Scientific American Frontiers episode, "A Different Way to
Heal" set out to examine some widely used approaches to health
care in the rapidly expanding field of alternative medicine.
The aim throughout the program was to ask what science has
to say about these alternative approaches and their respective
segment entitled "Adjusting
the Joints" explored the subject of chiropractic as a
healing art and science. The segment delved into the origin
and theory of chiropractic, presented a number of specific
techniques via trained chiropractors and their patients, and
raised questions about some aspects of chiropractic, including
evidence for the underlying principle of "subluxations" and
the connection between spine alignment and health, methods
of diagnosis, and the safety of certain forms of neck adjustment.
segment did not claim that chiropractic is fraudulent and
did not attempt to prove or disprove that chiropractic "works,"
but it does state that chiropractic has no basis in science.
This conclusion is entirely justified by both current research
and generally accepted views of human anatomy.
underlying principle of chiropractic theory is that there
is a direct association between the shape of the spine (the
alignment of the vertebrae and the spine's curvature) and
disease. Chiropractors claim that health problems can be caused
by "subluxations," or blockages of nerve energy, which are
caused by malpositioned vertebrae. By "adjusting" vertebra
manually exerting force on the spine so as to physically displace
parts of the skeletonchiropractors say they are removing
the subluxation and hence allowing the body to heal itself.
We felt it was important to review the scientific evidence
for the existence of subluxations, as defined by chiropractors.
We reviewed the scientific literature, with the guidance of
a number of qualified medical sources, and concluded that
there was no such evidence available in any form which would
meet generally accepted scientific standards. On the contrary,
there is scientific literature failing to find subluxations
and associated phenomena stretching back thirty years, as
was noted in the program.
viewers commented that the story was biased against chiropractic.
We made a serious effort to give the chiropractic profession
the opportunity to present their own case. Those in the segment
supporting chiropractic included: the president of one of
the most established and best-known chiropractic colleges
in the country; three experienced and fully licensed Doctors
of Chiropractic demonstrating and explaining in detail three
different widely used techniques; and a patient who expressed
her satisfaction with chiropractic treatment. To counter those
five pro-chiropractic individuals we presented two individuals
critical of chiropractic: a medical doctor and a former Doctor
of Chiropractic who practiced for many years and who taught
at a major chiropractic college. We allowed each of the individuals
included, both pro and con, to express their own opinions.
Other factual information conveyed in the segment included
direct quotations from Daniel Palmer, the founder of chiropractic,
and references to specific published papers in the medical
viewers commented that the program ignored positive studies
on chiropractic and included only negative studies. While
it's true that there are many studies which purport to show
the benefits of chiropractic, there are in fact very few which
were conducted to the highest scientific standards. In reviewing
research on chiropractic we held papers to those standards
and looked for rigorous, well-designed studies that appeared
in solid, peer-review medical journals. Our advisor in analyzing
studies on chiropractic was Dr. Wally Sampson, a retired Stanford
Medical School professor and editor of The Scientific Review
of Alternative Medicine. In that high-quality category there
are in fact very few positive papers supporting benefits of
chiropractic for particular health problems. The one area
where there is significant published evidence of chiropractic
benefit is in treating back pain. Valid studies have shown
that chiropractic can be of benefit to back pain sufferers.
However, chiropractic success rates were no greater than conventional
approaches like physical therapy and exercise. Since many
chiropractors use procedures that are similar to those of
conventional therapies, which do not require any belief in
theories of subluxation and spinal displacement, the back
pain studies cannot be used to validate chiropractic theory.
Because we felt the subject of chiropractic and back pain
was likely to be of importance for many viewers, we created
an expanded discussion of the subject on the the Scientific
American Frontiers Web site with the feature entitled "Keeping
the Spine in Line."
the question of chiropractic neck adjustments and stroke,
some viewers questioned the statistics we used and expressed
concern that stroke risk was exaggerated. Referring to a recent
Canadian study, what we said was, "20% of all strokes caused
by artery damage could be a result of neck manipulation. That
translates into more than 1300 strokes a year in the US."
We used the phrase "artery damage" to substitute for the technical
term "vertibrobasilar dissection." That being said, our narration
was a precise and accurate representation of the study in
question. Other viewers wished that we had cited more studies
on the stroke question. Indeed, we could have if not for time
constraints. One British study we would have liked to discuss
looked carefully at the question of under-reporting surrounding
stroke and neck manipulation. In the study, neurologists who
routinely treat stroke emergencies were first surveyed to
see if they ever asked patients if they'd had a chiropractic
neck manipulation recently. It was found that neurologists
did not ask, as a rule. Then the neurologists were instructed
to ask their patients as a matter of course. The incidence
of chiropractic-related stroke shot up. So this wasn't just
under-reporting that the study revealed more like zero
reporting. It seems that patients and neurologists have not
been making connections between events which, of course, may
well be days apart. The question of under-reporting
or more accurately of simply missing cause and effect
discussed in the Canadian study as well, is clearly now beginning
to get more attention in academic circles.
summary, we believe "Adjusting the Joints" was fair, accurate
and balanced and, in conjunction with the other segments of
"A Different Way to Heal" contributed to a more informed public
understanding of a significant trend in health care today.
June 11, 2002