Throughout its history, chiropractic has been the subject of internal and external controversy and criticism.[1][2] According to magnetic healer Daniel D. Palmer, the founder of chiropractic, "vertebral subluxation" was the sole cause of all diseases and manipulation was the cure for all disease.[3][4] Internal divisions between "straights," who adhere strictly to Palmer’s original philosophy, and "mixers," who incorporate broader medical practices, have further complicated the profession’s identity.[4] A 2003 profession-wide survey found "most chiropractors (whether 'straights' or 'mixers') still hold views of Innate Intelligence and of the cause and cure of disease (not just back pain) consistent with those of the Palmers".[5] A critical evaluation stated "Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today."[3] Chiropractors, including D.D. Palmer, were jailed for practicing medicine without a license.[3] D.D. Palmer considered establishing chiropractic as a religion to resolve this problem.[6] For most of its existence, chiropractic has battled with mainstream medicine, sustained by antiscientific and pseudoscientific ideas such as vertebral subluxation.[7]
Chiropractic researchers have documented that fraud, abuse and quackery are more prevalent in chiropractic than in other health care professions.[8] Unsubstantiated claims about the efficacy of chiropractic have continued to be made by individual chiropractors and chiropractic associations.[3] The core concept of traditional chiropractic, vertebral subluxation, is not based on sound science.[3] Collectively, systematic reviews have not demonstrated that spinal manipulation, the main treatment method employed by chiropractors, was effective for any medical condition, with the possible exception of treatment for back pain.[3] Spinal manipulation, particularly of the upper spine, can cause complications in adults and children that can cause permanent disability or death.[9][10][11] Scientific studies have generally found limited evidence for chiropractic efficacy beyond back pain, and concerns about patient safety, particularly with neck manipulations, have been raised.[12][13][14]
Legal battles, including the landmark Wilk v. AMA case and Simon Singh’s libel suit, highlight tensions between chiropractors and mainstream medicine.[15][16][17] Ethical issues, such as misleading advertising and opposition to vaccination, continue to draw criticism. Despite efforts to modernize, chiropractic remains controversial within both the medical community and the public sphere. In 2008, Simon Singh was sued for libel by the British Chiropractic Association (BCA) for criticizing their activities in a column in The Guardian.[18] A preliminary hearing took place at the Royal Courts of Justice in front of judge David Eady. The judge held that merely using the phrase "happily promotes bogus treatments" meant that he was stating, as a matter of fact, that the British Chiropractic Association was being consciously dishonest in promoting chiropractic for treating the children's ailments in question.[19] An editorial in Nature has suggested that the BCA may be trying to suppress debate and that this use of British libel law is a burden on the right to freedom of expression, which is protected by the European Convention on Human Rights.[20] The libel case ended with the BCA withdrawing its suit in 2010.[21][22]
Chiropractors historically were strongly opposed to vaccination based on their belief that all diseases were traceable to causes in the spine, and therefore could not be affected by vaccines.[23] Some chiropractors continue to be opposed to vaccination.[24] Early opposition to water fluoridation included chiropractors in the U.S. Some chiropractors opposed water fluoridation as being incompatible with chiropractic philosophy and an infringement of personal freedom. More recently, other chiropractors have actively promoted fluoridation, and several chiropractic organizations have endorsed scientific principles of public health.[25]
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).
WHO-guidelines
was invoked but never defined (see the help page).