Let me preface this article with my position on patients who are mislead by health professionals: these people are victims. I do not believe this makes all patients immune from criticism when they defend abhorrent practices, but it is worth keeping in mind that – between the patient and the caregiver – only one of these two has a professional obligation to disseminate reliable, science-based information and provide informed consent. With that in mind, this post is a rebuttal to a chiropractic patient’s perspective published by a group that advocates for various forms of pseudoscience. From the piece:

A common-sense piece of information – that misalignment equals stress, equals weakened immune response, equals heightened vulnerability to the COVID-19 pandemic – had been conflated into an outlandish accusation that chiropractors were claiming that chiropractic treatment would make one immune to the novel coronavirus and prevent COVID-19. Quite a stretch. But is it really so far-fetched that a healthy spine can improve one’s ability to fight off the coronavirus should one contract it? Or that an individual might suffer milder symptoms should they develop COVID-19? I think not.

Claiming that something is common-sense neither makes it so, nor does it make that belief true. Throughout the relatively brief history of science, there have been numerous cases where common-sense (what we might refer to as conventional wisdom) has be overturned by rigorous experimental science, producing results that differ from what was expected. This has been discussed to such great lengths that I won’t go into further detail here. The internet is your oyster, friends.

What I will dive into are the assumptions in the quote above, which are not-so-subtly glossed over. The first contention is that misalignment equals stress. This can be debunked without understanding it within a chiropractic (vitalistic model, to be clear) framework. There is substantial clinical evidence to inform us that just because something may appear to be misaligned or abnormal, does not mean that there is a real impact to a patient’s well-being. This has been an increasing concern with widespread use of advanced diagnostics that turn up incidental findings. Ironically, the treatment of these findings has – in some cases – lead to unnecessary harm as patients are subjected to therapies that carry risk for something that did not need to be treated.

This type of over-treatment is especially true for chiropractors who claim to diagnose and treat vertebral subluxations, which is the term most commonly used to refer to such misalignments. The major difference between medical over-treatment and over-treatment of subluxations is significant, however: subluxations – as defined by vitalistic chiropractors – do not exist and cannot be identified using any diagnostic technique. Don’t take my word. Refer the opinion of contemporary chiropractors, their associations, or chiropractic research if you must. On the immune issue, why not also check in with Canada’s largest chiropractic association, who are clear that “there is no scientific evidence that supports claims of a meaningful boost in immune function from chiropractic adjustments.” Interesting how this is left out of the article, no?

Regarding the claims that stress leads to a weakened immune system, leading to an increased susceptibility to COVID-19, these claims are plausible, but without clinical evidence, we can’t know if there is a meaningful impact nor if there was an approach to reducing stress that could meaningfully reduce your COVID-19 risk. Remember: common-sense is distinct from truth. Scientific methodologies are the best tools we have to overturn our false, preconceived beliefs. This is an ongoing effort in medicine.

In regards to the so-called “conflation,” I don’t recall identifying a chiropractor who guaranteed patients receiving care would not get COVID-19, not would I make such a claim; however, perhaps this was not directed at me. I will affirm that it is “far-fetched that a healthy spine can improve one’s ability to fight off the coronavirus should one contract it.” This is absolutely far-fetched, as should be clear at this point.

The author went on to cite a video from a chiropractic marketing firm run by the dubious Heidi Haavik, whose “research” assumes vitalistic philosophy a priori. I will be writing a post on Haavik and her bad science soon enough. For now, I will note two things about the video:

1. This is not scientific evidence, but a video constructed by a chiropractic marketing firm to deceive patients in order to make money.
2. The video constructs a reasonable narrative about the importance of the spine/brain, but concludes with nonsense that has no basis in science. Go ask Haavik for clinical science demonstrating meaningful benefits that would support her claims. There is nothing; this is smoke and mirrors.

The author goes on to cry fowl on the unimportant distinction between chiropractors offering some immunity benefits compared to chiropractors offering absolute immunity against COVID-19. These claims are different in magnitude, but they are both false. Again, I try to put great care into my own claims and doubt I have made the suggestion that chiropractors guarantee absolute immunity. She continues:

I also noted in my rebuttal that even yoga can improve overall health by reducing stress. And what do yoga and chiropractic have in common? They are all about alignment. They also both promote better breathing habits. Anyone who has taken a yoga class will know that breathing technique is very much incorporated into yoga practice. As for chiropractic, anyone with a bound-up spine and adjoining muscles will know that constricted muscles around the ribcage – which attach to the spine – will inhibit the ability to take a full breath. When one muscle or joint doesn’t move properly, other muscles will compensate, and before you know it, your whole body is in knots, which causes all kinds of stress, which can depress the immune system. More on that later.

Yoga probably can improve some facets of one’s well-being. It is, after all, simply exercise. I am not aware of any clinically demonstrated benefits derived from yoga’s stress reduction, however. The notion that yoga and chiropractic are both about “alignment” is nonsense. Again, contemporary chiropractors do not play make believe with their patients’ spines, pretending to correct non-existent misalignments. We can have a debate about whether spinal manipulation offers truly meaningful benefits for back and neck pain, but that it out of the scope of this discussion.

Further, there is absolutely no reliable evidence that spinal manipulation (or “adjustments” for chiropractors who got their education by applying to a school through a magazine ad) provides any benefits towards taking a “full breath.” In fact, research into chiropractic treatment of asthmatic patients has failed to elucidate any objective benefits for lung function, despite great efforts. To see how some chiropractors still spin negative results to fit their ideology, check out the conclusion of this sad paper. Returning to the article:

The news report makes much of “one Ontario man” who had submitted at least 34 complaints against various chiropractic clinics, citing “misinformation” regarding the health benefits of chiropractic. Ryan Armstrong, with his PhD in biomedical engineering, heads up an organization called “Bad Science Watch,” which according to its website is “an independent non-profit consumer protection watchdog and science advocacy organization dedicated to improving the lives of Canadians by countering bad science.” Armstrong’s conclusions about the efficacy of chiropractic in boosting immune system function are based on a lack of science, or more accurately, on his inability to find any. “There’s very immediate harm from this type of misinformation,” he says. Indeed, making assumptions and publicly dismissing claims of health benefits based on a lack of information, rather than on evidence that the claims are false, is truly harmful and bad science.

I’m not sure why the emphasis is put on “one Ontario man”. Do you disagree? Just to be clear, my personal activism from complaint writing is distinct from our work at Bad Science Watch, though we do have our sights set on this area of activism. Now, with that all cleared up, let’s address the author’s very limited and naive understanding of what science and evidence are.

What is science? What is evidence? These are philosophical questions that are far beyond the scope of both this post and my expertise generally (though I do read all I can on the philosophy of science and recommend so for anyone in science advocacy). Unfortunately, there really are not universally accepted standards that allow us to reliably determine what is science and what is not. This is known as the demarcation problem. I encourage the author to pursue some reading in this area. I think she will find it both enlightening and enjoyable.

The best I can do here is to tell what I mean by these things. Typically, I use science and evidence as short-hands. What I mean by science is close enough to the Wikipedia definition: the “systematic enterprise that builds and organizes knowledge in the form of testable explanations and predictions about the universe.” When one claims to be fitting pieces into our collective knowledge that do not appear to belong based on their incompatibility with existing knowledge and their lack of experimental rigor, I deem this to be bad science. This obviously includes the classic notion of the vertebral subluxation.

When it comes to evidence, I typically mean reliable evidence, leaving the reliable component to be assumed. Evidence – broadly speaking – is anything that is used to used to support a claim, but I find the term to be largely useless when used this way. To offer an example, you might tell me that there is no evidence that all of the vitalistic chiropractors across Canada have formed a death cult intending to bring about the destruction of the planet. After all, that is an absurd assertion. I would simply counter your point by saying I heard it from someone. You might say “well that doesn’t make it true,” and you would be right; however, it still constitutes evidence by definition. Is it reliable evidence that we should accept as truth to make better decisions? No.

When claims such as those made by chiropractors implying immune benefits are made, they should be dismissed for two reasons. The first reason is that they do not fit into our most refined and accepted scientific theories and paradigms (in fact, they contradict much of our understanding of human biology). The second reason is that there is no reliable evidence in the form of clinical trials looking at meaningful clinical outcomes supporting these claims. They fail on all counts.

You might think that it is “exceedingly difficult to either prove or disprove in a measurable scientific study that a chiropractic adjustment has a direct causal effect on improved immune system function” but this is false; you simply lack imagination and presumably a scientific background. I can think of a very simple trial design:

1. Randomize two large groups of subjects between real manipulation and sham manipulation.
2. Have subjects come in to clinics on a regular basis to receive their “treatments” over the course of maybe 4-12 months.
3. Measure a number of meaningful clinical outcomes: number of sick days, duration and incidence respiratory symptoms, hospitalization, other cold/flu symptoms, etc.
4. Make sure to do better than all other vitalistic chiropractic studies (well, we already are by having n>1) and control for the multiple endpoints when you compare outcomes.

There is a reason such a study has not been performed, and it is not because there is a global conspiracy against the minority of chiropractors who believe this nonsense. The study would not meet the minimal requirements to be deemed ethical nor would it meet the requirements to be funded by a granting agency. The cause for both of these is the same: the foundation for these beliefs is not in sound science, but in an outdated ideology.

Keep in mind, this is not for lack of trying. Vitalistic chiropractors have been trying for decades to (mis)use science to prove themselves correct. Despite significant efforts (largely through dubious special interest journals), they have failed. So although it would not be philosophically accurate to say that chiropractic immune claims are “disproven”, it would very much be pragmatic to do so, as the foundational ideas have so thoroughly failed every test that there is little more we could do. At very least, it would be deceptive for practitioners to suggest that they may benefit immune systems with a spine rub. If you don’t accept this, then you must also believe it acceptable for pharmaceutical companies to make any unproven claim for their products. Naturally, I object to both. Fraud is fraud.

With that said, I am confident to assert that spinal manipulation does not offer a real benefit to one’s immune system just as I am confident in asserting that there is no teapot between Earth and Mars that is orbiting the sun (I am sure it is just a matter of time before Trump’s Space Force inserts one, however, thereby proving God’s existence).

The author continues by grappling with statements made by friend of the blog Tim Caulfield. This next bit is staggering.

Caulfield said that he couldn’t find any evidence to support that 200% increase, in particular, and not that he couldn’t find any evidence of an increase in function at all. Not to mention that his search for this study consisted of a “quick Google search,” which apparently was fruitless, and which the CBC is implying as evidence that the study doesn’t exist. That’s just misleading representation of his words and shoddy reporting. Even if that is exactly what he meant by referring to an “alleged author,” implying that the study is fabricated by the chiropractic community to support their claims, again, it was sloppy journalism on the part of the CBC to blindly accept that and promote that interpretation. There were three journalists on this story – did none of them have the time to bother looking for the study themselves?

By the way, Tim Caulfield and Ryan Armstrong, to your claims that “there is no science behind it,” my own “quick Google search” yielded this “partial list” of 114 citations regarding the effects of spinal adjustment on immune system function, including the one Tim couldn’t find by “alleged author” Dr. Ronald Pero, PhD, chief of cancer prevention research at New York’s Preventive Medicine Institute and professor of medicine at New York University. Fill your boots.

https://healthsourcelombard.com/does-chiropractic-strengthen-immunity/

Let’s address the funny part: the author takes great issue with the suggestion that the chiropractic community has collectively manufactured a fabricated reference purporting that “adjustments” can boost the immune system by 200%. Why is this funny? Because that’s exactly what has happened here; this so-called study is nothing more than a fabrication. This is even recognized and refuted by evidence-based chiropractic groups.

So if the study is a fabrication, what exactly did the author cite to prove its existence? She cited a chiropractic clinic’s website, that simply contained the following reference:

Pero R. “Medical Researcher Excited By CBSRF Project Results.” The Chiropractic Journal, August 1989; 32.

You’re permitted to have a laugh here, reader. Even if we were to assume that the referenced article existed at one point in time, it is obviously not what practitioners purport it to be. At best, it appears to be an opinion piece published in a special interest chiropractic journal probably misquoting or misrepresenting a researcher over 30 years ago. Perhaps the author’s time would have been better spent asking chiropractors citing this why they have no respect for their patients or for science broadly? If her own chiropractor put her up to this, I implore her to ask the practitioner why they have so little respect for her that they would suggest a source without performing high-school level fact checking.

The second contention made by the author in the above segment is this: because a Google search of hers yielded many results “regarding the effects of spinal adjustment on immune system function,” there therefore is ample evidence of such effects. It is worth keeping in mind, dear author, that not everything you read on the internet is true or reliable. This is especially the case for these types of studies which do not contain any reliable evidence. Would you rather hear this from chiropractors? How about the most prominent international chiropractic association, which reviewed the available evidence on this topic and concluded:

No credible, scientific evidence that spinal adjustment / manipulation has any clinically relevant effect on the immune system was found. Available studies have small sample sizes and a lack of symptomatic subjects.

At the time of writing, there exists no credible, scientific evidence that would permit claims of effectiveness for conferring or enhancing immunity through spinal adjustment / manipulation to be made in communications by chiropractors.

I would also like to draw the author’s attention in this report to yet another dismissal of the alleged Pero study contained within the WFC’s report:

Overview: It has been reported that in 1986 Dr Ronald Pero, a Professor of Medicine in Environmental Health at New York State University, collaborated with Dr Joseph Flesia, a basic science researcher and
chiropractor. Reports state that subjects receiving chiropractic care (n=107) had a 200% greater immune competence than those who had not received chiropractic care and a 400% greater immune system competence than those with cancer or other serious disease.
Response: Numerous attempts have failed to retrieve this study. Without the original study to review, no scientific assessment of its claims can be made. Therefore, the “Pero and Flesia” study does not constitute credible, scientific evidence that spinal adjustment / manipulation enhances or confers immunity nor should it be used as a basis to provide care.

The author continues, repeating many of the same ineffectual arguments in, invoking both common-sense as well as her own personal experience. She concludes her tirade against myself and Caulfield with the following:

So can chiropractic care help to ward off COVID-19, just like any other virus? Of course it can. I believe retractions by the CBC, Ryan Armstrong, and Tim Caulfield are in order.

How ironic that the CBC should choose to end the news report with Ryan Armstrong’s statement that this “misinformation” about chiropractic “undermines our democracy.” I fail to see the democracy in the act of making sweeping one-sided statements based on a lack of information and understanding, particularly when, by his own admission, he has never been to see a chiropractor himself. I, for one, suggest that anyone who insists on discrediting an entire health care profession and dismissing the benefits it claims to offer needs to try it first before passing judgment. Far from doing the Canadian public a service through his work, he is dissuading us from availing ourselves of a valuable tool for improving and maintaining good health. This is particularly disadvantageous at this unprecedented time in history with worldwide quarantines, resulting in widespread job loss, leading to high levels of stress across the planet.

Here is my own conclusion, which – not that it matters – is in agreement with contemporary chiropractors and their associations: chiropractic care does not help ward off COVID-19 nor any other viral contagion. Chiropractors who continue to deceive patients otherwise are effectively committing health fraud while continuing to embarrass a profession with a reputation that hangs on a thread. Equally ironic and sad, my predictions have been fulfilled; chiropractors have disseminated misinformation in a way that has made their victims committed warriors of pseudoscience, weaponizing nonsense in another misleading article that orbits the world of health policy and regulation.

Finally, to the author I say this: I hold ill will against you. You have been mislead and deceived for profit. Your chiropractor has failed in their obligation to adequately inform you on serious matters of health and they have failed in their responsibilities to continue learning and remain competent. Just as troubling is to see your piece published by an organization guilty of consistently spreading health misinformation, whose Board of Directors all have direct stakes in the “alternative” health industry.

It is precisely because these forces are pitted against patients and the public that I feel science-based activism is more important than ever. And I will keep fighting for your rights as a patient even if you feel the need to attack me for it.