Trick or Treatment (24 page)

B. J. Palmer, who already led the Universal Chiropractic Association, became the new undisputed figurehead of the movement. He was a smart operator and shrewd entrepreneur. He rapidly accumulated a large fortune by teaching students and treating patients. On top of all this, in 1924 he started a lucrative sideline in selling
neurocalometers
, which supposedly helped chiropractors by detecting subluxations. Palmer was very proud of his invention and promoted it widely, but from a modern point of view we can see that it was clearly a worthless piece of technology. The neurocalometer contained nothing more than a simple
thermocouple
, which is a standard piece of electrical equipment designed to measure temperature. Hence, it would have been useless for detecting misalignments in the spine or pinched nerves. Although each neurocalometer cost less than $100 to build, he initially sold them for $1,150, and then he increased the price to $2,200. To put this figure into context, $2,200 would have been enough to buy a house in Iowa in the 1920s, and yet Palmer somehow persuaded over 2,000 graduates from his college and other chiropractors to buy his bogus invention.

Not surprisingly, his customers ended up dissatisfied. An attorney acting on behalf of one of the disgruntled customers attempted to sue Palmer: ‘In all our experience as practicing attorneys, nothing more closely resembling a fraud and a swindle has ever been brought to our personal attention than this proposition which your school is submitting to its graduates.’

In such situations, Palmer would repair his reputation by promoting himself on WOC, one of America’s pioneering radio stations, which he had established in 1922. Although it carried programmes on a range of subjects, such as current affairs and cookery, it also broadcast lectures by Palmer as well as other programmes directly related to chiropractic therapy. Its audience stretched across large parts of America and Canada, and Palmer even claimed he had listeners in Scotland, Samoa and at the North Pole.

Thanks to his radio station and other clever marketing techniques, Palmer oversaw the growth of the chiropractic movement over the next few decades, not just in America but also in Europe. For example, the British Chiropractic Association was founded in 1925 and the European Chiropractors’ Union formed in 1932, by which time there were 126 chiropractors in Britain, seventy-six across Norway, Denmark and Sweden, and a few dozen others in Ireland, Belgium and elsewhere.

Meanwhile, back in America, chiropractors were coming under increasing pressure from the medical establishment, which disapproved of their philosophy and methods. Doctors continued to encourage the arrest of chiropractors for practising medicine without a licence, and by 1940 there had been over 15,000 prosecutions. Palmer strongly endorsed the Universal Chiropractic Association’s policy of covering legal expenses and supporting members who had been arrested, which resulted in 80 per cent of chiropractors walking free from court.

When the legal route failed to dampen chiropractic spirits, the American Medical Association (AMA) tried other tactics, which culminated in 1963 in the formation of the Committee on Quackery. Its secretary, H. Doyle Taylor, wrote a memo to the AMA Board of Trustees, which reaffirmed that the Committee on Quackery considered its prime mission to be the ‘containment of Chiropractic and ultimately the elimination of Chiropractic.’ The Committee’s activities included lobbying to keep chiropractors outside the Medicare health-insurance programme, and arguing that chiropractic therapy should not be recognized by the US Office of Education.

This antagonism might seem unreasonable, but remember that the medical establishment had several reasons for despising chiropractors. These included their belief in the unscientific notion of innate intelligence, their denial that bacteria and viruses cause many diseases, and their conviction that realigning a patient’s spine could cure every ailment. On top of all this, conventional doctors were shocked by the fact that many chiropractors were fond of the
E-meter
, another bizarre diagnostic gadget. Invented in the 1940s by a chiropractor named Volney Mathison, the E-meter has a needle that swings back and forth across a scale when a patient holds on to two electrical contacts – apparently this is enough to determine a patient’s state of health. The E-meter was also widely used by the Church of Scientology, so much so that many Scientologists believe that it was invented by their founder L. Ron Hubbard. Unfortunately, the E-meter is nothing more than a piece of technical hocus-pocus, which is why in 1963 the US Food & Drug Administration seized more than 100 of them from the Founding Church of Scientology. In many ways, the E-meter bears a resemblance to the equally bogus neurocalometer, invented two decades earlier by B. J. Palmer.

Conventional doctors were equally dismissive of
applied kinesiology
, a method invented in 1964 by a chiropractor called George J. Goodheart, who argued that diseases could be identified by manually testing the strength of muscle groups. A patient’s muscles supposedly become immediately stronger if a treatment is beneficial, or the muscles become weaker if the treatment is harmful, or if a toxin or allergen is brought close to the body. Typically, the patient holds out an arm and a tester pushes against it to feel the strength and steadiness of the resistance. This is, of course, a highly subjective measurement, and it is hard to imagine why it should have any medical value. Indeed, controlled trials show that the claims of applied kinesiology have no basis in reality.

As far as the AMA was concerned, all these problems were compounded by the ambition of many chiropractors to act as primary care givers. In other words, chiropractors argued that they could replace general practitioners because they could also offer regular check-ups, long-term preventative treatments and cures for many conditions. In the 1950s and 1960s it was possible to find adverts for chiropractors with claims such as ‘there are very few diseases, as they are understood today, which are not treatable by Chiropractic method’, or ‘Correction and treatment of both acute and chronic polio by chiropractic methods have been unusually successful.’

The AMA continued to fight back with its concerted effort to eliminate the chiropractic profession, but in 1976 its campaign suddenly backfired. ‘Sore Throat’, an anonymous source within the AMA, leaked material that revealed the details and the extent of the AMA’s campaign, which prompted Chester A. Wilk, a chiropractor from Chicago, to file an anti-trust lawsuit against the AMA. Wilk was arguing that the AMA’s campaign against chiropractors amounted to anti-competitive behaviour, and that the medical establishment was merely trying to corner the market in treating patients.

After dragging on for over a decade, the lawsuit eventually ended in 1987. Judge Susan Getzendanner, who had presided over the case, ruled that the AMA had indeed acted unfairly against chiropractors:

The AMA took the decision to the Supreme Court, but the appeal failed in 1990 and thereafter the AMA was forced to alter its attitude. For example, it could no longer discourage its members from collaborating with chiropractors. Although the medical establishment had fought against this move, it had to acknowledge that it resulted in two undoubtedly positive outcomes. First, those doctors who collaborated with chiropractors persuaded many of them to be more sympathetic to the ideas of conventional medicine. Second, it also encouraged many chiropractors to rethink their attitude to their own chiropractic therapy. In fact, many chiropractors were already becoming increasingly disillusioned with the outlandish claims of their founding fathers. Although these practitioners were still committed to using chiropractic therapy to treat musculoskeletal problems, they were reluctant to treat other conditions and were suspicious about the concept of innate intelligence. In short, these rebel chiropractors adopted a more defined job description, namely back specialists. They became known as
mixers
, because they were willing to mix traditional chiropractic therapy with elements of mainstream medicine.

By contrast, chiropractors who strictly adhered to Palmer’s philosophy were known as
straights
. They firmly believed every word Palmer had preached, including his core belief that a perfectly aligned spine would guarantee the flow of the ‘innate’ and thus promote well-being throughout the entire body. The split between straights and mixers soon became bitter, with straights accusing mixers of betraying the chiropractic movement, and mixers accusing straights of being quacks. In 1998 Lon Morgan, a mixer, openly expressed his antagonism towards straight chiropractors and their odd beliefs: ‘Innate Intelligence clearly has its origins in borrowed mystical and occult practices of a bygone era. It remains untestable and unverifiable and has an un acceptably high penalty/benefit ratio for the chiropractic profession.’ Similarly, according to Joseph C. Keating, a mixer and a chiropractic historian: ‘So long as we propound the “One cause, one cure” rhetoric of Innate, we should expect to be met by ridicule from the wider health science community.’ In response, straights have accused mixers of not being real chiropractors, because they do not accept Palmer’s basis for chiropractic therapy.

It is relatively easy to find out who is right – straights or mixers – because the former set of chiropractors claims to cure everything and the latter restricts its ambitions to the back and neck. Ordeal by clinical trial is the obvious method for settling such an argument. In fact, many clinical trials have been conducted to test the impact of spinal manipulation on a range of conditions, and many of these were covered within the review of reviews by Ernst and Canter, which was discussed earlier in this chapter. We have already considered their conclusions relating to back and neck pain, but now it is time to look at their other conclusions.

Ernst and Canter looked at ten systematic reviews based on seventy trials that considered spinal manipulation as a treatment for headaches, period pains, infantile colic, asthma and allergies. Their conclusions were universally negative – there was no evidence to suggest that chiropractors could treat any of these conditions.

This should not be very surprising, as there is no logical, rational or scientific reason why manipulating a patient’s spine should treat, for example, allergies. Moreover, there is no evidence that a misaligned spine can cause any of these non-musculoskeletal conditions in the first place. Indeed, if spinal misalignments caused disease, then we would expect people with back pain to be more likely to suffer with other ailments, but in 1995 Donald Nansel and Mark Szlazak at the Palmer College of Chiropractic found no sign of this in the vast body of published medical literature: ‘There is not the slightest suggestion that patients suffering from severe primary mechanical low back pain, for instance, are more prone to develop higher incidences of prostate or testicular carcinoma, colitis, ovarian cysts, endometriosis, pancreatitis, appendicitis, diabetes, melitis, or any other category of regionally or segmentally related organ disease.’ In a follow-up study published two years later, the same researchers also failed to find any evidence that these diseases were more likely in ‘patients with broken necks or broken backs, or patients with entire hips or shoulders blown apart by shotgun blasts’.

Although Ernst and Canter’s review of reviews does not cover the impact of chiropractic manipulation on every non-musculoskeletal condition, it would be reasonable to conclude that chiropractors can offer nothing to help patients suffering from non-musculoskeletal conditions in general. This is partly because chiropractic therapy has failed whenever it has been tested as a treatment for specific non musculoskeletal conditions, and it is partly because – and this is worth stressing again – there is no reason why spinal manipulation should help with conditions ranging from ear infections to irritable bowel syndrome.

Bearing all this in mind, the scientific evidence shows that it would be unwise to visit a chiropractor for anything other than a problem directly related to your back
.

This might seem obvious, but several surveys suggest that between 11 per cent and 19 per cent of American chiropractic patients suffer from non-musculoskeletal conditions. These patients are attracted to these pointless treatments by practitioners who are willing to offer them. According to one survey, 90 per cent of American chiropractors think that the therapy should not be limited to musculoskeletal conditions, and another survey suggests that 78 per cent of Canadian chiropractors share this opinion – this indicates that the majority of North American chiropractors have straight tendencies. The percentages in Europe may be similar, particularly as supposedly responsible chiropractic bodies in European countries offer misleading information about the power of chiropractic therapy. For example, the General Chiropractic Council, which oversees chiropractic therapy in Britain, publishes a leaflet entitled ‘What can I expect when I see a chiropractor?’, which states that chiropractic therapy can lead to an improvement in ‘some types of asthma, headaches, including migraine, and infant colic’. Yet it is well known that the evidence from trials fails to support these claims.

Some words of caution for patients

In short, the scientific evidence suggests that it is only worth seeing a chiropractor if you have a back problem. However, it is still important to be cautious. In particular, we will offer six pieces of advice that should be useful for anybody considering a visit to a chiropractor: