‚ÄčAn MD is the first choice of 54% of American adults when choosing a health care provider for back or neck pain, according to a recent Gallup poll. Only 29% would choose a chiropractor. Then why does a graphic touting the poll's results on the Palmer College of Chiropractic website say that 57% of adults are likely to see a chiropractor for the same malady? This headline says one thing; their graphic says another. Actually, both are correct. It's all in what you want to emphasize. You reach the latter figure if you add those who would see a chiropractor initially to those would, or were somewhat likely to, see a chiropractor if all other treatments failed. (Interestingly, acupuncture comes in at a mere 1%.) 

The Gallup poll, which was paid for by Palmer College, is part of an effort to figure out how to increase chiropractors' share of the healthcare pie. Obviously, you can expect them to make the most of it. To be fair, the fact that 29% would choose chiropractic is in a different graphic. As is the fact that 54% would choose MDs first, but only if you click on a graphic touting the 29%. There are several such graphics on the website you can copy and use free of charge.

You can read the poll results and Palmer's spin on things by clicking on the links above. There is also a secondary analysis of the poll in the Journal of Manipulative and Physiological Therapeutics. Here's what I thought was interesting. 

61.4% of those surveyed agreed that chiropractic was effective in treating back or neck pain. Considering that back and neck pain is the chiropractor's bread and butter, it would be cold comfort to learn that almost 40% of adults did not think you were effective at your job.  There was a similar result on the question of trustworthiness.  A little over half of respondents agreed that chiropractors were trustworthy, which means a little under one-half don't think they can be trusted.  

This did not dampen the International Chiropractors Association's enthusiasm for the poll's results. The ICA announced, in an email, that "nearly 70 percent of the study participants indicat[ed] that chiropractic care is effective with neck and back pain." When I took math, if we were measuring in 10s, 61.4% would be rounded down to 60%, not up to 70. And a poll is not a "study," nor can it determine the effectiveness of a treatment. Undeterred by such subtleties, the ICA's headline for this announcement said: "Gallup study highlights chiropractic effectiveness and popularity with neck/back pain." 

Perhaps the most fascinating statistic of all is that 70% of those surveyed believe they know what chiropractors do. Which is interesting because chiropractors themselves can't agree what it is they do. Some chiropractors think they are primary care physicians and should be able to prescribe drugs. Others think they are spine care specialists who treat musculoskeletal problems. Still others hold on to the notion that phantasmagoric blockages in "nerve energy" running through the spine (the illusory "vertebral subluxation") can affect bodily function and that chiropractic "adjustments" are effective for all manner of ills. 

So what is it that everyone else thinks chiropractors do, even if they don't know themselves? Of the 12% of respondents who have actually seen a chiropractor in the last 5 years ("chiropractic users"), 41% want to see a chiropractors only for back and neck pain, while the same percentage disagree that they would see their chiropractor for these health issues only, although we are not told just what other problems they would see a DC for. 

60% of chiropractic users want to see a chiropractor only if they are in pain, but 31% want to see a chiropractor on a regular basis, even if not in pain. (Again, this is 31% of the 12% who have actually seen a chiropractor within the last 5 years; in other words, 3.7% of all respondents.)  To me, this says that while some users may view their chiropractor as a PCP, I would bet that most of them have been lured into regular treatments for "maintenance care," based on the totally unproven and highly implausible idea that regular spinal "adjustments" are necessary to maintain one's health. 

There's bad news here for the "DC as PCP" proponents: of chiropractic users, only 9% would choose their chiropractor as the first healthcare provider they want to talk to about their health. Even then, "talk about their health," which is the way the question was phrased, is pretty general.  I have to imagine a much different result if you started naming specific health issues normally treated by PCPs, such as cardiovascular disease or diabetes. More users (22%) would talk to their chiropractors about general wellness issues, such as diet and nutrition, but almost 60% of users would not. 

Rounding out the bad news: Of all respondents, almost 25% thought that chiropractic was dangerous. 43% agreed that chiropractic care was expensive and requires too many visits. (The average number of visits was 11 per year.)  Some people didn't know if their visits were covered by insurance and would see the chiropractor even more often if they were. This led to a suggestion by the JMPT article authors that chiropractors lobby for increased coverage of their services. As one who keeps up with state "CAM" legislation, I can tell the authors to rest easy: chiropractic lobbyists are on the case. A number of such bills are filed in the state legislatures annually.  

Chiropractors should stop blaming the medical profession for all of these problems. Only 13% of respondents said they had been discouraged from going to a chiropractor by an MD, although that figure rose to 21% for the chiropractic users. 

Finally, nearly half of all respondents think chiropractors need only 4-6 six years of education beyond high school to become a chiropractor. Palmer is already all over this one with a graphic.  A "Degree Requirements Comparison" of "educational hours" shows that an MD has 4,800 hours; a DO, 4,665; and a DC, 4,620.  In Palmer's world, medical residencies of 3-7 years and thousands of hours of training don't exist.  100% of me thinks this Palmer graphic is untrustworthy.