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Evidence of Unscientific Teachings
at Canadian Memorial Chiropractic College

Stephen Barrett, M.D.

In 1995, chiropractors in Canada began campaigning for an affiliation between Canadian Memorial Chiropractic College (CMCC) and York University. An intense controversy developed because York's administration favored the affiliation but the university's science faculty vigorously opposes it. On October 29, 1999, I testified at a Conference on Chiropractic Degree Studies sponsored by the university's Academic Policy and Planning Committee. This article is a slightly modified version of the written supplement to my oral testimony.

During the past 25 years, I have collected and become familiar with 200 chiropractic books, several thousand chiropractic journals, and more than 20,000 miscellaneous chiropractic documents. I also have about 200 audio and videotapes. I have visited a chiropractor as a patient, attended classes at Los Angeles Chiropractic College, watched students at work in the college clinic, attended the 1995 Chiropractic Centennial Celebration, and conversed with or exchanged correspondence with thousands of chiropractors. I also maintain Chirobase, a web site that presents a skeptical guide to chiropractic history, theories, and current practices. Although most of my source materials originate in the United States, I do know quite a bit about chiropractic in Canada.

Many chiropractors describe me as someone who is out to destroy their profession. That description simply doesn't fit. I have always believed that appropriate spinal manipulation—as performed not only by chiropractors but by physical therapists and medical and osteopathic physicians—can be effective for certain problems. My Web site contains a referral directory to help the public locate chiropractors who practice appropriately. I also believe that affiliation between established universities and chiropractic colleges—when properly executed—is a good idea.

Proponents of immediate affiliation may try to muddy the waters by discussing such things as: (a) the value of spinal manipulation, (b) "growing recognition" of chiropractic, (c) shortcomings of medical practice, and/or (d) the popularity of "alternative medicine." However, the key question for deciding whether York University should permit Canadian Memorial Chiropractic College to affiliate should be whether the teachings at CMCC reflect high academic standards that are solidly based on science. To determine this, it is necessary to examine what Canadian chiropractors believe as well as what they do. I am puzzled that York's science faculty was not used for this purpose. I hope that they will be used in the future.

Basic Theory

Chiropractic is a broad spectrum of practices based mainly on two notions: (1) spinal problems cause or help cause most ailments, and (2) spinal manipulation can prevent or remedy a wide range of health problems. Chiropractors date the founding of their profession to 1895 when a "magnetic healer" named Daniel David Palmer allegedly restored the hearing of a deaf janitor by "adjusting" a bump on his spine [1]. Soon afterward, he concluded that misaligned bones (which later were called "subluxations") interfered with the body's expression of "Innate Intelligence"—the "Soul, Spirit, or Spark of Life" that controlled the healing process. This is a metaphysical belief—not a scientific theory—and clashes with modern knowledge of anatomy, physiology, neurology, pathology, and clinical medicine.

Although philosophy and treatment vary greatly from one practitioner to another, most of today's chiropractors can be classified as "straights" or "mixers." Straights tend to cling to Palmer's doctrine that most health problems are caused by misaligned spinal bones ("subluxations") correctable by spinal adjustment. Mixers acknowledge that other causes exist, but they tend to regard mechanical disturbances of the nervous system as the underlying cause of lowered resistance to disease. A small percentage of chiropractors reject Palmer's metaphysical theories and regard manipulation as a way to relieve pain by stretching tight muscles and loosening tight joints.

Although subluxation-based chiropractors have a variety of beliefs about the nature and management of "subluxations," they typically suggest that manipulation can improve general health. They tend to advocate periodic spinal checkups and adjustments from birth onward. They also tend to treat children and to advise against immunization [2]. Some chiropractors attempt to conceal their hostility toward immunization by espousing "freedom of choice." However, chiropractors who do this typically tell their patients that immunizations do more harm than good.

What CMCC Teaches: Direct Evidence

Since practice is based on belief, any evaluation of chiropractic practice must take chiropractic beliefs into account. CMCC officials would like you to believe that its curriculum is solidly scientific and not subluxation-based. This claim can be directly examined by inspecting its chiropractic textbooks, visiting its library, auditing its classes, and watching how students manage patients in the school's clinics. Considerable time and expert knowledge of the subject matter are necessary to conduct this type of examination. A second way to judge the quality of CMCC teaching is to examine the beliefs of its graduates. This is easy to do if you know where to look. Ample evidence exists that something is seriously wrong. For example:

In 1997, the Association of Chiropractic Colleges issued a position paper strongly supporting the subluxation concept. The document was signed by CMCC president Jean Moss, D.C, and the presidents of 15 chiropractic colleges in the United States. The "Paradigm" section says this about subluxations:

Chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on the subluxation. A subluxation is a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health. A subluxation is evaluated, diagnosed, and managed through the use of chiropractic procedures based on the best available rational and empirical evidence [3].

CMCC's Web site includes the following description of CMCC's 50-hour course in "Chiropractic Principles":

Chiropractic Principles (CP 202) is an intermediate level course designed to provide students with a basis for understanding the vertebral subluxation and the chiropractic adjustment as they apply to the role of chiropractic in optimizing health. A lecture programme covers a detailed discussion of the mechanisms involved in the subluxation and the adjustment. This is followed by a small group problem-based series of case studies. The case studies illustrate the various dimensions of chiropractic practice and integrate the concepts of the art, science and philosophy of chiropractic. Student awareness is developed toward issues of risk management and informed consent [4].

Pediatric Chiropractic (1998), which CMCC uses as a textbook, states that "the chiropractor has an opportunity to normalize, if not minimize, the effects of vertebral subluxation complex. Thorough analysis and specific adjustments to the pregnant female and pediatric spine may have a far-reaching impact on whole body health." [5] The chapter on spinal examination advocates the use of a Temp-O-Scope, an instrument inappropriately claimed to be useful for detecting "subluxations" by reporting differences in skin temperature on either side of the spine. The book also advises: "Rather than advising the parent(s) to vaccinate or not to vaccinate, the chiropractic doctor should focus on educating the parent(s) on the subject and allow the parent(s) to make the decision they feel is most appropriate for their child." The book's 27-page chapter on these "issues" is devoted mainly to adverse reactions, contraindications, and "failures." Nothing in the chapter suggests that immunization is a good idea.

CMCC's bookstore sells homeopathic remedies and acupuncture and reflexology charts. Doing this encourages the outlandish beliefs associated with these practices.

What CMCC Graduates Believe

In a recent newspaper article, a York University spokesperson stated that the behavior of practicing chiropractors should not have anything to do with CMCC's proposal to affiliate with the university [6]. I disagree. Suppose it could be shown that the majority of CMCC graduates held unscientific beliefs and engaged in unscientific practices. Wouldn't that be evidence that something was radically wrong with their training and and that—at the very least—CMCC has failed to teach critical thinking? I believe it would. Here are some of my findings:

In 1994, a well-designed survey asked Canadian chiropractors the extent to which they agreed or disagreed with 13 questions related to chiropractic philosophy and scope of practice. Of the 403 who responded, 65% said they had been trained at CMCC. Based on their scoring system, the researchers concluded that only 18.6% rejected traditional (subluxation-based) chiropractic philosophy and the rest either embraced it completely (22%) or partially (59.4%). [7]

The Web site of the Ontario Chiropractic Association contains many highly questionable statements. This is significant because most of the Association's members are CMCC graduates [7,8]. The page titled "What Is Chiropractic?" states:

Chiropractors believe in whole body wellness. Wellness means many things to different people. To your chiropractor, wellness is the state of health where your body is free of interruption or interference to any part of your nervous system, enabling you full expression and enjoyment of life. Chiropractic care works to ensure that your nervous system is working fine, and this enhances your well being. Your chiropractor will discover any problems that are interfering with your nervous system and through hands-on-healing will work with you to eliminate them. After chiropractic care your body will be better able to heal itself. This, in turn, aids your body in maintaining optimum health and contributes to your overall wellness.

The page titled "What Are Subluxations?" states:

What are subluxations?
Subluxations are problem areas of the spine that affect your entire nervous system. In these problem areas the spinal bones are misaligned or have lost their normal range of movement. This irritates or puts pressure on local nerves which interferes with the communication between your brain and body (and vice versa).

How do subluxations happen?
The stresses and strains of everyday living such as housework, gardening, desk work, lifting, or even sleeping on the couch can cause spinal problems. So can falls, accidents (especially car accidents), sports activities and injuries. In children subluxations can initially occur during the birth process, learning to walk, in play and from everyday childhood activities.

What are some of the warning signs of subluxations?
Symptoms such as headaches, back pain, neck stiffness, pain in your shoulders, arms or legs, numbness in your hands or feet, or nervousness are the most common signs of subluxations. But like a tooth cavity, most people will have a subluxation long before they notice any symptoms.

How are subluxations corrected?
Your chiropractor will reduce and correct subluxations with highly skilled adjustments to your spine. If the subluxations have been present a short time, you may only need a few adjustments. However long-term, chronic subluxations will require more frequent adjustments to retrain the problem areas of the spine to hold the vertebrae in their normal, healthy positions. As subluxations are corrected, your nervous system starts to function properly again and your body heals itself.

How can I avoid subluxations?
If you want to keep subluxations from reoccurring, or new ones from developing, it's best to have periodic adjustments. Combined with a sensible diet and moderate exercise, chiropractic care can help you enjoy the best of health for the rest of your life. Seeing a chiropractor should go with everyone's job!

The page "Chiropractors and Children: Infants and Toddlers" stated:

Babies are naturally healthy, happy and active. When they're not, the reason could be a problem with their spine. Think about it. The nervous system, which controls every function of the body, is protected by the spine. A spinal bone that is out of alignment or not moving properly, (called a subluxation) may irritate or put pressure on local nerves. Communication between your brain and body (and vice versa) becomes hampered which may cause countless problems. Colic and irritability are examples of symptoms that can be caused by subluxations. . . .

When should you first take your child to a chiropractor?
As soon as possible after birth. Chiropractic care at an early stage could prevent many common childhood disorders from developing. But any age is a good time to start because a chiropractor will help your child's body keep itself healthy which can lead to a lifetime of good health.

This page was removed about a week after I complained about it at the York hearing, but a copy is still online on the site of Ontario chiropractor George I. Traitses, D.C.

The page titled "What Is an Adjustment" states:

What causes these spinal problems?
These problems are known as subluxations and can initially occur during the birth process. As your body grows and matures, falls, sports activities, accidents, bad posture or simply the stresses and strains of daily life can cause additional spinal problems to occur or can further irritate those that already exist. Left uncorrected, subluxations lead to conditions such as colic in infants, and headaches, back pain and generally poor health in adults.

Many chiropractors advise everyone to have their spine checked and adjusted monthly or even weekly throughout their life, even if they have no symptoms. Two Canadian chiropractors who conducted an extensive literature search found no scientific evidence supporting the widely held chiropractic belief that periodic spinal adjustments improve health status [9]. Yet the Ontario Chiropractic Association's page titled "Chiropractic Maintenance Care" states:

Remember, how you feel does not always reflect how healthy you really are. As a spinal health expert your chiropractor realizes it is easier to prevent spinal problems than to correct them. That's why a maintenance care program consisting of regularly scheduled chiropractic spinal examinations is being recommended to you.

The page titled "Chiropractic: Getting the Most Out of It" states:

A chiropractor adjusts your spine to reduce the problem areas —called subluxations*—which cause so many health conditions. When your spine is correctly aligned, it allows your nervous system to function properly, and your body can heal itself. Spinal adjustments give your body the opportunity to heal. *Ask your chiropractor for a brochure explaining subluxations.

Dubious Practices

Many Canadian chiropractors are engaged in practices that are unsubstantiated and lack a scientifically plausible rationale. A well-designed 1992 survey of Canadian chiropractors found:

In 1999, a reporter from the Toronto Star visited 15 randomly selected local chiropractic offices as a prospective patient who wanted information. The reporter's findings were consistent with the above examples:

A Devastating Report

On December 12, 1999, Canada's largest Internet network (CANOE) posted a very very comprehensive report by two reporters who attended the York hearing and spent two months investigating further. The report concluded:

The Bottom Line

Despite its denials, it is very clear that CMCC has been turning out a defective product. Some officials seem to think that the proposed York University affiliation would lead to significant improvement in the school and a general improvement of chiropractic practice throughout Canada. Although affiliation may be a worthwhile long-term goal, I do not believe it should proceed without appropriate safeguards.

CMCC should provide ironclad assurance that it intends to abandon the subluxation theory and reject a wide variety of dubious practices that Canadian chiropractors use. The first step in this direction should be to have the York University science faculty appoint a committee of faculty members and outside medical consultants to define what needs to be done. The committee should construct a list of unacceptable practices similar to the guidelines on Chirobase. If CMCC is serious about affiliation, it should pledge in writing to:

If such a pledge is secured, the committee should monitor CMCC for a minimum of four years, after which affiliation can be reconsidered.

For Further Information

References

1. Palmer DD. The Chiropractor's Adjuster (also called The Text-Book of the Science, Art and Philosophy of Chiropractic). Portland, OR: The Portland Printing House Company, 1910; reprinted in 1966.
2. Colley F, Haas M. Attitudes toward immunization: A survey of American chiropractors. Journal of Manipulative and Physiological Therapeutics 17:584-590, 1994.
3. Issues in Chiropractic. American Association of Chiropractic Colleges, 1997.
4. Curriculum and course descriptions, CMCC Calendar, 1999-2000, accessed October 18, 1999.
5. Anrig CA, Plaugher G, editors. Pediatric Chiropractic. Baltimore: Williams & Wilkins, 1998.
6. MacKinnon S. Quoted in Harvey R. Chiropractic alliance parks controversy: Degree program being planned by university. Toronto Star, Oct 22, 1999.
7. Biggs, L., Hay D, Mierau D. Canadian chiropractors' attitudes toward chiropractic philosophy and scope of practice: Implications for the implementation of clinical practice guidelines. Journal of the Canadian Chiropractic Association 41:145-154, 1997.
8. Christensen MG and others. Job Analysis of Chiropractic in Canada: A Project Report, Survey Aanalysis and Summary of the Practice of Chiropractic within Canada. Greeley, CO: National Board of Chiropractic Examiners, International Division, 1993.
9. Aker PD, Martel J. Maintenance Care. Topics in Clinical Chiropractic 3(4):32-35, 1996.
10. Harvey R. Chiropractic claims: A survey of offices across Toronto found most offered more than back and neck relief. Toronto Star, Oct 22, 1999.
11. Benedetti P, MacPhail W. Spin doctors: Deaths, deceptions, and dubious claims haunt chiropractors' bid for academic acceptance. CANOE.com, accessed Dec 12, 1999.

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This article was revised on December 12, 1999.