Media's Manipulative Subluxation

by Howard Fienberg

When does an 'alternative' medicine become an accepted part of the 'mainstream?' A recent Chicago Tribune story ("First line of defense," Nov. 26) declared that chiropractors-formerly underdog care givers "dogged by a shady reputation" who "resisted attempts to squelch their profession"-are now "becoming mainstream." But this story lacked an important journalistic ingredient needed to differentiate it from a mere infomercial: balance.

The Tribune described the origins of chiropractic care and interviewed patients who swear by it. Unfortunately the report did little to explain the basis for chiropractic care or to explore why the American Medical Association (AMA), which once called chiropractors an "unscientific cult," no longer does so. Previously, the AMA "fought to exclude them [chiropractors] from insurance programs and for decades forbade its members from referring patients to them." Reading the Tribune story, it appeared as if the AMA had somehow changed its mind. Left unmentioned was the ruling in an anti-trust lawsuit brought by a group of chiropractors against the AMA that legally forbade the organization from speaking out against chiropractic.

As the Tribune explained, "the mainstay of chiropractic treatment is the correction of subluxations through the use of spinal manipulation." The Tribune declined to define subluxations - so what are they? They are supposed to be troubles in the spine which interfere with the function of the nervous system - what chiropractic's inventor Daniel D. Palmer called the "Innate Life Force." Palmer had been trying to explain why germs were found in both healthy and sick people. His answer was subluxation, which he believed to be the root of all disease. Soon thereafter, modern medicine realized that the real secret was the immune system. Most chiropractors, while unable to agree on a precise definition of subluxation, have yet to acknowledge this simple discovery.

According to Dr. William T. Jarvis, professor of public health at Loma Linda University, no "chiropractor has ever been able to reliably demonstrate the existence of 'subluxations,' much less validate their importance to health and disease." Dr. Jarvis does admit that "there is sufficient evidence that manipulation can at least temporarily improve the range of motion of impaired joints and relieve pain ... to make it a worthwhile, although limited medical procedure." But the most likely reason for chiropractic's popularity lies in the "laying on of hands, which reportedly has the effect of relaxing the patient."

No mention was made of the numerous tests of chiropractors' consistency in diagnosing subluxations. Reporter Ralph Lee Smith discussed in his 1969 book, At Your Own Risk, his trips to two different chiropractors, from whom he received completely different subluxation diagnoses. Similar trials have been run since then, including those by consumer advocate Dr. Stephen Barrett, who sent a healthy four-year-old girl to five chiropractors for a simple check-up. Each practitioner found something entirely differently wrong with her, ranging from a "twisted" pelvis, to an "elevated" hip, to a "shorter left leg."

James Winterstein, president of the former National College of Chiropractic, told the Tribune "there's an awful lot of empirical evidence, but not an awful lot of double blind studies." That is the extent of the investigation. Lack of supporting scientific evidence was dismissed in the face of a pile of anecdotes. The Tribune concluded "a chiropractor can be helpful for a variety of health problems," following with a guide to choosing your chiropractor.

What was Dr. Jarvis' response to the favorable feature? "This article reads like a paid public relations piece for the American Chiropractic Association."

Howard Fienberg is research analyst with the Statistical Assessment Service (STATS), a nonprofit nonpartisan think tank in Washington, D.C.