A Skeptical Consumer’s Look at Chiropractic Claims: Flimflam in Florida?
Bruce Thyer and Gary Whittenberger
There is no scientifically credible evidence that chiropractic treatment can alleviate high blood pressure or arthritis, yet when an author called the offices of local chiropractors asking if they could help him with these conditions, three-fourths of the offices asserted that they could.
The late Carl Sagan said “Extraordinary claims require extraordinary evidence.” This skeptical principle can be applied generally to the area of consumer affairs and more specifically to the claims of chiropractic, an “alternative healing” approach now practiced widely throughout the United States and other parts of the world.
Chiropractic practice began in 1895, when D.D. Palmer administered a 'chiropractic adjustment' to a deaf man who reportedly regained his hearing. Palmer, a grocer and 'magnetic healer,' made great claims about the importance of his new treatment for human ailments. According to Palmer, “A subluxated vertebrae . . . is the cause of 95 percent of all diseases . . . the other 5 percent is caused by displaced joints other than those of the vertebral column.”
The very existence of vertebral subluxations and their etiological role in health problems is uncertain and subject to considerable controversy, since there is very little empirical evidence in support of the efficacy of chiropractic (see Crelin 1973; Keating, Charlton, Grod, Perle, Sikorski, and Winterstein 2005).
J.J. Palmer, the son of chiropractic’s founder, was primarily responsible for the development of chiropractic as a profession within the United States. In a little more than a hundred years, chiropractic has advanced dramatically to the point where there are now sixteen accredited colleges of chiropractic and fifty thousand licensed chiropractors in the U.S. alone.
Within the state of Florida, where the current study was initiated, chiropractic medicine is defined by law as “a noncombative principle and practice consisting of the science of the adjustment, manipulation, and treatment of the human body in which vertebral subluxations and other malpositioned articulations and structures that are interfering with the normal generation, transmission, and expression of nerve impulses between the brain, organs, and tissue cells of the body, thereby causing disease, are adjusted, manipulated, or treated, thus restoring the normal flow of nerve impulse which produces normal function and consequent health . . .” (Florida Statute 460.403). In 1998, Florida, with its four thousand practitioners, ranked fourth in the nation in the number of licensed chiropractors.
It is generally agreed that chiropractic may be a useful approach in alleviating pain for a very limited set of disorders associated with the back or spine. However, many skeptics are concerned that chiropractic is being applied to disorders for which it is an inappropriate intervention and for which solid evidence of its efficacy is lacking. If this is the case, then several unfortunate consequences might result. Patients might be harmed by the treatment itself, they might waste their time and money, or they might be deterred from seeking effective treatments. Skeptics fear that chiropractors and their representatives may often promise too much and create expectations that chiropractic can cure or heal medical problems for which it is ill suited.
This study was designed to ascertain the degree to which the representatives of chiropractic in a medium-sized Florida city would agree to treat a patient presenting complaints for which chiropractic has not been shown to be effective (see Goertz, Grimm, Svendsen, and Grandits 2002; Plaugher et al. 2002; Ernst and Canter 2006). The setting for this study was Tallahassee, the capital of Florida, with a population of approximately 151,000 people and where both the authors of this article reside. The local telephone book lists about thirty-three chiropractors in the city. Bruce Thyer contacted the offices of most of these practitioners by telephone during the months of December 2005 and January 2006 and was successful in reaching someone in the office in twenty-eight of the cases. Thyer used a standard opening script for each call: “Good afternoon, my name is Bruce and I am fifty-two. I am interested in learning if chiropractic can help me with high blood pressure and arthritis.” Occasionally, after an initial response, Thyer would ask for confirmation by saying “So you treat people with high blood pressure and arthritis?” In nearly every case, the call was received by a secretary, receptionist, technician, or someone representing the chiropractor, not by the chiropractor himself. So, how often did the representatives of chiropractors agree to treat a fifty-two-year-old man with high blood pressure and arthritis?
Twenty-one of the twenty-eight offices (75 percent) said that they could treat high blood pressure, arthritis, or both; two of the twenty-eight (7 percent) said they did not treat either of the disorders; and three of the twenty-eight (11 percent) indicated that they didn?t know or were uncertain if these problems could be treated. Among the positive responses were the following:
“Absolutely, all the time.”
“Yes, it should help.”
“Yes it can.”
“It has been known to be of great benefit for both.”
“I know it will help with the high blood pressure, and with the arthritis it will help maintain you, but it will not cure you.”
“Not high blood pressure, but arthritis, yes.”
“Yeah, sometimes, especially the high blood pressure part.”
“The arthritis . . . and generally, yes, blood pressure. He can help you in terms of making you feel better.”
“Sure, I can administer the adjustments, open up the joints and improve blood flow.”
“Can probably help with the pain of arthritis, but blood pressure, no that would need to get homeopathy treatment and he does that too.”
“Yes, the doctor can treat that [high blood pressure and arthritis]. What insurance do you have?”
Negative responses included:
“Generally that is not what chiropractic does.”
“Primarily [we] focus on spinal and orthopedic problems, not arthritis or high blood pressure.”
Uncertain responses included:
“This is something we would need to talk to the doctor about, and he is out of town.?”
In the end, three-quarters of the representatives of chiropractors in Tallahassee agreed that their offices would be able to treat someone with high blood pressure and/or arthritis. Now, it might be argued that the chiropractors themselves would have given responses much different from those obtained in this study. Maybe they would not have been as agreeable to the treatment of high blood pressure and arthritis as their employees were. At worst, the office employees were accurately representing the intentions of the chiropractors for which they work, and those chiropractors were offering treatment for high blood pressure and arthritis. At best, the employees were misrepresenting the intentions of the chiropractors for which they work and were promising too much, in which case the employees were not properly trained to interact with prospective patients. Neither outcome is in the best interest of the public.
Results similar to those of this study have been reported elsewhere. Recently, a reporter in Ontario, Canada, posed as a mother seeking treatment for her two-year-old son’s chronic ear infections. She called the offices of fifty randomly selected chiropractors and asked if the chiropractors provided treatment for young children and if they would be able to help with a child’s ear infections. Forty-five of the fifty offices (80 percent) said they treated young children and thirty-six of the fifty (72 percent) said they could help with the ear infections. These expectations were given even though the glosso-pharyngeal nerve in the ear doesn't go through the spine, which is the intended target of chiropractic. In the 1970s, physician Stephen Barrett supervised a woman who took her healthy four-year-old daughter to five chiropractors for a “checkup.” Prior to these visits, the child was examined by a pediatrician and found to be healthy. The mother carried a concealed tape recorder during the visits. One chiropractor ran a “nervoscope” up and down the child’s spine for a minute and said she had pinched nerves to the stomach and gallbladder, and he recommended X-rays. The second chiropractor said the child’s pelvis was twisted and needed adjusting. The third found one hip to be elevated, and recommended adjustments. The fourth found a shorter leg and neck tension, and recommended weekly adjustments. And the fifth found hip and neck misalignments and without permission provided adjustments to the four-year-old. The screams of the child during the adjustments, heard over the tape recorder, caused Dr. Barrett to terminate this study. Later, as an eleven-year-old, the girl was in good health and a gymnast (for more information, see www.chirobase.org).
There is evidence from this study and other similar investigations that chiropractors or their representatives are agreeing to treat, and possibly attempting to treat, disorders for which their practice is not appropriate. In a sense, they are advertising that they can effectively treat certain disorders when there are few or no controlled clinical studies that actually back up these claims. Thus, many of the claims of chiropractic can be considered extraordinary, and as Sagan would remind us, these claims require extraordinary evidence before they should be believed.
We also suggest that the approach used in this study, calling up health care providers and asking them about the types of disorders they claim to treat, is a very useful and low-cost investigative strategy that can be adopted by skeptical consumers in their local communities. Our study revealed that the large majority of chiropractic offices contacted claimed to be able to treat hypertension and arthritis, claims that the current scientific literature does not justify. The costs to consumers who are seeking legitimate and effective treatments for these serious health problems, and who instead receive inappropriate and ineffective diagnostic (e.g., spinal radiographs) and therapeutic procedures (spinal manipulation), are undoubtedly substantial. So, too, are the costs to private, state, and federal health insurance providers. The extent to which consumers are diverted from receiving evidence-based treatments for serious health problems is similarly unknown but also likely to be considerable.
- Crelin, E.S. 1973. A scientific test of chiropractic?s subluxation theory. American Scientist, September/October, pp. 574-80.
- Ernst, E. and P.H. Canter 2006. A systematic review of systematic reviews of spinal manipulation. Journal of the Royal Society of Medicine 99(4): 192-96.
- Goertz, C.H., R.H. Grimm, K. Svendsen, and G. Grandits. 2002. Treatment of hypertension with alternative therapies (THAT) study: A randomized clinical trial. Journal of Hypertension 20: 2063-2068.
- Keating, J.C., K.H. Charlton, J.P. Grod, S.M. Perle, D. Sikorski, and J.F. Winterstein. 2005. Subluxation: Dogma or science? Chiropractic & Osteopathy 13(17): 1-10.
- Plaugher, G., C.R. Long, J. Alcantara, A.D. Silveus, H. Wood, K. Lotun, J.M. Menke, W.C. Meeker, and S.H Rowe. 2002. Practice-based randomized controlled-comparison clinical trial of chiropractic adjustments and brief massage treatment at sites of subluxation in subjects with essential hypertension: Pilot study. Journal of Manipulative and Physiological Therapeutics, 25: 221-39.