so much time or sentiment. Prior to important discoveries like germ theory or genetics, simpler theories with much less evidence behind them thrived in their places. Some of these ancient theories held that the body was a vessel through which ill-accounted-for 'energy' flowed. This was not energy in any coherent, scientific sense. It was really just a sweeping metaphor that stood in for bodily functions that nobody understood yet. Similar to the theistic science's God of the Gaps, there is a folk medicine's Energy of the Gaps.
The more science has learned about the human body, the more medical therapies built around this Energy of the Gaps have seemed wrong-headed. Spiritualistic medical ideas like yatudhānya, Qi and miasma are really, in a very solid and basic sense, debunked scientific theories. Nowadays scientists know a great deal about viruses, bacteria, prions, and genetic disease. Scientists also have evidence that these entities exist. Other theories, like those behind acupuncture and reiki, are ancient failures that have not accounted for themselves. Some are demonstrably false. However the therapies built upon debunked theories persist for many complex cultural and economic reasons.
From now on, for clarity, I will refer to three different kinds of medicines - evidence-based medicine, which as the name suggests is supported by evidence; folk medicine, which refers to concepts like Qi that have no basis beyond anecdote; and alternative medicine, which refers to modern therapies adapted from folk medicines. Alternative medicines may have some level of evidential support. Generally though, when evidence supports an alternative medicine it becomes evidence-based medicine. Alternative medicine practitioners sometimes make claims outside the scope of evidential support. Today I am reflecting on just such claims, following up on a short post I made the other day about a dispute between chiropractors, the Broadcasting Standards Authority (BSA), and Dr Shaun Holt, who appears regularly on TV One's Breakfast. Here is footage of Holt's offending statements:
However, this first post focuses primarily on how chiropractic came to be, not on the dispute itself.
Chiropractic is an alternative medicine, and it grew out of theories that seemed a little more plausible in the late 1800s than they do now. In 1895 an Iowa man named Daniel David Palmer began treating patients by adjusting their spinal cords. Palmer had no medical training, although he did read medical journals, and he had quite a noble attitude towards scientific enquiry:
Chiropractic to be a science must be specific. In order to be scientific it must contain the knowledge of the principles and facts of biology reduced to an unvarying law and embodied into a system. Where science ends faith begins.
(The Chiropractor, D D Palmer, 1914)
(The Chiropractor, D D Palmer, 1914)
Unfortunately, Palmer's noble attitude was not paired with a sound understanding of anatomy. He was, after all, a grocery store owner, turned magnetic healer. A medical hobbiest, at best. Instead of learning the specifics of anatomy and healing, Palmer invented an increasingly complex and specious set of metaphors about the body to compensate his limited understanding. His Spiritualistic leanings wrought havoc on his ability to assess the human body's composition. Early in his career he did not really have the many benefits of Darwin's theory, so he presumed a Creator's conscious intent in many anatomical structures. He was too egotistical about the nature of life to accept that organisms might have the physical basis we now know they possess:
The science of chiropractic and that of machinery have no resemblance whatever, in their motive force. That being a fact, why try to illustrate either one by the principles belonging to the other? Just as well try to explain the science of grammar by that of astronomy; geography by mathematics; chemistry by agriculture; or that of music by navigation. Man is not a machine. The science of chiropractic is in no way related to the science of machinery. Its phenomena are dependent upon vital force, not that of dynamics. The structure of the body is defined under that of anatomy, not metalography -- a treatise on metals. Bodily functions depend upon vital force, not dynamics. The existence of metals, whether in the form of machinery or that of ore, depends upon certain inanimate qualities, whereas the existence of animals depends upon functions. Vital philosophy and mechanical philosophy are not correlated, they are radically and entirely different. The laws which govern the existence of animated beings and that of animated objects differ.
(ibid)
(ibid)
Palmer piled metaphors on top of metaphors:
Why not learn of the two ganglionic chains of the sympathetic nervous system which reach from the occiput to the coccyx, its plexus of nerves extending into the cranium, the fibers of which unite with the cranial nerves, and that these vertebral cords are distributing agencies of organic life, reaching to all the viscera?
(ibid, my emphasis)
My knowledge of the nervous system is slim to none, so I'm in no position to comment on how accurate his structural description is. It doesn't really matter because you don't need expert knowledge of anatomy to see that he was building up an unsubstantiated metaphor. What is the mystery force that the vertebral cords are 'distributing'? Vital force. But we still have no idea what vital force is, except that machines don't use it. I'll let Palmer explain vital force, to the best of his abilities:(ibid, my emphasis)
Molecular vibration is a law of the universe, nothing is exempt from this activity. It is universal in its application. Progression is an established principle. Spiritual progress towad perfection is dependent upon physical and spiritual growth. The universe is composed of spirit and matter. All living material is animated by spirit. The process of physical and spiritual growth are so intimately blended that it is difficult to separate one from the other. Our bodies are animated by spirit through molecular vibration; without vital force there would be no action guided by intelligence. Astral spirits composed of supersensitive substance, inhabiting supersensible spheres are far more refined than the material of this world, yet they are undergoing a process of advancement analogous to that of individuals on this earth.
(ibid)
Palmer built up his own imaginary brand of organism-specific physics in which an ill-identified force pumped out of the brain and into 'all the viscera', breathing life along the way. Palmer did draw analogies between 'vital force' and known energies in rather a long-winded passage here, but it was a futile exercise because he had no evidence that anything quite matching his definition of vital force really existed. There are definitely lots of energies in the body, and scientists can specify them. Some of them are transferred along the spine. Palmer (probably not consciously) believed he had absolved himself of specifying and individually categorising all this activity by labelling them under one collective, metaphysical term.(ibid)
From here, Palmer took another enormous leap, claiming that because this vital force is transferred along the spine, any disalignment in the spine causes diseases. In fact Palmer pushed that claim to its limits, claiming that 95% of all diseases that exist were caused by spinal issues, with the remaining 5% resulting from the disalignment of other joints outside the spine.
Chiropractic began as pseudo-science, and has remained pseudo-scientific. That is not to say that chiropractic is ineffective at relieving some minor back problems, but its ridiculous premise - however much it has been elaborated on and added to - means it is probably a very poorly-targeted treatment. It would be very specious to say this pseudo-scientific history alone discredits modern chiropractic altogether. It does not. No doubt there are some very good chiropractors who are very much akin to physiotherapists operating under another name. It is also clear that a surprising number of chiropractors claim they can treat conditions that clearly have nothing to do with messed up vertebrae, such as asthma and ear infections. You'll note in the video above that Holt is very charitable towards chiropractic, stating clearly that research confirms it to be 'as good as conventional medicine' for treating back pain, but also that there are not really any consistently reliable treatments for back pain. It is where chiropractors claim they can treat non-skeletal and non-muscular conditions that Holt objects.
In my next post, I'll list some of the claims that are on chiropractic websites in New Zealand and beyond, looking at how some of them relate back to D. D. Palmer's pseudoscientific concept of the human body. One of these claims is that chiropractors are 'doctors'. In truth, chiropractors have no mandate to use that title [edit: without qualifying it]. I will follow that with a third post, discussing the role of the BSA as a mediator of scientific discourse in the media. I will also touch upon some valid concerns about Holt's motives. Here is a list of links that I plan to include at the end of each post in this series. You should read these, if you are at all interested, because some of these bloggers and writers have expertise in medicine and/or biology.
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
