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Prevention is better than cure

Many if not most chiropractors claim that we all need regular 'adjustments', ie spinal manipulation for staying healthy.

Many if not most chiropractors claim that we all need regular 'adjustments', ie spinal manipulation for staying healthy.

It all starts at birth because the trauma of being squeezed through the birth canal causes no end of 'subluxations'. If we want to thrive, they need to be 'adjusted'. Later, during adult life, we develop 'subluxations' almost on a daily basis – thank God, we have the chiropractic profession to put them right. If not, serious illness will follow!

Given that maintenance therapy, as it is called, is so central for chiropractic, one would expect plenty of studies to show that it is worth the considerable expense. Alas, our expectation is disappointed.

A recent systematic review (1) - by chiropractors - found only one trial addressing this question. In this pilot study, 29 back pain sufferers were randomised either to receiving nine months of maintenance therapy or to having no such treatment. The results failed to show significant differences in pain at follow-up, but suggested a marginally positive effect in terms of disability (2). In other words, hardly any research on the effectiveness of chiropractic maintenance treatment is currently available and the few data that do exist fail to show that maintenance care is worth it. Barrett therefore concluded that 'maintenance care lacks a plausible rationale and has never been proven beneficial…' (3).

This is, of course, not the first time that unsubstantiated claims by chiropractors have been exposed. Chiropractors have demonstrated that the largest professional chiropractic associations in the US and Canada distributed patient brochures with claims which are not justified by the available scientific data (4). I recently pointed out that at least five professional chiropractic organisations from England, Ireland, New Zealand and Scotland make unsubstantiated claims about the effectiveness of chiropractic treatments for a range of paediatric conditions (5).

I would hope that this nonsense does end some time soon. False claims are clearly not good for patients and consumers. Even chiropractors, I would argue, need to be very short-sighted to endorse them.

Edzard Ernst Edzard Ernst

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