As a 35-year practicing chiropractor, I’ve heard satisfied patients who tell me that someone they know who needs chiropractic spinal care but refuses to seek help because “they don’t believe in chiropractic.”
It is past time we openly address the medical prejudice against chiropractors, an embedded bias I have coined as ‘chirophobia’—the irrational fear, antipathy, contempt, prejudice, aversion, or hatred of chiropractors instilled by decades of medical bigotry.
Similar to any bias like racism, sexism, or homophobia, the public has given little or no conscious deliberation of its accuracy or the dubious origin of this medical muck about chiropractors.
Fortunately, unlike ever before, the chiropractic profession now has more profound proof with supportive research that began in 1994 when an agency of the US Public Health Service recommended spinal manipulation as a ‘proven treatment’ for acute low back pain in adults.[1]
In 1997, the U.S. Public Health Service conducted another study, “Chiropractic in the United States: Training, Practice and Research,” that admitted “chiropractic has undergone a remarkable transformation” as well as other very positive conclusions:
“Spinal manipulation and the profession most closely associated with its use, chiropractic, have gained legitimacy within the United States health care system that until very recently seemed unimaginable.
“In the past several decades, chiropractic has undergone a remarkable transformation. Labeled an “unscientific cult” by organized medicine as little as 20 years ago, chiropractic is now recognized as the principal source of one of the few treatments recommended by national evidence-based guidelines for the treatment of low-back pain, spinal manipulation. In the areas of training, practice, and research, chiropractic has emerged from the periphery of the health care system and is playing an increasingly important role in discussions of health care policy.”[2]
Despite such glowing reports, the public remains unaware of this growing scientific evidence for our brand of spine care because this information is simply not publicized!
Medical Spine Incompetence
Today, we can put the shoe on the other foot with evidence that should convince any objective person in the court of public opinion—not only about the efficacy of chiropractic care, but also concerning the incompetence of medical spine care.
In fact, the huge burden of back pain can be laid at the doorstep of medical spine care that has been dubbed the “poster child of inefficient spine care” by Mark Schoene, associate editor of THEBACKLETTER, a leading international spine research journal. Mr. Schoene also warns that “such an important area of medicine has fallen to this level of dysfunction should be a national scandal. In fact, this situation is bringing the United States disrespect internationally.”[3]
Not only is the public unaware of the positive research about chiropractic care or the “national scandal” about medical care, it is also unaware of the clinical incompetence of most MDs and DOs in spine care.
Dr. Scott Boden, director of the Emory Orthopedics & Spine Center, admits, “Many, if not most, primary medical care providers have little training in how to manage musculoskeletal disorders (MSDs).”[4]
Others researchers agree that medical primary care physicians lack training in MSDs,[5] are more prone to ignore recent guidelines,[6] more likely to suggest spine surgery than surgeons themselves[7] and, due to their chirophobia, only 2% of medical PCPs refer to DCs despite our superior training and results.[8]
Perhaps the most ironic surprise showed that 70% of osteopathic graduates failed to attain a passing score on the MSD competency examination.[9] For a profession whose roots began in manipulative therapy, osteopaths today have fallen far from their founder’s tree.
The authors of a Johns Hopkins survey concluded, “This discrepancy appears to persist beyond the training years and into the realm of clinical practice.”[10] Certainly this lack of training detrimentally affects physician performance and patient care, but patients are blind to this fact that their favorite family medical PCP is most likely badly informed about MSDs.[11]
Above the din of chirophobia remains the irony of the medical glass house of spine care built on a flimsy foundation. The “national scandal” in spine care is fueled not only by the inept training of most MDs and DOs, but evidence critical of the main three medical spine treatments is emerging, such as:
The Hillbilly Heroin addiction and deaths attributed to the so-called “pill mills” that dispense opioid painkillers like Halloween candy, creating an epidemic of narcotic addiction.
The expensive, dangerous, and ineffective epidural steroids injections (ESIs) that have never been approved by the FDA for back pain.[12]
The tsunami of spine fusions based on a debunked ‘bad disc’ theory. The ‘bad disc’ diagnosis has been chided as irrelevant as “finding grey hair” and dubbed “incidentalomas” since they also occur in pain-free people.[13]
Imagine the millions of back pain patients who have been misdiagnosed, misinformed, and mistreated by MDs and the billions of dollars wasted. We see these failures daily coming into our offices searching for a better way; regretfully, rather than the proverbial last resort, we should be their first choice as the guidelines now recommend.
This medical mismanagement is clearly an equation where bad training + outdated practices + disproved theories + chirophobia + greed = an epidemic of back pain.
Now is the time to drop the other shoe of skepticism about medical spine care—that is, “Everybody knows to avoid opioid painkillers, epidural shots, and spine fusions before seeing a chiropractor first.”
[1] Bigos et al. US Dept. of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, Clinical Practice Guideline, Number 14: Acute Low Back Problems in Adults AHCPR Publication No. 95-0642, (December 1994)
[2] DC Cherkin, RD Mootz, eds. “Chiropractic in the United States: Training, Practice And Research.” Rockville, Maryland: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services, (1997); AHCPR Publication No. 98-N002.
[3]US Spine Care System in a State of Continuing Decline?, The BACKLetter, vol. 28, #10, 2012, pp.1
[4] S Boden, et al. “Emerging Techniques For Treatment Of Degenerative Lumbar Disc Disease,” Spine 28(2003):524-525.
[5] Elizabeth A. Joy, MD; Sonja Van Hala, MD, MPH, “Musculoskeletal Curricula in Medical Education– Filling In the Missing Pieces, The Physician And Sports Medicine,” 32/ 11 ( November 2004).
[6] PB Bishop et al., “The C.H.I.R.O. (Chiropractic Hospital-Based Interventions Research Outcomes) part I: A Randomized Controlled Trial On The Effectiveness Of Clinical Practice Guidelines In The Medical And Chiropractic Management Of Patients With Acute Mechanical Low Back Pain,” presented at the annual meeting of the International Society for the Study of the Lumbar Spine Hong Kong, 2007; presented at the annual meeting of the North American Spine Society, Austin, Texas, 2007; Spine, in press.
[7] SS Bederman, NN Mahomed, HJ Kreder, et al. In the Eye of the Beholder: Preferences Of Patients, Family Physicians, and Surgeons for Lumbar Spinal Surgery,” Spine 135/1 (2010):108-115.
[8] Matzkin E, Smith MD, Freccero DC, Richardson AB, Adequacy of education in musculoskeletal medicine. J Bone Joint Surg Am 2005, 87-A:310-314
[9] Stockard AR, Allen TW. Competence levels in musculoskeletal medicine: comparison of osteopathic and allopathic medical graduates. J Am Osteopath Assoc. 2006 Jun;106(6):350-5
[10] Medical Student Musculoskeletal Education, An Institutional Survey, Nathan W. Skelley, MD, Miho J. Tanaka, MD, Logan M. Skelley, BS, and Dawn M. LaPorte, MD, Investigation performed at the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
[11] Fowler PJ, Regan WD. The patient with symptomatic chronic anterior cruciate ligament insufficiency. Results of minimal arthroscopic surgery and rehabilitation. Am J Sports Med. 1987 Jul-Aug;15(4):321-5.
[12] Bicket MC et al, Epidural injections for spinal pain: A systematic review and meta-analysis evaluating the “control’ injections in randomized control trials, Anesthesiology, 2013; 119:907-31.
[13] RA Deyo, “Conservative Therapy for Low Back Pain: Distinguishing Useful From Useless Therapy,” JAMA 250 (1983):1057-62