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
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.
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