“Systematic reviews of controlled clinical studies of treatments used by chiropractors have found no evidence that chiropractic manipulation is effective, with the possible exception of treatment for back pain.[8] A 2011 critical evaluation of 45 systematic reviews concluded that the data included in the study “fail[ed] to demonstrate convincingly that spinal manipulation is an effective intervention for any condition.”[10] Spinal manipulation may be cost-effective for sub-acute or chronic low back pain, but the results for acute low back pain were insufficient.[11] No compelling evidence exists to indicate that maintenance chiropractic care adequately prevents symptoms or diseases.[12]”
If I pay for a business to make me a chocolate milkshake under the same health code regulations and standards as the place across town, I don’t want them finishing it off by stirring in a spoonful of shit with the ice cream as a bonus. Even if >99% of what’s in the cup is not shit, it isn’t somewhere I’ll go and I’ll make an effort to discourage people from going there too.
Osteopaths, chiropractors and all those other flavors of cargo cult imitation medical quackery differ only by the proportion of ingredients. Making a distinction between them is meaningless, it just lets the less-obvious liars get a foot in the door.
(Additional note because this is the internet: This is a “spherical cow in frictionless vacuum” scenario and ignores things like accidental contamination as well as the narrow range of illnesses where an appropriately-prepared and administered fecal transplant (which this is not) may be indicated.)
I think you’re misunderstanding what most of them keep practicing. It’s not the kooky cranial/cervical manipulation(you can make an argument that them having to learn that stuff in the first place is BS and a waste of time), but most do pick up a few muscle pressure point tricks and stretches that are essentially the same as what PT instructs patients on how to do. Is it bullshit? No more so than most medicine that’s practiced(the data behind the vast majority of what your average physician does is at best all over the place, the truly “settled” clinical questions are few and far between). In my book though, anything that keeps you from having to prescribe a scheduled drug (read as:narcotic or muscle relaxer) to get someone functional from something like severe trapezius tightness or piriformus syndrome is a heck of a tool to have at your disposal in a primary care or urgent care setting.
A broken clock might be right twice a day but that doesn’t mean you should rely on it for timekeeping. If something works, we study it in search of why, how and other details that may not be immediately obvious but could have an impact on patient outcomes. From what their product quality shows, chiropractors and their snake oil salespeople colleagues appear to be some combination of less diligent, less motivated and less capable when it comes to doing that sort of evaluation. Trying to blend that part of the market into the realm of legitimate evidence-based medicine is bad for almost everybody involved. Might as well start having the nurse follow the vitals check with a palm reading if the standard of “has a basis in reality” is too onerous for modern medicine.
We’re constantly making bigger and brighter lights to shine out into the darkness of what we don’t yet know while the Supplementary, Complementary and Alternative Medicine crowd sprints for the first patch of darkness to plant a flag and hide. You’re right that there are a lot of unanswered questions but an answer is not a valid substitute for a correct answer.