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Chiropractic
By Baur
There has been, within the United States, especially, a major paradigm shift in health care, with a "switch to" (or "return to") natural, less invasive, approaches, notably chiropractic, the so-called "alternative/complementary/integrative approach".
Major national inquiries have been undertaken by:
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The Agency for Health Care Policy and Research (AHCPR) in the United States [Bigos, S (Ed): Acute Low Back Problems in Adults. AHCPR Pbns pbn 95-0642. PHS, AHCPR. 1994. ] |
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Britain's Medical Research Council (MRC) [Meade, TW et al., Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment. BMJ. 1990, 300:1,431-1,437.] and in |
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Canada [Manga, P et al., A Study to Examine the Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain. Ontario, Canada, 1993.] |
In brief, the reports were hailed by every chiropractic community as an official seal of approval, chiropractic was finally recognized by a national government agency as being safe and effective, at least so far as low back pain was concerned.
The allopathic community, of course, led by orthopedic surgeons, raised such a ruckus that the AHCPR was reorganized and the government is never again to adopt the position of issuing clinical practice guidelines!
Orthopedic surgeons may be jealously guarding their "turf", which provides them with up to 500,000 back surgeries, annually. Intriguingly, Dr. Hochschuler of the Texas Back Institute, himself an orthopedic back specialist, makes the admission in one of his consumer books, that half of these surgeries (250,000) are unnecessary.
Unfortunately, many of these surgeries, whether necessary, or not, will also fail to fix the problem. Indeed, they may exacerbate it. However, the main theme is chiropractic, so we cannot go too far off course.
From the consumers standpoint, if chiropractic works, let' go for it. Is it as simple as heading for the nearest office with a chiropractor sign out front?
Unfortunately, chiropractic offices are not franchised, like McDonalds. They don't all offer the same "burgers, fries and cherry pies". Yet, this has not been addressed in the studies. In spite of ample evidence to the contrary, each report has tended to assess a uniform chiropractic technique, an osseous adjustment, as being the unique skill offered by the chiropractic profession.
A recent review in the single, peer-indexed chiropractic journal included on Medline discussed this issue:
"In chiropractic the short-lever high velocity-low amplitude (HVLA) thrust adjustment (typically associated with an audible cavitation or cracking sound) has been supplemented by a wide range of noncavitating methods, including flexion-distraction, sacro-occipital, Thompson, Activator, applied kinesiology, directional nonforce, and dozens of others. Defining chiropractic strictly in terms of the HVLA adjustment fails to accurately describe the practice of contemporary chiropractic."
(Nelson, CD et al., Manual healing diversity and other challenges to chiropractic integration. The Journal of Manipulative and Physiological Therapeutics, March/April, 2000, Vol. 23, No. 3: )
Next Topic: Part 2 of this article
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