Can Chiropractic Become a Science? A Chiropractor Offers a Plan to Remake His Profession
In the past, we here at RealClearScience have been very critical of chiropractic. The reasons are manifold, but they can be neatly summarized by saying that scientific evidence does not support the profession's tenets or treatments for any condition, even back pain.
But, as RealClearScience is guided by a science-based worldview, we forever strive to keep an open mind. If evidence or circumstances change, we are ready and willing to re-evaluate our positions.
It is in this spirit of curiosity that a recent article published in the journal Chiropractic & Manual Therapies has left us intrigued, and even slightly hopeful, for the future of chiropractic. Associate Professor Bruce Walker, the head of the chiropractic program at Murdoch University in Australia, offers a ten point plan to revitalize the profession and bring it in line with evidence-based medicine.
"By embracing this plan the profession can be set on a new path, a new beginning and a new direction," he writes. It will be the "New Chiropractic."
Here are a few of Walker's key points:
- Chiropractic education should take place at universities and institutions not solely focused on chiropractic. When in training, chiropractic students should gain hospital experience and learn from a wide array of professionals, from physical therapists to medical doctors.
- The chiropractic scope of practice must be significantly limited. "Chiropractors need to become solely musculoskeletal practitioners with a special emphasis on spinal pain," Walker writes. All other notions that hail back to the profession's "magical" beginnings will be discarded.
- Nonsensical and biologically implausible ideas will not be tolerated. Chiropractors will no longer recommend other alternative health treatments outside their scope of practice. Nor will they espouse anti-vaccine or anti-medicine propaganda.
- The profession must embrace evidence-based practice. "Chiropractors in the field need to become avid consumers of the evidence provided by good quality research as this will assist lifelong learning and best practice," Walker urges. Moreover, they must actively support and publish research. As Walker illustrates with the chart below, chiropractic's contribution to the scientific literature pales in comparison to physical therapy.
Walker's recommendations are absolutely worthwhile, and we wish him all the best in his efforts to implement them. However, a dash of nuanced skepticism is warranted. Walker admits that his plans may take a "generation" to succeed, but realistically, chiropractic might not be capable of re-making itself, no matter how much time is allotted for the transformation. "Science-based chiropractic" won't be chiropractic at all. Instead it will probably be a simpler and less effective version of physical therapy. Will faithful patrons keep going back for their "adjustments" when all of the profession's woo is cast out? I'm not so sure.
Clearly, Walker is a supporter of chiropractic. He makes that very plain.
"I contend that the global 'good' produced by the profession far outweighs the 'bad'," he writes. "The 'good' can be summed by recognising over a century of improvement to public health by improving pain and disability in countries where chiropractic is practised. It can be asserted that this has provided significant economic savings and improved productivity."
But as Mark Crislip noted over at Science-Based Medicine, this sweeping assertion is unreferenced. That's telling. The blunt truth is that if Walker and his chiropractic colleagues transition their profession to evidence-based practice and do so with intellectual honesty, they will almost certainly find that their profession is not all it's cracked up to be.
Source: Walker, Bruce. "The new chiropractic." Chiropractic & Manual Therapies. 2016 24:26 DOI: 10.1186/s12998-016-0108-9
(Image: Butch Comegys/AP)