Can chiropractic really get rid of with [sic] earaches and ear infections? That was the title to an article posted on an alternative medicine blog last week. The answer is, of course an emphatic NO! Unfortunately, the author of the article didn’t consult me (or any credible scientific evidence) prior to submission and went on to answer the question in the affirmative, providing evidence that the title to this post may be redundant. Oh boy.
I understand that this is just one junk article on one alternative medicine blog. I don’t even know if it’s a well known alternative medicine blog. This is more a situation of just one ridiculous claim too many that finally sent me to the keyboard. Claims like this are, unfortunately, not sparse in the chiropractic community, and I feel like I’ve been coming across them way too often recently. It is depressingly easy to find a practitioner that will claim to treat ear infections, colic, and asthma. Look a little harder, and it’s not much more difficult to find individuals who will treat autism, infertility, ADHD, Parkinson’s, etc. There was a chiropractor in my hometown (population: a paltry 25,000) that publicly asserted he could treat pancreatic cancer. As you might have guessed, there is absolutely zero credible scientific evidence to back up these claims.
In reality, most people are surprised to find that the vast majority of medical claims made by chiropractors, even most of the musculoskeletal claims, are not supported by evidence. Manipulative therapy has been shown to be moderately successful in the management of acute uncomplicated lower back strain. It’s important to note two things about that statement. First, I said manipulative therapy, not chiropractic. Manipulative therapy includes care provided by physicians, physical therapists, and osteopaths in addition to chiropractors. Second, manipulative therapy is shown to work as well as other treatments for acute uncomplicated lower back strain, not better than. These other therapies include medical management, physical therapy, and patient education. That’s where the science ends. There is no evidence to show that chiropractors can treat neck pain (though chiropractic manipulation of the neck can give you a stroke), much less ear infections and and autism. The perfect testament to this comes from an unlikely source: the British Chiropractic Association.
As I’ve written before, the BCA is currently involved in a libel case against Simon Singh as a result of his characterization of some chiropractic treatments as ‘bogus’ (including treatment for colic, asthma, and ear infections). Instead of presenting scientific evidence to refute Singh’s claims, the BCA sued the journalist. It was only several months later after a major grassroots campaign and a public relations nightmare that the BCA produced their ‘evidence.’ This was to be their coup de grâce, a refutation of Sing’s characterization backed up by the best evidence the scientific literature had to offer. The list has been torn apart in numerous blogs since it was first released in June. The following is an excerpt from The Lay Scientist.
“Of the 29 references, 1 is just the GCC’s code of practice; 6 is an irrelevent paper about medical ethics; 8, 9, 10 and 17 are about osteopathy; 26 is a description of evidence-based medicine; 27, 28 and 29 are about NSAIDs. That’s 10 down straight away, but what’s interesting about these is that 6 of them are just attacks on conventional medicine. In other words, this is not a particularly comprehensive or focused review of the literature. It is far from the ‘plethora’ of evidence promised.”
Unsurprisingly, the remaining studies are of very poor quality. The BCA failed to produce even one randomized, double blind, placebo-controlled study that supported the efficacy of chiropractic. This list was the best that a national chiropractic organization could come up with in the middle of internationally covered libel case, the crux of which is the apparent lack of evidence to support the majority of chiropractic claims. Their failure is very telling.
So what’s the verdict on chiropractic? Does the bad outweigh the good? I’m inclined to say yes, but the decision obviously lies with the individual. If someone is suffering from acute uncomplicated lower back strain, and chiropractic care seems to be the best option, they can feel fairly comfortable visiting a chiropractor. They should be educated about the possible drawbacks of chiropractic and keep the chiropractor very far away from their neck. Lastly, parents should keep chiropractors away from their children. The vast majority of practitioners advocate spinal manipulation of children and infants. A discussion of this didn’t fit well into the post, but I think a brief mention is merited as many of the conditions that chiropractors claim to treat (colic, ear infections, chronic bedwetting, etc.) affect children. This is both dangerous and exploitative. In the now famous words of Simon Singh: beware the spinal trap.