Confessions of a Quackbuster

This blog deals with healthcare consumer protection, and is therefore about quackery, healthfraud, chiropractic, and other forms of so-Called "Alternative" Medicine (sCAM).

Wednesday, January 12, 2005

FSU: Chiropractic has backers, but is it just voodoo?

Chiropractic has backers, but is it just voodoo?

A planned chiropractic school at FSU has intensified debate as to whether the practice is real treatment or simply manipulation.


By LISA GREENE, Times Staff Writer
Published January 9, 2005


ST. PETERSBURG - After the accident at work, nothing seemed to help Bob Cannon.

Doctors kept giving him pills, strong ones.

"It kept me in a stupor all the time," said Cannon, 60, of Gulfport. A surgeon told him he would be lucky not to spend the rest of his life in a wheelchair.

So Cannon looked elsewhere for help.

Fifteen years later, Cannon credits his chiropractor, Donald J. Krippendorf, with easing his pain and keeping him on his feet.

There are legions of patients such as Cannon, patients who say nothing worked for them until they turned to a chiropractor.

"If it wasn't for this here, I wouldn't be in the shape I'm in now," Cannon said after Krippendorf adjusted his back and neck last week.

But others argue that chiropractors' treatments do little good and even can be dangerous. A group of doctors and scientists at Florida State University is attacking the profession now because legislators have passed a plan to open a chiropractic school, which would be the first such school at a public university in the United States.

So, just what is chiropractic medicine, and why does it inspire so much venom from medical doctors that some at FSU compare it to studying Bigfoot or astrology?

Chiropractic comes from Greek words meaning "done by hand." Chiropractic doctors stress the body's ability to heal itself without drugs or surgery. They focus on manipulating the spine to lessen back pain, to improve overall health and, for some, to treat other ailments.

But how well it works remains a question. Chiropractic care is winning broader acceptance. Still, scientific studies give conflicting evidence on how effective such treatments are. And doctors say one treatment in particular, neck manipulation, has grave risks.


* * *

The proposed FSU school has angered so many faculty members that more than 500 of them have signed petitions against it.

"It is deluding the public when you give a doctor's degree to this person," said Dr. Ray Bellamy, an orthopedic surgeon who teaches part time at FSU and is leading the opposition. "It's almost fraudulent."

Scientific studies say chiropractic treatment helps low-back pain, although just how much is debatable. One New England Journal of Medicine study of 321 peopl e found chiropractic treatment to be more effective than giving patients a booklet on managing their back pain, but only "marginally better." An agency within the prestigious National Institutes of Health called the scientific evidence on chiropractors "weak and less than convincing" in a 2003 report summarizing the research.

A 2003 scientific review of low-back pain studies called the evidence "at best uncertain" and said that newer studies "have not tended to be encouraging." An analysis of such studies found spinal manipulation more effective than sham therapy, and about as effective as other treatments, such as medication.

Chiropractors point to other studies, such as one last year in the journal Spine. That study by two Australians who hold doctorates, one of whom also is a chiropractor, divided 115 patients with chronic back pain into three groups and found that the patients treated with chiropractic manipulation were much more likely to recover quickly than patients treated with drugs or acupuncture.

Other aspects of chiropractic care remain more controversial. Manipulating the neck may cause tears in an artery that could cause a stroke. Chiropractors say the risk is tiny, but doctors opposed to the practice say it is significant.

Also debated: whether chiropractic care has any effect on ailments unrelated to spinal pain, such as ear infections, asthma or digestive problems. Studies in two of the nation's most prestigious journals, the New England Journal of Medicine and the Journal of the American Medical Association, have found chiropractic treatment manipulation didn't help childhood asthma or tension headaches.


* * *

To Krippendorf, the FSU debate has been painful - a shift away from a trend among doctors toward greater acceptance of alternative medicine and more willingness to work with chiropractors. Most insurers now cover chiropractic treatment, and the Department of Veterans Affairs has started providing chiropractic care at many medical centers.

These days, about half his patients are referred to him by doctors, said Krippendorf, a St. Petersburg doctor of chiropractic who also is president of the American Chiropractic Association. He often sends his patients back to doctors for problems he can't treat. The law doesn't allow chiropractors, who do not have a medical degree, to prescribe medication, perform surgery or deliver babies.

"I think it's detrimental to the patient for there to be this appearance, that they're driving us apart," he said. "People who need care, be it medical or chiropractic, they're the ones who are being shortchanged here."

Krippendorf acknowledged that the medical research backing chiropractic treatments is sparse. But there's reason for that, he said.

"It's about dollars and cents," he said, and chiropractors haven't received the same funding as traditional medicine to study what works and what doesn't.

But the field has powerful evidence of another kind, he argued: its patients. Why would so many people keep seeing chiropractors if they didn't get help?

"The only reason it's been able to move forward and grow is because it works," he said.

Krippendorf allowed a reporter to observe him treating patients one morning last week, so long as the patients didn't object. All six were adults with back or neck pain. Each patient lay facedown on an exam table as Krippendorf manipulated their spines, pushing on different spots with different force for each patient.

He also performed a different adjustment, having each patient lie sideways as he pushed a bent leg upward and a shoulder back.

Patients receive other treatments in addition to manipulation, such as ultrasonic stimulation of their muscles. Krippendorf also has a room of weight machines, most of them designed to strengthen muscles in the back.

Krippendorf sometimes treats other illnesses as well. He has been treating one girl for ear infections by manipulating her back and her ears, he said.

But Krippendorf stresses that when he treats another disease, he doesn't interfere with a patient's medications or a doctor's treatment. For example, he said, he would offer diabetics advice about nutrition and exercise, but they still would receive insulin from their doctor.

Last week, Seminole resident Robert Nash, 71, told Krippendorf when he arrived that his treatments already have helped ease the pain shooting down his back through his left leg.

"This morning was the best I've felt in months," he told Krippendorf.


* * *

But to Bellamy, such testimonials are of limited value. Many patients do feel better after visiting a chiropractor, he said. He has seen studies that show some improvement to low-back pain, although he believes it's minimal, and research that shows patients are more satisfied with chiropractors than with doctors.

"It seems to have little benefit over placebo," meaning the "sugar pill" effect that a patient gets simply from believing they've been helped, Bellamy said. "Other than for low-back pain, in very specific instances of recent back pain, almost everything they do is bedside manner and placebo effect."

Chiropractors' successes point to problems in the medical field. Doctors often can't provide helpful treatment of low-back pain, and they often don't connect well with patients.

"Patients like to be fussed over," Bellamy said. "I think doctors need to learn to listen to patients more and be more hands-on and more caring."

But that doesn't mean chiropractors are the answer, Bellamy said. While he believes spinal manipulation can help back pain, he objects to chiropractors' claims that they can help treat other conditions, from asthma to ear infections to attention-deficit disorder.

"From a scientific standpoint, all of the beneficial part of chiropractics, that is better than placebo, could be taught in a one-semester course at a physical therapy school," rather than a full-fledged university program, he said.

Patients may not get medical help, or may be delayed in getting help, if they go to a chiropractor instead of a doctor, Bellamy said.

Bellamy and other doctors associated with FSU are especially worried about the risk of stroke from neck manipulations. Two emergency room doctors have contacted Bellamy, telling him of patients they have seen who suffered strokes after chiropractic treatment.

The danger, Bellamy said, is that by quickly twisting the neck, a chiropractor can tear the lining of an artery at the back of the neck. Blood clots can form, then travel to the brain, causing a stroke.

"We think about 2,800 times a year, it causes a stroke," said Dr. Bill Kinsinger, an Oklahoma anesthesiologist who opposes chiropractic care and is working with the FSU opponents. "And almost all of them are young and healthy."

Krippendorf argued that the risk of injury from traditional medicine (even taking aspirin, which can cause stomach bleeding) is much higher.

"Your odds of being killed by a lightning strike are far greater," he said.


* * *

One of the central tenets of traditional chiropractic teaching, "subluxation," also irks the doctors. Chiropractors are taught that subluxations, subtle misalignments of the spine, interrupt the flow of nerves to other parts of the body, causing a variety of health problems.

Such interruptions don't exist, Kinsinger said.

"A vertebral subluxation has never been seen on autopsy, in MRIs, or X-rays by anyone other than a chiropractor," he said.

The theory has become controversial among chiropractors as well. Samuel Homola, a retired chiropractor and author who lives in Panama City, Fla., has written a book criticizing the theory.

Homola has mixed feelings about the FSU school. He thinks it sounds "promising," but believes that if such a school is to be scientific, as advocates say it will be, then it must reject subluxation teachings and focus on mechanical problems of the spine.

"We have some good chiropractors, but the majority of the schools and the state laws define chiropractic as a method that shouldn't be taught at FSU," he said. "That's what disturbs me."

Times staff researchers Kitty Bennett and Carolyn Edds contributed to this report.










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