Chiropractic Healthiness

Question:

>It is false to compare side effects from drugs to side effects from >chiropractic, because unlike chiropractic drugs have to demonstrate >that they are effective in order to be marketed. The efficacy of >chiropractic is unknown. …

Bzzzzzt! Guess again.         From an article by George P. McAndrews, Attorney at Law, the man who lead the legal team for 11 years that finally convicted the AMA:         "… We knew that the AMA in 1966, had received a report from         an orthopedic surgeon trustee of the AMA by the name of Dr.         Hendryson. He had reported that during World War II, on Guadal-         canal, he had been assigned a chiropractor as an orderly, so         when the battle injuries came in, primarily the traumatic in-         juries, he set up a study by alternating the soldiers and marines         that he sent for care. Four orthopedic surgeons would take care         of one injured party and the chiropractor would take care of the         next one. After a long period of study, he concluded several things.         He concluded that chiropractic care obviously had therapeutic value,         and he was very impressed with some of the results the chiropractor         was able to get. Unfortunately, the military men probably didn’t         like it because the chiropractor was able to get the injured service-         men back up to the front lines quicker.         …         "In 1967, the Kentucky Medical Association surveyed the people of         Kentucky and found out that fully 25% of the middle and upper classes         of Kentucky thought that chiropractors were the specialists in         musculoskeletal problems, particularly pain. They went on to say         that undoubtedly people were getting help from these practitioners.         Now that was the second thing they knew about.         "Then, in 1971, Dr. Roland Martin, the medical director of the         Workmen’s Compensation Board out in Oregon did a study of specialist         care on workmen’s compensation cases and, although the numbers were         very limited, his conclusion was that chiropractors were twice as         efficient as medical physicians in getting injured workers, with         comparable injuries back on the job. There was our first numerical         two-to-one.         "In 1968, Dr. McMillan Mennell, M.D., had testified at the HEW         hearings in Washington that it was obvious that chiropractors were         getting patients back to work faster and at less cost than medical         physicians dealing with musculoskeletal problems and that the         actuarial tables made available to the Expert Review Panel by         insurance companies showed that to be true. Slowly, we have a         thought process evolving, that chiropractors, when dealing with         comparable musculoskeletal problems, to those being dealt with by         medical physicians, were more efficient and now the two-to-one was         showing up.         "By 1975, Dr. Wolf, who had written extensively on workmen’s comp-         ensation studies in the state of California, did a relatively         massive retrospective study of workmen’s compensation cases in that         state. He took 1,000 patient records and then decided, because there         was insufficient information on the records of the 500 who had been         treated by MDs, and 500 by doctors of chiropractic, to write to all         1,000 patients. He received replies from 634 of them, rather evenly         divided–296 had been treated by doctors of chiropractic and the         rest [338] had been treated by medical physicians. He parceled them         out by comparable injuries and found something rather amazing. He         found that at every single study level, chiropractors were twice as         efficient as medical physicians. Twice as many patients with no lost         time had been treated by chiropractors than had been treated by MDs.         At every single level of incapacitation, it was clear that the chiro-         practors were at least, and in some cases, more than twice as effic-         ient as the corresponding medical physician care.         "Twice as many patients under medical care were off work at seven         days, twice as many patients under medical care were off work at         21 days, than those cared for by chiropractors. To do away with any         argument that we were dealing with only simple sprains and strains,         the study showed that 13% of the patients treated by medical physic-         ians were off work more than 60 days, while only 6.7% of those treated         by doctors of chiropractic were off work more than 60 days. Anyone         will agree that any patient who is off work for more than 60 days         has a relatively complex or serious injury.         "There we have two-to-one again across a broad spectrum, in a large         retrospective study, and again done by a medical physician, not by         chiropractors. In September or October 1979, we had the famous New         Zealand study that came out, that declared that chiropractors were         the world’s recognized experts in the biomechanics of the neuro-         musculoskeletal system. That was exceedingly helpful. Again, it was         not a study performed by chiropractors, it was a study performed by         impartial, unbiased third parties, under a government sanctioned         investigation in different countries, including England, Canada,         the United States, Australia, and New Zealand.         "That 377 page study was enormously helpful to our case. After we         settled with the Illinois State Medical Society in 1985, several         hospitals in Illinois decided to add doctors of chiropractic to         their medical staffs. …" Care to ammend your previous statement? (Why do I somehow doubt it? Mark Sandrock — Univ of Illinois at Urbana-Champaign      ’The measure of mental health Chemical Sciences Computing Services      is the disposition to find good 505 S. Mathews Ave./Urbana, IL 61801      everywhere.’

Response:

   >It is false to compare side effects from drugs to side effects from    >chiropractic, because unlike chiropractic drugs have to demonstrate    >that they are effective in order to be marketed. The efficacy of    >chiropractic is unknown. …    Bzzzzzt! Guess again.    [Lengthy excerpt from an article lawyer for Wilks et all]    Care to ammend your previous statement? (Why do I somehow doubt it? I’d be happy to ammend it. Please tell me what the efficacy of chiropractic care is – 80%, 90%, 10%?  You might want to consult the RAND study before you answer. And, rather than go point by point with you (since you tend to ignore such responses), I’ll just point out that the judge also saw through the lawyers attempt to validate chiropractic by using the New Zealand study, and that there are an equivalent number of workmens comp studies that show that chiropractic care is of marginal value. Some of you who appear to practice chiropractism (the religion of chiropractic) seem to continually miss the point that I actually do believe there is some value to SMT. I do not necessarily think the SMT and chiropractic are the same thing, and I would love to know how effective SMT is compared to other approaches.  If you know this, then please tell me. Tell the RAND people too. sdb —

Response:

   I have a question for you, Dr. Kaplan. How many patients have you seen    that have suffered bad side effects because of chiropractic    manipulation? And how does that compare to the number of patients    you’ve seen who’ve suffered bad side effects from prescription drugs?    That should give you some idea of the relative safety of chiropractic    manipulation compared to drug therapy. It is false to compare side effects from drugs to side effects from chiropractic, because unlike chiropractic drugs have to demonstrate that they are effective in order to be marketed. The efficacy of chiropractic is unknown. Furthermore, as usually practiced, chiropractic is based on a false theory (subluxations). Just keep asking those 3 questions: 1) Is it safer than doing nothing? 2) Is it more effective than doing nothing? If the answer to 2 is no, then 3) Do the benefits outweigh the risks? For drugs we have: 1) No (not safer than nothing, usually) 2) Yes (more effective) 3) Yes (the benefits outweigh the risks) For chiropractic: 1) No (not safer than nothing) 2) ???? (effectiveness remains to be demonstrated) 3) ???? sdb —

Response:

 writes: >"Chiropractic" encompasses alot, Doctor.

The RAND study so many have quoted here specifically pertains to spinal manipulation for low back pain. I say again….. This study is the best known study to date on spinal manipulation and states that the risk from spinal manipulation is of unknown magnitude and includes the risk of paralysis or death.  It is unknown whether the incidence is higher when manipulation is done by MDs or DCs. If you know of better data, please quote it specifically. Otherwise this is the best information we have. >Exactly, it is "underestimated". But what has been >shown [from previous quotations] is that OUT OF THE >REPORTED [KNOWN] CASES 75% WERE M.D. INFLICTED. Again,

Citations please? Even if your statement is correct, it is meaningless because we have no way of knowing what % of MD complications are reported vs. what % of DC complications are reported. Based upon the most comprehensive analysis to date, spinal manipulation for low back pain carries potentially devastating consequences, the incidence rate of which may be low but is certainly unknown. In my opinion patients deserve to be informed of this information and then can make their own decisions. — Richard Kaplan M.D.           Medical Software Exchange BBS 806 2nd St. SW # 104          (507) 281-1989 14,400 HST Rochester, MN  55902          (507) 281-1689 Voice

Response:

Dr. Kaplan recently posted some informative articles discussing his views on the medical establishment.  I appreciated that, even though I neglected to thank him at the time. Now I’m wondering if Dr. Kaplan wouldn’t mind advising us on how to go about choosing an MD.  I’m assuming that doctors have some ideas of what goes into maintaining a competent and caring practice.  What questions should a prospective patient ask, which schools or degrees are particularly good or notorious, and what character traits make for good and bad MDs? I’m sure that many would appreciate some guidance from someone inside the profession.  I know I would. -r

Response:

 (Robert Hartman) writes: >Now I’m wondering if Dr. Kaplan wouldn’t mind advising us on how to >go about choosing an MD.  I’m assuming that doctors have some ideas >of what goes into maintaining a competent and caring practice.  What

OK, I’d be glad to give my thoughts on this topic.   I think it is perhaps easier to judge a given MD’s practice style than to locate an MD… that is to say, it may be necessary to visit/interview a few MDs before finding one who is qualified and suits your personal preferences. Commonly given advice is to choose an MD associated with a well known teaching hospital or medical school. While it may be true that you will not go too far off base by following this advice, I believe personally that you may lose some of the best doctors in the country if you follow this course.  Very often the lists of the "best" hospitals and "best" doctors which are quoted in the media and even discussed among doctors themselves are based upon these institutions’ or these doctors’ record of publication or other public, professional accomplishments.  While this may indicate the doctors or hospitals which are on the cutting edge of research, it by no means indicates these same hospitals or doctors are good at or interested in clinical care….  I can think of quite a few doctors at premier medical institutions who are marginal clinicians, and I can think of quite a few doctors in rural towns who do not perform research but who are outstanding, empathetic clinical doctors.   One question which is essential in choosing a doctor is whether you need to go to a primary care doctor or to a specialist.  It is becoming more and more common for patients to self-refer themselves to specialists for medical or surgical problems.  While this may be appropriate if the diagnosis/treatment is clear, e.g. a diabetic may seek out an endocrinologist/diabetologist when moving to another town, there are many times when the diagnosis is less clear and the patient may receive poorer care by first going to a specialist, i.e. a patient with back pain may go directly to an orthopedic surgeon and be offered surgery for a herniated disc whereas a family practitioner may see surgery only as a last resort and may first refer the patient for instruction in exercise and other pain relieving measures.  There a saying I have heard recently among doctors who do not approve of patient self-referral to specialists — "If you go to a gas station, you will get gas."  In other words, if you go directly to a specialist in a particular organ system you are much more likely to get a diagnosis related to that organ system.   Although our current medical reimbursement system does not acknowledge it, the real gems in medicine are good primary care docs who know when to use conservative treatment, when to refer to a specialist, and how to help a patient interpret possibly conflicting recommendations of multiple specialists. Regardless of whether you choose to visit a primary care doctor or a specialist, you should verify that he is board eligible (recently completed a residency and is eligible to take specialty exams) or board certified (completed a residency and has passed specialty exams).  Some people feel that doctors who graduated from foreign medical schools are not as qualified as those who graduated from American schools — this is a generalization which is not always true.  Certainly an immigrant from Britain who attended medical school there before moving to the U.S. cannot be directly grouped with a U.S. resident who could not gain admission to a U.S. medical school and could only go to a lesser quality Mexican medical school….. but there are certainly good medical schools in Mexico, and a studious student can do well anywhere, particularly if residency trained and board certified in the U.S.  So this is a difficult area to assess, and one in which there are no hard and fast guidelines. So we are left with the characteristics of a good physician. I believe the best way to judge a physician is to ask his past patients and to ask him about (and observe) his practice style. The following are signs of a physician I would trust personally for myself, my friend, or my family: * Board Eligible or Board Certified in his specialty * Willing to say "I don’t know" rather than give a   quick diagnosis to a difficult situation * Thorough in history and physical examination;   conservative/cautious (though informed) in utilizing expensive   new diagnostic/treatment modalities * Willing to discuss risks vs. benefits of multiple treatment   alternatives and act as an educator rather than   a dictator * Strongly devoted to patient education, as evidenced by   liberal use of written patient education materials and/or   a patient library * Willing to research the literature on new treatment   ideas patients inquire about, rather than blindly   dismissing new concepts * Most importantly, with a bedside manner which emphasizes   compassion, empathy, and patient autonomy rather than   blind dogmatism — Richard Kaplan M.D.           Medical Software Exchange BBS 806 2nd St. SW # 104          (507) 281-1989 14,400 HST Rochester, MN  55902          (507) 281-1689 Voice

Response:

 (Bernie Simon) writes: >I have a question for you, Dr. Kaplan. How many patients have you seen >that have suffered bad side effects because of chiropractic

Do you think my professional experience, or that of any other single M.D., is more valid as a source of data on chiropractic complications than a comprehensive meta-analysis of the medical and chiropractic literature? The scientific flaws in such an observation are immense. The simplest problem is referral bias….. If in my practice patients are more likely to see me because of problems caused by prescription drugs than to see me because of the types of problems caused by chiropractic, then I will have a biased view of the relative risks.  Not to mention the referral bias if a complication of either is death! I say again…. The best study to date, which was authored by both MDs and DCs and which was quoted here by both MDs and DCs, concluded that manipulation may result in serious complications whose incidence is unknown.  Unless you can provide data which believe to be superior to this, how can you deny this as the best information available to date? — Richard Kaplan M.D.           Medical Software Exchange BBS 806 2nd St. SW # 104          (507) 281-1989 14,400 HST Rochester, MN  55902          (507) 281-1689 Voice

Response:

I have a question for you, Dr. Kaplan. How many patients have you seen that have suffered bad side effects because of chiropractic manipulation? And how does that compare to the number of patients you’ve seen who’ve suffered bad side effects from prescription drugs? That should give you some idea of the relative safety of chiropractic manipulation compared to drug therapy. —

Response:

> writes: >Dr. Kaplan, I do believe the information has already been >posted. Go back in this thread and you will find the >citations documented of MD’s causing 75% of these >injuries [common sense tells one that this percentage is >based on REPORTED cases, not merely conjecture...] >I say again…. The RAND study, so often quoted by >proponents of chiropractic, says that the rate of >morbidity/mortality from chiropractic is unknown

"Chiropractic" encompasses alot, Doctor. >and that the reported rate in the literature is likely >an underestimate.  Therefore any claims in this

Exactly, it is "underestimated". But what has been shown [from previous quotations] is that OUT OF THE REPORTED [KNOWN] CASES 75% WERE M.D. INFLICTED. Again, this statistic was regarding "Neck Manipulation" not simply "Chiropractic". Chiropractic is not only neck manipulation as you well know. The point of the quotation was to show that "Neck manipulation" was safer when performed by a Chiropractor, not the rate at which it occurs. >newsgroup of an incidence rate of morbidity/mortality >from manipulation by either MDs or DCs are moot.

See above >– >Richard Kaplan M.D.           Medical Software Exchange BBS

Thomas

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