An interesting comment appeared earlier on an old post about Chiropractors. It's not the first time I've encountered the idea, but I think I ought to spend a few minutes sharing the comment, outlining the problem and proposing what I think the solution is. Sure, it's no business of mine, but when has that ever stopped me?
Here's the comment from Skg, in full:
I must say, that while some (many?) chiropractors promote bogus treatments, not all do. I have been to see a few on occasion, and while I have some chronic health problems with range from annoying to severe (all of which my chiropractors have been aware of) - chiro has stuck to working on my back.
Just because some chiropractors promote bogus treatments does not mean that all do, and as such just randomly tagging every chiropractor as promoting quackery smacks of the ridiculous. In the case of the chiropractor you tagged, yes, certainly, that's justified, but to call out for readers to tag their local chiropractor as promoting pseudoscientific evidence and quackery without any evidence of that being the case is unfair. Even if it could be established that most chiros don't acknowledge germ theory and think they can cure asthma (or cancer, or whatever bullshit that they think they can do - and yes, I have met chiropractors who believe that), that doesn't justify calling out all chiropractors based upon the actions of a majority.
The problem is this. There are really nutty chiropractors out there. And there are less nutty chiropractors out there. In general terms, they are often referred to as "strict" and "reform" chiropractors - strict being, if you like, the nutty D.D. Palmer fundamentalists and reform being those who try to follow a more evidence-based, scientific form of practice, with a whole range of grey area in between.
Now, I have to say, I do not agree that it's unfair to tag "reform" chiropractors with "Happily promotes bogus treatments". It is not unfair at all, and I'd like to explain why in some more detail.
The nutty factors in chiropractic that I object to include, but are not limited to
- Rejection of germ theory
- Anti-vaccination promotion
- Claims of panacea (that is, "chiro can cure anything")
- HIV/AIDS denial
- Ignorance or denial of severe side-effects
- Claims to cure implausibly-linked conditions such as asthma and colic
- Using applied kinesiology as a diagnostic technique
- Pushing magic amulets like Q-Link, Power Balance and the like
- Scope creep
The last I've included due to the fact that many chiropractors I've looked up don't stick merely to chiro but also promote other quack claims, including acupuncture, homeopathy, "black salves" and all manner of crazy, ineffective health claims.
There are chiropractors to whom all these objections apply, and there are chiropractors, rare chiropractors, who would be offended at being grouped with these categories.
And there's the problem.
These "evidence-based chiropractors"* are grouped with the nuts, and it's not me doing the grouping. They're doing it to themselves by retaining the title "chiropractor". They are lending legitimacy to the nuts and at the same time they are tarnishing their own practices by using the tainted title.
There comes a time in many areas where your beliefs and the beliefs of the group you identify with diverge. Think for instance of a political party which no longer fits with your ideals. If you self-identify as a "Republican supporter", but you no longer agree with the party, when does it become time to change your own self-identification? If you self-identify as Marxist, but you don't subscribe to any of that "all property in common, centralisation of production" mallarkey, shouldn't you stop calling yourself a Marxist?
What if your views are diametrically opposed to the group you started out with? Should you not change? I think you should.
...that doesn't justify calling out all chiropractors based upon the actions of a majority.
I'm afraid it does. The majority rules in this case, and besides, this is about what the word "chiropractor" really means.
D. D. Palmer, the originator of Chiropractic, codified the practice as a panacea. He, and those that followed him, codified it as an intervention oriented around the idea of "innate intelligence" (analogous, in some ways, to the concept of "qi"). He codified it as a treatment that could handle anything from deafness to asthma and anything in between. It was decreed that chiropractic was about spinal manipulation to treat subluxations, and nothing else.**
If you do not accept these fundamentals - if you don't treat subluxation, if you don't believe in "innate intelligence", if you think that spinal manipulation is probably only good for specific spinal problems, if you accept that your practice is not a panacea, if you treat only spinal problems via evidence-based spinal techniques, then why in the world would you call yourself a chiropractor?
- Is it because the name "chiropractic" is entrenched in a lucrative industry?
- Is it bloody-mindedness, do you think the other guys should drop the name?
- Is it because you think the practice should be somehow "inclusive"?
- Is it because you feel some sort of ownership over the name?
- Is it because you're nostalgic?
- Is it merely inertia?
- Is it because you think you can reform the entire practice from within?
- Is it because retraining and re-registering as a physical therapist is just too hard for you?
None of these are great reasons. And let's face it, if you stay in the boat, you will be coming under increasing fire from skeptics and health care authorities who will be demanding that you justify your claims and who will inevitably be attacking chiropractic as a domain of practice.
So the way I see it, "chiropractors" who value evidence have two choices. They can stay in the boat, keep trying to slowly reform the practice and face the coming storm, or they can jump ship, rename their practice and build a reputation untainted by association with quacks.
If these "evidence-based chiropractors" really care about evidence, I think it's time to get out. The name is tainted, and will continue to be tainted for the forseeable future. I'd rather work with the occasional evidence-based practitioner than work against them, and I'm sure they'd get some value from having skeptics on their side.
Now, I am not a chiropractor. Nor am I a doctor. I am merely an ordinary person concerned with evidence-based healthcare. What right do I have to suggest this? What right do I have to speak for skeptics to chiropractors?
No right at all, or at least, no more right than anyone else has, but it needs to be said. No-one else seems to be mentioning it.
Chiropractic, in its strict form, is unsupported by good evidence. If you care about your reputation and you care about your patients and more importantly, if you care about what's real, start now. Change your title. Be upfront and forthright about your mode of practice. Get out of the quack boat while you can, because the skeptics are coming.
* Who exactly are these so-called evidence-based chiropractors? Given that chiropractic only has evidence-based support for a very narrow, specific and relatively rare set of spinal issues, surely they don't make a lot of cash? I certainly don't see many of them, but I have to assume they exist in significant numbers, otherwise I wouldn't keep seeing these comments defending them, would I? Surely?
** For more on Chiropractic history, theory and support. check out Quackcasts 10 and 11. In fact, just subscribe to the whole thing.
Ooops. Image Credit: Zeno's Blog
posted @ Tuesday, November 9, 2010 10:00 PM