More to Chiropractic Than Just Treating the Back
Dear Editor:
I read with interest the story, "Chronic Back Pain Sufferers Want Drug-Free Care," featured on the front page of your October 7, 2004 issue. I agree with the conclusion that chiropractic should be promoted as "crucial to maintaining overall health and well-being." However, there are several statements in the article that must be challenged.
It is claimed, "With the exception of upper respiratory infections, back pain is the most common reason people give for visiting a doctor's office." Waddell1 notes: "This has been repeated ad nauseum in the introduction of papers about back pain until it has become a kind of creed...It comes from an old paper by Cypress (1983), using data from 1977-1978 and questionable diagnostic coding. It gives a very false impression."
A 1995 study2 paints a very different picture. Data from the National Ambulatory Medical Care Survey ranked mechanical low back pain as the fifth leading reason for a physician visit. It trailed hypertension, pregnancy care, general medical exams and wellness care, and acute respiratory infections. Low back pain accounted for a mere 2.8 percent of office visits. Put another way, more patients saw a doctor for exams and wellness care than mechanical low back pain! Furthermore, a recent article in the New York Times3 listed back pain as the eighth leading reason for a medical visit.
Another concern is the statement that "four out of five American adults will suffer an incident of back pain at some point in their lives." This may lead the reader to conclude that 80 percent of the population should seek chiropractic care for back pain. It is essential to realize that this does not mean 80 percent of the adult population suffers from back pain at a given point in time.
According to data from a recent study at Duke University,4 roughly 13 percent of the adult population reported suffering from pain in either the low back or upper back. Previous authors have suggested higher numbers, but these were generally "best estimates."
Some chiropractic leaders have suggested that low back pain should be our point of entry into the health care system. They frequently base this opinion on the premise that there is sound, incontrovertible scientific evidence that chiropractic care represents a superior approach to low back pain. In actuality, the evidence is equivocal, at best. First, manipulative therapy is not synonymous with chiropractic care. A growing number of practitioners, particularly physical therapists and osteopathic physicians, are offering this service. While adjustment of vertebral subluxation is a unique service provided by chiropractors, spinal manipulative therapy is a "common domain" procedure.
In addition, the scientific evidence supporting manipulation as a treatment for low back pain is equivocal. A recent review1 sought "to resolve the discrepancies related to the use of spinal manipulative therapy and to update previous estimates of effectiveness, by comparing spinal manipulative therapy with other therapies and then incorporating data from recent high-quality randomized controlled trials."
What did these investigators conclude? "Spinal manipulative therapy had no statistically or clinically significant advantage over general practitioner care, analgesics, physical therapy, exercises, or back school...there is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low-back pain." And what of the claim that chiropractors offer more effective manipulative treatment for back pain than other providers? The authors note, "Profession of manipulator...did not affect these results."
Is it any wonder that we are losing market share by promoting the notion that our services have value only to persons suffering from a short list of spinal pain syndromes? If only 13 percent of the adult population suffers from back pain, and it accounts for a mere 2.8 percent of physician visits, is it any wonder that we are losing our market share in the health care industry? It should be clear that any strategy limited to promoting chiropractic care as a treatment for back pain is not only flawed philosophically, but also makes no sense based on the evidence available in 2004.
References
- Waddell G: The Back Pain Revolution, 2nd ed. Edinburgh: Churchill Livingstone, 2004.
- Hart LG, Deyo RA, Cherkin, DC. Physician office visits for low back pain. Frequency, clinical evaluation, and treatment patterns from a U.S. national survey. Spine 1995;20(1):11.
- Kolata G. Healing a bad back is often an effort in painful futility. New York Times, Feb. 9, 2004.
- What are the costs of treating low back pain? The Back Letter 2004;19(5):56. Based upon data from Luo X, Pietrobon R, Sun SX, et al. Estimates and patterns of direct health health care expenditures among individuals with back pain in the United States. Spine 2004;29(1):79-86.
- Assendelft WJ, Morton SC, Yu EI, et al. Spinal manipulative therapy for low back pain. Cochrane Database Sys Rev 2004;(1):CD000447.
Christopher Kent, DC
Ramsey, New Jersey
Where Has Professional Courtesy Gone?
Dear Editor:
Regarding Dr, Geoffrey Bove's letter about chiropractors charging other chiropractors for treatment [We Get Letters & E-Mail, Oct. 7, 2004 issue: www.chiroweb.com/archives/22/21/18.html] - there has always been a significant portion of our profession that will do anything for money, as is evidenced by the number of chiropractors who have forgone full-time practice to work for managed care, leaching off those of us still trying to run ethical full-time practices. I call them anything-for-a-buck chiropractors. Throughout my career, I have treated not only other DCs, but MDs also, free of charge. It is called professional courtesy. It is evident that professional courtesy, ethics and pride are in short supply in our profession.
John Brennan, DC
Oakdale, California
What If Shakespeare Had Poked Fun at Chiropractic?
Dear Editor:
On Sept. 27, 2004, an episode of "Two and a Half Men" aired on CBS. This is a 30-minute, weekly sitcom that stars Charlie Sheen and Jon Cryer. Mr. Cryer's character is somewhat neurotic, somewhat innocent, mostly recessive (weak?) and, oh yes, he is a chiropractor. OK, fine.
So far, the series has not managed to malign our profession - at least the episodes I've seen. However, last night's quickie laugh at the end of the show was subtly, yet markedly, detrimental in my eyes. Some 20 million viewers were witness to a poor cervical half manipulation that resulted in Dr. Alan Harper, DC, later writing a check to the patient who had to go see an orthopedist. Ouch. Double ouch.
I would like to know who the chiropractic consultant is on this show, if any. If so, why did they not have the fortitude to object to this schtick? Maybe they did. But why the poor adjustment on a guy's couch? Talk about parlor games.
At that moment, I would estimate 2 million potential chiropractic patients with neck aches consciously or subconsciously said, "no way" to our help. Now, granted, dentists, psychologists and proctologists get much razzing and are fodder for comedy writers. But it seems far more superficial and usually involves an obvious exaggeration. Comedy writers will tell us that what makes something funny is recognition and identification with the actor/content/actions on the screen - or the audience knowing something the characters know not. (Shakespeare was the original comedy writer.) This little "bit" in the last minute of the show was neither.
Some marketing and advertising specialists are spin doctors. They can put a positive spin on a bad event and garner more attention and popularity from the exposure. Can we doctors do the same with this? This was more than a site gag. It made me gag and sad. Maybe I should have just giggled along with the show's laugh track. And maybe I'm just being a poor sport.
Kirk Parge, DC, ABCO
Bayview, Idaho
The Problem With Poll Questions
Dear Editor:
Your poll asks, "Do you believe all ailments are related to spinal function?" [Editor's note: This question was featured on ChiroPoll (www.chiroweb.com/chiropoll) from Sept. 13-27, 2004. Results appeared in the Nov. 4, 2004 issue of DC, and are accessible online at www.chiroweb.com/chiropoll/04archive/9_13_04.html.] Having some familiarity with polling, it is common knowledge that the way a question is framed can skew the response. While I am aware of your disclaimer that this is not a scientifically valid poll, I assume you intend it to indicate a general direction within the profession.
Anyone with an objective scientific mind would agree that factors such as genetics/heredity, exposure to toxins/pollution, and lifestyle choices cause serious human ailments. However, the basic science is sound, which demonstrates that the body is a self-regulating, self-healing organism. The study of pathology shows that all disease is first a loss of function, followed by structural change. Virtually all diseases are described as self-limiting; the reason being that the body marshals the necessary forces to overcome the disease.
There was a recent national poll of doctors of chiropractic regarding their views on subluxation, disease, wellness, scope of practice, etc., which has been widely publicized. Given the above, it seems reasonable that your polling question is skewed and results in a distorted response. It is my belief that if the question were asked, "Do you believe that the subluxation is a primary causative or aggravating factor in human disorders?" the responses may well reflect a different outcome.
Thank you for the opportunity to be heard.
Steven Lowe, DC
Pine, Arizona
Kudos to Rosner
Dear Editor:
I am writing to bring to everyone's attention the tremendous continuing contributions made to our profession by Dr. Tony Rosner. Not only will the future of our profession be molded by Dr. Rosner's contributions through FCER, but each individual chiropractor's practice is currently touched by his work - even though they may not be aware of it.
The homocysteine and vertebral artery dissection connection is brilliant [www.chiroweb.com/archives/22/08/18.html] and has improved the way we practice. We all need Tony, and should be strongly supporting FCER and their research.
Gerald T. Andreoli, DC
Arlington Heights, Illinois
Thanks for "Putting Your Pen to the Line"
Dear Editor:
I have read Dynamic Chiropractic for many years. Overall, I have appreciated most of the articles, even though I've cringed at some of the ads in your newspaper. But I guess that is the "cost" of a free publication. Pun intended. Over the years, Dynamic Chiropractic has significantly informed me of the many current issues we face as chiropractors in our efforts to offer a natural health care service to the public.
This is just a special note to express my appreciation as a Christian chiropractor for your excellent "Report of My Findings," Oct. 21, 2004, titled, "Letting the Wrong People Raise Our Children." In that "report," you expressed your concern over the influence of deleterious TV programming. It has long been my contention that we as a society have greatly underrated the powerful influence of the TV media on our lives. That influence can be for the betterment or the worsening of our lives and society. Unfortunately, it seems that the worsening factors are more prevalent. And that undesirable influence is especially important in the lives of our children who are in the formative period of their lives. If they are allowed to feed their minds and inner spirits with undesirable programming, there will be a strong tendency for that inferior mental influence to manifest itself in their lifestyles and actions, both currently and even into their future adult lives. The Scripture says, "As a man thinketh in his heart, so is he." So, what we think about and meditate on becomes us to a greater degree than we often are aware of in our lives.
Running on the heels of TV are vicious, almost lifelike video games that extol violence and murder. Such "gamers" feed on the inner psychic with unhealthy life ideals. Some people argue that they can watch and play such TV shows and video games, and that they are unaffected by them. That, in my opinion, is a smoke screen to try to defend such unwholesome viewing and detrimental activities. While it is true that some personalities are not as deeply affected as are others, the influence still exists to some degree in all of us. I think the most convincing argument supporting the actuality of this negative influence is the costly advertising business. Companies know that if they advertise, they will significantly increase the sales of their products, even though many people claim they are not influenced by what they see in the media or what they play on their computers. The millions spent on political advertising in the recent political campaigning on TV attest to the known impression it makes on a person's thoughts, opinions and resultant actions.
So, thanks again for being willing to put your "pen to the line" and to frankly call the attention of your readers to this very important, frequently overlooked influence on our families and its undesirable result on our society.
Lester A. Blank, DC
Gap, Pennsylvania
