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).

Saturday, October 23, 2004

Chiropractic Oranges

The "chiropractic subluxation" amounts to an orange that is being called an "apple". But a "chiropractic apple" isn't an apple, and any normal consumer of fruit will be confused and deceived. Using words to mean something other than what they normally mean has that effect.

Even if a lesion could be settled on (which is now called the "chiropractic subluxation"), it would still be a confusing use of the word "subluxation", which already has a clearly defined meaning in orthopedic medicine, and has absolutely no metaphysical aspects, unlike the chiropractic version. Chiropractic should be forced to quit misusing the word "subluxation" purely on a linguistic basis. The word can't be true in an orthopedic sense and also true in a chiropractic sense.

An apple is called an "apple". Just because some idiot insists on calling an orange an "apple", doesn't make it so. They should be required to call an apple an apple, and an orange an orange.

Since chiropractic "oranges" already are called that by the rest of the healthcare system, chiropractors should accept the established diagnosis system and terminology and call them "oranges" as well. One thing they aren't is "apples"!

Will this happen? Nope! It would amount to cutting off the tail of the entire profession - the tail that wags the dog.

No, they will continue to call oranges "apples", since they are in the orange business, but want to deceive people into thinking that they are also in the apple business.

The history of this quirk of terminology is interesting:

Chiropractic's Elusive "Subluxation"
Stephen Barrett, M.D.

If you are examined by a chiropractor, you may be told that you have one or more subluxations of your spine. This article examines what this means and how you should react.

Chiropractic theory is rooted in the notions of Daniel David Palmer, a grocer and "magnetic healer" who postulated that the basic cause of disease was interference with the body's nerve supply. Approximately a hundred years ago, he concluded that "A subluxated vertebrae . . . is the cause of 95 percent of all diseases. . . . The other five percent is caused by displaced joints other than those of the vertebral column."[1] He claimed that subluxations interfered with the body's expression of "Innate Intelligence"-- the "Soul, Spirit, or Spark of Life" that controlled the healing process. He proposed to remedy the gamut of disease by manipulating or "adjusting" the problem areas.

Over the years, chiropractors have gone beyond Palmer's theories, although some still cling to them for dear life. Some describe subluxations as "bones out of place" and/or "pinched nerves"; some think in terms of "fixations" and/or loss of joint mobility; some occupy a middle ground that includes any or all of these concepts; and a small percentage renounce Palmer's notions as biotheistic nonsense.

Are Subluxations Visible?

Chiropractors also disagree on whether their "subluxations" are visible on x-ray films. "Straight" chiropractors tend to believe that they cause nerve interference, are readily visible, and that virtually everyone gets them. Most other chiropractors (commonly referred to as "mixers") define subluxations loosely and see them when it suits their convenience. Chiropractors who reject subluxation theory consider them invisible but have been forced to acknowledge them to get paid by Medicare. When a respected chiropractic researcher was asked whether he had ever seen a subluxation on an x-ray film, he smiled and jokingly replied, "With my eyes closed." [2]

Old chiropractic textbooks show "before and after" x-rays that are supposed to demonstrate subluxations. In 1971, hoping to get a first-hand look at such x-rays, I challenged the local chiropractic society to demonstrate ten sets. They refused, suggesting instead that I ask the Palmer School to show me some from its "teaching files." When I did, however, a school official replied:

"Chiropractors do not make the claim to be able to read a specific subluxation from an x-ray film. [They] can read spinal distortion, which indicates the possible presence of a subluxation and can confirm the actual presence of a subluxation by other physical findings" [3].

In 1973, Congress authorized payment under Medicare for chiropractic treatment of "subluxations demonstrated by x-rays to exist." In 1972, to enable payment, chiropractors held a consensus conference that redefined "subluxations" to include common findings that others could see. The document, several pages long, described the supposed x-ray manifestations of 18 types of "subluxations," including "flexion
malposition," "extension malposition," "lateral flexion malposition," "rotational malposition," "hypomobility" (also called "fixation subluxation"), "hypermobility," "aberrant motion," "altered interosseous spacing," "foraminal occlusion," scoliosis, and several conditions in which "gross displacements" are evident [4]. I have been unable to determine how many billions of dollars chiropractors have received from Medicare since the law took effect.

Some of these terms are fancy names for the minor degenerative changes that occur as people age. The conditions often have nothing to do with a patient's symptoms and are not changed by chiropractic treatment. Some, as acknowledged by the conferees, are not even visible on x-ray films.

In 1997, Congress amended the law to permit payment for subluxations diagnosed by other means -- a policy scheduled to take effect on January 1, 2000.

Chiropractors also differ about how to find "subluxations" and where they are located. In addition to seeing them on x-ray films, chiropractors say they can find them by: (a) feeling the spine with their hand, (b) measuring skin temperature near the spine with an instrument, (c) concluding that one of the patient's legs is "functionally" longer than the other, (d) studying the shadows produced by a device that projects a beam of light onto the patient's back, (e)weighing the patient on special scales., and/or (f) detecting "nerve irritation" with a device. Some subluxation-based chiropractors say that subluxations at the top of the spine are the ones that count [A, B] some focus on the bottom of the spine, some work at both ends, and others locate and treat them throughout the spine. Undercover investigations in which many chiropractors have examined the same patient have found that the diagnoses and proposed treatments differed greatly from one practitioner to another.

Subluxation is also a medical term. The medical definition is incomplete or partial dislocation -- a condition, visible on x-ray films, in which the bony surfaces of a joint no longer face each other exactly but remain partially aligned. No such condition can be corrected by chiropractic treatment.

Elastic Definition

Two years ago, in an attempt to "unify" chiropractic terminology, the Association of Chiropractic Colleges issued the following definition:

"A subluxation is a complex of functional and/or structural and or pathological articular changes that compromise neural integrity and may influence organ system and general health."

In 1997, the Foundation for Chiropractic Education and Research issued a pamphlet called "Subluxation: What It Means to You," which states:

"What the above means is that a subluxation is a joint problem (whether a problem with the way the joint is functioning, a physical problem with the joint, or a combination of any of these) that affects the function of nerves and therefore affect the body's organs and general health."

This "definition" is still poppycock because the vast majority of spinal problems do not affect the body's organs or general health. (In addition, it makes no sense to use the consensus process to try to define something that is not a valid concept [5]. If you'd like to have some fun, ask a chiropractor to list the diseases or general health problems that spinal manipulation can cure.