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:
(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:
Palmer piled metaphors on top of metaphors:
(ibid, my emphasis)
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