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Chiropractic

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Chiropractic: from Greek chiro- χειρο- "hand-"
+ praktikós πρακτικός "concerned with action"
—(OED)
File:Chiropractic5.JPG

Chiropractic is a health care discipline and profession that emphasizes diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially the spine, under the hypothesis that these disorders affect general health via the nervous system.[1] The World Federation of Chiropractic has determined to no longer consider Chiropractic to be complementary and alternative medicine,[2] a characterization that many chiropractors reject.[3]

The primary modality of treatment involves manual therapy, including manipulation of the spine, other joints, and soft tissues; treatment also includes adjunctive physio-therapeutic modalities, nutritional supplementation, exercises, and health and lifestyle counseling.[4] Modern Chiropractic Doctors explain the basis of a Chiropractic adjustment by scientifically acceptable terms. Some do cling to an outmoded theory known by the acronym "BOOP", or "bone out of place" now rejected by the mainstream profession. [5] This is a notion that brings ridicule from mainstream science and medicine.[6]


D.D. Palmer founded chiropractic in the 1890s and his son B.J. Palmer helped to expand it in the early 20th century.[7] The profession is currently dominated by modern progressive Doctors who are attuned to the results of scientific studies, and are more open to other mainstream and alternative medical techniques such as exercise, massage, nutritional supplements, and acupuncture. [8] Chiropractic is well established in the U.S., Canada and Australia.[9], although, like any profession, there remains a small faction which refuses to give up a concept based in vitalism, called "innate intelligence" and consider subluxations to be the leading cause of all disease; "mixers"

Chiropractic has a strong political base, and sustained demand for services; in recent decades, it has gained greater acceptance among medical physicians and health plans in the U.S.,[10] and evidence-based medicine has been used to review research studies and generate practice guidelines.[11] Many studies of treatments used by chiropractors have been conducted. Collectively, systematic reviews of this research has demonstrated that spinal manipulation is effective. Spinal manipulation has been alleged to have serious complications in rare cases (about 1.4/1,000,000),[12][13] this is clearly less than the risk of taking an aspirin tablet, and thus chiropractic care is generally safe when employed skillfully and appropriately.[14]

Alternative medical systems - edit
NCCAM classifications
  1. Category:Alternative medical systems
  2. Category:Mind-body interventions
  3. Biologically based therapy
  4. Manipulative and body-based methods
  5. Energy therapy
See also


Chiropractic is autonomous, and competitive with mainstream medicine,[15] and osteopathy outside the U.S. remains primarily a manual medical system;[16] physical therapists work alongside and cooperate with mainstream medicine, and osteopathic medicine in the U.S. has merged with the medical profession.[15] Members distinguish these competing professions with rhetorical strategies that include claims that, compared to other professions, chiropractors heavily emphasize spinal manipulation, tend to use firmer manipulative techniques, and promote maintenance care; that osteopaths use a wider variety of treatment procedures; and that physical therapists emphasize machinery and exercise.[17]

WorldWide presence

Chiropractic is established in the U.S., Canada, and Australia, and is present to a lesser extent in many other countries.[9] In the U.S., chiropractic schools are accredited through the Council on Chiropractic Education (CCE) while the General Chiropractic Council (GCC) is the statutory governmental body responsible for the regulation of chiropractic in the UK.[18][19] CCEs in the U.S., Canada, Australia and Europe have joined to form CCE-International (CCE-I) as a model of accreditation standards with the goal of having credentials portable internationally.[20] Today, there are 18 accredited Doctor of Chiropractic programs in the U.S.,[21] 2 in Canada,[22] 6 in Australasia,[23] and 5 in Europe.[24] All but one of the chiropractic colleges in the U.S. are privately funded, but in several other countries they are in government-sponsored universities and colleges.[25]

Regulatory colleges and chiropractic boards in the U.S., Canada, and Australia are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency.[26][27] There are an estimated 53,000 chiropractors in the U.S. (2006),[28] 7,000 in Canada (2009),[29] 2,500 in Australia (2000),[30] and 1,500 in the UK (2000).[31]

A 2008 commentary proposed that the chiropractic profession actively regulate itself to combat abuse, fraud, and quackery, which are more prevalent in chiropractic than in other health care professions, violating the social contract between patients and physicians.[32] A study of California disciplinary statistics during 1997–2000 reported 4.5 disciplinary actions per 1000 chiropractors per year, compared to 2.27 for MDs; the incident rate for fraud was 9 times greater among chiropractors (1.99 per 1000 chiropractors per year) than among MDs (0.20).[33]

Utilization, satisfaction rates, and third party coverage

In the U.S., chiropractic is the largest alternative medical profession,[8] and is the third largest doctored profession, behind medicine and dentistry.[34] The percentage of population that utilizes chiropractic care at any given time generally falls into a range from 6% to 12% in the U.S. and Canada,[35] with a global high of 20% in Alberta.[36] Chiropractors are the most common CAM providers for children and adolescents, who consume up to 14% of all visits to chiropractors.[37] The vast majority who seek chiropractic care do so for relief from back and neck pain and other neuromusculoskeletal complaints;[38] most do so specifically for low back pain. Practitioners such as chiropractors are often used as a complementary form of care to primary medical intervention.[35] Satisfaction rates are typically higher for chiropractic care compared to medical care, with a 1998 U.S. survey reporting 83% of respondents satisfied or very satisfied with their care; quality of communication seems to be a consistent predictor of patient satisfaction with chiropractors.[39]

Chiropractic does not have the same level of mainstream credibility as other healthcare professions. Public perception of chiropractic compares unfavorably with mainstream medicine with regard to ethics and honesty: in a 2006 Gallup Poll of U.S. adults, chiropractors rated last among seven health care professions for being very high or high in honesty and ethical standards, with 36% of poll respondents rating chiropractors very high or high; the corresponding ratings for the other professions ranged from 62% for dentists to 84% for nurses.[32][40][41] According to the 2008 book Trick or Treatment, chiropractors, especially in America, have a reputation for unnecessarily treating patients, and in many circumstances the focus seems to be put on economics instead of health care.[42] Unsubstantiated claims about the efficacy of chiropractic have continued to be made by individual chiropractors and chiropractic associations.[43] The largest chiropractic associations in the U.S. and Canada distributed patient brochures which contained unsubstantiated claims.[44] Sustained chiropractic care is promoted as a preventative tool but unnecessary manipulation could possibly present a risk to patients. Some chiropractors are concerned by the routine unjustified claims chiropractors have made.[43]

Utilization of chiropractic care is sensitive to the costs incurred by the co-payment by the patient.[2] The use of chiropractic declined from 9.9% of U.S. adults in 1997 to 7.4% in 2002; this was the largest relative decrease among CAM professions, which overall had a stable use rate.[45] Employment of U.S. chiropractors is expected to increase 14% between 2006 and 2016, faster than the average for all occupations.[28]

In the U.S., most states require insurers to cover chiropractic care, and most HMOs cover these services.[37] In Canada, there is lack of coverage under the universal public health insurance system.[46] In Australia, most private health insurance funds cover chiropractic care, and the federal government funds chiropractic care when the patient is referred by a medical practitioner.[47]

History

Main article: Chiropractic history
Half-length sitting portrait of man in his fifties with large gray beard and mustache, wearing coat and vest
D.D. Palmer

Chiropractic was founded in the 1890s by Daniel David (D.D.) Palmer in Davenport, Iowa. Palmer, a magnetic healer, hypothesized that manual manipulation of the spine could cure disease. Chiropractic competed with its predecessor osteopathy, another medical system based on magnetic healing and bonesetting; both systems were founded by charismatic midwesterners in opposition to the conventional medicine of the day, and both postulated that manipulation improved health.[48] Although initially keeping chiropractic a family secret, in 1898 Palmer began teaching it to a few students at his new Palmer School of Chiropractic. One student, his son Bartlett Joshua (B.J.) Palmer, became committed to promoting chiropractic, took over the Palmer School in 1906, and rapidly expanded its enrollment.[7]

Early chiropractors believed that all disease was caused by interruptions in the flow of innate intelligence, a vital nervous energy or life force that represented God's presence in man; chiropractic leaders often invoked religious imagery and moral traditions. D.D. and B.J. both seriously considered declaring chiropractic a religion, which might have provided legal protection under the U.S. constitution, but decided against it partly to avoid confusion with Christian Science.[7][49] Early chiropractors also tapped into the Populist movement, emphasizing craft, hard work, competition, and advertisement, aligning themselves with the common man against intellectuals and trusts, among which they included the American Medical Association (AMA).[7]

Head and shoulders portrait of man writing at desk, with one hand to his forehead as if thinking. He appears to be in his thirties and has a dark trimmed beard and mustache.
B.J. Palmer

Chiropractic has seen considerable controversy and criticism.[50][25] Although D.D. and B.J. were "straight" and disdained the use of instruments, some early chiropractors, whom B.J. scornfully called "mixers", advocated use of instruments. In 1910 B.J. changed course and endorsed X-rays as necessary for diagnosis; this resulted in a significant exodus from the Palmer School of the more conservative faculty and students. The mixer camp grew until by 1924 B.J. estimated that only 3,000 of the U.S.'s 25,000 chiropractors remained straight. That year, B.J.'s promotion of the neurocalometer, a new temperature-sensing device, was another sign of chiropractic's gradual acceptance of medical technology, although it was highly controversial among B.J.'s fellow straights. By the 1930s chiropractic was the largest alternative healing profession in the U.S.[7]

Chiropractors faced heavy opposition from organized medicine. Thousands of chiropractors were prosecuted for practicing medicine without a license, and D.D. and many other chiropractors were jailed. To defend against medical statutes B.J. argued that chiropractic was separate and distinct from medicine, asserting that chiropractors "analyzed" rather than "diagnosed", and "adjusted" subluxations rather than "treated" disease. B.J. cofounded the Universal Chiropractors' Association (UCA) to provide legal services to arrested chiropractors. Although the UCA won their first test case in Wisconsin in 1907, prosecutions instigated by state medical boards became increasingly common and in many cases were successful. In response, chiropractors conducted political campaigns to secure separate licensing statutes, eventually succeeding in all fifty states, from Kansas in 1913 through Louisiana in 1974.[51] The longstanding feud between chiropractors and medical doctors continued for decades. The AMA labeled chiropractic an "unscientific cult" in 1966,[52] and until 1980 held that it was unethical for medical doctors to associate with "unscientific practitioners".[53] This culminated in a landmark 1987 decision, Wilk v. AMA, in which the court found that the AMA had engaged in unreasonable restraint of trade and conspiracy, and which ended the AMA's de facto boycott of chiropractic.[10] In 2008 and 2009, chiropractors used libel lawsuits and threats of lawsuits against their critics.[54]

Serious research to test chiropractic theories did not begin until the 1970s, and is continuing to be hampered by what are characterized as antiscientific and pseudoscientific ideas that sustained the profession in its long battle with organized medicine. By the mid 1990s there was a growing scholarly interest in chiropractic, which helped efforts to improve service quality and establish clinical guidelines that recommended manual therapies for acute low back pain.[51] In recent decades chiropractic gained legitimacy and greater acceptance by medical physicians and health plans, and enjoyed a strong political base and sustained demand for services. However, its future seemed uncertain: as the number of practitioners grew, evidence-based medicine insisted on treatments with demonstrated value, managed care restricted payment, and competition grew from massage therapists and other health professions. The profession responded by marketing natural products and devices more aggressively, and by reaching deeper into alternative medicine and primary care.[10]

Evidence basis

The principles of evidence-based medicine have been used to review research studies and generate practice guidelines outlining professional standards that specify which chiropractic treatments are legitimate and perhaps reimbursable under managed care.[11] Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs what is considered by many chiropractic researchers to be antiscientific reasoning and unsubstantiated claims,[1][6][55][56] that have been called ethically suspect when they let practitioners maintain their beliefs to patients' detriment.[1] A 2007 survey of Alberta chiropractors found that they do not consistently apply research in practice, which may have resulted from a lack of research education and skills.[57] Continued education enhances the scientific knowledge of the practitioner.[58]

Effectiveness

Opinions differ as to the efficacy of chiropractic treatment.[25] Many controlled clinical studies of spinal manipulation (SM) are available, but their results disagree,[59] and they are typically of low quality.[60] Health claims made by chiropractors about using manipulation for pediatric health conditions are supported by only low levels of scientific evidence[37][61] that does not demonstrate clinically relevant benefits.[62] A 2008 critical review found that with the possible exception of back pain, chiropractic SM has not been shown to be effective for any medical condition, and suggested that many guidelines recommend chiropractic care for low back pain because no therapy has been shown to make a real difference,[43] but a 2008 supportive review found serious flaws in the critical approach and found that SM and mobilization are at least as effective for chronic low back pain as other efficacious and commonly used treatments.[63] Most research has focused on spinal manipulation (SM) in general,[64] rather than solely on chiropractic SM.[11] A 2002 review of randomized clinical trials of SM[65] was criticized for not distinguishing between studies of SM in general, and studies on chiropractic SM in particular;[66] however the review's authors stated that they did not consider this difference to be a significant point as research on SM is equally useful regardless of which practitioner provides it.[64]

There is a wide range of ways to measure treatment outcomes.[67] Chiropractic care, like all medical treatment, benefits from the placebo response.[68] It is hard to construct a trustworthy placebo for clinical trials of spinal manipulative therapy (SMT), as experts often disagree about whether a proposed placebo actually has no effect.[69] The efficacy of maintenance care in chiropractic is unknown.[70]

Available evidence covers the following conditions:

  • Low back pain. There is continuing conflict of opinion on the efficacy of SMT for nonspecific (i.e., unknown cause) low back pain.[71] A 2008 review found strong evidence that SM is similar in effect to medical care with exercise.[63] A 2007 review found good evidence that SM is moderately effective for low back pain lasting more than 4 weeks;[72] a 2008 literature synthesis found good evidence supporting SM for low back pain regardless of duration.[73] Of four systematic reviews published between 2000 and May 2005, only one recommended SM, and a 2004 Cochrane review[74] found that SM or mobilization is no more or less effective than other standard interventions for back pain.[59] Methods for formulating treatment guidelines for low back pain differ significantly between countries, casting some doubt on their reliability.[71]
  • Whiplash and other neck pain. There is no overall consensus on manual therapies for neck pain.[75] A 2009 systematic review of controlled clinical trials found no evidence that chiropractic spinal manipulation is effective for whiplash injury.[76] A 2008 review found evidence that educational videos, mobilization, and exercises appear more beneficial for whiplash than alternatives; that SM, mobilization, supervised exercise, low-level laser therapy and perhaps acupuncture are more effective for non-whiplash neck pain than alternatives but none of these treatments is clearly superior; and that there is no evidence that any intervention improves prognosis.[77] A 2007 review found that SM and mobilization are effective for neck pain.[75] Of three systematic reviews of SM published between 2000 and May 2005, one reached a positive conclusion, and a 2004 Cochrane review[78] found that SM and mobilization are beneficial only when combined with exercise.[59] A 2005 review found consistent evidence supporting mobilization for acute whiplash, and limited evidence supporting SM for whiplash.[79]
  • Headache. A 2006 review found no rigorous evidence supporting SM or other manual therapies for tension headache.[80] A 2005 review found that the evidence was weak for effectiveness of chiropractic manipulation for tension headache, and that it was probably more effective for tension headache than for migraine.[81] A 2004 review found that SM may be effective for migraine and tension headache, and SM and neck exercises may be effective for cervicogenic headache.[82] Two other systematic reviews published between 2000 and May 2005 did not find conclusive evidence in favor of SM.[59]

Safety

Chiropractic care in general is safe when employed skillfully and appropriately. Manipulation is regarded as relatively safe, but as with all therapeutic interventions, complications can arise, and it has known adverse effects, risks and contraindications. Absolute contraindications to spinal manipulative therapy are conditions that should not be manipulated; these contraindications include rheumatoid arthritis and conditions known to result in unstable joints. Relative contraindications are conditions where increased risk is acceptable in some situations and where low-force and soft-tissue techniques are treatments of choice; these contraindications include osteoporosis.[14] Although most contraindications apply only to manipulation of the affected region, some neurological signs indicate referral to emergency medical services; these include sudden and severe headache or neck pain unlike that previously experienced.[13]

Spinal manipulation is associated with frequent, mild and temporary adverse effects,[12][13] including new or worsening pain or stiffness in the affected region.[96] They have been estimated to occur in 33% to 61% of patients, and frequently occur within an hour of treatment and disappear within 24 to 48 hours.[97] Rarely,[14] spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death; these can occur in adults[12] and children.[98] Estimates vary widely for the incidence of these complications,[97] and the actual incidence is unknown, due to high levels of underreporting and to the difficulty of linking manipulation to adverse effects such as stroke, which is a particular concern.[12] Several case reports show temporal associations between interventions and potentially serious complications. Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions.[77][99] Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy (whether chiropractic or not) and vertebrobasilar artery stroke.[100]

Chiropractors, like other primary care providers, sometimes employ diagnostic imaging techniques such as X-rays and CT scans that rely on ionizing radiation; practice guidelines aim to reduce unnecessary radiation exposure,[101] which increase cancer risk in proportion to the amount of radiation received.[102]

Cost-effectiveness

A 2006 qualitative review found that the research literature suggests that chiropractic obtains at least comparable outcomes to alternatives with potential cost savings.[103] A 2006 systematic cost-effectiveness review found that the reported cost-effectiveness of chiropractic manipulation in the United Kingdom compared favorably with other treatments for back pain, but that reports were based on data from clinical trials without sham controls and that the specific cost-effectiveness of the treatment (as opposed to non-specific effects) remains uncertain.[104] A 2005 systematic review of economic evaluations of conservative treatments for low back pain found that significant quality problems in available studies meant that definite conclusions could not be drawn about the most cost-effective intervention.[105] The cost-effectiveness of maintenance chiropractic care is unknown.[70]

Public health

Further information: Vaccine controversy and alternative medicine and Opposition to water fluoridation

Some chiropractors oppose vaccination and water fluoridation, which are common public health practices. Chiropractors' attempts to establish a positive reputation for their public health role are also compromised by their reputation for recommending repetitive life-long chiropractic treatment.[32] Within the chiropractic community there are significant disagreements about vaccination,[106][30] one of the most cost-effective public health interventions available.[107] Most chiropractic writings on vaccination focus on its negative aspects,[106] claiming that it is hazardous, ineffective, and unnecessary. Some chiropractors have embraced vaccination, but a significant portion of the profession rejects it, as original chiropractic philosophy traces diseases to causes in the spine and states that vaccines interfere with healing. The American Chiropractic Association and the International Chiropractors Association support individual exemptions to compulsory vaccination laws, and a 1995 survey of U.S. chiropractors found that about a third believed there was no scientific proof that immunization prevents disease.[30] The Canadian Chiropractic Association supports vaccination;[106] a survey in Alberta in 2002 found that 25% of chiropractors advised patients for, and 27% against, vaccinating themselves or their children.[108]

Early opposition to water fluoridation included chiropractors, some of whom continue to oppose it as being incompatible with chiropractic philosophy and an infringement of personal freedom. Other chiropractors have actively promoted fluoridation, and several chiropractic organizations have endorsed scientific principles of public health.[109]

References

  1. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named Nelson
  2. ↑ 2.0 2.1 Chapman-Smith DA, Cleveland CS III (2005). "International status, standards, and education of the chiropractic profession". in Haldeman S, Dagenais S, Budgell B et al. (eds.). Principles and Practice of Chiropractic (3rd ed.). McGraw-Hill. pp. 111–34. ISBN 0-07-137534-1. 
  3. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named Redwood-CAM
  4. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named content-of-practice
  5. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named History-PPC
  6. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named Keating-subluxation
  7. ↑ 7.0 7.1 7.2 7.3 7.4 Martin SC (1993). "Chiropractic and the social context of medical technology, 1895–1925". Technol Cult 34 (4): 808–34. doi:10.2307/3106416. PMID 11623404. 
  8. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named Kaptchuk-Eisenberg
  9. ↑ 9.0 9.1 Tetrault M (2004). "Global professional strategy for chiropractic" (PDF). Chiropractic Diplomatic Corps. http://chiropracticdiplomatic.com/strategies/global_strategy.pdf. Retrieved 2008-04-18. 
  10. ↑ 10.0 10.1 10.2 Cooper RA, McKee HJ (2003). "Chiropractic in the United States: trends and issues". Milbank Q 81 (1): 107–38. doi:10.1111/1468-0009.00040. PMID 12669653. 
  11. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named Villanueva-Russell
  12. ↑ 12.0 12.1 12.2 12.3 Ernst E (2007). "Adverse effects of spinal manipulation: a systematic review". J R Soc Med 100 (7): 330–8. doi:10.1258/jrsm.100.7.330. PMID 17606755. PMC 1905885. http://www.jrsm.org/cgi/content/full/100/7/330. Lay summary – Med News Today (2007-07-02). 
  13. ↑ 13.0 13.1 13.2 Anderson-Peacock E, Blouin JS, Bryans R et al. (2005). "Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash" (PDF). J Can Chiropr Assoc 49 (3): 158–209. http://www.jcca-online.org/Client/cca/jcca.nsf/objects/jcca-v49-3-158/$file/jcca-v49-3-158.pdf. 
    • Anderson-Peacock E, Bryans B, Descarreaux M et al. (2008). "A clinical practice guideline update from The CCA•CFCREAB-CPG" (PDF). J Can Chiropr Assoc 52 (1): 7–8. http://www.jcca-online.org/Client/cca/JCCA.nsf/objects/JCCA_March_2008_52_1/$file/jcca-v52-1-007.pdf. 
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  16. ↑ Baer HA (2006). "The drive for legitimization by osteopathy and chiropractic in Australia: between heterodoxy and orthodoxy". Complement Health Pract Rev 11 (2): 77–94. doi:10.1177/1533210106292467. 
  17. ↑ Norris P (2001). "How 'we' are different from 'them': occupational boundary maintenance in the treatment of musculo-skeletal problems". Sociol Health Illn 23 (1): 24–43. doi:10.1111/1467-9566.00239. 
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  19. ↑ "The General Chiropractic Council". http://www.gcc-uk.org/page.cfm. Retrieved 2008-07-26. 
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  30. ↑ 30.0 30.1 30.2 Campbell JB, Busse JW, Injeyan HS (2000). "Chiropractors and vaccination: a historical perspective". Pediatrics 105 (4): e43. doi:10.1542/peds.105.4.e43. PMID 10742364. http://pediatrics.aappublications.org/cgi/content/full/105/4/e43. 
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  32. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named Murphy-pod
  33. ↑ Foreman SM, Stahl MJ (2004). "Chiropractors disciplined by a state chiropractic board and a comparison with disciplined medical physicians". J Manipulative Physiol Ther 27 (7): 472–7. doi:10.1016/j.jmpt.2004.06.006. PMID 15389179. 
  34. ↑ "Establishing a database of U.S. chiropractic health manpower data: furthering the development of research infrastructure.". National Library of Medicine. http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102184948.html. Retrieved 2008-05-06. 
  35. ↑ 35.0 35.1 Lawrence DJ, Meeker WC (2007). "Chiropractic and CAM utilization: a descriptive review". Chiropr Osteopat 15: 2. doi:10.1186/1746-1340-15-2. PMID 17241465. PMC 1784103. http://chiroandosteo.com/content/15/1/2. 
  36. ↑ Crownfield PW (2007). "Chiropractic in Alberta: a model of consumer utilization and satisfaction". Dyn Chiropr 25 (6). http://chiroweb.com/archives/25/06/02.html. 
  37. ↑ 37.0 37.1 37.2 Kemper KJ, Vohra S, Walls R; Task Force on Complementary and Alternative Medicine; the Provisional Section on Complementary, Holistic, and Integrative Medicine (2008). "The use of complementary and alternative medicine in pediatrics". Pediatrics 122 (6): 1374–86. doi:10.1542/peds.2008-2173. PMID 19047261. 
  38. ↑ Hurwitz EL, Chiang LM (2006). "A comparative analysis of chiropractic and general practitioner patients in North America: findings from the joint Canada/United States Survey of Health, 2002–03". BMC Health Serv Res 6 (49): 49. doi:10.1186/1472-6963-6-49. PMID 16600038. PMC 1458338. http://www.biomedcentral.com/1472-6963/6/49. 
  39. ↑ Gaumer G (2006). "Factors associated with patient satisfaction with chiropractic care: survey and review of the literature". J Manipulative Physiol Ther 29 (6): 455–62. doi:10.1016/j.jmpt.2006.06.013. PMID 16904491. 
  40. ↑ "Gallup Poll: Americans have low opinion of chiropractors' honesty and ethics". Dyn Chiropr 25 (3). 2007. http://dynamicchiropractic.com/mpacms/dc/article.php?id=52038. 
  41. ↑ "USA TODAY/Gallup poll". USA Today. 2006-12-11. http://usatoday.com/news/polls/tables/live/2006-12-11-ethics.htm. 
  42. ↑ Singh S, Ernst E (2008). "The truth about chiropractic therapy". Trick or Treatment: The Undeniable Facts about Alternative Medicine. W.W. Norton. pp. 145–90. ISBN 978-0-393-06661-6. 
  43. ↑ 43.0 43.1 43.2 Ernst E (2008). "Chiropractic: a critical evaluation". J Pain Symptom Manage 35 (5): 544–62. doi:10.1016/j.jpainsymman.2007.07.004. PMID 18280103. 
  44. ↑ Grod JP, Sikorski D, Keating JC (2001). "Unsubstantiated claims in patient brochures from the largest state, provincial, and national chiropractic associations and research agencies". J Manipulative Physiol Ther 24 (8): 514–9. doi:10.1067/mmt.2001.118205. PMID 11677551. 
  45. ↑ Tindle HA, Davis RB, Phillips RS, Eisenberg DM (2005). "Trends in use of complementary and alternative medicine by US adults: 1997–2002". Altern Ther Health Med 11 (1): 42–9. PMID 15712765. 
  46. ↑ Garner MJ, Birmingham M, Aker P (2008). "Developing integrative primary healthcare delivery: adding a chiropractor to the team". Explore (NY) 4 (1): 18–24. doi:10.1016/j.explore.2007.10.003. PMID 18194787. 
  47. ↑ Xue CC, Zhang AL, Lin V, Myers R, Polus B, Story DF (2008). "Acupuncture, chiropractic and osteopathy use in Australia: a national population survey". BMC Public Health 8: 105. doi:10.1186/1471-2458-8-105. PMID 18377663. PMC 2322980. http://www.biomedcentral.com/1471-2458/8/105. 
  48. ↑ Baer HA (1987). "Divergence and convergence in two systems of manual medicine: osteopathy and chiropractic in the United States". Med Anthropol Q 1 (2): 176–93. doi:10.1525/maq.1987.1.2.02a00030. 
  49. ↑ Palmer DD (1911-05-04). "Letter to P.W. Johnson, D.C." (PDF). http://chiro.org/Plus/History/Persons/PalmerDD/PalmerDD's_Religion-of-Chiro.pdf. Retrieved 2008-06-29. 
  50. ↑ Homola S (2006). "Chiropractic: history and overview of theories and methods". Clin Orthop Relat Res 444: 236–42. doi:10.1097/01.blo.0000200258.95865.87. PMID 16446588. 
  51. ↑ 51.0 51.1 Keating JC Jr, Cleveland CS III, Menke M (2005). "Chiropractic history: a primer" (PDF). Association for the History of Chiropractic. http://data.memberclicks.com/site/ahc/ChiroHistoryPrimer.pdf. Retrieved 2008-06-16. 
  52. ↑ Johnson C, Baird R, Dougherty PE et al. (2008). "Chiropractic and public health: current state and future vision". J Manipulative Physiol Ther 31 (6): 397–410. doi:10.1016/j.jmpt.2008.07.001. PMID 18722194. http://jmptonline.org/article/PIIS0161475408001784/fulltext. 
  53. ↑ Cherkin D (1989). "AMA policy on chiropractic". Am J Public Health 79 (11): 1569–70. doi:10.2105/AJPH.79.11.1569-a. PMID 2817179. 
  54. ↑ Godlee F (2009). "Keep libel laws out of science". BMJ 339: b2783. doi:10.1136/bmj.b2783. http://www.bmj.com/cgi/content/full/339/jul08_4/b2783. 
  55. ↑ Keating JC Jr, Cleveland CS III, Menke M (2005). "Chiropractic history: a primer" (PDF). Association for the History of Chiropractic. http://data.memberclicks.com/site/ahc/ChiroHistoryPrimer.pdf. Retrieved 2008-06-16. "A significant and continuing barrier to scientific progress within chiropractic are the anti-scientific and pseudo-scientific ideas (Keating 1997b) which have sustained the profession throughout a century of intense struggle with political medicine. Chiropractors' tendency to assert the meaningfulness of various theories and methods as a counterpoint to allopathic charges of quackery has created a defensiveness which can make critical examination of chiropractic concepts difficult (Keating and Mootz 1989). One example of this conundrum is the continuing controversy about the presumptive target of DCs' adjustive interventions: subluxation (Gatterman 1995; Leach 1994)." 
  56. ↑ Science, antiscience, materialism and vitalism:
    • Keating JC Jr (1997). "Chiropractic: science and antiscience and pseudoscience side by side". Skept Inq 21 (4): 37–43. 
    • Phillips RB (2005). "The evolution of vitalism and materialism and its impact on philosophy". in Haldeman S, Dagenais S, Budgell B et al. (eds.). Principles and Practice of Chiropractic (3rd ed.). McGraw-Hill. pp. 65–76. ISBN 0-07-137534-1. 
  57. ↑ Suter E, Vanderheyden LC, Trojan LS, Verhoef MJ, Armitage GD (2007). "How important is research-based practice to chiropractors and massage therapists?". J Manipulative Physiol Ther 30 (2): 109–15. doi:10.1016/j.jmpt.2006.12.013. PMID 17320731. 
  58. ↑ Feise RJ, Grod JP, Taylor-Vaisey A (2006). "Effectiveness of an evidence-based chiropractic continuing education workshop on participant knowledge of evidence-based health care". Chiropr Osteopat 14: 18. doi:10.1186/1746-1340-14-18. PMID 16930482. PMC 1560147. http://chiroandosteo.com/content/14/1/18. 
  59. ↑ 59.0 59.1 59.2 59.3 Ernst E, Canter PH (2006). "A systematic review of systematic reviews of spinal manipulation". J R Soc Med 99 (4): 192–6. doi:10.1258/jrsm.99.4.192. PMID 16574972. PMC 1420782. http://www.jrsm.org/cgi/content/full/99/4/192. Lay summary – BBC News (2006-03-22). 
  60. ↑ Quality of SM studies:
    • Fernández-de-las-Peñas C, Alonso-Blanco C, San-Roman J, Miangolarra-Page JC (2006). "Methodological quality of randomized controlled trials of spinal manipulation and mobilization in tension-type headache, migraine, and cervicogenic headache". J Orthop Sports Phys Ther 36 (3): 160–9. PMID 16596892. 
    • Johnston BC, da Costa BR, Devereaux PJ, Akl EA, Busse JW; Expertise-Based RCT Working Group (2008). "The use of expertise-based randomized controlled trials to assess spinal manipulation and acupuncture for low back pain: a systematic review". Spine 33 (8): 914–8. doi:10.1097/BRS.0b013e31816b4be4. PMID 18404113. 
  61. ↑ 61.0 61.1 61.2 Gotlib A, Rupert R (2008). "Chiropractic manipulation in pediatric health conditions - an updated systematic review". Chiropr Osteopat 16: 11. doi:10.1186/1746-1340-16-11. PMID 18789139. PMC 2553791. http://chiroandosteo.com/content/16/1/11. 
  62. ↑ Ernst E (2009). "Chiropractic manipulation, with a deliberate 'double entendre'". Arch Dis Child 94 (6): 411. doi:10.1136/adc.2009.158170. PMID 19460920. 
  63. ↑ 63.0 63.1 Bronfort G, Haas M, Evans R, Kawchuk G, Dagenais S (2008). "Evidence-informed management of chronic low back pain with spinal manipulation and mobilization". Spine J 8 (1): 213–25. doi:10.1016/j.spinee.2007.10.023. PMID 18164469. 
  64. ↑ 64.0 64.1 Meeker WC, Haldeman S (2002). "Chiropractic: in response" (PDF). Ann Intern Med 137 (8): 702. http://annals.org/cgi/reprint/137/8/701.pdf. 
  65. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named Meeker-Haldeman
  66. ↑ Ernst E (2002). "Chiropractic" (PDF). Ann Intern Med 137 (8): 701. PMID 12379081. http://annals.org/cgi/reprint/137/8/701.pdf. 
  67. ↑ Khorsan R, Coulter ID, Hawk C, Choate CG (2008). "Measures in chiropractic research: choosing patient-based outcome assessments". J Manipulative Physiol Ther 31 (5): 355–75. doi:10.1016/j.jmpt.2008.04.007. PMID 18558278. 
  68. ↑ Kaptchuk TJ (2002). "The placebo effect in alternative medicine: can the performance of a healing ritual have clinical significance?" (PDF). Ann Intern Med 136 (11): 817–25. PMID 12044130. http://annals.org/cgi/reprint/136/11/817.pdf. 
  69. ↑ Hancock MJ, Maher CG, Latimer J, McAuley JH (2006). "Selecting an appropriate placebo for a trial of spinal manipulative therapy" (PDF). Aust J Physiother 52 (2): 135–8. PMID 16764551. http://ajp.physiotherapy.asn.au/AJP/vol_52/2/AustJPhysiotherv52i2Hancock.pdf. 
  70. ↑ 70.0 70.1 Leboeuf-Yde C, Hestbæk L (2008). "Maintenance care in chiropractic - what do we know?". Chiropr Osteopat 16: 3. doi:10.1186/1746-1340-16-3. PMID 18466623. PMC 2396648. http://chiroandosteo.com/content/16/1/3. 
  71. ↑ 71.0 71.1 Murphy AYMT, van Teijlingen ER, Gobbi MO (2006). "Inconsistent grading of evidence across countries: a review of low back pain guidelines". J Manipulative Physiol Ther 29 (7): 576–81, 581.e1–2. doi:10.1016/j.jmpt.2006.07.005. PMID 16949948. http://jmptonline.org/article/S0161-4754(06)00186-2/fulltext. 
  72. ↑ Chou R, Huffman LH; American Pain Society; American College of Physicians (2007). "Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline". Ann Intern Med 147 (7): 492–504. PMID 17909210. http://annals.org/cgi/content/full/147/7/492. 
  73. ↑ Lawrence DJ, Meeker W, Branson R et al. (2008). "Chiropractic management of low back pain and low back-related leg complaints: a literature synthesis". J Manipulative Physiol Ther 31 (9): 659–74. doi:10.1016/j.jmpt.2008.10.007. PMID 19028250.  An earlier, freely readable version is in: Meeker W, Branson R, Bronfort G et al. (2007). "Chiropractic management of low back pain and low back related leg complaints" (PDF). Council on Chiropractic Guidelines and Practice Parameters. http://ccgpp.org/lowbackliterature.pdf. Retrieved 2008-11-28. 
  74. ↑ Assendelft WJJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG (2004). "Spinal manipulative therapy for low back pain". Cochrane Database Syst Rev (1): CD000447. doi:10.1002/14651858.CD000447.pub2. PMID 14973958. 
  75. ↑ 75.0 75.1 Vernon H, Humphreys BK (2007). "Manual therapy for neck pain: an overview of randomized clinical trials and systematic reviews" (PDF). Eura Medicophys 43 (1): 91–118. PMID 17369783. http://www.minervamedica.it/en/getfreepdf.php?cod=R33Y2007N01A0091. 
  76. ↑ Ernst E (2009). "Chiropractic spinal manipulation for whiplash injury? A systematic review of controlled clinical trials". Focus Altern Complement Ther 14: 85–6. http://www.medicinescomplete.com/journals/fact/current/fact1402a05t01.htm. 
  77. ↑ 77.0 77.1 Hurwitz EL, Carragee EJ, van der Velde G et al. (2008). "Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders". Spine 33 (4 Suppl): S123–52. doi:10.1097/BRS.0b013e3181644b1d. PMID 18204386. 
  78. ↑ Gross AR, Hoving JL, Haines TA et al. (2004). "Manipulation and mobilisation for mechanical neck disorders". Cochrane Database Syst Rev (1): CD004249. doi:10.1002/14651858.CD004249.pub2. PMID 14974063. 
  79. ↑ Conlin A, Bhogal S, Sequeira K, Teasell R (2005). "Treatment of whiplash-associated disorders—part I: non-invasive interventions". Pain Res Manag 10 (1): 21–32. PMID 15782244. 
  80. ↑ Fernández-de-las-Peñas C, Alonso-Blanco C, Cuadrado ML, Miangolarra JC, Barriga FJ, Pareja JA (2006). "Are manual therapies effective in reducing pain from tension-type headache?: a systematic review". Clin J Pain 22 (3): 278–85. doi:10.1097/01.ajp.0000173017.64741.86. PMID 16514329. 
  81. ↑ Biondi DM (2005). "Physical treatments for headache: a structured review". Headache 45 (6): 738–46. doi:10.1111/j.1526-4610.2005.05141.x. PMID 15953306. 
  82. ↑ Bronfort G, Nilsson N, Haas M et al. (2004). "Non-invasive physical treatments for chronic/recurrent headache". Cochrane Database Syst Rev (3): CD001878. doi:10.1002/14651858.CD001878.pub2. PMID 15266458. 
  83. ↑ McHardy A, Hoskins W, Pollard H, Onley R, Windsham R (2008). "Chiropractic treatment of upper extremity conditions: a systematic review". J Manipulative Physiol Ther 31 (2): 146–59. doi:10.1016/j.jmpt.2007.12.004. PMID 18328941. 
  84. ↑ Brantingham JW, Globe G, Pollard H, Hicks M, Korporaal C, Hoskins W (2009). "Manipulative therapy for lower extremity conditions: expansion of literature review". J Manipulative Physiol Ther 32 (1): 53–71. doi:10.1016/j.jmpt.2008.09.013. PMID 19121464. 
  85. ↑ Everett CR, Patel RK (2007). "A systematic literature review of nonsurgical treatment in adult scoliosis". Spine 32 (19 Suppl): S130–4. doi:10.1097/BRS.0b013e318134ea88. PMID 17728680. 
  86. ↑ Romano M, Negrini S (2008). "Manual therapy as a conservative treatment for adolescent idiopathic scoliosis: a systematic review". Scoliosis 3: 2. doi:10.1186/1748-7161-3-2. PMID 18211702. PMC 2262872. http://scoliosisjournal.com/content/3/1/2. 
  87. ↑ Hawk C, Khorsan R, Lisi AJ, Ferrance RJ, Evans MW (2007). "Chiropractic care for nonmusculoskeletal conditions: a systematic review with implications for whole systems research". J Altern Complement Med 13 (5): 491–512. doi:10.1089/acm.2007.7088. PMID 17604553. 
  88. ↑ Hondras MA, Linde K, Jones AP (2005). "Manual therapy for asthma". Cochrane Database Syst Rev (2): CD001002. doi:10.1002/14651858.CD001002.pub2. PMID 15846609. 
  89. ↑ Husereau D, Clifford T, Aker P, Leduc D, Mensinkai S (2003) (PDF). Spinal Manipulation for Infantile Colic. Technology report no. 42. Ottawa: Canadian Coordinating Office for Health Technology Assessment. ISBN 1-894978-11-0. http://cadth.ca/media/pdf/177_spinal_manipulation_tr_e.pdf. Retrieved 2008-10-06. 
  90. ↑ Glazener CM, Evans JH, Cheuk DK (2005). "Complementary and miscellaneous interventions for nocturnal enuresis in children". Cochrane Database Syst Rev (2): CD005230. doi:10.1002/14651858.CD005230. PMID 15846744. 
  91. ↑ O'Connor D, Marshall S, Massy-Westropp N (2003). "Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome". Cochrane Database Syst Rev (1): CD003219. doi:10.1002/14651858.CD003219. PMID 12535461. 
  92. ↑ Fibromyalgia:
  93. ↑ Brand PL, Engelbert RH, Helders PJ, Offringa M (2005). "[Systematic review of the effects of therapy in infants with the KISS-syndrome (kinetic imbalance due to suboccipital strain)]" (in Dutch). Ned Tijdschr Geneeskd 149 (13): 703–7. PMID 15819137. 
  94. ↑ Proctor ML, Hing W, Johnson TC, Murphy PA (2006). "Spinal manipulation for primary and secondary dysmenorrhoea". Cochrane Database Syst Rev (3): CD002119. doi:10.1002/14651858.CD002119.pub3. PMID 16855988. 
  95. ↑ Pennick VE, Young G (2007). "Interventions for preventing and treating pelvic and back pain in pregnancy". Cochrane Database Syst Rev (2): CD001139. doi:10.1002/14651858.CD001139.pub2. PMID 17443503. 
  96. ↑ Thiel HW, Bolton JE, Docherty S, Portlock JC (2007). "Safety of chiropractic manipulation of the cervical spine: a prospective national survey". Spine 32 (21): 2375–8. doi:10.1097/BRS.0b013e3181557bb1. PMID 17906581. 
  97. ↑ 97.0 97.1 Gouveia LO, Castanho P, Ferreira JJ (2009). "Safety of chiropractic interventions: a systematic review". Spine 34 (11): E405–13. doi:10.1097/BRS.0b013e3181a16d63. PMID 19444054. 
  98. ↑ Vohra S, Johnston BC, Cramer K, Humphreys K (2007). "Adverse events associated with pediatric spinal manipulation: a systematic review". Pediatrics 119 (1): e275–83. doi:10.1542/peds.2006-1392. PMID 17178922. http://pediatrics.aappublications.org/cgi/content/full/119/1/e275. 
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  102. ↑ Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation, Board on Radiation Effects Research, U.S. National Research Council (2006). Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2. Washington, DC: The National Academies Press. ISBN 0-309-09156-X. http://books.nap.edu/catalog.php?record_id=11340. 
  103. ↑ Mootz RD, Hansen DT, Breen A, Killinger LZ, Nelson C (2006). "Health services research related to chiropractic: review and recommendations for research prioritization by the chiropractic profession". J Manipulative Physiol Ther 29 (9): 707–25. doi:10.1016/j.jmpt.2006.09.001. PMID 17142165. 
  104. ↑ Canter PH, Coon JT, Ernst E (2006). "Cost-effectiveness of complementary therapies in the United kingdom—a systematic review". Evid Based Complement Alternat Med 3 (4): 425–32. doi:10.1093/ecam/nel044. PMID 17173105. PMC 1697737. http://ecam.oxfordjournals.org/cgi/content/full/3/4/425. 
  105. ↑ van der Roer N, Goossens MEJB, Evers SMAA, van Tulder MW (2005). "What is the most cost-effective treatment for patients with low back pain? a systematic review". Best Pract Res Clin Rheumatol 19 (4): 671–84. doi:10.1016/j.berh.2005.03.007. PMID 15949783. 
  106. ↑ 106.0 106.1 106.2 Busse JW, Morgan L, Campbell JB (2005). "Chiropractic antivaccination arguments". J Manipulative Physiol Ther 28 (5): 367–73. doi:10.1016/j.jmpt.2005.04.011. PMID 15965414. http://jmptonline.org/article/S0161-4754(05)00111-9/fulltext. 
  107. ↑ Ehreth J (2003). "The global value of vaccination". Vaccine 21 (7–8): 596–600. doi:10.1016/S0264-410X(02)00623-0. PMID 12531324. 
  108. ↑ Russell ML, Injeyan HS, Verhoef MJ, Eliasziw M (2004). "Beliefs and behaviours: understanding chiropractors and immunization". Vaccine 23 (3): 372–9. doi:10.1016/j.vaccine.2004.05.027. PMID 15530683. 
  109. ↑ Jones RB, Mormann DN, Durtsche TB (1989). "Fluoridation referendum in La Crosse, Wisconsin: contributing factors to success" (PDF). Am J Public Health 79 (10): 1405–8. doi:10.2105/AJPH.79.10.1405. PMID 2782512. PMC 1350185. http://www.ajph.org/cgi/reprint/79/10/1405.pdf. 

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