Timing can often reveal a certain amount of irony in a situation. This is particularly true of two articles in this issue. The first, reporting on the results of the CHIRO study (the first of several such studies), illuminates the dilemma facing patients with acute low back pain (and other types of spinal pain).The point of the study was to demonstrate the difference between what happens to patients when guidelines are followed (i.e., patients are referred for chiropractic spinal manipulation) and when they are not followed (i.e., patients are referred for "usual care" by a family physician).
The patients seen by DCs were offered acetaminophen and provided with up to four weeks of specific chiropractic adjustments. At the end of 16 weeks (the point when low back pain can become chronic), these patients enjoyed a very significant 2.7-point improvement in their disability scores. These improvements persisted through to 24 weeks, 20 weeks after chiropractic care was administered. The "usual care" group was turned over to their family physician to receive whatever care that MD thought was best. Only 6 percent of this group received chiropractic spinal manipulation, even though that is what the guidelines in the U.S. and many other countries recommend.
After 16 weeks, 78 percent of this group "were still taking narcotic analgesic medications on either a daily or as needed basis." Those who were referred to a physical therapist received all sorts of manipulation and mobilization. Sadly, the addition of physical therapy was "shown to have no clinically worthwhile benefit when compared with [family physician] advice and acetaminophen alone." To top it all off, while these "usual care" patients showed improvement in bodily pain and physical functioning, they "showed no improvement whatsoever in back-specific functioning (RDQ scores) throughout the entire study period."
If this is typical of the fate of most back pain patients, it's no wonder we have a health care crisis. The majority of patients are walking into their MD, being put on drugs indefinitely, given physical therapy that has "no clinically worthwhile benefit" and end up showing "no improvement whatsoever in back-specific functioning" (the very problem they went to their MD to address in the first place), thereby becoming another person with chronic back pain. All of this is in violation of the worldwide, science-backed guidelines that would direct them to receive chiropractic spinal manipulation, the only form of spinal manipulation endorsed by the guidelines.
Meanwhile, back at the ranch in New Mexico, a second article in this issue discusses a new bill (HB 127) introduced into the state legislature during the first session of 2011. This bill is written to enact a number of changes, but the most noteworthy involve giving "advanced practice chiropractic physicians" the ability to "prescribe and administer any dangerous drug or controlled substance and perform any procedure that is accepted for use within the certified advanced practice chiropractic physician's clinical specialty."
First of all, let me just say that I take offense to the notion that an "advanced practice" doctor of chiropractic is defined as one who can "prescribe and administer any dangerous drug or controlled substance." This is not what I think of when I think about an advanced DC. I have had the privilege of meeting thousands of DCs. During my time with the Motion Palpation Institute, we conducted more than 1,200 seminars. I was palpated and adjusted by literally hundreds of doctors back then. To me, an advanced DC is one who can palpate and adjust with an incredible sense of touch and healing. Dr. Leonard Faye quickly comes to mind.
The irony of this new bill is exposed by the CHIRO study; it will give chiropractic doctors in New Mexico the ability to be just as ineffective as the medical providers were in the study.
For whatever reason, there are those who are looking to follow in medicine's footsteps, even in the face of unrelenting evidence that the "usual care" of the family physicians fails to provide improvement in "back-specific functioning." Again, this leaves patients to live with chronic back pain, all the while taking more drugs and losing more function, with little hope that their condition will resolve.
There is always more than one way to look at something. My perspective is not always accurate and my opinion is not always right. But to me, this is like a person waiting for their fiance, whose flight is supposed to arrive at the airport at 5 p.m., and when they find out the flight has been delayed, start looking for a prostitute to marry.
Much of the research regarding chiropractic's effectiveness is still coming. But that doesn't mean doctors of chiropractic need to embrace a more flawed (albeit better established within health care) model of care. For those looking to address all forms of illness, go to medical school and be the best MD you can be. But for those looking to continue providing healing "without drugs or surgery", chiropractic is still the leading profession and will be as long as we stay true to our profession.
Click here for more information about Donald M. Petersen Jr., BS, HCD(hc), FICC(h), Publisher.