Dynamic Chiropractic

Dynamic Chiropractic Facebook Twitter Get the Latest News FASTER - View Digital Editions Now!
Dynamic Chiropractic
Advanced Search
Wellness Blog
Dynamic Chiropractic PracticeINSIGHTS
Current Graphic
Dynamic Chiropractic – December 17, 1993, Vol. 11, Issue 26
Dynamic Chiropractic
Printer Friendly Email a Friend PDF RSS Feed
Share |
Dynamic Chiropractic

Is There Really Support for Unconventional Medicine?

Don't Be Fooled

By David Seaman, DC, MS, DABCN

An article by Eisenberg et al.1 that discusses unconventional therapy was recently published in the New England Journal of Medicine. Dr. Eisenberg is on staff at Beth Israel Hospital and Harvard Medical School in Boston. I have heard many chiropractors speak highly of his article, stating that "it supports the need for alternative therapies like chiropractic." This is a dangerous and superficial interpretation of the article and equates with other misinterpretations such as, "the RAND Report supports the use of chiropractic care and the adjustment." The difference between the two misinterpretations is that we will probably not be scolded if we misquote Eisenberg's article.

Ask yourself, is chiropractic care unconventional? If it is, then chiropractic represents an illogical and irrational approach to patient care. If we accept the public declaration that we are unconventional and/or alternative therapists, then we publicly agree that chiropractic should be placed in the same category as spiritual healing and crystal therapy. The Eisenberg article, as well as an editorial by Campion2, both place us in such a category. Moreover, Campion states, "The public's expensive romance with unconventional medicine is a cause for our profession to worry," and that "unconventional treatments often seem to make people feel more comfortable, even when their accompanying theories are silly." If you have not read these articles, perhaps you should. If you have chosen to feel more secure about chiropractic's status, because of someone else's interpretation of these articles, it might be the time to choose a more appropriate feeling.

The Random House Dictionary of the English Language3 tells us that "unconventional" is defined as something that is not conventional. This is not a great revelation, however, we are also told that eccentric, individualistic, idiosyncratic, and atypical are all synonyms for the word unconventional. Would you define chiropractic as eccentric therapy, individualistic therapy, idiosyncratic therapy, or atypical therapy? The definitions for these four descriptors of therapy are certainly less than flattering. The next two paragraphs discuss the definitions of alternative and conventional. Pay close attention to the definitions and you will discover as I did, that our command of the English language could be better. I realized that I regularly use words that I do not understand as well as I should. See what you think.

With respect to the word "alternative," we are provided with a number of definitions. The first states, "a choice limited to one of two or more possibilities, as of things, propositions, of course of action, the selection of which precludes any other possibility." The second is rather innocuous: "One of the things, propositions, or courses of actions that can be chosen." The sixth definition states: "Employing or following nontraditional or conventional ideas, methods, etc.; existing outside the establishment."

It appears that being characterized as either unconventional or alternative therapists is equally insulting and degrading. To my surprise, even the definition of "conventional" is insulting. The first definition is straightforward: "conforming or adhering to accepted standards, as of conduct and taste." The second states: "pertaining to convention or general agreement; established by general consent or accepted usage; arbitrarily determined." The key word in the second definition is "arbitrary," a very offensive word considering that it means "capricious, unreasonable, and unsupported." Imagine that, conventional therapy equates with capricious, unreasonable therapy, and unsupported therapy -- not something one should aspire to render. On a comical note, because only 15 percent of all therapeutic interventions are supported with adequate research,4 we can safely conclude that nearly all current therapies (unconventional, alternative, and conventional) are "conventional" by definition.

Based on the information presented thus far, it seems appropriate to entirely drop "unconventional," "alternative," and "conventional" as descriptors for the word therapy. It might be better to assign therapeutic interventions into one of two categories, those being logical/rational and illogical/irrational therapies. We could not use the words "proven" or "unproven" therapies because, as stated earlier, only 15 percent of all medical interventions have any degree of validity. Even 15 percent is a shaky estimate as only one percent of all articles in medical journals are characterized as scientifically sound.4 With this information in mind, read Campion's editorial and you will see that his tone has much to be desired. Consider his concluding paragraph:

"The public's expensive romance with unconventional medicine is cause for our profession to worry. We need to demonstrate more effectively our dedication to caring for the whole patient -- worries, quirks, and all. This can be done partly be helping reform our health care system so that it proves our commitment to primary care for all, commercial deception for none, and simple acceptance of most human foibles. As a profession we must act to guarantee every American something that all deserve: a physician."

Regarding "Unconventional Medicine in the United States,"1 and subsequent reports and comments on the paper, it appears that errors may exist in our interpretation of the data. In the abstract we are told that, "Extrapolation to the U.S. population suggests that in 1990, Americans made an estimate 425 million visits to providers of unconventional therapy. This number exceeds the number of visits to all U.S. primary care physicians (388 million)." The key word in this statement is "suggests," but what sticks in our minds are the numbers. We win on total visits (425 million to 388 million). If we choose to view the paper based upon these numbers alone a potential conclusion is, "Well, I guess we have nothing to worry about. They are finally finding out how great we've know we are all along." Guess again!

On closer inspection of Eisenberg's paper, the reader discovers that his group interviewed 1,539 adults over the age of 18. We are told that 34 percent (523 individuals) of the 1,539 adults used some form of unconventional therapy (i.e., chicken soup for a cold, herbs for a headache). We are also told that 33 percent (172 individuals) of the 523 actually entered the office of an unconventional therapist, and averaged 19 visits.

The ratio of 172:1,539 was then applied to the entire adult population to achieve a ratio of 22,000,000:180,000,000. In other words, based on 1,500 phone calls, it was "suggested" that 22 million people, out of the adult population of 180 million, saw an unconventional therapist in 1990. Multiply 22 million by 19 visits and you approach the estimated total visits of 425 million.

The 425 million visits is only an estimate, a suggested possibility! We should not interpret it as gospel and should not assume that we have arrived. I have also heard many claim that this vast number impressed the NIH so much, that it created the impetus to open the NIH's Office of Alternative Medicine (OAM).

And many are also excited about the NIH's subsequent commitment to fund research to substantiate alternative approaches. This is totally inappropriate excitement, as practitioners generally do not understand the nature and the expense required to fund defensible research -- it costs millions and millions and millions of dollars. The NIH's OAM budget is only $2 million per year for all of alternative medicine combined! This is a drop in the bucket compared to the NIH's $10 billion budget.5,6 Two million dollars represents .02 percent of the total budget. Unconventional medicine has impressed them so much that we have been allocated a grand total of 2/100ths of a percent. In other words, funding doesn't really exist, only words of funding exist. If the 425 million to 388 million office visit figures had any real impact, then we would probably see additional funding. That not being the case, then what are we really seeing?

If, in the past, you felt any relief because of the Eisenberg paper, eliminate that relief and any satisfaction you may also feel. Rev. Marvin Frady, DC, tells us that "complacency and perhaps even denial show up when our mental image of something is satisfied."7 Indeed, Frady provides us with a sobering statement that should be interpreted as a warning. If we are not careful about how we characterize chiropractic, and how we let others characterize chiropractic, then we are potentially in store for a shattering wake up call that will even rattle the graves of chiropractic pioneers. We need to ask ourselves a simple question: Do we want the Centennial Celebration to be a party or a funeral?


  1. Eisenberg D: Unconventional medicine in the US. NEJM 328: 246-52, 1993.


  2. Campion E: Why unconventional medicine? NEJM 328(4): 282-83, 1993.


  3. The Random House Dictionary of the English Language, 2nd ed. unabridged, Random House, Inc., New York, 1987.


  4. Smith R: Where is the wisdom ...? The poverty of medical evidence. Brit Med J 303: 797-98, 1991.


  5. "Medicine Man," People Magazine p. 95-97, 4/12/93.


  6. Fax report from NIH News, 10/18/93.


  7. Frady M: Being mentally tough. Georgia Chiropractic 13(9): 9, 1993.

David R. Seaman, DC, MS, DABCN
Asheville, North Carolina

Editor's Note: Dr. Seaman's patient education package, Chiropractic and Pain Control, is available on MPI's Preferred Reading list. For more information, see #P-709 on the Preferred Reading and Viewing List on pages XX.

Click here for more information about David Seaman, DC, MS, DABCN.

Dynamic Chiropractic

Dynamic Chiropractic
Printer Friendly Email a Friend PDF RSS Feed
Share |
Dynamic Chiropractic
Dynamic Chiropractic
Join the conversation
Comments are encouraged, but you must follow our User Agreement
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.
comments powered by Disqus
Dynamic Chiropractic
How often do you reach out to patients who haven't visited your practice in six months or more?
Every few months
Every 3-4 months
Every six months or so
Once a year
Less frequently

Sign Up for Our Webinars
Receive Advanced Notice of Future Webinars