Redwood on Chiropractics

[Guest guest]

In a roundtable discussion at an NIH conference on acupuncture

(published in 1996 in the Journal of Alternative and Complementary

Medicine, of which I am now associate editor), one of the

participants said, " Some true points are not on the meridians. If any

sham point is more than 50% effective, then that is a new real

point. " (3) Similarly, whatever presumably minimal physical contact

the chiropractor applied as a sham in the NEJM study cannot be

presumed to have no effect. Obviously, if the DC never touched the

patient's back or neck, my point is moot. My assumption, however, is

that there was contact applied.

 

 

Because chiropractors differ in the techniques they use, and (perhaps

more significantly) in their technical mastery of their manual art,

we are going to have to expect inconsistency from one study to the

next. For the sake of discussion, consider the 1985 Cassidy-Kirkaldy-

Willis study in Canadian Family Physician(4). The truly spectacular

results from chiropractic treatment (approximately 80 percent of

patients 'totally disabled' for an average of 7 years back on the job

and doing well after 3 weeks of daily adjustments) reflect, in my

view, not only the positive value of low back adjustments but also

the exceptional skill of the particular chiropractor (I believe it

was Dr. Cassidy).

 

With chiropractic (as with other non-drug approaches including

acupuncture, physical therapy, and massage) we are not dealing with a

substance of standardized potency, but with a physical modality that

varies from one adjustment to the next, and from one adjuster to the

next.

 

These issues (sham vs. real, and individual variation) pose a genuine

challenge in CAM research circles today, one with which some very

good minds in other disciplines continue to struggle. In addressing

the challenge of the NEJM studies, I think they are both worth

pondering further.