chiropractic controversy and criticism chiropractic controversy and criticism throughout its history, chiropractic has been the subject of internal and external controversy and criticism. according to magnetic healer daniel d. palmer, the founder of chiropractic, "vertebral subluxation" was the sole cause of all diseases and manipulation was the cure for all disease. a 2003 profession-wide survey found "most chiropractors (whether 'straights' or 'mixers') still hold views of innate intelligence and of the cause and cure of disease (not just back pain) consistent with those of the palmers". a critical evaluation stated "chiropractic is rooted in mystical concepts. this led to an internal conflict within the chiropractic profession, which continues today." chiropractors, including d.d. palmer, were jailed for practicing medicine without a license. d.d. palmer considered establishing chiropractic as a religion to resolve this problem. for most of its existence, chiropractic has battled with mainstream medicine, sustained by antiscientific and pseudoscientific ideas such as vertebral subluxation. chiropractic researchers have documented that fraud, abuse and quackery are more prevalent in chiropractic than in other health care professions. unsubstantiated claims about the efficacy of chiropractic have continued to be made by individual chiropractors and chiropractic associations. the core concept of traditional chiropractic, vertebral subluxation, is not based on sound science. collectively, systematic reviews have not demonstrated that spinal manipulation, the main treatment method employed by chiropractors, was effective for any medical condition, with the possible exception of treatment for back pain. spinal manipulation, particularly of the upper spine, can, rarely, cause complications in adults and children that can cause permanent disability or death. in 2008, simon singh was sued for libel by the british chiropractic association (bca) for criticizing their activities in a column in the guardian. a preliminary hearing took place at the royal courts of justice in front of judge david eady. the judge held that merely using the phrase "happily promotes bogus treatments" meant that he was stating, as a matter of fact, that the british chiropractic association was being consciously dishonest in promoting chiropractic for treating the children's ailments in question. an editorial in nature has suggested that the bca may be trying to suppress debate and that this use of british libel law is a burden on the right to freedom of expression, which is protected by the european convention on human rights. the libel case ended with the bca withdrawing its suit in 2010. chiropractors historically were strongly opposed to vaccination based on their belief that all diseases were traceable to causes in the spine, and therefore could not be affected by vaccines. some chiropractors continue to be opposed to vaccination. early opposition to water fluoridation included chiropractors in the u.s. some chiropractors opposed water fluoridation as being incompatible with chiropractic philosophy and an infringement of personal freedom. more recently, other chiropractors have actively promoted fluoridation, and several chiropractic organizations have endorsed scientific principles of public health. historical controversy and critical elements d.d. palmer the birth of chiropractic was on september 18, 1895. there is controversy over what happened with several different accounts. daniel d. palmer later claimed that on that day he manipulated the spine of harvey lillard, a man who was nearly deaf, allegedly curing him of deafness. palmer said "there was nothing accidental about this, as it was accomplished with an object in view, and the expected result was obtained. there was nothing 'crude' about this adjustment; it was specific so much so that no chiropractor has equaled it." however, this version was disputed by lillard's daughter, valdeenia lillard simons. she said that her father told her that he was telling jokes to a friend in the hall outside palmer's office and palmer, who had been reading, joined them. when lillard reached the punch line, palmer, laughing heartily, slapped lillard on the back with the hand holding the heavy book he had been reading. a few days later, lillard told palmer that his hearing seemed better. palmer then decided to explore manipulation as an expansion of his magnetic healing practice. simons said "the compact was that if they can make it, then they both would share. but, it didn't happen." in spite of the fact that lillard could hear well enough to tell jokes, b.j. palmer claimed under sworn testimony that lillard had been "thoroughly deaf". since 1895, the story of palmer's curing a man of deafness has been a part of chiropractic tradition. palmer's account differs significantly from what actually happened, in that, according to lillard's daughter, his improved hearing was likely caused by an accidentally fortuitous jarring of lillard's body and not, as claimed by d.d. palmer, caused by a "specific" adjustment. it was after this event that palmer began to experiment with manipulation. he also claimed that his second patient, a man with heart disease, was also cured by spinal manipulation. chiropractic included vitalistic ideas of innate intelligence with religious attributes of universal intelligence as substitutes for science. evidence suggests that d.d. palmer had acquired knowledge of manipulative techniques from andrew taylor still, the founder of osteopathy. although d.d. palmer combined bonesetting to give chiropractic its method, and "magnetic healing" for the theory, he acknowledged a special relation to magnetic healing when he wrote, "chiropractic was not evolved from medicine or any other method, except that of magnetic." he also "claimed that his profession had nothing to do with medicine, that he healed by the laying on of hands;... he also said that he had a diploma from no earthly school but from high heaven." according to d.d. palmer, subluxation was the sole cause of all diseases and manipulation was the cure for all diseases of the human race. a 2003 profession-wide survey found "most chiropractors (whether "straights" or "mixers") still hold views of innate and of the cause and cure of disease (not just back pain) consistent with those of the palmers. on one hand, modern promotional brochures make a bid for medical legitimacy by describing innate and adjustments using more scientific-sounding terms such as "inherent" and "nerve force."" chiropractic has had a strong salesmanship element since it was started by d.d. palmer. his son, b.j. palmer, asserted that their chiropractic school was founded on "...a business, not a professional basis. we manufacture chiropractors. we teach them the idea and then we show them how to sell it". d.d. palmer established a magnetic healing facility in davenport, iowa, styling himself 'doctor'. not everyone was convinced, as a local paper in 1894 wrote about him: a crank on magnetism has a crazy notion that he can cure the sick and crippled with his magnetic hands. his victims are the weak-minded, ignorant and superstitious, those foolish people who have been sick for years and have become tired of the regular physician and want health by the short-cut method... he has certainly profited by the ignorance of his victims... his increase in business shows what can be done in davenport, even by a quack. before adopting the term "chiropractic" in about 1896, his advertising used the term "magnetic". in 1891–92, a city business directory stated: "dr. palmer can cure with his magnetic hands diseases of the head, throat, heart, lungs, stomach, liver, spleen, kidneys, nerves, and muscles, ten times quicker than any one can with medicines." give me a simple mind that thinks along single tracts, give me 30 days to instruct him, and that individual can go forth on the highways and byways and get more sick people well than the best, most complete, all around, unlimited medical education of any medical man who ever lived. chiropractic was rooted in mystical concepts, leading to internal conflicts between straights and mixers which still persist. it has two main groups: "straights", now the minority, emphasize vitalism, innate intelligence and spinal adjustments, and consider subluxations to be the leading cause of all disease; "mixers" are more open to mainstream and alternative medical techniques such as exercise, massage, nutritional supplements, and acupuncture. the straights adhere religiously to the gospel of its founders while mixers are more open. there is a lack of uniformity and consensus among chiropractors in regard to their role. depending upon whose point of view, chiropractors are, for example, subluxation-correctors, primary care physicians, neuromusculoskeletal specialists, or holistic health specialists. straights have claimed mixers are not real chiropractors because they do not acknowledge palmer's foundation of chiropractic therapy. in 1906, d.d. palmer was the first of hundreds of chiropractors who went to jail. chiropractors were jailed for practicing medicine without a license. in the 1920s hundreds of unlicensed chiropractors chose jail rather than fines. herbert reaver was the most jailed chiropractor in the u.s. chiropractors were charged with not complying with the medical practice act. california chiropractors adopted the motto, "go to jail for chiropractic." 450 chiropractors were jailed in a single year at the peak of the controversy. many chiropractors treated fellow prisoners and visiting patients while in jail. d.d. palmer defined chiropractic as "a science of healing without drugs" and considered establishing chiropractic as a religion as a means to use religious "exemption clauses" to resolve legal difficulties presented by restrictive "chiro laws". in 1911, he stated (emphasis in original): you ask, what i think will be the final outcome of our law getting. it will be that we will have to build a boat similar to christian science and hoist a religious flag. i have received chiropractic from the other world, similar as did mrs. eddy. no other one has laid claim to that, not even b.j. exemption clauses instead of chiro laws by all means, and let that exemption be the right to practice our religion. but we must have a religious head, one who is the founder, as did christ, mohamed, jo. smith, mrs. eddy, martin luther and others who have founded religions. i am the fountain head. i am the founder of chiropractic in its science, in its art, in its philosophy and in its religious phase. now, if chiropractors desire to claim me as their head, their leader, the way is clear. my writings have been gradually steering in that direction until now it is time to assume that we have the same right to as has christian scientists. chiropractors have struggled with survival and identity during its formative years, including internal struggles between its leaders and colleges. for much of the history of the chiropractic profession chiropractors showed little interest in scientific research and regarded their principles and practices as valid. despite heavy opposition by mainstream medicine, by the 1930s chiropractic was the largest alternative healing profession in the u.s. long-standing american medical association (ama) policies against chiropractic contributed to a lack of acceptance within mainstream public health. the ama created the committee on quackery "to contain and eliminate chiropractic." using the committee on quackery, efforts were made to prevent the participation of chiropractic in organized health care. in 1966 a policy passed by the ama house of delegates stating:it is the position of the medical profession that chiropractic is an unscientific cult whose practitioners lack the necessary training and background to diagnose and treat human disease. chiropractic constitutes a hazard to rational health care in the united states because of its substandard and unscientific education of its practitioners and their rigid adherence to an irrational, unscientific approach to disease causation.the longstanding feud between chiropractors and medical doctors continued for decades. the ama labeled chiropractic an "unscientific cult" in 1966, and until 1980 held that it was unethical for medical doctors to associate with "unscientific practitioners". this culminated in a landmark 1987 decision, wilk v. ama, in which the court found that the ama had engaged in unreasonable restraint of trade and conspiracy, and which ended the ama's de facto boycott of chiropractic. the rivalry was not solely with conventional medicine; many osteopaths proclaimed that chiropractic was a bastardized form of osteopathy. serious research to test chiropractic theories did not begin until the 1970s, and is continuing to be hampered by antiscientific and pseudoscientific ideas that sustained the profession in its long battle with organized medicine. by the mid-1990s there was a growing scholarly interest in chiropractic, which helped efforts to improve service quality and establish clinical guidelines that recommended manual therapies for acute low back pain. some people believe chiropractic has little more than a placebo effect, while some randomized trials of spinal manipulation