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Fact and Fiction

Educational information about chiropractic treatment

We accept our responsibility to provide educational information that demonstrates the validity of conservative chiropractic treatment modalities for those who may be skeptical about chiropractic treatment, or those who of you that may have been exposed to any of the anti-chiropractic misinformation in the media or on the internet. The detailed items in this section are intended to provide scientific evidence that conservative chiropractic treatment is a safe and effective treatment alternative to drug and other allopathic treatments. Our aim is to provide you with the information necessary to make informed decisions about your health care, to counter the skeptic, or expose the hidden agendas of those who seek to contain or eliminate access to alternative health care. We are not implying that prescription medications do not have their benefits. However, there is cause for concern about indiscriminate prolonged utilization.  We are blessed to have developed medications for the treatment of a wide range of diseases and ailments. 

Fact chiropractic treatment:

The United States Government Agency for Health Care and Policy Research [AHCPR] included spinal manipulation as one of only 2 recommended treatments for acute low back problems in adults. Bigos S, et al. Acute Low Back Problems in Adults. Clinical Practice Guideline, Number 14 Rockville Maryland: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, AHCPR Pub. No. 95-0642

Fact chiropractic treatment:

20% of newly FDA approved drugs will be labeled “Dangerous” or withdrawn from the market. A study published in the May 1,2002 Journal of the American Medical Association revealed that 20% of newly FDA approved drugs will be labeled “Dangerous” or withdrawn from the market. According to the authors “Premarketing drug trials are often underpowered to detect ADR [Adverse Drug Reactions] and have limited follow up. This is important for consumers of newly approved prescription medications to understand.

The authors specified that their definition of a serious ADR was “conservative” since it was limited to the most serious black box warnings found in the Physicians Desk Reference, and did not consider other labeling changes such as bolded warnings without boxes, warning letters to health care professional, or case reports in the medical literature. They also stated that “serious ADR’s commonly emerge after FDA approval -Lasser KE, Allen PD, Woolhandeler SJ, Himmelstein DU, Wolf SM, Bor DH Timing of black box warnings and withdrawals for prescription medications. JAMA2002;287:2215-220.

Fact chiropractic treatment:

One in 5 senior citizens receive drugs that medical experts themselves deem inappropriate for use in the elderly.

According to research published in the Journal of the American Medical Association, Dec 12, 2001 one in 5 senior citizens each year is receiving drugs that experts deem inappropriate for use in the elderly. The study examined prescriptions given to patients over 65 during 1996. About 7 million seniors received on of the 33 drugs that are thought to be too dangerous to give to such patients because of serious side effects. Some concerns have been expressed that the drugs are leading to a wide variety of seemingly unrelated effects such as hip fractures. Many of the side effects are often dismissed as new conditions developing or the patient just “getting old”.

Fact: A recent survey of over 2,500 people taken by the Boston University school of Public Health published in the January 16, 2002 issue of the Journal of the American Medical Association sheds some light on to the medicinal habits of American citizens: The results for persons 18 years and older include:

  • 81 percent used at least one medication in the preceding week.
  • 50 percent took at least one prescription drug.
  • Seven percent took five or more medications.
  • The highest rate was among elderly women: 94 percent had taken one medication in the past week, and 12 percent had taken at least 10.

Fact chiropractic treatment:

You can’t count on the FDA.

According to an Oct.04, 2004 Wall Street Journal article titled; Vioxx Recall Raises Issues for FDA, “The FDA oversees a database that gets reports of about 280,000 incidents a year of potential adverse drug reactions. About 90% of those reports come from drug makers, who are required to disclose them; doctors and other medical personnel aren’t required to participate. By some estimates, FDA’s database may reflect as few as 10% of such incidents.”

Fact chiropractic treatment:

DISTURBING DRUG COMPANY ADVERTISING PRACTICES

In an article titled “Curbing the Drug Markets” the July 5, 2004 issue of Time sheds light on the disturbing practices of the pharmaceutical manufacturers.

  • Since 2001 the pharmaceutical companies have agreed to pay $2 billion to settle allegations of illegal sales and marketing practices. [marketing drugs for “off label uses]
  • From 1997-2002 there was a 93% increase in total spending on pharmaceutical promotion in the U.S.
  • From 1995 to 2000 marketing staff at brand name drug companies increased 59%.
  • From 1995 to 2000 research and development staff at brand name drug companies was reduced by 2%.
  • According to a report published by Public Citizen, a congressional watchdog group, a total of 526 pharmaceutical company lobbyists were registered, or about one for every member of congress.
  • U.S. prescription-drug sales grew 11.5% to $216 billion in 2003.

Fact chiropractic treatment:

Muscle Relaxants: Overused, ineffective for acute low back pain.

A 1998 study published in the journal Spine examined the use of muscle relaxants in more than 1600 individuals who sought a health care provider for relief of [LBP] low back pain. The study demonstrated that for cases of low back pain, muscle relaxants were overused and ineffective for acute cases of LBP. The authors reported that “In patients with severe acute LBP… muscle relaxant use was associated with a statistically significant increase in time to functional recovery”. In patients with less severe episodes of back pain, “there was no demonstrable effect from muscle relaxant use. This held true even after controlling for Roland Score {[-measure of functional status]}, subjective pain, sciatica, income, duration of episode [greater or less than 2 weeks], NSAID use, and workers’ compensation.”

After adjusting for baseline status, the researchers noted that patients who took muscle relaxants “return to self-assessed ability to perform their daily activities more slowly than patients who do not take muscle relaxants.” [- a delay in functional recovery]

-Cherkin DC, Wheeler KJ, Barlow W, et al. medication use for low back pain in primary care. Spine 1998;23:607-14. See also: Bernstein E, Carey TS, Mills Garrett J. The use of muscle relaxant medications in acute low back pain. Spine 2004:29(12):1346-51

“This graph originally appeared in the 02 /26/ 05 issue of Dynamic Chiropractic. It appears with permission. www.chiroweb.com.”

Fact chiropractic treatment:

Research has demonstrated that chiropractic manipulation is effective for migraine and tension-type headaches.

Over our 110 year history, chiropractors have developed a reputation for successfully treating headaches. Some estimates list headache as the 3rd most frequent reason tht people seek chiropractic physicians. For the far majority of people seeking headache relief the details of the following research studies, which confirm the therapeutic benefits of chiropractic treatment, should be sufficient to assure potential patients that conservative chiropractic treatment is effective for treating headaches. These studies compare a commonly prescribed pharmaceutical drug treatment, for both migraine and tension-type headaches, to spinal manipulation over time. The abstracts are presented here, as they are referred to elsewhere on this site [yellow highlight emphasis added]. For a in depth review of this and other information regarding the safety and effectiveness of chiropractic treatment for other conditions is available at: http://www.FCER.org. To make an appointment or to request a free pamphlet regarding chiropractic treatment for headache sufferers, contact our office at 516-599-3999.

Fact chiropractic treatment:

The total budgeting for all chiropractic institutions is only $224 million and of that $4 million is for research programs. Harvard University alone receives $739 million a year just from the National Institute of Health to do research. In the entire 100+ year history of the chiropractic profession less than $10 million has been acquired from the federal government for research. The top 25 medical schools received $6 billion from the NIH in the year 2000 alone.

Nelson Migraine Study The Efficacy of Spinal Manipulation, Amitriptyline and the Combination of Both Therapies for the Prophylaxis of Migraine

Nelson CF, et al. Journal of manipulative and Physiological Therapeutics. Oct.1998; Vol.21, No. 8, pp.511-519.

ABSTRACT: Background: Migraine headache affects approximately 11 million adults in the United States. Spinal manipulation is a common alternative therapy for headaches, but its efficacy compared with standard medical therapies is unknown. Objective: To measure the relative efficacy of amitriptyline, spinal manipulation and the combination of both therapies for the prophylaxis of migraine headache. Design: A prospective, randomized, parallel-group comparison. After a 4-wk baseline period, patients were randomly assigned to 8 wk of treatment, after which there was a 4-wk follow-up period. Setting: Chiropractic college outpatient clinic. Participants: A total of 218 patients with the diagnosis of migraine headache. Interventions: An 8-wk course of therapy with spinal manipulation, amitriptyline or a combination of the two treatments. Main Outcome Measures: A headache index score derived from a daily headache pain diary during the last 4 wk of treatment and during the 4-wk follow-up period. Results: Clinically important improvement was observed in both primary and secondary outcomes in all three study groups over time. The reduction in headache index scores during treatment compared with baseline was 49% for amitriptyline, 40% for spinal manipulation and 41% for the combined group; p = .66. During the post treatment follow-up period the reduction from baseline was 24% for amitriptyline, 42% for spinal manipulation and 25% for the combined group; p = .05. Conclusion: There was no advantage to combining amitriptyline and spinal manipulation for the treatment of migraine headache. Spinal manipulation seemed to be as effective as a well-established and efficacious treatment (amitriptyline), and on the basis of a benign side effects profile, it should be considered a treatment option for patients with frequent migraine headaches.

Boline Study Spinal Manipulation vs. Amitriptyline for the Treatment of Chronic Tension-Type Headaches: A Randomized Clinical Trial

Boline PD, Kasak K, et al. Journal of manipulative and Physiological Therapeutics. March / April 1995; Vol 18, No.3, pp. 148-154

ABSTRACT: Objective: To compare the effectiveness of spinal manipulation and pharmaceutical treatment (amitriptyline) for chronic tension-type headache. Design: Randomized controlled trial using two parallel groups. The study consisted of a 2-wk baseline period, a 6-wk treatment period and a 4-wk post-treatment, follow-up period. Setting: Chiropractic college outpatient clinic. Patients: One hundred and fifty patients between the ages of 18 and 70 with a diagnosis of tension-type headaches of at least 3 months’ duration at a frequency of at least once per wk. Interventions: 6 wk of spinal manipulative therapy provided by chiropractors or 6 wk of amitriptyline treatment managed by a medical physician. Main Outcome Measures: Change in-patient-reported daily headache intensity, weekly headache frequency, over-the-counter medication usage and functional health status (SF-36). Results: A total of 448 people responded to the recruitment advertisements; 298 were excluded during the screening process. Of the 150 patients who were enrolled in the study, 24 (16%) dropped out: 5 (6.6%) from the spinal manipulative therapy and 19 (27.1%) from the amitriptyline therapy group. During the treatment period, both groups improved at very similar rates in all primary outcomes. In relation to baseline values at 4 wk after cessation of treatment, the spinal manipulation group showed reduction of 32% in headache intensity, 42% in headache frequency, 30% in over-the-counter medication usage and an improvement of 16% in functional health status. By comparison, the amitriptyline therapy group showed no improvement or a slight worsening from baseline values in the same four major outcome measures. Controlling for baseline differences, all group differences at 4 wk after cessation of therapy were considered to be clinically important and were statistically significant. Of the patients who finished the study, 46 (82.1%) in the amitriptyline therapy group reported side effects that included drowsiness, dry mouth and weight gain. Three patients (4.3%) in the spinal manipulation group reported neck soreness and stiffness. Conclusion: The results of this study show that spinal manipulative therapy is an effective treatment for tension headaches. Amitriptyline therapy was slightly more effective in reducing pain at the end of the treatment period but was associated with more side effects. Four weeks after cessation of treatment, however, the patients who received spinal manipulative therapy experienced a sustained therapeutic benefit in all major outcomes in contrast to the patients that received amitriptyline therapy, who reverted to baseline values. The sustained therapeutic benefit associated with spinal manipulation seemed to result in a decreased need for over-the-counter medication. There is a need to assess the effectiveness of spinal manipulative therapy beyond four weeks and to compare spinal manipulative therapy to an appropriate placebo such as sham manipulation in future clinical trials.

Fact chiropractic treatment:

Adverse drug reactions shown to be between the 4th and 6th leading cause of death in the U.S.

[04/15/98 J. Lazarou, BH Pomeranz, and PN Corey “incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies” Journal of the American Medical Association 279(15):1200-5].

The authors conducted a meta analysis of 39 out of 153 prospective studies from US hospitals published from 1966-96 concerning serious adverse drug reactions [ADR’s]. They excluded errors in drug administration, noncompliance, overdose, drug abuse, therapeutic failures, and possible ADR’s. The authors defined ADR’s as those that required hospitalization, were permanently disabling, or resulting in death. They estimated that overall 2,216,000 [1,721,000-2,711,000] hospitalized patients had serious ADR’s, and 106,000 [76,000-137,000] had fatal ADR’s making these reactions between the fourth and sixth leading causes of deaths in the US in 1994. The most incredible aspect of this article is the realization that an average of 106,000 hospitalized patients died and 2,216,000 had a serious reaction to the right drug being given for the correct diagnosis and in the correct dosage in a single year.

Fact chiropractic treatment:

Drug makers are dramatically increasing their advertising budgets.

07/20/98 Bill Meyers (98-07-20). Wonder drugs, wonderful profits: Drug makers have healthy outlook USA Today: 3B.

Drug makers business is booming with some companies reporting growth of more than 30% per year. Drug manufacturers had been dramatically increasing their advertising budgets by approximately 39% to 3.2 billion from 1995-97. In spite of the fact that the correct drug in the correct dose kills more than 100,000 hospitalized Americans per year and makes more that 2 million seriously ill, these drugs remain a good Wall Street investment, primarily as a consequence of advertisement. 0

8/31/98 John Hendren. U.S. prescriptions rise with new array of drugs. THE DENVER POST. From the Associated Press: A7.

The author notes that the number of prescriptions that Americans take will rise an estimated 6% in1998 over 1997. Retail pharmacy sales are expected to rise 15% to $102.5 billion from $89 billion in 1997. Consumers will pick up 2.8 billion prescriptions in 1998 more than 11 for every man woman and child in the U.S. The authors also note that some cholesterol lowering drugs cost $1,000.00 per year and are meant to be taken for life, and that many managed care companies are actually paying for it. [Do you know of any managed care companies that will consider paying $1,000.00 per year for life for chiropractic care?]

10/19/98. Steve Rubenstein and Chronicle Staff Writer. Doctors Warned on Antibiotics: Pediatricians told to think twice before prescribing them. San Francisco Chronicle: A5

This article was based on the keynote address given to the 5,000 pediatricians who were meeting at the American Academy of Pediatrics Convention in San Francisco. The article states “There are too many antibiotics being dispensed for routine sinus infections.” “Antibiotics are useless against viruses, the cause of many sinus infections. Unnecessary use of antibiotics enables bacteria to become resistant to them.” “The result of 88 sinus research studies found that only one [1] claimed that antibiotics were the best treatment.” “ A pediatrician can be pressured into prescribing antibiotics, even against his or her better judgment, because other pediatricians are doing it.”

Fact: This research article demonstrates what medical physicians consider to be acceptable therapeutic risk for the non-steroidal anti- inflammatory drugs [NSAID’s] that they commonly prescribe. Compare the potential benefits and risk associated with this single class of drug therapy to the benefits and risk associated with chiropractic manipulations [for all conditions].

04/01/99 “Epidemiology of NSAID induced gastrointestinal complications.” Journal of Rheumatology.

  • It is estimated that more than 30 million people take NSAIDs daily.
  • Gastrointestinal complications related to NSAID therapy are the most prevalent category of adverse drug reactions.
  • Patients with arthritis are among the most frequent users of NSAIDs and are therefore particularly at risk for these side effects.
  • Endoscopic lesions [i.e. ulcers] are common and can be seen in up to 80% of patients treated with NSAIDs.
  • Serious gastrointestinal complications can occur without any prior side effects or prior evidence of mucosal [gut lining] damage. 81% of patients who had serious GI complications had no prior GI symptoms.
  • Conseratively, the number of hospitalizations for serious GI complications per year is estimated to be 103,000, with a conservative cost estimate of $15-20,000 per hospitalization, with an annual cost exceeding $2 billion.
  • The overall estimates for NSAID related deaths among patients with rheumatiod arthritis and osteo-arthritis is 16,500. If NSAID related deaths were tabulated separately in the national vital statistics reports it would be the 15th most common cause of death in the US. None of this mortality data includes mortality from over the counter use or for use in nonarthritis indications (e.g., analgesia [pain relief] and injuries)

The article goes on to state “A possible explanation of these findings is that by suppressing symptoms, H2 antagonists and antacids may actually increase the probability of a serious GI event by creating a false sense of security for the physician and patient. Suppression of symptoms may encourage the use of higher doses of NSAIDs for longer periods, ultimately resulting in more severe GI complications. Ongoing use of prophylactic medications may continue to suppress early warning symptoms that would otherwise lead the physician to discontinue or change NSAID. Here is another example of the serious risks associated with suppression of symptoms with medications.

06/17/99 M. Michael Wolfe, M.D., David R. Lichtenstein, M.D., Gurkipal Singh, M.D., “Gastrointestinal toxicity of nonsteroidal anit-inflammatory drugs.” New England Journal Of Medicine

  • NSAID agents constitute one of the world’s most widely used classes of drugs, with more than 70 million prescriptions and more that 30 billion over -the –counter tablets sold annually in the US.
  • Does of aspirin as low as 30mg are sufficient to suppress prostaglandin synthesis in the gastric mucosa initiating gastric-duodenal mucosal injury resulting in the release of oxygen derived free radicals.
  • After ingestion of an NSAID damage to the gastric epithelium occurs within minutes, and gross endoscopically detectable hemorrhages and erosions in the gastroduodinal epithelium occur within several hours.

The authors note that it is hoped that cox-2 inhibitors [available in the US since Feb. 1999] will have a reduced capacity to cause injury to the gastro-duodenal mucosa. However, they are known to cause defects in renal function, alter the regulation of bone resorption, impair female reproductive physiology, and increase the rate of thrombotic events in patients with increased risk for cardiovascular disease.

As dangerous as drugs are, drug companies are allowed to spend billions of dollars in advertising, including advertisements directly to the consuming public. Consequently these “legal” medical drugs have been shown by these and numerous other scientific articles to be:

  • A leading cause of both death and serious illness in our country.
  • A profitable and favorite investment on Wall Street and worldwide. So how would you rate the FDA’s job of protecting the consumer in our country? Do you think the FDA should concentrate their efforts on cleaning up the Drug companies instead of harassing nutritional & vitamin companies and distributors?

Fact chiropractic treatment:

Medical accidents and mistakes kill 400,000 people a year ranking behind only heart disease and cancer as the leading cause of death. “Mistakes alone kill more people each year than tobacco, alcohol, firearms or automobiles.”

July 15, 1999 R. A. Rosenblatt, “HMO Chief: Patients are at risk: Blunders take 400,000 lives every year, Kaiser head says.” LOS ANGLES TIMES, Oakland Tribune, July 15, 1999.

Dr. David Lawrence, chief executive of Kaiser Permanente [Kaiser is the largest HMO in the US.] was quoted in this article about his speech to the National Press Club:

“Medical accidents and mistakes kill 400,000 people a year, ranking behind only heart disease, and cancer as the leading causes of death”

“Mistakes alone kill more people each year than tobacco, alcohol, firearms, or automobiles” Patients “continue to believe in the myth of Marcus Welby, the unbridled benefits of technology, and the assumption that competence and safety are spread evenly and consistently throughout the health care system.”

Fiction:

Chiropractic manipulation is not indicated for patients with lumbar discopathy.

There is little if any scientific basis for a medical doctor to not recommend spinal manipulation even is cases of disc herniation. According to an article published by the FCER, the concept of a disc rupturing during spinal manipulation may have had its origins in a study published by Farfan in 1970. The study stated that rotational stress causes disc failure. This study demonstrated that in rotation normal discs withstand an average of 23 degrees of rotation, and degenerated discs an average of 14 degrees before failure occurred which resulted in disc herniation. However, research has demonstrated that the posterior facet joint of the lumbar vertebrae, limit rotation to a maximum of 2-3 degrees and would have to fracture in order to allow any further rotation to occur.

One of the most comprehensive studies on the subject was conducted by Oliphant who calculates the net risk of a clinically worsened disc herniation or cauda equine syndrome from 6245 million patients studied over a 40 year period who presented with lumbar disc herniation to be less than one in 3.7million excluding anesthesia. The article goes on to compare spinal manipulation to other treatment modalities and demonstrates that conservative chiropractic care is a safe and effective alternative.

  • If significant complications occur in 1-4% of NSAID users, spinal manipulation is between 37,000 and 148,000 times safer.
  • If significant complications occur in just 1.5 -12% of lumbar disc herniation surgeries spinal manipulation is between 55,000 and 444,000 times safer.
  • If cauda equine syndrome [CES] occurs in the aforementioned 1 per 3.7 million manipulations and in 0.2 – 1% of surgeries spinal manipulation is at least 7,400 to 37,000 times less likely to yield CES.

The methods of manipulation that are utilized at Malverne Chiropractic Office are performed well within the normal limits of joint range of motion. By performing manipulations within the physiological limits of motion, the possibility of further injuring the joint is minimal.

Nwuga conducted a randomized clinical trial involving 51 cases of myelographically confirmed disc herniations comparing the effectiveness of spinal manipulation to conventional physical therapy, exercise, and postural education. The manipulation group demonstrated greater improvement in range of motion and straight leg raising compared to the physical therapy cohort leading the researchers t conclude that manipulation was superior to conventional treatment. -Nwuga VCB. Relative therapeutic efficacy of vertebral manipulation and conventional treatment in back pain management. American Journal of Physical Medicine 1982;61(6):273-278

A second trial examined 40 patients with unremitting sciatica diagnosed due to lumbar disc herniation with no clinical indication for surgical intervention. Subjects were randomized into two treatments: chemonucleolusis [chymopapain injection under general anesthesia] and manipulation. Back pain and disability was appreciably lower in the manipulated group at 2 and 6 weeks with no improvement in the chemonucleolytic group. By 12 months there were improvements noted in both groups with a tendency towards superiority in the manipulated cohort.

Educational information about chiropractic treatment.

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