Don't Let Chiropractors Fool You

Chiropractors claim their profession was founded in 1895 when Daniel David Palmer restored the hearing of a deaf janitor by "adjusting" a bump on his spine. Soon afterward, he concluded that misaligned bones ("subluxations") interfered with the body's expression of "Innate Intelligence" -- the "Soul, Spirit, or Spark of Life" that controlled the healing process.

Although philosophy and treatment vary greatly from one practitioner to another, most of today's 60,000-or-so chiropractors can be classified as "straights" or "mixers." Straights tend to cling to Palmer's doctrine that most diseases are caused by misaligned spinal bones ("subluxations") correctable by spinal adjustment. Some straights, however, maintain that they neither diagnose nor treat diseases, but confine themselves to detecting and correcting vertebral subluxations. Mixers acknowledge that factors such as germs and hormones play a role in disease, but they tend to regard mechanical disturbances of the nervous system as the underlying cause of lowered resistance to disease. Louis Sportelli, D.C., who later became chairman of the American Chiropractic Association's board of governors, expressed this concept in a pamphlet called "What Kinds of Conditions Do Chiropractors Treat?" which he distributed in the 1980s. The pamphlet stated:

In addition to spinal manipulation, mixers may prescribe nutrient concoctions, homeopathic products, and various types of physiotherapy (heat, cold, traction, exercise, massage, and ultrasound). Straights tend to disparage medical diagnosis, claiming that examination of the spine is the proper way for chiropractors to analyze their patients. Mixers are more likely to diagnose medical conditions in addition to spinal abnormalities, and to refer patients to medical practitioners for treatment. Some practitioners claim that chiropractic treatment is effective against nearly the entire range of human ailments. A small percentage of chiropractors reject Palmer's dogma and treat only musculoskeletal problems. I do not believe that spinal manipulation is effective against other problems.

Although chiropractors have promoted these reports as endorsements of chiropractic, they are not. They merely support the use of manipulation in carefully selected patients. Only a few of the research studies on which their conclusions were based involved manipulation by chiropractors; most were done by medical doctors and physical therapists whose practices are not identical to those of chiropractors. Most chiropractors manipulate the vast majority of patients who walk through their door, some use techniques that have not been studied scientifically, and many urge all of their patients to undergo monthly or even weekly "preventive maintenance" visits throughout their life. In addition, many chiropractors emphasize a technique that is more vigorous (and therefore less safe) than the controlled manipulation used by other practitioners.

The only places where "chiropractic" and "chiropractors" are mentioned in the body of the AHCPR report are in the passages about the make-up of the AHCPR expert panel.

Most chiropractors claim that x-rays help them locate the "subluxations" that D.D. Palmer envisioned. But they do not agree among themselves about what subluxations are. Some chiropractors believe they are displaced bones that can be seen on x-rays and can be put back in place by spinal adjustments. Others define subluxations vaguely or say they do not necessarily show on x-rays. But what chiropractors contend about x-rays also depends upon who asks and how the question is posed.

Chiropractic coverage under Medicare, which began in 1973, was limited to manual manipulation of the spine for the treatment of "subluxations demonstrated by x-rays to exist." To enable payment, federal officials accepted an elaborate chiropractic "definition" of subluxations for which payment could be made. During the mid-1980s, the U.S. Department of Health and Human Services' Office of the Inspector General (OIG) surveyed 145 chiropractors by telephone about their billing practices. Eighty-four percent said that some subluxations do not show on x-rays. Nearly half responded that when billing Medicare, they "could always find something" (by x-ray or physical examination) to justify the diagnosis, or they actually tailored the diagnosis to obtain reimbursement. The OIG's report noted that chiropractic manipulation was the ninth most frequently billed procedure under Medicare during 1983.

In 1997, after many years of intense lobbying, chiropractors persuaded Congress to remove the mandatory x-ray provision. The Balanced Budget Act of 1997 eliminates the requirement as of January 1, 2000, and requires the Secretary of Health and Human Services to develop and implement utilization guidelines for chiropractic coverage when a subluxation has not been demonstrated by X-ray.

Managed-care plans provide unlimited access to one's primary physician, but specialized care must be authorized by that physician -- usually a family practitioner. Chiropractors are worried that if they cannot be accessed directly, their income will suffer.

Moreover, in communities where managed care predominates, nonparticipating chiropractors could lose their ability to earn a living. Chiropractic leaders are attempting to deal with this threat by claiming that chiropractors are primary-care providers to whom patients should be given access without referral.

In line with this viewpoint, most chiropractors claim they can diagnose conditions within their scope and refer the rest to appropriate providers. However, clinical training in chiropractic schools is vastly inferior to that in medical schools. Whereas medical school faculties are large and contain experts in virtually every aspect of medical practice, chiropractic schools have little or no input from medical experts. Whereas medical students see patients encompassing the full range of disease, most patients seen by chiropractic students have musculoskeletal problems. Although some of their courses are based on standard medical textbooks, chiropractic students lack the clinical experience necessary to make the information meaningful. Chiropractic schooling in such subjects as pediatrics, obstetrics, and gynecology is usually limited to classroom instruction with little or no actual patient contact and no experience with hospitalized patients. One school, for example, has used only rubber models to teach students how to perform pelvic and rectal examinations! The thousand-member Federation of Straight Chiropractors and Organizations (FSCO) asserts that chiropractic practice should be limited to the analysis and correction of "subluxations." FSCO asserts that chiropractors are neither licensed nor trained to diagnose medical problems or make medical referrals. Large percentages of chiropractors do not believe that immunizations are effective and do not recommend them to their patients .

For these reasons and more, the claim that chiropractors are generally qualified to be "primary-care providers" is absurd.

The usual cause of the strokes was thought to be tearing of the vertebral artery walls . A recent review of 116 articles published between 1925 and 1997 found 177 cases of neck injury associated with neck manipulation, at least 60% of which was done by chiropractors .

Anderson R. Chiropractors for and against immunization. Medical Anthropology 12:169-186, 1990.

To what extent can chiropractors help people? Does it ever make sense to seek chiropractic care? If so, how can a reliable chiropractor be found? These questions -- which are not simple to answer -- are thoroughly discussed in Chiropractic: The Victim's Perspective (1995), written by George J. Magner, III, and Inside Chiropractic: A Patient's Guide (1999), by Samuel Homola, D.C. Both were edited by me and published by Prometheus Books.

Let's face the real isue. The chiropractic and medical professions have similar goals. MD's are disease care doctors. Chiropractors are health care doctors. You treat disease. We aim to clear the cause of disharmonies in the body's operating machinery that we deem negative to the efficient operation of the body. The medical profession seeks to alter the body's chemistry to correct an affect of some cause. In the majority of cases that I have been exposed to MD's only treat symptoms. Do you think that the body regulates itself and is self sufficient? If you do, then do you believe that instances exist where that ability or abilities might become compromised? As a chiropractor I strive to locate those entities and aid the body in ridding itself of those negative disharmonies in order to facillitate the body doing its thing in a better way. Adapt or die. If you can't adapt to all the environmental forces you come into contact with sooner or later your system will be overwhelmed. In closing I will say that I am not anti-medicine. But I am pro-chiropractic and as a patient I feel like I have had a better quality of life with chiropractic care. We see things different yes. But, don't knock something until you have tried it. . . . I thank you for your time and attention. Merry Christmas and have your spine checked.

A Message to Chiropractors:

My chiropractic source materials include hundreds of books, thousands of journals, and tens of thousands of assorted publications, audiotapes, videotapes, advertisements, correspondence, and other documents. Many have come unsolicited from chiropractors who happen to think that what I'm doing is valuable. This article discusses some of chiropractic's shortcomings and steps that could be taken to correct them. It updates my 1988 presentation on this topic to the American Chiropractic Association's House of Delegates.

Do chiropractors treat "pinched nerves?" Do they release "nerve energy?" Is "choked off" nerve energy the source of disease? There isn't the slightest scientific basis for such beliefs. If you don't abandon them completely, along with the term "subluxation," you will be considered quacks and cultists by the scientific community whether they say so openly or not.

On the other hand, it is clear that chiropractors help people. I'm not quite sure how, and I'm not sure that you know either. But some of you are obviously doing something right. I am not sure who or what you should be treating. I'm not sure this is clear to you either—and it won't be clear to me until it's clear to you. I would suggest that you make an attempt to define your scope. That won't be simple to do, but as long as your scope is undefined, you are going to be criticized for exceeding it.

Then there is the issue of x-rays. I doubt that 14" x 36" full-spine films yield much useful information. The percentage of chiropractors utilizing such films for screening purposes is no longer high, but it is still too high.

Then there "preventative maintenance." Years ago, on a radio talk show, I had an interesting discussion with Arnold Cianciulli, D.C., a prominent New Jersey chiropractor who later became a board member of the Chiropractic Foundation for Education and Research. He and I seemed to agree on what would be improper for chiropractors to do, but we disagreed on what percentage were acting improperly. He thought there were just a few, while I thought there were many. During the program, five chiropractic patients called in to criticize me. Upon questioning, all five said they had been seeing their chiropractor once a week for ten years. I don't think people who feel well should come weekly or monthly for life to have their spine examined and "subluxations" adjusted. I don't know how many chiropractors recommend this, but it is clear that too many do so. Investigations have been conducted by people who went to several chiropractors and said they felt well but wanted a checkup. Almost all of the chiropractors recommended treatment, but there was little or no agreement about what needed treatment.

There are also abuses in the area of nutrition. The number of people who can benefit from high doses of vitamins is very limited. Moreover, I don't believe that any disease for which megavitamin therapy is actually appropriate falls within within the scope of chiropractic. Diseases of this type are seldom appropriate for general medical practitioners either, but are usually treated by medical specialists. Yet many chiropractors prescribe megavitamins to their patients.

I know that some chiropractors understand scientific nutrition principles and use them to advise patients properly. However, I also know there are chiropractors who are doing unscientific nutrition. At least a dozen companies market "dietary supplements" that contain little bits of animal glands, enzymes, vitamins and/or minerals. Some of these companies market hundreds of concoctions that don't have the slightest use for anybody. These concoctions are marketed through seminars and books that indicate how to "prescribe" them. I have several such books. One lists more than a hundred diseases and five or six supplements for each. It is illegal to market supplements for the treatment of disease without FDA approval. It is also unscientific and unethical. Companies marketing such supplements advertise repeatedly in chiropractic journals.

Surveys by the National Board of Chiropractic Examiners (NBCE) have repeatedly asked chiropractors whether "nutritional counseling, therapy, or supplements" was part of their practice. Large majorities have said it was. I don't know how many of these were prescribing supplements inappropriately, but I suspect it was nearly all of them.

Chiropractors seem to gravitate in a higher percentage than other professions into some very strange things. I happen not to believe in "applied kinesiology." I don't believe that each disease is accompanied by a weak muscle or that putting a potato on your chest or sugar under your tongue and then pulling on a patient's arm can yield any useful information. Yet it's being done. The NBCE surveys have also found that more than 30% of chiropractors said they practiced homeopathy. Homeopathic products are worthless.

There is also widespread confusion about spinal "adjustment." There seem to be about 100 systems of manipulative treatment. It's hard to imagine that they are all equally valid. If some are not, why haven't chiropractors abandoned them?

There is also the problem of inappropriate charges. I've seen bills totaling thousands of dollars per month for services. Some practice-builders and equipment sellers teach how to charge these fees. Practice-builders state that thousands of chiropractors attend their seminars and use their services. Manufacturers of worthless devices advertise through chiropractic publications and exhibit their wares at chiropractic conventions. Some chiropractors pay thousands of dollars to learn deceptive practice-building techniques.

Let me tell you how chiropractors are perceived by the insurance industry. Several years ago, I gave a talk to senior claims examiners representing more than a hundred companies. When I asked how many service chiropractic claims, 160 hands went up. But when I asked how many were not having trouble with chiropractic claims, not one hand was raised. As far as I can tell, nearly every insurance company that is handling chiropractic claims has a very low opinion of your profession. I would not suggest that you attribute that to outside enemies. The insurance companies simply represent themselves. They're not organized in any way. They look at the claims and they are horrified.

The way you are perceived by the medical profession is very difficult to document because nobody seems interested in taking a sophisticated survey. During the past twenty years there has been a modest increase in the number of referrals between medical doctors and chiropractors. Chiropractors regard this as "acceptance" by medical doctors. However, I can assure you that the average physician still views chiropractic very harshly.

Your basic enemy is yourself: your colleagues engaged in unscientific practices, economic ripoffs, cheating insurance companies, opposing vaccination, selling unnecessary supplements, and generally overselling themselves. Most chiropractors would like to believe that the number of such colleagues is small. I think it is large and is probably a large majority.

Can "mainstream" chiropractic somehow cast off chiropractors who recommend weekly or monthly visits for life, who prescribe worthless and illegal nutrition supplements, who charge $500 or more for an initial visit, or who utilize applied kinesiology, contact reflex analysis, or other bizarre diagnostic practices? Who would be left?

Over the years, a number of chiropractors have approached me for help. Some, for example, said: "I want to practice scientifically. What can I do? How can I get on a hospital staff?" Some were having difficulty in gaining permission to attend lectures at hospitals in their community. In every case, I offered to use my influence to help them get permission to do so and advised that doing this might eventually provide an opportunity to demonstrate that what they did was useful enough to warrant staff privileges.

To establish credibility with the scientific community (which extends beyond the medical profession), you have to do meaningful research. There are also some other things that you ought to do that won't cost a penny. To begin with, endorse water fluoridation. Chiropractors have been in the forefront of political battles against fluoridation as well as against immunization. If you want scientific credibility, you had better reverse those processes and come out on the side of science. And do something about cigarettes, the nation's leading cause of premature deaths. Why haven't chiropractors and chiropractic groups been fighting to ban cigarette promotion, raise cigarette taxes, and ban smoking in public places?

Undercover Investigations of Chiropractors

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.

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.

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.

Another volunteer, a 36-year-old housewife, visited seven more chiropractors selected without regard for their advertising practices.

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, P.O. Box 1747, Allentown, PA 18105.

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.

In 1993, a healthy 25-year-old producer from WJW-TV in Cleveland, Ohio, visited three chiropractors who had advertised free examinations.

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.

In 2002 and 2003, anesthesiologist John W. Kinsinger M.D., visited three chiropractors to test whether they would recognize th significance of symptoms that required urgent medical referral.

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.

Kinsinger JW. My Visits to Three Chiropractors

Manipulation is most readily available from chiropractors, however, and a report issued by the RAND Corporation stated that 94% of all such manipulation in the United States is done by chiropractors . For this reason, many people who have back pain will visit a chiropractic office where they will experience spinal manipulation for the first time.

Obviously, many people with back pain are going to chiropractors, and most of them are satisfied with the care they receive. But many are unaware of the controversy and the nonsense associated with some forms of chiropractic treatment and often become victims of misinformation.

It is now generally accepted that spinal manipulation can relieve some types of back pain. Most chiropractors claim to do more than just treat back pain, however. Clinging to the scientifically rejected theory that misasligned or "subluxated" vertebrae cause "nerve interference" that results in disease or ill health, many chiropractors use "spinal adjustments" to treat disease and infection as well as back pain. The Association of Chiropractic Colleges bolstered support for this theory in 1996 when the presidents of all 16 North American chiropractic colleges reached a consensus and issued a position paper stating that "Chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on the subluxation." .

The chiropractic profession continues to define itself as a method of correcting subluxations to restore and maintain health, despite the fact that there are no scientific studies to indicate that vertebral misalignment or any other problem in the spine is a cause of disease or infection. Basing their treatment on the vertebral subluxation theory, many chiropractors claim to be primary care physicians capable of treating and preventing a broad scope of human (and animal) ailments.

Some chiropractors advise that spinal adjustments should begin at birth to correct subluxations caused by "birth trauma." The entire family may be advised to undergo regular life-long spinal adjustments in order to maintain optimum health by "keeping the spine in line." Some chiropractors specialize in chiropractic pediatrics. According to the American Chiropractic Association, 10% of patient visits to chiropractors are made by children and adolescents who are treated for such maladies as otitis media, asthma, allergies, infantile colic, and enuresis (bedwetting).

Studies conducted by chiropractors and published in "peer reviewed" chiropractic journals often recommend treatment for such conditions as infantile colic and asthma. A study published in the Journal of Manipulative and Physiological Therapeutics for example, concluded that "Spinal manipulation is effective in relieving infantile colic" -- a conclusion not confirmed with reliable, unbiased research and recently refuted by a well designed study by a Norwegian research team .

Since chiropractors work on the back, most people think of the chiropractor as a back specialist. But when back-pain victims visit a chiropractic office, they may be given pamphlets suggesting that chiropractic treatment is also beneficial for asthma, infantile colic, ear infection, digestive disturbances, and a host of other organic or visceral problems. There are many good chiropractors who do a good job treating back pain, but few voluntarily limit their treatment to the care of back pain. Chiropractic colleges are still teaching the theory that using spinal adjustments to correct vertebral subluxations will restore and maintain health.

Chiropractors who believe that slightly misaligned vertebrae can cause disease often use machines or small hand-held spring-loaded mallets to tap misaligned vertebrae back into place. A 1998 survey by the National Board of Chiropractic Examiners found that 62.8% of survey respondents said they used an Activator mallet to adjust subluxations . Such chiropractors might also use instruments to measure heat and electrical activity over skin surfaces in a search for subluxations. The only treatment they may offer is a spinal adjustment for whatever ails you.

A chiropractor who is reasonably competent in making a diagnosis might immediately refer you to a specialist if certain red flags are present, such as: fever; a history of cancer; prolonged back pain unrelieved by rest; the possibility of a fracture resulting from advanced age, long-term use of steroids, or severe injury; and so on. In the case of a simple strain, you might be advised that rest and time are the 'best treatment. But you cannot always rely on the diagnostic ability of a chiropractor. Some chiropractors "analyze" the spine in a search for subluxations rather than make a diagnosis. They always find subluxations that require spinal adjustments. Such chiropractors are less likely to offer appropriate advice and are more likely to subject you to prolonged and unnecessary treatment.

Chiropractic patients often interpret these sounds as movement of vertebrae that are out of place. Some chiropractors use the popping sound to encourage patients to return for regular spinal adjustments in order to "maintain vertebral alignment." While such treatment has a strong placebo effect, it is misleading and tends to perpetuate illness or fear of illness.

Some subluxation-based chiropractors believe that most ailments, including low-back pain, are related to misaligned vertebrae in the neck. These "upper cervical specialists" always adjust the neck, usually the top two vertebrae at the base of the skull. This can be dangerous, since excessive rotation of the head and upper cervical spine places a strain on the vertebral arteries and can result in vascular injury or stroke.

There are special cases in which cervical manipulation can be beneficial when vascular problems have been ruled out and head rotation during manipulation does not exceed 50 degrees. But cervical manipulation should never be done routinely, especially as a preventive-maintenance measure. Most of us will never need cervical manipulation. Upper cervical chiropractors who manipulate the neck of every patient they see should be avoided. Elderly persons, especially those who have vascular disease or who might be taking blood thinners, should not submit to neck manipulation of any kind.

Chiropractors commonly manipulate the upper cervical spine as a treatment for head and neck pain. But since such pain in itself can be a symptom of vertebral or carotid artery dissection, especially following injury, it may be wise to forego neck manipulation for sudden onset of head or neck pain until risk factors can be better identified. Informed consent should always be obtained from patients about to undergo cervical manipulation. In many cases, massage, traction, and other forms of therapy can be substituted for prescribed cervical manipulation. Tension headache, for example, is commonly treated with chiropractic neck manipulation. A study published in the Journal of the American Medical Association found that spinal manipulation was no more effective than massage in relieving episodic or recurring tension headache . So be cautious.

But until the chiropractic profession cleans up its act, and its colleges uniformly graduate properly limited chiropractors who specialize in neuromusculoskeletal problems, you'll have to exercise caution and informed judgment when seeking chiropractic care.

Chiropractors also disagree on whether their "subluxations" are visible on x-ray films. "Straight" chiropractors tend to believe that they cause nerve interference, are readily visible, and that virtually everyone gets them. Most other chiropractors (commonly referred to as "mixers") define subluxations loosely and see them when it suits their convenience. Chiropractors who reject subluxation theory consider them invisible but have been forced to acknowledge them to get paid by Medicare. When a respected chiropractic researcher was asked whether he had ever seen a subluxation on an x-ray film, he smiled and jokingly replied, "With my eyes closed."

Chiropractors do not make the claim to be able to read a specific subluxation from an x-ray film. can read spinal distortion, which indicates the possible presence of a subluxation and can confirm the actual presence of a subluxation by other physical findings .

In 1973, Congress authorized payment under Medicare for chiropractic treatment of "subluxations demonstrated by x-rays to exist." In 1972, to enable payment, chiropractors held a consensus conference that redefined "subluxations" to include common findings that others could see. The document, several pages long, described the supposed x-ray manifestations of 18 types of "subluxations," including "flexion malposition," "extension malposition," "lateral flexion malposition," "rotational malposition," "hypomobility" (also called "fixation subluxation"), "hypermobility," "aberrant motion," "altered interosseous spacing," "foraminal occlusion," scoliosis, and several conditions in which "gross displacements" are evident . I have been unable to determine how many billions of dollars chiropractors have received from Medicare since the law took effect.

Chiropractors also differ about how to find "subluxations" and where they are located. In addition to seeing them on x-ray films, chiropractors say they can find them by: (a) feeling the spine with their hand, (b) measuring skin temperature near the spine with an instrument, (c) concluding that one of the patient's legs is "functionally" longer than the other, (d) studying the shadows produced by a device that projects a beam of light onto the patient's back, (e) weighing the patient on special scales, and/or (f) detecting "nerve irritation" with a device. Undercover investigations in which many chiropractors have examined the same patient have found that the diagnoses and proposed treatments differed greatly from one practitioner to another.

Rondberg is president of the World Chiropractic Alliance (WCA), a group that promotes subluxation-based practice and is president of Chiropractic Benefit Services, a malpractice company that insures subluxation-based chiropractors. He also publishes The Chiropractic Journal (a newspaper for chiropractors), the Journal of Vertebral Subluxation Research and WCA News/ Health Watch (a weekly electronic newsletter that attacks what it considers to be "the dangers and abuses of medical and drug interests."). VSRI taught chiropractors how to recruit "research volunteers" and convert them into lifetime chiropractic patients. Its chiropractor clients were instructed to use telemarketing and other approaches to ask people to volunteer for a nationwide study on spinal conditions. During the first office visit they would be examined and given a brochure—"The Silent Killer"—which explains how subluxations can be caused by physical, chemical, and emotional trauma. (The brochure claimed, for example, that food additives, air pollutants, spoiled food, fear, worry, hate, greed, sadness, grief, emotional shock, and severe disappointment can cause muscle spasms that result in subluxations.) During the second visit, they would be advised to have their subluxations treated. TheVSRI program was concluded in 1991 . A subsequent WCA survey found that 65% of members who responded said that their patient education material referred to the vertebral subluxation as the "silent killer."

The FTC claims that chiropractors can only tell patients that chiropractic care can be beneficial for low back pain. Nothing else, not subluxations, wellness, headaches, sciatica, allergies, children's health, ear infections, whiplash, etc. Although Koren Publications' literature states that chiropractic is not the treatment of diseases but the correction of vertebral subluxations, the FTC doesn't like the "impression" we're giving the public and patients .

Although Dr. Koren's specific message is somewhat different from Dr. Rondberg's, their activities are quite similar. Both sell books and pamphlets which sometimes are distributed by chiropractors, and both are strong advocates of the benefits of chiropractic care. . . .

Dr. Rondberg does not believe that chiropractic is a direct cure or even a treatment for any disease or condition other than vertebral subluxation. However, all chiropractors believe that keeping the spine healthy and correcting spinal nerve interference can have a beneficial effect, and may sometimes lead to a resolution of some medical conditions. But Dr. Rondberg stresses that the purpose of chiropractic is to correct spinal nerve interference, not to treat any disease or medical condition .

Not all chiropractors regarded the FTC investigation as unwarranted.

To what extent can chiropractors help people? Does it ever make sense to seek chiropractic care? If so, how can a reliable chiropractor be found? These questions—which are not simple to answer—are thoroughly discussed in Chiropractic: The Victim's Perspective (1995), written by George J. Magner, III, and Inside Chiropractic: A Patient's Guide (1999), by Samuel Homola, D.C. Both were edited by me and published by Prometheus Books.

1. In order to bash something, you have to know what it is first. ALL chiropractors know that we can't heal anything, it is the body that does the healing.

All we do is help the body maintain its normal function. In order to function normally, the nervous sytem must be able to flow freely, because it is the nervous system that basically controls everything else in the body. Whether it directly controls something such as muscles, or indirectly like enzyme release, it does effect every part of the body. In the course of the entire body, it is possible for the nerve to be compressed, either by bone directly, or by surrounding soft tissue. This works just like stepping on a water hose. If you step on a hose, the water coming out the end slows, and if you step hard enough, it stops. The same is basically true of nerves. If the nerve is compressed, then the nerve impulse is inhibited, if not completely stopped, thus affecting the area innervated by that nerve. Hopefully you will agree that if a specific muscle or other tissue loses its innervation, it will begin to atrophy, and can possibly die completely. All chiropractors do is move the surrounding bone and or soft tissue to relieve the compression on the nerve, thus allowing it to flow freely. The body can heal itself better than any drug can, and I think you know that.

In general, western medicine's philosophy of health in a pill is over-prescribed and harmful. . . . Millions are seeking alternatives, there is an innate healing power of the body, and chiropractors are well trained, intelligent health care providers. Much of the physiology of the body is still unknown, open your mind to new possibilities or you will be left behind.

Chiropractic leaders misrepresent the significance of workers' compensation studies which found that patients treated by chiropractors were more satisfied and returned to work sooner than patients treated medically. These studies did not scientifically validate what the chiropractors did and were not designed for that purpose. Although most contain data appearing to favor chiropractic, their authors did not evaluate whether the patients had comparable problems. In addition, the duration and costs of disability and time lost from work are influenced by factors other than effectiveness.

In 1995, the New England Journal of Medicine published a study comparing the cost of low-back pain treatment by family physicians, orthopedists, and chiropractors in North Carolina. The median total charges were $545 by urban chiropractors, $383 by orthopedists, $348 by rural chiropractors, $214 for rural primary-care physicians, and $169 for urban primary-care physicians. Although chiropractors charged less per visit, their treatment was costlier because they saw their patients about five times as often .

Additional data were collected at the Group Health Cooperative, a staff model HMO in Madison, Wisconsin. Dan Futch, D.C., chief of chiropractic practice, found that the patients he saw require an average of three visits per episode, considerably fewer than the average reported for chiropractors in other settings. Futch was also executive director of the National Association for Chiropractic Medicine, a small group of medically oriented chiropractors who renounced chiropractic's unscientific dogma.

Many chiropractors believe that after a painful condition resolves, patients should continue indefinitely for "maintenance care." Many also believe that every spine should be examined and adjusted monthly or weekly throughout life. No evidence exists that either of these approaches benefits patients. Managed care can limit overutilization by excluding chiropractors who practice unscientifically and setting limits on the rest. Rather than raising their standards, chiropractors have file lawsuits and ask legislators to break down managed-care barriers.

Dr. Futch's experience demonstrates that scientifically oriented chiropractors (a tiny minority of practitioners) can be integrated into managed care. What about acupuncturists, homeopaths, naturopaths, and unscientific chiropractors?

Naturopathy is based on the notion that diseases are the body's effort to purify itself and that cures result from enhancing the body's ability to heal itself. Naturopathic treatments can include "natural food" diets, vitamins, herbs, tissue minerals, cell salts, manipulation, massage, exercise, diathermy, colonic enemas, acupuncture, and homeopathy. Like some chiropractors, many naturopaths believe that virtually all diseases are within the scope of their practice. I don't see how practitioners involved in so much nonsense can fit into a science-based health-care team.

Chiropractic encompasses a broad spectrum of practices related to the false premise that spinal misalignments ("subluxations") are the cause, or underlying cause, of most ailments. Chiropractic's founder postulated that the body's "vital force," which he termed "Innate," expresses itself through the nervous system. Chiropractors who cling strictly to this notion allege that subluxations cause most illnesses by interfering with the flow of "nerve energy" to body organs. Most chiropractors acknowledge the importance of other factors in disease but tend to regard mechanical disturbances of the nervous system as an underlying cause. Many chiropractors engage in unscientific diagnostic procedures, prescribe inappropriate food supplements, and utilize homeopathic remedies. Small percentages denounce chiropractic's basic dogmas, spurn its unscientific practices, and confine their practice to musculoskeletal problems. Thus while virtually all chiropractors manipulate the spine as their primary method of treatment, their rationale and techniques vary considerably. Many homeopaths, naturopaths, and chiropractors are lukewarm or opposed to immunization.

1. Carey TS and others. The outcomes and costs of care for acute low back pain among patients seen by primary care practitioners, chiropractors, and orthopedic surgeons. New England Journal of Medicine 333:913-917, 1995.

The survey was sponsored by the American Heart Association. A total of 177 neurologists reported treating 56 such patients, all of whom were between the ages of 21 and 60. One patient had died, and 48 were left with permanent neurologic deficits such as slurred speech, inability to arrange words properly, and vertigo (dizziness). The usual cause of the strokes was thought to be a tear between the inner and outer walls of the vertebral arteries, which caused the arterial walls to balloon and block the flow of blood to the brain. Three of the strokes involved tears of the carotid arteries . In 1991, according to circulation figures from Dynamic Chiropractic, California had about 19% of the chiropractors practicing in the United States, which suggests that about 147 cases of stroke each year were seen by neurologists nationwide. Of course, additional cases could have been seen by other doctors who did not respond to the survey.

Louis Sportelli, DC, NCMIC president and a former ACA board chairman contends that chiropractic neck manipulation is quite safe. In an 1994 interview reported by the Associated Press, he reacted to the American Heart Association study by saying, "I yawned at it. It's old news." He also said that other studies suggest that chiropractic neck manipulation results in a stroke somewhere between one in a million and one in three million cases . The one-in-a-million figure could be correct if California's chiropractors had been averaging about 60 neck manipulations per week. Later that year, during a televised interview with "Inside Edition," Sportelli said the "worst-case scenario" was one in 500,000 but added: "When you weigh the procedure against any other procedure in the health-care industry, it is probably the lowest risk factor of anything." According to the program's narrator, Sportelli said that 90% of his patients receive neck manipulation.

In 1996, RAND issued a booklet that tabulated more than 100 published case reports and estimated that the number of strokes, cord compressions, fractures, and large blood clots was 1.46 per million neck manipulations. Even though this number appears small, it is significant because many of the manipulations chiropractors do should not be done. In addition, as the report itself noted, neither the number of manipulations performed nor the number of complications has been systematically studied . Since some people are more susceptible than others, it has also been argued that the incidence should be expressed as rate per patient rather than rate per adjustment.

A 1999 review of 116 articles published between 1925 and 1997 found 177 cases of neck injury associated with neck manipulation, at least 60% of which was done by chiropractors .

One gets the impression that the risks of spinal manipulation are being played down, particularly by chiropractors. Perhaps the best indication that this is true are estimates of incidence rates based on assumptions, which are unproven at best and unrealistic at worse. One such assumption, for instance, is that 10% of actual complications will be reported. Our recent survey, however, demonstrated an underreporting rate of 100%. This extreme level of underreporting obviously renders estimates nonsensical .

In 2006, the Journal of Neurology published a German Vertebral Artery Dissection Study Group report about 36 patients who had experienced vertebral artery dissection associated with neck manipulation . Twenty-six patients developed their symptoms within 48 hours after a manipulation, including five patients who got symptoms at the time of manipulation and four who developed them within the next hour. In 27 patients, special imaging procedures confirmed that blood supply had decreased in the areas supplied by the vertebral arteries as suggested by the neurological examinations. In all but one of the 36 patients, the symptoms had not previously occurred and were clearly distinguishable from the complaints that led them to seek manipulative care. This report is highly significant but needs careful interpretation. Although it is titled "Vertebral dissections after chiropractic neck manipulation . . . " only four of the patients were actually manipulated by chiropractors. Half were treated by orthopedic surgeons, five by a physiotherapist, and the rest by a neurologist, general medical practitioner, or homeopath. It is possible—although unlikely—that the nonchiropractors used techniques that were more dangerous than chiropractors use in North America. The authors suggested that the orthopedists' treatment was safer, but there is no way to determine this from their data. Regardless, the study supports the assertion that neck manipulation can cause strokes—which many chiropractors deny.

Some chiropractors advocate "screening tests" with the hope of detecting individuals prone to stroke due to neck manipulation . These tests, which include holding the head and neck in positions of rotation to see whether the patient gets dizzy, are not reliable, partly because manipulation can rotate the neck further than can be done with the tests.

Several medical reports have described chiropractic patients who, after neck manipulation, complained of dizziness and other symptoms of transient loss of blood supply to the brain but were manipulated again and had a full-blown stroke. During a workshop I attended at the 1995 Chiropractic Centennial Celebration, Terrett said such symptoms are ominous and that chiropractors should abandon rotational manipulations that overstretch the vertebral arteries. But, as far as I know, his remarks have not been published and have had no impact on his professional colleagues.

Chiropractors cannot agree among themselves whether the problem is significant enough to inform patients that vertebrobasilar stroke is a possible complication of manipulation . In 1993, the Canadian Chiropractic Association published a consent form which stated, in part:

Among other things, the jury recommended that all patients for whom neck manipulation is recommended be informed that risk exists and that the Ontario Ministry of Health establish a database for chiropractors and other health professionals to report on neck adjustments .

As far as I know, most chiropractors do not warn their patients that neck manipulation entails risks. I believe they should and that the profession should implement a reporting system that would enable this matter to be appropriately studied. This might be achieved if (a) state licensing boards required that all such cases be reported, and (b) chiropractic malpractice insurance companies, which now keep their data secret, were required to disclose them to an independently operated database that has input from both medical doctors and chiropractors.

Meanwhile, since stroke is such a devastating event, every effort should be made to stop chiropractors from manipulating necks without adequate reason. Many believe that all types of headaches might be amenable to spinal manipulation even though no scientific evidence supports such a belief. Many include neck manipulation as part of "preventative maintenance" that involves unnecessarily treating people who have no symptoms.

Even worse, some chiropractors—often referred to as "upper cervical specialists"—claim that most human ailments are the result of misalignment of the topmost vertebrae (atlas and axis) and that every patient they see needs neck manipulation.

Chiropractors Angry about bus ad

How Chiropractors Oversell Themselves:

Chiropractors who practice part time would be likely to drag the average down, whereas some who really sell themselves would tend to raise it.

Intensive selling of the spine begins in chiropractic school as instructors convey the scope and philosophy of chiropractic to their students. After graduation, chiropractors can get help from many practice-building consultants who offer seminars and ongoing management advice. I have collected information about their offerings for more than 25 years.

During the 1970s, flamboyant ads from practice-builders were much more common than they are today. The Drennan Seminar, for example, offered to "double your income and patient volume in 90 days" and said that one out of every ten registrants would receive a free Cadillac. The Stoner Chiropractic Research Foundation offered to "show you how to make $350,000 as easily as $50,000"; promised "no more end-of-the-month jitters"; and depicted a chiropractor headed for the First National Bank, pushing a wheelbarrow overflowing with stacks of money. Dr. Robert A. Jarmain invited chiropractors to a three-day seminar to "build the $1,000,000 practice." The Yennie Chiropractic Success Seminar offered to "put you on the road to total success" and to "upgrade your practice into the $100,000-$200,000-$300,000 service levels." In 1978, Clinic Masters advertised that three thousand chiropractors had enrolled in its program and increased their incomes, on average, more than $50,000 a year. Its fee for a program of seminars and ongoing consultation was $20,000-$100 initially and the rest payable as income rose. Its seminars included "How To Increase Insurance Business $100,000 Or More A Year" and "How To Achieve The 'Optimum Gettable' With Every Patient." Santavicca and Associates charged $30,000 for its advice-$100 for an initial three-day seminar and the rest payable as income rose.

During the 1980s, Practice Management Associates (PMA), a Florida-based firm run by Peter Fernandez, D.C., advertised that chiropractors who followed its guidelines would gross an average of $240,000 in their first year of practice and that the average for all of their clients was about $350,000 . Fernandez also produced a five-volume series called "Secrets of a Practice-Building Consultant." The first edition of Volume I, 1001 Ways to Attract Patients; was published in 1981. The final volume, How to Become a Million Dollar a Year Practitioner, was published in 1990.

Parker, D.C. A 1987 brochure for its Parker School of Professional Success Seminar claimed that "over 125,000 Doctors of Chiropractic, spouses and staff assistants worldwide-over two thirds of all practicing chiropractors-have attended nearly 300 Seminars more than 400,000 times. . . . Resulting in millions and millions of additional patients being served. . . . And surely resulting in at least a billion dollars of EXTRA CHIROPRACTIC EARNINGS!"

There is no logical reason to believe that regular spinal "check-ups" and "adjustments" provide any general health benefit or -- in most cases -- prevent problems from recurring. Chiropractors who sell these notions typically recommend monthly or even weekly check-ups to detect and correct "subluxations." If you encounter such a chiropractor, the most prudent strategy is to go elsewhere.

Membership in the National Association for Chiropractic Medicine or the Canadian Academy of Manipulative Therapists (CAMT) is a very good sign, but the number of chiropractors who belong to these groups is small. CAMT's "orthopractic guidelines" describe a science-based approach to manipulative therapy.

In addition to manual manipulation or stretching of tight muscles or joints, science-based chiropractors commonly use heat or ice packs, ultrasound treatment, and other modalities similar to those of physical therapists.

Avoid chiropractors who advertise about "danger signals that indicate the need for chiropractic care," make claims about curing diseases, try to get patients to sign contracts for lengthy treatment, promote regular "preventive" adjustments, use scare tactics, or disparage scientific medical treatment or preventive measures such as immunization

Avoid chiropractors who purport to diagnose or treat "subluxations," who have waiting room literature promoting "nerve interference" as an underlying cause of disease, or who post charts or distribute literature suggesting that chiropractic might help nearly every type of health problem.

Avoid chiropractors who "prescribe" dietary supplements, homeopathic products, or herbal products for the treatment of disease or who sell any of these products in their offices. For dietary advice, the best sources are physicians and registered dietitians.

Avoid chiropractors who offer Biological Terrain Assessment, body fat analysis, computerized "nutrient deficiency" testing, contact reflex analysis,, computerized range-of-motion analysis, contour analysis

Avoid chiropractors who utilize acupuncture, Activator Methods, allergy testing, applied kinesiology, Bio Energetic Synchronization Technique (B.E.S.T.), chelation therapy, colonic irrigation, cranial or craniosacral therapy, laser acupuncture, magnetic or biomagnetic therapy, Neuro Emotional Technique (NET), or Neural Organization Technique (NOT), or who exhibit a dogmatic attachment to any other specific chiropractic technique or school of thought.

Spinal manipulations involving sudden movements have greater potential for injury than more conservative types of therapy. Be aware that chiropractic neck manipulation can cause serious injuries. Neck manipulation should be done gently with care to avoid excessive rotation that could damage the patient's vertebral artery. It should never be used unless symptoms indicate a specific need for it. A small percentage of chiropractors advocate neck manipulation to "balance" or "realign" the spine no matter where the patient's problem is located. I recommend avoiding such chiropractors.

Although some chiropractors know enough to avoid diagnostic difficulty, there is no simple way for a consumer to determine who can do so. As an additional safeguard, ask any chiropractor who treats you to discuss your care with your medical doctor.

Remember that although manipulative therapy has value in treating back pain and may relieve other musculoskeletal conditions, chiropractors are not the only source of manipulative therapy. Physical therapists, many osteopathic physicians, and a small number of medical doctors do it also. The Canadian Association of Manipulative Therapists is a good referral source for Canadian practitioners.

Christenson MG, Morgan DRD. Job Analysis of Chiropractic: A Report, Survey Analysis, and Summary of the Practice of Chiropractic within the United States. Greeley, Colorado: National Board of Chiropractic Examiners, 1993. This report is based on the responses by 4,835 full-time chiropractors who responded to a 1991 NBCE survey about their practices during the previous two years. The figures included: Activator Methods 51.2%, applied kinesiology 37.2%, acupressure/meridian therapy 65.5%, acupuncture 11.8%, cranial adjusting 27.2%, and homeopathic remedies 36.9%. "Nutritional counseling, etc." was listed by 83.5%. Although the data don't indicate what this involved, it is clear that a large percentage are inappropriately prescribing dietary supplements.

Chiropractors. Consumer Reports 59:383-390, 1994. This included a survey of 476 chiropractors chosen randomly from the American Chiropractic Association membership directory. Nearly one quarter of the 274 who responded sent material stating that spinal misalignments and "interferences" threatened overall health, and 35% implicated the spine in disorders of the body's organs.

He then worked for three years as a clinical laboratory technician and for eleven years as a biological research technician for the U.S. Department of Agriculture. In 1991, after concluding that chiropractors had permanently injured him, he founded Victims of Chiropractic, a support network and clearinghouse for information about chiropractic's hazards. He donated his royalties from sale of this book to the National Council Against Health Fraud for use in public education. In 1997, he died of colon cancer. Victims of Chiropracticis now headed by Don Paulin of Fountain Valley, California.

I have studied the activities of chiropractors for nearly thirty years.

I became interested while teaching health and physical education at a boarding school. As a gymnastics coach, I had noted that manipulative therapy seemed to help certain athletic injuries. In time, a neighborhood chiropractor began indoctrinating me. Although I had a master's degree in health education, my coursework had never covered chiropractic. I began reading everything I could find on the subject. The health-education literature was highly critical of chiropractic, but my mentor attributed this to prejudice. So I explored chiropractic literature to see what chiropractors said about themselves. What I saw convinced me that chiropractic was a cult whose participants were often victimized by their own misguided philosophy and training.

My doctoral dissertation, completed during the early 1970s, was based on a study assisted by nineteen chiropractors. My close association with these practitioners persuaded me that they were basically honest, hard-working, well-meaning individuals who believed that their treatment was effective even though no scientific studies had tested this belief. One of the chiropractors even acknowledged that the trouble with chiropractic was that it had never been proven scientifically. "What I do is treat patients the way I was taught," he said candidly. "Those who like it come back, those who don't like it do not. Enough people come back to keep me busy, so I must be helping them."

Many of these chiropractors proudly told me about patients who were almost miraculously relieved of their pain and dysfunction. When I asked whether they could tell which patients or conditions were likely to respond to their methods, all said they could not. How sad, I thought, that chiropractors had practiced for seventy-five years without determining what they can effectively do. Although nearly twenty-five more years have passed since that thought first occurred to me, chiropractic has still not made a single noteworthy contribution to the scientific knowledge of health care.

Chiropractic students learn conversational medicine. This enables them to speak as if they know about disease and healing processes and creates the illusion that they understand medical science. Chiropractic literature, however, indicates that many chiropractors don't even understand the most basic concepts of disease etiology. Some chiropractic authors still attack the germ theory as erroneous, and speak of it as if it were scientific medicine's only theory of causation.

Many new graduates are dumped into the cold, hard world where survival values often displace ethics. Many discover that they are not in a true profession, but a guild of survivors who must sink or swim. A large percentage \ half, according to chiropractic sources \ fail in practice. This is one reason that chiropractors have the unhappy distinction of having the highest default rate of all who obtain Health Education Assistance Loans from the federal government. (Figures released in January 1998 showed that 817 chiropractors owed a total of $59 million.)

One chiropractor told me how he had gone from practice to practice trying to find a job that did not violate his conscience. Nearly every chiropractor who interviewed or hired him wanted high-volume work. In other words, "Just pop those spines and move on to the next patient." These chiropractors encouraged patients to return frequently for manipulations, a practice that can stretch ligaments, make joints less stable, and lead to more frequent musculoskeletal problems. My informant's greatest concern was the chiropractors who insisted that patients be x-rayed during nearly every visit. In an office where he worked, one woman had been x-rayed more than seventy times in a year-and-a-half. The idea of that much radiation exposure to a patient's body frightened him and caused him to quit the practice.

Sample Passage (Toftness Radiation Detector) ||| Article: Don't Let Chiropractors Fool You

The following legislation and policies currently regulate individuals who practise complementary and alternative medicine: the Physiotherapy Act 1949, the Massage Parlours Act 1978, the Medicines Act 1981, the Chiropractors Act 1982, the Health and Disability Commissioner Act 1994, the Medical Practitioners Act 1995, the Fair Trading Act 1996, and the Code of Health and Disability Services Consumers' Rights 1996 (pursuant to the Health and Disability Commissioner Act 1994).

Chiropractors are currently the only statutorily regulated CAM profession in New Zealand. They must complete a recognised training course and register with the New Zealand Chiropractic Board. Membership of the main professional body, the New Zealand Chiropractors' Association, is voluntary.

In the UK, osteopaths and chiropractors are currently the only CAM practitioners regulated by specific legislation: the Osteopaths Act 1993 and the Chiropractors Act 1994, respectively. Note that it is the practitioners, rather then the modalities, that are regulated. Other therapists may use osteopathic or chiropractic techniques provided they do not claim or imply that they are osteopaths or chiropractors.

Osteopaths have their own medical schools and are required to undergo training similar to that of biomedical doctors. Chiropractors are regulated in all states but, unlike osteopaths, are not licensed physicians and are not regarded as mainstream. Chiropractic achieved recognition despite sustained objections from the American Medical Association. The debate culminated in a Supreme Court judgement in favour of the chiropractors. US doctors are now obliged to refer to and receive referrals from chiropractors.

Chiropractors All provinces

Alberta, British Columbia, Quebec Chiropractors

Until the various State Medical Acts were passed, CAM practitioners throughout Australia were free to practise under a common law right similar to that of the UK (Fulder 1996). However, the regulation of CAM practitioners is now the responsibility of individual states or territories. Chiropractors and osteopaths are currently regulated in all Australian states. Medicare reimburses fees for osteopathic and chiropractic treatment. The State of Victoria has recently passed legislation to implement a regulatory system for practitioners of traditional Chinese medicine, and a Traditional Chinese Medicine Board has been set up to register practitioners. Queensland and New South Wales are expected to implement similar arrangements.

At least that was the theory. According to Toftness, when the lens came to a diseased part of the back, the operator's fingers would encounter increased friction and start to "stick" on the rubbing plate. The lens, he believed, was sensitive to a very subtle form of radiation that was emitted by portions of the spine that were in need of chiropractic manipulation. Toftness conducted seminars to train chiropractors in the proper use of his apparatus. He would then lease these devices to them for use in their own offices.

In January 1982, the United States District Court in Wisconsin issued "a permanent nationwide injunction against the manufacturing, promoting, selling, leasing, distributing, shipping, delivering, or using in any way any Toftness Radiation Detector or any article or device that is substantially the same as, or employs the same basic principles as, the Toftness Radiation Detector." The United States Court of Appeals for the Seventh Circuit upheld this decision in 1984. Although the chiropractors who were charged by the State of Oregon claimed to have abandoned the outlawed Toftness device, prosecutors maintained that they were guilty of using a Toftness-like device. Their particular derivative had been designed by one of the defendants, also as an aid for spinal diagnosis. It consisted of a block of wood with an embedded concave plastic surface. This time, however, the "rubbing plate" was placed on an adjacent horizontal surface, rather than being part of the instrument that was in direct contact with the spine.

Despite these similarities, the Oregon chiropractors strongly denied that theirs was a Toftness-like device. Although the chiropractor who designed the Oregon rubbing plate had been trained by Toftness and had previously used the Toftness Radiation Detector himself, he claimed that he no longer believed that Toftness' instrument detected radiation of any sort. In fact, he now believed that the sticking of the fingers on the plate with both the Toftness and the Oregon instruments was not triggered by any physical signal at all. Instead, he argued that the sticking was a trained subliminal response of the chiropractor, evoked unconsciously by his or her accumulated experience in locating spinal problems. He claimed that, although the visual and tactile signs of pathology obtained from spinal palpation were often too weak to be consciously perceived by a chiropractor, years of acquired expertise in spinal diagnosis were stored in his or her unconscious. Supposedly, this expertise could be brought to the surface with the aid of the rubbing plate.

Reputations were ruined, alleged perpetrators were jailed, and families were torn apart. Eventually, controlled, blinded experiments isolated the information coming to the facilitator from that coming to the patient, proving the source of the messages was the facilitator, through ideomotor action. Another example is "applied kinesiology." Legitimate kinesiology is the study of human motor performance using the standard tools of biochemistry, physiology, biomechanics, and psychology. "Applied kinesiology" purports to show that isolated muscle group weakness can be used to diagnose allergies, toxicities, and other disorders. Naturopaths and chiropractors are among its most ardent practitioners. Such things as refined foods, foods grown with chemical fertilizers, artificial food colorants and preservatives, infinitesimal pesticide residues, refined sugar, or even flourescent lighting are said to sap vital energies and cause disease.

A team of chiropractors came to demonstrate the procedure. Several physician observers and the chiropractors had agreed that chiropractors would first be free to illustrate applied kinesiology in whatever manner they chose. Afterward, we would try some double-blind tests of their claims.

The chiropractors presented as their major example a demonstration they believed showed that the human body could respond to the difference between glucose (a "bad" sugar) and fructose (a "good" sugar). The differential sensitivity was a truism among "alternative healers," though there was no scientific warrant for it. The chiropractors had volunteers lie on their backs and raise one arm vertically. They then would put a drop of glucose (in a solution of water) on the volunteer's tongue. The chiropractor then tried to push the volunteer's upraised arm down to a horizontal position while the volunteer tried to resist. In almost every case, the volunteer could not resist.

The chiropractors stated the volunteer's body recognized glucose as a "bad" sugar. After the volunteer's mouth was rinsed out and a drop of fructose was placed on the tongue, the volunteer, in just about every test, resisted movement to the horizontal position. The body had recognized fructose as a "good" sugar.

The nurse then left the room so that no one in the room during the subsequent testing would consciously know which tubes contained glucose and which fructose. The arm tests were repeated, but this time they were double-blind -- neither the volunteer, the chiropractors, nor the onlookers was aware of whether the solution being applied to the volunteer's tongue was glucose or fructose. As in the morning session, sometimes the volunteers were able to resist and other times they were not. We recorded the code number of the solution on each trial. Then the nurse returned with the key to the code.

According to the president of NANP, until 1953 many of the schools In the United States which taught naturopathy were schools of chiropractic . It is believed that many chiropractors are also naturopaths. The most widely used chiropractic textbook was written by a naturopath-chiropractor.

(Doctor of Chiropractic) as well as the N.D. (Doctor of Naturopathy) diploma. So far as their actual practices and activities go, it is difficult to distinguish the naturopaths from the chiropractic "mixers." As a matter of fact, they are often one and the same. Many naturopaths are former chiropractors -- chiropractors who began using so many other healing methods that they ceased to call themselves chiropractors.

The exact number of naturopath-chiropractors is unknown. However, the president of the NANP believes there are about 3000 to 4000 naturopath-chiropractors practicing naturopathy. If this is true, most naturopaths are also chiropractors, since according, to estimates of State licenses and the NANP there are only about 500-1000 persons with only the ND degree.

The NCNM requires a high school diploma and two years of college for admission. Students have included midwives and chiropractors.

In 1964, the Canadian Royal Commission on Health Services undertook a study of naturopaths. As part of this study a research team headed by Donald Mills , sent a detailed questionnaire to all naturopaths, chiropractors and osteopaths in Canada. The recommendation of the Royal Commission concerning naturopathy which was in part based on the Mills report was as follows:

Donald Mills, Chiropractors, Osteopaths and Naturopaths in Canada, (Ottawa: Queen's Printer and Controller of Stationery, 1966).

In just the last 20 years, at least 73 randomized clinical trials involving spinal manipulation have made their appearance in the English-language literature. Even more amazing is the fact that the majority of these have been published in general medical and orthopedic journals. These trials address not only back pain, but also headache and neck pain, the extremities, and a surprising variety of nonmusculoskeletal conditions. When spinal manipulation is employed, the majority of these trials have shown positive outcomes with the remainder yielding equivocal results. There are 43 trials addressing acute, subacute, and chronic low back pain with 30 showing us that manipulation is more effective than control or comparison treatments and the remaining 13 reporting no significant differences between treatment groups. None of these studies appears to have produced a negative outcome and none indicate that manipulation is any less effective than any comparison intervention .

Even more remarkable is the efficiency of chiropractic research. When compared to the NIH budget of nearly $20B, the $10M investment in federal funds is substantially less than a tenth of 1 percent, which makes it less than a rounding error or, as a couple of wags have offered in the past—obviously, the federal government must believe in alternative medicine because it has given chiropractic researchers homeopathic doses of money with which to work.

So then why am I dismayed? Let me share with you just one example out of many which typify our problem. A recent report on workers' compensation claimants from Florida is particularly galling. It pointed out that for industrial musculoskeletal injuries, chiropractic care demonstrates lower costs and shorter durations in both reaching maximal medical improvement and return to work. Incredibly, over the same 7-year period, the frequency of specific musculoskeletal related cases treated by chiropractors in 1999 was only 25% of the level seen in 1994 (the date that managed care was introduced into the Florida workers' compensation system) . In other words, just when access of workers to chiropractic care should be increased to result in significant direct and indirect cost savings (as previously shown by Manga , we are witnessing precisely the opposite. Chiropractic care seems to be getting squeezed out of the system. Look at the neighboring state of Georgia, in which chiropractic workers' compensation cost recoveries were just 0.8% of the benefits disbursed to physicians in 1997 and 1998 . Again one suspects the exclusion of chiropractic services.

Is this paranoia? Not when you consider that, despite the wealth of its research information with such little funding, it has been necessary time and time again for the chiropractic profession to seek both legislative and legal recourse to achieve its earned recognition with the most meticulous of research, ironic in light of a recent report which shows that chiropractic practices in at least one locale can demonstrate that a higher percentage of its treatments are evidence-based than found in medical interventions .

. Rosner implies chiropractic progress was retarded by alleged AMA "discrimination" that took place many years ago. The simple fact is that chiropractic research was (and still is) hampered by the widespread chiropractic belief that "chiropractic works" and does not need to be proven.]

Jaroff L. Back off, chiropractors! TIME.com, February 27, 2002.

The leading publisher/distributor of AK educational materials for chiropractors and their patients appears to be Systems DC, of Pueblo, Colorado. Its pamphlet on infections and child health states:

Several chiropractors were tested at a medical office while under unblinded and blinded conditions. During the volunteers lcould resist downward pressure when a drop of glucose was placed on their tongue but could resist when fructorse was administered. The the arm tests were repeated using substances in coded test tubes so that the volunteer, the chiropractors, abd the onlookers could not tell which solution being applied to the volunteer's tongue. When the code was revealed, There was no connection between ability to resist and whether the volunteer was given the "good" or the "bad" sugar .

Muscle testing related to alleged "energy imbalances" are involved in many other treatment systems, most of which are used mainly by chiropractors:

Its practitioners claim that "adjusting" these bones by applying pressure to various structures of the head can cure these problems. This claim is not only unsubstantiated but clashes with the fact that the bones of the skull are tightly fused by age two. NOT's originator was Carl A. Ferreri, D.C. (1928-2007) of New York City, who said he had trained hundreds of chiropractors. NOT came to public attention in 1988 when chiropractors subjected children to it in a "research" program sponsored by school officials in Del Norte County, California. For five months, dozens of children from age four to sixteen, with epilepsy, Down's syndrome, cerebral palsy, dyslexia, and various other learning disorders, were "treated" by having their skull compressed with viselike hand pressure. The children were also forced to endure painful thumb pressure against the roof of the mouth and finger pressure against their eyes. According to news reports, the children struggled, cried, and screamed as they were forcibly restrained. One reportedly experienced his first seizure when his eye sockets were "adjusted." Some of the children became violent, explosive, rebellious, uncontrollable, and lacking in self-motivation and drive . In 1991, a jury ordered Ferreri to pay $565,000 in damages to seven children and their parents who had filed suit for physical and emotional pain related to the treatment. Two other chiropractors involved in the case settled out of court for a total of $207,000.

NET's developer, Scott Walker, D.C., of Encinitas, California, states that during the ten years he has been teaching the technique, 2,700 health care practitioners (mostly chiropractors but some physicians, psychologists and dentists) have leaned it, and most use it regularly in their practice. According to Walker, "the reason homeopathy works so well is that it allows the body to remember what toxins it needs to get rid of in order to reestablish homeostasis." He also says that although psychotherapy is valuable, an "emotional memory locked in the body" can't be resolved through therapy alone . The ONE (Our NET Effect) Foundation was incorporated in 1993 "to help NET practitioners scientifically validate their technique, promote their practices, and bring NET to the world."

The chiropractors involved worked in a chain of "family health" clinics. Since they (or their telemarketers) did not appear to know who I was, I decided that it might be possible for me to experience what these chiropractors normally do with new patients.

Toward the rear were two small rooms used for examinations and a third room for taking x-rays. The walls were decorated with posters depicting the autonomic system and the spine. One poster stated: "Subluxation - The Silent Killer - Chiropractors Correct Subluxations." Pamphlets relating subluxations to disease were displayed in two racks.

On the way out, I asked Dr. Y about his background and learned that he had graduated from Sherman College of Straight Chiropractic, had practiced in another city for about three years, and had been recruited for this clinic about six months previously. He said that the facility was part of a chain of straight chiropractors, explaining that they only did treatment with their hands. He said this was a second career for him, that he had previously been a yacht captain.

Sherman College of Straight Chiropractic teaches that the foundation of chiropractic is "correcting subluxations that interfere with the body's innate strivings to maintain its health." A brochure I picked up at a school display in 1995 states: "At Sherman College, you learn highly sophisticated methods of locating analyzing, and correcting vertebral misalignments which interfere with the nervous system." The school's philosophy -- as exhibited by Dr. Y -- considers medical diagnosis irrelevant to chiropractic practice. Some chiropractors refer to this viewpoint as the "super-straight" philosophy. Somewhere between 2% and 4% of chiropractors belong to organizations that espouse this philosophy -- which the majority of chiropractors consider extreme. (That translates to one or two thousand in the United States.) However, the percentage of chiropractors who encourage large numbers of visits to correct "subluxations" is much higher and may be a majority.

To what extent can chiropractors help people? Does it ever make sense to seek chiropractic care? If so, how can a reliable chiropractor be found? These questions -- which are not simple to answer -- are thoroughly discussed in Chiropractic: The Victim's Perspective (1995), written by George J. Magner, III, and Inside Chiropractic: A Patient's Guide (1999), by Samuel Homola, D.C. Both were edited by me and published by Prometheus Books.

For example, conventional medicine has a long tradition of being concerned with preventing disease as evidenced by the development of programs for immunizations, healthier mothers and babies, family planning, safer and healthier foods, fluoridation of drinking water, control of infectious diseases, reducing deaths from heart disease and stroke, decreasing the use of tobacco products, and promoting motor vehicle safety and safer workplaces . [The idea that "CAM" health care generally advocates a broad specturm of preventive and public health measures is a flat lie. Only about a third of chiropractors advocate immunization and two national chiropractic organizations strongly oppose it.

The difference between conventional and CAM health care systems in many of these areas, however, is one of emphasis. In part, because of the many technological advances that have occurred in conventional health care over the years (see Recent History of CAM section, below), pharmacological, surgical, and other technological approaches have come to dominate conventional health care. While acknowledged, prevention and wellness promotion have been underemphasized. For example, according to a recent report by the Nutrition Education Consortium, the teaching of nutrition in medical schools and residency programs remains "woefully inadequate," and a survey by Cooksey et al. found that most medical schools do not have faculty trained specifically in nutrition. As a result of this lack of training in nutrition in medical education, many practicing physicians are not adequately prepared to provide nutrition counseling to their patients. However, registered dieticians and clinical nutritionists are employed by hospitals and clinics. These are the specialists who are trained in this area and are well established in the conventional health care system.

Early American health care consisted of an eclectic mix of systems. In fact, until the middle of the 19th century, the vast majority of primary medical care in this country was provided by botanical healers, midwives, chiropractors, homeopaths, and an assortment of other lay healers offering a variety herbs and nostrums for a range of illnesses .

A recent national survey by Astin found that back problems were the most common medical condition (24 percent) for which people reported using CAM treatments. In this survey, neck problems also were associated with frequent use of CAM. Other studies have found that one-third of all patients suffering from back pain choose chiropractors over physicians to treat them, and that chiropractors provided 40 percent of primary care for back pain . Moreover, these studies found that chiropractors retained a greater proportion of their patients (92 percent) for subsequent episodes of back pain care than did other providers. Similarly, Krauss and colleagues found that CAM practitioners and products were chosen more often than conventional physicians and therapies by those persons with chronic pain (52 versus 34 percent) and headaches (51 versus 19 percent ), as well as by persons suffering from other associated maladies, including depression (34 versus 25 percent), anxiety (42 versus 13 percent), and insomnia (32 versus 16 percent).

Evidence suggests that a growing number of physicians already use some CAM practices and consider them safe and effective in offering them to their patients. A comprehensive review of 25 surveys of physician practices and beliefs regarding five commonly used CAM practices -- acupuncture, chiropractic, homeopathy, herbal medicine, and massage -- found that about half of the surveyed physicians believed in the efficacy of these five CAM practices . This study found that a significant proportion of conventional physicians were both referring patients to CAM practitioners and/or offering some of these CAM treatments in their practice.

Berg RN. AMA enjoined from boycotting chiropractors. Journal of the Medical Association of Georgia 1990 Jun;79(6):391-393.

Barrett, and his minions, had the common sense to stay away from criticizing Chiropractors until (I believe) the Federal Judge died.

In 1976, various chiropractors began a series of civil suits against the AMA, other professional organizations, and several individual critics, charging that they had conspired to destroy chiropractic and to illegally deprive chiropractors of access to laboratory, x-ray, and hospital facilities. Most of the defendant groups agreed in out-of-court settlements that their physician members were free to decide for themselves how to deal with chiropractors.

In 1987 -- not 1976 as stated by Bolen -- federal court judge Susan Getzendanner concluded that during the 1960s "there was a lot of material available to the AMA Committee on Quackery that supported its belief that all chiropractic was unscientific and deleterious." The judge also noted that chiropractors still took too many x-rays. However, she ruled that the AMA had engaged in an illegal boycott. She concluded that the dominant reason for the AMA's antichiropractic campaign was the belief that chiropractic was not in the best interest of patients. But she ruled that this did not justify attempting to contain and eliminate an entire licensed profession without first demonstrating that a less restrictive campaign could not succeed in protecting the public. The case was decided on narrow legal grounds (restraint of trade) and was not an evaluation of chiropractic methods.

Some chiropractors use questionable test procedures that supposedly determine "hidden allergies" responsible for a broad range of health problems. The tests results are then used to make dietary recommendations and possibly to recommend dietary supplements.

At least 50 companies are marketing irrationally formulated supplement products exclusively or primarily through chiropractors.

Some of these companies (or their distributors) sponsor seminars at which chiropractors are taught pseudoscientific nutrition concepts-including the use of supplements to treat disease. These seminars enable manufacturers and distributors to provide information on alleged therapeutic uses that would not be legal to place on product labels. Some companies issue newsletters and/or product literature that provide dubious advice.

Most chiropractors who recommend supplements sell them to their patients at two to three times their wholesale cost. The products invariably cost much more than similar products (if available) in retail outlets. I have encountered useless recommended regimens that cost as much as $10 per day.

The percentage of chiropractors engaged in unscientific nutrition practices is unknown but is probably a majority. Sound nutrition advice, when needed, can easily be obtained elsewhere.

Surface electromyography: This test, which measures the electrical activity of muscles, can be useful for analyzing certain types of performance in the workplace. However, some chiropractors claim that the test enables them to screen patients for "subluxations" and to follow their progress. This usage is invalid .

Thermography: Thermographic devices portray small temperature differences between sides of the body as images. Chiropractors who use thermography typically claim that it can detect nerve impingements or "nerve irritation" and is useful for monitoring the effect of chiropractic adjustments on subluxations. These uses are not appropriate .

Unnecessary x-rays: X-rays examinations can be important to look for conditions that require medical referral. However, it is not appropriate for chiropractors to routinely x-ray every patient to look for "subluxations" or to "measure the progress" of patients who undergo spinal manipulation .

Many insurance administrators are concerned about chiropractic claims for "maintenance care" (periodic examination and "spinal adjustment" of symptom-free patients) , which is not a covered service. To detect such care, many companies automatically review claims for more than 12 visits. In 1999, the U.S. Inspector General recommended automatic review after no more than 12 visits for Medicare recipients . Some chiropractors attempt to avoid review by issuing a new diagnosis after the 12th visit.

Many instances have been discovered in which corrupt attorneys and health-care providers (usually chiropractors or chiropractic/medical clinics) combine to bill insurance companies for nonexistent or minor injuries. The typical scam includes "cappers" or "runners" who are paid to recruit legitimate or fake auto accident victims or worker's compensation claimants. Victims are commonly told they need multiple visits. The providers fabricate diagnoses and reports and commonly provide expensive but unnecessary services. The lawyers then initiate negotiations on settlements based upon these fraudulent or exaggerated medical claims. The claimants may be unwitting victims or knowing participants who receive payment for their involvement . Mill activity can be suspected when claims are submitted for many unrelated individuals who receive similar treatment from a small number of providers.

Barrett: Necks and spines don't get out of alignment. That's a nonsensical chiropractic concept. Joints tighten. Chiropractors can sometimes loosen them. The spine is held together by some of the strongest ligaments in the body, and the bones don't change in relation to each other. And a chiropractor doesn't change that either. Probably a chiropractor can stretch a tight area. He may make the joint looser or relieve fight muscles that are causing pain.

Biography: Do you respect chiropractors or think they're quacks?

Barrett: Neither. Chiropractors fall along a very broad spectrum of belief and practice. A few practice in a scientific manner. I am a consultant to a national organization of chiropractors who do that. On the other hand, many do all sorts of nonsensical things. Some say they can put their hands on your body and regulate your biomagnetic field. Others think they can pull down your arm after putting some substance in your mouth like sugar or vitamins, and by the way your arm reacts -- whether it gets weaker or stronger -- tell whether the substance is good for you. And one out of three chiropractors, according to their own survey, practices this sort of thing.

I won't stop you from seeking any kind of medical help you wish...do me the same favor. By the way...I take supplements and have for YEARS, I go to chiropractors AND homeopaths and am perfectly satisified with the treatments and remedies and I am not stupid nor gullible nor self-deluded about the results I'm having and I resent your insulting my intelligence by saying so!

From someone from Tennessee who is fond of chiropractors

My opinion of you personally is that you are an asshole. Threatened and insecure your ugly head rises only to attempt to make chiropractors and any other non-medical healers look bad. In a society where drug addiction prevails, your profession doesn't have a prayer's chance in hell of escaping criticism. Your profession doles out drug prescriptions like lollipops and greatly added to addiction rate.

Gee, the people who vehemently strike back at you don't seem to get it. Nothing on your site negates the fact that "traditional" doctors may also maim, cripple, and kill. That's just not your topic. As a psychiatrist, you have to believe in the power of the spoken word or faith in something. I don't think you would rule out that snake oil might help some people. You work with some chiropractors, so called "alternative practitioners." I think you are just trying to give people a fair way to evaluate "snake oil" therapies. At least you have the guts enough to publish both ways.

Some chiropractors recruit new patients through postural checks and other free screening examinations at health expositions, shopping centers, or other places where there is heavy foot traffic. Some offer free screening at their offices. Most people screened are inappropriately advised to have further evaluation or treatment at the chiropractor's office.

Some chiropractors use x-ray films to persuade normal people that they have a "spinal curvature" (or not enough curvature, or too much curvature). After "treatment," the curvature "improves" because the patient is positioned differently for the examination.

To what extent can chiropractors help people? Does it ever make sense to seek chiropractic care? If so, how can a reliable chiropractor be found? These questions -- which are not simple to answer -- are thoroughly discussed in Chiropractic: The Victim's Perspective (1995), written by George J. Magner, III, and Inside Chiropractic: A Patient's Guide (1999), by Samuel Homola, D.C. Both were edited by me and published by Prometheus Books. Together they provide the most detailed analysis of the chiropractic marketplace ever published. Comprehensive information is also available on Chirobase, our skeptical guide to chiropractic history, theories, and current practices.

Robbins graduated in 1978 from Cleveland Chiropractic College in Kansas City, Missouri, but he also claims to have a Doctor of Naturopathy (ND) degree from the Anglo-American Institute of Drugless Therapy and a Doctor of Medicine (MD) degree from the British West Indies College of Medicine. The Anglo-American Institute of Naturopathy was a British diploma mill that issued credentials to people who completed mail-order lessons, submitted a thesis, and paid a modest fee. The "British West Indies College of Medicine" was not an actual school but was a scheme created by con man Gregory E. Caplinger to defraud chiropractors of "tuition" money . In 1996, Caplinger was arrested in Florida on ten counts of racketeering and grand theft, but the charges were withdrawn after he made partial refunds.

In 1996, the Pennsylvania Department of Laboratories informed three Pennsylvania chiropractors that Infinity2's "Nutritional Blood Analysis" could not be used for diagnostic purposes unless they maintain a laboratory that has both state and federal certification for complex testing . The company's attorney replied:

Wlazelek A. Chiropractors cease blood cell show and tell.