The Survey as Science
Dear Editor:
American Specialty Health, Inc. (ASH) is concerned with DC's February 8 ChiroPoll (www.chiroweb.com/chiropoll/03_pollarchives.html), concerning chiropractors and perceived patient attitudes toward managed-care companies. While it is understandable wanting to survey practicing chiropractors regarding their attitudes on many issues, Internet polls are well-known to be highly unscientific, as you state with every poll you publish. It is difficult to define the sample, and a mechanism to eliminate multiple entries needs to be in place. Most importantly, the survey question needs to ask an appropriate question from the appropriate group. Thus, it is inappropriate to ask practitioners your question.
The only group that can answer this question appropriately is the patients who received chiropractic care from a network provider participating in the respective managed-care company.
For your information, I have included the patient satisfaction survey results of patients treated by ASH participating chiropractors in 2002. An independent NCQA-certified company performs this national patient satisfaction survey annually using a HEDIS validated survey instrument. The number of patients surveyed is 1,557. The results speak for themselves.
(Editor's note: A complex, if not comprehensive, description of the HEDIS survey procedures is online at www.ncqa.org/docs/hedis/100denomin.doc, viewable as a Microsoft Word document file.)
Kurt Hegetschweiler, DC
Vice President, Professional and Governmental Affairs
American Specialty Health
San Diego, California
Don't Presume "One Cause, One Cure" Dear Editor:
I read with awe that a chiropractor had found an apparent cure for not one, but three disease syndromes: Bell's palsy, trigeminal neuralgia (TN) and Parkinson's disease ["Parkinson's Disease, Meniere's Syndrome, Trigeminal Neuralgia and Bell's Palsy: One Cause, One Correction," by Michael T. Burcon, DC, in the May 19 issue]. According to the clinical report presented by the doctor, he noted dramatic improvement in 22 cases of patients with these disorders with "one or two cervical adjustments," based on an atlas subluxation, with secondary thoracic and pelvic abnormal curvatures.
Anyone outside of chiropractic would consider the discussion of this dramatic report to be significant; otherwise it would not take up a number of pages in a newspaper that reaches over 70,000 DCs. Reading "case studies," an X-ray illustration, a diagram and citations, an outsider would conclude that DC was presenting credible information that would certainly meet the standards of a clinical report to the profession.
For chiropractors, this is old news. We skim a report like this, amazed, as always, by the energy of the presentation and the conviction, but unimpressed by the findings. None of the information is useful in actual practice - just fancy talk of listings; X-ray markings; procedure; tests; and evaluations.
Let's take the case of the 74-year-old Parkinson's patient: The "case report" tells us that following the second adjustment, the patient's tremor "ceased immediately." However, the patient could not rise out of his chair. With a second adjustment, the patient could rise out of the chair. End of case report.
TN and Bell's palsy are also complicated disorders we see in our practices. TN patients are, for instance, extremely vulnerable to talk of dramatic cures, because of the sometimes unbearable pain of the disorder and the lack of successful medical intervention.
I am convinced chiropractic has a role in treating Parkinson's, and possibly more directly in treating Bell's palsy and TN. CAM is trying to develop alternative protocols, including natural medicines, stress management - and chiropractic care - that may replace the dependence on drugs in managing these conditions. None of these protocols I've seen are presumptuous enough to say they have a cure, let alone "one cause, one cure."
I know I'll never convince the presenter of this report, but I hope his article doesn't appear in some legislative hearing when we're fighting for our credibility. I hope students will read such "clinical reports" with a discriminating eye. Chiropractic has been marginalized by the medical community and the media, and seems stuck, for the time being, seeing 10 percent of the population. But the continuation of exaggerated claims and "bone-back-in-place" pseudoscience is the fault of the profession itself, and one reason for its difficulty in convincing more of the general public of its considerable benefits.
Arn Strasser, DC
Mount Pleasant, South Carolina
Life's Shortcomings Dear Editor:
I am a former Life College student who took time off from school for personal reasons and am no longer residing in the Atlanta area. Your article on the class-action lawsuit by Life students is well past due.
I personally saw many of the infractions take place at the clinics the CCE cited as reasons for removing Life's accreditation. Having already been through one career and seeking another (through Life College), I sympathized with many of the teachers at the school in how they were "caught in the middle." Many of them were exceptional teachers who were "turned off" to teaching by the school itself and its quiet policy to look the other way, when many of the young students were tempted to take shortcuts, not realizing how they were really cheating themselves and the chiropractic goal.
I have mixed feelings about the suit, but I still must look into it. Thank you, and continue the great work.
Ernie Williams
Tampa Bay, Florida
