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</A> -Cui Bono?-
In a message dated 3/26/00 8:43:20 AM Central Standard Time,
[EMAIL PROTECTED] writes:
<< The accident caused a subluxation of my lower spine >>
A "subluxation"....hmmmm...you mean "the silent killer"??
Bill.
Chiropractic's Elusive "Subluxation"
Stephen Barrett, M.D.
If you are examined by a chiropractor, you may be told that you have one or
more subluxations of your spine. This article examines what this means and
how you should react.
Chiropractic theory is rooted in the notions of Daniel David Palmer, a grocer
and "magnetic healer" who postulated that the basic cause of disease was
interference with the body's nerve supply. Approximately a hundred years ago,
he concluded that "A subluxated vertebrae . . . is the cause of 95 percent of
all diseases. . . . The other five percent is caused by displaced joints
other than those of the vertebral column." [1] He claimed that subluxations
interfered with the body's expression of "Innate Intelligence"-- the "Soul,
Spirit, or Spark of Life" that controlled the healing process. He proposed to
remedy the gamut of disease by manipulating or "adjusting" the problem areas.
Over the years, chiropractors have gone beyond Palmer's theories, although
some still cling to them for dear life. Some describe subluxations as "bones
out of place" and/or "pinched nerves"; some think in terms of "fixations"
and/or loss of joint mobility; some occupy a middle ground that includes any
or all of these concepts; and a small percentage renounce Palmer's notions as
biotheistic nonsense -- which they were.
Are Subluxations Visible?
Chiropractors also disagree on whether their "subluxations" are visible on
x-ray films. "Straight" chiropractors tend to believe that they cause nerve
interference, are readily visible, and that virtually everyone gets them.
Most other chiropractors (commonly referred to as "mixers") define
subluxations loosely and see them when it suits their convenience.
Chiropractors who reject subluxation theory consider them invisible but have
been forced to acknowledge them to get paid by Medicare. When a respected
chiropractic researcher was asked whether he had ever seen a subluxation on
an x-ray film, he smiled and jokingly replied, "With my eyes closed." [2]
Old chiropractic textbooks show "before and after" x-rays that are supposed
to demonstrate subluxations. In 1971, hoping to get a first-hand look at such
x-rays, I challenged the local chiropractic society to demonstrate ten sets.
They refused, suggesting instead that I ask the Palmer School to show me some
from its "teaching files." When I did, however, a school official replied:
Chiropractors do not make the claim to be able to read a specific subluxation
from an x-ray film. [They] can read spinal distortion, which indicates the
possible presence of a subluxation and can confirm the actual presence of a
subluxation by other physical findings [3].
In 1973, Congress authorized payment under Medicare for chiropractic
treatment of "subluxations demonstrated by x-rays to exist." In 1972, to
enable payment, chiropractors held a consensus conference that redefined
"subluxations" to include common findings that others could see. The
document, several pages long, described the supposed x-ray manifestations of
18 types of "subluxations," including "flexion malposition," "extension
malposition," "lateral flexion malposition," "rotational malposition,"
"hypomobility" (also called "fixation subluxation"), "hypermobility,"
"aberrant motion," "altered interosseous spacing," "foraminal occlusion,"
scoliosis, and several conditions in which "gross displacements" are evident
[4]. I have been unable to determine how many billions of dollars
chiropractors have received from Medicare since the law took effect.
Some of these terms are fancy names for the minor degenerative changes that
occur as people age. The conditions often have nothing to do with a patient's
symptoms and are not changed by chiropractic treatment. Some, as acknowledged
by the conferees, are not even visible on x-ray films. In 1997, Congress
amended the law to permit payment for subluxations diagnosed by other means
-- a policy scheduled to take effect on January 1, 2000.
Chiropractors also differ about how to find "subluxations" and where they are
located. In addition to seeing them on x-ray films, chiropractors say they
can find them by: (1) feeling the spine with their hand, (2) measuring skin
temperature near the spine with an instrument, (3) concluding that one of the
patient's legs is "functionally" longer than the other, (4) studying the
shadows produced by a device that projects a beam of light onto the patient's
back, (5) weighing the patient on special scales., and/or (6) detecting
"nerve irritation" with a device. Undercover investigations in which many
chiropractors have examined the same patient have found that the diagnoses
and proposed treatments differed greatly from one practitioner to another.
Subluxation is also a medical term. The medical definition is incomplete or
partial dislocation -- a condition, visible on x-ray films, in which the bony
surfaces of a joint no longer face each other exactly but remain partially
aligned. No such condition can be corrected by chiropractic treatment.
Elastic Definition
Two years ago, in an attempt to "unify" chiropractic terminology, the
Assocation of Chiropractic Colleges issued the following definition:
A subluxation is a complex of functional and/or structural and or
pathological articular changes that compromise neural integrity and may
influence organ system and general health.
In 1997, the Foundation for Chiropractic Education and Research issued a
pamphlet called "Subluxation: What It Means to You," which states:
What the above means is that a subluxation is a joint problem (whether a
problem with the way the joint is functioning, a physical problem with the
joint, or a combination of any of these) that affects the function of nerves
and therefore affect the body's organs and general health.
This "definition" is still poppycock because the vast majority of spinal
problems do not affect the body's organs or general health. (In addition, it
makes no sense to use the consensus process to try to define something that
is not a valid concept [5]. If you'd like to have some fun, ask a
chiropractor to list the diseases or general health problems that spinal
manipulation can cure.
The Silent Killer?
In the late 1980s, the Vertebral Subluxation Research Institute (VSRI) was
launched by Terry Rondberg, D.C., of Chandler, Arizona. Rondberg is president
of the World Chiropractic Alliance (WCA), a group that promotes
subluxation-based practice. He also publishes The Chiropractic Journal (a
newspaper for chiropractors), the Journal of Vertebral Subluxation Research,
and Health Watch (a newsletter that attacks what it considers to be "the
dangers and abuses of medical and drug interests."). VSRI taught
chiropractors how to recruit "research volunteers" and convert them into
lifetime chiropractic patients. Its chiropractor clients were instructed to
use telemarketing and other approaches to ask people to volunteer for a
nationwide study on spinal conditions. During the first office visit they
would be examined and given a brochure - - "The Silent Killer" -- which
explains how subluxations can be caused by physical, chemical, and emotional
trauma. (The brochure claimed, for example, that food additives, air
pollutants, spoiled food, fear, worry, hate, greed, sadness, grief, emotional
shock, and severe disappointment can cause muscle spasms that result in
subluxations.) During the second visit, they would be advised to have their
subluxations treated. TheVSRI program was concluded in 1991 [6]. A subsequent
WCA survey found that 65% of members who responded said that their patient
education material referred to the vertebral subluxation as the "silent
killer."
A 1992 WCA training manual, written for chiropractic assistants by Rondberg's
wife Cindy, describes how the subluxation concept can be explained to
patients:
When -- through physical, mental, or chemical stress -- one of the 24
vertebrae in the spinal column becomes slightly misaligned, it's called a
subluxation. When a subluxation occurrs, it puts pressure on delicate nerves,
and the organ or body part at the other end of the nerve does not receive the
proper messages it's so dependent on. This has been compared to someone
stepping on a water hose, interfering with the flow of water. The vertebral
subluxation does precisely the same thing, interfering with the messages from
the brain to the body. When the communication from the brain to the organ is
broken down, there is a malfunction and disease may eventually develop [7].
Patient Media, Inc., a company that markets patient education materials
offers a subtler but still scary approach. Its "Subluxation" pamphlet states:
Subluxations are serious!
However, the most important aspect of a subluxation is its affect on your
nervous system. Compromising the way your nervous system controls and
regulates your body can have grave consequences. Distorted communications
between your brain and your body can cause all kinds of health problems
beyond just headaches and backaches. . . .
There are three basic causes of subluxations. Physical causes include slips
and falls, accidents, repetitive motions and improper lifting. Stress, anger
and fear are examples of emotional causes of subluxations. Alcohol, drugs,
pollution and poor diet can be chemical causes of subluxations. . . .
You can have subluxations and not even know it. Like tooth decay or cancer,
subluxations can be present before any warning signs appear. The results of a
thorough examination can show the location and severity of any subluxations
you may have [8].
Pending FTC Action
Warnings about "subluxations" predate VSRI and still apear in many ads,
brochures, and office posters. For example, a widely distributed pamphlet
from Koren Publications warns:
A vertebral subluxation is a spinal abnormality that interferes with your
nerves. It can create dis-ease, lowered resistance to disease, pain,
imbalance, fatigue and can pave the way for ill health. It is sometimes
called the "silent killer" because it can slowly eat away at your health and
vitality without your having the slightest awareness of it. . . .
Subluxations are so very common they can be considered an epidemic -- nearly
everyone has them.
Subluxations can undermine your health just as termites can undermine the
foundation of your home. . . . By the time symptoms appear a certain amount
of the damage caused by longstanding subluxations may be irreversible.
For that reason periodic spinal examinations to locate and correct vertebral
subluxations should be part of every family's health routine. Correcting
silent subluxations today could save you and your family from diseases that,
later in life, could not possibly be ignored [9].
Company president Tedd Koren, D.C., is a 1977 graduate of Sherman College of
Chiropractic, the "straightest" of the chiropractic colleges. The company
publishes a large line of subluxation-based patient-education brochures which
suggest that spinal manipulative care can help nearly the entire gamut of
health problems. A 1998 flyer for Koren's 12-hour seminar on "The Natural
Superiority of Chiropractic" states that a total of 24 million of these
brochures have been distributed worldwide. Claims made in some of Koren's
brochures are being challenged by the Federal Trade Commission. In a recent
catalog, Koren stated:
The FTC claims that chiropractors can only tell patients that chiropractic
care can be beneficial for low back pain. Nothing else, not subluxations,
wellness, headaches, sciatica, allergies, children's health, ear infections,
whiplash, etc. Although Koren Publications' literature states that
chiropractic is not the treatment of diseases but the correction of vertebral
subluxations, the FTC doesn't like the "impression" we're giving the public
and patients [10].
In October 1998, Rondberg filed a lawsuit intended to stop the FTC action
against Koren and other likeminded providers. Asserting that Koren's
publications (and therefore his own) should be protected by the
Constitutional right to free speech, the suit papers stated:
In or about mid-1998, the FTC concluded that Dr. Koren's activities
constitute false advertising and or deceptive trade practices. The FTC sent
him a proposed consent order and a proposed administrative complaint. The FTC
said sign the consent order or face a lengthy and costly administrative
proceeding. The proposed consent agreement basically prohibits Dr. Koren from
making any public claims about the benefits of chiropractic unless the claims
are supported by scientific studies which the FTC believes to be
authoritative or valid. . . .
Although Dr. Koren's specific message is somewhat different from Dr.
Rondberg's, their activities are quite similar. Both sell books and pamphlets
which sometimes are distributed by chiropractors, and both are strong
advocates of the benefits of chiropractic care. . . .
Dr. Rondberg does not believe that chiropractic is a direct cure or even a
treatment for any disease or condition other than vertebral subluxation.
However, all chiropractors believe that keeping the spine healthy and
correcting spinal nerve interference can have a beneficial effect, and may
sometimes lead to a resolution of some medical conditions. But Dr. Rondberg
stresses that the purpose of chiropractic is to correct spinal nerve
interference, not to treat any disease or medical condition [11].
The Bottom Line
My advice about "subluxations" is very simple. If a chiropractor purports to
locate and fix them -- "killer" or otherwise -- seek treatment somewhere else.
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