Copyright, NCAHF. Permission to reprint is granted with proper citation.
NCAHF Position Paper on Chiropractic
ContentsIntroduction Manipulative Therapy Chiropractic Manipulation Chiropractic's Unique Therapy The Practices of Chiropractic Super-Straights, Straights, and Spinologists Treating "Cause" versus "Effect" Mixers Antiscience Attitudes Hazardous Practices Hucksterism State Licensure, Regulation, and Recognition The Reformers NCAHF's Description of a Scientific Chiropractor Recommendations References
Chiropractic is a controversial health care delivery system with an estimated 24,000 practitioners in
the United States. Chiropractors are licensed in all states and several foreign countries. According to the American
Chiropractic Association, 9.8 million patients made 135 million office visits during 1983 and utilization increased by 77%
from 1964-74 while the population grew at only 10.4%.(1)
Politically aggressive and public-relations minded, chiropractors
are seeking to expand their legal scope of practice, and are attempting to establish their methods as suitable alternatives
to conventional medicine. However, most chiropractors do not share the view of health and disease held by health scientists
worldwide. Most dispute the idea that germs are the primary cause of infectious diseases, disparage conventional medical practices--particularly
drug therapy and surgery -- and oppose various scientifically-based public health measures. In short, chiropractic has
been anti-science in its philosophy and approach to health care.
NCAHF's recommendations in this paper are based upon extensive study of materials from within chiropractic itself, inquiries
and investigations by government and consumer agencies, criticisms by scientists and medical practitioners, insights provided
by chiropractors who share NCAHF's principles, and the Council's own investigations. NCAHF believes that the chiropractic
controversy is best understood when manipulative therapy, chiropractic's unique theory, and the practices of chiropractors
are considered separately.
Manipulative therapy has a history extending back at least to Hippocrates. Folk healers (i.e.
"bonesetters") and early osteopathic physicians used manipulation as a panacea, believing that many organic disorders were
caused by "displaced" bones. Today manipulative therapy is employed by medical specialists (e.g. physiatrists, orthopedists,
sports medicine practitioners), osteopathic physicians, physical therapists and athletic trainers as well as chiropractors.
There is substantial evidence that manipulative therapy has value in treating back pain. Although it may not be any more
effective than other modalities in the long term, manipulation may offer short term benefits when compared to other commonly
used modalities. Several studies have found that about one-third of patients will experience more rapid relief with manipulation
than with other modalities.(2-4) Manipulation is probably not utilized as fully as it might be in relieving the symptoms
of some chronic disorders. It has been reported to be beneficial in controlling migraine pain.(5) Because manipulation
involves the laying on of hands, a procedure employed throughout history by folk and faith healers, it enhances suggestibility
and the placebo effect.(6,7) Occasionally, manipulation produces dramatic results. An example involves immediate recovery
from paraplegia caused by an auto accident.(8) Manipulative therapy is not without risk. Many cases of serious complications
following manipulative therapy have been reported in the medical literature. (9-15)
Chiropractors probably are more skilled in the art of manipulation than other practitioners
since it constitutes the major emphasis of their training. Chiropractors are usually the most accessible manipulative
therapists in a community, and some receive referrals from medical doctors. However, many physicians are reluctant to refer
patients to chiropractors. This may be due to a fear that the chiropractor may attempt to indoctrinate patients in deviant
health beliefs, a disbelief in the value of manipulative therapy, or an apathy to non-medical practitioners.(5)
A major criticism of chiropractors is that they over utilize manipulation, both in excessively treating conditions known
to be responsive to manipulation and in applying it to conditions for which there is no known justification. According to
anecdotal reports by chiropractors, and patients who may have turned to chiropractic when conventional medical treatment failed
to provide relief, manipulation has sometimes produced beneficial results. Such positive outcomes appear to be unpredictable
and unexplained. These reports are selective, emphasizing positive results, but are common enough to warrant further study.
Chiropractors have demonstrated some degree of clinical success in workmen's compensation studies.(16-18) Unfortunately,
the failure to apply rigorous scientific methodology has prevented the identification of any special value chiropractic manipulation
might have. This absence of scientific evidence is due largely to the confidence placed in the validity of chiropractic's
Chiropractic's Unique Therapy
Chiropractic's uniqueness is not its use of manipulative therapy but its theoretical
reason for doing so. Just as early osteopathy found its justification in the "rule of the artery" (i.e., the belief that manipulation
improved circulation), chiropractic is based upon the "rule of the nerve", which assumes manipulation exerts important effects
upon ''nerve flow ''.
The term ''chiropractic'' literally means "done by hand." The word was adopted by chiropractic's founder, Daniel
D. Palmer, a layman with an intense personal interest in the metaphysical health philosophies of his day such as magnetic
healing, phrenology, and spiritualism. In 1895, Palmer claimed to have restored the hearing of a nearly deaf janitor
by manipulating his spine.
Palmer believed that he had discovered the primary cause of disease and theorized that 95 percent of all disease was caused
by spinal subluxation and the others by luxated bones elsewhere in the body. Palmer was not employing the term "subluxation"
in its medical sense, but with a new metaphysical meaning. Palmer's "subluxations" supposedly interfered with the body's
expression of the Universal Intelligence (God) which Palmer dubbed the Innate Intelligence (spark of life or spirit).(19)
Thus, D.D. Palmer invented chiropractic, named it, and established a guild of practitioners to further its development.
For this reason chiropractic fits the dictionary definition of a cult (i.e. a system for the cure of disease based upon dogma
set forth by its promulgator) (Webster's New Seventh Collegiate Dictionary).
The Practices of Chiropractors
In practice, chiropractic presents a chaotic picture. Few practitioners limit
themselves to pure chiropractic. Practitioners are divided into a variety of factions and political battles over which
faction deserves rightful title to the designation of "chiropractor" are still taking place. These divisions produce
such variations that almost any generalization is inapplicable to some individuals or faction. Thus, any single description
of chiropractic may be challenged as "unrepresentative." In the following paragraphs are descriptions of a variety of
Super-Straights, Straights and Spinologists
Chiropractors who restrict their practices to analyzing the spine for
"subluxations" and removing them exclusively by manipulation without regard to a patent's disease refer to themselves as "straights."
They eschew the concept of diagnosis. Instead, they believe that if they analyze the spine and eliminate the "subluxations,"
health will follow. Those who cling to the metaphysics of Palmer's original theory constitute a persistent minority who insist
that they are the true chiropractors. Such have been referred to as "radical religious" (20)
Some innovative chiropractors recently created the term "spinology" in which "subluxations" are renamed "obstrusions," and
allege that keeping the spine free of obstrusions will enable a person to reach his/her maximum genetic potential. Reference
to disease or treatment is definitely implied but specifically denied. Spinology is clearly another version of "super
Treating "Cause" Versus "Effect"
Chiropractors who restrict their practice to manipulation may be correctly labeled
"straights", but whether practitioners believe their manipulation to be removing "causes" or "effects" is essential when evaluating
individuals. Scientifically oriented manipulative therapists usually see their treatments as relieving the muscle
spasms and nerve irritation (i.e., symptoms or "effects") of improper body mechanics, psychological stress, trauma, or some
other "primary" cause. Philosophically oriented chiropractors are loathe to admit that they treat only "effects" or merely
relieve symptoms. Chiropractic students are taught a distorted view which portrays medical doctors as philosophically
committed to the "allopathic" theory of Hippocrates by which they merely treat the symptoms (i e, "effects") of disease. Chiropractic
is portrayed as superior to medicine because it focuses on "subluxations" which it regards as the primary causes of disease.
In reality, medical doctors abandoned practicing on the basis of philosophy long ago as they accepted scientific methodology.
Medicine's dedication to the Hippocratic Oath is due to its acceptance of its code of behavior of physicians; not Hippocrates'
Chiropractors who utilize other modalities in addition to manipulation are labeled "mixers" by the straights.
Unfortunately, these additional techniques are unscientific. Many mixers are opportunists who readily incorporate health fads
into their practices. Straight chiropractors charge that mixers are actually "naturopaths" practicing under the guise of chiropractic
in order to circumvent the fact naturopathy is illegal in most states. NCAHF tends to agree with this assessment.
Naturopathy is a form of "eclecticism" (i e, a school of thought professing to select from what is best from all systems
of medicine) that borrows from a wide variety of healing philosophies, applying them by subjective experience. Naturopaths
usually mix common sense (e.g., advice against smoking and drug abuse and the advocacy of exercise and cleanliness) with bizarre
theories about health and disease. Naturopaths employ a wide variety of questionable methods borrowed from folk medicine,
pseudoscience and discarded medical practices. One is iridology, based upon the notion that every disease, habit, etc.
is reflected directly through the nervous system to the iris of the eye.(21)
Iridology, like reflexology, scleraglyphics, graphology and a host of other suspicious diagnostic techniques, utilizes
methods common to a technique known as ''cold reading''.(22) Using a chart as a guide, the clinician fishes for past
and present health problems. The subject may be quizzed, "Have you had problems with your stomach, liver, back, etc.?"
If the patient acknowledges that he/she has, or ever has had, any kind of problem in the area in question, a 'hit' is claimed,
and the "finding'' is exploited. If the chart indicates a problem that the subject does not acknowledge, it can be claimed
that there is "a weakness and a tendency for disease in the area" (a finding which opens the door for "preventive" treatments
to keep the alleged disease from occurring). Thus, the practitioner is never judged as wrong. Such methods are characteristic
of fortune-telling, not science.
Naturopathic treatments may include shining colored lights on the patient (i.e., chromotherapy) on the theory that red
"...might be used in ailments of the blood . . orange is helpful in fevers...yellow rays aid stomach troubles", and so forth.
Patients might be sold "glandular" products on the theory that pills made from eyes will help the eyes, pancreatic substances
the pancreas, liver extracts the liver, and so forth. Naturopaths prescribe megavitamins and herbs, either of which
may function as drugs, belying the claim that their therapies are "drugless" or benign. Naturopaths tend to emphasize colonics
based upon the discredited nineteenth century "intestinal toxicity" theory. The different kinds of treatments employed by
naturopaths and mixer chiropractors are not necessarily any more "natural'' than those used by medical practitioners, but
are simply non-scientific in nature or application.
Chiropractors complain that they are cut out from the rest of the health sciences and have even
carried this charge to the point of bringing antitrust suits against a number of professional health organizations.
In reality, it is chiropractic, with its deviant views on health and disease, that has isolated itself from the health sciences.
Chiropractic theory and philosophy contest with basic anatomy, physiology, neurology, microbiology, pharmacology, pathology,
immunology, and many other basic sciences. Despite their claims of persecution by organized medicine, chiropractic expends
far more effort attacking conventional medical practice than vice versa. Chiropractors often play upon patients' natural
fears of surgery and confuse patients by linking responsible therapeutic drug use with drug abuse.
In addition, chiropractors generally oppose public health programs such as fluoridation, immunization, and sometimes pasteurization
of milk. Those who engage in nutrition counseling commonly attack modern food technology and promote unscientific ideas.
It seems curious that although chiropractic students use many standard medical textbooks, what they learn deviates significantly
from others schooled in the health sciences. The source of these problems appears to be faulty schooling where chiropractic
philosophy and pseudoscience are mixed with training in manipulative therapy.
Chiropractic's lack of science has led it to violate the basic Hippocratic principle of "first
of all, do no harm." The conviction held by chiropractic true-believers that every spine will benefit from an adjustment
causes them to manipulate spines inappropriately.(23,24)
Among the concerns about chiropractic manipulation is
the widespread use of the explosive "dynamic thrust" which takes the patient by surprise, as opposed to more conservative
techniques. This maneuver has a greater potential for inflicting injury.
The practice of greatest concern is the rotary neck movement (sometimes called "Vaster cervical'' or "rotary break"). This
type of manipulation has led to trauma (25-27), paralysis (28,29), strokes (30,31), and death (32-33)
among patents. Even chiropractic's legal advisors have warned against its use.(34)
The overuse of x-ray by chiropractors poses potential patient harm. Of primary concern is the 24' x 36' full spine
x-ray. This technique exposes patients to a substantial amount of radiation. (35,38) Exposing the body trunk
to x-rays can have serious long-range consequences (36-37) and should be avoided. Further, according to
NCAHF's chiropractic advisors, such radiographs have little or no diagnostic value.
The most disturbing feature of chiropractic is the number of ''success schools" which teach ethically
questionable practices and sometimes outright fraud to be used in practice-building. The methods employed have been
described elsewhere (38-39)
and will not be reviewed here in detail; just three examples will suffice.
First, is the practice of leading people to believe that vague symptoms common to everyday life are warning signs of serious
disease in need of chiropractic care. Second, is the tactic of selling patients on a belief that weekly or monthly
"preventive" chiropractic care is needed to insure health. Third, is the rehearsal of explanations to recite to patients
who have become discouraged in order to keep them returning despite the apparent absence of benefit.
The message, which is clear to NCAHF from its review of such abuses, is the critical importance of patient trust and practitioner
trustworthiness in health care. Chiropractors pay strong lip service to freedom of choice in the health marketplace.
However, after reviewing many of the techniques taught by the success promoters in chiropractic, such "freedom" could easily
be construed to mean a license for unethical practitioners to use their superior position in the doctor/patient relationship
for exploitation. Patients who are deceived or desperate because of sickness, fear or pain are not choosing freely.
State Licensure, Regulation, and Recognition
Chiropractic claims that the fact it is licensed by the state legitimizes
it. Close examination reveals major flaws in this assertion. State licensure is the method used to control the
scope of practice of providers. Historically, chiropractors were licensed to restrict their use of prescription drugs
and invasive techniques. At first, chiropractors were regulated by boards made up primarily of medical doctors, but
in time most states set up boards comprised mainly of chiropractors. NCAHF finds this situation indefensible.
Representatives on chiropractic examining boards enjoy state authority to endorse nonscientific practices among chiropractors.
NCAHF agrees with the 1967 Report of The Health Manpower Commission which called for a reexamination of the basic assumption
that the censure of chiropractors facilitates regulation (40), and the assessment by Consumer's Union that "current
licensing laws, in our opinion, lend a aura of legitimacy to unscientific practices and serve to protect the chiropractor
rather than the public." (41)
Legislators who review chiropractic practice acts are sometimes confused by the warring factions within chiropractic.
Straights wish to have chiropractic practice limited to the manipulation of the spine for the purpose of removing "subluxations."
Mixers favor expanding practice acts to permit them to engage in a broad scope of practice. Mixers outnumber straights by
about four-to-one enabling them to exert more pressure on legislators. Consumers will benefit if scope-of-practice laws
are designed in terms of proven safety and effectiveness and not the views of special interest groups.
Malpractice insurers have some power to encourage and enforce rational practices by chiropractors. These companies
may deny insurance coverage to or withhold payment from non-scientific practitioners. In doing so they will simultaneously
protect the public health and their purse.
There is a small but growing number of chiropractors who recognize the failings of their profession,
but sincerely believe that there is a place for chiropractic in the health marketplace. It is estimated that 70-80%
of people will suffer back pain at some time in their lives. If, as studies seem to indicate, one third of these can
find more rapid relief by having safe, conservative manipulative therapy, then there appears to be a large market for the
services of scientifically oriented chiropractors. Further, a national study of health practices found that three-fourths
of chiropractic patients seek relief from musculo-skeletal problems. (42)
This means that a minority seek the
type of treatments found in the plethora of nonsense practiced by the chiropractor/naturopaths. If chiropractic were
to purge itself of its quackery and offer valid back care, it could expect a substantial increase in physician referrals.
One small faction of reformist chiropractors is conducting and publishing meaningful research in the field of manipulative
therapy. This group is not openly critical of chiropractic's shortcomings and has not agitated for outright repudiation
of the "subluxation" theory. They apparently seek to change chiropractic by evolution, bypassing the theory by ignoring
it or applying the term "subluxation" to a number of spinal aberrations in a general manner. It is NCAHF's view that
these chiropractors are too greatly outnumbered and overshadowed by practitioners profiting from pseudoscience to effectively
change chiropractic in this manner.
A more progressive-minded group has formed the National Association for Chiropractic Medicine (NACM), a professional association
with views which are in harmony with science and consumer protection. Using guidelines set forth by the NCAHF Task Force
on Chiropractic, NACM has openly renounced the "subluxation" theory and unscientific practices. Members limit their
scope of practice to neuro musculo-skeletal conditions, and its modes of treatment to those which have scientific validity.
NACM does not present itself as an alternative health care system to medical science.
NCAHF'S Description of a Scientific Chiropractor
At the request of a chiropractor, NCAHF established a task force
to describe in practical terms what, in its view, would constitute acceptable chiropractic practices. The task force is comprised
mostly of chiropractors who share NCAHF's beliefs in science and consumer protection NCAHF's position is as follows:
A scientific chiropractor will:
- Advance only methods of diagnosis and treatment which have a scientific basis.
- Openly disclaim the nonscientific 'subluxation theory'.
- Restrict the scope of practice to neuromusculoskeletal problems loosely defined as Type M conditions (i.e. muscle spasms,
strains, sprains, fatigue, imbalance of strength and flexibility, stretched or irritated nerve tissue, and so forth) recognizing
that some Type M problems will fall outside the scope of even a scientific chiropractor.
- Work closely with medical practitioners, consulting with them on cases involving possible pathology and readily referring
when reasonable and prudent.
- Use conservative methods of manipulative therapy.
- Avoid exposing patients to unnecessary radiation.
- Work to increase public awareness about abuses by non-scientific chiropractors.
- Help other chiropractors become more scientific in their approaches to health care delivery.
- Work to prohibit unqualified practitioners of all kinds from performing manipulation.
- Aid in the prosecution of alleged malpractice.
Scientific chiropractors will not:
- Use the title "doctor" in such a way as to mislead someone to believe the practitioner is other than a chiropractor.
- Induce anyone to behave that a chiropractor should be consulted first in preference to a medical practitioner in respect
to any disease or disorder.
- Induce anyone to believe that chiropractic adjustment will cure or alleviate infectious diseases, arthritis, cancer, diabetes,
nutritional deficiencies or excesses, appendicitis, blood disorders, kidney diseases, gall bladder problems, hypertension,
ulcers, heart disease or other non-Type M conditions.
- Fail to take reasonable steps to advise a patient to consult or continue consulting a medical practitioner when engaged
by someone requiring medical care.
- Publish or publicly exhibit any circular extolling non-scientific chiropractic treatment or preventive care.
- Condemn without scientific justification public health measures such as fluoridation, immunization, pasteurization of
- Use their status as a health professional to sell or profit from the sale of products to patients.
- Excessively treat patients.
- Present themselves as specialists in pediatrics or claim the ability to treat children's diseases.
- Claim that chiropractic adjustments will help raise resistance to disease or prolong life without valid evidence.
- Claim to be a "(w)holistic" practitioner.
- Claim to be qualified as a "family practitioner."
- Practice obstetrics.
- Claim to be qualified to administer mental health care.
- Utilize unproven*, disproven, or questionable methods, devices, and products such as adjusting machines, applied kinesiology,
chelation therapy, colonic irrigation, computerized nutrition deficiency tests, cranial osteopathy, cytotoxic food allergy
testing, DMSO, gerovital, glandular therapy, hair analysis, herbal crystalization analyses, homeopathy, internal managements,
iridology, laser beam acupuncture, laetrile, magnetic therapy, Moire contourographic analysis, Neurothermograph, orthomolecular
therapy, pendulum divination, pyramid power, "Reams" test, reflexology, scleraglyphics, Spinal column stressology, Thermography
Thermoscribe, Toffness device, and so forth.
*Except on an approved experimental basis in which patients are fully-informed about risk-benefits, protocols
are monitored by an Independent Committee, and patients are not charged a fee for services or products.
NCAHF believes that a health care delivery system as confused and poorly regulated as is chiropractic
constitutes a major consumer health problem. The fact is that practitioners possess useful skills in manipulative therapy,
and the apparent need for such skills provides an opportunity for a constructive solution. The chiropractic problem
is so broad-based that every segment of the community involved with health care - scientifically, economically, legally, or
educationally - must inject itself into the chiropractic controversy. Only a comprehensive approach to a solution has any
hope of succeeding. For this reason NCAHF makes the following recommendations:
- As consumers you are largely at your own risk when choosing a practitioner of any kind because the law offers more protection
to providers than consumers. Therefore choose health-care practitioners carefully - particularly a chiropractor.
- Distinguish between manipulative therapy per se and treatment based upon the specious chiropractic theory. Be alert
to the fact that, although manipulatlve therapy has distinct value in the treatment of back pain and may provide subjective
relief on other chronic conditions, and chiropractors are educated and trained in manipulation, they represent but one source
of this service. If you do choose a chiropractor, ask him/her to work closely with your medical doctor.
- Chiropractic theory is nonscientific, and most chiropractors have not been taught to practice on the basis of the same
body of knowledge about health and disease recognized by health scientists around the world.
- Understand that some chiropractic treatments involve considerable risk. Manipulation involving the rapid rotation
of the head and neck or sudden movements have greater potential for injury than more conservative types of therapy.
Do not submit to a "full spine" x-ray. This practice has doubtful diagnostic value, and the radiation exposure may have
long range dangers.
- Be aware that many chiropractors engage in nonscientific practices which can result in unnecessary expense.
Also, nonscientific practitioners may delay the proper treatment of serious disorders causing excessive debility or needless
- Beware of chiropractors who advertise about "danger signals that indicate the need for chiropractic care," make claims
about cures, try to get patients to sign contracts for lengthy treatment, promote regular preventive "adjustments," use scare
tactics, or disparage conventional health care.
- Demand that your legislative representative introduce and/or support laws that provide greater consumer protection
in health care.
To Insurance Carriers and Third-party Payers:
- Limit reimbursement to medically necessary services and to those practitioners who provide appropriate medical documentation
that establishes the diagnosis and justifies treatment.
- Establish an independent commission financed by an insurance industry levy to investigate and curtail fraud and abuse
in health care.
- Recognize that legislatures have the greatest power to control chiropractic practices. Regulatory agencies
and the courts can only enforce the laws passed by legislative bodies. Education alone cannot protect consumers or help
people who do not realize that they are being deceived.
- Restrict the scope of practice of chiropractors to neuromusculoskeletal problems. Prohibit their treatment
of other conditions unless under medical referral. Specify the procedures that chiropractors may NOT perform,
such as: Colonies. herbology, hair analysis, cancer therapies, or any unproven methods unless working on a bonafide experimental
project in cooperation with qualified medical researchers.
- Restrict the use of x-ray by chiropractors--particularly prohibit techniques that involve unnecessary radiation exposure
to patients such as the "full spine" x-ray.
- Prohibit chiropractors from using the title 'doctor' in any manner that doesn't clearly reveal that they are chiropractors.
- Incorporate chiropractic training into the same university systems which teach medical, dental, and other allied health
professionals so that instruction in basic sciences and training in diagnosis and patient screening will be brought up to
the same standards as other primary entry health care providers. Designate the chiropractic degrees issued by these
institutions "Doctor of Chiropractic Medicine" to distinguish them from previous diplomas. Establish standards for people
holding "Doctor of Chiropractic" diplomas to upgrade themselves to the standards of the new degree. Set a time
limit (e.g. ten years) in which this upgrading must occur to maintain licensure.
- Permit Doctors of Chiropractic Medicine to utilize prescription drugs suitable to the limitations of their practices.
- Regulate all health care providers through a single board of quality assurance constituted by a wide variety of members
adept in the methods of scientific methodology and the bases for consumer protection legislation. Include on the board
representatives from the basic sciences, public health, education and legitimate consumer groups. Restrict practitioners
from the various health care delivery providers to service in a consultant status.
- Make violation of the medical practice act a felony.
- Recognize that the chiropractic controversy involves the basic sciences more than medicine per se. These sciences
are chiropractic's intellectual competitors in a manner similar to flat-earth believers versus astrological societies; however,
chiropractic must be taken more seriously because it involves health care.
- Take chiropractic seriously enough to become knowledgeable about its basis and conduct basic research to test the validity
of its claims.
- Use your influence to bring about reform in the health marketplace.
Academicians and Educators
- Recognize that the academic community has an obligation to the communities at large to help resolve controversial issues
which bear upon public health and well being.
- Recognize that chiropractic promotes itself as an alternative to conventional scientifically-based health care, and that
it is the largest and best organized nonscientific health care system in Western society. Its impact upon public health
is too great to ignore.
- Become familiar with chiropractic's tenets and practices. Teach about these to your students.
- Be aware that chiropractic recruiters are working through career guidance counselors to attract students to the profession.
Inform students about the true nature of chiropractic so they can make wise choices.
- Urge educators to work with reformist chiropractic organizations to incorporate chiropractic education into accredited
To Attorneys and Law Enforcement Agencies:
- Recognize that litigation offers an effective means to bring reform to chiropractic. A number of scientifically
oriented chiropractors now stand ready to offer assistance in malpractice lawsuits. This helps to take away the usual
defense of justifying a chiropractor's clinical inadequacies of diagnosis and treatment as standard practice.
- Become familiar with the fallacies and common abuses of chiropractic. Attorneys with insights in these areas can
serve as specialists in the prosecution of chiropractic malpractice
- Vigorously enforce current scope of practice laws. Many of the current abuses by chiropractors are illegal.
To Medical Doctors, Dentists, and Other Scientific Health Care Providers:
- Limit your professional association to chiropractors who reject the cultism and pseudoscience of chiropractic and meet
the criteria for scientific practitioners as suggested by NCAHF.
- Encourage professional associations to undertake studies of chiropractic within their regions and issue appropriate statements
of their findings.
- Actively lobby legislators to enact laws to curtail abuses by chiropractors and other health care deliverers.
- Report chiropractors who exceed their legal scope of practice to law enforcement agencies.
- Provide educational materials to patients about the nature of chiropractic.
- Cooperate with efforts to control the quality of health care delivery such as the establishment of a single regulatory
board with broad representation from basic science and legitimate consumer groups for all providers.
To Reformist Chiropractors:
- Organize yourselves into a clearly identifiable group with a code of ethics, standards of practice, and scientific guidelines.
- Publicly proclaim the shortcomings of cultist and pseudoscientific chiropractors.
- Lobby for laws to reform chiropractic practice.
- Be available to attorneys to enable injured patients to receive just recompense for abuses by irresponsible and nonscientific
chiropractors, and to bring pressure by the courts to more clearly define malpractice.
- Press for reform within established chiropractic organizations.
- Encourage chiropractors who have remained silent about the abuses of public relations oriented chiropractic leadership
while they practiced in a reasonable conservative manner to take a stand for reform.
- Establish a liaison between your reformist groups and other professional health organizations to gain their support and
- Communications Dept., Chiropractic: State of Art 1984, American Chiropractic Association, Arlington, VA, 1984
- Farrell, J and Twomey,L.,''Acute low back pain'' MedJ Aust 1:160-164, 1982
- Haldeman, S. "Spinal manipulative therapy" Clin Orth & Rel Res, 179:62-70, 1983
- Moritz, U. "Evaluation of manipulation and other manual therapy", Scand J. Rehab Med, ll:173-179, 1979
- Parker, G. B. and Tupling, H., "A controlled trial of cervical manipulation for migraine" Aust New Zealand J Med, 8:589-593,
- Neher, A. The Psychology of Transcendence, Englewood Cliffs:Prentice-Hall, 1980
- Homola, S. Bonesetting, Chiropractic, and Cultism, Panama City, FL: Critique Books, 1963
- Duke, R. and Spreadbury, T. "Closed manipulation leading to immediate recovery from cervical spine dislocation with paraplegia,"
The Lancet, pp. 577-578, September 12,1981
- Dan, N. and Saccasan, P. "Serious complications of lumbar spinal manipulation," Med J Aust, 2:672-673, 1983
- Kewalramani, L., et al, "Myelopathy following cervical spine manipulations" Am J Phys Med, 61:165-175, 1982
- Daneshmend, R., et al, "Acute brain stem stroke during neck manipulation" Brit Med J, 288:189, 1984
- Gorman, R., "Vertebral artery occlusion following manipulation of the neck" New Zealand Med J, 89:362, 1979
- Nyberg-Hansen, R., Loken, A., and Tenstad, 0., "Brainstem lesion with coma for five years following manipulation of the
cervical spine," J Neurol 218:97-105, 1978
- Simmons, K., et al, "Trauma to the vertebral artery related to neck manipulatlon" Med J Aust, 1:187-188, 1982
- Easton, J. and Sherman. D, "Cervical manipulation and stroke" STROKE, 8:594-597
- Kane, R., et al "Manipulating the patient: A comparison of the effectiveness of physician and chiropractic care," The
Lancet, June,29: 1333-1336, 1974
- Martin, R. "A study of time loss back claims," Workmen s Compensation Board, State of Oregon, March, 1971
- Higley, H., Back Injuries, Des Moines, IA: American Chiropractic Association, 1966
- Homewood, A. The Neurodynamics of the Vertebral Subluxation Canada: Chiropractic Publishers, 1973
- Jarvis, W. "The New Zealand chiropractic report--an evaluation" New Zealand J Physio 8:6-10, 1980
- Jensen, B. The Science and Practice of Iridology, Bi-World Publ,, Provo, UT, 1952
- Hyman, R. "Cold Reading: How To Convince Strangers That You Know All About Them" The Zetetic, 1:18-35, 1977; 22a.
- Livingston, M. "Spinal manipulation causing injury: A three year study" Clin Orth Relat Res, 81:82-86, 1971
- Modde, P. "Malpractice as an inevitable result of chiropractic philosophy and training" Legal Aspects of Med Practice,
- Zauel, D., and Carlow, T., "Internuclear Ophthalmalegia following cervical manipulation" Annals of Neurol, l:308,
- Beatty, R. "Dissecting hematoma of the internal carotid artery following chiropractic cervical manipulation" J Trauma,
- Davidson, K., et al, "Traumatic vertebral artery pseudoaneurysm following chiropractic manipulation" NEURORADIOLOGY,
- Rinsky. L, et al, "A cervical spinal cord injury following chiropractic manipulation" Paraplegia, 13:223-22, 1976
- Benassy, J. and Wolinetz, E., "Quadraplegia after chiropractic manipulation," RHUM, 24:555- 556, 1957
- Schelihas, K., et al, "Vertebrobasilar injuries following cervical manipulation" Am Med Assoc, 244:1450-1453, 1980
- Miller, R. and Bunon, R. "Stroke following chiropractic manipulation of the spine" JAMA, 229:189-190, 1974
- Zak, S. and Carmody, R . "Cerebellar infarction from chiropractic neck manipulation" Ariz Med, 41:333-337, 1984
- Krueger, B. and Okazakl, H. "Vertebral-basilar distribuation infarction following chiropractic cervical manipulation",
Mayo Clin Pros. 55:322-332, 1980
- Harrison, J. ''Strokes'' ICA Malpractice Alert, 2:1-2, 1981
- Levine, J., Howe, J., and Rolofson, J., "Radiation exposure to a phantom patient during simulated chiropractic spinal
radiography", Radiol Health Data Reports, 12:245-251, 1971
- Smith, P and Doll, R., "Mortality among patients with ankylosing spondylitis after a single treatment course with x-rays",
Brit Med J, 284:449-460, 1982
- Abrams, H., "The overutilization of x-rays", New England J MED, 300:1213-1216, 1979
- Barrett, S., The Health Robbers, Philadelphia:George Stickley Co., 1980
- Smith, R., "A golden touch for chiropractors" Todays Health, June, 1968
- National Advisory Commission on Health Manpower, Report of National Advisory Commission on Health Manpower, Vol
II, Washington. D.C.: U S Government Printing Office, 1967
- Consumer's Union, "Chiropractors: Healers or Quacks?", October, 1975
- National Analysts Inc., "A Study of Health Practices and Opinions" Springfield, VA: National Technical Information Service,
- Whorton, J., Crusaders for Fitness, NJ: Princeton University Press, 1982
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