 Welcome back. I'm Dr. Harriet Hall, and this is lecture three in a series of ten lectures on science-based medicine. In the last lecture, I talked about CAM in general, and now let's look at some specifics. Of all the things in alternative medicine, chiropractic is probably the most widely accepted. Thirty percent of Americans have visited a chiropractor in their lifetime. It's not so popular in other parts of the world. There are 50,000 chiropractors in the United States, but about half the countries in the world have no chiropractors at all. Chiropractors are not medical doctors. They can say they're doctors because they hold the D.C. degree, Doctor of Chiropractic. If a chiropractor calls himself Dr. Jones and doesn't explain, his patients may assume that he's a medical doctor. Some people don't even know there's a difference. They think chiropractors are just MDs who specialize in the back. Most customers go to chiropractors for treatment of back pain, but some people go to chiropractors for all their health needs and for health maintenance and prevention. That's a mistake. These claims were made by a chiropractor in the comments on the science-based medicine blog. They are all false. Chiropractic is not a science. It's a pre-scientific belief system. It is not based on neurology, anatomy, and physiology. It's based on a myth, the myth of the so-called chiropractic subluxation. Chiropractors are not doctors of the nervous system. Neurologists are doctors of the nervous system. Chiropractors are more like physical therapists. And there's no evidence that chiropractic care improves health or quality of life. I'm going to tell you how chiropractic originated, what chiropractic theory says, and why science rejects it. I'm going to tell you about some of the complications chiropractic can cause. I'm going to show you that chiropractic is a magnet for quackery, for unproven and implausible tests and treatments. I'm going to tell you about some of the harmful and unethical things that some chiropractors do. And finally, I'm going to tell you what chiropractors do that really works. And I'm going to give you some guidelines on how to choose one. Chiropractic is not a science. It's the brainchild of a single individual who invented chiropractic all by himself in a single day. The day was September 18th, 1895. It says so right there on his monument. The inventor had no training in science or medicine. He was a grocer and a magnetic healer named D.D. Palmer. He based his whole theory on one patient. He thought a bone was out of place in a deaf janitor's back. He pressed on the janitor's back and thought he had replaced the bone, and immediately the janitor said he could hear again, according to Palmer. According to the janitor's daughter, her daddy remained deaf until the day he died. We'll never know what really happened, but we can be sure that nothing Palmer did to the janitor's back could have restored his hearing. Palmer was ignorant of anatomy. He didn't know that the nerves to the ear are all in the skull, with no connection to the spine. And today, few of any chiropractors would even try to treat deafness. But Palmer was convinced, and from this one case he extrapolated, to say that he had found the one cause of all disease. Really, he thought that all disease was due to subluxation, bones out of place, 95% subluxation in the spine, and 5% subluxations of other bones. He didn't test his idea to see if he was right. He knew he was right, so he proceeded to develop a thriving practice cracking backs. Now, think about the state of medicine in 1895. Conventional medical treatments of the day were just as likely to harm as to heal. Pasteur, who discovered germs, died in 1895, and the germ theory of disease wasn't yet widely accepted. The first antibiotic didn't come along for another 50 years. In 1895 was the same year Rintgen discovered x-rays, so when Dee Dee Palmer thought he felt a bone out of place, he had no way of verifying it. Dee Dee Palmer lived in a pre-scientific world, and he didn't know any better. But modern chiropractors don't have that excuse. Don't confuse chiropractic with osteopathy. DO is Doctor of Osteopathic Medicine. DC is Doctor of Chiropractic. Chiropractors and osteopaths originated about the same time, and they did the same back manipulations, but the osteopaths thought they were restoring blood flow, and the chiropractors thought they were restoring nerve flow. DOs accepted scientific medicine, and today an American DO gets the same training as an MD plus training in spinal manipulation techniques. In the United States, DOs have to pass the same licensing exams as MDs, and they take the same internships and residency training. They practice mainstream medicine, and they seldom do manipulations once they're out in practice. For chiropractors, manipulations are their main reason for existing. There are three parts to chiropractic theory, subluxation, nerve impairment, and innate. Subluxation is the idea that displacement of bones is the root of all disease. Palmer imagined that he could feel bones out of place in the spine, and he thought he could put them back. Nerve impairment is the idea that all body functions are governed by nerves from the spine, and that displaced bones interfere with nerve function by stretching or compressing nerves where they exit the spine. Inate. Palmer thought a mystical vital force called innate was transmitted through the nerves, and that realigning the spine would restore proper flow of innate, which would cure disease. All three of these ideas are false. First, subluxation. Subluxation is a medical term for a partial dislocation. You can see real subluxations on x-rays. The picture on the left shows a torn finger ligament that has allowed a subluxation or a partial dislocation or slippage. The x-ray on the right shows a complete dislocation of the same joint. Actual bone displacements are obvious on x-rays. The chiropractic subluxation is not. Chiropractors think they can see subluxations on x-rays, but different chiropractors see them at different locations on the same x-ray, and radiologists don't see them at all. When chiropractors were tested on before and after x-rays, they couldn't tell a difference. When chiropractic schools were challenged to produce sample teaching x-rays demonstrating subluxations, they weren't able to do so. When a chiropractor produces an audible crack in your back, he may tell you it's the sound of the bone popping back into place. But it isn't. It's just the same kind of sound you get when you crack your knuckles. It's produced by gas rushing in to fill a vacuum when two bones are pulled apart at a joint to create a potential space. It creates a little bubble with a big sound. Remember when your mom told you to stop cracking your knuckles because it was bad for you? Well, it probably wasn't. But some orthopedic specialists worry that repeatedly forcing a spinal joint beyond the normal range of motion may stretch the ligaments. It might loosen the joints and make the patient more prone to developing back pain. We don't know if that's true, but some patients do seem to become addicted to adjustments. The more they get, the more they seem to need. Chiropractors originally believed in boop, bones out of place. When that theory couldn't be demonstrated on x-ray, they said silly things like, well, there is a displacement that's enough to cause disease, but it's too tiny to show up on an x-ray. Eventually, they had to give up on boop. They redefined subluxation and said it was a complex of functional and or structural and or pathological articular changes that compromise neural integrity and may influence organ system and general health. Does that even mean anything? I think it's just gobbledygook. A disease like diabetes is defined so that every doctor who evaluates the patient will make the same diagnosis. But this vague definition of subluxation can be interpreted pretty much any way you choose. It really just amounts to a pretext, an excuse to treat anyone the chiropractor wants to treat. Some chiropractors are now rejecting the subluxation concept entirely. A recent study by chiropractors found no supportive evidence for the chiropractic subluxation being associated with any disease process or creating suboptimal health conditions. They concluded the subluxation construct has no valid clinical applicability. But the law still defines chiropractic in terms of the subluxation and the word subluxation is still very much in common use. The second part of chiropractic theory is nerve impairment. Palmer thought all body functions were governed by nerves from the spine. They aren't. He didn't know about cranial nerves and he didn't know about hormones. And apparently he didn't realize that some spinal nerves exit through the sacrum and the sacrum can't be manipulated. Today with organ transplants we know that you can sever all the nerves to an organ and transplant it into another person's body and it still works just fine. And true subluxations don't necessarily affect nerves. You can have a subluxation without nerve impairment and you can have nerve impairment without subluxation. In a condition called spondylolisthesis true subluxations have occurred and you can see them on x-ray but they may not cause any pain or impairment unless the displacement is very advanced and the pain is usually muscle pain rather than nerve pain. One condition where nerves are affected is a ruptured disc. When a disc ruptures the disc material breaks through the fibrous annulus and puts pressure on the nerve. But there is no displacement of the bones with a ruptured disc. Chiropractic claims that pressure on a nerve impedes the flow of messages through the nerve like stepping on a garden hose as in this picture from an early chiropractic advertisement. Today we know that's faults. Nerve impulses don't flow like water. They are electrical impulses and today we can actually measure nerve conduction speeds. In carpal tunnel syndrome the nerve is compressed in a small area at the wrist. We make the diagnosis by showing that the nerve conduction is normal above and below the wrist and slowed only across the area of compression. And just how easy is it to pinch a nerve? Well here's a picture showing how the relatively small spinal nerves come out of a big hole between the vertebra. The spine is built to allow movement. The cross section on the right shows the available space in white in the diameter of the nerve in black. It shows that there's plenty of room so that even a large displacement of bones would not cause a problem. One pathologist took a spine from an autopsy and he showed that you could bend the spine into a U-shape before there was any impingement on spinal nerves. If nerves were that easy to pinch, this woman would be in real trouble. The third part of chiropractic theory is innate. Innate is a mystical power that maintains health. It is a semi-religious concept. Indeed, Palmer actually thought of making chiropractic a religion at one point. This is a diagram that chiropractors have used to show how the patients innate is influenced by the chiropractors innate. Kind of like ESP. I don't know what that little trap door in the patient's head is supposed to be. The cadaver I dissected in my gross anatomy class didn't have one of those. Does this sound a bit like New Age you create your own reality nonsense? This is not science. This is a philosophical position called vitalism. The idea that some unmeasurable, undefined, undetectable life energy invests material bodies. There is absolutely no objective evidence that any such force exists. Vitalism has been soundly rejected by science. Like many myths, this one has a grain of truth behind it. Doctors don't heal patients. The body heals itself. Medical treatment only makes it easier for the body to do that. But the healing isn't accomplished by any woo-woo force. Healing occurs through physiologic processes that can be detected and studied. Chiropractic manipulations can cause harm. Neck manipulations can cause strokes by damaging the vertebral arteries. Here's how it happens. This is the normal position of the vertebral artery going straight up the side of the neck into the base of the skull. When you turn your head, it kinks. Now, arteries are pretty elastic and turning your own head is usually no problem. But imagine being jerked into this position forcefully during manipulation or having the joint forced beyond its normal range of motion. That can cause a small tear in the delicate lining of the artery. Sometimes this causes immediate damage from bleeding, but sometimes the tear is temporarily sealed with a clot. And later on the clot breaks loose, travels to the brain and clogs an artery, causing a delayed stroke as much as several days later. With a delayed reaction, the connection to manipulation may be missed. How often does that happen? Well, by one estimate, 20% of one kind of stroke, basilar strokes, are due to spinal manipulations that works out to 1,300 strokes a year in the United States. Patients with basilar strokes who were under the age of 45 were five times more likely than controls to have visited a chiropractor within a week of the event. Chiropractic strokes are underreported. Neurologists who see stroke patients don't routinely ask about chiropractic care and if the stroke is delayed, the connection may not be apparent. This is Sandra Netty. She was a healthy 40-year-old woman who was feeling fine, but she went to her chiropractor for a maintenance adjustment that she thought would help keep her healthy. When the chiropractor used a rapid thrust maneuver on her neck, she suddenly felt dizzy and unwell. When she complained, the chiropractor didn't recognize that it was an emergency. His only response was to offer to sell her massage services. He let her try to drive herself home, and she only made it part way. Doctors found tears in both of her vertebral arteries, one of them three inches long. As the stroke progressed, she developed locked-in syndrome, an intact mind locked in a paralyzed body. She was in pain, was unable to eat or breathe on her own, and was able to move one arm just enough to type on a special keyboard. She sued. The chiropractor later admitted to the court that after he learned he was going to be sued, he had forged Sandra's signature on an informed consent form. Chiropractors have tried to defend themselves by saying the patients who had strokes had come to them with neck pain because they were already in the early stages of a stroke, but Sandra had no neck pain. Neither did Lori Jean Mathiason. She originally went to a chiropractor for pain in her tailbone. By one account, she had a whopping 186 manipulations over a six-month period. I haven't been able to confirm that, but other sources said she had over 20 neck manipulations. With the last one, she went into convulsions on the chiropractor's table. The chiropractor's only response was to try to revive her by slapping her face. She died in a coma three days later. Even when patients do have neck pain, if chiropractors can't identify patients in the early stages of stroke, they have no business manipulating their necks. We don't know the actual risk of stroke from neck manipulation because the appropriate studies haven't been done. Strokes are undoubtedly rare, but if a drug had the same small risk of stroke and so little demonstrable benefit, then it would almost certainly have been taken off the market. Here are some of the other undesirable effects from manipulation. Half of patients experience local discomfort, headache, tiredness, and radiating discomfort. More serious complications include broken bones, herniated discs, disability, paralysis, and even death. I read about one family that kept going back to the same chiropractor until three family members had suffered strokes. Some chiropractors deny that manipulation can cause strokes, but their insurance companies are aware that there's a problem. In 2002, 9% of the claims paid by the major chiropractic insurance company were for strokes. That isn't proof that they were caused by manipulation, but it is proof that the insurance companies can't deny that there's a problem. When it comes to quackery, chiropractic is a veritable duck pond. Chiropractors are quack magnets. They adopt every new idea that might increase their patient count, no matter how crazy. And they keep using quack methods even after they've been disproven. I'll give just a few examples. Moire contour analysis maps the surface of the body and supposedly picks up asymmetries that help locate disease areas. It doesn't work. Chiropractors have been using these gadgets for almost a century. They run it down your back with a prong on either side of the spine. It's supposed to pick up temperature differences to pinpoint subluxations. Unfortunately, the needle also moves when you press harder, so it's really easy to fool yourself. For patients who don't like the idea of having their back forcibly cracked, the activator is a spring-loaded device that can be adjusted to various impacts that can be as light as a finger tap. This machine that looks sort of like a drill press is a special activator that taps a specific spot on the atlas, the top cervical vertebra, at a carefully calculated angle. Adjusting the atlas is supposed to fix the entire spine. Applied kinesiology is a bogus muscle testing technique that a whopping 43% of American chiropractors use to diagnose allergies and other conditions. They believe it even works by proxy. This chiropractor is diagnosing the little girl by testing the strength in her mother's arm. This is a toughness device. The operator rubs his fingers on the detection plate and claims to feel a stickiness when the device is positioned over a subluxation. It's totally bogus. It was banned by the FDA in 1980, but it's still being used. In 1991, 3.3% of chiropractors were still using it. In 2007, the FDA confiscated 96 of them. As recently as 2013, the California Board of Chiropractic examiners disciplined chiropractor David Monago for using one. Some chiropractors use a variety of other bogus tests and treatments. This is just a partial list. It includes things like homeopathy and divination with a pendulum. I won't read the list now, but you can find it in the course guide. Chiropractors used to routinely take full spine x-rays that exposed the pelvis and reproductive organs to unnecessary radiation. They were mostly out of focus because of the different thickness of the body at different levels. They still do a lot of unnecessary x-rays. X-rays are not indicated for most common cases of low back pain. They may recommend repeating x-rays at frequent intervals to assess progress, which is silly because subluxations don't show on x-ray. The only legitimate reason for x-rays is to make sure there are no fractures or tumors or anything else that would be a contraindication to manipulation. CME, or Continuing Medical Education for Chiropractors, often amounts to courses in practice management to boost their patient count. They often engage in unethical advertising. D.D. Palmer's son, B.J., was a publicity genius and something of a con man. He had a favorite saying that the spine supports the ribs, supports the skull, and supports the chiropractor. He was interested only in making money. They put blind ads in the newspaper that don't reveal that they're chiropractors, even though that practice is prohibited by the ethical guidelines of their own organizations. They offer to mail you free medical reports about new discoveries to treat back pain or whiplash or to cure ruptured discs by space age technology with no need for surgery. There are no new discoveries, just minor variations on old techniques, and they have to sneak this information to you by mailing you a report at your request because the FTC would not allow them to make false claims in direct advertising. They do anything and everything to drum up business, like the free exam and the double scale at the county fair that diagnoses everyone as lopsided. I mean, just try standing on two scales and getting them both to register the same weight. These free exams are guaranteed to find subluxations in every customer, and chiropractors will tell you that everyone needs regular chiropractic adjustments to maintain normal health. Some chiropractors give very bad advice. Less than 50% of chiropractors support immunizations, and some are adamantly against them. Many are against water fluoridation. Many of them give diet advice based on unsubstantiated theories, and they sell diet supplements and vitamins out of their office at inflated prices. Many of them try to persuade their patients to avoid conventional medical care, claiming that it's almost always harmful. Some want to be your family doctor, but they're not trained to fill that role. Some of them have missed obvious diagnoses that required referral. In one study, a patient went to several chiropractors complaining of the symptoms of a heart attack. Instead of rushing him to the ER, they all offered him chiropractic adjustments for his pain. In another study, chiropractors failed to recognize that a high fever in a very young infant was an emergency. Most of them just offered to adjust the infant's spine. Many chiropractors create a chiropractic neurosis by doing lifelong maintenance adjustments and convincing patients that every symptom they get, every sniffle or itch, is a reason to run back to the chiropractor because it means their last adjustment has slipped. A chiropractor in my town in Puyallup, Washington had a website where he claimed that childbirth stretches the baby's neck up to two-and-a-half times its normal length. I tried to tell him that if childbirth could do that, he wouldn't have a baby anymore, just a corpse. It's impossible to stretch a baby's neck that far. The bones don't stretch, and they can't separate because they're tightly bound by muscles and ligaments. Just try stretching your Thanksgiving turkey's neck to two-and-a-half times its normal length. It can't be done. His website also claimed that every newborn should be adjusted as soon as possible after birth, preferably right in the delivery room, and that delaying chiropractic treatment until puberty could cause irreversible damage. This is nothing but the most errant bull spit. Baby's bones haven't even finished forming. They mostly consist of separate ossification centers in a cartilage matrix. Here's a chiropractic ad for earaches. Ear infections are the number one reason for children to visit a chiropractor, but there is no evidence that chiropractic works for ear infections. Chiropractors can get away with claiming that it does because most ear infections will go away on their own without treatment. Occasionally, they miss an infection that does require antibiotics and complications like mastoiditis and brain infections can occur. They make other claims for pediatric conditions like colic, but there is no evidence that chiropractic benefits any pediatric condition. Many authorities feel that no child under the age of 12 should have chiropractic treatment period. A skeptical chiropractor named Samuel Hamola says that manipulating children is scientifically indefensible and it puts children at risk for things like brain bleeds and periplegia and fatal brain and spine injuries. It also delays diagnosis of treatable illnesses like cancer and meningitis. I found a chiropractic website that had a cynical list of ploys to deliberately undermine the parent's trust in their pediatrician and get them to bring their kids to a chiropractor for their primary care. An example, examine a child's spine and say, hmm, like you found something worrisome. And then ask mom if the child breastfed more from the right breast or the left breast. Whichever she answers, say, I thought so, and then ask, did your pediatrician ever ask you that? Chiropractors come in different flavors. These are their professional organizations. The International Chiropractors Association is for straights. The American Chiropractic Association is for mixers. The straights limit their practice to chiropractic adjustments only. The mixers may add anything from massage to voodoo. There is also a small group of upper cervical or nuca practitioners who only work on the top vertebra in the neck. Even most other chiropractors think that they're wrong. They follow the whole in one theory. The idea that if you adjust the atlas, the top vertebra, the rest of the spine will somehow magically fall into alignment. The picture supposedly shows how health and healing messages come from the brain down to the atlas vertebra, but can't get past it if the head and neck are misaligned, which is nonsense. They take unnecessary x-rays. They draw lines on x-rays before and after treatment, and they pretend to show improvement by drawing the lines slightly differently. They claim to treat everything from allergies and ear infections to multiple sclerosis and epilepsy. There's a nuca practitioner in Seattle that I call the no-touch chiropractor. One hand over the other and makes a cracking sound in her own wrists while remaining about an inch away from the patient's skin. Sometimes, instead of using their hands to adjust the atlas, they use a machine like this. It provides an impulse to a tiny spot at a precisely calculated angle. They call this atlas orthogonal. And there's another small, slowly-growing category of reform chiropractors who reject the subluxation concept and try to provide evidence-based care. They limit their practice to short-term treatment of musculoskeletal problems. There aren't very many of them, and they're hard to find. They essentially operate as if they were physical therapists with special expertise in the back. It's hard to see how they can call what they're doing chiropractic. Chiropractors have lots of satisfied patients, and they do help people. Chiropractors do well. They provide effective physical therapy for back pain, and they offer sympathy, explanations, and support. The doctor says, I don't know why your back hurts. Here, try these pills. The chiropractor says, I know exactly why your back hurts, and I can fix it, and I can keep it from recurring. It's satisfying to have an explanation even if that explanation is wrong. And he provides lots of personal attention, hands-on care, and wants to see you again soon and your whole family too. For benign self-limiting conditions, the chiropractor may keep the patient entertained long enough for the condition to resolve naturally, and that may keep them from trying surgery or other treatments that might have dangerous side effects. And they're good psychologists. They know how to please patients who are dissatisfied with their regular doctors. There is one treatment they use that is really effective. Spinal manipulation therapy has been proven to work for low back pain, but it isn't any more effective than other forms of treatment. In one study, it didn't work any better than just giving the patient a pamphlet about back care. But it may offer more rapid relief, and it's a reasonable option for patients who want to avoid pills. But there's nothing uniquely chiropractic about it. DOs, physical therapists, please use it too. If a chiropractor offers to provide spinal manipulation therapy for back pain, that's acceptable. But if he claims to be adjusting your spine to correct subluxations, that's not acceptable. Neck manipulation has been proven effective for neck pain, but it's no more effective than general mobilization, and neither manipulation nor mobilization will work unless they're combined with an exercise program. Chiropractic has many of the hallmarks of suicide. It has its own journals and publishes studies, but they're of very low quality. They publish a lot of case reports and uncontrolled studies designed to impress readers that chiropractic works, not to find out if it works. Science makes progress. Chiropractic doesn't. Science rejects things that have been shown not to work. Chiropractic doesn't. They just keep adding more adjustment techniques to over a hundred now. They haven't tested them against each other to see if some are more effective than others. They just want to have the freedom to choose any treatment they want. This book is a travesty. It's a matter of visceral aspects of chiropractic. It's a textbook intended for use in schools of chiropractic. It's about treating disease in other parts of the body instead of just the spine. It claims that chiropractic can treat asthma, colic, ear infections, disorders, menstrual pain, and a host of other internal disorders. The subtitle claims it is an evidence-based approach. But I read this entire book and I didn't find anything in it that could be classified as evidence-based medicine or science-based medicine. Their concept of evidence is anecdotal reports, uncontrolled studies, and poorly designed studies that have never been replicated. If you still want to consult a chiropractor about all this, here's how to choose a safe one. Look for one who rejects subluxation therapy, who doesn't take unnecessary x-rays, who doesn't use quack procedures or tests, who doesn't do preventive or maintenance adjustments, who doesn't promote unproven dietary supplements, who doesn't pretend to be a family doctor, who doesn't treat young children, who doesn't demonstrate antagonism to scientific medicine, who doesn't discourage immunizations, who limits his practice to short-term treatment of musculoskeletal problems, and who knows when to refer. The skeptical chiropractor Samuel Homola used to tell his patients, I can't predict whether manipulation will help you, but let's try it for three treatments. If it's not helping at that point, we'll stop. Remember Lori Jean Mathiason's multiple treatments over six months? Don't you think she should have realized before that point that it wasn't working? Pick a chiropractor who's wearing the hat on the left. Trust me, I'm a scientist, rather than the one on the right. That shit crazy. I think I've made it clear that chiropractic is not science-based, but let me add a few horror stories. In a recent online forum, chiropractors were arguing about whether you could ever die if your spine were kept in perfect alignment. Some of them thought you couldn't die. Since everyone dies, I guess they thought that no one's spine is ever kept in perfect alignment. A chiropractor told me categorically that germs can't possibly cause disease, because if they did, we'd all be dead. He has never had an immunization, and he claims that he can't catch anything because his spine is in alignment. Incidentally, he happens to be morbidly obese. Maybe all that fat is helping hold his spine in place. I met a chiropractor who diagnoses allergies by having the patient hold a sealed glass vial of allergen in one hand while he tests their muscle strength in the other arm. If their muscles seem weaker when they hold a vial, that proves to him that they're allergic to the vial's contents. He suspected one patient was allergic to something at work, and he didn't have a vial of bowing. So he just had the patient think about bowing, and that worked just as well. A child in my neighborhood had died of meningitis because he was treated with chiropractic adjustments instead of antibiotics. I asked if the family had sued the chiropractor, and I was told that they couldn't very well do that because the treating chiropractor was the child's own father. His false beliefs killed his own child. A friend of mine had a narrow escape. He had a backache that just wouldn't go away, and on a Friday afternoon he made an appointment for Monday. On Saturday, his back pain stopped, and it never came back. Chiropractic must really be powerful if it works by just making an appointment. Remember the post-hoc or go-prop-to-hoc fallacy from lecture one. If he had seen the chiropractor on Friday, and the pain went away the very next day, who do you think would have gotten the credit? He probably would have thought the chiropractor was a miracle worker, and he would have kept seeing him forever. So to summarize, chiropractic is a pre-scientific belief system. It's based on a myth, the subluxation. It has tried to establish scientific credibility for over a century, and has failed. Sometimes chiropractors help people feel better, but they can also cause harm. When chiropractic does help, it's not really anything uniquely chiropractic that helps. If a chiropractor offers spinal manipulation therapy for short-term treatment of certain kinds of musculoskeletal pain, he might be able to help you. If he offers to adjust your subluxations or to treat problems elsewhere in the body, he's not to be trusted. In the next lecture, I'll talk about another CAM that is highly overrated. Acupuncture.