I went to a chiropractor in the 1980s for a stiff neck that had not improved after a month. A coworker praised him with the evangelical certainty usually reserved for miracle diets, used car salesmen, and people who have just read one book on nutrition. I was skeptical but adventurous, which is how most regrettable life decisions begin.
The adjustment worked. My neck improved. Worse still, my chronic asthma improved as well.
At the time, I was deeply unhappy in my first professional job after earning a bachelor’s degree in psychology and a master’s degree in applied behavioral science at Wright State University in Dayton, Ohio. I worked for a personnel-testing firm that marketed itself as scientific while relying on psychological instruments invented—without irony—in-house. Their psychometric rigor consisted largely of confidence, clipboards, and an aggressive font choice.
Compared with the pseudoscientific theater I was being paid to defend, chiropractic felt almost wholesome.
These tests produced false positives and false negatives with impressive symmetry, giving employers either a false sense of security or a convenient scapegoat. Qualified people quietly lost livelihoods. Chiropractic, by contrast, seemed refreshingly concrete. Hands. Spines. Patients who said they felt better. I imagined self-employment, ethical work, relief of pain, and perhaps even improved health. Compared with the pseudoscientific theater I was being paid to defend, chiropractic felt almost wholesome. In retrospect, this should have been a warning sign.
Why Chiropractic Made Sense at First
I had been trained in program evaluation, a discipline shaped by people obsessed with how to infer causality in the messy real world where randomization is often impossible and people insist on behaving like people. This was the era of stress research—Hans Selye, Thomas Holmes, and Richard Rahe—demonstrating that belief, expectation, and circumstance could predict outcomes as dramatic as Navy pilots crashing jets on aircraft carriers.
Chiropractic appeared to offer a humane alternative: a hands-on profession marginalized by a medical establishment overly confident in pharmaceuticals and procedures. Like many, I believed useful treatments had been discarded not because they failed, but because they threatened professional turf. I believed science had limits, and that those limits had been selectively enforced, preferably against someone else.
So I decided to become one myself, and in 1987 I graduated from the San Jose campus of Palmer College of Chiropractic and joined the ranks of doctors of chiropractic—eager, idealistic, and spectacularly unaware of the epistemic ecosystem I had entered.
Inside the Bubble
The dominant narrative was simple: conventional medicine had unfairly dismissed us. Scientific objections were cherry-picked. Our methods worked; medicine simply refused to look properly, or long enough, or with an open heart and an open mind liberated from all that oppressive critical thinking.
On weekends, I studied at Stanford’s Green Medical Library and noticed something curious: the library did not carry chiropractic’s premier scientific journal. I proposed that Palmer purchase a subscription for Stanford. We did. Stanford thanked us politely, in the tone such institutions reserve for unsolicited fruit baskets.
Subtle vital forces, innate intelligence, and spinal “subluxations” hover just beneath the surface of even the most modern curricula, like software that never quite finishes installing.
Old-guard chiropractors complained that we risked spilling our secrets to scientific medicine. The truth is, chiropractic education exists in a parallel universe. Its founding figure, D.D. Palmer, died in 1910, but his metaphysical afterlife remains active. Subtle vital forces, innate intelligence, and spinal “subluxations” hover just beneath the surface of even the most modern curricula, like software that never quite finishes installing.
The 1990s brought chiropractic its brief flirtation with legitimacy. The NIH’s Office of Alternative Medicine was established, fueled in part by philanthropic enthusiasm from abroad.
I interviewed for a position at an English health estate owned by Sir Maurice Laing, who had both an interest in alternative medicine and the resources to indulge it. I declined the offer, tethered as I was to America, but not before inserting myself into meetings with leaders of British complementary medicine.
To the British Committee on Complementary medicine, I proposed a heresy: stop arguing about putative mechanisms; first determine what works, for whom, and under what conditions. Program evaluation before explanation. My suggestion was politely ignored. Before assuming his kingship, King Charles quietly stepped away from his advocacy of complementary medicine. One suspects reality intervened, possibly with charts.
The Cracks Appear
After years of practice and research involvement, my discomfort grew. Chiropractic diagnostics increasingly failed a basic test: face validity.
My practice partner believed she could diagnose disease by testing the strength of specific muscles, a method known as applied kinesiology (AK). Patients loved it. The ritual was impressive. They asked why I did not perform AK, as though I were withholding a party trick. I asked her once how often her diagnoses were correct. “About half the time,” she said, without irony.
This is precisely the accuracy one would expect from a fair coin flip, except coins do not bill insurance companies or require continuing education credits. These tests were never compared to gold standards, so strictly speaking they were never correct or incorrect at all. They simply were.
What finally broke me was not only the epistemology—it was the economics. Chiropractic education devotes astonishing energy to practice management. Seminars, workshops, and consultants descend with the same message delivered in different fonts: sell care plans, sell frequency, sell fear. Some that you pay for one-to-one counsel offer referrals when referring to other chiropractors. My millionaire business coach promised me $1000 per referral that signed up—but always called a few weeks later with a sad reason not to pay.
The mantra was explicit: ABC—Always Be Closing. The bottom line of all the chiropractic continuing education and coaching programs was to lie about how chiropractic is crucial for overall health, and the bottom-bottom line was that advising chiropractors is much more profitable than being one.
Patients were no longer people with problems to be evaluated; they were “cases” to be converted. Thirty-six-visit plans were praised. Lifetime care was normalized. Preventive adjustments were marketed with the confidence of seatbelts and vaccines—minus the evidence, testing, and regulatory oversight.
Certainty, I learned, is a remarkably precious commodity in chiropractic world.
Those who questioned this model were told they lacked confidence, commitment, and the proper chiropractic spirit. Skepticism itself became a personal failure. Success was measured not in clinical outcomes, but in collections. The resemblance to the psychometric firm I had fled years earlier was no longer subtle. With a quiet corruption of Avedis Donabedian’s classic framework—structure, process, and outcome—chiropractic leaders instead sold belief, structure, and certainty. And certainty, I learned, is a remarkably precious commodity in chiropractic world.
Indeed, one of the central problems with chiropractic is its frank comfort with ignoring evidence in favor of belief systems that “just make sense.” Plausibility substitutes for proof. Confidence substitutes for outcomes.
In practice, chiropractic operates at two largely disconnected levels of knowledge. At the top sit researchers, faculty, and administrators—those who define the profession’s identity—yet who typically know very little about the day-to-day realities of practice. At the bottom are practicing chiropractors, submerged in diagnosis codes, billing rules, collections, hiring and firing staff, training front-desk help, negotiating with insurers, and keeping the lights on.
The irony in all that is that the most influential voices shaping chiropractic practice are almost entirely those who do not practice. These are the “paycheck chiropractors,” whose authority is inversely related to their proximity to the trenches. They do not argue with insurers. They do not explain denied claims. They do not rehire front-desk staff every six months. Yet this has never impaired their confidence in advising clinicians how to act, what to treat, and what to expect from every imaginable or unimaginable combination of symptoms.
Practicing chiropractors, for their part, are remarkably comfortable with this arrangement. When things wobble or fail, blame flows inward. The practitioner assumes personal deficiency: insufficient belief, insufficient technique, insufficient commitment. It functions like a built-in self-protection virus for the profession—very convenient for avoiding collective accountability.
This arrangement is also useful when graduates eventually notice three inconvenient facts:
- There are few jobs.
- There is no meaningful referral network within medicine.
- Fifty years of accumulating studies have failed to make a compelling case for chiropractic’s widespread clinical utility.
Chiropractic does not compete well with medicine—or even with itself. When studied carefully, its apparent effectiveness dissolves into non-specific factors: expectation, attention, ritual, and natural history. When chiropractic researchers properly control for placebo and natural recovery, the specific effect of spinal manipulation reliably shrinks or disappears altogether. Paradoxically, better science makes chiropractic look worse.
Structurally, the profession is a two-tiered, one-directional system that rarely improves, because the real problems are invisible at the top and permanently personalized at the bottom. Some leaders continue selling early-20th-century dogma, steering chiropractic safely away from medicine by avoiding diagnosis and disease altogether.
When a profession cannot hear its own failures, cannot correct its own assumptions, and cannot tolerate honest uncertainty, leaving stops feeling like betrayal and starts feeling like hygiene.
At some point, the pattern became impossible to ignore. When a profession cannot hear its own failures, cannot correct its own assumptions, and cannot tolerate honest uncertainty, leaving stops feeling like betrayal and starts feeling like hygiene. That was when I knew I was done.
Many of my former classmates reached the same conclusion, some more quickly than I did. Privately, several admitted that much of what we had been taught was baloney. They were not amused. A $200,000–$400,000 investment over four years had produced clinicians who knew just enough medicine to realize how little they could safely treat. The coping mechanism was predictable: at least we help 50 percent of patients—better than nothing.
Some eventually realized that 50 percent accuracy in a two-outcome probability space is not success at all.
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