Chiropractic, homeopathy … and more

Jay M. Pasachoff

In his chapter on medical cults in Fads and Fallacies in the Name of Science (1957), Martin Gardner discussed chiropractic, osteopathy, and homeopathy. Your January/February 2008 issue has interesting articles about two of these three but no discussion of osteopathy.

The discussion of the third leg of the tripod is important, since doctors of osteopathy (DOs) are now often the only kind of primary care provider that is accessible. My local medical group, for example, just hired two DOs and gave me no access to their surviving MDs on the retirement of my current MD this month. I have been looking elsewhere on the ground that the pseudoscientific beliefs and training of the DOs make me suspicious of everything else they do.

But I gather that DOs are becoming more mainstream and that they can have good residencies after their osteopathic training. That raises questions as to why they went to osteopathic school instead of medical school in the first place, and what there might be in their training that could lead to nonscientific conclusions as they see patients. Online researching indicates various nonscientific teachings that persist in the osteopathic schools. Under managed care and the pressure of treating patients at a high rate, is it that they act 100 percent like medical doctors (MDs)?

Jay M. Pasachoff

Field Memorial Professor of Astronomy and Director, Hopkins Observatory Williams College

Williamstown, Massachusetts

Author Samuel Homola, DC, replies.

Professor Pasachoff's letter raises important questions and a valid concern. I am not an osteopath and therefore cannot speak authoritatively on the subject of osteopathy. It is my impression, however, that the educational requirements and the training of medical doctors and osteopaths are the same, except that osteopathic schools may include training in manipulative therapy and body mechanics. Some researchers have reported that grade point averages and Medical College Admission Test scores of osteopathic students may be lower than those of medical students.

Since the definition of osteopathy places emphasis on the structural aspects of healing, I'm sure that some well-qualified students of medicine choose to study osteopathic medicine in order to combine the two methods of treatment, reserving use of manipulation (in combination with medical procedures) for treatment of musculoskeletal problems while depending upon medical procedures in the treatment of nonmusculoskeletal problems. An osteopath who combines appropriate use of manipulation with mainstream medical care can offer a valuable and unique service.

Today, the percentage of practicing osteopaths who use manipulative therapy for any reason is low; most are occupied with the practice of medicine. I have no problem with evidence-based osteopaths who include use of manipulative therapy in their treatment armamentarium. Nor do I have a problem with osteopaths who are devoted entirely to medical and surgical procedures. Both can be dependable specialists and primary care providers. But I do understand the concern of persons who question why a qualified pre-med student who is not interested in osteopathic manipulation would choose to attend an osteopathic college rather than a medical college--except for the difficulty of being admitted to an accredited medical college. And one might also wonder if a surgical residency in an osteopathic hospital is equal to residency in a medical hospital.

Unfortunately, it appears that a few osteopaths still cling to the original osteopathic theory, which embraces the idea that osteopathic manipulation can heal disease by removing interference with nerve and blood supply, particularly in the spine. Some of these practitioners may make questionable claims and use such questionable treatment methods as "cranial osteopathy"--claims and methods rejected by mainstream osteopathic and medical practitioners. Graduates of osteopathic colleges that fail to denounce such methods may be less evidence-based than others.

I wanted to pass on to you an experience I had with a friend who is seeing a chiropractor. She was excited about the "doctor" discovering what allergies she had and wanted me to see the woman. This is how this chiropractor tests for allergies: she has the patient hold a metal rod, and then the chiropractor exposes them to an allergen and waits for, as my friend put it, the "histamine reaction." Using this "test" the chiropractor claimed my friend was allergic to soy products and a number of other things. You can imagine her letdown at my lack of interest in contacting the chiropractor to take advantage of her "therapy."

My friend never misses a chance to talk about the chiropractor. But if she thinks I'm going to see someone and pay $150 for small bottles of water that have "memories" and be diagnosed for allergies with a metal rod, she's got another thing coming. Wouldn't this be classified as practicing medicine without a license? Inquiring people want to know.

Donell Meadows

New Bern, North Carolina

With the availability of scientific literature, I am shocked that so many journalists do not do their research. In response to the statement "there is no scientifically credible evidence that chiropractic treatment can alleviate high blood pressure ..." ("A Skeptical Consumer's Look at Chiropractic Claims," SI, January/ February 2008), I present to you the most current research regarding chiropractic adjustments and hypertension. This study took place at Rush University Hypertension Center and was published in the Journal of Human Hypertension in May 2007. The authors concluded "that restoration of Atlas alignment is associated with marked and sustained reductions in blood pressure similar to the use of two-drug combination therapy." This is a pilot study. However, the results were so astounding that another study is currently underway.

I request that a rebuttal be published to correct the misinformation. The profession of chiropractic is struggling to find its identity. However, the professional commitment remains to provide the most effective care and accurate information for individuals. I hope that this commitment to accurate information is shared by the editors of SKEPTICAL INQUIRER.

Julianne Newman

Castro Valley, California

Authors Bruce A. Thyer and Gary Whittenberger respond:

We welcome the comment by Ms. Newman regarding a newly published study evaluating the effects of chiropractic manipulation of the Atlas vertebra on high blood pressure. Since this article was published in May 2007, after our survey was conducted and accepted for publication, we can hardly accept her judgment that our report was somehow shoddy journalism. We note that the persons with whom we spoke and who claimed that chiropractic could help with high blood pressure would not have known about this study as they tried to recruit patients with presumptive hypertension. This remains an unjustifiable practice.

The study Ms. Newman brought to our attention (Barkis et al. 2007) tested the effects of a precise, delicate, manual alignment of a single vertebra, C-1 or Atlas vertebra, located at the top of the spine. This specialized method is not typical of the full spinal-based manipulations provided by most chiropractors.

A further problem with Bakris et al. is that although they claimed that Atlas realignment reduced blood pressure to an extent similar to using anti-hypertensive drugs, we would like to point out that they did not include a comparison group actually treated with medication, surely an essential control feature in order to legitimately claim that Atlas adjustment works as well as does conventional drug therapy. An even earlier randomized controlled trial compared the anti-hypertensive effects of diet management plus chiropractic adjustments versus diet management alone, and found that adding spinal adjustments had absolutely no effect on blood pressure (Gertz, Grimm, Svendsen, and Grandits, 2002).

One flawed pilot study certainly does not constitute sufficient evidence for an entire profession (chiropractic) to assert that it can legitimately treat patients with high blood pressure using spinal manipulation. To do so borders, in our opinion, on medical malpractice, and we hope that the appropriate regulatory authorities in the individual states act to curb such excessive claims of chiropractors, their assistants, and representatives.

In "The Difference between Hahnemann and Darwin" in your January/February 2008 issue the author makes the statement that when diluting a 1-mole solution by a factor of 1/10 for 24 times, there will be no solutes remaining in the resulting diluted solution.

Matter can neither be created nor destroyed. The 6.022 x [10.sup.23] molecules of the original solute are still present in the resultant 1024 doses of the diluted solution. Assuming that the total diluted solution is uniform, the best that can be said is that the probability of finding a single molecule of the original solute in a resultant dose is 0.6022. This is less than 1 but certainly greater than 0.

Bruce T. Lowerre, PhD

lowerre@comcast.net

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