DCs have never been able to pass a test in which they are challenged to identify the subluxations alleged to exist on an x-ray submitted by other DCs, such as the test conducted by the National Association of Letter Carriers in the 1960s:

Our doctor (medical) presented 20 sets of x-rays that had been submitted by chiropractors. Each film was purported to show a subluxation; in several instances, four to six subluxations had been diagnosed on a single x-ray. One after another, each film was placed in the view box. The chiropractic representatives, including a radiologist of their own selection, were invited to point out the subluxations. Not a single one was identified. Nor did the chiropractic representatives offer a solitary comment.

Standard medical terminology defines a subluxation as an "incomplete or partial dislocation," but does not recognize the chiropractic version of the concept. In what can easily be construed as a conspiracy to deceive Medicare, the conference developed a set of diagrams to be used to report alleged "subluxations."

The majority (81%) stated that, on an older person's x-ray, more "wear and tear" osteoarthritis and osteoporosis will show up, and not subluxations per se.

The majority of respondents (84%) said that there are subluxations that do not show up on x-rays.

Chiropractors who restrict their practices to analyzing the spine for "subluxations" and removing them exclusively by manipulation without regard to a patent's disease refer to themselves as "straights." They eschew the concept of diagnosis. Instead, they believe that if they analyze the spine and eliminate the "subluxations," health will follow. Those who cling to the metaphysics of Palmer's original theory constitute a persistent minority who insist that they are the true chiropractors. Such have been referred to as "radical religious" (20) and "super-straights." Some innovative chiropractors recently created the term "spinology" in which "subluxations" are renamed "obstrusions," and allege that keeping the spine free of obstrusions will enable a person to reach his/her maximum genetic potential. Reference to disease or treatment is definitely implied but specifically denied. Spinology is clearly another version of "super straight" chiropractic.

Chiropractors who restrict their practice to manipulation may be correctly labeled "straights", but whether practitioners believe their manipulation to be removing "causes" or "effects" is essential when evaluating individuals. Scientifically oriented manipulative therapists usually see their treatments as relieving the muscle spasms and nerve irritation (i.e., symptoms or "effects") of improper body mechanics, psychological stress, trauma, or some other "primary" cause. Philosophically oriented chiropractors are loathe to admit that they treat only "effects" or merely relieve symptoms. Chiropractic students are taught a distorted view which portrays medical doctors as philosophically committed to the "allopathic" theory of Hippocrates by which they merely treat the symptoms (i e, "effects") of disease. Chiropractic is portrayed as superior to medicine because it focuses on "subluxations" which it regards as the primary causes of disease. In reality, medical doctors abandoned practicing on the basis of philosophy long ago as they accepted scientific methodology. Medicine's dedication to the Hippocratic Oath is due to its acceptance of its code of behavior of physicians; not Hippocrates' healing theory.

Legislators who review chiropractic practice acts are sometimes confused by the warring factions within chiropractic. Straights wish to have chiropractic practice limited to the manipulation of the spine for the purpose of removing "subluxations." Mixers favor expanding practice acts to permit them to engage in a broad scope of practice. Mixers outnumber straights by about four-to-one enabling them to exert more pressure on legislators. Consumers will benefit if scope-of-practice laws are designed in terms of proven safety and effectiveness and not the views of special interest groups.

Before January 1, 2000, the law required that an x-ray confirm the presence of subluxations in order for Medicare to reimburse for their treatment. Because radiologists do not qualify under Medicare rules as treating physicians who can order x-rays, and because Medicare similarly restricts chiropractors from ordering x-rays, the regulations provided an exception wherein patients would be reimbursed if a radiologist took the x-rays at the request of a chiropractor. In 2000, the law eliminated the requirement that subluxations be demonstrated by x-rays in order for chiropractic services to be covered. The new policy aligns Medicare policies with the 2000 statutory change. The American Chiropractic Association argued that (a) x-rays are essential to the chiropractic treatment plan of Medicare patients and (b) permitting referrals to radiologists would reduce health care spending by enabling patients to avoid additional trips to their primary care provider.

CMS disagreed, noting that x-rays are not needed to identify spinal subluxations.

The underlying principle of chiropractic theory is that there is a direct association between the shape of the spine (the alignment of the vertebrae and the spine's curvature) and disease. Chiropractors claim that health problems can be caused by "subluxations," or blockages of nerve energy, which are caused by malpositioned vertebrae. By "adjusting" vertebra- manually exerting force on the spine so as to physically displace parts of the skeleton-chiropractors say they are removing the subluxation and hence allowing the body to heal itself. We felt it was important to review the scientific evidence for the existence of subluxations, as defined by chiropractors. We reviewed the scientific literature, with the guidance of a number of qualified medical sources, and concluded that there was no such evidence available in any form which would meet generally accepted scientific standards. On the contrary, there is scientific literature failing to find subluxations and associated phenomena stretching back thirty years, as was noted in the program.

The paper claims that checking for "subluxations" is analogous to periodic dental and blood-pressure check-ups.

However, blood pressure and tooth decay can be objectively demonstrated, but the subluxations to which WCA refers are a figment of chiropractic's collective imagination Amato is appealing the board's action but is unlikley to succeed.

On January 15, 2001, the Centers for Medicare & Medicaid Services (CMS) declared that Medicare+Choice organizations "may not use non-physician physical therapists for manual manipulation of the spine to correct a subluxation." The American Physical Therapy Association has responded with a letter seeking clarification. The problem has arisen because in the early 1970s, Congress amended the Medicare law to include coverage for "manual manipulation of the spine to correct a subluxation of the spine . . . which has resulted in a neuromuscular condition for which such manipulation is appropriate." To enable payment, chiropractors held a consensus conference that produced a 7-page document defining 18 types of "subluxations," many of which are fancy terms for the minor degenerative changes that occur as people age and are not changed by chiropractic treatment.

Some describe subluxations as "bones out of place" and/or "pinched nerves"; some think in terms of "fixations" or loss of joint mobility; and some occupy a middle ground that includes any or all of these concepts. Physical therapists are justified in seeking to preserve their right to perform manual manipulation to relieve back and neck discomfort. They do not actually treat any type of subluxation. However, it remains to be seen whether the semantic tangle created by the Medicare law will be used to restrict them.

"Subluxations" are the primary "cause" of disease, and restoration of nerve flow is essential to healing.

4. Chiropractic use of x-rays of infants and children to diagnose so called vertebral subluxations is unscientific and of no value whatsoever. These x-rays can contribute, without any benefit to the child, to the future risk in the child of cancers and genetic damage. Parents should never allow their children's spines to be x-rayed by a chiropractor.

"Vertebral subluxations" are nebulous and have not been scientifically defined or demonstrated. Sherman's Web site does not mention its probationary status.

Medical physicians, osteopathic physicians and physical therapists are not qualified by education and training to diagnose spinal subluxations or to perform manual manipulation of the spine to correct a subluxation. To a medical doctor, a spinal "subluxation" connotes a complete dislocation of the spine that is untreatable by manual manipulation.

Doctors of chiropractic are the only providers educated and trained to perform chiropractic adjustments to correct vertebral subluxations, and as such, chiropractic adjustments should be provided only by a licensed doctor of chiropractic.