On April 14, Heath Action Network Society published an article by a Canadian client of chiropractic, Anita. The article was written in response to a March 30, 2020 CBC story that claims there’s no scientific evidence that chiropractic care can boost the immune system.
On April 18, one of those interviewed in the CBC story, Ryan Armstrong, a pseudoscience skeptic who runs an independent non-profit called Bad Science Watch, responded to Anita’s article through this website with Despite How Some Chiropractors Deceive Patients, “Adjustments” Do Not Benefit The Immune System.
Yesterday, Anita once again put hands to keyboard and crafted another masterful response, this time to Ryan Armstrong’s rebuttal. This is an impassioned and important read from a consumer who fully claims her absolute right to the therapy that works for her. Please take a moment to read another outstanding response from Anita.
My sincere thanks to everyone for their (almost) unanimous support for my first article on the CBC’s March 30, 2020 news report regarding the link between chiropractic and immunity. I’d like to keep the momentum going, so here is an update and more food for thought.
As I noted in the footnote to my first article, Tim Caulfield contacted me within 24 hours of receiving it. He asked me for a copy of the Pero study, which he had dismissed in the news story. While I suspect he thought I’d never find it, I am hot on the trail, having obtained the name of both the individual who funded the study (now a sought-after speaker on chiropractic and a chancellor at an American university) as well as a chiropractor/lawyer who was involved in the study, also very prominent in the American chiropractic community. I expect to receive information about the study in the very near future. I have to say, though, that it was not my responsibility to track it down for Caulfield, nor for Armstrong, nor for the three CBC journalists on the story, particularly after they had already slammed it in the national news. This is not my day job.
I am pleased to see that Ryan Armstrong has written an extensive rebuttal to my article. That helps us get this out in the open. I had already drafted this article in response to a paper Tim Caulfield had sent me, which as it happens, is the same one Armstrong identified at the end of his rebuttal. How fortuitous. I have here added a response to Armstrong’s other comments.
Regarding Armstrong’s observation that my article appeared on the HANS website, that is irrelevant. I am neither an employee, nor even a member of HANS. In fact, I was only made aware of HANS as a result of having written the article. Whether it appeared on the HANS website or the CTV website or CNN website is immaterial. That is a red herring and would not have changed the content of my article.
The first fatal flaw in Armstrong’s argument is that I have not been misled by anyone. The views in my article were not fed to me by any chiropractor, nor did anyone put me up to it. My views are entirely my own. I can read, I can understand, and I can think critically. I form my own opinions, regardless of who is providing the information. I most certainly am not a victim. I do believe that he has good intentions, but speaking as a client, his work on this is doing me a grave disservice. Ryan, I beg you to please talk to the clients, listen to the clients, and validate the clients’ experiences. If your idea of standing up for my rights is to continue to discredit the health practitioners I have most benefited from, please stop. Instead, stand up for my right to choose. I would be most appreciative of your support on that.
Armstrong states, “There is quite a bit of clinical evidence to inform us that just because something may appear to be misaligned or abnormal, does not mean that there is any real impact to a patient’s well-being.” This is another fatal flaw in his argument – I am not depending on any research in making my statements. I am reporting on my own personal experience as someone with multiple spinal issues. Yes, most certainly, if my spine is misaligned and is causing me great discomfort, particularly for extended periods of time, that does have an impact on my well-being, physically and emotionally. I find it bizarre that he should be discounting my own personal experience. Again, a red herring.
As for how I address that negative impact on my well-being, it is entirely up to me to decide what sort of treatment I undergo to address any condition that is causing me stress, whether physical or emotional. As well, the level of stress one experiences is commensurate with the seriousness of the spinal issue. A correction of misalignment will clearly have varying effects, depending on the degree of misalignment and how much discomfort, and therefore stress, it was causing.
I am genuinely embarrassed for Armstrong regarding this statement: “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 that what they are doing is correcting some non-existent misalignment.” Since Armstrong has admitted that he has never been to see a chiropractor, perhaps he has never had an issue with vertebrae being out of alignment – isn’t he lucky. The fact that he dismisses chiropractic as a “spine rub” also demonstrates an embarrassing lack of knowledge about the practice. I recall going to a previous chiropractor who took an X-ray of my neck, which I could barely turn. His comment was, “You sure have a funny-looking neck, Anita.” I was shocked to see on the X-ray that my cervical vertebrae were badly misaligned, looking rather like a Jenga puzzle. I saw it with my own eyes and felt it in my own neck. Please don’t tell me that my misalignment was non-existent or that it wasn’t diminishing my well-being. I am grateful to that chiropractor for significantly improving my mobility. As to the connection between yoga and alignment, I say to him, please conceptualize it as balance of the entire body, with optimal posture. Maybe that will help you to understand.
Regarding his criticism of my comment on the benefit of chiropractic in providing breathing benefits (“research into chiropractic treatment of asthmatic patients has failed to elucidate any objective benefits for lung function…”) nowhere did I say anything about asthma. I was explicitly referring to the release of muscle tension around the ribcage, which attaches to the spine, and again, the comment was based on personal experience. This is yet another red herring. Maybe we should be invited to a seafood feast.
What is frustrating to me is that chiropractic (and yoga) are being ripped apart by people who so clearly know nothing about them. I am also frustrated by the insistence on depending on scientific evidence, rather than trusting one’s own experience of what causes stress, what relieves stress, and how one responds under stress. I would ask Ryan Armstrong whether he knows when he is stressed or whether he needs to have a saliva sample analyzed for cortisol to confirm whether he is stressed. Does he then also need to have a blood test to confirm whether he is feeling unwell as a result of stress or does he just know that he is feeling run down or burned out. This absolutely is a matter of common sense.
Regarding Dr. Pero’s study, Armstrong says, “this so-called study is nothing more than a fabrication.” He goes on to say, “Even if we were to assume that the referenced article existed at one point in time…” meaning that he has never seen it, but assumes – sight unseen – that it is garbage. As I noted above, this study involved at least two individuals prominent in the American chiropractic community, in addition to Dr. Pero, chief of cancer prevention research at New York’s Preventive Medicine Institute and professor of medicine at New York University, not Elmer Fudd and Bugs Bunny.
Let us consider a plausible scenario that may help to explain how a 200% increase in the functioning of the immune system could be possible. With respect to the effects of stress on the immune system, here’s a study that reviewed 300 empirical articles concerning the effect of psychological stress on the immune system. Even the first paragraph in the abstract is very informative:
Dr. Pero’s study was conducted on cancer patients. These were individuals who had the knowledge that they had a grave disease, that they could possibly die from it, and some may indeed have been terminally ill. They may have been in pain and may have been suffering for years, physically and emotionally. In addition to having the disease, they would have been subjected to the horrors of chemotherapy and radiation treatment, in the state they were in during the 1980’s. They may have had child-care issues, such as having to look after their children themselves while they were recovering from treatment, or having to have complete strangers look after their children if they were unable to find licenced child care. They possibly were unable to work and consequently had financial issues, which would also have had implications for child care, as well as basic living expenses, mortgage, rent, etc. You better believe these people were stressed.
As I noted in my previous article, psychological studies have found that patients with PTSD were suffering not just psychologically, but also physically, due to the muscle tension associated with “fight or flight,” i.e., elevated cortisol and the activity of the sympathetic nervous system. The suggested treatment was a combination of psychological and physical methods, which would allow the nervous system to return to its parasympathetic state, thereby reducing cortisol and its effect on the immune system, as well as on the muscles. In the case of these patients, it would not be surprising that being treated with the human touch – as opposed to being stabbed with needles, pumped full of toxic chemicals, or laying on a cold, hard machine being battered by radiation, both of which would have made them feel deathly ill, on top of the cancer – would have been a welcome change and a stress relief in itself. As well, chiropractic could have helped to alleviate the muscle tension associated with the stress and possible consequent misalignment, or at least increased muscle mobility around the joints, such as the hips and shoulders, even if there was no actual misalignment.
Now here’s the most important point: whether the improvement in immune system function was 200% or 2%, if there was an improvement that would help these people heal faster or that would enhance their palliative care to make their last days more comfortable, there is no reason not to do it, especially if no harm can be proven. Furthermore, it is not up to Ryan Armstrong, nor Tim Caulfield, nor the CBC to decide for me whether I am going to accept chiropractic treatment. It is not being forced on anyone, so just butt out, would you, please?
With respect to my “limited and naive understanding” of what is science, I have completed three post-secondary programs with reputable institutions, from the technical level to the graduate level. I was always taught that following the scientific method could not prove anything. It could only yield results that would either support or reject a null hypothesis. Either the question asked was supported by the data obtained through the researcher’s study or it wasn’t. Even if it is supported (or rejected), there’s no end to the possible explanations for a given outcome, such as bias, poor design, insufficient sample size, or confounding variables, hence the need for retesting using different methods, different assumptions, not to mention different researchers. My graduate work was with respect to the development of trust between conflicted parties. Regarding Armstrong’s proposed research design, because there are clearly polarized views on the subject, I suggest teaming up with researchers of the opposite view, collaboratively coming up with various study designs that all can agree to, and jointly conducting a series of studies. Then we can talk.
Finally, regarding his comment about “chiropractors who got their education by applying to a school through a magazine ad,” to obtain a DC or Doctor of Chiropractic designation, here is the academic and practical study required in the Doctor of Chiropractic Program at Canadian Memorial Chiropractic College and here are the admission requirements, in particular a university undergraduate degree. The minimum grade point average required is pretty standard and comparable with other Canadian universities. Please be assured, Ryan, that Joe Schmoe with zero education nor two brain cells to rub together would not be admitted to the program.
While it is not my intention, nor my responsibility, to conduct a literature review for Armstrong nor for anyone else, I identify here a few additional studies from peer-reviewed journals for consideration, since the science is clearly important to him:
This study discusses yoga from a biomechanics and physical performance perspective:
Yoga Empowers Seniors Study (YESS): Design and Asana Series
Armstrong notes that he is not familiar with any clinically demonstrated effects of yoga on stress reduction. Here’s one:
Effects of Yoga on Stress Management in Healthy Adults: A Systematic Review
The conclusion was that, while the study revealed positive effects of yoga on stress reduction in healthy adult populations, further studies should be conducted. Here’s an opportunity for further research. Or better yet, Ryan, in the interest of having first-hand knowledge of the effects of yoga, how about just taking a few yoga classes and seeing how you feel.
The conclusion on this one: “This study concludes that Yogic breathing has a significant effect on the reduction of state trait anxiety level of dental students.”
Here’s another one connecting psychological stress to increased susceptibility to illness:
Psychological Stress and Susceptibility to the Common Cold
With respect to Armstrong’s charge that I have left out information about the findings of chiropractic research that determines that “there is no scientific evidence that supports claims of a meaningful boost in immune function from chiropractic adjustments,” as I noted above, I had already prepared the response below to such findings. I am not trying to hide anything. In fact, I am very glad that he brought that up. Armstrong says, “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.” Let’s take a look at one of these reports that claim no scientific evidence, put forward by an international regulatory body – the very one noted by Armstrong at the end of his rebuttal. Thank you again for handing this to me on a silver platter.
Tim Caulfield had given me a link for this “rapid review” by the World Federation of Chiropractic (WFC) which he was holding up as evidence that there is no link between chiropractic and immunity:
According to its website, the WFC consists of “90 national associations of chiropractors in 89 nations. The WFC represents them and the chiropractic profession in the international community. Its goals…include:
● Acting with national and international organizations to provide information and other assistance in the fields of chiropractic and world health;
● Promoting uniform high standards of chiropractic education, research and practice;
● Developing an informed public opinion among all peoples with respect to chiropractic; and
● Advancing the chiropractic profession and protecting the character and status of the profession.”
Note the last three bullets in particular, with the emphasis on high standards, informed public opinion, and protecting the character and status of chiropractic. This, folks, is where the plot thickens. First of all, in my estimation, the above report is stunningly biased. Secondly, I shake my head again at Caulfield’s comment in the CBC news report about the erosion of our critical thinking, and both his and Armstrong’s reference to this report as evidence that there is no evidence. This speaks to my comment about our biases clouding our thinking and preventing us from truly thinking critically.
The following is based on the rebuttal I sent to Caulfield and I await his response. (I sent it to him on April 15th, so I’ll give him the benefit of the doubt that he’s been too busy to give me a fulsome response just yet. Perhaps this article and any additional encouragement from you, dear readers, will stimulate a quicker response.) In the interest of promoting open and unbiased discussion, I would be interested in hearing all (informed) perspectives, so please feel free to voice any dissenting views.
My initial reaction to the WFC’s review was surprise that only seven studies were reviewed, since the website I identified in my first article listed 114 of them, and even that number was noted as being only a partial list of available research. Granted, those studies are not the easiest to get a hold of, since many were pre-internet era and there are a number of broken links. Still, every effort should be made to locate them, rather than ignoring them or dismissing them sight unseen. If they can not be located, the validity, not to mention the results, are simply unknown and more research should be undertaken. A lack of research does not in itself suggest that chiropractic is ineffective in stimulating or improving the function of the immune system.
I found it bizarre that regardless of the sort of research undertaken, no matter what was said or done, the WFC seemed determined to shoot everything down regardless, with no hint of positivity or excitement about encouraging results. That is baffling to me. Unless harm or malice can be proven, if people agree to participate in a study or to undergo a given treatment, it isn’t anyone’s business but the patient’s to decide whether or not to partake.
Providing balanced and objective information is fine and then let the patient decide. If they feel they are deriving some benefit, even if only placebo, then what’s the problem? That’s particularly true in a hospital setting where the patients don’t even have to pay for it. The mind is a powerful thing – if one truly believes that they are benefiting, chances are that they will. On the other hand, speaking from experience, the benefit I have received from chiropractic is not only in my head. I know when I am or am not in pain.
I suggest that researchers should put more emphasis on self-reporting and on outcomes, rather than focusing on the cellular level, given the difficulty of measuring the activity of the immune system when we know so little about it, and particularly about showing causal connections. And as you’ll read in the WFC’s review, it is even more difficult to convince an ornery regulatory system that changes in the immune system can be attributed to chiropractic. How exactly is a chiropractor and/or researcher to design a study that will satisfy them? With the goal posts constantly moving, it’s impossible to know where to kick.
I reviewed the WFC’s response to each study and read whatever information I could access on each study to form my own opinions. These were my conclusions:
1. Pero R, Flesia J, (1986) University of Lund, Sweden
This is the study Caulfield was referring to in the CBC news report and that Armstrong was also making light of in his rebuttal. Note that Dr. Pero’s collaborator Dr. Joseph Flesia was referred to as “a basic science researcher and chiropractor.” I have no idea what a “basic” science researcher might be, but that sounds to me like an attempt to dismiss his credentials, since Dr. Pero’s are impressive. With respect to the study, since the WFC had no documentation to review, I found it most irresponsible of them to state that the “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.” Similar to Caulfield and Armstrong, they had nothing to base that conclusion on, except their opinion that the results seem implausible. Therefore, their conclusion is invalid. By their own admission, “no scientific assessment of its claims can be made.” There’s a lack of information one way or the other. The appropriate conclusion should be that the validity of this study is an open question.
2. Enhanced phagocytic cell respiratory burst induced by spinal manipulation: potential role of substance P.
The WFC’s response is that the “clinical meaning” is unknown, since this study is at the cellular level. Isn’t evidence at the cellular level what is being sought in these studies to prove the effectiveness of chiropractic? If the WFC wants clinical evidence, then that would be a logical next step in this study, rather than dismissing it as not being credible. At the same time, having to take blood samples in a clinical environment while a chiropractor is trying to perform an adjustment seems unreasonable. I’d certainly feel that it was taking away from my session and with negligible benefit to me.
In the abstract, I read (forgive the mumbo-jumbo and apologies if you go cross-eyed): “The CL [chemiluminescence] responses of both PMN [polymorphonuclear neutrophils] and monocytes from subjects who received spinal manipulation were significantly higher after than before treatment, and significantly higher than the response in sham or soft-tissue treated subjects.”
As well, “Plasma levels of SP [Substance P] before and after treatment in sham treated subjects did not differ significantly; however, elevated plasma SP was observed in subjects after spinal manipulation.” Basically what they’re saying is that there was more immune system activity after a chiropractic adjustment than there was after other types of treatment, which suggests that chiropractic adjustments have the effect of stimulating the immune system.
Clearly there is potential here for positive results in a clinical environment, so why not encourage that? Again, “not known” does not equal “not credible.”
What is the value the WFC sees in assuming that it would be ineffective in a clinical environment? Why are they assuming that? And what exactly is the “clinical meaning” they would like to see?
Again, the WFC is blowing off this study as having unknown clinical meaning, so same criticism as above.
4. Interleukin 2-regulated in vitro antibody production following a single spinal manipulative treatment in normal subjects.
Yet again, same criticism as above. Where the researchers state that the results are unclear, fair enough, there’s room for more investigation.
The authors themselves acknowledged that the sample size was small, therefore the results are preliminary and more study is warranted. The WFC’s response that the results were “highly questionable” seems unnecessary to me and strikes me as biased. They could have just said that they’d like to see the study repeated with a larger study group.
6. One hundred thousand cases of influenza with a death rate of one-fortieth of that officially reported under conventional medical treatment. 1919 | The Journal of the American Osteopathic Association [It’s hard to know exactly what the WFC was looking at, since they didn’t provide a link. However, you’ll find a pdf to the 1919 paper at this website.]
This is another instance of where there isn’t enough information to properly assess, but the WFC is assuming the worst. The link provided in the response goes to this page: The 2012-2013 Influenza Epidemic and the Role of Osteopathic Manipulative Medicine | The Journal of the American Osteopathic Association. Regarding the comment, “Their lack of methodological structure or data analysis is likely to have resulted in incomplete information and a high likelihood of bias,” I’m not clear on how incomplete information necessarily leads to a “high likelihood” of bias. We just don’t know. Regarding the comment, “These various reports do not provide the necessary evidence to justify the use of spinal adjustment / manipulation for infectious diseases,” again I say it’s really none of their business if a patient should choose to undergo chiropractic treatment if no harm can be proven.
7. The Effects Induced by Spinal Manipulative Therapy on the Immune and Endocrine Systems
The WFC states, “This study supports that there is no current basis for which to provide spinal adjustment / manipulation for the purpose of conferring or enhancing immunity.” Absolute garbage. No, it doesn’t. The quote says that the results are “mixed and conflicting,” “mixed” suggesting that there was evidence in support as well as against; therefore the results are unclear and more investigation is warranted. It is inaccurate to say that there is “no” current basis.
The rapid review conclusion that “available studies have…a lack of symptomatic subjects” isn’t even true. There were cancer patients, flu patients, and AIDS patients. What kind of symptoms are they wanting to see? Regarding “no credible, scientific evidence,” what do they call “credible”? What is it exactly that they’re looking for?
This entire report is shockingly biased and suggests a strong negative agenda. It would be laughable if it weren’t disturbing that these people are actively trying to discredit a mode of health care from which I derive great benefit. Looking again at the WFC’s goals, I fail to see how their rapid review promotes high standards of education, informed public opinion, or protects the character and status of the profession. In fact, it looks to me like the WFC is trying to destroy the profession from within. To what end? Where is this coming from and who are they really trying to protect? Unfortunately, this bizarre activity is fodder for the skeptics like Tim Caulfield and Ryan Armstrong, who apparently aren’t critiquing the critiques, but are accepting them without question.
In an attempt to get around the moving goal posts for “credible” and “clinically meaningful” evidence of chiropractic vis a vis immunity, I submit that it may be more productive to look at outcomes, such as before-and-after medical imaging, with whatever controls might be necessary to satisfy the WFC. In fact, I would be more than happy to offer myself up as a research subject. I underwent a CT scan shortly before I started treatment with my current chiropractor, which showed severe degeneration, including stenosis or narrowing of the spaces within the spine, which can cause pressure on the nerves and spinal cord. Within less than nine months, I had relief of my symptoms. No matter how I bend or twist or angle my hips, I can not reproduce the pain I was experiencing before I started seeing my chiropractor. I haven’t been taking anti-inflammatories, and have made no dietary or exercise changes, therefore, I see no other explanation for that other than the chiropractic care. I would be very interested to know whether any physical changes would be significant enough to show up on another CT scan. What I was told was that my chiropractor’s technique can actually stimulate reabsorption of abnormal growth in the vertebrae, thereby reversing the stenosis. That would be a function of the immune system.
Certainly as far as my personal experience goes, I no longer feel like my vertebrae are closing in on my spinal cord and I am pain-free, for which I am eternally grateful. No invasive or surgical procedures have been required. The WFC, as well as Caulfield and Armstrong, can keep their noses out of my business and I don’t care what they believe or don’t believe.
At the risk of sounding like a conspiracy theorist, it is hard not to conclude that there is a bizarre and surreal plot to silence and discredit the chiropractic profession, with pressure coming from both external skeptics and the news media, as well as from within. Far from attacking chiropractors and any connection between chiropractic and immunity, the real news story here should have been the impending self-destruction of chiropractic, starting with the upper echelons of the chiropractic regulatory system, and the skepticism that feeds on it. So you see, folks, we are at the ground level of attempting to understand what is behind this attack. If this is not resolved – and soon – the potential outcome could be that our freedom to decide what sort of medical practitioners we seek help from will be taken away. In fact, it is being eroded as we speak. While Ryan Armstrong suggested that “false” claims about chiropractic boosting immune system function undermine our democracy, this is the true threat to our democracy. So, dear readers, I invite you to speak up now, challenge the skeptics, and let the regulators and news media know that you are onto them. We have just begun!
Anita B., Concerned Citizen and Grateful Recipient of Chiropractic Care