Hi, I'm Wendy Zuckerman and you're listening to Science Versus. This is the show that pits facts against... Oh... Ah, the satisfying sound of a back being cracked. Cause today on the show, Tire of Practice... Are they legit? BAD BAD BAD BAD BAD Millions of people have back and neck pain, and it can be pretty hard to treat. There are drugs that can help, but they can also have some pretty nasty side effects. And so people are desperately looking for other solutions. Like going to the Cairo. Around one in ten adult Americans went to the Cairo in 2022, mostly for pain. That's according to the National Institutes of Health. And of course, it's not just Americans going to the Cairo Practor. Several years ago, producer Caitlin Sory called up her parents, who are big fads of going to the Cairo. Katie, how is New York going? It's good. So you still ride your bike to work? Yeah, I do. Don't worry, I'm safe. Your mother is worried. Katie's mum is Chris and her dad is Bill. And the whole Sory family had been going to the Cairo for years. So Katie, tell us all about it. Yeah, so my parents have been going to the Cairo for ages, and I actually didn't know about this until we called them up to talk to them about it. But I was actually taken to the Cairo Practor as a newborn baby. Wait, why did they want to take you to the Cairo? Because my delivery, my birth was really rough. They had to really yank me out. And so the idea was that maybe my bones were misaligned, so they wanted to take me to the Cairo Practor to see if it could help. Yeah, because you had such a traumatic birth. You know, like, you had huge marks around your face with the force of the Crabget Ticks. So you didn't look too terrific for the first few days because of that. And mum says visiting the Cairo seemed to be good for me. I slept better. And so when my brothers were born, they were also taken off to the Cairo. And my parents still go for neck and back pain. Dad has smashed himself a fair bit over the years. So I've fallen out of the tree. I've fallen off motorbike. Yeah, dad's been thrown off a motorbike. He's fallen off the ladder. So the Cairo makes him feel better, same with mum. My muscles feel a lot more relaxed and my neck feels like it's not so grindy. It's the best way to describe it. Wait, so do you remember going as a kid? Yeah, so the whole family, we went right up until I was 18, all five of us, every six weeks or so. Okay, so I've never been to a Cairo. What do they actually do when you get in there? Yeah, so the main thing that Cairo's doing is this thing called spinal manipulation. So they're basically checking your spine, all the little segments in your spine to see if anything's out of place. And then they're popping it back into place. And they can use a little tool or they can use their hands, but it's a quick thrust. It's not like a massage where you're needing, needing your back. It's like pop back into place. Anyway, it was just the thing the whole family did. We'd skip out happy little veg once. We were happy little veggie mites coming out of the Chi-Fractors office. It's an Aussie thing. So is this thing that we did throughout my childhood? Total BS. So tell us about the science. Come on. Because not everyone out there reckons that going to the Cairo will make you a happy little veggie might. People on social media have been calling them out for being dangerous, for having a strange mystic history. And they're really starting to question whether this is legitimate medicine or a scam. Why am I only just learning that Cairopractors are not real doctors? Yeah. Letting a Cairo-Practor touch your neck is a threat to your life. I don't believe in Cairopractors at all. I think it's 98% horses. We at Science Verses first looked into the science of Cairopractors several years ago. But we've cracked open this episode once more, updated the research. And today we are going to find out. One, can Cairo's help your back and neck pain? Two, should you take your baby Katie to the Cairo? And three, what are the risks here? When it comes to Cairopractors, there's a lot of happy little vegie ones. But then there's science. Science Verses Cairopractors is coming up. Welcome back. Today we've got a cracking episode for you. We are looking at where the Cairopractic can help treat pain. And yes, Cairopractic. It sounds like an adjective, but it's actually a noun. It bothers us too. But moving on. So, why did Cairopractors think they could help little baby Katie and everyone else in her family too? Well, it turns out that you can trace it back to one guy who lived in Iowa more than a hundred years ago. And to get this story, we spoke to Cairopractic royalty. Carl S. Cleveland III. Yes, Carl comes from a long line of Cairopractors. My great grandmother was a Cairopractor. My grandfather and grandmother were Cairopractors. And my mother and father were Cairopractors as a child. I thought everybody grew up to be a Cairopractor. And he's the president of Cleveland University, Kansas City, which was founded as a Cairopractic college. In fact, his family started it. And so, Carl told us about the birth of Cairopractic. It began with a man called D.D. Palmer. He was Canadian, appeared to be a stocky man, had a full beard. D.D. Palmer was a magnetic healer in the late 1800s. So, he thought he had a personal excess of magnetic energy that he could channel through his fingers to treat people. It was a thing back then. But something changed for D.D. Palmer. And soon he would switch from magnetic healing to back cracking. Here's basically how the legend goes. D.D. Palmer met this janitor who was hard of hearing and also had a hump on his back. And D.D. Palmer thought he could help. So, he pushed the janitor's back with a big thrust. And a few days later, the guy came back with some very curious news. Saying, Mr. Palmer, I hear the racket of the wagons in the street. A new profession was born. And D.D. Palmer named it Cairopractic, meaning in Greek, a practice done by hand. And Palmer then thought he found a cure for deafness. Put out a sign, D.D. Palmer healed of the deaf. Soon, D.D. shifted away from just curing deafness by manipulating spines. He now wanted to cure practically everything. And this brings us to the theory behind Cairopractic. Basically, D.D. Palmer started to think that the spine was the key to health. And he is what he thought was going on. D.D. believed that there was energy flowing through the spine to keep us healthy. It was a spiritual man. And he saw that when spinal joints didn't move right, and that that in some way obstructed the flow of nerve energy and life force through those nerves to the body parts. That is, he reckoned that these kind of blockages in the spine, or what he called subluxations, could make you sick by interfering with that mystical energy. At other times, he said those subluxations tweaked people's nerves. D.D. ultimately thought that 95% of diseases were the result of subluxations. And in fact, he wrote that it was unjust to blame germs for disease. And today, D.D. Palmer's term subluxation is still used by a lot of Cairo's. The word means slightly different things to different Cairo practice. For Carl, a subluxation is basically a joint that doesn't move properly. And that could result in pathological changes that affect nerves, muscles, ligaments, the vascular tissue in the areas, well as the connective tissue. And some other Cairo's even say that this could lead to things like asthma and high blood pressure. For Carl, he reckons that people need to visit the Cairo, not just when something saw, but for regular checkups, kind of like how you go to the dentist. A periodic spinal checkup to maintain posture, to maintain function and mobility of those joints. We think that's important. Despite the mystical origins of Cairo practice, it is actually starting to get some real cred. In fact, in the US, Medicare, the Federal Health Insurance Program, covers the Cairo-Practic Treatment of Subluxation. And in 2017, in the search for better ways to fight back pain, the American College of Physicians included spinal manipulation on their list of suggested treatments. Which brings us to this question of how good is the evidence that Cairo's can help you treat your pain. And specifically, let's look at back in neck pain, which is why most people go to the Cairo. To get some answers, we called up Anita Gross, a physical therapist and researcher who specialises in neck and back pain at McMaster University in Canada. Hello, how are you? Several years ago, Anita and her team come through almost 40 trials looking into where the spinal manipulation, the thing that Cairo's do, can actually help with neck pain. And a lot of what she found were crappy trials. So for example, many of them were small, often involving no more than 30 people. And by the way, in science, you don't officially call these studies crappy. Instead, you call them low quality. Low quality actually is not the worst. The worst is very low quality. So low quality, believe it or not, has a little bit of hope in it. And she did find some hope. Anita found that for people who had multiple sessions with a Cairo, well, they actually did tend to have less pain in their neck. And one of the studies she looked at even compared spinal manipulation to conventional medication, like taking anti-inflammatory drugs, muscle relaxants, and even opioids. And it ultimately found that going to the Cairo turned out to be more helpful than drugs. That is, after a year, the people going to the Cairo Bractor had less pain than those who are on the meds. Now, we do need more data here to see if this holds up. But for now, it sounds pretty impressive. So the studies are showing that spinal manipulation actually does help. It's valuable, yeah. And just this year, in 2025, another review on whether spinal manipulation helps neck pain came out. And ultimately, they found the same thing. Low quality evidence that, for some people, it helps. So those were studies in neck pain. And then when you look at back pain, the research is pretty similar. So again, we don't have great studies, but what we do have suggests that spinal manipulation can help. And when patients walk through a need a store, she'll sometimes give spinal manipulation a go. So it's something that I use clinically in my own practice. Since you do these big reviews and you find that there's low quality evidence that it helps, how come you give it to your patients? To do nothing with your patients isn't of any value either. You're getting them better in their everyday life, their function and being able to actually do their activities. Ultimately, Anita says that mainstream medicine just doesn't have a lot of great options for treating this kind of pain. And so spinal manipulation is sometimes useful. And she did point out that she typically doesn't just use spinal manipulation on its own. She also likes to combine it with these other exercises that can help make people stronger and move their bodies better. So going to the chiro might help you with pain along your spine. But some chiro's reckon that it should be used for way more than that. And one of the most controversial claims is that even kids should be going to the chiro. The American Chiropractic Association openly encourages this. And according to the National Institutes of Health, chiropractic is one of the most common forms of non-traditional medicine used in kids in the US, which takes us back to little baby Katie getting her tiny little spine aligned. Can you describe how they did it? Like what was what was actually happening? Kind of just message your head and then they they would just lift you up by your ankles and just swing you but just really gently, really, really gently. And then just lay you back down again. I'm so nervous for me in retrospect. They'd recommended I did that every day, which I did for about three months, I think. And then why did you stop at three months? Because you get a bit heavy and I was like, hmm, this is not good. And recently there's been quite a bit of controversy about taking kids to the chiro. A few years ago, a video of an Australian chiropractor holding a baby up from its ankles and using a tool to manipulate its spine started making the rounds on social media and in the news. A two week old baby swarms as he's dangled upside down before a spring loaded instrument is used to prod the newborns neck. We're going to come into here. The video sparked widespread condemnation, particularly from the medical community. If I had a child in this age group right now, I would not let this happen to them. It caused such a scare that Australia temporarily banned spinal manipulation in kids while experts tried to figure out what the hell was going on here. They ultimately came to the conclusion that there just isn't any good evidence that supports taking your kids to the chiro. And while they pointed out that really scary outcomes from doing this are very rare. They still didn't think it was worth the risk. And right now in Australia, there is a ban on kids under two going to the chiro. And it's not just Australia that's having this conversation. And international team of researchers, including Anita Gross, recently did this big review looking at chiropractic treatments for kids on a bunch of conditions from asthma to autism to breastfeeding difficulties, excessive crying, bed wetting. And ultimately concluded that there is, quote, no good evidence to explicitly support the effectiveness of spinal manipulation or mobilization for any condition in pediatric populations. End quote. And when I ask Carl about that study, he acknowledged that when it comes to kids in chiro, the research is not there. Currently, there's insufficient research to either support or refute the use of manual therapy in children. But if there's limited evidence that chiropractic can help, why would you take your child to a chiropractor for those things? Because those patients respond to care. And I think it's a matter of time before we have formal evidence. But from a practical standpoint, where the satisfied patient that sees the child that is pain free, that's improvement. It's just a period of time before those studies, in my opinion, that those studies will be completed. So it's also possible that in the future, as we do clinical trials, those trials will show that it doesn't help. That's a possibility. This is an area where we require additional research. Carl told us that since the risks for children are low, and if chiro's are doing this gentle manipulation, the risks are low. And since Carl told us that a lot of parents report being happy with the chiro they get for their kids, he reckons there's still a role for chiropractic kids. But we spoke to Katie's parents about the research here. Do you want the science on the kids? Do you want to know that? Yeah, it's pretty much there's pretty much no good sides that it works for anything when it comes to kids. We've got soccer. What did your dad just say? He said they got sucked in. They just trusted the chiropractor. Back in the day, everyone was going. So like everyone was the same sort of thing. So we didn't question as much. It feels a little bit like your sort of sucked into this vortex almost of believing everything they say. After the break, we go further into the vortex. Today's AI Bites is brought to you by ServiceNow. AI is only as powerful as a platform it's built into. That's why it's no surprise that more than 85% of the Fortune 500 used the ServiceNow AI platform. While other platforms duct tape tools together, ServiceNow seamlessly unifies people, data, workflows, and AI connecting every corner of your business. And with AI agents working together autonomously, anyone in any department can focus on the work that matters most. Learn how ServiceNow puts AI to work for people at ServiceNow.com. Now we go to AI Bites. Our segment about the way scientists are using AI in their work. Dr. Ryan Carney from the University of South Florida is using AI to improve our surveillance of mosquitoes that carry diseases. It is actually the mosquito that is the deadliest animal on the planet. Especially because of malaria, which every year kills over half a million people. But Ryan says not all mosquitoes are equal. Only some species are known to transmit malaria. And one of them that's particularly good at it is called the Anopheles Steven Sy. Not only does Anopheles Steven Sy really thrive in urban places, but it's also resistant to insecticides and temperature extremes. Anopheles Steven Sy is the perfect malaria supervellen. And this mosquito has been spreading. It's needed to South Asia and the Arabian Peninsula, but it's been popping up in parts of Africa. So scientists like Ryan have been trying to keep track of it. And one way they do this is through citizen science apps. These are apps where people post photos of animals or bugs or other stuff they see in nature. But it can be hard to identify mosquitoes from just a photo and the naked eye. Like Ryan's colleague came across an old photo of a mosquito larva taking in Madagascar. They suspected it was anopheles Steven Sy, but there have been no recorded sightings of it there before. Plus, multiple entomologists couldn't identify the photo to species. And since the specimen was long gone, it was AI to the rescue. AI was really our only hope of cracking the case. So Ryan and his team started training an AI by feeding at thousands of confirmed photos of the Anopheles Steven Sy. Where we'll flip and rotate and modify the images as well to give some variability to the data set. And then the algorithm essentially figures out what the features or patterns are that are tied to each species. So basically says, okay, this image is classified as anopheles Steven Sy. These are the pixels that were most important in making that prediction. And the AI did end up identifying pixels unique to the species. Like one area that really stood out were these tiny dots in the male larvae, which turned out to be pigmented testes. And while with the final models, Ryan's team identified the mystery larva as very likely to be anopheles Steven Sy, which they say would be the first detection of the species and Madagascar. Now we have our artificial intelligence algorithms running on a daily basis for all of this citizen science platforms looking for any potential Steven Sy that may come up. They hope that finding more of these mosquitoes will help activate malaria prevention efforts and ultimately save lives. That is the goal. That is exactly what we're trying to do. Once again, today's AIBites was brought to you by ServiceNow. Learn how ServiceNow puts AI to work for people at ServiceNow.com. Welcome back. So today we're talking about chiropractors and this thing they do called spinal manipulation. And we just heard that it may help with back and neck pain, but there's no good science behind taking kids to the chiro. Now we're going to dive right into the core beliefs of chiropractic to see if the idea of spinal manipulation holds up. Now a lot of people might have heard about a spine being out of alignment or misaligned and that's why you go to the chiro. But what exactly is a misaligned spine? Well, to understand that, we have to go back to old Iowa. Did he parmer the guy who came up with chiropractic thought that a lot of our health issues could be traced back to a misaligned spine? And the thing that was making your spine misaligned was what he called subluxations. Now at one point he thought these subluxations could block a mystical force that flowed through the spine causing disease. Now that's clearly not science. But did he also had this theory that shifted a little but has basically stuck around today? And that is that subluxations are bones out of place or some say stiff joints that then squish against our nerves in some way, making us sick. And this could lead to things like asthma or high blood pressure. And now not every chiro thinks this way anymore, but a lot of them still do. A study of several hundred Canadian chiro's found that almost one in five thought fixing a subluxation was the key to health. The science behind it is not likely to come because the science behind it is simply not there. The belief system is entirely contrary to our knowledge of physics and chemistry and biology. That's Macello Costa. He was a professor of neurophysiology at Flinders University in Australia. And Macello says that there's no good evidence that problems with your spine out of blame for many of the diseases that some chiro's claim to fix. So let's take asthma, for example. We don't know exactly what causes asthma. It's been linked to genetics and immune reactions. But here's the important thing. We don't have any good evidence that manipulating the spine could have any effect on asthma. There's no bazaar whatsoever that it can cure asthma. That's a completely nonsense. There's no, not only there's no evidence that one can believe, but there's no reason whatsoever to assume that the manipulative in the spine will help the asthma of a young child. And so in the sense, there's a complete, there's a complete nonsense. And maybe this asthma thing is low hanging fruit. Like it kind of seems obvious that it's a bit bonkers. But Macello says that even if you just zoom out to this idea that a back could be misaligned and afflicted with subluxations, well, he says that even that concept is spineless. And the subluxations simply do not exist physically. They don't exist at all. They don't exist at all. You simply just tell you a complete thing. The fact that some of them believe this is even more worrying. And some of them actually don't believe it. And they want to ditch this idea of subluxations altogether. Several papers have now been written by chiro's acknowledging that there is no good evidence behind subluxation. One paper called it an untested hypothesis and said that it was like, quote, an albatross around our collective necks. End quote. Now, Macello says that there are clear-cut medical conditions that affect your spine. Like a slip disk, that's where the jelly-like stuff in between the bones of your spine push against the nerves. And this can hurt. But that's often not what chiro's are talking about when they talk about misalignments or subluxations. And Macello says that if you do have these conditions, you do really need a proper doctor and not a pseudo doctor. And if Macello sounds particularly narkey, it's because he hates that chiro's have this veneer of legitimacy around them. Like they call themselves doctors even though they don't have a medical degree. And so here's a kind of fun fact about chiropractors. A survey of more than a thousand chiro's found that one in four of them agreed with this statement. Quote, there is a lack of evidence from clinical trials to support most of the treatments I use in my practice. Yeah, one in four thought that. But still, there is evidence that going to a chiro might help you with back neck pain. But if chiro's aren't fixing subluxations, then what are they doing to help with your pain? Well, scientists aren't quite sure how spinal manipulation works. Research into this very question says that it could be that that sharp, thrust triggers a chain of events that might block pain receptors or it could reduce muscle tension or stiffness. And then there's another explanation that it's not to do with pain receptors or stiffness. But actually, it's just about someone taking care of you and from that, you're expecting to feel better. It's that thing we call the placebo effect. We put this to Bill and Chris, Katie's parents. Would it matter to you if it was placebo and it wasn't sort of aligning you back and, you know, whatever they say it might be? No, no, it's still go. Why? Why? Because it helps the pain, yeah. It's all about whether it feels good for you. That point, right? If it's making people feel better, what is the problem here? Well, there are some risks. And we talked about them with Anita Gross, the physical therapist from the Star of the Show, because while she was doing her big assessment on the evidence around chiropractic care and neck pain, she also looked at the risks here, because getting a spinal manipulation, particularly the kind that twists and cracks your neck, it does seem scary. And what Anita found is that sometimes people said that their neck pain actually got worse after a spinal manipulation. Other people would get headaches, nausea, or even dizziness. Here's Anita. The manipulation happens so quickly that, ah, you got that dizziness. Now, we don't know how often this happens because many studies actually don't record the side effects. Either way, those things that Anita talked about, they tend to go away on their own. But very rarely there are more serious problems that can happen. Bones can fracture, a twist or a push to the neck can actually dislodge a blood clot, or even cause a small tear in the artery. And there are cases where people have actually died. May was seeking treatment for what she said was just a pinch nerve. And less than a week later, she was dead. Several years ago, Katie May, a 34-year-old model, died soon after going to the chiro and her family blamed the treatment. This year, a report came out into another death after a 29-year-old woman died after a chiropractor adjusted her neck. Now, we didn't talk about those cases specifically with Anita, but she did tell us that this kind of thing, it's rare, really rare, but it can happen. Yeah, a young person between the age of 20 and 40 something goes, gets their neck manipulated, and then they die. Like, we've had a few cases like that. Oh my gosh. What are they dying of? From aneurysms or the vascular system just being torn in the neck, and then they get bleeds into their head. So what are the chances that this will happen to you if you go to the chiro? Some say that one out of every few million manipulations could lead to a death, others say it's more common, and some even question whether chiropractors caused these deaths or something else did. So when it comes to science versus chiropractors, does it stack up? Like a nice, healthy spine? Well, for people with back or neck pain, the research shows that getting a spinal adjustment from a chiropractor might help, but we don't really know why. As for taking your kids to the chiro, there's no good evidence that it will help them. And what about the whole point of chiro that our spines need to be aligned for our overall health? That subluxation thing. Well, there's no good evidence that it's real. And finally, this isn't a totally risk-free option. Very rare, but very serious consequences can occur from spinal manipulation. Bill Sory, Katie's dad, sees it this way. It's a bit like religion, you're going to filter out the bull wait, what did your dad just say? He said chiropractors are a bit like religion, you've got to filter out the bull. Bill Sory, I know. He's so sassy. That's science versus chiropractors. This episode has 137 citations in it. If you want to see them, go to our show notes and click on the link to the transcript. They're all there. If you want to get in touch with this, we'd love it if you want to say hello. Let us know what you thought of the episode. We're on Instagram, science underscore VS. I'm also on TikTok at Wendy Zuckerman. We interviewed Marcella Costa for this episode in 2017. We really appreciated his help and we just wanted to note that he died last year. This episode was produced by Rose Rimla with help from me, Wendy Zuckerman, Caitlin Sory, a Kelly Foster Keys, Shritty Revindran and Heather Rogers. We're edited by Blithe Tarell, back checking by Michelle Harris, sound designed by Martin Peralta and Bobby Lord, music written by Bobby Lord, recording help from Asher Griffith. For this episode, we also spoke to Dr. Richard Dayo, Professor Tim Merz, Professor Gregory Whitcomb, Dr. Adam Chiffoux and Julie Nack. Thank you for your insights. An extra big thanks to Rachel Ward, Emma Morgan Stern, Christina Sullivan, Jasmine Romero and VB Flanagan, as well as Alex Ward, Russell Greg, Fiona Crawl and Judy Dayo. Also a shout out to the Sories. Thank you, villain Chris. I'm Wendy Zuckerman, back to you next time. It's a new bike. It's a good one. It's got two brakes on it. Okay. That has nothing to do with cars that are colliding with you though, Caitlin. It doesn't matter the bike yet. It means I can stop more quickly. What about your helmet? Yep, new helmet. Okay, we're going to go. Well, you go, okay. Okay. Okay. I'll start with the old. Not.
