Book Review

Chiropractic in America: The History of a Medical Alternative

N Engl J Med 1994; 331:283July 28, 1994

Article

Chiropractic in America: The History of a Medical Alternative
By J. Stuart Moore. 228 pp., illustrated. Baltimore, Johns Hopkins University Press, 1993. $34.95. ISBN: 0-8018-4539-4

J. Stuart Moore's history of chiropractic in the United States seeks to explain why chiropractic has survived whereas other fringe medical movements have disappeared. The author's first conclusion appears on the initial page of his preface: the vast market and imperfect methods for the alleviation of back pain have permitted more than one style of practice. Moore also argues that the very persecution by which standard medicine hoped to suppress chiropractic led to a sense of martyrdom that enabled chiropractic to persist through missionary zeal. Finally, Moore claims that chiropractic flourished because of its effectiveness, a fact supported by his research in chiropractic archives but uninformed by an awareness of the power of the placebo effect.

The story begins with the late-19th-century “discoveries” of D.D. Palmer of Davenport, Iowa, about the flow of nervous energy from the spine to all organs of the body. It was the disruption of that flow that Palmer believed led to ills of all organs, not just back pain; its restoration could thus cure a wide range of diseases. Later leaders of chiropractic realized that this position was untenable and limited their claims to musculoskeletal pain. Moore discusses the schisms in chiropractic over differences in dogma, the introduction of various machines for diagnosis and treatment, and the evolution of chiropractic under the glare of opposition from the American Medical Association. He emphasizes two themes in chiropractic theory that at times competed for dominance: the emphasis on the harmonious flow of bodily spirits (which could become disrupted and be restored), and the more mechanistic view of bone malalignment and nerve compression. Moore's story is well told and enlightening, albeit more favorable to the claims of chiropractic than some physicians may find palatable.

My main disappointment with this book is that it has missed an opportunity. Although he charts the change in chiropractic with clarity, Moore never asks how that change has been governed. In standard medicine, change comes legitimately from new scientific discoveries. Change may be catastrophic, as old therapies or theories are overthrown, but at least as a group, medical practitioners accept science as the ultimate arbiter of therapeutic efficacy and source of new ideas. Not so in chiropractic, which depends on a canon without a mechanism for change built into the structure of the field. How, then, can legitimate change occur? Who is the arbiter of change when, for example, chiropractors start using the “Neurocalometer” or begin emphasizing vitamin therapy? Here Moore, perhaps overly influenced by his sources in chiropractic who claim effectiveness so persuasively, fails to analyze what may be the most fundamental difference between chiropractic and standard medicine.

Margaret Humphreys, M.D., Ph.D.
Duke University, Durham, NC 27701