Trick or Treatment (23 page)

The individual reviews came to varying conclusions. In the case of neck pain, two reviews concluded that spinal manipulation was ineffective, although one of them did find some evidence that chiropractic manipulation could be effective when used in combination with standard treatments. However, the combination effect is hard to dis-entangle, so it would be difficult to draw anything significant from this. The third review was more positive, concluding that spinal manipulation offered patients a moderate benefit, but it is worth noting that the lead author on this review was a chiropractor. Ernst and Canter had previously shown that chiropractors tend to generate more optimistic conclusions than scientists, perhaps because they have an emotional investment in the result. All in all, the evidence was insubstantial.

For back pain, there was more of a consensus that spinal manipulation could be effective. Each review suggested that, on average, patients received benefit from the sort of treatments offered by chiropractors, but there was disagreement over the extent of that benefit and the evidence was not conclusive. The fact that chiropractic spinal manipulation might help with back pain is not a major milestone in the history of medicine – but it is particularly noteworthy in the context of this book, because this is the most significant evidence so far that an alternative treatment might genuinely help patients.

On the other hand, this conclusion should not be interpreted as an endorsement of chiropractors or a recommendation that patients with back pain should try spinal manipulation. The key question is not merely ‘does spinal manipulation work?’, but rather ‘does spinal manipulation work better than other forms of treatment?’

Dealing with back problems is notoriously difficult, and conventional medicine has struggled to develop truly effective treatments. In terms of dealing with the underlying problem, doctors might recommend physiotherapy or exercise. And in terms of dealing with the symptoms, doctors often prescribe non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. These approaches are, however, only mildly or marginally effective. A truly life-changing cure for back pain has not yet been found.

When the two approaches are compared against each other, spinal manipulation versus conventional medicine, the result is that each is just about as effective (or ineffective) as the other. Indeed, this was one of the main conclusions of Ernst and Canter’s review of reviews: spinal manipulation might help those who suffer with back pain, but conventional approaches offer similarly marginal levels of benefit.

In a situation where two or more rival treatments match each other in terms of their effectiveness, there are several other deciding factors that determine which one is best. The simplest determining factor is often cost, which mitigates strongly against chiropractors, who generally charge a great deal for their services based on the misguided claim that their treatment is superior to conventional treatments. Compare ten sessions with a chiropractor at £50 each with regular exercise or ibuprofen, which are both relatively cheap, and the price difference becomes obvious.

Furthermore, there are more important factors which also favour conventional treatment over chiropractic spinal manipulation. In fact, there are serious problems with chiropractic philosophy and practice, both of which should raise major concerns for prospective patients. These issues are closely linked to the early development of this form of treatment, so in order to appreciate them properly we will take a historical detour and explore the origins of chiropractic therapy.

The bone-setting panacea

The first documented account of manipulating the spine for therapeutic reasons dates back to Hippocrates in around 400
BC
. In order to deal with back problems, he asked patients to lie face down on a board and his assistants applied traction by pulling on the head and feet. At the same time, Hippocrates pressed on the painful part of the spine, or sat on it, or bounced up and down, or walked along it. We do not, by the way, recommend you try this at home!

As the centuries passed, it became the responsibility of specialists known as
bone-setters
to treat bones that were broken, misaligned or dislocated. In Norway the local bone-setter was often a first-born child, whereas in Ireland the bone-setter was typically the seventh-born, but birth order did not matter in Scotland as long as the person had been born feet first. Because bone-setters were not usually formally educated and were not therefore part of the medical establishment, they often drew criticism from physicians. For example, Sarah Mapp, who was one of the most famous bone-setters in London in the 1730s, was nicknamed ‘Crazy Sally’ by many physicians. Percival Pott, an eminent English surgeon who was the first to demonstrate that soot could cause cancer in chimneysweeps, went further and called her an ‘ignorant, illiberal, drunken, female savage’. On the other hand, Sir Hans Sloane, who was President of the Royal College of Physicians, had sufficient respect for ‘Crazy Sally’ to ask her to treat his niece’s back injury.

Chiropractic therapy, which emerged out of the bone-setting tradition, was founded by Daniel David Palmer, who was born near Toronto, Canada, in 1845 and who moved to Iowa at the age of twenty. Palmer gradually developed an interest in medicine, which included spiritual and magnetic healing, but his interest in the potential of spinal manipulation can be traced to a specific event that took place on 18 September 1895. Here is how Palmer later recorded the event:

On its own, this incident would not have started a revolution, but Palmer treated a second patient in a similar manner:

Palmer believed that he had stumbled upon a new medical technique. He was so convinced that chiropractic therapy offered a novel approach to healthcare that he opened the Palmer School of Chiropractic in 1897 in Davenport, Iowa. His reputation and charisma rapidly attracted many students to the school, where the main teaching resource was a textbook entitled
The Chiropractor’s Adjuster
, written by Palmer himself. This outlined every detail of his chiropractic therapy in its 1,000 pages, including how Palmer came to name his new treatment: ‘Rev. Samuel H. Weed of Portland selected for me at my request two Greek words,
cheir
and
praxis
, meaning when combined “done by hand”, from which I coined the word “chiro-practic”.’

Perhaps the most surprising feature of Palmer’s chiropractic therapy was its ambition. Having allegedly treated deafness and a heart condition by realigning the spine of his patients, he was confident that spinal manipulation could deal with all the ills of the human race. For Palmer, chiropractic therapy was not primarily about treating back problems. He explicitly wrote: ‘Ninety-five per cent of all diseases are caused by displaced vertebrae.’

This statement might seem shocking to us, but it made perfect sense to Palmer, who viewed the spine as key to the health of the entire body. He was keenly aware that the spine provides the highway that connects the brain and the spinal cord to the rest of the body by way of the peripheral nervous system. Hence, according to Palmer, displaced vertebrae would impact on particular neural pathways, negatively influence the organs connected via this pathway and thereby cause diseases. Consequently, if chiropractors realigned these displaced vertebrae then they could cure diseases: not just deafness and heart disease, but also everything from measles to sexual dysfunction.

This is already an extraordinary claim, and it appears even more bizarre when phrased in Palmer’s own language. As mentioned earlier in the chapter, Palmer used the term ‘subluxation’ to describe a displacement in the spine, which resulted in a blockage of the body’s so-called ‘innate intelligence’. He developed a theory whereby innate intelligence acted as the body’s guiding energy, carrying both metaphysical and physiological significance. This is why he believed that blocking its flow seriously disrupted the body’s harmony and could lead to all manner of diseases.

It is important to stress that the term ‘innate intelligence’ is utterly meaningless beyond Palmer’s unique view of the human body. On the other hand, the term ‘subluxation’ is used in orthodox medicine, but has a meaning that has nothing to do with blocking innate intelligence. If a doctor talks about ‘subluxation’, it simply means a partial dislocation of any joint, such as a twisted ankle. In short, Palmer’s ‘innate intelligence’ and ‘subluxation’ carry no scientific significance.

Figure 5
A chiropractic chart shows how each vertebra relates to different parts of the body and is responsible for various ailments. This simplified chart shows the ailments corresponding to only some of the vertebra. For example, a misaligned third lumber vertebra could cause bladder problems, and realignment could cure this. When Palmer cured his first two patients, he presumably manipulated the fourth cervical vertebra and the second thoracic vertebra, as these are linked with hearing loss and heart problems.

The concept of innate intelligence was so strange that it seemed as if chiropractic therapy was not only a new medical doctrine, but also a new religion. Indeed, Palmer viewed God as the Universal Intelligence, guiding the totality of existence, which meant that innate intelligence represented God’s guiding influence within the human body. In Palmer’s own words, ‘I am the founder of chiropractic in its science, in its art, in its philosophy and in its religious phase’. He even likened himself to ‘Christ, Mohamed, Jo. Smith [founder of the Latter Day Saints movement], Mrs. Eddy [founder of the Christian Science church], Martin Luther and other[s] who have founded religions.’

Conventional doctors were suspicious of Palmer’s quasi-religious philosophy, and they were particularly angered by his extraordinary claim that the spine was the root cause of disease and that spinal manipulation was the best way to cure patients. They were annoyed by his boast that ‘chiropractic is a science of healing without drugs’, and they were alarmed by his refusal to acknowledge the role of germs in causing many of the diseases prevalent at the time. Not surprisingly, it was not long before there was a campaign against Palmer, led by a local doctor named Heinrich Matthey. He accused Palmer of teaching an unproven medical concept and practising medicine without a licence. In fact, this led to Palmer being taken to court three times and on the third occasion, in 1906, he was sentenced to time in jail when he refused to pay a fine. If anything, this strengthened the fast-growing movement: chiropractic therapy had its first martyr, and many more would follow.

D. D. Palmer’s son was Bartlett Joshua Palmer, and it was he who continued to promote chiropractic therapy while his father was indisposed. He became successful in his own right, so much so that he was able to buy the first car in Davenport, but unfortunately in 1913 he ran over his father at the Palmer School of Chiropractic home-coming parade. D. D. Palmer died just a few weeks later – officially the cause of the death was recorded as typhoid, but it seems more likely that his death was a direct result of injuries caused by his son. Indeed, there is speculation that this was not an accident, but rather a case of patricide. Father and son had become bitter rivals over the leadership of the chiropractic movement. Also B. J. Palmer had always resented his father and the way that he had treated his family: