COMMENTARY

Regarding Chiropractic Subluxation Theory as a Threat to Public Health?

Richard Bartley, MSc, MCSP, MISCP

Disclosures

July 30, 2001

Introduction

Dr. Homola claims that chiropractors, at least in the United States, are guilty of practicing pseudo-science that is not only misleading the public, but may even be putting some patients at risk.

Such a claim could be made against most healthcare professions, including mainstream medicine. There is a need for all clinicians, regardless of their professional background, to pursue evidence-based practice.

My experience of cooperating with UK-based chiropractors has been a positive one. Most seem to practice "common-sense" physical medicine, while having a healthy interest in common medical diseases. Where their scope of practice permits, they work closely with local family doctors in managing patients in the community.

Nearly of all them that I have spoken to consider the term "chiropractic subluxation" to be outdated, and while they quite correctly consider a holistic approach to patient management to be vitally important, few have advocated to me that chiropractic adjustment alone can cure visceral disease.

Chiropractic intervention, working in consort with orthodox medicine, could potentially result in favorable outcomes in some chronic visceral diseases, for example, asthma. The mechanisms involved may be difficult to explain, but our knowledge of the neurologic system is not yet complete.

Undoubtedly, clinical studies are needed to verify such claims, No one would doubt that such research is complex and challenging, and to undertake such a challenge requires considerable commitment from the chiropractic professions.

Where research has been undertaken, chiropractic has been shown to be effective in managing musculoskeletal conditions.

Meade and colleagues,[1] in 1994, demonstrated the effectiveness of chiropractic in managing low back pain. While there were some unfortunate flaws in the study that unjustly showed members of my own profession in a poor light, it did at the very least confirm that chiropractic has an important role in managing patients with musculoskeletal disability.

If Dr. Homola's criticisms of the US-based chiropractors are accurate, then there is indeed cause for concern. I suspect, however, that as in other healthcare professions, US-based chiropractic care consists of the (very) good, the bad, and the ugly.

It is for the professional bodies themselves to regulate the practice of their members. Publicly broadcasted criticism always runs the risk of the professions under attack closing ranks and being seen to defend dogma when in reality they have much to positively promote.

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