Back in black Spin Doctor

Canadian author Paul Benedetti sounds chiropractic alarm bell

Chiropractic treatment is a contentious topic undergoing much scrutiny today. Dogged with lawsuits and news reports of people suffering strokes, paralysis and death from the very controversial neck manipulation, the field is not accepted by the medical establishment and struggles to obtain university recognition. This problem haunts chiropractic although it is a self-regulating profession whose practitioners, after four years of study following a mandatory three years of university, are allowed to call themselves doctors.
Chiropractic work is done by manipulating, or adjusting, the neck and spine. According to the Ontario Chiropractic Association's website, chiropractic takes a holistic approach to health focused on the neuromusculoskeletal system, considering the overall wellness of a patient. It states that the nervous system "determines how well you feel physically, mentally, and emotionally." According to the Association, various physical problems are caused by "sublaxations," which are "problem areas (where) the spinal bones are misaligned or have lost their normal range of movement, (irritating or putting) pressure on local nerves which interferes with the communication between your brain and body." Sublaxations, the website goes on, can be caused by the many everyday stresses of daily living, from housework or sleeping on a couch; and in children from play, learning to walk or even the birth process.
Paul Benedetti vigorously disputes these claims and sees little value in chiropractic. In the book Spin Doctors: The Chiropractic Industry Under Examination, he and co-author Wayne MacPhail present a frightening case against it. Going back to its roots over a 100 years ago to its links with spiritualism and techniques like magnetic healing, they contend that chiropractic has no scientific evidence to back it up; that sublaxations have never been proven to exist; and that today it is essentially bilking people by performing unnecessary, and often dangerous, adjustments on people of all ages, including babies and small children. It slams the profession for encouraging work to be done on healthy people, for some practitioners making unsubstantiated claims to cure anything from allergies to earaches, and for its governing bodies being unable, or unwilling to properly police its members. It goes into detail about several high-profile cases in recent years in Canada where people were left paralyzed or dead from cervical spine manipulations, including the case of 20-year-old Laurie Jean Mathiason of Saskatchewan. The 1998 inquest into her death recommended among other things that Ministries of Health in this country undertake immediate studies to determines the risks and benefits of this type of manipulation, and the rate of incidence of strokes associated with it.
In a recent interview with Tandem, Benedetti points to a number of studies that indicate chiropractic cannot cure all that ails you. "For uncomplicated lower back pain and some neck pain chiropractic manipulation is no better than any number of other interventions, such as anti-inflammatories and pain killers, such as light exercise," he explains. He notes that spinal manipulative therapy, performed by physiotherapists and other trained health care professionals, can do the same things for the lower back as chiropractic. "So that means you've got an entire profession whose only proven treatment is neither better nor worse than a bunch of other therapies that are easily accessible within the regular mainstream medical field." He questions whether the government should be paying for something "that's no better or worse than a bunch of other treatments, and sometimes no better than doing nothing. It was our view (in the book) that unless there's wide scale reform of the profession, and we don't see that happening, then we don't really see that there's not that great a benefit to the whole thing."
There is however with chiropractic a higher level of patient satisfaction in spite of its proven minimal benefits. Benedetti notes several reasons for this satisfaction. One is patient interaction. Chiropractors spend more time with patients. They also touch them, which is a key issue. "It's called the 'laying on of hands,' which has been practiced by healers of all kinds," he explains. "Physical contact is very important to the patient's sense of feeling better."
Benedetti found that the confidence of the practitioner plays a big part in patient satisfaction. Unlike medical doctors, who will say there is not much to be done with a sore low back but to rest, take some painkillers and wait a few weeks for it to clear up, chiropractors will claim that with a few adjustments they will cure the problem. "Their confidence is transmitted to the patient. It's confidence in the face of evidence," he continues. "Chiropractors are not particularly influenced by scientific evidence and by evidence based on trials. They're really convinced of what they do irrespective of the evidence."
The natural progression of the problem also influences the patient. "The reality is in over 90 percent of acute low back pain, which is what most North Americans suffer from, those incidents last between three to six weeks," he notes. "So what most honest doctors would tell you is, whether you come to me or not, you'd be feeling better in a few weeks anyway, you might even be feeling better in a few days." Then there is the placebo effect. A few days after a chiropractic adjustment your back begins to perhaps feel better as it would in any case, and the human mind sees cause-and-effect, that the adjustment cured the problem. "But the evidence for that is not is not very solid," stresses Benedetti. "In fact your back was probably getting better anyway and the adjustment neither helped nor hindered that recovery process."
A disturbing section of Spin Doctors deals with an 11-year-old girl with a clean bill of health from Dr. John Wedge, chief of surgery at Toronto's Sick Kids Hospital, who Benedetti and MacPhail used on a random test of chiropractors. Of the five visited, only one chiropractor recommended no manipulation on the child. The four who did recommend chiropractic treatment did so for different "serious" problems, from one longer leg, to scoliosis, and early osteo-arthritis.
"Treatment of children was just really one of the prime motivators that just made us feel this has to be disclosed to the public," says Benedetti. "You can't have infants and children being taken there. In my view, there's simply no evidence to support the treatment of children with chiropractic manipulation for any number of illnesses that they claim to treat. It's insupportable, and just wrong."
Benedetti, the son of a father from Conegliano, near Treviso, and a first-generation Canadian mother born in Hamilton to parents from near Rome, is a journalist who for several years has covered stories on alternative medicine and health fraud. He also teaches journalism at the University of Western Ontario. He first became interested in off-mainstream medicine in the 1980s, when a proliferation of alternative nutritional therapists appeared, giving seminars and lectures.
"They called themselves nutritional consultants, which is much different than dieticians or proper nutritionists that go to the University of Guelph and get their degrees," he recalls. "The more I looked into it the more I found out there was this world of supplements and remedies and herbal stuff, and that there were people churning out diplomas and all kinds of fake titles. I just got enthralled with it." This led him to speak with dieticians and nutritional scientists, exposing a North America-wide conflict between conventional science and the alternative group. Benedetti was particularly driven by his interest in the human element. "You needed to really think about how we protect people," he explains. "People who believe in it, people who are paying, who take their children."
Spin Doctors wades into other alternative treatments, exploring the wide interpretations of chiropractic practiced today including practitioners who use these various other therapies that often have no scientific evidence to back them up. "It's not a minority, a small minority of chiropractors that use adjunctive alternative therapies as the profession often claims," Benedetti states. Though the profession says 'oh, those are just a few bad apples, a couple of fringe players who are besmirching the name of the profession' with electro diagnostic machines, herbal remedies and lasers, Benedetti begs to differ. "When they do surveys, they find that significant proportions of chiropractors use many of those therapies, machines and modalities that have no proven benefit, and in some cases are just kind of wacky."
Cautioning that chiropractors offer a mixed bag of remedies and offering that one would be better served seeing a nutritionist for dietary advice, Benedetti suggests that the world of other alternative therapies, naturopath, homeopaths and herbalist professions are in general "just as mired in unscientific thinking as chiropractic is." He emphasizes this about homeopathy, which proposes taking a substance that causes the symptoms that you're experiencing, like will cure like. "By using increasingly huge dilutions until finally, in many homeopathic remedies there's not a single molecule of the substance. You're simply using water or alcohol. Their ideas are really counter to the basic fundamental rules of chemistry, of physics as we understand them."
Investigation into other alternative therapies, Benedetti says, may need a whole other book.

Spin Doctors: The Chiropractic Industry Under Examination (296 pages, $24.99) by Paul Benedetti and Wayne MacPhail, is published by Dundurn Press.

Publication Date: 2003-09-07
Story Location: http://tandemnews.com/viewstory.php?storyid=3125