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The conflict among chiropractors has become more consequential as the Delta variant of the coronavirus spreads and the rate of new vaccinations slows.
Anyone who listened to the Idaho chiropractor Steven Baker’s podcast in May would have heard a cornucopia of misinformation about the coronavirus and the vaccines protecting hundreds of millions of people against it.
In an episode titled “Are the ‘Vaccinated’ People Dangerous?” (they aren’t), he claimed that scientists had never identified the whole virus (they have), that the vaccines turned people into “modern-day zombies” who spewed spike proteins in every breath and body fluid (they don’t), and that vaccinated people could disrupt the menstrual cycles of women around them (they can’t).
So, Dr. Baker said, he had a new policy: If any patients made “what I would consider a horribly poor decision to go get this shot,” he would not allow them inside his office for 30 days.
Dr. Baker, who didn’t respond to a request for comment, doesn’t represent all chiropractors, many of whom support vaccinations. But he is among a vocal cadre who have promoted doubts about the coronavirus vaccines online and in their clinics and, in the process, exposed a longstanding split within the profession.
On one side are people like him, who dismiss the overwhelming medical consensus that the vaccines are effective and safe. These chiropractors closely follow the ideas espoused more than a century ago by the profession’s founder, Daniel David Palmer, who rejected germ theory and believed that diseases were caused by spinal misalignments called subluxations that disrupted an innate life force.
The chiropractic profession, which involves adjustment of the spine through manual manipulation and is sometimes just called chiropractic, “emerged from this vitalistic, almost supernatural idea of healing,” said Timothy Caulfield, the Canada research chair in health law and policy at the University of Alberta. “It’s difficult for them to escape their roots, and I think that’s one of the reasons that so many people continue to be attracted to chiropractic who are more likely to be vaccination hesitant, and why so many chiropractic practitioners are in fact vaccination hesitant.”
On the other side are chiropractors who have called on their peers to encourage vaccination as recommended by the Centers for Disease Control and Prevention and other medical authorities. In a 2013 paper in the Journal of the Canadian Chiropractic Association, for example, four chiropractors wrote that by recommending vaccines “as clinically indicated, the chiropractic profession would promote the public good and, by doing so, would be in a better position to be embraced by the broader health care community.”
That paper, said one of its authors, Brian Gleberzon, a professor at Canadian Memorial Chiropractic College, “is still relevant.”
As the Delta variant of the coronavirus spreads and the rate of new vaccinations slows, the conflict within the profession has become more consequential. The United States is administering about 530,000 doses per day on average — compared with a peak of more than three million in April — and while case numbers are low nationally, they are spiking in states like Missouri and Arkansas, where vaccination rates are lagging.
Many fields of alternative medicine are home to anti-vaccination sentiment, but chiropractic is one of the most popular of those fields, and its tensions are more in the open. More than 35 million Americans visit a chiropractor each year, according to the American Chiropractic Association. And even though chiropractors aren’t required to receive specialized training in infectious diseases — they must attend chiropractic school, not medical school — many patients look to them for medical advice.
Professor Caulfield’s research has found that people who are attracted to alternative therapies like chiropractic are “also the people who are likely to be susceptible to misinformation,” he said. “If you’re open to alternative medicine, you’re also more likely to be attracted to anti-vaccination rhetoric, so the ideas cluster.”
Annette Bernat, a spokeswoman for the American Chiropractic Association, said the group encouraged members to follow C.D.C. guidance on Covid-19 prevention and supported “evidence-informed care and generally accepted best practices based on current, high-quality research,” but had no stance on vaccines.
But several state organizations said it could be appropriate for chiropractors to weigh in on vaccinations or other medical issues outside their scope of practice.
The Arizona Association of Chiropractic — one of 11 reached for this article — said individual chiropractors were free “to make their own decision with regard to the efficacy of vaccinations.”
Speaking for himself and not on behalf of the organization, James Bogash, a board member, argued that vaccination should be an individual choice based on risk tolerance and said scientists could not yet know the vaccines’ long-term effects.
Mr. Bogash also expressed frustration “that prior Covid infection is completely not part of the discussion, despite every evidence to support the fact that natural immunity is stronger and longer lasting than acquired immunity.” (Research indicates that the vaccines are likely to create stronger and more reliable immunity, particularly against variants.)
Without mentioning vaccines, Dawn Benton, executive vice president of the California Chiropractic Association, said chiropractors were “well trained in the recognition of conditions that are outside of our scope so that we can determine when a patient is best treated in our office or by another health care professional.”
“Given our training,” she said, “there are times when a doctor of chiropractic can appropriately comment on many medical topics, and we leave the decision on that up to each individual doctor of chiropractic and the regulations they practice under.”
Only two of the 11 organizations reached — the Delaware Chiropractic Society and the Washington State Chiropractic Association — said directly that chiropractors should refer patients to medical doctors for questions on medical subjects.
“Providing clinical advice on out-of-scope topics would violate numerous statutes and regulations governing health care licensees,” said Jeff Curwen, the executive director of the Washington association. “Chiropractors can and should discuss with their patients how nonchiropractic treatments may affect their chiropractic care, but they should always refer those patients to the appropriate provider type for specific answers to out-of-scope questions.”
Some practitioners, though, have shared inaccurate or unsourced information without prompting.
On his website, Greg Werner, a chiropractor in New York City and Westchester County, N.Y., claims that there is no proof vaccines work and that germ theory “doesn’t exist” because “if it did EVERYONE would be sick ALL the time.” (He declined an interview request.)
A New Jersey chiropractor, J. Zimmerman, has routinely cited figures on his blog from the Vaccine Adverse Event Reporting System — a federal database to which anyone can report health problems after vaccination — and suggested that vaccines caused the problems reported. He did not mention the C.D.C.’s disclaimer — “A report to VAERS does not mean that the vaccine caused the adverse event, only that the adverse event occurred some time after vaccination” — in his posts until after The New York Times emailed him questions about his use of VAERS.
Dr. Zimmerman did not answer those questions.
Sean B. Carroll, vice president for science education at the Howard Hughes Medical Institute and a professor of biology at the University of Maryland, wrote in Scientific American in November that the chiropractic arguments against vaccines reminded him of arguments against evolution.
He identified six tactics, the first five being “doubt the science,” “question scientists’ motives and integrity,” “magnify disagreements among scientists and cite gadflies as authorities,” “exaggerate potential harm” and “appeal to personal freedom.”
People challenged on one front, he said, typically shift to another. And if all else fails, he said, they turn to the sixth: “Reject whatever would repudiate a key philosophy.”
It is because of this pattern that pro-vaccine chiropractors’ voices are essential, Dr. Carroll said: Just as he cannot persuade creationists to accept evolution but clergy members sometimes can, chiropractors may be able to persuade their colleagues to accept vaccines where scientists can’t.
“Outsiders are suspect, and they’re pretty much disregarded on the face of things,” he said. “Always the best way is that somebody from the in-group, or some group from the in-group, says, ‘We think differently.’”