John Badanes received a B.A. in fine art and World Music from Wesleyan University in 1968. He trained as a chiropractor at Life Chiropractic College West (LCCW) in San Lorenzo, CA, and graduated summa cum laude in 1984. Badanes was class valedictorian and recipient of the college's Clinical Excellence Citation. He then became a Licensed Acupuncturist and was in private practice as both a chiropractor and acupuncturist from 1985 to 1992. During this period, Badanes also served as faculty at LCCW's outpatient clinic.

On a 1988 trip to Indonesia to perform the Balinese music he'd studied and taught since 1971, Badanes visited with friends and families whom he hadn't seen since pursuing his career in chiropractic and Traditional Chinese Medicine. The disparity between their health care needs and what he could provide as a so-called "doctor" defined for him the fundamental difference in clinical basis between Alternative Medicine and medical practice that's informed by bioscience.

Badanes returned to the U.S. and obtained a Pharm.D (Doctor of Pharmacy) degree from the University of California, San Francisco, in 1997. This program strengthened his commitment to science-based intervention and sharpened his criticism of the arbitrary diagnostic and therapeutic methods that proliferate within the chiropractic profession and characterize Alternative Medicine. He now works as a community pharmacist in western Massachusetts.

I watched the show regarding chiropractic last night and would like to know what you recommend as an alternative to chiropractic. Would massage therapy, acupressure and acupuncture be good choices? Also, what was the title of the book exposing chiropractic?

Badanes' response:
This is a question of "Which Witch is Which" --how does one choose between one so-called "Complementary and Alternative Medicine (CAM)" and another for any given complaint, since they ALL claim to "work." For back pain, let's say, on what BASIS should you see an acupuncturist, homeopath, colonic therapist, chiropractor, physical therapist, Therapeutic Touch practitioner, or psychic healer? It's a terrific question since any attempt to answer it begins to shed light on consumer issues like choosing ANY Alt-Med (never mind a particular one) for something that won't resolve on its own, or the implications of self-diagnosing yourself with a "homeopathic" versus a "chiropractic" problem when picking one or the other from the Yellow Pages.

Personally and professionally, I find it useful to separate medicines and therapies that are grounded in bioscience FROM those that are arbitrary, self-referencing, proprietary medical fictions and mythologies. Biomedical diagnoses and treatments, for example, have a physical and substantive reality that can be referenced and "measured" in anatomy and physiology. On the other hand, CAM "problems" tend to be unverifiable conceptual "pathologies" that are fully "owned and operated" by whatever CAM therapy YOU're considering and THEY're selling. Each CAM has its own version of "science" which proceeds from their own definitions of how the world around us works, rather than vice versa --in which the observable world ruthlessly limits what can, and can not be said about it.

With back pain, for example, the physical therapist and MD sound plausible and reasonable to me when they explain I've "strained a muscle" and their treatment will be directed at resolving the pain and inflammation related to this "strain." This is obvious in much the same way that it makes undeniable sense that it would be unpleasant to get poked in the eye with a burning stick. It's this very direct and reproducible physical basis of a medicine that makes the difference. When muscles are "pulled," the injury is predictable and the treatment makes sense, even though it may not be perfect.

Compare this with proprietary and non-reproducible diagnoses of "Blocked QI (pronounced "chee") of the acupuncturist, "Accumulated TOXINS" of the colonic therapist, the "SUBLUXATION" of your friendly chiropractor, or "a problem with ENERGY" that's "soothed" and "directed" by the hand-waving of the Therapeutic Touch adherent. How can you really distinguish between any of these non-physical diagnoses? I submit that to the extent you can't, the therapies offered by these respective CAM practitioners are then interchangeable for any given patient presentation and diagnosis. They will do what they do, no matter, and you can choose any and all them for any given complaint and for whatever reason.

I realize this may not be the concrete answer you sought, but I hope that you can begin to see a recurrent pattern and theme in CAM that will help you distinguish the viability of one medical choice when compared with another. As Mark Twain said about history --it may not repeat itself but it sure does rhyme. It's not so different when considering CAM. Once you appreciate the motif I'm describing, it won't be such a jungle out there when considering all the competing claims. Science can help.

The title of the book that was featured on "A Different Way to Heal?" is: "CHIROPRACTIC, The Victim's Perspective," by George Magner. It's a terrific book and really has much more to do with an overview of "chiropractic" than the title suggests. In other words, there's a lot of useful non-partisan information there and the book isn't really about being "victimized" by chiropractors.

One of the very BEST books about "chiropractic" was written in 1963: "BONESETTING, CHIROPRACTIC, and CULTISM," by Samuel Homola, DC. While this is out of print, luckily, you can read this "online" at [http://www.chirobase.org/05RB/BCC/00c.html]. More recently, Sam wrote "Inside Chiropractic: A Patient's Guide" published in 1999 by Prometheus Books.

Matthew C. asks:
My friend is a student at Life Chiropractic in Atlanta. After much caution I allowed him to adjust me. He used a method called Thompson to adjust me. What is this method and what are the possible mistreatments that can be performed on me? Should I continue to allow him to perform these adjustments and also neck manipulations?

Badanes' response:
When any single brand Chiropractic Technique (chirodigm) is looked at, each will have its own definition of what's "wrong," its own means of detecting the "problem" as they see it, technique-specific Adjustments that purport to correct its version of "Subluxation," and methods to insure that this pathologic "Entity" has been duly exorcised by the chiropractic doctor. We had the opportunity to see some of this in the SAF chiropractic segment in which the Gonstead (Dr. Rowe), Activator (Dr. Donaldson), and Toggle (Dr. Browning) Techniques were demonstrated.

Someone using the Thompson Technique (like the student intern who is treating you) locates and presumably corrects proprietary (technique-specific) diagnoses including Derefield-Thompson Pelvic Negative or Positive Syndrome, Right or Left Positive Cervical Syndrome, and Thompson Bilateral Cervical Syndrome. The Thompson practitioner INFERS these diagnoses from changes in functional leg-lengths using virtually the same leg-length examination you saw used by the Activator practitioner (Dr. Donaldson) on the SAF show.

For example, the treating doctor concludes there is a "Right Cervical Syndrome" if during the exam of the prone patient, the legs "level" or "balance" in the "second" (flexed) position when the patient rotates their head to the RIGHT. The DC "corrects" this by "Adjusting" the neck (the patient's head turned to the right) with the aid of a cervical "drop piece" --which releases when the "adjustive thrust" is made. The functional leg-length is then re-checked after the Adjustment and if there is no longer a leg-length discrepancy when the patient turns their head, the "correction" is assumed to have been made. "If after adjustment there is no change in the leg length reaction with head rotation (the original positive finding persists) --repeat the entire cervical syndrome correction, but change the segmental contact point to the next lower vertebra." [Thompson Technique Booklet] If at first, you don't succeed, and all...

I've taken the trouble to go through this SINGLE chiropractic technique analysis/treatment pair from ONE chirodigm (Thompson) to illustrate a couple of things. You might not have noticed, for example, that it wouldn't make any difference what your entering complaint is --headache, ankle pain, nausea. A Thompson diagnostic/treatment algorithm will be used almost ritualistically, no matter --if you're at the office of a Thompson practitioner, that is. You're getting "Adjusted," after all.

Moreover, these chirodigm specific analysis/"correction" pairs are diagnostically and therapeutically arbitrary and are abstractions of patients and their complaints. In other words, what is a "Right Positive Cervical Syndrome," anyway? Once you leave the chiropractic office of the Thompson chiropractor, it doesn't exist. Compare this to a biomedical diagnosis such as glaucoma (increased intraocular pressure) which is the same no matter where you are in the WORLD.

Now, we're in a position to consider the REST of the Chiropractic Technique Spectacle and the implications of having "200 [chiropractic] motels," as the late Frank Zappa might have sung. Remember, that each subluxation-based chirodigm exists more or less independently of the others, and is a self-referencing diagnostic-treatment loop which always, by its own definition "works." For the consumer and third-party payer (that's insurance) this presents a dilemma that borders on a nightmare. In short, there is no standard of care in the profession. As Forest Gump might say, "A chiropractic office is like a box of chocolates: YOU NEVER KNOW WHAT YOU'RE GOING TO GET!"

Here are some possibilities, though:
Activator Technique (featured on the SAF show)
Logan Basic Technique
Gonstead Technique (featured on the SAF show)
Directional Non-Force Technique (DNFT)
Thompson Technique (that's your student DC)
Pettibon Spinal Biomechanics
NETWORK (you wouldn't believe me if I told you)
Mears Technique
Spinal Stressology (incomparably stunning)
Toftness Technique
Chiropractic Biophysics Technique
Atlas Specific/HIO (Toggle Recoil)
Pierce-Stillwagon Technique
NUCCA Technique
Barge (Tortipelvis/Torticollis) Technique
BioEnergetic Synchronization Technique
Sacral Occipital Technique (SOT)
Applied Kinesiology
Neuro Organizational Technique (NOT)
Perianal Postural Reflex Technique
Meric Technique
Receptor Tonus Technique (NIMMO)
Lemond Brain Stem Technique
Grostic Technique
Neuro Emotional Technique (NET)
Holographic Diagnosis and Treatment etc...plus at least 50 more.

The point here is that for any complaint such as neck or low back pain, you really can't be sure of what you're buying. Equally pertinent from the standpoint of comprehensive health care generally, an MD can not feel confident referring their patients into this Chiropractic Technique Jungle. That's a problem. Further, not a single one of these chirodigms has been shown to be more, or LESS effective than any other one, for ANY condition. Even the CHIROPRACTOR has no basis for choosing one Chiropractic Technique over another (beyond their personal preference), and each MD or self-referral to a chiropractor remains still another random experiment in "science." Indeed, not one of these chirodigms has been demonstrated INDIVIDUALLY to be effective for any particular condition, including diagnoses as common as sprain or strain.

So, SHOULD you continue with your Thompson practitioner? I don't know. That would be up to you. Hopefully, you have a little more information on which you can make an informed decision. At least, the next time someone tells you "chiropractic works" or insists, "But, there are studies," you'll be in a position to ask pertinent questions like, "What's chiropractic?" and "Which chiropractic?" and for "What condition?"

Cynthia asks:
Are you aware that recent chiropractic studies show post adjustment improvements as documented by surface EMG, Thermography, Functional MRI and EEG?

Badanes' response:
No. In fact, I'm not aware that since its inception in 1895, chiropractors have even the slightest bit of agreement as to what it is they treat --never mind whatever you could be calling an "adjustment." You MAY be confusing manipulative therapy with the Chiropractic Adjustment. Generic manipulative intervention has at least some minor validation supporting its application for a limited number of presentations in some patients, some of the time. Remember, though, that manipulative therapy isn't the same as a Chiropractic Adjustment any more than Mennell, Fiske, and Maitland are chiropractors. Further, in over 101 years of chiropractic "dalmatians," not a single thing that uniquely defines "chiropractic" --the Chiropractic Subluxation AND its so-called Adjustment-- has ever been validated scientifically.

For example, on the show, you saw chiropractors using leg-checks, "instrumentation" (Nervo-Scope), and x-rays to help them make their proprietary, non-medical (chiropractic) diagnoses. Yet, the "imbalance," heat differential, and "sacral-base posterior" inferred respectively from each of these "diagnostics" have never been demonstrated to have any bearing on health or disease --never mind anything resembling things as mundane as sprains and strains. These diagnoses are arbitrary and chirodigm specific --applicable to each and every patient no matter what their complaint. As Dr. Rowe told patient, Kimberly Mah, who complained of sinus congestion, headache, and fatigue, "We'll take a look at your spine and see how you're REALLY doing."

Moreover, why would you suggest that by offering my observations and straightforwardly answering the questions I was asked on the show, that I DON'T value science and the scientific process. Because you disagree? On the contrary, I not only find the sciences personally compelling, but I strongly advocate for their application in medicine. Besides allowing practitioners to see beyond their own nose when making recommendations and providing therapy, without the scientific process, no medicine can grow and change as new information and data is acquired. There's something "healthy" and "alive" about a medicine that's capable of informed change and something suspicious about one that doesn't excise its "dead weight" and/or repair its damaged "DNA."

That said, you should be able to easily find five or ten things that chiropractors once thought and did that have been DISCARDED and/or modified because it was demonstrated through rigorous scientific study that what was previously believed was either simply wrong --or, was modified and replaced with something that was demonstrated to be more effective and/or safer than what was done at the turn of the century. Since I don't think you will be able to name even one thing, I would suggest that much of what chiropractors currently think, do, and say in the name of "chiropractic" was immutably in place and perfectly configured at its inception in 1895. Notably, this is a characteristic motif of "faith-based" medicines and therapies, generally. Don't take my word for it --take a look.

Maureen M. asks:
Dear Mr. Badanes, Last night on Scientific America you seemed to be very negative towards chiropractic manipulation. How can you explain why my back feels so much better after I've had a visit with my chiropractor? I've been to many doctors over the years about back problems and my chiropractor is the only one who has been able to give my back relief without using pain killers.

Badanes' response:
No, I CAN'T explain why you find "relief" at the chiropractic office. But, I'd wager your chiropractor can't, either --even though I imagine you've been offered a chiropractic reason why you might. In any case, you haven't said anything about your complaint, what's been diagnosed by anyone who's seen you, and what therapies you've tried, biomedical and/or otherwise. So there's no way for me to reasonably comment on the specifics of your case.

Naturally, I'm pleased that you're back feels better but I'd be reticent to simply recommend "chiropractic" as a remedy for back pain or anything else on the BASIS of your testimonial --or even hundreds like it. Similarly, and for the same reason, I seriously doubt you'd tell me you DON'T feel better if I supply any number of anecdotes from patients who said they received NO benefit from seeing the chiropractor or who claimed they were injured by one. That's because each of our stories are just hearsay and rumor --nothing you'd want to rely-on when choosing or recommending a medical intervention.

The fact is, patients often respond to all KINDS of empty therapies and for no good reason. Even so, while they are pleased with the "result" they associate with the particular medicine or event, it's incumbent on the scientific practitioner to do better. DD Palmer, for example, the "father" of the chiropractic (featured in the historic part of the SAF segment), treated Harvey Lilliard with the first Spinal Adjustment. He reasoned that his spinal treatment restored Lilliard's hearing. Does this mean that he had discovered the cure for deafness and should then open a clinic for the deaf? Of course not. One thing had nothing to do with the other and for all we know, Palmer just dislodged some earwax when he "cracked" Lilliard's back.

Like I say, I'm pleased you have rapport with your chiropractor and that you enjoy and apparently benefit from your sessions. On the face of your testimonial, however, I would be unable to distinguish your report from someone who enthusiastically insists their lymphoma disappeared after a visit to Lourdes or after getting sprinkled with "Tirta" (Holy Water) by a Balinese priest. I couldn't explain any of this, either. I just wouldn't choose these medicines if I were the patient and I wouldn't recommend or use them for patients as a science-based practitioner.

Todd asks:
You stated on the PBS program that the popping sound you hear in the joints is gas being released, which I agree with. However, do you agree that this sound also indicates that the joint has been mobilized? You stated that this does not indicate that the joint has moved positions, chiropractic corrects many problems by mobilizing joints that are not functioning properly.

Badanes' response:
I stated that the "popping" of a joint doesn't signal any change in the "position" of that joint any more than "cracking" a knuckle does. Similarly, "mobilizing" knuckles does NOT a medicine make, despite the testimonials of "knuckle-crackers" who are continually and habitually doing this and claiming relief. In any case, the extension of an argument for "knuckle-mobilization" is that you could imagine an entire profession of chiropractors fully dedicated to providing and billing for the equivalent of "spinal knuckle-cracking." Vertebral joints are synovial-type joints that "pop" when you "stretch" them just as I demonstrated on the show when I "popped" a single finger joint. There is no evidence that cracking knuckles OR spines makes them "function" any better --at least as "dysfunction" and "function" are variably defined by chiropractors from office to office.

Gas coming out of solution when joint spaces are expanded is (to borrow a phrase of one of the DCs featured on the show), "Just physiology." Well, so is gas that sometimes evolves in the intestine after eating; but we don't refer to its casual release as a medicine, even as it might occasionally provide temporary relief. In a society with limited health care resources, we certainly don't train Doctors of Intestinal Gas (DIGs) and then pretend we're talking about gastroenterology. This would be making a "medical mountain" out of a physiologic "mole hill," wouldn't it.