by Grant Reid, D.C.

 

         I met with a gentleman who works for a large publishing company the other day. This company publishes primarily novels for the average reader. I asked him what is currently selling in the area of health. He answered diet. Diet is always the hot topic. I suggested that a book showing the fallacies and myths in many diet programs, and why they don’t work might be of interest to the readers. He told me that the best two items are new revolutionary ideas that require little effort, or books that explain why it is not your fault that you can’t lose weight. I was a little confused on the second point, so he clarified it and said, “Well, actually, Japanese people don’t really care if the diet works or not, but they do want an excuse for why they can’t lose weight. Facts are not really relevant.”

            The following week, I met with a friend and we got to talking about popular things in health recently. The conversation turned to a business in Tokyo that reshapes women’s bodies, and faces by massage methods. I asked her if the women who go there know that you can’t reshape a human body by massage, and that they were probably just wasting their time and money. She told me that that wasn’t important. What was important was that he makes them feel good about the results, and tells them how much better they look. Psychologically they are better off, and that is why he is doing well at it.

            To top this off, I fell off my bed while watching a television program three nights back. They started by showing the differences in the right and left half of the human face, and went on to say that this is because of eating habits and problems with the alignment of the teeth. But the real reason behind the bad eating habits and teeth misalignment is misalignment of the tongue. They “proved” this by having various people press on a meter with their tongue in different positions. Following this, they went to a dentist’s office and had him show x-rays. The dentist began showing x-rays of women’s pelvis. The normal size of the sacro-iliac joint, he said, is 3-5 millimeters. Then he showed a different x-ray and said, “This x-ray shows a gap of 5-7 millimeters. This woman’s pelvis is misaligned,” and then went on to somehow tie in a relationship between asymmetrical faces, and sacroiliac gapping of 5-7 millimeters. Because women have a menstrual cycle, their pelvis is subject to widening and narrowing in everyday life, it gets stretched wide, and causes the whole body to unbalance.

 

            Fortunately (Yes, fortunately, I didn’t want to hear any more of the details), my Japanese is not quite well enough to understand the details of what this dentist was saying, but it doesn’t take much education to know that the sacroiliac joint does not gap 5-7 millimeters because of the menstrual cycle, and even if it did, to view it on x-ray would require taking a picture at 90 degree angle to the joint, not 90 degrees to the body. And to measure it would require a joint that is non-concave.

    So, I asked my wife, “Do people really believe this? They are making this program like it is an authority on this subject, not some sort of joke. What do people think? My wife’s response was, “Japanese people do not want to know the truth.” They want to hear a reason behind why things are the way they are, and why they can’t change things about themselves.”

    “What about facts?” I asked her, “Don’t they want to know the facts?”

    “No,” she said, “You go around trying to tell people that according to a report in Spine Journal, 1997, the sacroiliac joint movement is 1 millimeter etc., and people look at you like you are being rude to the flow of things. This is Japan. Here we have a saying; the nail that sticks up gets hammered down!” “Go with the flow, don’t upset things.”

            Well, in actuality, I have been enlightened. This explains a conversation I had with a chiropractor. He asked me, “When you palpate the spine, and the spinous is rotated to the right (PR listing), which is more effective, contacting the spinous, or the transverse process?” I said, “You can not determine a listing by feeling the spinouses. They are naturally bent left and right, on top of that a single vertebra, according to various sources, can only rotate 2 to 3 degrees (Pure rotation), and one can not feel that from palpation.” “Further, when you adjust, vertebra move as groups, and end up in the same position as when they started (Sollinger). He said, “Okay, but any way, when it is rotated to the right which is the best contact?”

            He didn’t get it. His diagnosis was incorrect, and the method of treatment was irrelevant, but he still wanted to hear which contact was best.

            So now, I am confused. Do the Japanese Chiropractors really want to hear the truth? Or do they just want to hear what goes with the flow? And let’s not just pick on the Japanese Chiropractors. How about chiropractors in America? How many chiropractors use Thompson Technique regardless that there is no research to demonstrate validation of the theory behind it. How many chiropractors use the Gonstead nervoscope (Go Scope) despite the fact that Plaugher et al stated themselves after testing, that strong conclusions regarding the usefulness of it in clinical settings requires further investigation.1 Let’s count the total number of research articles supporting SOT (Sacro-occipital) technique? Zero (Honestly, I am not sure about this, but I have never seen any).

            Let’s see what Arlan Fuhr says about his research findings regarding the validity of leg length checks, “Despite claims of usefulness, many problems are inherent in the prone leg check such as measurement error, patient position, table interference, ...”2

            And to CBP® (Chiropractic Biophysics®) we have the following response, “Don Harrison is fat and speaks facts without listening to opinions, besides that, he is bald, so I ain’t gonna study CBP®!”3

            I don’t want to diverge too much off the topic here; this article is about medicine and chiropractic, not chiropractic techniques. I just want some understanding behind why this article was written.

            This article is written to reveal some facts with regards to research findings in medicine, and chiropractic. The news media seems to enjoy announcing breakthroughs in medicine, and dangers and failures in chiropractic, so what I would like to do, is touch upon some of the opposite.

 

Articles That Never Made It In the News

(Medicine)

 

The Knee

            Arthroscopic surgery, a method of treatment that has advanced to the front as the method of treatment for the injured knee. It has been used for well over 25 years, and is the primary method of treatment for torn menisci or ruptured ligaments in the knee for athletes, the elderly, and just about anyone who needs serious knee treatment. Uncontrolled retrospective case studies (Meaning, one person asks a patient how they feel, and then that person writes a report and gets it submitted in a journal), in the past have shown good results from this procedure. Here is the result of the first double-blind controlled study for surgery on the knee (Double blind, in this case, means the patient didn’t know what procedure the doctor did, and the person measuring the results of the procedure didn’t know which procedure was performed on the patient).

            180 patients were divided into three groups.4 Group 1 received arthroscopic surgery involving lavage (Washing the insides), and smoothing of tears or damage to the meniscus. Group 2 received debribement (removal of torn or damaged tissue), with lavage. Group 3 received a fake surgery. With fake surgery, the knee was opened, and the doctor pretended he was doing surgery, asking for the scalpel etc., and then splashed the area with a saline solution to fake lavaging of the joint. The surgeon was board-certified, in practice 10 years, and a former US Olympic team doctor, as well as the orthopedic surgeon for the Houston Rockets (National Basketball Team).

            Results were measured subjectively and objectively at 2 weeks, 6 weeks, 3 months, 6 months, 12 months, 18 months, and 24 months. What they found was that all groups reported less pain after the procedure. Objective examination revealed worse mobility of the knee joint in the group that received debribement than in the remaining two groups.

            Not only does the research show that this method of treatment is ineffective, but it reveals another sad fact. This invasive procedure has been performed for roughly 15 years, but with no blinded RTC’s (Randomized Controlled Studies).

 

Ear Infections

            Modern medicine has not always made tremendous advances in fighting infectious diseases. The Department of Family Medicine at Memorial Hospital, Rhode Island, studied the results of antibiotic treatment on 3660 children.5  All children were diagnosed as having acute otitis media by pus, bulging, and reddening of the ear and tympanic membrane.

            After reviewing the results, they had this to say, “Patients who did not take antibiotics had a higher rate of recovery than those who did; the rate of recovery did not differ between different types of antibiotic.” They conclude by saying, “Antibiotic treatment did not improve the rate of recovery of patients in this study.”

            The Department of General Practice at Dunedin School of Medicine also studied ear infections and antibiotic treatment.6 A retrospective analysis of 2901 consultations for otitis media was undertaken. Specific diagnostic groups were compared for antibiotic treatments offered, duration of therapy, and treatment success. They found, “There were no difference in success rates between antibiotic and no antibiotic therapies.” In fact, they say, the results of success of treatment are more closely related to the patients’ age than to specific diagnosis, type or duration of therapy.

            The Centre for General Practice, University of Queensland performed a comprehensive review.7 They reviewed all the RCT’s (Randomized Controlled Trials) to date and found six that were well performed and worthy of review. The results showed after 24 hours of onset, 60% of patients receiving placebo treatment were pain free, and 60% of patients receiving medication were pain free. Over a period of one week, the antibiotics seemed to produce a slightly better result, but the authors themselves state, “The medications seemed to have no influence on subsequent attacks of otitis media or deafness at one month, but by taking antibiotics, there is a near doubling of the risk of vomiting, diarrhea, or rashes.”

            It is worth asking chiropractors this, if research showed that spinal manipulation didn’t improve neck pain, or headaches, but did double the incidence of vomiting, diarrhea, and rashes in your patients (In the young patients), would you continue using neck manipulation? In medicine, doctors still regularly prescribe antibiotics for ear infection.

 

Heart Disease

            Heart disease and medical advances in surgery are regularly announced on television. Here is one result that never made it on any of the news networks.

            Published in the American Journal of Cardiology, Cobb’s compared artery ligation surgery and sham (Fake) surgery for treatment of angina pectoris.8 Six months after the surgery, patients were compared. They found that 63% of the patients receiving surgery improved. Unfortunately, 56% of the patients that received a sham surgery also improved. Considering the difference of only 7% maybe surgery isn’t so smart.

            Dimond confirmed these results in a similar study.9 He compared the same surgical procedure against a sham procedure and found that one year after the operation, 69% of the patients that received surgery felt at least half better. In the group that received sham treatment, 100% felt at least half better.

 

Prostate Cancer

            For the male gender, looking forward to that day when it comes time to make a decision about one of the more treasured areas, the Journal of the American Medical Association published the findings of surgery for prostate cancer, compared to doing nothing (10). This was the first RCT ever comparing removal of the prostate, radiation therapy, and hormone treatment, versus doing nothing at all (I always thought they tested treatment procedures before doing them).

            The study involved 223 patients and they followed the results for 10 years. After 10 years, the group receiving medical treatment had an 88% survival rate. The group that did not receive treatment had an 87% survival rate. Of course, meaning that whether the patient had his testicles removed, and received estrogen therapy, or whether he did nothing, the result was the same.

Rheumatoid Arthritis

            Individuals afflicted with rheumatoid arthritis, and fortunate enough to have adequate insurance coverage, will receive a drug containing gold, considered to be the most effective form of treatment for their pain and crippling.

            The Lancet published an article studying the effects of a one-year vegetarian diet on patients with this disease.11 Twenty-seven patients were placed on a vegetarian diet, and 26 participated in the control group. The control group never changed their diet, but did receive drug therapy. After four weeks the vegetarian diet group showed significant improvement in tender joints, pain, morning stiffness, as well as and improved results on blood examination. “The benefits in the diet group were still present after one year.”

 

Articles That Never Made It In the News

(Chiropractic)

 

Low Back Pain

    Dr. Meade, a Medical Doctor, compared chiropractic treatment to treatment in hospitals in England on 741 patients.12 The results of this 10 year study showed that chiropractic produced better patient satisfaction. Even at three years post treatment, the results showed that the patients receiving chiropractic care on average had a 29% better result than those receiving medical treatment.  Dr. Meade states, “The beneficial effect of chiropractic on pain was particularly clear. Introducing chiropractic into NHS practice should be considered.” He went to far as to say that if the Government of England were to include chiropractic in their health care system, it would result in several million dollars in savings. Keep in mind that three years is a long time. Also keep in mind that this research was directed by a medical doctor, not a chiropractor.

            The Danish Institute for Health Technology reviewed research to date and prepared a report giving guidelines for treatment of lower back pain.13  This report was then submitted to the government. They evaluated treatment methods, patient access to the methods, and economics, with regard to the method of treatment. The board consists of a the chairman who is a medical doctor, an economist, relaxation therapist, physiotherapist, epidemiologist medical doctor, neurosurgeon, orthopedic surgeon, rheumatologist, general medical practitioner, occupational therapist, chiropractor, the chief of musculoskeletal medicines medical doctor, and the head of the arthritis associations medical doctor. In summary they said the following:

            In 1998 the Ontario Workers’ Safety and Insurance Board (The WSIB is one of the largest workers’ compensation agencies in the world), set up a panel of 11 experts to review the literature regarding treatment for chronic back pain.14 The panel consisted of experts in family medicine, neurology, nursing, orthopedic medicine, physical medicine, acupuncture, psychiatry, psychology, chiropractic, anesthesiology, and rheumatology. They rated the methods of treatment from level one, to level 4. A Level 1 indicates strong research evidence demonstrating efficacy of the treatment method.

            Again it is worth noting that this was an expert panel with no biased opinions toward or against chiropractic. They simply reviewed all the literature up to 1998 and published the results.

 

Safety of Spinal Manipulation

            There seems to be an ongoing controversy with regards to the safety of neck manipulation. Here are some of the facts.

            The Canadian Stroke Consortium published an article known as SPONTADS in the Canadian Medical Association Journal in 2000.15 Research to date has shown that the possibility of suffering major injury to the vertebral artery from SMT is about 1 in 4,000,000.16, 17, 18, 19, 20 Meaning that of 25 chiropractors practicing on average for 40 years each, one will fall upon this problem. SPONTADS study found that the possibility was more close to around 50 incidences a month, indicating that chiropractic SMT is much more dangerous than previous thought. Dr. Norris announced the results of this study on National Television in July 2000.

            Here is what wasn’t announced on national television. The estimated number of accidents was made by sending a survey to neurologists and asking them how many patients they saw that had a stroke after SMT. In a courtroom testimony while under cross-examination, Dr. Norris admitted that SPONTADS was not a published “Major Prospective Study,” but rather a preliminary informal survey to see if further study should be taken.21 He also said under oath that it (SPONTADS) had not produced a single case documenting stroke caused by manipulation, and that the figure of 50 strokes per month was only guesswork, and wrong, and could be characterized as “absurd.” Professor David Sackett, known worldwide as the father of evidenced-based medicine, stated, while in testimony at the Lewis Inquest, that Dr. Norris had been “Scientifically irresponsible,” and “Incompetent as a scientist in the study of causation .”22

            By the way, to put things into perspective, cervical spine surgery is accompanied by a paralysis rate of 15,600/1,000,000, and a death rate of 6,900/1,000,000 (20).

            At the University of Calgary, and published in 2002, the first study ever was performed to measure the actual forces at the vertebral artery from manipulation.23 They found after performing various tests on the cervical spine that SMT produces “Strains on the vertebral artery of about one-ninth of the strain of mechanical failure.” This strain ended up being about the same as is produced when performing standard range of motion exams. They conclude that “under normal circumstances, a single typical SMT thrust is very unlikely to mechanically disrupt the vertebral artery.”

            Scott Haldeman et al, published an article in Spine Journal 2001. This study is probably the most thorough and comprehensive to date with regards to manipulation and stroke.24 Some of the highlights from this study:

            1. There are no known factors precipitating strokes (Diabetes, smoking, arthritis, birth control pills, high blood pressure, age, and sex are not related to strokes).

            2. The belief that accidents can be avoided by prescreening tests or appropriate history is not supported by any data.

            3. Inherent artery defects may be the cause of strokes, and they are completely unpredictable.

            What this means to chiropractors is that there is no such thing as knowing what kind of patient is susceptible to stroke, and there is no such thing as a patient that could be considered a poor candidate for SMT. It is not the SMT that is unsafe.

 

Neck Pain

            Spine Journal, in 2001, published an article comparing exercise, and chiropractic adjustments.25 Patients with neck pain were put into three groups. One group received chiropractic adjustments, the next exercise therapy, and the third, both exercise and chiropractic. At three months after care, all three groups improved significantly. At one year, the group that did the best was the group that received chiropractic and exercise, not just one, or the other. One can conclude that exercise combined with chiropractic works better than exercise, or chiropractic alone, but I look at this article as a sign of changing times. They didn’t even bother to compare drugs as a method of treatment for neck pain.

            Lynton Giles, Director at the National Unit for Multidisciplinary Studies of Spinal Pain compared SMT, acupuncture, and medication for the treatment of neck pain.26  After treatment for a period of four weeks, they found the acupuncture and medication groups made no significant improvement. The group that received SMT made a 30% average improvement. He comments that the improvement in the SMT group were uniformly evident, meaning each person improved about the same degree (It wasn’t one or two people that made a tremendous improvement, hence altering the overall average). There were no side effects from the SMT, or acupuncture, but three patients taking medication had significant stomach problems as a side effect of the drugs.

 

Pregnancy

            Too often chiropractic is associated with neck and back pain, so I added this just to show otherwise. 166 women averaging four years of infertility were placed into separate groups.27 Group A received relaxation, stretching, and SMT as well as mobilization at the sacral and lumbar joints. Group B received active and passive exercises. Group C received the same as Group B, but the exercises were delayed six months. Group D, exercises to do at home on their own. Group E were the patients that were from groups B, C, and D but remained unable to get pregnant. They were then treated by the same methods as those in Group A. The pregnancy success rates as shown below clearly demonstrate higher success in the patients that received stretching, relaxation, and SMT/mobilization to the sacral and lumbar joints.

            This is not a compilation of outstanding findings, but rather a sample of the many studies available demonstrating chiropractic efficacy. I could go on, but I just wanted to point out some of the articles that represent a sign of changing times. I recall a research article published in, I believe it was the American Journal of Chiropractic, around the time I graduated, 1983. The doctor showed before and after x-rays of 5 patients with arthritis. He was demonstrating that through Chiropractic, one could reverse the degenerative process. This was considered mediocre research at the time. Nowadays, this wouldn’t even be considered as worthy of a review. Chiropractic has stepped into the research arena. And along the way, medicine is now also being asked to show proof. Research, fortunately, is blind to popularity, or public opinion. We may win in the research arena, but we have yet to win in popularity. 90% of the public still runs to drugs for their health problems.

 

Do People Really Want to Hear the Truth?

            What would I want to hear if I had prostatic carcinoma? I would want to hear that advances in medicine have resulted in a surgery that is completely effective at getting rid of it. If I had Rheumatoid arthritis, I don’t want to hear that I should be taking vitamins, and eating less red meat. And certainly, if I had injury to my knee, I want to know that a top rate surgeon is about to perform surgery using breaking edge technology that will undoubtedly fix me. I don’t want to hear that the road to fixing my knee requires six months of rehabilitation, and exercise, with visits of three days a week to the doctor’s office.

            In the 60’s and 70’s, many chiropractic techniques prospered based on the personality of the chiropractor. Most all the techniques in chiropractic today that remain extant were started by flamboyant, self-confident, and warm-hearted chiropractors. Those that were based on research, have yet to prosper.  This can be said for medicine as well. It stands to reason that a doctor who has studied for 6-7 years in a government funded institution, has an office with diagnostic equipment surpassing $100,000.00, and the backing of health care insurance will hold a better image in the public eye than the chiropractor who studied at a private institute, has a used x-ray machine, or even less, and is not admitted into the insurance system.

            But in any case, what I have learned from my recent discussions with my Japanese friends, and from what I know from the research, is that popularity still rules over truth, in Japan, or in America. The difference between the two being that in America, the public is much more intelligently deceived, and by much more capable organizations. Here in Japan, the deception techniques are lower quality and not as well funded.

            As long as we as a profession, continue to believe that the power that made the body is the power that heals the body, and that the road to health requires time, effort, and responsibility for oneself, we will lay on the side of unpopularity. And, we will probably always be the nail that sticks out, and fortunately unable to be hammered down.

 

References

            1. Plaugher G, et al: The interexaminer reliability of a galvanic skin response instrument. JMPT 1993, 16(7): 453-9

            2. Osterbauer PJ, Fuhr AW: Motion analysis as a means to objectify changes in apparent (prone) leg length inequality. The proceedings of the California chiropractic foundation’s seventh annual conference on research and education 1992, Palm Springs Cal.; p. 291-292

            3. Rumor: This May or May Not Be Fact

            4. Moseley JB, O’Malley K et al: A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee. NEJM 2002; 347(2):81-87

            5. Froom J, Culpepper L, Grob P et al: Diagnosis and antibiotic treatment of acute otitis media: report from International Primary Care Network. BMJ 1990; Mar 3;300(6724):582-6

            6. Tilyard MW, Dovey SM, Walker SA: Otitis media treatment in New Zealand general practice. N Z Med J 1997 Apr 25;110(1042):143-5

            7. Del Mar C, Glasziou P, Hayem M: Are antibiotics indicated as initial treatment for children with acute otitis media? A meta-analysis. BMJ 1997 May 24;314(7093):1526-9

            8. Cobb LA, Thomas I, Dillard DH, et al: An evaluation of internal-mammary artery-ligation by a double blind technique. N Engl J Med 1959; 260:1115-8

            9. Dimond EG, Kittle CF: Comparison of internal mammary ligation and sham operation for angina pectoris. AM J Cardiol 1960; 5:483-486

            10. Johansson J, Adam H, et al: High 10-year survival rate in patients with early, untreated prostatic cancer. JAMA 267(16):2191-2236

            11. Kjeldsen-Kragh, Haugen M, et al: Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis, The Lancet, 1991; 338:899-902

            12. Meade TW; Dyer S; Browne W; Frank AO: Randomised comparison of chiropractic and hospital outpatient management for low back pain: results from extended follow up. BMJ, 311(7001):349-51 1995 Aug 5

            13. Manniche C et al: Low-Back Pain: Frequency Management and Prevention from an HDA Perspective. Danish Health Technology 1999, 1(1)

            14. Smith B, Gribbin M: Etiology Prevention, Treatment, and Disability Management of Chronic Pain. Clin J Pain 2001, 17:S1-S132

            15. Norris JW, Beletsky V et al: Sudden Neck Movement and Cervical Artery Dissection. CMAJ 2001, 163(1):38-40

            16. Haldeman S, Kohlebeck FJ et al: Risk Factors and Precipitating Neck Movements Causing Vertebrobasilar Artery Dissection After Cervical Trauma and Spinal Manipulation. Spine 1999, 24(8):785-794

            17. Terrett AGJ: Current Concepts in Vertebrobasilar Complications Following Spinal Manipulation. 2001 NCMIC Group Inc, West Des Moines, IA

            18. Hosek TS, Schram SB, Silverman H, and Meyers JB: Cervical manipulation. J Amer Med Assoc 1981; 2(45):922

            19. Carey PF: A Report on the occurrence of cerebrovascular accidents in chiropractic practice. Can Chiropractic Assoc 1993; 37:104-106

            20. Coulter ID, Hurwitz EL, Adams AH, Et al: The appropriateness of manipulation and mobilization of the cervical spine. Published by RAND, Santa Monica 1996

            21. Chapman-Smith D: The Chiropractic Report. 2002, July16:4

            22. Sackett D, Testimony at the Lewis Inquest, Coroner’s court, Toronto, November 20, 2002

            23. Herzog W, Symonts B: The Mechanics of Neck Manipulation with Special Consideration of the Vertebral Artery. JMPT 2002, 25(8):504-510

            24. Haldeman S, et al: Unpredictability of Cerebrovascular Ischemia Associated with Cervical Spine Manipulation Therapy: A Review of Sixty-Four Cases After Cervical Spine Manipulation_Spine 2001, 27(1):49-55

            25. Bronfort G, Evans R et al: A randomized Clinical Trial of Exercise and Spinal Manipulation for Patients with Chronic Neck Pain. Spine 2001, 26(7):788-800

            26. Giles LGF, Muller R: Chronic Spinal Pain Syndromes: A Clinical Pilot Trial Comparing Acupuncture, a Nonsteroidal Anti-Inflammatory Drug, and Spinal Manipulation. JMPT 1999, 22(6):376-381

            27. Volejnikova H: Female Infertility: A Study of Physical Treatment by the Method of L. Mojzisova for Functional Disturbances of the Pelvic Region.  J Ortho Med 2001, 23(2):47-49