Your Friday Dose of Woo: "Touchless" chiropractic

While I am on vacation, I'm reprinting a number of "Classic Insolence" posts to keep the blog active while I'm gone. (It also has the salutory effect of allowing me to move some of my favorite posts from the old blog over to the new blog, and I'm guessing that quite a few of my readers have probably never seen many of these old posts.) These will appear at least twice a day while I'm gone (and that will probably leave some leftover for Christmas vacation, even). Enjoy, and please feel free to comment. I will be checking in from time to time when I have Internet access to see if the reaction to these old posts here on ScienceBlogs is any different from what it was when they originally appeared, and, blogging addict that I am, I'll continue to post the occasional dispatch.

This particular piece could have been a Friday Dose of Woo if I had started the series when I wrote it. I didn't have the time or the inclination to produce a new Friday Dose of Woo during my vacation; so this will serve admirably. In the meantime, there will indeed be fresh woo for you next week!

I've been looking critically at various claims of alternative medicine practitioners and outright quacks for a while now. I thought I had heard everything. I didn't think there was a claim that I could come across that was so outrageous, so obviously and ridiculously bogus, that it would still have the power to surprise or shock me.

Then I came across "touchless" chiropractic manipulation.

Touchless? Yes touchless:

The popping sound, the grunting and the hands all belong to Dr. Johanna Hoeller. What she does has been described by some as nothing short of a miracle.

Dr. Hoeller is a chiropractor who specializes in a procedure where the atlas or C1 - the small doughnut-shaped ring at the top of the spine - is carefully adjusted back to center, thus balancing the spine.

This practice is part of NUCCA - National Upper Cervical Chiropractic Association.
But it's how the doctor does the adjustment that leaves many of her patients wondering.

Mike West, the morning DJ for KMTT, has been seeing Hoeller for more then 7 years.

"I remember going on the radio and all of sudden, click, and I would have to crawl off the floor to go to the doctor to get her to fix," he said. "I don't know what she does but it works."

What has West and other patients - some from as far away as Alaska - scratching their heads is the fact that Joanna Hoeller does not really touch them.

"I'm not a witch doctor," said Hoeller.

But wait, you say. Isn't chiropractic dependent upon spinal "manipulation" to treat everything from back problems to, say, migraines or asthma? And doesn't that manipulation or "spinal adjustment" depend upon the chiropracter's supposed skill in realigning your spinal column using good old-fashioned muscle? At least that's what I always thought chiropractic involved.

You can learn about it from a video segment done by a particularly credulous host named John Curley for a show in Seattle called Evening Magazine. [NOTE: Since this piece was first published, this video segment no longer seems to be on the website.] After the Curley's introduction, in which he describes how his wife had been suffering neck pain after an auto accident and had given up on getting relief, the video segment went to a photo of Joanna Hoeller leaning over a patient moving her hands over his neck and grunting. We hear popping sounds. It certainly seems as though she's doing something. But what? No movement of the patient's neck or head is observed.

"I'm not a miracle-worker," she says. "The miracle is the human body. It's just a gentle procedure, and, when it's gentle, people have a difficult time with it sometimes."

The procedure is apparently so gentle that it doesn't even require Dr. Hoeller to touch the patient.

No, Dr. Hoeller, I don't have a difficult time with your procedure because it's so "gentle," but rather because there's no physical basis for it to work unless you believe in some sort of magic or "energy transfer." Even by the stated basis of chiropractic of realigning the spine as a means of treating disease, it can't work. Indeed, one of her patients interviewed on the segment unintentionally seems to nail it on the head when he said, "I used to try to figure out what she did, and how she did it. I do believe she has some sort of magical powers. I just think she's that kind of a person."

Another patient: "Like I said, if it works I like it. I don't care what it is. Hocus-pocus, whatever. If it takes the pain away, hooray."

Hocus-pocus indeed, Hoeller's claims sure sounds like magic or hocus-pocus, and it would take such a belief in magic to think that such a ridiculous "therapy" could work. (Calling the Amazing Randi!) For one thing, it's not the patient's neck that's popping, but Dr. Hoeller's wrists, something Curley himself narrates later in the segment, when he says that Dr. Hoeller will keep doing the adjustment until the "popping in her wrist stops." Says Hoeller, "My body is my instrument, so to speak. When the atlas and the structure is correct, my hand tends to stop popping. So that's how I generally have a feedback of whether something is now locked, and then no more force can get in there." Worse, she takes before and after X-rays of the patient's skull and cervical spine. The first one shows (of course) that the patient's spine is horribly "out of alignment," with her head sitting at least a 2 cm lateral to where it should be relative to the atlas (never mind that if her head were truly that much out of whack relative to her spine, her spinal cord would probably have been crushed or severed). And--miracle of miracles!--the second one is almost "perfectly" aligned. In fact, if you look closely at the two X-rays, all that changed is where Dr. Hoeller drew her blue and red lines, as Skepdic showed very nicely here.

Hard to believe that anyone falls for this, isn't it? What's even harder to swallow is the part where Curley shows Dr. Hoeller a videotape of herself in action, and she claims she had never realized that she wasn't touching the patient. Come on, give me a break! What we have here is simply confirmation bias and self-deception on Dr. Hoeller's part, probably with a dash of magical thinking thrown in for good measure, and the placebo effect on the part of the patients. There's almost certainly a bit of regression to the mean (also known as the regressive fallacy) in there as well.

Of course, even if Hoeller could do what she claims without touching her patient, there is no basis in science to assume that upper cervical adjustment will do anything. She uses a method called N.U.C.C.A (for National Upper Cervical Chiropractic Association). This flavor of chiropractic teaches that many diseases can be treated by "adjusting" the upper cervical spine, specifically C1 (the atlas) back to "center," thus supposedly "realigning" the spine. To quote Joanna Hoeller, "Just when you thought you have tried everything, have you checked to see if your head is on straight?"

No, Joanna. Have you?

To see a whole bunch of pseudoscientific altie claims, one need only look at NUCCA's website, which greets visitors with:

Over 5,000 types of diseases can be restored to good health with this method? Apparently so, according to NUCCA:

After an upper cervical correction...

"An 80 year old man, suffering from numbness in both legs, receives an upper cervical adjustment and immediately experiences a return of normal feeling and mobility in his legs."

"A new scientific research study just concluding reveals Chronic Fatigue Syndrome and Fibro Myalgia cases have recovered in 3-12 months, but the Mayo Clinic reports 3 years of drug treatment with no improvement or hope."

"ADD (Attention Deficit Disorder) and similar cases have shown remarkable recovery with neck correction, enabling the freedom from the harmful drugs used in such cases... drugs now suspected of addicting some children."

"A thirty year old father was sent by his neurologist for an upper cervical analysis and correction. He had suffered from migraine headaches for ten years with severe side effects which disabled him from his work for 3 to 5 days per week. No treatment which he had received had helped him. Two adjustments left him symptom free for two years. A truck accident caused a temporary relapse but for over 5 years he has been symptom free!"

"A child with bronchial asthma breathes normally again, the acute attack stilled by a chiropractic adjustment!"

Nothing but testimonials.

I can see how one might--I repeat, might--get relief from spinal manipulation for nerve root compression or back pain, but no chiropracter has yet been able to explain to me how it can do anything for asthma, migraines, ADD, or chronic fatigue syndrome, or any other disease not related to the spine. The NUCCA site (like every other chiropractic site I've seen) is long on testimonials and impressive-sounding jargon about nerves and the spine and short on actual data from scientific studies and clinical trials.

What's next? Autism? Yes, chiropractors even claim they can treat autism and hiatal hernias. Is there any disease chiropractors can't treat by manipulating the spine?

Apparently not. And at least one of them doesn't even need to touch the patient to do it.

Traditional Chinese medicine healers who practice qigong (energy healing) had better watch out. It looks as though at least one chiropracter is getting ready to muscle in on their business.

This post originally appeared on the old blog on January 30, 2006.