Pictured: Not a justification for chiropractic care
I debated which of two topics to blog about this week that appeared in my feeds.

The first was “Graduate slams CQU for offering ‘pseudoscience degree’,” where an Australian is upset that her University is offering an undergraduate Bachelor of Science in Chiropractic and a postgraduate Master of Clinical Chiropractic degree because chiropractic is “complete pseudoscience”.

And the second was:
Foundation for Chiropractic Progress Publishes Landmark White Paper : Non-Pharmaceutical Pain Management is a Safer Strategy than Opioids.”

Why choose? Just keep in mind that chiropractic is “complete pseudoscience” as we look at the landmark white paper.

First some chiropractic PR

The Foundation for Chiropractic Progress is a not for profit organization that:

…educates the public about chiropractic care through positive press.

It is an interesting site since as best I can tell the word subluxation is nowhere to be found. They are supported by several chiropractic colleges, including the Palmer College of Chiropractic, whose philosophy statement includes:

Chiropractic posits that subluxation of the spinal column and other articulations can affect nervous system function and the expression of health, which may result in symptoms, infirmity and disease.

So I suspect the nonsense that is subluxation is part of their world view.

They are curiously vague as to just what chiropractic is and what chiropractors do, but they do suggest that chiropractic is safe and effective. In fact, in a colorful and glossy pdf (can pdf’s be glossy?) they suggest chiropractic is a safer strategy than opioids for back pain.

This appears to be the current push of chiropractic: to position the profession as the best provider of treatment for acute and chronic back pain. And I fear it is going to work.

They start out with the issues that modern medicine has with chronic pain and opiate use and abuse. No real argument there.

There is a nice patina of conspiracy mongering in the white paper:

When combined with the relentless pursuit of financial gain, these circumstances are magnified many times over by the nation’s drug manufacturers

And the evil of the pain-profit nexus, where:

we are facing a situation where the good intention of pain relief was upended by special interests.

There are those who find these conspiracy arguments compelling, but is always hard to take the aluminum hat crowd seriously, especially when they are shills of big supplement to the tune of over a million dollars, and over a million dollars from big shoe inserts.

The supplement-insert-chiropractic-profit nexus looks like they are getting ready to give the pain-profit nexus a run for, well, their money.

Cherry Pickin’ Daddies

I love their song, Subluxation Riot.

What is the solution for the problem of chronic pain and opiate abuse? Go to Midas, get a muffler. The supplement-insert-chiropractic-profit nexus suggests?

Chiropractic, the aforementioned pseudoscience.

Chiropractic care is a hands on, non-invasive approach documented to be effective in the acute and chronic neuro-musculoskeletal pain environment, yielding improved clinical outcomes, reduced costs and high levels of patient satisfaction. Chiropractic patients may receive spinal adjustments and/or alternative drugless therapies that assist the innate capabilities of the body to relieve pain, restore health and prevent disease. Chiropractic adjustments may aid in musculoskeletal mobilization to reduce pain and improve function.

I love the weaselly ‘may’; at least they have the courage of their convictions. Even the white paper channels the quack Miranda.

Effective? The most recent Cochrane reviews suggests:

High quality evidence suggests that there is no clinically relevant difference between SMT and other interventions for reducing pain and improving function in patients with chronic low-back pain. Determining cost-effectiveness of care has high priority. Further research is likely to have an important impact on our confidence in the estimate of effect in relation to inert interventions and sham SMT, and data related to recovery.

And:

Combined chiropractic interventions slightly improved pain and disability in the short-term and pain in the medium-term for acute and subacute LBP. However, there is currently no evidence that supports or refutes that these interventions provide a clinically meaningful difference for pain or disability in people with LBP when compared to other interventions.

The supplement-insert-chiropractic-profit nexus somehow fails to mention just how thin the gruel of their data is. Which comes as no surprise given that chiropractic is based on fantasy.

The ‘other interventions’ also do not have the potential for complications of chiropractic like stroke, that chiropractors work so hard to deny.

They do note:

The peer-reviewed scientific literature evaluating the effectiveness of U.S. chiropractic treatment for patients with back and neck pain suggests that these treatments are at least as effective as other widely used treatments.

“Suggests”. “At least as effective”. “May”. That is one strong foundation upon which to build the care of chronic pain.

I’ll take the other therapies: they are not based in magic, they do not have the risks of adverse reactions, and are not often linked with other wackaloon modalities and ideas promulgated by many in the supplement-insert-chiropractic-profit nexus like applied kinesiology, supplements, and anti-vaccination.

Like philosophers at a computer, they finish with a series of demands which I will ignore, such that reality based physicians should

begin prescribing safer alternatives such as chiropractic care for chronic pain management.

I’ll pass. Safer? Sure. But the supplement-insert-chiropractic-profit nexus? I’ll pass. I’ll stick with reality-based interventions.

And who puts profits before patients?

The white paper suggests:

The time has come for putting patient safety and health above self-interest and profits.

As if the supplement-insert-chiropractic-profit nexus has ever had any interest in safety. The supplement-insert-chiropractic-profit nexus is a topic in my feeds dominated by links for practice building aka self-interest and profits. Safety and efficacy? Not so much.
The white paper reminds me of Ben Goldacre’s immortal phrase: FLAWS IN AIRCRAFT DESIGN DO NOT PROVE THE EXISTENCE OF MAGIC CARPETS.

Posted by Mark Crislip

Mark Crislip, MD has been a practicing Infectious Disease specialist in Portland, Oregon, since 1990. He is a founder and  the President of the Society for Science-Based Medicine where he blogs under the name sbmsdictator. He has been voted a US News and World Report best US doctor, best ID doctor in Portland Magazine multiple times, has multiple teaching awards and, most importantly,  the ‘Attending Most Likely To Tell It Like It Is’ by the medical residents at his hospital. His growing multi-media empire can be found at edgydoc.com.