A recent article in the “medical journal” Medical Acupuncture describes the “treatment” of adult idiopathic scoliosis with acupuncture and cupping at a Veterans Administration (VA) “Department of Whole Health” in Fargo, North Dakota. [Access requires a subscription.] This “research” was “supported with the resources and the use of facilities” at the Fargo VA. To the authors of the article, the results indicate that “more research is needed on the efficacy of TCM [Traditional Chinese Medicine] for treating adult idiopathic scoliosis.”
My takeaway is different. To me, the article confirms that the ideology of so-called integrative medicine is firmly imbedded in the VA and that veterans are being subjected to unethical, time-consuming, and worthless treatments that pose risks without the possibility of benefit. These treatments are being foisted upon veterans by “health care providers” who do not have sufficient knowledge of even the most basic medical facts behind their patients’ presenting condition. All of this, by the way, is being done on the taxpayers’ dime.
We’ll begin with a brief description of the patient, his presenting condition, and the medical science on scoliosis, the latter to help us understand just how far afield this patient’s treatment drifted.
According to the article, our veteran is 34 years old and presented to a chiropractor (and one of the article’s authors) at the Fargo Veterans Health Care System “Department of Whole Health” with back pain of some 7 months’ duration. (This chiropractor is also on the faculty of the chiropractic school at Northwestern Health Sciences University in Minnesota, the relevance of which will be revealed shortly.) The patient complained of pain in the thoracic spine that interfered with bending and sitting. He denied any trauma but the article notes that he wore heavy body armor during his service.
Based upon an undisclosed rationale, the chiropractor decided to take an x-ray prior to initiating treatment and discovered “an idiopathic right-convex scoliosis” of around 21 degrees, of which the patient was previously unaware.
Now, to the science. According to an orthopedic surgeon I consulted, there would be no medical rationale for reducing the curve in an adult patient with this degree of scoliosis and, in any event, the only effective way to do so is surgery. So, had this veteran been under the care of a physician, the scoliosis itself would not have been treated and he could have been offered evidence-based therapies for his back pain.
But that’s not what happened.
Our chiropractor, “during the second and third chiropractic visits”, “adjusted” the patient for a “spinal subluxation“. To those unfamiliar with chiropractic jargon, let me translate. To a medical doctor, a “subluxation” is the partial dislocation of a joint, like a dislocated shoulder. But to a chiropractor, a subluxation is a putative spinal lesion that interferes with “nerve flow” between the brain and the body’s organs, thereby causing ill health. There are numerous other, equally implausible, definitions of the chiropractic subluxation because, for over 100 years, chiropractors have been trying to retcon a reasonable-sounding explanation of the subluxation into their founding myth that, in 1895, a “magnetic healer” initially discovered the subluxation when he cured a deaf man by hitting him on the back. (No, really, I promise.) This is the same fantastical belief system that gets chiropractors into trouble for falsely claiming they can “boost” the immune system by detecting and correcting these subluxations, thereby helping one avoid COVID-19.
As to the “adjustment“, spinal manipulation, a manual therapy performed by chiropractors, physical therapists, and some physicians, is a treatment of questionable benefit for back pain. An “adjustment” is a special form of spinal manipulation, the purpose of which is to address the chiropractic subluxation. Of course, this is impossible because chiropractic subluxations do not exist. So, while physical therapists and physicians may use spinal manipulation for back pain, only chiropractors “adjust” the spine for these mythical subluxations.
Which brings us back to our chiropractor-author. The supposedly more science-based chiropractors spend a lot of time and effort trying to convince us that the subluxation is not the basis of modern chiropractic practice and that it is not taught in chiropractic schools any longer. But, here we have a chiropractor on the faculty of an accredited chiropractic school adjusting subluxations at a VA medical facility. Draw your own conclusions.
The chiropractor referred our veteran to an acupuncturist, the lead author of the article and also on the staff of the Fargo VA, “with the hope of relieving this patient’s pain that was related to a muscle spasm in his thoracic spine due to the scoliosis”. According to my orthopedic consultant, the pain may not have been due to a muscle spasm, the chiropractor perhaps misdiagnosing taut paraspinal muscles that appear in nearly all scoliosis cases as a spasm. In fact, we don’t know from this article whether the pain was caused by the patient’s scoliosis at all.
Nevertheless, the acupuncturist, who also attributed the patient’s “tight, protruding, tender muscles” to a spasm, took things even further. Not only was she going to treat this supposed spasm with acupuncture, she decided to get rid the spinal curvature itself!
After a clinical review, the acupuncturist hypothesized that a combination of acupuncture and cupping techniques would help relax this patient’s muscles along his thoracic spine, thereby allowing the correction of his scoliotic curvature. [Emphasis added.]
The acupuncturist was proceeding on the notion that
certain acupuncture-needle stimulation techniques can either tonify or sedate energy in meridians . . . [which] can have a relaxing and balancing effect. . . [C]upping, a therapy that often uses fire [!] inside of a glass cup to create a vacuum effect . . . creates a negative pressure on the areas of the body that it is applied to [and is] believed to increase the blood and energy flow to the area cupped . . .
In other words, the acupuncturist was attempting to affect the flow of a mythical energy supposedly traveling through equally mythical meridians in the body in order to straighten a curvature of the spine.
This is not, of course, anywhere in the vicinity of a hypothesis. As well, it is worth noting that this acupuncturist is so poorly educated and trained she does not know that her patient’s spinal curvature (1) doesn’t required treatment and, moreover, (2) this “correction” is impossible. Why she thought relaxing the muscles would straighten the spine is not revealed (not that this is possible, mind you) since “idiopathic scoliosis” means, by definition, that the cause is unknown.
She proceeded to get informed consent “to establish a case study”. In this, the acupuncturist perhaps confused “case study“, which this is not, with “case report“, which this also is not. This is an n=1 experiment on a human subject and, as such, it is unethical because, as former SBM blogger Dr. Mark Crislip pointed out in a post on CAM research, it is a waste of resources, it exposes a person to risk for no purpose, and it will not result in useful knowledge.
Acupuncture was performed on our veteran approximately two times a week for a total of 15 treatments. I’ll spare you the details of which acupuncture points were punctured and for what reason. Cupping was applied after needle removal and repeated at subsequent visits based, in part, “on the appearance of previous cupping marks”, meaning the bruises caused by cupping were still there several days later. This was followed by t’ui na, “a method of TCM massage and bodywork” and the application of an “herbal analgesic oil”.
After treatment by the acupuncturist, more x-rays were taken by the same VA chiropractor, who found “a potential reduction” of 3 degrees in the scoliotic curve to 18 degrees, although the authors admit this finding
could have been due to radiograph variation [for some unexplained reason, the chiropractor used different x-ray views] and observer calculation variability, as previous studies have found variations with single-observer measurements of up to 3.2 °.
The patient’s self-reported pain since he initiated the approximately 7 ½ weeks of acupuncture was “85% alleviated” and “everything is feeling a bit looser”.
The authors conclude that their “study”
demonstrated the effects of combination acupuncture and cupping therapy for a 34-year-old veteran . . . with adult idiopathic scoliosis.
Although this case study did not find conclusive evidence on the ability of combination TCM to treat adult idiopathic scoliosis, the potential decrease in this patient’s . . . curvature warrants a larger randomized controlled trial to understand that effectiveness of combination TCM therapies to treat adult idiopathic scoliosis.
I disagree. I conclude:
- Treatment of the patient’s back pain was fantasy-based, not evidence-based.
- The patient’s decrease in pain cannot be attributed to any treatment he received.
- The patient did not need any treatment for his scoliosis.
- The treatment he did get amounted to unethical experimentation on a human subject lacking in any scientific rationale whatsoever.
- The chiropractor and acupuncturist, in thinking there was any possibility that acupuncture and cupping could affect the spinal curvature, were shockingly ignorant of the basics of scoliosis.
- There is no possible rationale for further study of acupuncture and cupping for scoliosis (or anything else, for that matter).
- The VA is allowing chiropractors and acupuncturists free rein to impose their pseudoscience on veterans, apparently with no supervision by medical staff.
- This whole affair is a shameful waste of taxpayers’ money and is likely siphoning off funds from science-based healthcare at the VA.