For the second time in less than a year,1,2 the Wall Street Journal has challenged the value of chiropractic. On June 3, an article in the "Personal Journal" section of the Journal discussed a meta-analysis published in the Annals of Internal Medicine3 that evaluated the effectiveness of spinal manipulation for treating back pain.
The Journal article, "Study Questions Chiropractic Care,"4 included several quotes from Paul Shekelle, MD, PhD, one of the study's authors, who noted that the study found manipulation of the spine was "no more effective" than the treatment options offered by other providers.
"We aren't saying that spinal manipulation isn't useful, but it's no more effective than other kinds of care that medical doctors or physical therapists can do," Dr. Shekelle told the Journal. Ironically, he was the lead author of the 1992 RAND report that supported the use of spinal manipulation for low-back pain.
In the Journal article, George B. McClelland, DC, a spokesman for the American Chiropractic Association, took issue with the study, pointing to several design flaws. He also criticized the way the results of the study have been interpreted by the popular press, emphasizing that coverage of the story could have "a negative influence" on the chiropractic profession.
"Even if spinal manipulation is no better than other interventions, if it is equally effective, and has less potential serious side effects and greater patient satisfaction, what's wrong with that?" noted Dr. McClelland.
What the Journal failed to include in its article was any mention of the specific details of the study. First, a review of the Annals paper revealed that the meta-analysis evaluated the effectiveness of spinal manipulative therapy, not chiropractic specifically. Second, of the 39 studies indexed in the analysis, only 14 specified spinal manipulation performed by chiropractors; the majority of the studies specified outcomes based on manipulation performed by medical doctors, physical therapists or osteopaths. Moreover, as Dr. McClelland alluded to, the analysis did not conclude that spinal manipulation was ineffective, but that it was equally as effective as other therapies for treating back pain.
While "chiropractic" was prominent in the title of the WSJ article, the meta-analysis itself never really singled out chiropractic specifically. This is a pattern we continue to see in the media: If the research is positive for "manipulation," the popular press (if they even decide to run an article) extol the benefits of "manipulation"; if the research has the slightest appearance of being negative, they condemn "chiropractic."
Sadly, the Wall Street Journal also seems guilty of this backhanded bashing of our profession.References
- Should you try a chiropractor? Wall Street Journal, Nov. 19, 2002.
- DuVall strikes again! Wall Street Journal article reveals NACM position. Dynamic Chiropractic, Jan.1, 2003: www.chiroweb.com/archives/21/01/04.html.
- Assendelft WJJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG. Spinal manipulative therapy for low back pain. Annals of Internal Medicine 2003:138, pp871-81.
- Study questions chiropractic care. Wall Street Journal, June 3, 2003.
Michael Devitt, senior associate editor
