There is an idea that chiropractic care is for back pain, and back pain only. And if a chiropractor makes the claim that they can help with a symptom away from the spine, then that chiropractor is acting like a quack.
Let’s dig into this situation and find out what might be happening in an even-handed way. And I invite you to refer to the video in this post, where I deal with a little bit more nuance.
What do people mean when they say quackery?
But first, let’s talk about the elephant in the room: the word quack. What does it mean? Where does it come from?
A quack is understood to be a medical charlatan, who offers unproven remedies for ailments. But it originates at a time (mid 16th century) when no doubt many prescriptions for health problems were strange and unproven because, let’s face it, controlled randomized clinical trials were not existent. The age of “scientific medicine” wasn’t going to be around for many centuries.
Many holistic practitioners view the application of the word to be political more so than being descriptive; let’s see why.
quack wasn’t focused on the what, but the how
What separated a quack from another kind of doctor or healer, in an age when there were no clinical trials? Wasn’t by definition everyone a quack at that point in history? Well, no, because medicinal plants, bodywork, spiritual cleansing, and other traditional healing methods that included all kinds of interesting practices were what people relied on so solve medical issues.
By today’s standards, everyone was a medical charlatan when the use of the word quackery originated, so maybe the meaning of the word had a slightly different emphasis?
The origin of the word seems to be rooted in the manner in which the remedy was sold: quacksalver, or “hawker of salve” was the combination of the word quack, which meant boast or brag, with the word salve.
In other words the origin of the word was less about the solution (the salve) per se, and was about the loud, boastful, selling of remedies in an unseemly way (quack).
quack became anything opposed by the official voice of mainstream medicine
The situation is a bit different today, when remedies of all kinds, pharmaceutical and alternative, are boastfully sold in the marketplace during prime time TV, and late night infomercials…And many of those remedies prescribed off-label. Salves are being hawked! Often through the influence of pharmaceutical representatives!
Now we typically use the word for something that seems strange, contrary, unproven, or that has been dismissed by the official authorities of medical science. Those authorities include hospital administrators, public health officials, academic researchers, and clinical scientists. (Individual medical doctors are rarely treated as authorities, even within mainstream medicine.)
That’s why, the American Medical Association Associated the charlatan meaning of quack, and quackery with chiropractors, and chiropractic practice in 1963 in an attempt to contain and eliminate chiropractic as a separate and distinct profession (1). A brief summary of the tactics used by AMA, including prohibiting members from referring their patients to chiropractors is detailed here. This situation wasn’t addressed institutionally until the Wilk v. AMA anti-trust lawsuit in 1976 (in which the AMA was eventually found guilty of violating the Sherman Antitrust Act). Final remedies in this case were not rendered until 1990.
Most people don’t use the word quack in daily life, but the political AMA influence on language lives on
The second understanding of quack (a charlatan not in step with the official story of the medical complex) is what seems to have lived on in mass culture, perhaps evidenced in search interest in the word in Google Trends. Searches related to quack were at a downward trend through the late 2000s after an initial spike around Bird Flu in 2005. With the extended flu season of 2009-2010 (Swine Flu) quack as a search term began an upward trend. That slow upward trend jumped at the start of Ebola Epidemic in 2013, and climbed again with the CV19 Pandemic in March 2020.
By the CV19 Pandemic, quack was again a popular search term, often combined with public figures active in the media who were questioning the response of government to the pandemic. Queries on Google Trends still reveal a strong association between quack and quackery as a search term and specific figures in alternative health media who’s questioning of the narrative around the pandemic were going viral.
I can’t say for certain that these search trends for the word quack are definitely linked to the medical controversies around each of these flu outbreaks, but there may be an association.
Used in a political fashion, the word quack has less to do brash selling of remedies using exaggerated claims, and more to do with whether one questions or dissents against public health policy and/or popular trends in mainstream medicine.
So, when we ask the question if a chiropractor in particular is acting like a quack, we have to ask ourselves: are we asking these things because of the behavior of the chiropractor when it comes to treating his or her patients, or the response of a chiropractor, or perhaps members of chiropractic profession to policy decisions?
If the answer is policy related, your answer to whether or not a particular chiropractor is acting like a quack is probably political, and is most likely shaped by your agreement or disagreement with the chiropractor’s health politics. We have certainly seen an increase in these kind of discussions in 2020 due to the controversies related to the response to CV19. Your belief in the quackery (or not) of the chiropractor is probably not going to be swayed by any evidence.
So, is chiropractic care for something other than back pain actually quackery?
The point of all that semantics is to say that I’m going to do my best to address this question when it comes to chiropractors actually treating patients, and not the political use of the word quack. There’s a difference.
So, here is what I think is important when it comes to answering this question.
Lost in translation?
If a health professional is potentially being judged a quack, based on the claims that the professional is making, we need to be sure that something isn’t being lost in translation. When health care terms move from health professional to the office staff, to the patient, back to another health care professional, there can subtle changes in meaning that can distort what is really being said.
Most people use medical terms incorrectly or with some inaccuracy, including many health care providers who use words colloquially so patients will understand what they’re saying.
For example, “helping the body manage the sequelae of Parkinson’s Disease” can easily become “he said he can cure my Parkinson’s tremor” in the language of a patient. Cure is a word that’s rarely used by health care practitioners, but is often used by lay people.
The nature of health care language is specific and often difficult for patients without training to understand. Here is a story that really drove home that point to me.
One time I had a patient who told me that an orthopedist had taken an x-ray and discovered her scoliosis and she would be stopping her chiropractic care to pursue his treatment recommendations.
This was a few days after we examined her spinal x-ray together and we measured the degree of her scoliotic curvature she had in her spine. In other words, I too had taken an x-ray, and described the curvature in her spine as scoliotic (curved) and even put a number on the curve measurement. Her orthopedic examination came after my examination.
Because I didn’t look her in the eye and tell her I was diagnosing her with scoliosis, a word she recognized, my talk and measurements of a scoliotic curve didn’t register. The difference between scoliosis as a condition and scoliotic curve is enough to confuse an average person.
Can we see why something can be lost in translation?
Hygiene versus treatment, why we talk in systems and how that creates confusion
Hygiene is the caring for an entire system through maintenance. Hygiene for your automobile includes oil and other fluid changes, rotating tires, and even washing the exterior. By doing these things you improve the overall performance of the vehicle over time.
Treatment is the (often temporary) solving of a particular problem. When you blow a gasket in your engine, no amount of maintenance at this point is going to improve its performance. You need to replace the gasket. Proper hygiene (maintenance) may have prevented or delayed this problem.
Your also body has hygiene and treatment demands. But because it’s a living organism with self-healing potential (unlike an automobile), sometimes addressing system hygiene is enough for a variety of problems to go away with less treatment and even without it.
It’s very easy to see treatment as hygiene and hygiene as treatment, especially when the self-healing potential of the body kicks in.
Weight-loss as a form of metabolic hygiene
We see this regularly with weight-loss, which we can describe as a form of metabolic hygiene. By shifting behavior in such a way that a person drops a certain percentage of body fat, then nearly every aspect of their health, from hormones, to blood sugar, to joint stress, to heart stress, to energy levels are going to change, despite the fact that other specific treatments are available for all of these problems.
We understand that if a person has to go on a blood pressure medication, blood thinner, and diabetic medication it’s a treatment to control a problem, but not a system wide update. We understand that it would be better for that person’s entire system to lose enough weight to make all the interrelated systems function better, even though weight-loss is not a specific treatment that will always change these problems every single time.
It would be common for lay people to say that a doctor treated their Type II diabetes with a weight-loss regimen, but it would be better to say that their particular metabolic problem (Type II diabetes) resolved when their doctor recommended that the patient establish and maintain a healthy weight.
See the difference?
Chiropractic care as a form of hygiene?
Chiropractic care can be described as a form of a hygiene. Many people understand it as a specific kind of treatment of a family of problems related to spinal pain. But chiropractors often think about what they’re doing as a form of systems care that works beyond the local inflammation that leads to pain. Shifts in:
- Vagal Tone
- cerebrospinal fluid flow
- sensorimotor integration (2)
- cortical brain firing (3)
after chiropractic adjustments are just some of the ways that chiropractic can influence the nervous system that has a hygienic potential.
A change in a variety of symptoms that seem unrelated in the popular mind to the spine may be a result of this spinal hygiene.
Telling patients about the potential improvements in function brought about by improvements in spinal hygiene are no more quackery than talking about the potential improvements in metabolic hygiene. From a holistic-oriented/hygiene perspective, your practitioner is rarely offering a cure or direct treatment for a particular condition or disorder, but is offering an improvement for the function of the system en total.
Because we aren’t trained to think hygiene and systems by the current health care paradigm, this different emphasis in language can lead to confusion in whether or not your holistic provider is offering a treatment or cure. When health care is essentially waiting for something to go wrong so we can suppress it with a pill or remove it via surgery, the differences in language and orientation between hygiene practitioners and treatment practitioners can make discussions of healing potential sound bizarre if one doesn’t know that hygiene is even an option!
But what if I’m really concerned about a quack claim of a chiropractic practitioner, what should I do?
Still, you may still have a concern about some chiropractor or another practitioner making a claim that you feel makes them a quack…What should you do?
In the video response to this question, I outline a framework for thinking about this issue in a way that might ease your mind. I ask you to consider:
- Has something been lost in translation?
- Does the motivation of the alleged “quack” seem sincere?
- Is what the practitioner is recommending actually going to cause harm?
Hopefully considering these aspects will help you answer the question when faced with a health care practitioner making claims that you don’t understand.
(1) Agocs, S. Chiropractic’s Fight for Survival. https://pubmed.ncbi.nlm.nih.gov/23131408/
(2) Haavik-Taylor H, Murphy B. Cervical spine manipulation alters sensorimotor integration: A somatosensory evoked potential study.Clinical Neurophysiology. 2007; 118(2):391-402.
(3) Barwell R, Long A, Byers A, Schisler C. A Four Case Study: The effect of the Chiropractic adjustment on the brain wave pattern as measured by QEEG. Summarizing an additional100 (approximately) cases over a three year period. Private research.