To the Editor: The article by Dr
Weinstein1 offered sound advice on the prudent use of
radiologic diagnostic studies. For too long these expensive and
potentially harmful tests have taken the place of an investigative
clinical examination and history taking and may have led to unnecessary
intervention.
In addition to coordinating provider networks for managed care groups,
I am a chiropractic physician practicing with a large group of
orthopedic surgeons, so I am in a unique position to see health care
from many sides. After reading Weinstein's remarks concerning
chiropractic efficacy in the treatment of low back pain, I am reminded
that old bias and inherent prejudices continue—many times to the
detriment of the patient. Weinstein states, "There remain many
anecdotal reports of beneficial outcomes and sudden recovery from
manipulative and traction therapies." I would hardly call the
abundance of quality studies on the efficacy of chiropractic management
anecdotal. Clinical investigation from the distinguished RAND
Corporation as well as studies published in respected medical journals
have clearly shown chiropractic management to be
effective,2 as well as cost-efficient.2- 3
Organized medicine's continued allegations of only anecdotal evidence
of the validity of chiropractic therapeutic techniques is interesting
when according to medical researchers such a small percentage of
medical studies and everyday interventions are supported by solid
scientific evidence.4- 5 Nevertheless, these practices
continue to benefit patients, who care less about science and more
about their health and quality of life. Weinstein also mentions the
Agency for Health Care Policy and Research guidelines and comments that
the report offers "little evidence to support passive physical
therapy (eg, heat, ice, massage, manipulation, braces, biofeedback,
traction, etc)." But the report advises that manipulation is 1 of the
2 best management tools in the treatment of low back pain. Why did
Weinstein classify manipulation with physical therapy rather than
chiropractic therapy when chiropractors deliver more than 94% of all
manipulations in the United States?6