The random thoughts of a sceptical activist

Obituary: The death of the subluxation

It is with no sadness whatsoever, that the death of the chiropractic subluxation at the ripe old age of 115 has finally been declared.

The long-anticipated demise was announced this evening by Skeptic Barista and, indeed, there are grounds for believing that he played a very significant part in that death. It is rumoured that he will be helping the ASA with their enquiries, although he maintains there is not a jot of evidence to support those bogus allegations.

It died on Wednesday 12 May during a meeting of the General Chiropractic Council after suffering numerous assaults, particularly over the past 12 months and despite a rigorous wellness maintenance program.

All in vain, it seems.

Career

The subluxation — more formally known as the vertebral subluxation (to distinguish it from its unconnected and distant cousin), but who also had many other aliases — had a long but chequered career. From its miraculous virgin birth to D D Palmer in 1895, it has been blamed for all human — and other animal — ailments. However, despite numerous customer satisfaction surveys by chiropractors and also proper studies, these vicious allegations proved to be completely unfounded.

One of the most thorough of these investigations (conducted mainly by chiropractors) concluded:

No supportive evidence is found for the chiropractic subluxation being associated with any disease process or of creating suboptimal health conditions requiring intervention. Regardless of popular appeal this leaves the subluxation construct in the realm of unsupported speculation. This lack of supportive evidence suggests the subluxation construct has no valid clinical applicability. (Source)

and another:

This experimental study demonstrates conclusively that the subluxation of a vertebra as defined by chiropractic—the exertion of pressure on a spinal nerve which by interfering with the planned expression of Innate Intelligence produces pathology—does not occur. This is what should be expected when one recognizes that the vertebral column has been evolving for over 400 million years to support the body and protect the central nervous system. By a process of natural selection the vertebral column of mammals has evolved into one in which the articulations allow an overall range of motion so that individuals may function well for survival within their environment. At the same time the selective process has favored vertebral columns that have spacious intervertebral foramina in combination with the barest minimum of displacement between adjacent vertebrae—two factors that preclude impingement upon the spinal nerves as they pass through the foramina. (Source)

This damning latter study was from 1973, but despite this major setback, the subluxation continued to provide very lucrative businesses for many chiropractors in the UK and abroad.

Achievements

For many years, the subluxation continued to be touted by its followers as the root cause of medical conditions that only the skilled hands of a properly trained chiropractor could detect, locate and resolve, frequently requiring ongoing chiropractic ‘wellness’ and maintenance care to prevent recurrence. And wallet-lightening.

The only remedy for a subluxation was a course of:

…often gentle, specific adjustments (the chiropractic word for manipulation) to improve the efficiency of the nervous system and release the body’s natural healing ability. (Source)

It is of particular note that these specific adjustments never involved surgery or drugs.

The pinnacle of subluxation’s success was the setting up a decade ago of the General Chiropractic Council to try to regulate chiropractors. However, the divisions within the chiropractic trade are legion and at times it must have felt like they were herding cats. And probably still does.

Despite (or indeed because of) this success, there was to be a major setback and it came from an unexpected quarter: in retrospect, this was probably the beginning of the end.

After one of the guardians of the subluxation decided to sue Dr Simon Singh for an article he wrote about chiropractic, skeptical attention was focussed on the subluxation and the claims being made for it by its devoted followers. This resulted in an unprecedented number of complaints to the GCC after which, many of the claims miraculously and instantaneously disappeared from websites up and down the country. Since the wheels of regulation grind very slowly indeed (possibly due to a C2 subluxation), it has still to be decided whether these complaints will be upheld.

Despite the subluxation’s popularity (in some clinics at least) and monetary success, the ASA were not convinced of these achievements. Now, it seems, neither is the GCC. No more will chiropractors be allowed to blame the subluxation for musculoskeletal conditions (the Bronfort report has already taken care of the non-musculoskeletal conditions that many chiropractors claimed to be able to treat).

Many are now asking what possible future is in store, particularly for those hardest hit (in the pocket).

Education

Although the mainstay of teaching in many of the chiropractic training establishments for over a century, the subluxation will now have to be relegated to the history lessons at these seats of learning. It is not known how the students will fill the empty 7 hours 59 minutes of their daily timetable. However, one source — who wished to remain anonymous — opined that they could always start by reading a certain book by Ernst and Singh.

Tributes

Not surprisingly, few friends and colleagues of the subluxation were available for comment, but one wag was heard muttering that the subluxation had always been ‘spineless’. Another was heard to quip that there has never been a jot of evidence for the subluxation and that reports of its existence had been greatly exaggerated.

Ceremonies

Since the subluxation cannot be found, there will be no burial or cremation. There will also be no memorial ceremony, but lots of weeping and gnashing of teeth is expected from some quarters as resurrection is attempted.

The subluxation is survived by an aura, two Bach flower remedies and a very dilute homeopathic potion of excrementum can.

The subluxation (1895–12 May 2010)

RIP

36 Responses to Obituary: The death of the subluxation

  • Beautifully written post, Zeno.

    I think it’s worthwhile reminding readers of the following comments which were made in the GCC’s Fitness to Practice Report 2007 (p.13 of the original document) regarding a complaint it received against one of its registrants:

    Quote:
    “The GCC’s expert witness advised that the discovery of subluxations (areas of vertebral restriction in the spinal joints) is commonplace to the point of universality in patients.”
    http://www.gcc-uk.org/files/link_file/FITNESS_TO_PRACTISE_REPORT_2007_FINAL_FOR_WEBSITE.pdf

    I wonder if that expert witness will now be called to account for misleading the disciplinary panel?

    There’s also the following from 2004 in which the GCC claimed that there was “scientific evidence” for the many interpretations of the word ‘subluxation’. See point 4 here:
    http://www.chirovictims.org.uk/images/GCC%20letter%20Page%202%2017%20June%202004.pdf

    I wonder what happened to that “scientific evidence” at its 12th May 2010 meeting?

    [For those interested, that second link is lifted from the June 2004 correspondence which the group, Action for Victims of Chiropractic, conducted with the GCC. See here:
    http://www.chirovictims.org.uk/victims/news.html

  • Excellent!

    I’m sure it has gone to a better place!

  • Great Stuff.

    One comment, though:

    The inconvenient fact of non-existence has historically not deterred many Alt.Med types from insisting things are really there. Really

    So they could still have a funeral.

    I would suggest the symbolic remains (a pile of unpaid lawyers’ invoices?) be cremated and the ashes taken to America (where the chiropractors’ Snake-Oil still seems to be depressingly popular).

    Or scattered outside the Court of Appeal.

  • This is welcome news, as one can not defame the dead :-)

  • As one bit of psuedo-science dies, another, it seems, shall be born:

    Neuro-emotional complexes or N.E.C.s, as defined below, are possibly the most overlooked factor in our patients’ health. They influence one third of the total health picture and are rarely treated because we haven’t known how to find them or intervene for their resolution. The technology is now here to diagnose and treat them in the course of a regular office visit.

    Downloaded from: http://www.chiroeco.com/chiropractic/news/9520/45/The-triangle-of-health;-once-more-with-feeling/

    Just when you thought it was safe to venture out to you local mall

  • Thanks for that link Andrew. I don’t use the phrase often, but the stupid, it burns.

  • Excellent commentary (as usual).

    The GCC said “The General Council has never considered the research evidence for the chiropractic vertebral subluxation complex” and as soon as they do look at it – They kill it off.

    For 115 years they have been teaching, preaching and practicing something that has no evidence to support it and something they conveniently chose to avoid looking at …. these are the same ‘professionals’ who are starting to petition for prescribing rights!

  • MAybe chiropractors no longer care about the subluxation (RIP, old fiend) because the “British Chiropractic Association asks the General Chiropractic Council to seek prescribing rights for its members”

    from http://www.chiropracticlive.com/?p=391

  • As a chiropractor with nigh-on 25 years in practice, I must say that I am only too happy if we have finally seen the back of the “subluxation”.

    I have never used the term myself because I do not believe that it is a good one for describing the problems that chiropractors treat, and it is confusing because it already has a definite and different meaning in orthopaedics.

    I suppose the trouble is that there aren’t any simple phrases that accurately describe and encapsulate what happens when spines stop working properly. I believe that when chiropractors use the term “subluxation” they are generally trying to give the patient a simple concept to help them understand their problem. What we know is that if a patient has an understanding of their problem, they cope with it better and their recovery is faster. I believe that this is the main reason that the term “subluxation” has survived until now, even though it is a poor one.

    Interestingly, although it is true that GPs will rarely diagnose a subluxation, they are quite likely to tell a patient that they have a “trapped nerve” or a “slipped disc”, both of which are equally flawed concepts. However, they serve to give the patient an impression, albeit one that is not accurate, that allows them to cope better with their condition.

    I think it’s a mistake to get bogged-down in an argument over the subluxation concept, because I don’t believe that it would have come in for so much criticism if it wasn’t for the marketing techniques of a small minority of practitioners. The problem with these characters is that they have endeavoured to build up their practices by exaggerating the severity of a patient’s condition and then persuading them into unnecessarily extended treatment programmes. They also have a habit of talking a lot about subluxations.

    There is no place for people like this in the profession and I can’t wait until we’ve weeded them all out so that the good name of chiropractic can be restored. Thankfully, when the General Chiropractic Council has found evidence of this type of practice it has taken action, for instance in the case of Peter Proud who was struck off the register in 2007 http://www.gcc-uk.org/files/link_file/NR%20Proud.pdf

    The vast majority of chiropractors in the UK, especially those trained at either of the two major teaching institutions (the Anglo-European College of Chiropractic and the Welsh Institute of Chiropractic), treat musculoskeletal disorders, principally of the spine, in an evidence-based and highly ethical manner. A number have continued to use the term “subluxation” but as I say, I never have and nor has any of the people I’ve worked with over the years. I certainly won’t miss it.

    On a separate note, the business of prescribing rights for chiropractors is an interesting one. This issue has not arisen because of a strong desire for chiropractors to have these rights. It came about because chiropractors were ASKED if they would be interested in having them.

  • David said,

    “The problem with these characters is that they have endeavoured to build up their practices by exaggerating the severity of a patient’s condition and then persuading them into unnecessarily extended treatment programmes. They also have a habit of talking a lot about subluxations.”

    This description fits both of the chiropractors I have seen and, given the number of times you have posted on this blog decrying what you insist is a ‘tiny minority’ of chiropractors, I’m wondering why you didn’t complain to the GCC yourself about such people. Personally, I see no reason to believe it’s a tiny minority, or even a minority who resort to the kind of scaremongering I experienced walking into a surgery covered with posters about the dangers of the subluxation and hearing a chiro give a well-rehearsed spiel on the same theme.

  • @ Skepticat

    I’m sorry to hear that your experience of chiropractors has been as you describe. I’m interested to know, where did these chiropractors you have seen graduate?

    Thankfully, in my area all the chiropractors I know do not practice that way and I have never had to complain about anyone’s marketing or practice methods.

  • Great article! Now when can we kill off religion? That can’t be proven either.

  • Yes, kill religion because millions of people have been killed in the name of God, Allah, and other dieties than chiropractors could ever harm.

    To the grave with them both.

  • I doubt this will be the end of the subluxation. Whether it is or not, there is a more important question to be answered. While I admit that there are chiropractors who keep their patients coming back for treatments that are unnecessary, many people with certain kinds of pains have been successfully been treated by chiropractors when other forms of treatment have failed. So, if it is not a subluxation that is being corrected, exactly what is happening? I’ve known doctors and physical therapists who admit that their patients or they themselves have been helped by chiropractors. When does their manipulation help and why? This, to me, is the next obvious question.

  • @ Alice

    You’ll find the answers to your questions here:
    http://www.sciencebasedmedicine.org/?p=538

    NB. It’s important not to confuse spinal manipulation with ‘chiropractic’.

  • As a DC, this is music to my ears. I have written with others about us having a lack of Cultural Authority since we have never been able to prove, nor disprove this elusive lesion. I have always vehemently hated this term and wish indeed this was a proper notification that the word would be forever gone and all connection between chiropractic and this word would be buried, never to surface again. Unfortunately, there are still too many “believers.” I applaud you for an excellent article, please keep me humored with many more wonderful enlightening articles.

  • Anyone heard of this new, err, ‘journal’ about pediatric chiropracty.

    http://www.pr.com/press-release/234864

  • Have you seen who’s on its editorial board?

    Barbara Loe Fisher, Co-Founder & President National Vaccine Information Center

    I take it you’ll have heard of her, but if not, read all about her on Skeptic’s Dictionary and Orac on her attempt to sue Paul Offit over vaccines.

    They also have:

    Christina Cunliffe, Ph.D, DC, CBiol, FIBiol, FCC, FMCA, MCC (Paediatrics)
    Principal – McTimoney College of Chiropractic
    Abingdon, Oxfordshire, United Kingdom

    However, looking through their grand total of six issues, they mostly seem to be case study reports. They have gems such as:

    “Resolution of Chronic Constipation and Neck Pain Following Chiropractic Care in a 6-Year-Old Female”

    “Improvement in a Child with Scoliosis, Migraines, Attention Deficit Disorder and Vertebral Subluxations Utilizing the Pierce Chiropractic Technique”

    “Improvement in a Child with Cerebral Palsy Undergoing Subluxation Based Chiropractic Care”

    “Female Infertility, Subluxation & Chiropractic Care: A Case Series and Selective Review of the Literature”

    I see it’s published by McCoy Press. Oh look! The editor is Matthew McCoy. Coincidence or a vanity publication?

  • Thanks Zeno

    How do you get the time for all this investigation?

    I hadn’t heard of Barbara Loe, but a quick squize at that link certainly has me up to speed now.

    I did find a useful link for chiropractic ‘publications’ a while ago (http://www.chiro.org/LINKS/journal.shtml#Journals), which no doubt you’ll have seen. Pity most have restricted access.

  • Any chance of burying the phrase ‘slipped disc’ while you’re at it? This is common parlance amongst GP’s and despite being anatomically incorrect used on a daily basis to explain back pain symptoms to the lay public who then seek therapy that will put the disc back into place!

  • I am heartened at this news. I am a chiropractor, practicing in the States, for 21 years now. I have been ‘railing against the wind’ for nearly all that time, with my patients, one-on-one. However, with few exceptions, it is not wise to stand up in a group of practitioners and speak the truth because the vast majority of us (some reports have it at about 80%) still hold on to this ‘dead’ concept. If subluxations don’t exist, then treatment methods designed to reduce or correct them are of no possible benefit. I contend that no more a baseless method exists than any form of instrument ‘adjusting’, including the very popular tool employed by ‘A. M.’. I anxiously await the day when this is widely acknowledged.

  • @ Herb Congram DC

    I suspect the ‘A.M.’ tool you mention is the very same one that will be the subject of a seminar (worth 11 Continuing Professional Development hours) at the Anglo European College of Chiropractic (AECC) in November 2010…
    http://www.aecc.ac.uk/feeds/cpd/activator-basic-scan-protocol.aspx

    Readers should note that the AECC styles itself as a “World Leading Chiropractic Education and Research” college. Hmm.

  • Dear Zeno,
    I’m sorry I didn’t ask your permission, but I couldn’t help translating your post on my blog. And photoshopping a hypothetical gravestone for the deceased [ http://doppiocieco.splinder.com/post/22895840/la-morte-della-sublussazione ]

  • As a chiropractor, and someone who has benefited from chiropractic care my whole life, i saddens me to see what is happening in England. If any of these zealots were to look into the History of Chiropractic, they would find that it was B. J., not D. D. who coined the term “Subluxation”, to be used in the chiropractic profession. Had this word never been put into use, and the Chiropractic Profession as a whole, educated the public to care for their Spine, the world may be a healthier place. So many people have such strong emotions for “words”, that humanity suffers greatly as so many people are turned away from Chiropractic because of such petty arguments.

    Medicine is now recognized (in the US), as the leading cause of Death. Are any of you doing anything about the thousands of people that are being killed every day in the UK because of Medical Error? Chiropractors are the health care providers like to attack the most because we have people like Margret Coates running things in the UK, who has NO LOVE at all for this profession. Every Medical Doctor swears an oath, a “Hippocratic Oath”. No one finds that ironic, as it was Hippocrates who first said “Look well to the Spine, for the cause and prevention of Disease”. What if he had said the word “Subluxation”, would that have made how nature created us (as the Nervous System as the ruling system in the body), any different?

  • Mark

    The GCC is a UK statutory body, not an English one.

    I have no idea why you think someone who wants chiropractors to abide by their statutory CoP is a zealot, and it also matters little who it was who invented the word ‘subluxation’.

    The number of ‘Deaths’ apparently caused by proper medicine is irrelevant: it has no effect on the paucity of evidence for chiropractic. Neither does the number of lives enhanced and saved by conventional medicine.

    Fortunately, we now — thanks to science — know much more about the working of the human body than Hippocrates did. Or either of the Palmers for that matter.

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