Teachable moments: why do useless treatments seem to work?

A chiropractor reached out today to suggest that I could be more inclusive in my views towards chiropractic adjustments. In his experiences, his patients do improve.

In his words, “people can practise how they want and still get results”.

Do I have something against spinal manipulation?

chiropractor singapore
People seem to forget I did offer chiropractic adjustments. Sure, my patients love it. Are they results spectacular? No. Here is the irony: Chiropractors who tell me their treatments “work” are often also those who sell 40 to 80-session packages.

I am fairly vocal against chiropractors in Singapore because they are largely unethical.

In the early days of COVID, local chiropractors did blog about adjustments boosting immunity, and therefore has a protective effect against COVID.

In my opinion, it was deceitful — intentional or otherwise. I am not alone this. In fact, the claims were worrisome enough for chiropractic STUDENTS to call for action against unsubstantiated claims.

COVID aside, many Singapore chiropractors claim to help with things like infantile colic, asthma, high blood pressure, period pain, and migraine. In their experiences, their patients do probably get better.

However, there is no research to support these claims.

Even chiropractors around the world agree. Late last year, 50 researchers (including many chiropractors) gathered in a global submit to conclude that chiropractic adjustments do not help with those conditions.

I don’t have anything against spinal adjustments. I am against treatments that are not supported by science.

Science does not care about your professional title.

Hierarchy of evidence pyramid showing the strongest studies to the weakest based on research design. “In my experience . . .” is not scientific evidence.

I like science because science gives us answers. It tells us what works versus what does not work beyond a “in my experience” argument.

I had written about how an orthopaedic surgeon was wrong about back pain and provided academic references to support my assertion.

I had written about how the articles on neck pain published by Singapore General Hospital‘s physiotherapy department are not aligned to the latest research.

You see, science allows us to evaluate claims beyond a “I am Dr xxx therefore I am right”.

Despite these articles having been online for years, nobody — not a single soul — had brought any studies to challenge my arguments.

Many had reached out to complain, yes.

But no, none sent me an actual study.

In my opinion, this is a problem.

Why do useless treatments seem to work?

If what chiropractors are doing to help people do indeed help people, why do we not see the same effects during clinical trials?

Chiropractic adjustment is not the only treatment with this problem. Knee surgeries have also been found to be no better than placebo.

(See, my beef is not against adjustments alone.)

Despite what research is telling us, why do some patients seem to get better?

Natural history of disease or regression to the mean.

This is why we encourage our patients to not chase pain. Improvements in pain could be due to many factors. Improvement in function is tangible and cannot be from mere passage of time.

Honestly, most pain do get better with the passage of time. This is why clinical trials are so important in determining true effects.

If patients who receive real chiropractic adjustments and patients who receive fake adjustments respond the same, it’s fair to say that the improvements aren’t a true effect.

People could get better by virtue of time. They could have received zero treatment and still improve.

Most people also tend to seek treatment when their pain is at its worst. With that, the normal trajectory then is for their pain to move towards its usual baseline (i.e., improve). This can also be viewed as as a regression to the mean.

Biases. Lots and lots of biases.

Because patients have already spent the money on the treatment, they often want it to work.

Confirmation bias occurs when patients seeks out evidence to suggest that they are better while ignoring other signs and symptoms.

You know when you want to buy an iPhone and you decide to Google “reasons to buy an iphone” without actually doing any research on reasons not to buy one? This is confirmation bias at play.

There’s nothing wrong with confirmation bias though. If it helps you improve and it helps you feel better, why not?

I have no issues with this.

My issue is when practitioners claim that their treatments work because their patients get better.

Your patient get better for a lot of reasons. It doesn’t need to be because your treatment work.

First, cure your ignorance.

chef cooking high pressure
Turn down the heat. Then increase your capacity. This was exactly what Chiara did to help herself with her recovery.

These are not my words. It is the title of a letter published last year by a patient with chronic pain.

Chiara experienced pain since she was 12. She tried massage, manipulation, acupuncture to no avail. MRIs and x-rays didn’t help either.

She ended up working with a psychologist to make sense of her pain. Her strategy then became to try to alleviate (not eliminate) some pain. Then become stronger than her pain.

In her words:

Exercise is an effective treatment for persistent pain. A sufficient intensity and dosage should be appropriately tailored to the patient’s profile.

Science, unsurprisingly, supports this!

Yes, you can practise however you want and still get results.

Yes, it is absolutely possible for patients to get better even if they receive ineffective treatments. For these patients, the improvements experienced is NOT specific to the treatment.

In that sense, they could have pretty much done anything else and still also got better.

In my opinion, again, this is not good enough.


Frustrated by the lack of results-driven and ethical chiropractic clinics in Singapore, Chiropractor Jesse Cai found Square One Active Recovery to deliver meaningful and sustainable pain solutions.

Our goal? To make our own services redundant to you.

*We do not offer temporary pain relief such as chiropractic adjustments, dry needling, or any form of soft tissue therapy.