Sunday, August 9, 2015

Chiropractors Must Join MDs, DOs, Podiatrists, Dentists, Nurses, OT, PT, etc. in Embracing Science

I am a pretty new 4th year medical student who has spent a grand total of 1 year on the wards. Despite this paucity of clinical experience, I have now personally seen 2 patients who have had strokes after chiropractors "adjusted" their necks. This is not an unknown phenomenon:

Some chiropractors apparently think it's okay to do this extremely dangerous procedure on 6 year old kids.

This procedure needs to be banned. And perhaps the profession of chiropractic as well (I jest, but only slightly). Their entire field is based on a scientifically disproven theory of disease. (Subluxations aren't a thing. Period.) It's the equivalent of bleeding someone to release the evil humors and make them better.

Now, it should be remembered that folks with an MD next their name weren't exactly the white knights of the scientific method 100 years ago.  But we have come a long way since then.  Medicine is art and science, and sometimes we have to use our basic knowledge and make an educated guess as to the best treatment for a patient.  I saw such a case just today in a patient with repeated SVC thrombosis after we already tried to take out the clot once.  We tried something new.  Would it work?  We had no scientific evidence either way.  But we figured we had to give it a shot.  However, we based this decision on facts which are scientifically known: how to sterilize instruments, how to attach blood vessels, how to place someone on cardiopulmonary bypass, etc.  Even when we are trying something new, we base it on underlying science.

Chiropractors literally base their treatments on mostly nothing.  There is zero clear data that manual cervical manipulation actually helps neck pain.  Meanwhile, the odds ratio for people under 45 years old who had a stroke was 5:1 for visiting a chiropractor in the one week before the stroke.  Now, the scientist in me is honor-bound to say that correlation is not causation- it is conceivable that people simply visit chiropractors when they have neck pain, which is actually from a neck artery dissection which will lead to a stroke.  But, the evidence seems plenty concerning.  And in light of the total lack of evidence of any benefit from neck adjustments, we might want to rethink letting any patients undergo the treatment, with an exception for volunteers willing to take part in an experiment to prove it's safety and efficacy.

It is encouraging that some individuals, schools, and groups are trying to move the field towards a more scientific basis.  But at the same time the field is being dragged back by many others- like the ones in California who made Chiropractors the only health group in California to oppose SB 277, the bill to make vaccines mandatory for any child attending public school.  Others tried to sue for libel a popular British science writer who wrote about the misleading claims made by many chiropractors- but faced a furious backlash for it- to the point where British libel laws were literally rewritten because of the case.  Chiropractors need to clean up their act as allopathic and osteopathic medicine did over 100 years ago, and start basing their treatments on science and not what feels good and looks impressive.