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Undercover Investigations of Chiropractors

Stephen Barrett, M.D.

This article reports on the experiences of three children and seven adults who visited more than 100 chiropractors as part of various investigations. Thirty-one of these chiropractors were selected because they offered free consultations. Seventeen others were selected because they indicated that they treat children. The rest were chosen without regard for their marketing behavior or scope of practice. Some of the visits were audiotaped or videotaped with a concealed device. The rest were documented by notes made soon afterward. In my opinion, only two of the chiropractors gave appropriate advice.

"Check-Ups"

During the 1970s, I supervised a study in which a young woman took her healthy four-year-old daughter to five chiropractors for a "check-up." The woman, who was a practical nurse, had contacted me because she was afraid that her younger sister, who had started working for a chiropractor, was being "brainwashed" into having unnecessary "spinal adjustments" every week. When I expressed interest in seeing how chiropractors deal with healthy people, she eagerly volunteered to do some research.

At that time, about 25% of chiropractors in our community had engaged in advertising that was flamboyant and misleading. We decided to choose from among these first. The first said the child's shoulder blades were "out of place" and found "pinched nerves to her stomach and gallbladder." The second chiropractor showed a movie which stated that "chiropractic can also be effective in combating most childhood diseases." He said that the child's pelvis was "twisted" and advised that she have "adjustments, vitamins, and a check every four months." The third said one hip was "elevated" and that spinal misalignments could cause "headaches, nervousness, equilibrium or digestive problems" in the future. The fourth predicted "bad periods and rough childbirth" if her "shorter left leg" was not treated. He said he adjusted his own family once a week and recommended weekly checkups and adjustments for everyone else. The fifth not only found hip and neck problems, but also "adjusted" them without bothering to ask permission. Unfortunately, the adjustments were so painful that I decided to postpone further investigation until adult volunteers could be found.

The next volunteer, a healthy 29-year-old psychologist, visited four more chiropractors for check-ups. The chiropractors were selected from the telephone directory without regard to their advertising practices. The first diagnosed an "atlas subluxation" and predicted "paralysis in fifteen years" if this problem was not treated. The second found many vertebrae "out of alignment" and one hip "higher" than the other. The third said the woman's neck was "tight." The fourth said that misaligned vertebrae indicated the presence of "stomach problems." All four recommended spinal adjustments on a regular basis, beginning with a frequency of twice a week. Three gave adjustments without warning—one of which was so forceful that it produced dizziness and a headache that lasted for several hours.

Another volunteer, a 36-year-old housewife, visited seven more chiropractors selected without regard for their advertising practices. The first found "minor structural problems" in the neck, mid-back and lower spine regions and recommended four to six treatments. The second found nothing wrong. The third said the woman's left hip was lower than her right hip, adjusted a few areas of her spine (painfully) and suggested she return if she felt "sluggish." The fourth said her right hip and several vertebrae were "twisted." After pressing on the offending body parts, he suggested a return appointment in a week to see if the adjustments held. The fifth chiropractor thought there might be a serious problem with a "pinched nerve" in the neck that could cause "sinus trouble"—but he could not be sure without an x-ray. The sixth, who called himself a "herbologist," used muscle-testing to diagnose a "vitamin C deficiency" and indicated he could do extensive nutritional testing if requested. The seventh thought there was a hip problem, adjusted it, and recommended an x-ray for further diagnosis.

In 1979, I supervised a study in which 35 local chiropractors were interviewed by investigators posing as college students. The investigators contacted all of the chiropractors (approximately 50) listed in the local telephone directories and met with as many as they could. When the chiropractors were asked how often people who feel well should have their spine examined and adjusted, almost all recommended at least one checkup per year. The majority gave answers in the range of four to twelve times a year!

In 1981, Mark Brown, a reporter for the Quad-City Times, a newspaper in Davenport, Iowa, conducted a five-month investigation of chiropractors during which he visited about two dozen of them as a "patient." He reported that each one said he was a "chiropractic case," and that all but one insisted on x-rays before treatment. One chiropractor placed a potato and an egg on the reporter's chest to test the strength of his arms, held a magnet over his thymus gland, concluded that nutrient deficiencies were present, and sold him four bottles of "glandular" substances for $47.50. Another chiropractor was noted to diagnose patients by passing a cylindrical instrument over the patient's back and marking any spots over which the instrument makes a squeaking noise. Another claimed to diagnose subluxations by using an instrument that records temperature differences from one side of the spine to another. Another examined patients' eyes for markings he claimed would indicate what diseases were found within the body—a practice called iridology. Another told the reporter his ears were acting as "antennae for nerve energy" that had become congested in his diaphragm. Brown also reported that on one day during his investigation, one chiropractor told him his left leg was shorter than his right and another chiropractor told him just the opposite. Other chiropractors also told him that he suffered from hiatal hernia, "ileocecal valve syndrome," and "ocular lock." Copies of his fascinating 36-page report can be obtained for $6 from Quackwatch; Chatham Crossing Suite 107/208; 11312 US 15-501 North; Chapel Hill, NC 27517.

During 1989, William M. London, Ed.D., assistant professor of health education at Kent State University, visited 23 chiropractors in Ohio and Florida who had advertised free consultations or examinations. Every one of them espoused subluxation theory either during the consultation or in waiting-room literature, and all but two recommended periodic preventive maintenance. Seventeen performed examinations. Of these, three identified subluxations (at differing locations), three said his left leg was shorter than his right leg, and two said his right leg was shorter than his left. Seven recommended treatment, and one treated him with a motorized roller device before examining him.

In 1993, a healthy 25-year-old producer from WJW-TV in Cleveland, Ohio, visited three chiropractors who had advertised free examinations. The first one found nothing wrong (as had an orthopedist and a chiropractor used as consultants for the investigation). The second chiropractor, using a "biomagnetic scanner," diagnosed "underactive pituitary, underactive adrenal, underactive gallbladder, underactive kidney, and problems with the liver." The third chiropractor, whose comments followed a script distributed by a practice-building organization, told the producer he had "twisted vertebrae" and should have at least ten treatments. If he did not, the chiropractor claimed, the problem would insidiously get worse, "kind of like cancer. . . . You don't know it usually until it's the end."

Ear Infections

In 1994, ABC's "20/20" reported on visits to 17 chiropractors who had made it known through advertising or other means that they treated children. In one segment, an infant named Blake was taken by his mother to nine chiropractors in the New York metropolitan area, accompanied by a "friend" who was carrying a hidden camera. Blake had had recurring ear infections, a problem that a pediatrician said could be managed with antibiotics and would eventually be outgrown. Every chiropractor found a problem, and all said they could help and recommended care ranging from several weeks to a lifetime. The first found "a misalignment between the second and third bones in his neck." The second said it was "on the right side of his neck between the first and second bones." The third, using muscle-testing, found "weakness in the adrenal glands." The fourth said there was a subluxation because one of Blake's legs was shorter than the other. The fifth claimed he could diagnose the boy's problem by pulling on his mother's arm while she touched the boy on the shoulder. The sixth chiropractor did a similar test by pulling on the mother's legs while Blake lay on top of her back. After diagnosing "jamming of the occiput (the back bone of the skull)," the chiropractor said he corrected it by "lifting" Blake's occiput with his thumbs. He also said: (a) Blake needed work on his immune system, (b) learning disorder might be a problem, (c) both mother and son had "eyes that don't team too well," and (d) the cameraman, whom the chiropractor incorrectly assumed was the boy's father, had the same eye problem.

The same program also reported on visits to eight Wisconsin chiropractors by a five-year-old boy with chronic ear infections so severe that medical doctors wanted to insert tubes in his ears to drain them. All eight chiropractors found problems, but not usually the same ones. One diagnosed a pinched nerve in the boy's neck. Another said his left leg was shorter than his right. Another said his right leg was shorter than his left. Another diagnosed zinc deficiency. Another chiropractor blamed the boy's ear problems on "food sensitivities" and advised avoiding corn, cow's milk, and white flour. Another gave similar dietary advice but said that the main diagnosis was a "subluxation" in the top vertebra. Another said the boy didn't have an ear problem but had scoliosis—a diagnosis disputed by a pediatrician and a radiologist who reviewed this chiropractor's findings.

Serious Misdiagnosis

In 2002 and 2003, anesthesiologist John W. Kinsinger M.D., visited three chiropractors to test whether they would recognize the significance of symptoms that required urgent medical referral. One failed to recognize the classic symptoms of heart-related chest pain (angina) and attributed his symptoms to an out-of-place rib. The other two showed no apparent realization that his reported abdominal pain could be caused by appendicitis. All three recommended chiropractic care.

Significance

Because some of these studies were done long ago, and because some of the chiropractors were not chosen randomly, their findings cannot be used to calculate the current odds that consulting a chiropractor will yield appropriate advice. They certainly suggest that chiropractors who advertise flamboyantly or who purport to treat children are very likely to render inappropriate care. The studies also suggest that people considering chiropractic care should investigate carefully before making an appointment. A good first step would be to read Inside Chiropractic: A Patient's Guide, which traces chiropractic's history and provides the most detailed analysis of the chiropractic marketplace ever published.

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This article was revised on December 12, 2003.