Abstract

Chiropractic is the largest "unorthodox" health profession in the United States. It is licensed in all 50 states and its services covered by governmental and private health insurance. Yet chiropractic remains, in the opinion of medical commentators, an unscientific healing cult. Chiropractic holds that much illness is caused, directly or indirectly, by derangements in homeostasis that result from subtle vertebral malalignments called "subluxations". Only a minority of "straight" chiropracters continue to provide spinal manipulation as their only treatment, while the majority "mixers" have embraced physical therapy, vitamin supplements and a wide variety of drugless symptomatic treatments. Clinical trials suggest that spinal manipulation has short-term benefit in back pain, but the success of chiropractic is not fully explained by that effect. The clinical art, though, as manifested in the chiropractor-patient interaction contributes greatly to chiropractic healing. This process promotes patient acceptance and validation, fulfills expectations, provides explanations and engages the patient's commitment. The same process lies at the core of the "art of medicine". Seeing the clinical art as it functions in chiropractic can help us to understand its independent power in medicine.