It's not a science; in fact it's more like a cult or a religion. But it is covered by my health insurance. And FSU up in Tallahassee may soon have an entire school devoted to it, now that our esteemed state legislature has voted funds for an FSU Chiropractic College.
Needless to say, the FSU faculty are not happy to find the legislature giving them this surprise gift. Several of the biggest names on campus have threatened to resign. It's all a glorious political mess, and there's even a special-purpose blog to tell us all about it: FSUblius.
I hate to burst your bubble, but there are many examples in the practice of mainstream medicine that do not meet a physicists definition of what constitutes scientific method. MD’s have achieved over the last 150 years through political and academic organisation and co-operation with the pharmaceuticals dominance as the gatekeepers of health care. The opposition to this is professional politics and nothing more. I am disappointed that Prof. Froomkin who’s opinion I respect greatly on his blog, would feel the need to comment outside of his area of speciality. Imagine if the same attitudes had prevailed against the work of Dr Freud and Dr Jung in the past, the world would be poorer now. Every profession wants to achieve status, there are vested interests. Another discipline should have the right to oppose the establishment of a discipline at a public university, only if that discipline refuses within the halls and committees of that university to submit to the rigours of an objective method. Many disciplines starting with law, do not have any scientific basis in the classical empirical sense, but nonetheless have achieved acceptance and status because they have developed there own internal rigour. Allow the chiropractors to attempt this and the quality of the research, teaching and practice of the profession will be raised, which will in turn benefit health care and the public interest. After all, public universities exist primarily to advance knowledge for the benefit of society, not to act as professional gatekeepers and wardens for entrenched interests. If the tradition of FSU as a top-tier research university with 2 nobel laureates is indeed what is claimed, the climate of academic rigour and excellence will stand in the face of something that is “not a science; in fact its more like a cult or a religion”.
Actually, I would raise much of the same critique against the work of Freudians and Jungians (as a school) as a mode of medical treatment: the failure to validate via controlled trials.
I can accept in clinical subjects such as medicine the absence of a developed theory as to why something works, but not the absence of controlled evidence that it does in fact work, and most certainly not the ignoring of evidence that it does not in fact work.
Not all chiropractors are quacks (professing to treat all sorts of conditions through some sort of mystical manipulation) or charlatans (selling long courses of treatment to injured people to pump up insurance/damages recoveries). Mine does a superb job of treating certain sorts of aches and pains (primarily sports-related), doesn’t try to do more than that, and will send you somewhere else if you need some other sort of treatment.
I have been directly involved in the approval of clinical research trials for an “alternative medicine” program at a public university. The approval committee process consisted of faculty from multiple health professions. The accumulated input of highly skilled professionals from diverse medical specialities resulted in high quality trials being conducted. This in turn sets the benchmark for the quality of trials that other members of the profession conduct outside of the institution.
As to any professional performing procedures in the face of disproven efficacy, that is a matter of professional ethics and conduct of the profession which should be sanctioned by members of the profession and if necessary by a legislature. Sanction coming from faculty members of a high quality research institution towards members of the profession is always going to carry more weight in helping clean up professional practice.
The reality is that many people derive great benefit from chiropractic. My mother for one was booked to undergo extensive neurosurgery for a chronic and intractable sciatica. The sciatica was treated successfully by a student intern. The need for surgery was completely averted and she remains pain free 8 years later. One anecdotal case is not scientific evidence. However I use it to illustrate the fact that as a profession chiropractic is here to stay as the public perception is that there is value to be derived from the treatments offered. The public good is therefore served by having high quality training with rigorous clinical trials.
Reflecting upon this issue, I would be inclined to say that were I a chiropractor practicing disproven methods and general quackery, I would fear the creation of a hight qaulity program at a premier university for the reasons that I cite above and in my first comment.
[T]he public perception is that there is value to be derived from the treatments offered. The public good is therefore served by having high quality training with rigorous clinical trials.
The public perception is that there is value to be derived from astrology. Doesn’t mean we should be establishing state funded schools in it though.
Some of the remedial aspects of western and eastern astrology purport to be able to treat medical conditions. Can you provide relative statistics on the number of people that spend money on visiting an astrologer versus a chiropractor, the number of health insurance companies that pay for astrological consultations versus chiropractic and the number of referrals from medical doctors to astrolgers versus chiropractors?
Perhaps you missed the entirety of my point. High quality training combined with rigourous research will elevate the quality of the daily practice of chiropractic. Medicine used to believe in the therapeutic value of trepinning and frontal lobotomies perfomed in surgeons consulting rooms. This did not stop medical schools from being established and continuing. Society needs a profession that can
1. certify death
2. prescribe dangerous chemicals like vioxx (safely)
and mainstream medicine happens to be that profession. Accordingly a lot of status and power flows from that. However medical students receive at most 2-4 weeks of training on treating muscoloskeletal conditions and the approaches generally result in the prescription of a painkiller or a coricosteroid, failing that surgery. Chiropractors spend immeasurably more time learning non-pharmaceutical and non-surgical approaches to treating musculoskeletal conditions. Submission of their method to high quality trials will result in poor approaches being rejected and successful approached being adopted. Again, this serves the public good.
Chiropractic is viewed by too many otherwise intelligent people as nothing but some kind of quack therapy. Of course there are quacks, but there are quack MD’s as well. There are quack economists, and where would the Bush administration be without them? So, as I’ve actually had some experience with this, I have a different view.
When I was 16 and running cross country on my high school track team, I had an injury from landing badly in a pothole. It wrenched my back a bit and I laid off for a couple of days. As I started running again, still a bit tender, I favored one leg a bit. Over the course of several months, I continued to feel slight pain that eventually grew worse and sidelined me by the following spring. Then, one day, my mom was hemming a new pair of pants for me. When she went to sew them up, she discovered that one leg was longer than the other.
After having some regular doctors x-ray me (lying down) and failing to find anything wrong, we went to a chiropractor. He had me take an x-ray standing up. Sure enough, subtle – but clear enough for my mom and I to see, there was a slight sideways curve to my spine – scoliosis, it’s called. Over the course of the next few months, I received regular adjustments. At the end of my treatment, the scoliosis was gone and my pants legs were even. I’ve been lucky to never again have problems with my back.
My chiropractor was professional and knew the limits of what chiropractic could do. Many standard medical back treatments, on the other hand are a bit, shall we say, medieval. Fusing vertebra and other surgical treatments often leave you with more pain and in no better shape than before the treatment. My mom, a nurse, believes that letting a doctor operate on your back should be the absolute last option.
Clearly, some problems don’t have a good solution, like ruptured disks or other problems that involve trauma or serious damage. But, for a great number of more minor (but chronic and painful) problems, making sure the vertebra are in proper alignment and giving the muscles of the back a chance to relearn to hold them in the proper position is a fundamentally sound proposition. Many problems like pinched nerves (sciatica was mentioned above) fall into this category. Think about it — all those small bones stacked up and held in position by muscles. And with very sensitive nerves coming through the gaps.
The reason chiropractic is now typically covered by insurance is because it actually does work. The medical profession has played a role in keeping the practice stigmatized, and some chiropractic evangelicals want to believe it offers much more wide-ranging benefits than is justified, but I’ve seen it work. Anecdotal, sure. So sue me.
Does FSU offer the doctorate in English literature? How about continental philosophy? I thought so. So, why complain about chiropractors? (An ABD ex-grad student in English speaking.)
My secretary swears she gets something out of her chiropractor visits. Who am I to argue?
Well, yes, and so does Harvard, Columbia, and Stanford, but they are not establishing programs in chiropractic. (In fact, I believe that FSU is weak in continental philosphy; its department has more of an analytical focus, and has a number of well-regarded faculty, including Russ Dancy, Alfred Mele, and Michael Ruse.) Let’s put aside the solipsistic and multi-cultural jibberish for a moment — that a public research university should invest in and teach anything that any individual, or a substantial number of people, in a democracy believe(s). In fact, as you probably know, that is a highly controversial view of the university generally. But I’ll grant that to you, for purposes of exploring why science matters here.
The FSU program purports to teach chiropractic “science.” It also (I understand from the newspapers) proposes to have chiropractic students study alongside first and second year medical students. It seems to me that there are some fundamental questions about science that need to be asked here before FSU does this, if it is serious about it mission as a research university. (FSU is not proposing to put this program in its liberal arts college. For example, if a religious studies department had a certificate in creationist science, this would be controversial but would not raise the same concern that I and many faculty am.) Chiropractic claims to have scientific support, but then its proponents fall back on silly arguments about how it has a scientific basis because consumers demand it and that chiropractic has less total malpractice judgments than medicine so therefore it should be considered on equal par. These are flawed policy arguments. More important, they are hardly science. What is the scientific support? I see very few clinical studies — and many have statistical problems or have not been replicated. Their peer-reviewed journals often include graduates of the proprietary schools publishing them on their editorial boards, and often have only one or two board members with any methodological training in science outside of chiropractic. There is little or no basic science — i.e., exploration of the mechanisms by which chiropractic treatments are efficacious. There is an interesting story on this in today’s Tallahassee Democrat — see http://www.tallahassee.com/mld/tallahassee/10711501.htm — in which FSU Provost Larry Abele even calls the science behind FSU’s proposal into question. All of this means more science is needed, but why is a university chiropractic program that invests public money to put the science cart before the data horse necessary for this to occur?
Answer one question: do universities exist to serve society and the public good or do they really exist to preserve the employment, status, tenure of the faculty? Reading the tone of the arguments against the establishment of this program, it sounds like the latter interest is being served.
Apparently universities do exist to serve the public good. Florida’s Board of Governors killed the chiropractic plan, but never fully explored why FSU’s administration and faculty was wasting its time with this proposal in the first place!