There Will Never Be Enough Research To Satisfy Our Critics
A Chiro.Org Editorial
For some, there will never be enough research to support the use of chiropractic. These people will forever hide behind the claim that they wish to protect patients from quackish practices.
For those who may have forgotten, or for those who never knew, organized medicine spent decades and tens of millions of dollars trying to discredit and destroy chiropractic. Today, the vestiges of that oppression is still found on fringe web sites that ignore the body of peer-reviewed research supporting chiropractic care.
The Wilk anti-trust case against the AMA and 20 other named medical groups revealed that the AMA Plan was to:
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Undermine Chiropractic schools
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Undercut insurance programs for Chiropractic patients
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Conceal evidence of the effectiveness of Chiropractic care
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Subvert government inquires into the effectiveness of Chiropractic, and
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Promote other activities that would control the monopoly that the AMA had on health care
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They even threatened their own ranks: any MD who taught in our schools, performed research with chiropractors, or accepted a referral from, or made a referral to a chiropractor, would lose their hospital privileges, leaving them unable to treat patients.
while, all along, they knew that:<
There also was some evidence before the Committee that chiropractic was effective – more effective than the medical profession in treating certain kinds of problems such as workmen’s back injuries.
The Committee on Quackery was also aware that some medical physicians believed chiropractic to be effective and that chiropractors were better trained to deal with musculoskeletal problems than most medical physicians.
(Opinion pp. 7)
The Wilk suit demonstrated that the defendants had participated for decades in an illegal conspiracy to destroy chiropractic. On August 24, 1987, following 11 years of legal action, U.S. District Court judge Susan Getzendanner ruled that the AMA and its officials were guilty, as charged, of attempting to eliminate the chiropractic profession.
She ruled that the AMA had engaged in a “lengthy, systematic, successful and unlawful boycott” designed to restrict cooperation between MDs and chiropractors, in order to eliminate the profession of chiropractic as a competitor in the United States health care system.
Even so, with the hatchet supposedly buried, organized medicine and a small, loose organization of pseudo-evidence-based proponents have continued to try to deny the truth.
The first Meade study (British Medical Journal 1990) randomized 741 patients to receive either chiropractic care or standard hospital management for low back pain. The outcome was that Chiropractic treatment was more effective than hospital outpatient management for these patients, and the authors concluded that:
“For patients with low back pain in whom manipulation is not contraindicated chiropractic almost certainly confers worthwhile, long term benefit in comparison with hospital outpatient management. The benefit is seen mainly in those with chronic or severe pain. Introducing chiropractic into NHS practice should be considered.”
It didn’t take long for the vultures to circle, claiming that the overall improvement in the chiropractic group was not dramatic enough, and that it was not clear that chiropractic was effective for chronic low back pain over the long run.
As a response to this criticism, Meade tracked this same group of patients for an additional 3 years (British Medical Journal 1995), finding the improvement in the chiropractic group was 29 percent greater than those treated by hospitals, and this was equally true for those with acute AND chronic low back pain.
Organized Medicine “blew a blood vessel” when the AHCPR published the “Acute Low Back Problems in Adults” series in 1994. This extensive review of all the forms of treatment for low back pain stated that most medical treatments were untested, questionable, or harmful, and of all the types of management they reviewed, only chiropractic care (spinal manipulation) could both reduce pain AND improve function.
Amusingly enough, at the same time that medicine was criticising these chiropractic studies, Timothy Carey, MD was organizing short courses to teach primary care physicians (MDs) how to perform spinal manipulation.
Even though chiropractors take around 1000 class hours in technique to master spinal adjusting, Carey’s complete training program entailed two one-day training sessions, along with a refresher session, adding up to a grand total of 18 hours of training. Impressive! Then this group performed a randomized trial to gauge their impact on patients with low back pain.
In 2004, the publication of the:
“European Guidelines for the Management of Chronic Non-specific Low Back Pain”
demonstrated that Government and Researchers ARE reviewing the literature. Our June 25th, 2010 review of these Guidelines is available for your review.
The salient points include the fact that almost ALL of what’s considered “standard conservative medical treatment” is listed as invasive treatments, that should NOT be recommended for non-specific Chronic Low Back Pain (CLBP).
(see complete list below
Aside from recommending spinal manipulation as a well-supported treatment, the invasive treatments they rail against include:
- Bed rest
- Local facet nerve blocks
- Epidural corticosteroids
- Intradiscal injections
- Trigger point injections
- Intra-articular (facet) steroid injections
- Acupuncture
- Prolotherapy
- Botulinum toxin
- Intradiscal radiofrequency lesioning
- Intradiscal electrothermal therapy
- Radiofrequency facet denervation
- Radiofrequency lesioning of the dorsal root ganglion, and
- Spinal cord stimulation
Most recently, the University of Pittsburgh Medical Center Health Plan now mandates conservative care before even considering surgery for chronic Low Back Pain by adopting these landmark guidelines for the management of chronic low back pain.
As of Jan. 1, 2012, candidates for spine surgery must receive “prior authorization to determine medical necessity,” which includes verification that the patient has “tried and failed a 3-month course of conservative management that included physical therapy, chiropractic therapy, and medication.”
They even put teeth into it:
“Surgical procedures for low back surgery performed without prior authorization will not be reimbursed at either the specialist or the hospital level.”
Since those heady early days, the
Low Back Pain and Chiropractic Page and the
Chronic Neck Pain and Chiropractic Page have continued to document the vast superiority of chiropractic care
over standard medical management for these same musculoskeletal complaints.
The following study is just another, in a long line of studies that shows the benefits of chiropractic care, by helping to
clarify which groups of patients may benefit the most from care, and which groups may be refractory to care.
Predictors of Improvement in Patients With Acute and Chronic Low Back Pain Undergoing Chiropractic Treatment
J Manipulative Physiol Ther. 2012 (Sep); 35 (7): 525-33
Cynthia K. Peterson, DC, Jennifer Bolton, PhD, MAEd, B.
Kim Humphreys, DC, PhD
Professor, Chiropractic Department,
Faculty of Medicine,
University of Zürich,
Zürich, Switzerland
OBJECTIVES: The purpose of this study was to investigate outcomes and prognostic factors in patients with acute or chronic low back pain (LBP) undergoing chiropractic treatment.
METHODS: This was a prognostic cohort study with medium-term outcomes. Adult patients with LBP of any duration who had not received chiropractic or manual therapy in the prior 3 months were recruited from multiple chiropractic practices in Switzerland. Participating doctors of chiropractic were allowed to use their typical treatment methods (such as chiropractic manipulation, soft tissue mobilization, or other methods) because the purpose of the study was to evaluate outcomes from routine chiropractic practice. Patients completed a numerical pain rating scale and Oswestry disability questionnaire immediately before treatment and at 1 week, 1 month, and 3 months after the start of treatment, together with self-reported improvement using the Patient Global Impression of Change.
RESULTS: Patients with acute (<4 weeks; n = 523) and chronic (>3 months; n = 293) LBP were included. Baseline mean pain and disability scores were significantly (P < .001) higher in patients with acute LBP. In both groups of patients, there were significant (P < .0001) improvements in mean scores of pain and disability at 1 week, 1 month, and 3 months, although these change scores were significantly greater in the acute group. Similarly, a greater proportion of patients in the acute group reported improvement at each follow-up. The most consistent predictor was self-reported improvement at 1 week, which was independently associated with improvement at 1 month (adjusted odds ratio [OR], 2.4 [95% confidence interval, 1.3-4.5] and 5.0 [2.4-10.6]) and at 3 months (2.9 [1.3-6.6] and 3.3 [1.3-8.7]) in patients with acute and chronic pain, respectively. The presence of radiculopathy at baseline was not a predictor of outcome.
CONCLUSIONS: Patients with chronic and acute pain reporting that they were “much better” or “better” on the Patient Global Impression of Change scale at 1 week after the first chiropractic visit were 4 to 5 times more likely to be improved at both 1 and 3 months compared with patients who were not improved at 1 week. Patients with acute pain reported more severe pain and disability initially but recovered faster. Patients with chronic and acute back pain both reported good outcomes, and most patients with radiculopathy also improved.
The movie “Doctored” showed a great amount of the anti trust case. Like I always say, you can’t patent and adjustment and stick it in a bottle.
Never enough…. it often feels that way. Some of the so-called critics base their identity/linguistic message on being critical of chiropractic at all cost. Sometimes I feel chiropractic is an easy target for many reasons. Yet on the other hand I do believe the paradigm is shifting. That being intervening/managing health conditions in their earlier stages ie. pre diabetes or pre hypertensive. This country is finding out the hard way about the cost of health care especially with conditions that could be greatly or even avoided with personal responsibility/lifestyle medicine. What I’m getting at is chiropractic can be a player in the “lifestyle medicine” arena. Many of us have been involved in “lifestyle medicine” for sometime. Now more of the public may be willing to listen. We have to move forward and let the critics be critics. We must pick our fights if you will. We must engage the public otherwise we will be left behind. The P.T.’s are hoping we give up as they try and take our (perceived) turf. Come to your clinic/patients with sound health care information they need it. Heck with the critics and their misinformation agenda. They are trying to put us/keep us in a box….I say no way.
Hi Karl
I’m with you, and this is why I post these editorials. Our website is devoted to collecting and archiving the materials that detail the effectiveness and safety of what we do.
Even so, we do ourselves a disservice by ignoring those who misrepresent research findings to support their pseudo-evidence-based rants against us.
I’m in agreement with you Frank. We must keep our critics(enemies) close to us. I appreciate your dedication to this site and the profession. I hope to see the above mentioned movie ‘Doctored” which further reveals the monopoly of medicine/big Pharma and patient co-dependency.
thank you for this article. the research we have now is very compelling. we can always do more, i always wonder, i always wonder what happened to the passion in these science folks. even science has its faults. it’s no reason to not adjust folks and let their their bodies do the rest
Thanks for your awesome article. I myself am hosting a website for chiropractors and can understand where you come from – might even use some of the information you provide here.
Thank you!
Thanks Ted for your kind comments!
You are welcome to LINK to our materials, but all my writings are copyrighted, and duplicating them whole-cloth is not acceptable.
When I want to emulate someone else’s writing, I have 2 options:
1. Get their permission (I do that a LOT), or
2. I copy the first few paragraphs, followed by a link back to the original materials, saying something like:
“Read the rest of this article here“
I have always said that even if we get research showing chiropractic having positive effects on non NMS conditions (I know we have some, but not enough and can be better), what will be the point? Regarding low back pain we have more research then just about any other condition yet it seems to be ignored.
But we cannot whine about it because we need to realize that it’s not just the AMA, but many special interest groups who have a stake in traditional medicine profits, and money is the bottom line in the country.
This country is now run by special interest and politicians need to beg them for changes, so though we can appeal to our government, they really have lost much of thier power in my opinion.
Some say we are still here due to legal fights we have won, but I think it is from what we offer is so powerful.
And Until we can bring more value in what we can do instead of ging away free exams and chicken dinners (do we still do that?), we will continue to struggle.
How many times has someone spent $800 for a bad headache at an ER with little help only to get rid of thier pain in one visit for a fraction of the cost? We have all seen this, I am sure.
We do need to stay close to the medical doctors, many are good toward us (as if being honest and considering what is best for some pts is being good…..I know). I do not think the majority of MDs are the issue, it is those organizations whose job it is to protect thier turf.
For ever one MD saying something idiotic to one of my patients, like I will hurt them, thier are 2 or 3 more saying that they agree the chiropractic helps. That’s better then it use to be 10 years ago.
Dr. Raymond
Good Post!
Dr. Steven Visentin D.C