Chiropractic: A Critical Evaluation

Chiropractic: A Critical Evaluation

Chiropractic was defined by D.D. Palmer as “a science of healing without drugs.” About 60,000 chiropractors currently practice in North America, and, worldwide, billions are spent each year for their services. This article attempts to critically evaluate chiropractic.

The specific topics include the history of chiropractic; the internal conflicts within the profession; the concepts of chiropractic, particularly those of subluxation and spinal manipulation; chiropractic practice and research; and the efficacy, safety, and cost of chiropractic.

A narrative review of selected articles from the published chiropractic literature was performed. For the assessment of efficacy, safety, and cost, the evaluation relied on previously published systematic reviews. Chiropractic is rooted in mystical concepts.

This led to an internal conflict within the chiropractic profession, which continues today. Currently, there are two types of chiropractors: those religiously adhering to the gospel of its founding fathers and those open to change. The core concepts of chiropractic, subluxation, and spinal manipulation, are not based on sound science. 

Back and neck pain is the domains of chiropractic but many chiropractors treat conditions other than musculoskeletal problems. With the possible exception of back pain, chiropractic spinal manipulation has not been shown to be effective for any medical condition.

Manipulation is associated with frequent mild adverse effects and with serious complications of unknown incidence. Its cost-effectiveness has not been demonstrated beyond a reasonable doubt. The concepts of chiropractic are not based on solid science and its therapeutic value has not been demonstrated beyond a reasonable doubt.

Today, some chiropractors view chiropractic as an “alternative form of healthcare,” but in most countries, chiropractic is seen as an adjunct to rather than a replacement of conventional medicine. Chiropractor Redwood City has legal recognition in about half of the world, whereas in the other half, such recognition is lacking. In India, China, former Russia, parts of Europe, and most of South Africa, chiropractic is not legally recognized.

In the United States, between $2.4 and $4.0 billion is spent each year on chiropractic care. Chiropractic is covered by Medicare, a substantial proportion of private and public insurance plans, all state-workers compensation systems, all forms of managed care, most health maintenance organizations, and private health insurance plans. All 50 U.S. states, Puerto Rico, the District of Columbia, and the Virgin Islands license chiropractors. 

About 60,000 chiropractors currently practice in North America, a number that has tripled between 1970 and 1990. The proportion of the population using chiropractic services has doubled in the last two decades. The chiropractic profession is thus growing rapidly; more than 4,000 students graduate each year from about 30 chiropractic colleges in the United States, and the total number of U.S. chiropractors is predicted to reach 100,000 by 2010. 

This article critically analyzes the history, rationale, and practice of chiropractic. It asks the question: Does chiropractic generate more good than harm? It draws mainly on the published chiropractic literature, including several articles that have previously reviewed chiropractic. The scarcity of critical in-depth analyses is noted; its implications are described.

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