We Get Letters & E-Mail

"The Medical Establishment Does Not Even Have a Clue about Back Problems"

Dear Editor:

In the March 8, 1999 issue of Dynamic Chiropractic, Robert Cooperstein,DC, reported on the proceedings of the American Back Society meeting just concluded.

I really do not want to be confrontational, but the medical establishment does not even have a clue about back problems. They dance and dart like a subatomic particle from theory (or better yet, thought) to theory, but are floundering because they have no basic concepts upon which to build.

One ray of hope, though, was radiated by Vladimir Janda,MD, when he pronounced the definition of the subluxation complex: "Muscle imbalance results in altered joint mechanics, limited ROM and hypermobility, altered proprioceptive input, impaired reciprocal innervation and altered programming of the CNS." Medicine/physical therapy attempt to remedy this by directly working on the muscles, while chiropractic accomplishes this through the joint adjustment.

But before Dr. Janda spends time and money trying to reinvent the wheel, he might simply read David Seaman's excellent book Chiropractic and Pain Control.¹ It says it all. Yes, chiropractic has been saying for years what Dr. Janda just discovered, and in this instance we do have the answers, though they won't be accepted until a million dollar study is published in The New England Journal of Medicine.

I wish that the heads of our chiropractic institutes would also read the book. It has been a time since I was in college, but are we still teaching the pinched nerve theory? We had better modernize our conception of what we do if we are to gain any kind of recognition and professional acceptance.

We have to intellectually justify just why maintenance care is justified, and why people don't get better after six treatments. Otherwise, the proliferation of "studies" now flooding the market will kill us: the structural approach ("Look, there's your subluxation on this x-ray photo"); the bone-out-of-place explanation; the pinched nerve theory; and yes, the ruptured disc phenomena -- they're just giving the medical skeptics fuel for the fire.

Reference

1. Seaman DR. Chiropractic and Pain Control. Drs. Systems, 1996.

Clifford H. Morris,JD,DC
Hengelo, The Netherlands

Dear Editor:

In your May 3, 1999 issue was the article "Survey of HMOs Finds Greater Alternative Care Access." The survey was published by Landmark Healthcare of Sacramento, California.

This is the same Landmark Healthcare that wanted me to sign a "chiropractic participation attestation" to become a provider that included the following non-chiropractic principles:

A. Treatment of nonmusculoskeletal conditions is not covered or approved. Examples of nonmusculoskeletal conditions may include (but are not limited to) asthma, allergies, earaches, organ dysfunction, heart or lung problems, gastrointestinal conditions, genitourinary problems, cancer, diabetes, etc.

B. Some adjustive techniques are not accepted by Landmark Healthcare, such as applied kinesiology.

C. X-rays are taken solely for the purpose of evaluating subluxation for technique purposes.

D. I was not to advise patients against child immunization or providing patients with literature advising against child immunization.

I wrote to Landmark informing them that I wouldn't be signing the scope of practice attestation. I didn't go to chiropractic school and graduate school in nutrition to have my practice limited to such a degree by an HMO that supposedly supports alternative health care.

I was shocked when I spoke to one of the "clinical reviewers" at Landmark who was a chiropractor. He informed me that he supports all the practice attestations. I told him that he should go back to chiropractic school to learn what chiropractic health care is all about, because it certainly was not in Landmark's scope of practice attestation.

I find it unbelievable that a chiropractor would sign an agreement. I always thought that alternative health care was to seek out alternative treatments from the conventional medical model.

It is very sad that our profession is losing sight of what made it great: helping people get well naturally for both musculoskeletal and nonmusculoskeletal conditions.

Stephen Renick,MS,DC
North Salem, New York

Dear Editor:

Dr. Liebenson talks about disability and chronicity, and also talks about Waddell's biopsychosocial model (see the May 3rd issue). This model talks about the necessity to engage the patient in a different strategy, avoiding a passive approach and encouraging the patient to stay active. Liebenson talks about how the traditional medical or orthopedic approach overprescribes passive approaches. The medical diagnosis emphasizes factors which can be seen on imaging views, such as degenerative arthritis or herniated or bulged discs. I completely agree that this is a major problem with the medical approach.

It is also important to note that we as chiropractors are often guilty of the same thing. We take x-rays and emphasize the misalignments, reversed curves and DJD that we see on the film. We then tell the patient that the answer is in a series of adjustments, a passive therapy. The practice management folk teach us to emphasize the chronic aspect of the patient's problem.

How many of our patients, from either what we told them or what their MD told them, are walking around thinking of themselves as having a "herniated disc" or "arthritic back"? Does this self-image enhance healing or encourage dependency and sickness behavior?

We need to emphasize in our reports to our patients the distinction between their anatomical problems and the fixable problems they have. We need to show them what they can do to help themselves via strengthening, stretching, staying active and changing their ways of moving and lifting. If doctors don't know how to rehab. patients, they need to learn. This is a basic chiropractic skill. We need to talk about the subluxation complex as a correctable entity, something that our adjustments can correct, especially if they will help change the muscle function around the area. We need to encourage them to get back quickly to the physical activities that they enjoy. We need to see our roles as allowing and encouraging our patients to get "back into life." Thank you, Dr. Liebenson, for all your work in teaching us as chiropractors, to emphasize an active approach.

Marc Heller,DC
Ashland, Oregon

Dear Editor:

It is about time that AK is exposed for the pseudoscience that it really is. I enjoyed your article in the 6-14-99 issue of DC. If chiropractic ever wants to fully move into the mainstream it must clean the chaff and quackery from our profession. It is with concern and consternation that I admit that the profession that I love has so much pseudoscience. Our colleges are guilty of helping to promote the quagmire that is trying to suck the good attributes of chiropractic beneath the surface resulting in the demise of the entire profession.

Thank you for this small amount of exposure, hopefully more articles will come until the monster is destroyed.

Brad Dopps,DC
Wichita, Kansas

Dear Editor:

Dr. John McDaniel's thoughts that AK should be abandoned due to lack of research or supportive evidence brought back memories of when I was in school at National. The medical profession was saying that chiropractic should be "abandoned" because there was no scientific evidence that it worked. Seems like what goes around comes around.

Bruce Born,BA,DC
Southfield, Michigan