Chiropractic’s choice: Quackery or medicine
© 2016 Roy Benaroch, MD
Can the chiropractic profession evolve and renew itself as a legitimate part of the health care system? Prominent Australian chiropractor Bruce Walker, who is also the editor-in-chief of the Journal Chiropractic and Manual Therapies, has proposed a 10 point plan to ensure that chiropractors create a profession based on science, knowledge, and genuine healing. He makes a strong case that chiropractors need to embrace research, shun “nonsensical elements”, and follow evidence-based practice models. Can this be the spark that leads to genuine reform?
Walker lists several practices that he characterizes as “aberrant” and damaging to the reputation of chiropractic, including over-servicing their patients, pushing “life time” chiropractic care, misleading and deceptive advertising, and an “unhealthy disregard of clinical research.” He singles out two items of special interest to pediatricians, calling for chiropractors to stop their unnecessary treatment of babies and their penchant for anti-vaccination propaganda. (Anti-vax fraud doc Andrew Wakefield is a speaker at this year’s International Chiropractors Association Pediatrics Council.)
“The New Chiropractic,” as Walker calls his plan, relies on a very different model of professional conduct. He calls for improved education and accreditation of chiropractic learning centers, an emphasis on improving public health, and ongoing efforts to improve clinical practice with research and outcomes-based study. Specifically, he says that chiropractors ought to focus on the musculoskeletal system, with a special emphasis on spinal pain – becoming the spinal pain experts.
There’s certainly room for a profession of healers dedicated to the non-pharmacologic treatment of skeletal and back pain. These are common problems, and there’s a growing body of research both in support of alternative treatment modalities for pain and for the potential harms done with the chronic use of pain-killing drugs. But many chiropractors believe their expertise extends far beyond the back, and far beyond pain. There’s no evidence for that, as Walker and his journal have made clear.
For those of you interested in chiropractic care, or in making a career in chiropractic, it’s worth reading Walker’s commentary in full. There’s a lot going on in the chiropractic profession, including disillusionment with the educational expenses, high loan default rates, and a challenging job market for new graduates. Meanwhile, efforts at reining in health care costs are squeezing chiropractors at the payment end. By embracing these changes and demonstrating that chiropractors can be a cost-effective, helpful part of the health care system, chiropractors may yet be able to save themselves a place at the table. We’ll see what they decide.