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, January 22, 2005

Proposed School At FSU Heats Chiropractic Debate

Jan 14, 2005

Proposed School At FSU Heats Chiropractic Debate

William March

TAMPA - Chiropractic health care treatment is popular with the public, but is it real medical science?

The proposal for a school of chiropractic at Florida State University has reignited a long-simmering conflict over that question between chiropractors and physicians.

Politics and money leaven the dispute, which includes huge financial stakes in the health care business.

Chiropractors long have craved recognition as a legitimate science - and the resulting financial rewards, including the right to insurance and government reimbursement of their fees.

Physicians, on the other hand, have a history of guarding their turf against attempts by chiropractors, osteopaths, optometrists and others to expand the services being sold.

``Certainly this is about dollars and cents,'' said state Sen. Dennis Jones, R-Treasure Island, a chiropractor and author of the legislative plan to create the FSU school.

After all, Jones said this week, ``there's only so much pie'' to go around.

For chiropractors, much of the battle has been won. In the early 1990s, they prevailed in a major antitrust lawsuit against the American Medical Association. All states now license chiropractors; Medicare and most insurance companies cover it.

``Fifty percent of my referrals come from medical doctors,'' chiropractor Susan Welsh, of Tampa, said Thursday. ``There is no rift there anymore.''

Some critics contend chiropractors won this respect, however, ``through legislation, politics and lobbying, not because of the legitimacy of the science,'' in the words of Bill Kinsinger, an Oklahoma City anesthesiologist and chiropractic opponent who came to Tallahassee this week to advocate against the FSU school.

For chiropractors, Kinsinger said, ``there's still one piece of the puzzle missing: recognition by a major public research university.''

FSU would be the first in the country, bringing with it the prospect of government research grants and a new level of respect.

Some previous attempts at this have failed.

In 1999, for example, York University in Toronto rejected a proposal for affiliation with a Canadian chiropractic school, despite an offer of $17 million in new university facilities.

Subluxation Theory

Even some physicians and scientists who don't mind chiropractic balk at its admission to the canon of accepted science.

``We're not opposed to chiropractors. This isn't about them wanting to practice and patients wanting to go there,'' said David Stewart, a pathologist and president of the Capital Medical Society, which opposes the school.

``This is about them wanting to put a school at the university. They've been trying for years to get that to legitimize their art,'' he said.

A stumbling block to mainstream scientific acceptance of chiropractic has been its basis in the theory of subluxation.

According to a 2003 National Institutes of Health study, modern chiropractic was founded in the 19th century by Daniel David Palmer, of Iowa, a ``self-taught healer.''

He contended most diseases are caused by interruptions in ``nerve flow'' caused by subluxations, or misalignments, in the spine interfering with nerves connected to the spinal cord. Adjusting the vertebrae could cure those diseases, he reasoned.

Subluxation, in fact, is the basis of the belief that chiropractors can cure ailments beyond muscle or joint pain, including ear infections, migraine headaches, asthma and menstrual cramps.

``Those are conditions for which individuals report some benefit from chiropractic treatment,'' said Wayne Wolfson, chairman of the Florida Board of Chiropractic Medicine, which licenses chiropractors in the state.

However, subluxation has divided the profession.

Traditionalists cling to it as a defining principle, saying chiropractors can identify subluxations through X-rays and other diagnostic techniques.

``The one unique service chiropractors offer to the healing arts is the correction of subluxations,'' said Robert Braile, a former Florida practitioner and former president of the International Chiropractors' Association.

Other services, he said, are offered by other kinds of practitioners.

Conventional scientists counter that no one has demonstrated what a subluxation is or how to find one. Some call it quackery.

``The theory that human health and disease is controlled through the spinal column through nerve blockage is pseudoscience,'' said George Bates, a molecular geneticist at FSU. ``There is no evidence for subluxation.''

Many modern chiropractors play down the role of subluxation, describing their profession as a healing technique involving ``evaluation and treatment of the whole person, ... using noninvasive procedures, without surgery or drugs, emphasizing manual treatments including manipulation of the body,'' in Wolfson's words.

Braile represents a minority view different from that of the American Chiropractic Association, the dominant trade organization, Wolfson said.

Yet Wolfson acknowledged subluxation is ``certainly the basis of chiropractic.''

It also is taught at existing chiropractic schools such as Palmer College of Chiropractic Florida in Port Orange, the only one in the state.

The instruction is given at least in part because the organization accrediting the schools, the Council on Chiropractic Education, requires it.

Jones, the chiropractor-legislator, didn't answer directly when asked this week whether the FSU school would teach subluxation. He said the program ``has to be scientific- based.''

Wolfson said he expects the theory would be taught, however.

``That's what we want to find out,'' said Bates, chairman of FSU's Graduate Policy Committee, which performs a function common to major universities by directing faculty control of academic programs.

He suggested the FSU school might not be eligible for accreditation without teaching the theory.

Bates' committee hasn't made a decision on the school but voted recently to assert that it should approve or disapprove the proposal.

Sought-After Treatment

The NIH study, available in the Alternative Medicine section of the NIH Web site - - found research has been inconclusive about chiropractic effectiveness in relieving lower back pain.

That's partly because clinical studies have been few and ``of insufficient quality,'' the report states.

Critics warn that chiropractic manipulation of the neck can result in stroke by damaging arteries. The NIH said stroke cases have been reported, but there have been no systematic studies about the frequency of side effects.

Popular demand remains the engine that drives chiropractic.

``Patients of chiropractors will tell you they love them,'' said Jay Wolfson, a public health professor at the University of South Florida and no relation to Wayne Wolfson.

``They love the attention they get, the hands-on treatment, which they often don't get from an MD, and in many cases, relief from pain,'' the professor said.

Chiropractors even contend they can offer primary care to patients, serving as the health care system gatekeepers who treat some ailments and refer patients to other professionals as needed.

``Chiropractic,'' Jones said, ``is around because people have benefited from it.''