Chiropractic Gains Respect Among MDs

Spinal manipulation is appropriate for nearly half the chiropractic patients who undergo that treatment for lower back pain, according to new research by a physician who says chiropractors deserve more respect.

The study is the latest example of the medical community’s growing acceptance of alternative treatments.

In 46% of sample cases reviewed, spinal manipulation was administered to people likely to benefit from it, while it was inappropriately used on 29% of patients, according to the study, published July 1 in the journal Annals of Internal Medicine.

It was unclear whether spinal manipulation--manual adjustments to achieve proper alignment and mobility of spinal joints--was the right treatment in 25% of the 859 cases reviewed.

Lead author Dr. Paul G. Shekelle, an internist with the West Los Angeles Veterans Affairs Medical Center and the RAND research institution of Santa Monica said the study had a mixed message.

“Chiropractors can be treated just like medical doctors,” Shekelle said. “Medical doctors like me should stop thinking that everything they do is quackery. . . . There’s research that supports that some of the things they do is beneficial.”

An “appropriateness rate” of nearly half is comparable to findings for some medical procedures when such measures were introduced 12 years ago, he explained.

“Instead of thinking of chiropractic as an alternative or some kind of therapy separate from other health care, we really should consider it equivalent,” Shekelle said.

On the other hand, he said, chiropractors need to work on lowering their rate of inappropriate care.

“They need to realize that as a profession, they are responsible for the quality of care that they deliver, and their quality of care can be assessed just as quality of care for medical doctors can be assessed,” he said.

Researchers reviewed records of patients who sought treatment for low back pain in chiropractic offices in the United States and Canada from 1985 to 1991.

The U.S. Agency for Health Care Policy and Research in 1994 recommended spinal manipulation for patients with uncomplicated, acute low back pain, and is developing new guidelines for use of chiropractic manipulation to treat chronic headache. Concerns have been raised about the quality of chiropractic care, but there was no solid data available to measure it, the researchers said.

“Our study basically provides the first systematic look at the quality of chiropractic care,” Shekelle said.

The study, conducted by a team of medical and chiropractic doctors and funded by three chiropractic research organizations, looked only at the appropriateness of the decision to initiate treatment, not at the frequency or duration.

“It’s a good study,” said Jerome F. McAndrews, a chiropractor and spokesman for the Virginia-based American Chiropractic Assn., adding that it represents another step toward improved relations between medical and chiropractic doctors. “We’re working very hard to build those professional bridges,” he said.

Pat Vollrath, a Philadelphia chiropractor, says he has seen a change in medical doctors’ attitudes toward his profession.

More and more, he said, “the medical profession does seem to appreciate that the chiropractic profession didn’t get their degrees out of a Crackerjack box.”

As for the 46% appropriateness rate, Vollrath said, chiropractors are “getting better and better and better educated in the assessment of patients.” The 29% inappropriateness rate could reflect a difference in medical and chiropractic doctors’ diagnostic methods, he said, but he acknowledged that some people may get adjustments they don’t need.

“There are good chiropractors and bad chiropractors, just like there are good medical doctors and bad medical doctors,” Vollrath said.