While sifting through the annals of research evidence, I was taken aback by what appears to be a new classification (or at least a terminology) pertaining to medical evidence that appeared recently in JAMA. Citing the recent Institute of Medicine [IOM] report concerning medical errors,1 built largely upon years of survey results at American hospitals by Lucien Leape,2 McDonald and his co-authors lament the "hot and shrill" element of the message emerging from this report.3 Hot and shrill? Sounds more like a withering dinner table putdown of a brassy relative who happens to make a living doing nightclub routines in Las Vegas!
This terminology owes itself to the authors' contention that the IOM report "shouts" about the 44,000-98,000 death and disability rates quoted annually. Should these figures have been "whispered" instead? The point is, preventable death rates in U.S. hospitals are no laughing matter, regardless of whatever volume setting may have been used to transmit the data. To allude to irritations to our auditory systems and thermo-receptors caused by the report seems a bit like trying to kill the messenger, throwing up a smokescreen, or both. I would rather contend that the "grating" characteristic of the IOM document is the emblem of true success-that the report has indeed found its mark.
The authors' argument is built upon the premise that most patients admitted to hospitals have high disease burdens and are high death risks even before they enter the hospital; that those patients selected for chart review in the Harvard Medical Practice Study (on which much of the IOM Report was based) were a high severity group and would of course reflect a higher mortality.2 What McDonald and his co-authors overlook is that [i] the screened group contained many patients who were not very sick at all; [ii] a large proportion of the patients in the MPS sample who were severely ill, had complicated conditions, or who were admitted for planned terminal care were not included at all; [iii] adverse medical events occurring outside the hospital (including the six percent of events discovered after discharge) were excluded; and [iv] patient death and disability figures gleaned from actual prospective studies dwarf those indicated by the large record-review studies.4,5
To set the record straight, the points are simply the following:
In a study of patients lost to acute myocardial infarction, pneumonia, or cerebrovascular accidents (conditions found to account for 36 percent of all hospital deaths,6 percent were deemed preventable.7
The indignation comes, of course, when you look at the figures of safety in spinal manipulation, the untoward events of which are often lambasted mercilessly across the media. Even though the going death rate from neurological complications from cervical manipulation, most recently estimated at 0.3 per million manipulations,13 is a figure that the chiropractic profession strives to improve upon, it is absurdly low when compared to death rates 400 times greater from GI bleeding due to the use of NSAIDs14 or 700 times greater due to spinal surgery.15,16 Or when compared to the following death rates reported in the past from such lifestyle activities as: 1/200 from cigarette smoking, 1/100,000 from canoeing, 1/5,900 from automobile driving in the United Kingdom, or 1/25,000 from playing soccer or football.17
"Hot and shrill" are the words that I would use to describe my reaction to the inequities of media coverage of the risk factors stated above. "Hot and shrill" should also describe the public response to the present quality of American health care. In a recent ranking of quality of health care, the United States ranked 37th in a list of 191-while France, Italy, San Mariono, Andorra, Malta, Singapore, Spain, Oman, Austria and Japan ranked in the top 10. Add to this the fact that the United States spends an estimated $3,724 per person on healthcare each year, compared to almost half that in France and less than half that figure in Japan (which is ranked #1 in the length of life lived in good health). Perhaps the problem is best summed up by the remarks of a Princeton health economist Uwe Reinhardt, who indicates that "while good at expensive, heroic care, Americans are very poor at the low-cost preventive care that keep Europeans healthy."18
Considering this wake-up call of an assessment, a better invitation for chiropractic research and practice could not be found. This is the entire approach to health care that chiropractic has embraced for decades, now producing reverberations in the alternative healthcare movement worldwide. The point is to be able to fund this research and then to be certain that it is conveyed, digested and understood by the proper parties. Shouldn't the tone of my entreaty be "hot and shrill"?
References
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
