Apologetics for Chiropractors
As a Christian chiropractor it behooves me to serve others to the best of my abilities. This includes providing evidence-based care that is supported by scientific research. The problem is that chiropractic has been considered for over a century as an alternative healthcare system, with all the trappings and limited to nonexistent accountability that goes with that label. We science-based chiropractors get lumped together with the crystal-waving, chakra-balancing practitioners who now make up only a small, and ever shrinking, periphery of the profession. We are not only tarred with the same brush, we are tied to the same stake with the same fate threatened. I have, therefore, on occasion had to defend my profession against critics who did have some ammunition to fling around. I have had the following comments thrown in my face more than once:
“Chiropractic isn’t supported by science”.
“Chiropractic is quackery”.
“You can get a chiropractic degree in 6 months, and it is worthless”.
I will limit this blog to addressing these specific accusations, as they are, to me, the crux of the issue when it comes to modern chiropractic. One just has to do a google search for “chiropractic quackery” to be bombarded with dozens (hundreds?) of opinion pieces ranting about how terrible chiropractic is. One I read accused chiropractors of being murderers. If the pretext of the article in question were correct, then I would be guilty of wiping out a small, but significant, proportion of the local population over the 14 years I have been in practice. I think I would have noticed if that were happening – I would have at least got a phone call. A mass murderer I am not, but the article would have you think otherwise. How the heck can I fight against that kind of merciless assault? With the only weapons that matter in this case – fact and logic. Now, I will say that every profession, from scrap metal merchant’s laborer (my father’s job title on my birth certificate, if you want to know) up to politician, has its fair share of liars, thieves and charlatans. I do not take this as reflective of any particular profession, but as an indictment of human nature – there will always be those out to steal, whether it be innocence, property or life, and there will be those who will believe any kind of nonsense that is presented to them. Every branch of healthcare has its get-rich-quick schemers and its nonsensical dreamers. To address this, in part, I have already blogged about how to choose a good chiropractor. With all that said, now I can get on with discussing some facts. But where do I start? How about chiropractic in 2018? I could write a dissertation on where chiropractic has been (and it has been to some weird places), but I do not have the time or patience to exhaust my muse on a 5-volume book that no one will read (unless they are seeking a very radical cure for terminal insomnia). I know where the chiropractic profession has been, but where is it going?
1. “Chiropractic isn’t supported by science”.
Chiropractic has been with us for 123 years, and it has changed much during this time. The medical profession has also changed over time, and medical doctors no longer treat the 4 humors, although it did take them over 2000 years to work out that they were barking up the wrong tree (this is not a dig at the medical profession, only an appreciation of how some wrong ideas can persist, even in the presence of geniuses - I am very grateful to the surgeon who removed my perforated appendix when I was 10, instead of trying to bleed me and slap a couple of leeches on my stomach). Strangely enough, the medical profession has come full circle with the humble leech (yes, it really does have a modern medical application, and no, you don’t swallow it). In each profession there are those who cling to outmoded and disproved ideas. These dinosaurs are slowly going extinct, and not before their time. To adequately judge any profession, we should look at the mainstream, not the peripheral nutjobs and shysters. To those out there who accuse us chiropractors of not being science-based, this was a fair reproach in the past, just as it was a fair reproach to the medical profession over a century ago. Not anymore. Research published in peer-reviewed medical journals over the past few decades has shown the benefits of chiropractic manipulative therapy. Insurers, whether private or public, look at this research and use it as a guide as to what care should be covered/reimbursed. Medicare/Medicaid, the US Department of Veterans Affairs (VA), Workers’ Compensation and almost all private health insurance companies include chiropractic care based on this research. They wouldn’t spend a cent if the research wasn’t there. In response to the opioid epidemic that has now reached crisis levels in the US, the American College of Physicians (ACP) has updated its guidelines for the treatment of acute and chronic low back pain, recommending that non-drug treatments, including chiropractic manipulative therapy, be attempted prior to resorting to drug therapies. In 2016 the Centers for Disease Control and Prevention (CDC) released new guidelines in response to the opioid epidemic promoting non-pharmacologic alternatives, including chiropractic, for the treatment of chronic pain. In 2015, the Joint Commission, the organization that accredits more than 20,000 health care systems in the US (including every major hospital), recognized the value of non-drug approaches by adding chiropractic to its pain management standards. All this was done because research has shown the benefits of chiropractic in specific circumstances, without the potentially serious side effects of pain medications or invasive procedures. Research regarding the benefits of chiropractic is ongoing and is expanding. A recent study evaluating chiropractic care directed at female US veterans with low back pain indicated improved clinical outcomes (that means decreased pain and improved function to you and me). The National Institutes of Health (NIH) has just committed $7 million to the Palmer Center for Chiropractic Research and their partners to cover 11 clinical studies over 2 years, including research at VA facilities. The NIH is renowned for being incredibly stingy when it comes to handing out grants for chiropractic research, and this level of support is quite unprecedented. I think the argument that chiropractic is not science-based is looking a bit wobbly. Perhaps it needs an adjustment?
2. “Chiropractic is quackery”.
Quackery? Quackery?!!? Yes, finally on to the next accusation, that of chiropractic quackery. In the words of one of my role models, “Bah, humbug!”. There has been, there is, and there will always be a level of quackery in all fields of healthcare. I am aware of some in the chiropractic, medical and dental professions who are to this day making ludicrous claims. I shun this tiny minority of misfits. My practice is run on evidence-based protocols, extrapolated from the research mentioned in passing above. Most chiropractic practices are migrating to evidence-based care models, as this is what insurers are using as the yardstick for reimbursement. If you still have doubts of the science-based nature of modern chiropractic, then please read point 1 above again. Let the cries of “quackery!!” fade.
3. “You can get a chiropractic degree in 6 months, and it is worthless”.
Last but not least in this opus is the contentious topic of chiropractic education. In the US chiropractors are educated in nationally accredited, 4-year doctoral graduate school programs through a curriculum that includes a minimum of 4,200 hours of classroom, laboratory and clinical internship, with the average DC (doctor of chiropractic) program equivalent in classroom hours to allopathic (MD) and osteopathic (DO) medical schools. Chiropractic education has come on leaps and bounds since I graduated, and I am quite jealous of the opportunities chiropractic students now have in areas such as hospital rotations (through the VA, discussed below), research programs, etc. Chiropractors must pass national and state board examinations to be able to practice. Chiropractors also must take continuing education credits to maintain their state licenses. Chiropractors are considered by state law and statutes as physicians. While in the past there have not been opportunities for chiropractors to be involved in residency programs, the VA, which conducts the country’s largest healthcare provider clinical training program, now has chiropractic residency and student rotation programs at 5 locations, and it is expected to expand the programs in the future. While some decry the absorption of chiropractic into mainstream healthcare, my contention is that chiropractic will not disappear as a separate healthcare profession while it continues to serve those in pain.
If you managed to read this far, then I applaud your tenacity (the state of your sanity after reading my ramblings is a different matter). Let me close by pointing out a few simple facts. Dr. Christyann and I have helped thousands of people in pain in our community, and the care we provide is extremely safe (chiropractors have one of the lowest malpractice insurance rates in the US) and is backed up by scientific research. We will continue to provide this quality care at affordable prices. We are here when you need us.
Robert Fox, DC