The annals of quackademic medicine: Testing chiropractic in pregnancy

Is chiropractic woo?

I’m often asked that question, and my answer has usually been something along the lines of, “It depends on what it is used for.” Of course, there’s no doubt that the “theory” behind chiropractic, namely that so-called “subluxations” of the spine are the source of nearly all disease, is a load of the purest woo. After all, going back to the origin of chiropractic in 1895, you will recall that Daniel David Palmer essentially made up chiropractic out of whole cloth when he claimed to have restored the hearing of a deaf janitor by “adjusting” a bump on his spine. As a result of this, he concluded that “subluxations” somehow mess up the body’s expression of “innate intelligence.” When you come right down to it, though, “innate intelligence” comes off sounding very much like the Eastern concept of qi, or life energy, and adjustments of “subluxations,” in concept relative to qi, are not unlike acupuncture in that chiropractors claim that “adjusting” these subluxations release “nerve interference” and thus cure disease caused by this interference, much as acupuncturists claim to “unblock” the flow of qi.

Consequently, my answer to the question of whether or not chiropractic is woo is multifaceted. The theory of chiropractic is, without a doubt, pure woo, but many modern day chiropractors try to downplay the woo part and “mix” with modern medicine. Chiropractic might have value in back pain and other spinal problems, but, if it does, it is the same sort of value that a good physical therapist provides with physical manipulation of the spine, which is why I have sometimes referred to chirpractors as physical therapists with delusions of grandeur. (In fact, for back pain I’d far rather have a good physical therapist than a chiropractor.) A man’s got to know his limitations, and many chiropractors don’t know theirs, claiming to treat asthma, sinus diseases, diabetes, infectious diseases, and infant colic. Indeed, criticizing chiropractors for claiming to be able to treat infant colic when there is no valid scientific evidence to support such a claim is what got Simon Singh into trouble when the British Chiropractic Association sued for libel. In any case, apparently there is almost nothing chirpractors can’t treat, at least if you believe their claims.

They also seem to think that they know how to treat pregnant women during labor:

Post doctoral research fellow at the New Zealand College of Chiropractic, Dr. Jenny Kruger and Research Director, Dr. Heidi Haavik-Taylor, have commenced research into how chiropractic care can make giving birth an easier, safer experience for pregnant women.

The study, launched last month, will specifically look at how chiropractic care may influence pelvic floor muscle function in healthy women, before and after childbirth, and in women suffering from pelvic floor dysfunction.

‘We are working with a number of pregnant women here in New Zealand and the University of Australia in Sydney, which is also involved in the study, is testing hundreds, of woman’ explains Dr. Kruger. ‘We are using state of the art, 4D ultrasound to visualise the pelvic floor of women, pre and post chiropractic adjustments. We want to see whether spinal adjustments can alter the way the pelvic floor works.’

‘We are learning more and more as we go along,’ adds Dr. Kruger. ‘Our ultimate aim is to reduce the number of women suffering from prolapse after giving birth. We would like to be able to identify those that are at a greater risk before they even go into labour. That way, their health professionals can work with them before birth and take special precautions once they are in hospital, to give them the best chance of having a safe, trouble free birth.’

This is exactly what I mean by quackademic medicine. Here we have all the trappings of scientific medicine and actual clinical research in the form of ultrasounds and an apparent clinical trial. We have a university, the “University of Australia in Sydney,” which my Australian friends tell me doesn’t exist. (Maybe they meant the University of Sydney.) Unfortunately, all this “science-y-ness” is yoked to the neck of an incredibly implausible hypothesis, namely that spinal “adjustment” would somehow prevent uterine prolapse or can somehow make a trouble-free birth more likely. What is the preclinical evidence that justifies such a trial? Who knows? Certainly it isn’t studies like this one, which claims a benefit but has no control group and wasn’t randomized. Even systematic reviews of chiropractic performed by chiropractors and published in the “alternative medicine” literature don’t show any real evidence of benefit that can be distinguished from the placebo effect or the natural history of the clinical problem. Certainly the press release announcing the study doesn’t show any convincing evidence to justify this trial.

There is, however, throughout the Internet on chiropractic websites, a whole lot of woo claiming that chiropractic is very useful for pregnancy. For instance, a chiropractor named Martha Collins opines:

Chiropractic care through pregnancy is not only safe, it is essential. We can look at the implications of subluxation from a bio mechanical, hormonal and neurological standpoint. It is easy for all of us to see postural changes through pregnancy-the centre of gravity changes, the weight of the baby places increased pressure on the spine and pelvis, and towards the end of the pregnancy, changes are seen in gait pattern-the “waddle.” What we can’t see, are the millions of different hormonal changes and chemical reactions occurring both in the mother and the developing baby–all of which are controlled and coordinated through the nervous system.

But it’s not just the mothers who need chiropractic, don’t you know? It’s the babies as well:

When we listen to mothers’ stories of their pregnancy, labor and delivery, the children who suffer the most from the above complaints, are the ones who’ve had the greatest trouble with their births. Even relatively easy deliveries can result in subluxations. That’s why every child should be checked, before problems with their health even develop. That’s preventive care in the truest sense-preventing subluxations in mothers to prevent subluxations in their babies during childbirth. This is why every woman needs Chiropractic through pregnancy-so that the arrival of their baby is a “wonderful experience”, as one of my patients told me last week, after her son was born.

Even if it’s possible to justify the use of chiropractic as a form of glorified physical therapy for patients with back pain, it’s not possible to justify the chirpractic adjustment of babies using any decent scientific and clinical studies. The ideas used to justify using chiropractic on pregnant women derive from the nonsensical concept that vertebral subluxations can cause poor function of the uterus by somehow putting pressure on spinal nerves. This concept leads to the claims of chiropractors that:

  • Failure to prevent sacral and pelvic subluxations can result in abnormal positioning of the baby in the uterus.
  • Babies can be turned from a breech position to a normal vertex (head down) position simply by adjusting the sacrum.

If you want to get an idea of the degree of self-delusion going on here, look at the Bagnell technique, which appears to be similar to the Webster technique. Using this technique, chiropractors claim to be able to reverse a baby in breech presentation. No success rate is given other than to say that “often, within 48 hours of the first adjustment to the mother’s spine and pelvis. Without any sort of controlled trials, it’s impossible to know whether chiropractic manipulation had any effect whatsoever or whether these were simply spontaneous versions out of breech. In another article, two chiropractors claim to have a 95% success rate. If this were true, you’d think they could verify this number with some actual data, wouldn’t you? At least, I would. Given that most breech presentations early in term resolve spontaneously, unless these chiropractors can show that they have a 95% success rate at 39 or 40 weeks, the far more plausible explanation is that the chiropractic manipulations had no effect.

Once again, we see alt-med promoters putting the cart before the horse. Chiropractors have an incredibly unlikely hypothesis, without any good clinical data to sugest that chiropractic can reverse breech presentation other than the claims of some chiropractors that they have a 95% success rate, with no evidence to document such a fantastic claim. They think that preventing fantastical subluxations in the mother prevents them in the baby and that babies born with these magical disorders require–of course!–chiropractic adjustment. In the meantime, in New Zealand, chiropractors are subjecting pregnant women to what is almost certainly a useless procedure and even studying it in a clinical trial.

Quackademic medicine marches on.