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).

Thursday, January 13, 2005

FSU: School could prove -- or dispel -- claims

Posted on Thu, Jan. 13, 2005


School could prove -- or dispel -- claims

FSU's proposed chiropractic college highlights the profession's struggle to move from broad unscientific claims to evidence-based pain treatment.


This is the founding legend of chiropractic:

In 1895 a self-taught healer squeezed the spine of a janitor who had been deaf for 17 years. A bone moved and the man's hearing returned.

And so chiropractic was born, along with ''subluxation theory'' -- the belief that manipulating slight misalignments in the spine could treat everything from diabetes to ear infections.

More than a century later, subluxation theory remains an unproven article of faith -- a fact that has led hundreds of Florida State University faculty members to oppose creating a chiropractic college at FSU. It would be the first such school in the nation associated with a major research university.

''Their whole concept of science is just totally off,'' said Dr. Raymond Bellamy, an orthopedic surgeon who teaches at FSU and who has led the campaign against the chiropractic school.

Yet studies suggest chiropractic treatments -- covered by most insurance plans and practiced by more than 60,000 chiropractors in the United States -- can help ease back pain.

Chiropractors argue that a chiropractic college at FSU would help distinguish facts from myths and improve treatment for the 15 million Americans who visit chiropractors.


''The chiropractic profession as a whole . . . is ready to step up to the plate and to let its belief systems be tested scientifically,'' said Dr. John Triano, a chiropractor who served on the advisory committee for the FSU school. ``Let the chips fall where they may.''

The FSU school could be a force in chiropractic's transition from fringe to mainstream, according to Triano. ``The transition is from the stereotypical impression of chiropractic as a bunch of people running around claiming they can treat everything, to a very evidence-based but open-minded practice approach.''

Students in the proposed five-year program would be required to earn a master's degree in one of five non-chiropractic disciplines: aging studies, food and nutrition, movement and exercise science, health policy research, or public health.

FSU Provost Lawrence Abele said the chiropractic school would not teach subluxation theory, which is at the root of the profession's unscientific claims. That theory holds that correcting the spine's alignment is central to good health.

Scientific scrutiny of the field does not support this claim. A recent analysis of existing studies found no good evidence that chiropractic treatments help diabetes, chronic pelvic pain, menstrual irregularities or hypertension.

Some evidence suggests chiropractic treatment can help headaches and neck pain, although neck treatments may carry a slight risk of stroke. The best evidence is for short-term back pain, which chiropractic appears to treat effectively.

''It's not so much that spinal manipulation looks like a panacea, but that it looks at least as good as many medical treatments,'' said Daniel Cherkin, a University of Washington epidemiologist who studies chiropractic. ``Relative to the alternatives, it's a reasonable thing to do.''

As a result, most chiropractors now focus on treating pain through spinal manipulation. Yet surveys show nearly 20 percent of chiropractors -- more than 10,000 nationwide -- still believe in subluxation theory, Triano said. And the chiropractic college accreditation guidelines endorsed by the U.S. Department of Education make several references to the diagnosis and treatment of ``subluxations.''

FSU's refusal to teach subluxation theory could force the accreditation body to revise its standards.


The debate over the FSU program is the latest chapter in a long feud between physicians and chiropractors that goes back a century and includes a federal anti-trust lawsuit settled in 1987, when a judge ruled that the American Medical Association tried to ''destroy'' the chiropractic profession.

More recently, as interest in alternative medicine has grown among doctors and researchers, relations have thawed.

FSU's Abele said a chiropractic school should be created only if the profession is ready to shed its unscientific roots and move toward an evidence-based system.

Has that day come?

''I don't think there is a clear answer yet,'' Abele said.