I’m a medical worker, and I’ve been trying to read about the history of chiropractice. It’s fascinating to me how the field was started as a spiritual practice. But with the background of chiropractic care being challenged by modern science, and spinal manipulation being disproven to have any benefits, how is chiro so mainstream today? It’s covered by health insurance, even though medical researchers are regularly publishing data that disproves the benefits. DISCLAIMER: IM NOT TRYING TO HATE ON ANYTHING, I’m genuinely interested in the history and how the practice became so mainstream with a somewhat unsteady foundation.
In: Biology
Pain management is a really big problem faced by many people in the modern world. Hard pain medication like opioids are scary, so if you see an alternative, lots of people are going to go for it. Chiropractice does have some real (if minimal) benefits in some types of back pain, and more than that, it **feels** like it should work. There are a lot of satisfying clicks and crunches, and in the aftermath you might feel a little bit better for a while. The placebo effect is real: if you believe something is going to work, there is a possibility you can see some improvement. That gets passed on anecdotally. On top of that, many people are aware that it has some vague Indian based spiritual practice component, and the idea of ‘lost native wisdom’ in alternative medicine is really alluring. When your choices might be as narrow as “addictive drugs” or “click-crack pseudo-medicine massage”, a lot of people are going to be interested in trying the latter.
Beats me. People still go to psychics and homeopathists, and major health providers are doing trendy Eastern mysticism, like acupuncture. Kaiser’s mental health department is kind of an underfunded joke, but at least you can do Qi Gong to fix your imaginary chakras in your intensive-outpatient mental health program. They’re all out of ideas, and paying for talk therapy is expensive, so… I guess pray.
They’re trying to be welcoming of spiritual people, because spiritual-people money spends the same (and is often easier parted), but also the kind of things that offer you that sweet-ass placebo effect are also higher profit margins than treatments where you had to use all that expensive *science* and *technology.*
Some people make money by selling you things people need. Others make money by selling you things you don’t. Sometimes bullshit is the thing you don’t need that they’re selling.
From what I understand, there is value in it for chronic musculoskeletal pain. Not much different from PT in that regard, but exercises/stretches over a long period can help.
My MIL who lives in the UK went to the ER and after that could only see a chiropractor because the NHS often rations care out there. He ordered an X-ray of the upper back, where’s they only did one of the lower back, revealing broken vertebrae that were missed previously.
When Chiropractors are honest and know their limitations, I think they can be valuable. I don’t know how many of them fall into this category, but it’s something to keep in mind.
That said, the whole manipulation/adjustment thing is a load of crap at best and dangerous at worst.
Short answer: it feeds off of the desire for a quick fix that’s easy. Just some pain and supposedly the pain is gone. That and its a lot less scary than surgery, a lot easier than physical therapy, and seems like its less debilitating than opioids.
The reality is most of the patients of chiro’s need physical therapy or surgery and are either unable to afford it or unwilling to accept they need to spend 6+ months to recover. Then they get the ‘quick fix’ and they go why would I believe these doctors the chiro fixed me. Then a few days later the same problem shows up again. The problem is they don’t connect that its a lifestyle behavior that needs correcting (new sitting position, walking gait etc) that PT can help with instead of getting popped, getting the endorphins and dopamine and feeling great for a few days.
Basically chiro’s became mainstream because people like a quick fix that doesn’t involve a ton of work and they complained to insurance companies enough that they started covering it.
Medical student here with some clarification and some of possible explanations:
– I would not say that chiropractors are trusted in medicine. No doctor I know refers to chiropractors. We steer patients towards physical therapy as an option for back pain. Insurance coverage is a different story.
– Most patients don’t understand the difference in between a physical therapist and a chiropractor.
– Many chiropractors will introduce and describe themselves as doctors. This fosters a false sense of trusted authority. I had a patient who was a chiropractor and would show up to appointments with his Dr badge still on. He, and many chiropractors, insist that it’s basically the same training and they get more clinical hours than us anyway. It’s not therapeutic to correct someone in a setting like that, but both of these claims are untrue.
– Chiropractors seem scientific. They all have lots of anatomy models in their offices, and they do alignments, which just sounds evidence based; your car can get an alignment, why can you?
– MDs are under substantial pressure to quickly see as many patients as possible. When you compress everything into a 15 or 20 minute appointment slot (such as: reviewing labs, managing medical conditions, conducting health screening, and addressing new complaints of back pain), you sacrifice a lot of trust building and listening. The evidence is pretty clear that is how you earn people’s trust. Pseudoscientific practices have a clear advantage here. They have less overhead and the luxury of time.
– Medicine doesn’t have great treatments for low back pain. You will get addicted/have increased tolerance to opioids over time, physical therapy requires a lot of ongoing work and isn’t effective for everyone, and surgical interventions come with risks and more pain down the road- pretty much everyone I have seen with spinal surgery still has pain and ends up getting a revision done. When there are really bad options in evidence based medicine, that creates an environment where pseudoscience can flourish.
– Evidence demonstrates that pain is worsened by mood. If you have someone who takes the time listen to your concerns and validate your experience, that might help with your back pain. The studies probably don’t capture this effect. Most of the time they compare real chiropractors to “sham” chiropractors, which is where someone pretends to do alignments and stuff. These studies probably don’t replicate the supportive listening and kind environment that chiropractors are able to foster in their clinical settings.
– I can’t attest to why insurers treat chiropractors differently. Perhaps it is cheaper to send someone to a chiropractor 20 times than pay for orthopedic surgery an initial trial of physical therapy, an MRI, a consultation with the surgeon, the surgery itself, the hospital for the stay, all the support staff, care for any resulting complications, and physical therapy for rehab.
Because believing is easier than thinking.
Also it’s more “natural”, which appeals to people who distrust “big medicine” because “it’s *so* expensive!” and “they really don’t want to cure you, because they don’t make money off of well people”, not realizing that starting chiropractic manipulation is basically signing up for a never-ending subscription.
So it can appeal to “spiritual” types *and* conspiracy theorists. This conspirituality is a natural entry to the “Woo to Q” pipeline.
In the best case, a chiropractor who doesn’t buy into the pseudoscience that permeates the profession, can be about as as effective as a physiotherapist. However, due to the fundamental tenets of the profession, they still practice highly risky maneuvers such as the “high-velocity, low-amplitude thrust” which is basically unnecessary, and carries the risk of causing serious harm, including the worst-case outcome of a cerebral artery dissection, which can easily become fatal.
This basically comes down lobbying. If insurance covers something, then it is given legitimacy and made less expensive to try.
The Chiropractic Industry’s lobbyists were able to gain influence with lawmakers during the 1960s and 1970s and, ultimately, get Chiropractic care covered in Medicare by the early 1970s.
Some very large and influential states have also mandated private insurers cover Chiropractic care, which made insurers more likely to cover it as a standard. These states include California, New York, Florida and Texas.
Once something is covered by insurance, it is seen as legitimized medicine. Even though Chiropractors are not medical doctors, and even though Chiropractic care gets mixed-at-best results from unbiased studies, it doesn’t generally cause harm and it has a lot of momentum (and legal protection) that leads to it being locked into American culture.
Trusted ? By the medical establishment? I wouldn’t say that. Chiropractors are routinely mocked.
Patients ? Some trust chiropractors more, but others go to chiropractors because they’re desperate and not getting help from the medical establishment. Chiropractors are more accessible. Its easy to get an appointment. And it doesn’t take months of phone calls, begging for referrals, thousands of dollars, waiting for appointments with doctors who will just send you to other doctors before any treatment can begin, and delays by the insurance company who hopes you’ll get better or die before they have to pay for anything.
A “good” chiropractor is going to listen to your concerns, evaluate you on the first visit, tell you if you’re standing straight and walking evenly, etc. They’ll suggest basic stretches and strengthening you can do at home ( whether they’re qualified to do that……..you decide ). The Chiropractor will tell you all this, and tell you costs and “treatment” options, on the very first visit. You don’t get that at a doctors office. And – chiropractors usually have machines that gently decompress and stretch your spine in their office – something that provides immediate but temporary relief for many back pain sufferers. They’ll suggest back supports and neck braces ( again – whether they’re qualified or not to do that…..you decide). A good chiropractor will tell you if you they can’t treat you and you need to see a specialist. A bad one….well………we know how that ends. To a lay person, its all the same. Everyone knows bad doctors too.
If the subject of chiropractors is interesting to you, take a look at D.O.s. Osteopathic doctors have a lot in common with chiropractors, plus their own weird history and practices.
Here in German-speaking countries like Germany, Austria, etc., homeopathy is a big thing, although everyone knows that it doesn’t work beyond the placebo effect. It is sold in pharmacies and in Germany there are attempts to prohibit health insurance companies from paying for it. When I buy a medicine in my pharmacy, I always have to ask twice whether it really contains an active ingredient or whether it is homeopathic mumbo-jumbo.
People are stupid.
Chiropractors are actually available and promise to fix your pain this week. Having someone actually look at you, listen to you, and do some basic stretching / massage every week for a few months can help you feel comfortable while issues resolve on their own.
Mainstream medicine wants you to see your primary care doctor in 2 weeks, try physical therapy for 6 weeks (starting in a month when they can fit you in), and if that didn’t work they’ll refer you to a specialist (2 month wait for an appointment) who will order imaging (1 month) and then see you a month after that to discuss the results and make a plan for surgery in 2-6 months, with a 4-12 week recovery time. Meanwhile, you’ve been in pain for a year.
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