Articles by JCS
Chiropractic & Alternative Medicine:
Not So Alternative Anymore
Alternative health care in America is at an all-time high with patients making more visits to non-MDs according to surveys conducted by Dr. Daniel Eisenberg of Harvard. In fact, in 1997, his survey revealed Americans, mostly college-educated baby boomers, made 629 million office visits to chiropractors, nutritionists, massage therapists, etc., compared to only 386 million office visits to medical doctors, and spent $30 billion on alternative treatments, according to a recent Harvard study. As Dr. Eisenberg concluded, “Maybe ‘alternative’ isn’t so alternative anymore.”
Harvard Medical School, acknowledging that patients are increasingly experimenting with holistic and other alternative treatments, is creating an institute for nontraditional medicine. Harvard researchers will examine the effectiveness of such treatments as chiropractic, acupuncture, herbal therapies, and massage, and look at how they work or interact with traditional medicine.
“You can't practice medicine these days without knowing what patients are doing, and a tremendous amount of them are doing it,'' said Dr. Dan Federman, who helped start Harvard's new program.
Considering the WHO last June announced that the US healthcare delivery system ranked 37th in the world, allthewhile Americans spent over $1.2 trillion while leading the world in every category of chronic degenerative disease, the need to find better solutions for these chronic disorders is paramount, and investigative doctors are looking everywhere for help—even outside their traditional methods of drugs and surgery, and for good reason.
The Institute of Medicine (IOM) criticized the American healthcare delivery system in an April, 2001 article blasting the healthcare system as a “tangled, highly fragmented web that wastes resources to provide safe, high-quality care to millions of Americans.” We heard the same sentiments about waste, fraud and greed in 1994 when Clinton started the Health Care Reform Act? Indeed, the more health care has changed with managed care, the more the same problems still exist.
“The system is failing because it is poorly designed,” says William C. Richardson, chair of the committee that wrote the report and president of the WK Kellogg Foundation. Whether it’s poorly designed or riddled with junk science using too many outdated, ineffective methods with greedy practitioners and biased administrators ignoring the better mousetraps such as chiropractic care, there is no doubt the two trillion dollar plus health care industry in the US needs urgent critical care. While expenses increase dramatically, American’s health statistics are lagging behind other countries that spend a lot less. Perhaps it’s time to think out of the medical box of solutions to find other solutions to these problems.
As Mr. Richardson mentioned, “the system is a maze for many patients, and as a result, many do not receive the services from which they would likely benefit.” Chiropractors have long understood the shortcomings of this medical-pharmaceutical approach to the management of disease, especially in the realm of neck and back problems. The medical boycott of chiropractic officially ended after a 12-year long antitrust case was won by the chiropractic profession against the AMA et al., but it has taken even longer for the medical profession and researchers to look seriously at the help given to millions of patients by doctors of chiropractic.
Incidentally, back pain is not a minor ailment. It is the second-leading cause of disability other than heart/vascular disease, and the leading on-the-job injury. To say that back pain is an epidemic is an understatement, and a costly one at that. While it may not kill anyone, back pain certainly cripples and disables many Americans.
Not only will 9 out of 10 adults suffer from an episode of LBP, costing upwards of $50 to 75 billion annually in the US alone, now the National Academy of Sciences admits this back crisis is worsening. In The Back Letter (vol. 16, # 3, 2001), the NAS reports that “musculoskeletal disorders (MSDs) represent the most common cause for disability among workers in their 50s and 60s… and projections suggest that these figures are rising.”
According to the recent NAS report, MSDs are the most common reason for seeking health care after respiratory conditions, and back pain is the most common musculoskeletal reason for a health care visit. “For 1989, it was estimated that there were 19.9 million visits for back pain, 8.1 million for neck pain, and 5.2 and 5.7 million for hand and wrist pain, respectively,” according to the NAS report.
This report also notes that MSDs account for nearly 70 million physician office visits in the US every year and an estimated 130 million total health care encounters, including outpatient, hospital, and emergency room visits. In addition, nearly one million US residents took time off from work because of a MSD in 1999.
Although much has been said about this trend to alternative health care in the US, much confusion still exists why alternative methods like chiropractic are so popular. While some medical critics chide chiropractic care for being non-surgical and non-drug, much of the public likes this idea of a natural solution for the epidemic of back pain.
The primary reason why spinal manipulation works so well as opposed to back surgery is the key to understanding this epidemic. Moreover, an agency of the US Public Health Service reported, “Surgery has been found to be helpful in only one in 100 cases of back problems.” As the researchers have found, the cause of back pain is not “slipped disks,” as so often explained by medical doctors, but rather, the cause is slipped spinal joints.
First of all, consider the anatomy of the spine itself—24 spinal vertebrae sitting on top of three pelvic bones interconnected by 137 spinal joints and covered by six layers of ligaments, tendons and muscles. In fact, the backbone is actually a pillar of very small back bones connected by disk cartilage, and very susceptible to trauma, bad posture, and bad leverage. Indeed, it doesn’t take much to misalign these joints, and once they do, secondary problems like swollen disks and pinched nerves do occur, leading to muscle spasms and pain.
But the main source of back pain is not stemming from disk abnormalities. Recent MRI research has shown most adults without back pain also have disk degeneration. In fact, the University of Miami Medical School has called a moratorium on back surgeries instead opting for spinal rehab, and has not needed a single spinal surgery since this onset. The link between back pain and disk problems is remote at best, although some leg pains may stem from bulging disks. Indeed, the disk theory has been disproved by every investigation into the back pain epidemic.
“Computed tomography (CT) and MRI are more sensitive than plain radiography for the detection of early spinal infections and cancers. These imaging techniques also reveal herniated disks and spinal stenosis, which plain radiography cannot. Early or frequent use of these tests is discouraged, however, because disk and other abnormalities are common among asymptomatic adults. Degenerated, bulging, and herniated disks are frequently incidental findings, even among patients with low back pain, and may be misleading. Incidental findings may lead to overdiagnosis, anxiety on the part of patients, dependence on medical care, a conviction about the presence of disease, and unnecessary tests or treatments.”
In their Table 1: “Differential Diagnosis of Low Back Pain,” they did show that “Mechanical Low Back or Leg Pain” constituted 97% of these cases, of which “lumbar strain, sprain” accounted for 70% of these cases; “Nonmechanical Spinal Conditions accounted for “about 1%”; “Visceral Disease” accounted for 2%.
Dr. Deyo published another article in 1998 in the Scientific American titled “Low-Back Pain.”[i] He mentions, “Calling a physician a back-pain expert, therefore, is perhaps faint praise--medicine has at best a limited understanding of the condition. In fact, medicines’ reliance on outdated ideas may have actually contributed to the problem.”
If not slipped disks causing back pain, how else can it be explained? Chiropractors explain it as joint dysfunction of the spinal joints, aka “vertebral subluxations” in chiropractic parlance. When spinal joints misalign, they cause a variety of problems—joint instability/stiffness/pain, pinched nerves, muscle reflex spasms and swelling. Until the misalignments are corrected, the tissues will continue to cause pain and will eventually lead to degeneration of the disks, vertebrae and nerves, leading to larger problems with muscular and organic problems.
[i] Deyo, RA. Low -back pain., Scientific American, pp. 49-53, August 1998.