Chiropractic (from Greek chiros and praktikos meaning "done by
hand") is a health care profession whose purpose is to
diagnose and treat mechanical disorders of the spine and musculoskeletal system with the intention of affecting the nervous system and improving health.[1] It is based on the premise that a spinal joint dysfunction can interfere with the nervous system and result in many different conditions
of diminished health. While some chiropractors use the term vertebral subluxation to describe what they treat, others have dropped this concept and
concentrate mostly on the musculoskeletal components of spinal injury and rehabilitation of the spine.[2] In contrast, the term subluxation as used in conventional medicine is usually associated with specific conditions which are a
direct consequence of injury to joints or associated nerves.
Chiropractic was founded in 1895 by D. D. Palmer, and it is now practiced in more
than 100 countries.[3][4]
Chiropractic treatments vary depending on the patient's condition and the type of approach taken by the particular
chiropractor. They commonly include spinal adjustments, although other interventions
may be used as well.
Today there are four main groups of chiropractors: "traditional straights", "objective straights", "mixers", and
"reform".[citation needed] All groups, except reform, treat patients using a subluxation-based system.
Differences are based on the philosophy for adjusting, claims made about the effects of those adjustments, and various additional
treatments provided along with the adjustment.
Since its inception, Chiropractic has been the subject of controversy, criticism, and outright attacks. It has come from
critics within the profession, critics outside the profession, and from researchers in the scientific community. Historically,
these have indirectly led to the scientific investigation of chiropractic and an antitrust suit against the American Medical
Association. As a direct result of this criticism, as well as the relative dissatisfaction with its medical counterpart,
surveys show that chiropractic patients have the highest satisfaction rate among the various healthcare disciplines. [5][6]
History of the basic premise
Chiropractic was founded in 1895 by Daniel David Palmer, based on his assertion
that 95% of all health problems could be prevented or treated using adjustments of the spine (spinal adjustments), and 5% by adjustments of other joints, to correct what he termed vertebral subluxations. He, and later his son B.J. Palmer,
proposed that subluxations were misaligned vertebrae which caused nerve compression that interfered with the transmission of what
he named Innate Intelligence. This interference interrupted the proper flow of
Innate Intelligence from "above, down, inside, and out" (ADIO) to the organ to which it traveled. As a result, the human body
would experience "dis-ease" or disharmony which would result in loss of health. Palmer related this concept as similar to
applying pressure to a hose that supplies a garden; relieve the pressure and the garden flourishes.
While the "pinched garden hose theory" has mostly been abandoned, it is still used in a modified form by some chiropractors to
explain vertebral subluxation.[citation needed] However, the concept of the subluxation remains integral to typical
chiropractic practice. In 2003, 90% of North American chiropractors believed the vertebral subluxation complex played a significant role in all or most diseases.[7]
Explanation
Manipulation of the spine, when
performed by a chiropractor, is frequently referred to as an adjustment. Though spinal
manipulation for back pain has been documented from the time of the ancient Egyptians,[8] and early osteopaths practiced
generalized spinal maneuvers, the attempt to precisely correct theoretical vertebral subluxations is a uniquely chiropractic
endeavor.
A modern chiropractor may specialize in spinal manipulations only, or may use a wide range of methods intended to address an
array of neuromusculoskeletal and general health issues. Examples include massage,
strength training, dry needling (similar to
acupuncture), functional electrical
stimulation, traction, and nutritional
recommendations. Some chiropractors specialize in chiropractic sports medicine, which includes manipulation of the extremities, and exercises to increase
spinal strength. Chiropractors may also use other complementary alternative methods as part of a holistic treatment approach.
Chiropractors generally cannot write medical prescriptions. Traditionally, they
consider the prescription of drugs the province of conventional medicine, with the chiropractor's role being to pursue drug-free
alternative treatments. More recently (2003), a survey of North American chiropractors found that a majority supported limited
prescription rights.[7] A notable exception
is the state of Oregon, which allows chiropractors with minor additional qualification to prescribe over-the-counter
drugs.[9] Depending on the country or state in which a
Chiropractic school is located, some chiropractors may obtain additional training to perform minor surgery, obstetrics and
proctology.[10] When indicated, the doctor of chiropractic
consults with, co-manages, or refers to other health care providers.[1]
Origins of Chiropractic and the concept of subluxation
Autonomic Nervous System
Blue = parasympathetic
Red = sympathetic
-
DD Palmer, using a vitalistic approach, imbued the term subluxation with a metaphysical and philosophical meaning. He held that a malposition of spinal bones, which protect the spinal cord and nerve roots, interfered with the transmission of
nerve impulses. Because half of the nervous system is sensory and the other half motor (control), he postulated that living
things had an Innate intelligence, a kind of "spiritual energy" or life force that received the sensory information from the various parts of the body and made a decision as to
what the motor nerves should convey. DD Palmer claimed that subluxations interfered with this innate intelligence, and that by
fixing them, all diseases could be treated.[11] He qualified this by noting that knowledge of Innate Intelligence was not essential to the
competent practice of chiropractic.[12]
The idea that all diseases were the result of a subluxation was in line with the common thinking of the day; that there was
one cause for disease. The vitalistic concepts implied an intelligent governing entity that was readily perceived as spiritual
constructs by many both inside and outside the profession. Chiropractors used these metaphorical concepts to rationalize their
thinking about the body’s self-healing capacity.[13] In 1998, Lon Morgan DC, a reform chiropractor, wrote that: "Innate Intelligence clearly
has its origins in borrowed mystical and occult practices of a bygone era. It remains untestable and unverifiable and has an
unacceptably high penalty/benefit ratio for the chiropractic profession. The chiropractic concept of Innate Intelligence is an
anachronistic holdover from a time when insufficient scientific understanding existed to explain human physiological processes.
It is clearly religious in nature and must be considered harmful to normal scientific activity."[14]
Meridel I. Gatterman DC, educator and writer observed:
- "The word subluxation has been ... embodied with a multitude of meaning by chiropractors during the past one hundred years.
To some it has become the holy word; to others, an albatross to be discarded ... to add to the confusion, more than 100 synonyms
for subluxation have been used. Why then do we persist in using the term when it has become so overburdened with clinical,
political, and philosophical ... significance ... that the concept that once helped to hold a young profession together now
divides it and keeps it quarrelling over basic semantics? The obvious answer is: The concept of subluxation is central to
chiropractic."[15]
Debate about the need to remove the concept of subluxation from the chiropractic paradigm has been ongoing since the mid
1960s. While straights hold firmly to the term and its vitalistic construct, reformers suggest that the mechanistic model will
allow chiropractic to better integrate into mainstream medicine without making claims inherent in the term. Anthony Rosner PhD,
director of education and research at the Foundation for Chiropractic Education and Research (FCER) considered subluxation and
the concept of Occam's razor. He suggests "there is no obvious reason to discard the
concept of subluxation, while at the same time maintaining that it is not a rigid entity, but rather an important model and
concept; a work in progress that undoubtedly will undergo extensive modification as our concepts of light or psychoanalysis have
evolved over half a century."[16]
Despite the term's vitalistic roots, chiropractic today may still use the term Innate Intelligence; however, it has taken on a
less metaphysical meaning. Innate Intelligence today is used to describe the self-healing power of the body. Thus, a modern
chiropractic view is that by removing the restrictions caused by subluxation, the chiropractor is improving the body's own
potential for self-healing.[17]
It should be noted, however, that not all chiropractic institutions subscribe to the vertebral subluxation theory.[18]
Chiropractic’s approach to healthcare
According to Robert Mootz D.C. and Reed Phillips D.C., Ph.D., although chiropractic has much in
common with other health professions, its philosophical approach distinguishes it from modern medicine. Chiropractic philosophy
involves what has been described as a "contextual, naturopathic approach" to health care.[19] The traditional, "allopathic" or "medical" model considers disease as generally
the result of some external influence, such as a toxin, a parasite, an allergen, or an infectious agent: the solution is to
counter the perceived environmental factor (e.g., using an antibiotic for a bacterial infection). By contrast, the
naturopathic approach considers that lowered "host resistance" is necessary for disease to occur, so the appropriate
solution is to direct treatment to strengthen the host, regardless of the environment. In contemporary clinical practice, one can
find elements of both naturopathic and allopathic philosophy among all types of providers.[13] The degree to which a practitioner emphasizes different tenets
of these philosophies is one factor that determines the manner in which they practice.
- Chiropractic Perspectives That Reflect a Holistic Approach to Patient Care
- noninvasive, emphasizes patient's inherent recuperative abilities
- recognizes dynamics between lifestyle, environment, and health
- emphasizes understanding the cause of illness in an effort to eradicate, rather than palliate, associated symptoms
- recognizes the centrality of the nervous system and its intimate relationship with both the structural and regulatory
capacities of the body
- appreciates the multifactorial nature of influences (structural, chemical, and psychological) on the nervous system
- balances the benefits against the risks of clinical interventions
- recognizes as imperative the need to monitor progress and effectiveness through appropriate diagnostic procedures
- prevents unnecessary barriers in the doctor-patient encounter
- emphasizes a patient-centered, hands-on approach intent on influencing function through structure
- strives toward early intervention, emphasizing timely diagnosis and treatment of functional, reversible conditions
- Source:AHCPR Chapter 2 Chiropractic Belief Systems, Robert D. Mootz DC; Reed B. Phillips DC, PhD
The Chiropractic approach to healthcare stresses the importance of prevention. Former president of National College of
Chiropractic, Joseph Janse DC (1909-1985) explains:
- "Unless pathology is demonstrable under the microscope, as in the laboratory or by roentgenograms, to them [allopaths] it
does not exist. For years the progressive minds in chiropractic have pointed out this deficiency. With emphasis they
[chiropractors] have maintained the fact that prevention is so much more effective than attempts at a cure. They pioneered the
all-important principle that effective eradication of disease is accomplished only when it is in its functional (beginning) phase
rather than its organic (terminal) stage. It has been their contention that in general the doctor, the therapist and the
clinician have failed to realize exactly what is meant by disease processes, and have been satisfied to consider damaged organs
as disease, and to think in terms of sick organs and not in terms of sick people. In other words, we have failed to contrast
disease with health, and to trace the gradual deteriorization along the downward path, believing almost that mild departures from
the physiological normal were of little consequence, until they were replaced by pathological changes..."
Most patients who visit a chiropractor do so initially with a chief complaint related
to musculoskeletal problems (especially low back and neck pain), although most chiropractors say they concern themselves with the
overall health of the patient. According to a survey by the National Center for Complementary and Alternative
Medicine, in 2002, chiropractic was the fourth (7.5%) most commonly used Complementary and alternative medicine (CAM) therapy among adults in the USA.[20][21]
The profession has evolved so that treatment consists of hundreds of different techniques.[22] The U.S. Department of Labor's Occupational Outlook Handbook said:
- Because chiropractors emphasize the importance of healthy lifestyles and do not prescribe drugs or perform surgery,
chiropractic care is appealing to many health-conscious Americans. Chiropractic treatment of the back, neck, extremities, and
joints has become more accepted as a result of research and changing attitudes about alternative, noninvasive health care
practices.[23]
Most DCs are in private practice or work in small groups, employing chiropractic assistants as office staff and to perform
therapeutic activities. They may also employ massage and physiotherapists as adjuncts to chiropractic care.
History
-
DD Palmer gave the first chiropractic adjustment to a deaf janitor, Harvey Lillard, on September 18, 1895, reportedly resulting in a restoration of the man's
hearing.[11]
Friend and Rev. Samuel Weed suggested combining the words cheiros and praktikos (meaning "done by hand") to
describe Palmer's treatment method, creating the term "chiropractic." In 1896, DD added a school to his magnetic healing
infirmary, and began to teach others his method. It would become known as Palmer School of Chiropractic (now Palmer College of Chiropractic), located in Davenport, Iowa.
Medicine vs. chiropractic
In September 1899, a medical doctor in Davenport, IA, named Heinrich Matthey started a campaign against drugless healers in
Iowa. DD Palmer, whose school had just graduated its 7th student, insisted that his techniques did not need the same courses or
license as medical doctors, as his graduates did not prescribe drugs or evaluate blood or urine. However, in 1906, Palmer was
convicted for practicing medicine without a license. He chose to turn over his interests in the PSC to his son, BJ and wife,
Mabel.
BJ Palmer re-develops chiropractic
BJ Palmer Developer of Chiropractic 1882-1961
BJ created the Universal Chiropractic Association (UCA) for the purpose of protecting its members by covering their legal
expenses should they get arrested.[24] Its first case
came in 1907, when Shegataro Morikubo DC of Wisconsin was charged with unlicensed practice of osteopathy. Morikubo was freed using the defense that chiropractic philosophy was different from osteopathic
philosophy. The victory reshaped the development of the chiropractic profession, which then marketed itself as a science, an art
and a philosophy, and BJ Palmer became the "Philosopher of Chiropractic".
Straight versus mixer
State laws to regulate and protect chiropractic practice were eventually introduced in all fifty states in the US, but it was
a hard-fought struggle. Medical Examining Boards worked to keep all healthcare practices under their legal control, but an
internal struggle among DCs on how to structure the laws significantly complicated the process. Initially, the UCA, led by BJ
Palmer and armed with his philosophy, opposed state licensure altogether. Palmer feared that such regulation would lead to
allopathic control of the profession.[25] The UCA eventually caved in, but BJ remained strong in the opinion that examining boards
should be composed exclusively of chiropractors (not those who mixed chiropractic with other remedies). Mixers campaigned to
alter education standards toward those of medical schools and consistent with the tenets of the medical profession while Palmer
resisted any alteration in standards away from his conceptualization of the chiropractic profession.
The movement toward science
In 1975, the National Institutes of Health brought chiropractors,
osteopaths, medical doctors and Ph.D. scientists together in a conference on spinal
manipulation to develop strategies to study the effects of spinal manipulation. In 1978, the Journal of Manipulative & Physiological Therapeutics (JMPT) was
launched, and in 1981 it was included in the National Library of Medicine's Index
Medicus.[26] Joseph
Keating dates the birth of chiropractic as a science to a 1983 commentary in the JMPT entitled "Notes from the (chiropractic
college) underground" in which Kenneth F. DeBoer, then an instructor in basic science at Palmer College in Iowa, revealed the
power of a scholarly journal (JMPT) to empower faculty at the chiropractic schools. DeBoer's opinion piece demonstrated the
faculty's authority to challenge the status quo, to publicly address relevant, albeit sensitive, issues related to research,
training and skepticism at chiropractic colleges, and to produce "cultural change" within the chiropractic schools so as to
increase research and professional standards. It was a rallying call for chiropractic scientists and scholars.[26]
Wilk et al. vs the American Medical Association (AMA)
-
Until 1983, the AMA held that it was unethical for medical doctors to associate with an "unscientific practitioner", and
labeled chiropractic "an unscientific cult". Principle 3 of the AMA Principles of Medical Ethics stated:
- "A physician should practice a method of healing founded on a scientific basis; and he should not voluntarily professionally
associate with anyone who violates this principle."
A Chicago chiropractor, Chester A. Wilk, initiated an antitrust suit
against the AMA and other medical associations in 1976 - Wilk et
al. vs AMA et al..[27] The landmark lawsuit ended in 1987 when the US District Court found the AMA guilty of
conspiracy and restraint of trade; the Joint Council on Accreditation of Hospitals and the American College of Physicians were
exonerated. The court recognized that the AMA had to show its concern for patients, but was not persuaded that this could not
have been achieved in a manner less restrictive of competition, for instance by public education campaigns. The AMA lost its
appeal to the Supreme Court, and had to allow its members to collaborate with DCs.[5]
Judge Susan Getzendanner, who presided over the Wilk case, said:
- "Evidence at the trial showed that the defendants took active steps, often covert, to undermine chiropractic educational
institutions, conceal evidence of the usefulness of chiropractic care, undercut insurance programs for patients of chiropractors,
subvert government inquiries into the efficacy of chiropractic, engage in a massive disinformation campaign to discredit and
destabilize the chiropractic profession and engage in numerous other activities to maintain a medical physician monopoly over
health care in this country."
She then said that chiropractors clearly wanted "a judicial pronouncement that chiropractic is a valid, efficacious, even
scientific health care service." She said no "well designed, controlled, scientific study" had been done, and concluded "I
decline to pronounce chiropractic valid or invalid on anecdotal evidence, even though "the anecdotal evidence in the record
favors chiropractors."[5]
Safety
- See also: Spinal adjustment#Safety
issues
- See also: Spinal manipulation#Safety
issues
The World Health Organization states that when "employed skilfully and appropriately, chiropractic care is safe and effective
for the prevention and management of a number of health problems."[28] The International Chiropractic Association (ICA) suggests that chiropractic is one of the safest
health professions and chiropractors have some of the lowest malpractice insurance premiums in the health care industry.[29]
Scientific investigation of chiropractic
-
| The Testable Principle |
The Untestable Metaphor |
| Chiropractic Adjustment |
Universal Intelligence |
| Restoration of structural integrity |
Innate Intelligence |
| Improvement of Health Status |
Body Physiology |
| Materialistic |
Vitalistic |
| Operational definitions possible |
Origin of Holism in chiropractic |
| lends itself to scientific inquiry |
cannot be proved or disproved |
| Table 1. Two chiropractic system constructs.
Source: Phillips RB, Mootz RD. Contemporary chiropractic philosophy. In Haldeman S (ed). Principles and Practice of
Chiropractic, 2nd Ed. Norwalk, CT: Appleton & Lange, 1992. Chart reprinted from Keating J (1995), D.D. Palmer's Forgotten
Theories of Chiropractic[5]
|
Chiropractic researchers Robert Mootz and Reed Phillips suggest that, in chiropractic's early years, influences from both
straight and mixer concepts were incorporated into its construct. They conclude that chiropractic has both materialistic qualities that lend themselves to scientific investigation and vitalistic qualities that do not (Table 1).
With relatively little federal funding, academic research in chiropractic has only recently become established in the USA. In
1994 and 1995, half of all grant funding to chiropractic researchers was from the US Health Resources and Services Administration
(7 grants totaling $2.3 million). The Foundation for Chiropractic Education and Research (11 grants, $881,000) and the Consortium
for Chiropractic Research (4 grants, $519,000) accounted for most of the rest. By 1997, there were 14 peer-reviewed chiropractic
journals in English that encouraged the publication of chiropractic research, including The Journal of Manipulative and
Physiological Therapeutics (JMPT), Topics in Clinical Chiropractic, and the Journal of Chiropractic Humanities.
However, of these, only JMPT is included in Index Medicus. Research into
chiropractic, whether from Universities or chiropractic colleges, is however often published in many other scientific
journals.[30]
While there is still debate about the effectiveness of chiropractic for the many conditions in which it is applied,
chiropractic seems to be most effective for acute low back pain and tension headaches.[31] When testing the efficacy of health treatments, double blind studies are considered acceptable scientific rigor. These are designed so that neither the
patient nor the doctor knows whether they are using the actual treatment or a placebo (or "sham") treatment. However,
chiropractic treatment involves a manipulation; "sham" procedures cannot be easily
devised for this, and even if the patient is unaware whether the treatment is a real or sham procedure, the doctor cannot be
unaware. Thus there may be "observer bias" - the tendency to see what you expect to see, and the potential for the patient to
wish to report benefits to "please" the doctor. Similarly, it is often difficult to devise a sham procedure for surgical
procedures, but it is not impossible. It is also a problem in evaluating treatments; even when there are objective outcome
measures, the placebo effect can be very substantial. Thus, DCs have historically relied mostly
on their own clinical experience and the shared experience of their colleagues, as reported in case
studies, to direct their treatment methods. In this, they are not different to the practice in much of conventional
medicine.
There is evidence that spinal manipulation is effective for the treatment of acute
low back pain, tension headaches and some musculoskeletal issues, but not all studies support this conclusion.[31] A systematic review of systematic reviews in 2006 by
Ernst and Cantor concluded that "Collectively these data do not demonstrate that spinal manipulation is an effective intervention
for any condition. Given the possibility of adverse effects, this review does not suggest that spinal manipulation is a
recommendable treatment."[32] In 2007, Ernst
performed another review, drawing similar conclusions.[33] A commentary from a chiropractic and osteopathic journal disputed Ernst and Cantor's
conclusion as, "..definitely not based on an acceptable quality review of systematic reviews and should be interpreted very
critically by the scientific community, clinicians, patients, and health policy makers. Their conclusions are certainly not valid
enough to discredit the large body of professionals utilizing spinal manipulation."[34]
One controlled trial showed a lowering of blood pressure in hypertensive patients[35] after alignment of the atlas vertebra.
Sociologist Leslie Biggs interviewed 600 Canadian DCs in 1997: while 86% felt that chiropractic methods needed to be
validated, 74% did not believe that controlled clinical trials were the best way to evaluate chiropractic. Moreover, 68% believed
that "most diseases are caused by spinal malalignment", although only 30% agreed that "subluxation was the cause of many
diseases".[36]
Even when a valid mechanism of action is not determined, it is generally thought sufficient to present evidence showing
benefit for the claims made. There is wide agreement that, where applicable, an evidence based medicine framework should be used to assess health outcomes, and that systematic
reviews with strict protocols are important for objectively evaluating treatments. Where evidence from such reviews is lacking,
this does not necessarily mean that the treatment is ineffective, only that the case for a benefit of treatment may not have been
rigorously established.
A 2005 editorial in JMPT, "The Cochrane Collaboration: is it relevant
for doctors of chiropractic?"[37] proposed that
involvement in Cochrane collaboration would be a way for chiropractic to gain greater acceptance within medicine. The
collaboration has 11,500 contributors from more than 90 countries organized in 50 review groups. For chiropractic, relevant
review groups include the Back Group; the Bone, Joint, and Muscle Trauma Group; the Musculoskeletal Group; and the Neuromuscular
Disease Group. The editorial states that, for example, "a chiropractor may provide conservative care supported by a Cochrane
review to a patient with carpal tunnel syndrome. If the patient's symptoms become progressive, the doctor may consider referring
the patient for surgery using a recent Cochrane review that examined new surgical techniques compared with traditional open
surgery..."
The Cochrane Collaboration did not find enough evidence to support or refute the claim that manual therapy (including, but not
limited to, chiropractic) is beneficial for asthma. Carpal
tunnel syndrome trials have not shown benefit from diuretics, non-steroidal anti-inflammatory drugs, magnets, laser
acupuncture, exercise or chiropractic and there is not enough evidence to show the effects of spinal manipulation (including, but not limited to, chiropractic) for painful menstrual periods.
Bandolier found limited evidence that spinal manipulative therapy (including, but
not limited to, chiropractic) might reduce the frequency and intensity of migraine attacks, but the evidence that spinal
manipulation is better than amitriptyline, or adds to the effects of amitriptyline,
is insubstantial for the treatment of migraine, although "spinal manipulative therapy might be worth trying for some patients with
migraine or tension headaches."
According to Bandolier, a systematic review of a small, poor quality set of trials provided no convincing evidence for
long-term benefits of chiropractic interventions for acute or chronic low back pain, despite some positive overall
findings[38] but there might be some short-term pain
relief, especially in patients with acute pain.[39]
However, the BMJ noted in a study on long-term low-back problems "...improvement
in all patients at three years was about 29% more in those treated by chiropractors than in those treated by the hospitals. The
beneficial effect of chiropractic on pain was particularly clear."[40] A 1994 study by the U.S. Agency for Health Care Policy and Research (AHCPR) and the U.S. Department
of Health and Human Services endorses spinal manipulation for acute low back pain in
adults in its Clinical Practice Guideline.
The first significant recognition of the appropriateness of spinal manipulation
for low back pain was performed by the RAND Corporation. This meta-analysis
concluded that some forms of spinal manipulation were successful in treating certain
types of lower back pain. Some chiropractors claimed these results as proof of chiropractic hypotheses, but RAND's studies were
about spinal manipulation, not chiropractic specifically, and dealt with appropriateness, which is a measure of net benefit and
harms; the efficacy of chiropractic and other treatments were not explicitly compared. In 1993, Dr Shekelle rebuked some DCs for
their exaggerated claims: ...we have become aware of numerous instances where our results have been seriously misrepresented by
chiropractors writing for their local paper or writing letters to the editor....[41]
There is conflict in the results of chiropractic research. For instance, many DCs claim to treat infantile colic. According to a
1999 survey, 46% of chiropractors in Ontario treated children for colic.[42] In 1999 a Danish randomized controlled clinical
trial with a blinded observer suggested that there is evidence that spinal manipulation might help infantile colic.[43] However, in 2001, a Norwegian blinded study
concluded that chiropractic spinal manipulation was no more effective than placebo for
treating infantile colic.[44]
In 1997, historian Joseph Keating Jr described chiropractic as a "science, antiscience and pseudoscience", and said "Although
available scientific data support chiropractic's principle intervention method (the manipulation of patients with lower back
pain), the doubting, skeptical attitudes of science do not predominate in chiropractic education or among practitioners". He
argued that chiropractic's culture has nurtured antiscientific attitudes and activities, and that "a combination of uncritical
rationalism and uncritical empiricism has been bolstered by the proliferation of pseudoscience journals of chiropractic wherein
poor quality research and exuberant over-interpretation of results masquerade as science and provide false confidence about the
value of various chiropractic techniques". However, in 1998, after reviewing the articles published in the JMPT from
1989-1996, he concluded,
- "substantial increases in scholarly activities within the chiropractic profession are suggested by the growth in scholarly
products published in the discipline's most distinguished periodical (JMPT). Increases in controlled outcome studies,
collaboration among chiropractic institutions, contributions from nonchiropractors, contributions from nonchiropractic
institutions and funding for research suggest a degree of professional maturation and growing interest in the content of the
discipline."[45]
The Manga Report<
