Chiropractic Controversies

Question 1

Existing literature indicates that benign adverse events following manual treatments to the spine are ___, while serious adverse events are ___

Answer 1

benign adverse events are common
serious adverse events are rare

Question 2

Why are incidence and causal relationships between spinal manipulation and serious adverse events challenging to establish?

Answer 2

Gaps in the literature and inherent methodological limitations of studies

Question 3

What is vitalism?

Answer 3

Doctrine that all living organisms are sustained by an inexplicable non-physical vital force
“both different from and greater than physical and chemical forces”

Question 4

What is the common phrase within vitalism?

Answer 4

The whole is greater than the sum of its parts

Question 5

The “vital force” is believed to not only be the source of life, but also…

Answer 5

a key component of health and healing

Question 6

What are four concerns regarding vaccination?

Answer 6

• Safety
• Efficacy
• Possible alternatives
• Public policy vs personal choice

Question 7

immune function and chiropractic

Does stimulus imply treatment effect?

Answer 7

No

Question 8

Is it known whether HVLA controlled vertebral thrusts have a clinically relevant impact on immunity?

Answer 8

No, further research is needed to explore this

Question 9

What is currently the most performed orthopedic procedure in the world?
What do studies show about this?

Answer 9

Arthroscopic partial meniscectomy (APM)
Studies conclusively show that outcomes are no better than a sham/placebo surgery

Question 10

What is now being touted as a viable and effective alternative to APM (arthroscopic partial meniscectomy)?

Answer 10

Meniscal repair

Question 11

What are three important aspects of an open-clinic?

Answer 11

• HIPAA
• Privacy
• Comfort

Question 12

Over service can be combatted by what model?

Answer 12

Fee-for-service model:
* Salary
* Fee for performance

Question 13

What is a subluxation to a medical doctor?
What is it to a chiropractor?

Answer 13

Medical: a partial dislocation
Chiropractic: a slight misalignment of the vertebrae

Question 14

A chiropractic subluxation is often referring to…

Answer 14

the vertebral subluxation complex: nerve, muscle, CT, etc.

Question 15

Why might one criticize chiropractic for implausible diagnostics and therapies?

Answer 15

• Construct validity
• Physiological mechanism of action

Question 16

Describe the evidence behind wellness care in chiropractic

Answer 16

Evidence is scarce for prevention

Question 17

What are some issues with treating visceral or non-musculoskeletal conditions?

Answer 17

• Construct validity
• Still testing mechanism of action

Question 18

Does literature support that mechanical stimulation of the spine modulates organ functions?

Answer 18

Literature confirms modulation in some organ functions in some cohorts

Question 19

If organ functions are modulated by mechanical stimulation of the spine, what is the rationale?

Answer 19

A comprehensive neurobiological rationale for this general phenomenon has yet to appear

Question 20

What is a general belief of chiropractors around drugs and medicine?

Answer 20

There is evidence of over-medicalization and over-prescription

Question 21

What is an issue with the advertising of chiropractic?

Answer 21

It can be misleading (as can other advertising)

Question 22

What is the evidence of the benefits of routine spinal X-rays?

Answer 22

Postulated benefits have limited or non-existent evidence

Question 23

What are some potential harms associated with spinal X-rays?

Answer 23

• Increased ionizing radiation exposure
• Overdiagnosis
• Subsequent low-value investigation and treatment procedures
• Increased, unnecessary costs

Question 24

In the vast majority of cases who present to chiropractors, does the potential benefit from spinal X-rays outweigh the potential harms?

Answer 24

No

Question 25

Should spinal X-rays be performed as a routine part of chiropractic practice?

Answer 25

No, decision to perform diagnostic imaging should be informed by evidence based clinical practice guidelines and clinician judgement

Question 26

In chiropractic care of infants, what is the likelihood of serious injury?

Answer 26

Very rare

Question 27

What are some concerns with chiropractic care of infants?

Answer 27

• Safety
• Efficacy

Question 28

What are some arguments that say chiropractic disregards evidence informed practice?

Answer 28

• Non-specific treatment effects
• Placebo
• Natural history