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Dynamic Chiropractic
January 16, 1995, Volume 13, Issue 02

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Title: Spine Letter

Category: Digest of current information and literature on the spine.

Publisher: J.B. Lippincott Company

Publication: Eight-page monthly, 8-l/2 x 11 format, three hole punched for convenient retention.

Cost: $95 (US)

This review is based on a reading of the March, June, and August samplings of the Spine Letter.

It appears that this newsletter has been designed to disseminate current issues relative to the spine that do not have a place in Spine (the journal) or are time sensitive. Like Spine, which from a chiropractic point of view may contain absolutely nothing relevant in one issue and an abundance in the next, the newsletter appears to follow the same direction.

Taking one issue as an example, June l994, the following was relevant to chiropractic.

"Back Pain and Care Seeking in North Carolina
Clear MD and DC Differences Seen"

This is a well written, and for the most part, an unbiased report of 8,000 people surveyed for low back pain over two years. An abridged version of some of the findings:

  1. similar outcomes for MDs and DCs;
  2. DCs preferred to MDs;
  3. DCs use more radiographs, have more visits;
  4. disability, not pain, predicts the outcome, a concept that until this study was always thought to be the reverse.

This study is ongoing. The Spine Letter will publish new information as it is available. (For more information on the study, see "Chiropractic Treats 33% of Back Pain Patients, Study Says," Sept. 12, 1994 issue of "DC.")

The Manga Report

This is a review of the report from the medical point of view, and so it should come as no surprise that the report is criticized. The Manga report is just that: a report of findings that in no way interferes in the way the medical profession practices. The reason the report was commissioned is always lost in the minds of those who review it. Personal paranoia and an ego-driven limbic system echo throughout this review. I wonder if it was actually read from start to finish, as the big picture was missed.

SpineScope: People in the News

This is an enlightening section containing new information about a diverse range of topics. The June issue featured data about Dr. David Cassidy receiving, along with Dr. K. Yong-Hing, a one-million dollar grant for a five_ year study of whiplash injuries (see "Million Dollar Canadian Whiplash Grant," Feb. 25, 1994, "DC").

The remainder of the Spine Letter was in a medical model, although reading this material is often revealing when you come across statements like this from Dr. Keller of the state of Maine: "... we also need equally urgently better information about the risks, benefits, and outcomes of spinal surgery."

The task of trying to remain apolitical or at best transpolitical is indeed a formidable challenge. The Spine Letter is trying to do just that and in its short history has made a valiant effort. Although I was extremely disappointed with the crass treatment given the Manga report, I have not been where the MDs have been nor have I experienced their frustrations which, like ours, must be monstrous. I have subscribed to Spine for over 20 years and look forward to the Spine Letter becoming similar in quality and quantity.

Rating: a solid 9 out of 10.

Title: Chiropractic: A Review of Current Research Category: Patient education Publisher: Foundation for Chiropractic Education and Research (FCER), 1-800-622-6309 Publication: Paperback, 10 pages

Ten pages may not seem like much, but it is the perfect size for a booklet of sound bites on the effectiveness of chiropractic. It can be read quickly by patients in the reception room of your office, by company decision makers you are contacting about who to send injured workers to for care, by PI attorneys, or anyone you need to quickly impress.

Page one cites David M. Eddy, MD, PhD, who said only about 15 percent of all medical interventions are supported by solid scientific evidence. This is followed by reviews of 12 studies, starting with the RAND study.

What follows is the British Medical Journal study (June 1990) which stated chiropractic confers worthwhile, long-term benefits in comparison to hospital outpatient management. The British Medical Journal study (March 1992) compared chiropractic, physiotherapy, MD, and placebo. Chiropractic come out on top followed by physiotherapy; both were better than MDs and placebo.

A review of literature done for the Department of Defense is cited which is favorable to chiropractic, as is an article in the Annals of Internal Medicine.

The cost-effectiveness of chiropractic care is addressed in the second half of the booklet. A study in the Chiropractic Journal of Australia (June 1992) concluded that workers who went to chiropractors required fewer days off, cost the carriers less per claim, and fewer patients became chronic compared to medical management.

The Journal of Occupational Medicine (August 1991) examined cost comparisons between medical and chiropractic providers for back-related injuries with identical diagnostic codes. It concluded that compensation costs for work time lost were only $68.38 for patients who received chiropractic care; those who received standard, nonsurgical medical treatment averaged $668.39. The number of work days lost was nearly 10 times higher for those receiving medical care.

A study by FCER in 1988 looked at the duration of temporary total disability (TTD) in 10,652 Florida cases and found that TTD was 51.3 shorter; the total cost of care was 58.8 percent lower for chiropractic patients compared to medical patients. Two other studies are detailed related to cost-effectiveness.

Patient satisfaction is the next major issue in the booklet. A nationwide Gallup poll finds that "Nine of 10 chiropractic users felt their treatment was effective ... Eight of 10 chiropractic users were satisfied with the treatment received and they felt that most of their expectations were met." The Western Journal of Medicine (March 1989) stated that chiropractic patients were three times more satisfied with their care than patients of family practice physicians.

Well, there it is. A professional-looking booklet that toots our horn loudly and can be read in five minutes or less. It can be purchased from FCER at (800) 622-6309 or (515) 282-7118 (this is booklet #9222). If anyone at FCER is reading this, I would recommend for future printings that each study be given its own page(s) to make the presentation a little cleaner and the cover be jazzed up a little. For the rest of you, don't hold these criticisms against the book. Buy dozens of them and spread the word.

Eggleston Rating: 9

Dynamic Chiropractic
January 16, 1995, Volume 13, Issue 02

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