Various organizations of practicing chiropractors have outlined formal codes of professional ethics. Actual practice has revealed a wide range of behaviors which may or may not conform to these standards.
The American Chiropractic Association (ACA) has a "Code of Ethics" [1] "based upon the acknowledgement that the social contract dictates the profession’s responsibilities to the patient, the public, and the profession; and upholds the fundamental principle that the paramount purpose of the chiropractic doctor's professional services shall be to benefit the patient." The smaller International Chiropractor's Association (ICA) also has a detailed set of professional canons. [2]
Various situations have occurred in which the ethics of chiropractors and chiropractic organizations have been called into question.
A 2008 commentary proposed that the chiropractic profession actively regulate itself to combat abuse, fraud, and quackery, which are more prevalent in chiropractic than in other health care professions, violating the social contract between patients and physicians. [3]
Gleberzon et al. identify "deliberate fraud" as a notably harmful element of the chiropractic profession, finding that dubious practice techniques can translate into "outlandish billing and utilization rates". [4] Those at the "fringe of ethical behavior" present the profession with a challenge, they believe, and must be weeded out. [4]
A study of California disciplinary statistics during 1997–2000 reported 4.5 disciplinary actions per 1000 chiropractors per year, compared to 2.27 for medical doctors, and the incident rate for fraud was nine times greater among chiropractors (1.99 per 1000 chiropractors per year) than among medical doctors (0.20). [5] According to a 2006 Gallup poll of U.S. adults, when asked how they would "rate the honesty and ethical standards of people in these different fields", chiropractic compared unfavorably with mainstream medicine. When chiropractic was rated, it "rated dead last amongst healthcare professions". While 84% of respondents considered nurses' ethics "very high" or "high," only 36% felt that way about chiropractors. Other healthcare professions ranged from 38% for psychiatrists, to 62% for dentists, 69% for medical doctors, 71% for veterinarians, and 73% for druggists or pharmacists. [3] [6] [7] [8] Similar results were found in the 2003 Gallup Poll. [9]
In 2001, the largest chiropractic associations in the U.S. and Canada were reported to have distributed patient brochures which contained unsubstantiated claims. [10] Chiropractors, especially in America, have a reputation for unnecessarily treating patients. In many circumstances the focus seems to be put on economics instead of health care. [11] [12] Sustained chiropractic care is promoted as a preventative tool, but unnecessary manipulation could possibly present a risk to patients. [13] Some chiropractors are concerned by the routine unjustified claims chiropractors have made. [13] A 2010 analysis of chiropractic websites found the majority of chiropractors and their associations made claims of effectiveness not supported by scientific evidence, while 28% of chiropractic websites advocate lower back pain care, which has some sound evidence. [14]
Although in the vast majority of US States chiropractors are considered physicians pursuant to statute[ citation needed ] (exceptions are inter alia, New York and California). The Joint Commission recognizes chiropractors as physicians as well. [15] In some jurisdictions, like New Zealand, chiropractors appeared to have used the title 'doctor' in a New Zealand yellow pages telephone directory in a way that implied they are registered medical practitioners, when no evidence was presented it was true. [16] In New Zealand, chiropractors are allowed to use the title 'doctor' when it is qualified to show that the title refers to their chiropractic role. A representative from the NZ Chiropractic Board states that entries in the yellow pages under the heading of 'Chiropractors' fulfills this obligation when suitably qualified. [17] If a chiropractor is not a registered medical practitioner, then the misuse of the title 'doctor' while working in healthcare will not comply with the Health Practitioners Competence Assurance Act 2003. [16]
UK chiropractic organizations and their members make numerous claims which are not supported by scientific evidence. Many chiropractors adhere to ideas which are against science and most seemingly violate important principles of ethical behaviour on a regular basis. The advice chiropractors gave to their patients is often misleading and dangerous. [18] In 2009, a backlash to the libel suit filed by the British Chiropractic Association (BCA) against Simon Singh, has inspired the filing of formal complaints of false advertising against more than 500 individual chiropractors within one 24-hour period, [19] [20] prompting the McTimoney Chiropractic Association to write to its members advising them to remove leaflets that make claims about whiplash and colic from their practice, to be wary of new patients and telephone inquiries, and telling their members: "If you have a website, take it down NOW." and "Finally, we strongly suggest you do NOT discuss this with others, especially patients." [19] An editorial in Nature has suggested that the BCA may be trying to suppress debate and that this use of British libel law is a burden on the right to freedom of expression, which is protected by the European Convention on Human Rights. [21] The libel case ended with the BCA withdrawing its suit in 2010. [22] [23]
Chiropractic is a form of alternative medicine concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially of the spine. It has esoteric origins and is based on several pseudoscientific ideas.
Naturopathy, or naturopathic medicine, is a form of alternative medicine. A wide array of pseudoscientific practices branded as "natural", "non-invasive", or promoting "self-healing" are employed by its practitioners, who are known as naturopaths. Difficult to generalize, these treatments range from the thoroughly discredited, like homeopathy, to the widely accepted, like certain forms of psychotherapy. The ideology and methods of naturopathy are based on vitalism and folk medicine rather than evidence-based medicine, although practitioners may use techniques supported by evidence. The ethics of naturopathy have been called into question by medical professionals and its practice has been characterized as quackery.
Osteopathy is a pseudoscientific system of alternative medicine that emphasizes physical manipulation of the body's muscle tissue and bones. In most countries, practitioners of osteopathy are not medically trained and are referred to as osteopaths.
In chiropractic, a vertebral subluxation means pressure on nerves, abnormal functions creating a lesion in some portion of the body, either in its action or makeup. Subluxations are not necessarily visible on X-rays.
Simon Lehna Singh, is a British popular science author, theoretical and particle physicist. His written works include Fermat's Last Theorem, The Code Book, Big Bang, Trick or Treatment? Alternative Medicine on Trial and The Simpsons and Their Mathematical Secrets. In 2012 Singh founded the Good Thinking Society, through which he created the website "Parallel" to help students learn mathematics.
Wilk v. American Medical Association, 895 F.2d 352, was a federal antitrust suit brought against the American Medical Association (AMA) and 10 co-defendants by chiropractor Chester A. Wilk, DC, and four co-plaintiffs. It resulted in a ruling against the AMA.
Spinal adjustment and chiropractic adjustment are terms used by chiropractors to describe their approaches to spinal manipulation, as well as some osteopaths, who use the term adjustment. Despite anecdotal success, there is no scientific evidence that spinal adjustment is effective against disease.
Spinal manipulation is an intervention performed on spinal articulations, synovial joints, which is asserted to be therapeutic. These articulations in the spine that are amenable to spinal manipulative therapy include the z-joints, the atlanto-occipital, atlanto-axial, lumbosacral, sacroiliac, costotransverse and costovertebral joints. National guidelines come to different conclusions with respect to spinal manipulation with some not recommending it, and others recommending a short course in those who do not improve with other treatments.
The National Association for Chiropractic Medicine(NACM) was a minority chiropractic association founded in 1984 that described itself as a "consumer advocacy association of chiropractors". It openly rejected some of the more controversial aspects of chiropractic, including a basic concept of chiropractic, vertebral subluxations as the cause of all diseases. It also sought to "reform the chiropractic profession away from a philosophical scope of practice and towards an applied science scope of practice." It stated that it was "dedicated to bringing the scientific based practice of chiropractic into mainstream medicine" and that its members "confine their scope of practice to scientific parameters and seek to make legitimate the utilization of professional manipulative procedures in mainstream health care delivery." "While the NACM is focused on furthering the profession, its primary focus is on the rights and safety of the consumers." The NACM was the object of much controversy and criticism from the rest of the profession. It quietly dropped out of sight and its demise apparently occurred sometime between May 30, 2008 and March 6, 2010.
The history of chiropractic began in 1895 when Daniel David Palmer of Iowa performed the first chiropractic adjustment on a partially deaf janitor, Harvey Lillard. Palmer claims to have had principles of chiropractic treatment passed along to him during a seance by a long-dead doctor named Dr. Jim Atkinson. While Lillard was working without his shirt on in Palmer's office, Lillard bent over to empty the trash can. Palmer noticed that Lillard had a vertebra out of position. He asked Lillard what happened, and Lillard replied, "I moved the wrong way, and I heard a 'pop' in my back, and that's when I lost my hearing." Palmer, who was also involved in many other natural healing philosophies, had Lillard lie face down on the floor and proceeded with the adjustment. The next day, Lillard told Palmer, "I can hear that rackets on the streets." This experience led Palmer to open a school of chiropractic two years later. Rev. Samuel H. Weed coined the word "chiropractic" by combining the Greek words cheiro (hand) and praktikos.
Chiropractors use their version of spinal manipulation as their primary treatment method, with non-chiropractic use of spinal manipulation gaining more study and attention in mainstream medicine in the 1980s. There is no evidence that chiropractic spinal adjustments are effective for any medical condition, with the possible exception of treatment for lower back pain. The safety of manipulation, particularly on the cervical spine has been debated. Adverse results, including strokes and deaths, are rare.
Throughout its history, chiropractic has been the subject of internal and external controversy and criticism. According to magnetic healer Daniel D. Palmer, the founder of chiropractic, "vertebral subluxation" was the sole cause of all diseases and manipulation was the cure for all disease. A 2003 profession-wide survey found "most chiropractors still hold views of Innate Intelligence and of the cause and cure of disease consistent with those of the Palmers". A critical evaluation stated "Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today." Chiropractors, including D.D. Palmer, were jailed for practicing medicine without a license. D.D. Palmer considered establishing chiropractic as a religion to resolve this problem. For most of its existence, chiropractic has battled with mainstream medicine, sustained by antiscientific and pseudoscientific ideas such as vertebral subluxation.
Sports chiropractic is a specialty of chiropractic. It generally requires post-graduate coursework and a certification or diplomate status granted by a credentialing agency recognized in a practitioner's region.
Osteomyology is a multi-disciplined form of alternative medicine found almost exclusively in the United Kingdom and is loosely based on aggregated ideas from other manipulation therapies, principally chiropractic and osteopathy. It is a results-based physical therapy tailored specifically to the needs of the individual patient. Osteomyologists have been trained in osteopathy and chiropractic, but do not require to be regulated by the General Osteopathic Council (GOsC) or the General Chiropractic Council (GCC).
Trick or Treatment? Alternative Medicine on Trial is a 2008 book by Simon Singh and Edzard Ernst. The book evaluates the scientific evidence for alternative medicines such as acupuncture, homeopathy, herbal medicine, and chiropractic, and briefly covers 36 other treatments. It finds that the scientific evidence for these alternative treatments is generally lacking. The authors concluded that homeopathy is merely a placebo.
The British Chiropractic Association (BCA) was founded in 1925 and represents over 50% of UK chiropractors. It is the largest and longest established association for chiropractors in the United Kingdom. The BCA have implemented campaigns regarding awareness of many modern technologies and the injuries that can result from them, such as RSI from smartphone and laptop use.
Daniel David Palmer was the founder of chiropractic. Palmer was born in Pickering Township, Canada West, but emigrated to the United States in 1865. He was also an avid proponent of pseudoscientific alternative medicine such as magnetic healing. Palmer opposed anything he thought to be associated with mainstream medicine such as vaccination.
British Chiropractic Association (BCA) v Singh was an influential libel action in England and Wales, widely credited as a catalytic event in the libel reform campaign which saw all parties at the 2010 general election making manifesto commitments to libel reform, and passage of the Defamation Act 2013 by the British Parliament in April 2013.
Anti-vaccinationism in chiropractic is widespread, but there are notable differences within the trade. Chiropractic is a form of alternative medicine founded on the idea that all disease is caused by disruption of the flow of "innate" in the spine, by so-called vertebral subluxations – a pseudoscientific concept. Over time chiropractic has divided into "straights" who adhere to the subluxation theory and "mixers" who adhere more closely to a reality-based view of anatomy. "Straight" chiropractors are very likely to be anti-vaccination, but all chiropractic training tends to reduce acceptance of vaccines.
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