Alternative health peddlers get rich exploiting desperate sufferers of intractable ailments or pain, often with disastrous consequences.
There are few things more likely to motivate one to grasp at straws than desperation about an intractable health condition. One of the most common is chronic pain.
Despite extensive research, there are many chronic pain conditions – such as lower back pain – that scientific, evidence-based medicine is not yet very good at diagnosing or treating.
Chronic or recurring pain can be crippling. It causes depression. Even when you think you can cope, it often sucks the joy right out of life. For some, it outright ruins life.
Back on fire
Imagine a lovely day braaing with friends by the river. Now imagine knowing that within an hour or so of standing around the fire, or sitting in a camping chair, your back will be on fire.
Imagine a stimulating conference with great speakers, engaging panel discussions, and quality interaction with peers. Now imagine that same conference, but suffering gradually worsening back pain throughout the day – pain that is unresponsive to over-the-counter analgesics.
Imagine working a job where, every day, you have to power through pain that impairs your concentration, makes it hard to move without grimacing, and makes it difficult to get to sleep at night.
This is the lot of a substantial share of the population. Globally, about 7.5% of people are known to suffer from lower back pain. That is almost certainly an under-estimate, and that is only one type of chronic pain.
In some countries, among some age groups, among some demographics (such as overweight people) and among some types of workers (such as office workers), rates of back pain are far higher, and can affect one in three people.
Of those, up to nine out of every ten suffer from non-specific back pain, for which no cause can be clinically determined, and which can therefore only be treated symptomatically.
Some conditions causing back pain can be treated surgically. Back surgery is a major intervention, with a long recovery time and uncertain prognosis. Many people who have had back surgery once flatly refuse to have it ever again. It is gruelling.
Non-surgical treatments
This leaves non-surgical interventions, of which there are many. The problem is, most of them don’t work at all, and those that do, work poorly.
A recent systematic review and meta-analysis of placebo-controlled randomised trials, conducted by a team of nine researchers from Australia, Canada, the USA, and Brazil, examined the efficacy of non-surgical and non-interventional treatments for adults with low back pain compared with placebo.
They investigated 377 studies of 56 different treatments or treatment combinations, and found that only one treatment for acute lower back pain and five treatments for chronic lower back pain probably (with moderate certainty) provide small reductions in pain.
These treatments are non-steroidal anti-inflammatories for acute pain, and for chronic pain, exercise, spinal manipulative therapy, taping, antidepressants and so-called TRPV1 agonists (like capsaicin).
Maybe they work, but not very well, and all of these treatments, other than exercise, have risks, side-effects and downsides. We’ll get to some of them in a minute.
Weak evidence
That isn’t to say that all of the other treatments were ineffective. The only treatments where the evidence was moderately certain not to be effective were for exercise, paracetamol and glucocorticoid injections in the case of acute lower back pain, and anaesthetics and antibiotics or antimicrobials for chronic lower back pain.
For the dozens of other treatments, which include acupuncture, heat and light, osteopathic treatments, electrical stimulation, cannabioids, opioids, topical creams and even bee venom, the certainty level was low or very low. That is, the evidence either way was weak.
For most of these treatments the trials, inadequate though they were, found moderate, small or no reductions in pain, when compared with placebos. The only exceptions worth noting were massage, where there was poor evidence of large reductions of both acute and chronic back pain, and opioids, which might produce large reductions in pain in the treatment of acute lower back pain.
Desperation
All this leaves sufferers in a quandary. If 90% of potential treatments are not proven to work, or proven not to work, and the remainder might work, but only to reduce pain by small amounts, what now?
Chronic pain with few treatment options makes people desperate. They cast about for solutions, much like cancer sufferers who are prone to roll the dice on quack treatments like bicarbonate of soda or black salve. Desperation trumps rationality.
It is just the same with pain. Even the slightest chance of some relief may be enough to convince someone to try a treatment that promises the slightest chance of a little relief.
Alternative medicine providers exploit this desperation for profit.
(I ought to repeat my ritual invocation of the great Tim Minchin: “By definition, alternative medicine has either not been proved to work, or been proved not to work. Do you know what they call alternative medicine that’s been proved to work? Medicine.”)
This leads me to zero in on the above-mentioned survey’s mention of “spinal manipulative therapy”.
Chiropractic
The paper doesn’t include a list of the studies it considered, but there are some papers (like this one; it’s systematic review and meta-analysis all the way down!) that claim manipulating the spine might offer “statistically significant benefits” in treating chronic pain.
Note that “statistically significant” means anything beyond the margin of error. One can usually infer that it means “very minor benefits in very few cases”; otherwise they’d have used some other adjective indicating greater certainty of larger benefits.
There’s a problem, though. As this journal article points out: “Spinal manipulative therapy (SMT) is a controversial treatment option for low back pain, perhaps in part because it is most frequently administered by chiropractors. Chiropractic therapy is not widely accepted by some traditional health care practitioners. This may be, at least in part, because some early practitioners of chiropractic care rejected the germ theory, immunisations, and other scientific advances.”
That puts it mildly.
Chiropractic is rooted in pre-modern folk beliefs and mysticism, and is not based on scientific evidence. In fact, its 19th-century founder claims it was inspired by conversations with the ghost of a dead doctor.
Some chiropractors are trying to walk back their field’s magical belief that “vertebral subluxations” (which are slight dislocations of the joints of the spine, undetectable by X-rays or any other means) underlies most diseases, and that spinal manipulation can therefore cure almost any condition.
Unlike “straight” chiropractors, who cling to the 19th-century orthodoxy, these modern revisionists are referred to as “mixers”. They mix archaic, intuitive, vitalistic, and utterly unscientific nonsense with modern diagnostic and treatment approaches.
Chiropractors usually advertise their services using patient testimonials, which is always a red flag for quackery. Many do not believe that controlled clinical trials are the best way to validate their methods.
Doctoring or witch-doctoring
It’s a toss up, therefore, whether you’ll get doctoring or witch-doctoring from these chiropractors. Given their claim to understand modern medicine, they really ought to know better. (They probably do, but money talks.)
Even their own kind have studied the medical literature and concluded that chiropractic cannot cure or prevent any condition “other than musculoskeletal conditions”.
Chiropractors achieve spotty results, even for actual musculo-skeletal conditions proximate to the spine such as lower back or neck pain.
If you go to a chiropractor with complaints of chronic pain, what you will get is chronic treatment. Patients are routinely asked to return for weekly “adjustments” for many months or years.
Top tip: if a doctor needs to treat you weekly, forever, the treatment isn’t working. It is, however, very, very profitable. Chiropractic is reportedly a $15 billion industry.
Horror stories
Manipulation of the spine is dangerous. This might seem obvious, but millions of people continue to visit chiropractors regardless. Some aren’t lucky enough to survive the trip.
Someone calling themselves “leftHandedFootball” reports that he walked into a chiropractor’s office for minor back pain, and left in a wheelchair for the emergency room with paralysing sciatic nerve pain.
Keanu Reeves lookalike Rigel Darkmoore went to a chiropractor complaining of tinnitus – a persistent ringing in the ears. After treatment, he had a splitting headache, and felt terrible. He took himself to a hospital the next day, where a CT scan found that the chiropractor had dissected his carotid artery. “Never going to a chiropractor again,” he declared.
Twenty-eight year old Caitlin Jensen visited a chiropractor in 2022, and got four dissected vertebral arteries, a stroke, cardiac arrest and paralysis for her trouble.
Playboy model Katie May, 34, the self-described “queen of SnapChat” with more than two million Instagram followers, went to a chiropractor for a pinched nerve in her neck. She posted on social media that the chiropractic neck manipulation she received “really hurt”. Days later, she told her followers that she was still in pain, and would return to the chiropractor. This time, the chiropractor ripped one of her arteries, and May died a few days later in hospital. The Los Angeles medical examiner declared her cause of death to be “neck manipulation by chiropractor”.
A surgeon created a post on a medical forum to beg chiropractors to stop adjusting cervical spines. “I’m a spine surgeon and I’m going on my 7th complication I’ve seen from this subluxation of the C-spine. Some of these patients are permanently maimed as a result. If you must insist, informed consent would be nice. Tell the patient they may fracture a vertebrae, especially if they [have] osteoporosis. Tell them you may cause a [vertebral artery] dissection which can lead to stroke. Tell them the research supporting the subluxation of the C-spine has a low evidence of efficacy for neck pain relief.”
The comments, most from real doctors, are sobering. Yet despite these risks, chiropractors continue to peddle their half-baked cures, and even advertise their services for newborn babies, despite the relative fragility of their spines and the concerns of paediatricians over the risks and efficacy of chiropractic treatment.
It is more profitable to commit people to weekly “adjustments” from a very young age, of course.
People won’t take a vaccine because they fear side-effects, but they’ll go to a chiropractor – or take their child to one – for a treatment for which there is weak evidence of minimal benefit, but excellent evidence of risks of permanent injury, paralysis and death. Go figure.
Exercise
The other treatments for chronic lower back pain from that study, for which there is moderate certainty of small reductions in pain, are less risky but not much better.
Taping, which emerged from sports medicine, is a new-fangled idea about which there is a lot of confusion. Maybe it works. Maybe you’re going to get ripped off (see what I did there?)
Antidepressants have obvious complications. They’re powerful psychotropic medications that are poorly understood, and while they can be life-savers for many people, they also have significant side-effects.
I don’t know much about TRPV1 antagonists, and couldn’t understand the Wikipedia page, but I love chillies, so I’m going to go out on a limb and say their use for the treatment of pain is a promising field of research.
Which, for chronic lower back pain, leaves exercise.
As a sufferer from chronic upper back and neck pain, I can sympathise with chronic lower back pain sufferers. As a reluctant and often delinquent exerciser, I can sympathise with people who seek a simple medical (or medical-sounding) solution to their pain.
It is an unfortunate fact of life, however, that despite the awesome progress of science in the medical field over the last century, some ailments do not yet have satisfactory cures, or even known causes.
That sucks, but don’t let desperation lead you from the path of rationality and evidence-based medicine, into the arms of greedy witch-doctors, quacks, snake-oil peddlers, soothsayers and ghost-inspired illusionists.
The consequences could be fatal.
[Image: An American chiropractor in a promotional image holding a baby]
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