Chiropractic

Abstract

Chiropractic is an important component of the US health care system and the largest alternative medical profession. In this overview of chiropractic, we examine its history, theory, and development; its scientific evidence; and its approach to the art of medicine. Chiropractic's position in society is contradictory, and we reveal a complex dynamic of conflict and diversity. Internally, chiropractic has a dramatic legacy of strife and factionalism. Externally, it has defended itself from vigorous opposition by conventional medicine. Despite such tensions, chiropractors have maintained a unified profession with an uninterrupted commitment to clinical care. While the core chiropractic belief that the correction of spinal abnormality is a critical health care intervention is open to debate, chiropractic's most important contribution may have to do with the patient-physician relationship.

Differentiating intraprofessional attitudes toward paradigms in health care delivery among chiropractic factions: results from a randomly sampled survey

“…Although perceived divisions within the chiropractic profession have been well described [18,19], current models suggest that there are not two, but six strata within chiropractic – only one of which is clearly dissident from the majority [3]. …”

“…As pointed out by Wardwell [18] and Kaptchuk and Eisenberg [19] the chiropractic profession has been plagued by internal ideologically-based strife throughout its history. However, in the current evolution toward institutionalization, the extent to which factions exist that are either orthodox and biomedically based or unorthodox in nature, may explain the level at which there is internal challenge to future claims for legitimacy [20] and influences care delivery based upon faction membership.…”

Professional Identity at Los Angeles College of Chiropractic

“…In the formative years of the chiropractic profession, D. D. Palmer sought a new approach for maximizing health, and he initially did so in a way that could be described scientifically27, 29 and embraced a multisystem approach 7 . Later, the legal pressures from the Morikubo trial, among other factors, influenced the Palmers to shift their teachings to a narrower focus which was represented as distinct from medicine and osteopathy, hence focusing on a distinct “chiropractic philosophy.” This distancing was a pragmatic strategy that may have preserved the profession, but it also undoubtedly had the effect of creating a separatist component within the chiropractic professional identity.…”

“…As recently as 1998, health care scholars have documented lack of acceptance of chiropractic within the mainstream medical community: “Although the American Medical Association no longer prohibits its members from consulting with chiropractors, especially because it was found guilty of conspiracy in this regard, chiropractic’s size and power have not translated into complete acceptance.”27, 29…”

Self-regulation in a small professional group is an important step toward professionalization: the Chiropractic Association in Singapore

“…However, “their long effort to gain access to reimbursement was waged largely during the fee-for-service era, during which chiropractors were paid principally out-of-pocket, but their victory carries with it the constraints of managed care and the expectations of patients that others will pay for the services rendered.” 28 The uncertainty of the appropriate amount of visits and the not yet well established efficacy of treatment, especially beyond low back pain 29 and neck pain, 30 has led employers to become less cooperative. These circumstances could lead to diminishing reimbursement and together with the expected rise in number of chiropractors 28 could have a profound effect on future income levels.…”