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educes causes and cures of health problems to a single factor vertebral subluxation 31 homeostasis emphasizes the body s inherent self healing abilities chiropractic s early notion of innate intelligence can be thought of as a metaphor for homeostasis 32 a large number of chiropractors fear that if they do not separate themselves from the traditional vitalistic concept of innate intelligence chiropractic will continue to be seen as a fringe profession 231 a variant of chiropractic called naprapathy originated in chicago in the early twentieth century 232 233 it holds that manual manipulation of soft tissue can reduce interference in the body and thus improve health 233 straights vitalists versus mixers materialists edit 1914 advertisement for a straight chiropractic as opposed to a mixer chiropractic by 1914 234 chiropractors had begun to divide into two groups straights adherents of the palmers supernatural vitalist beliefs and mixers who sought to integrate chiropractic into science based mainstream medicine 235 172 range of belief perspectives in chiropractic perspective attribute potential belief endpoints scope of practice narrow straight broad mixer philosophic orientation vitalistic materialistic falsifiability untestable cannot be proven or disproven testable lends itself to scientific inquiry taken from mootz phillips 1997 33 originally straight chiropractors adhered to pseudoscientific vitalist ideas set forth by d d and b j palmer and even modern straights often retain metaphysical definitions and vitalistic qualities 225 straight chiropractors believed that vertebral subluxation leads to interference with an innate intelligence exerted via the human nervous system and is a primary underlying risk factor for many diseases 225 straights view the medical diagnosis of patient complaints which they consider to be the secondary effects of subluxations to be unnecessary for chiropractic treatment 225 thus straight chiropractors are concerned primarily with the detection and correction of vertebral subluxation via adjustment and do not mix other types of therapies into their practice style 225 their philosophy and explanations were metaphysical in nature and they preferred to use traditional chiropractic lexicon terminology such as perform spinal analysis detect subluxation correct with adjustment 231 they preferred to remain separate and distinct from mainstream health care 231 modernly straights are a minority among chiropractors though they have been able to transform their status as purists and heirs of the lineage into influence dramatically out of proportion to their numbers 231 mixers who make up the majority of chiropractors mix chiropractic with diagnostic and treatment approaches from mainstream medical and osteopathic practices 231 unlike straight chiropractors mixers believe subluxation is just one of many causes of disease and mixers are open to mainstream medicine 231 many mixers incorporate mainstream medical diagnostics and employ conventional medical treatments including techniques of physical therapy such as exercise stretching massage ice packs electrical muscle stimulation therapeutic ultrasound and moist heat 231 but some mixers also use techniques from pseudoscientific alternative medicine including unnecessary nutritional supplements acupuncture homeopathy herbal remedies and biofeedback 231 author holly folk writes that few mixer chiropractors use the term anymore today one is more likely to hear this side described as holistic wellness oriented or integrative practitioners 235 114 folk argues that osteopathy underwent a straight mixer debate between traditional vitalists and a faction that embraced the new medical science 172 although mixers are the majority group many of them retain belief in vertebral subluxation as shown in a 2003 survey of 1 100 north american chiropractors which found that 88 wanted to retain the term vertebral subluxation complex and that when asked to estimate the per cent of disorders of internal organs that subluxation significantly contributes to the mean response was 62 221 a 2008 survey of 6 000 american chiropractors demonstrated that most chiropractors seem to believe that a subluxation based clinical approach may be of limited utility for addressing visceral disorders and greatly favored non subluxation based clinical approaches for such conditions 236 the same survey showed that most chiropractors generally believed that the majority of their clinical approach for addressing musculoskeletal biomechanical disorders such as back pain was based on subluxation 236 chiropractors often offer conventional therapies such as physical therapy and lifestyle counseling and it may for the lay person be difficult to distinguish the unscientific from the scientific 237 restraint of trade decision 1989 edit the ama labeled chiropractic an unscientific cult in 1966 30 and until 1980 advised its members that it was unethical for medical doctors to associate with unscientific practitioners 238 this culminated in a landmark 1987 decision wilk v ama in which the court found that the ama had engaged in unreasonable restraint of trade and conspiracy and which ended the ama s de facto boycott of chiropractic 10 growing scholarly interest edit serious research to test chiropractic theories did not begin until the 1970s and is continuing to be hampered by antiscientific and pseudoscientific ideas that sustained the profession in its long battle with organized medicine 225 by the mid 1990s there was a growing scholarly interest in chiropractic which helped efforts to improve service quality and establish clinical guidelines that recommended manual therapies for acute low back pain 225 in recent decades chiropractic gained legitimacy and greater acceptance by medical physicians and health plans and enjoyed a strong political base and sustained demand for services 10 however its future seemed uncertain as the number of practitioners grew evidence based medicine insisted on treatments with demonstrated value managed care restricted payment and competition grew from massage therapists and other health professions 10 the profession responded by marketing natural products and devices more aggressively and by reaching deeper into alternative medicine and primary care 10 public health edit further information vaccine controversy alternative medicine and water fluoridation controversy some chiropractors oppose vaccination and water fluoridation which are common public health practices 31 within the chiropractic community there are significant disagreements about vaccination one of the most cost effective public health interventions available 239 most chiropractic writings on vaccination focus on its negative aspects 28 claiming that it is hazardous ineffective and unnecessary 29 some chiropractors have embraced vaccination but a significant portion of the profession rejects it as original chiropractic philosophy traces diseases to causes in the spine and states that vaccines interfere with healing 29 the extent to which anti vaccination views perpetuate the current chiropractic profession is uncertain 28 the american chiropractic association and the international chiropractors association support individual exemptions to compulsory vaccination laws and a 1995 survey of u s chiropractors found that about a third believed there was no scientific proof that immunization prevents disease 29 the canadian chiropractic association supports vaccination 28 a survey in alberta in 2002 found that 25 of chiropractors advised patients for and 27 against vaccinating themselves or their children 240 early opposition to water fluoridation included chiropractors some of whom continue to oppose it as being incompatible with chiropractic philosophy and an infringement of personal freedom other chiropractors have actively promoted fluoridation and several chiropractic organizations have endorsed scientific principles of public health 241 in addition to traditional chiropractic opposition to water fluoridation and vaccination chiropractors attempts to establish a positive reputation for their public health role are also compromised by their reputation for recommending repetitive lifelong chiropractic treatment 31 controversy edit main article chiropractic controversy and criticism throughout its history chiropractic has been the subject of internal and external controversy and criticism 231 242 according to daniel d palmer the founder of chiropractic subluxation is the sole cause of disease and manipulation is the cure for all diseases of the human race 9 243 a 2003 profession wide survey 221 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 244 a critical evaluation stated chiropractic is rooted in mystical concepts this led to an internal conflict within the chiropractic profession which continues today 9 chiropractors including d d palmer were jailed for practicing medicine without a license 9 for most of its existence chiropractic has battled with mainstream medicine sustained by antiscientific and pseudoscientific ideas such as subluxation 225 collectively systematic reviews have not demonstrated that spinal manipulation the main treatment method employed by chiropractors is effective for any medical condition with the possible exception of treatment for back pain 9 chiropractic remains controversial though to a lesser extent than in past years 25 see also edit medicine portal chiropractic education chiropractic schools councils on chiropractic education international list of topics characterized as pseudoscience toftness device world federation of chiropractic references edit the dark side of musculoskeletal care why do ineffective techniques seem to work a comprehensive review of complementary and alternative therapies 2025 02 06 1 2 3 4 5 6 7 nelson cf lawrence 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ypmed 2009 05 004 pmid 19465044 1 2 3 4 urits i schwartz rh orhurhu v maganty nv reilly bt patel pm wie c kaye ad mancuso kf kaye aj viswanath o january 2021 a comprehensive review of alternative therapies for the management of chronic pain patients acupuncture tai chi osteopathic manipulative medicine and chiropractic care adv ther review 38 1 76 89 doi 10 1007 s12325 020 01554 0 pmc 7854390 pmid 33184777 1 2 3 posadzki p ernst e 2011 spinal manipulation an update of a systematic review of systematic reviews the new zealand medical journal 124 1340 55 71 pmid 21952385 1 2 canter ph coon jt ernst e 2006 cost effectiveness of complementary therapies in the united kingdom a systematic review evidence based complementary and alternative medicine 3 4 425 32 doi 10 1093 ecam nel044 pmc 1697737 pmid 17173105 archived from the original on 2008 05 11 1 2 van der roer n goossens me evers sm van tulder mw 2005 what is the most cost effective treatment for patients with low back pain a systematic review best practice research clinical rheumatology 19 4 671 84 doi 10 1016 j berh 2005 03 007 pmid 15949783 1 2 3 4 5 gouveia lo castanho p ferreira jj 2009 safety of chiropractic interventions a systematic review pdf spine 34 11 e405 13 doi 10 1097 brs 0b013e3181a16d63 pmid 19444054 s2cid 21279308 archived pdf from the original on 2016 09 19 1 2 3 4 5 ernst e 2007 adverse effects of spinal manipulation a systematic review journal of the royal society of medicine 100 7 330 38 doi 10 1177 014107680710000716 pmc 1905885 pmid 17606755 archived from the original on 2010 05 16 christian nordqvist 2007 07 02 spinal manipulation should not be routinely used new study warns med news today 1 2 3 4 haynes mj vincent k fischhoff c bremner ap lanlo o hankey gj 2012 assessing the risk of stroke from neck manipulation a systematic review international journal of clinical practice 66 10 940 47 doi 10 1111 j 1742 1241 2012 03004 x pmc 3506737 pmid 22994328 1 2 ernst e 2010 vascular accidents after neck manipulation cause or coincidence international journal of clinical practice 64 6 673 77 doi 10 1111 j 1742 1241 2009 02237 x pmid 20518945 s2cid 38571730 1 2 3 4 5 6 7 ernst e 2010 deaths after chiropractic a review of published cases international journal of clinical practice 64 8 1162 65 doi 10 1111 j 1742 1241 2010 02352 x pmid 20642715 s2cid 45225661 for an explanation regarding the description of chiropractic as a pseudoscience see singh simon ernst edzard 2008 the truth about chiropractic therapy trick or treatment alternative medicine on trial london bantam press isbn 978 0 593 06129 9 oclc 190777228 good r slezak p 2011 introductory comments on pseudoscience in society and school science education springer pp 401 409 doi 10 1007 s11191 010 9331 2 the uncritical habits of mind that allow pseudosciences like subluxation chiropractic astrology intelligent design and countless new age medical cures to flourish are an important indication that science education needs to be changed ...