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LETTERS: Alan Breen, Eva Leerberg, Michael D Pedigo, Gordon Waddell, Lynton G F Giles, E Ernst, and W J J Assendelft Chiropractic for low back pain BMJ 1999; 318: 261a [Full text]

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Chiropractic and low back pain

T W Meade   (11 March 1999)

Medical Bias is unprofessional

Yung Vu   (18 June 1999)

Medical bias exists without good reason

Huw Richards   (19 June 1999)

Chiropractic and low back pain 11 March 1999
T W Meade Send response to journal: Re: Chiropractic and low back pain	Editor Patient satisfaction is increasingly recognised as an important outcome in trials. Whatever interpretation Ernst and Assendelft (23rd January) themselves place on changes in the Oswestry score, they did not mention that regardless of whether patients in our trial[1] were recruited from hospitals or chiropractic centres, significantly more of those treated by chiropractic expressed satisfaction with their outcome at three years than those treated in hospital, i.e. 84.7% (127/150) compared with 65.5% (76/116) for those referred by chiropractors: (p<0.0001), 79.2%, (103/130) compared with 60.2% (71/118) for those recruited from hospitals (p=0.001). This aspect was assessed three years after entry to the trial. The main stimulus to the Medical Research Council's current trial were the suggestive results and further questions raised by our own initial observations. Assendelft's critique[2] can hardly be considered to have been one of its "starting points". Professor TW Meade MRC Epidemiology and Medical Care Unit Wolfson Institute of Preventive Medicine Charterhouse Square London EC1M 6BQ 1 Meade TW, Dyer S, Browne W, Frank AO. Randomised comparison of chiropractic and hospital outpatient management for low back pain: results from extended follow-up. Br Med J, 1995;311:349-351. 2 Assendelft WJJ, Bouter LM, Kessels AGH. Effectiveness of chiropractic and physiotherapy in the treatment of low back pain: a critical discussion of the British randomized clinical trial. J Manipulative Physiol Ther, 1991;14:281-286.
Medical Bias is unprofessional 18 June 1999
Yung Vu, Chiropractor Australia Send response to journal: Re: Medical Bias is unprofessional	Firstly, the study conducted by Cherkin et al is a remarkably unscientific approach to evaluation of the efficacy of chiropractic treatment. The results of this study show very little indeed, whilst the methodology of the study simply shows the author's complete ignorance about the process of chiropratctic treatment. The study shows exactly what should be expected, that after a month of treatment and eighteen months observation there is very little observable benefit from chiropractic care. A more useful study would allow the chiropractor to dictate the course of treatment as they feel is appropriate for the particular patient. This would produce results of some clinical significance, rather than the largely hypothetical results seen in this study. Secondly, immunisation should not be seen as the only approach that parents can take for their children. There are certainly two sides to this argument, and a wealth of documentation showing not only possible benefits from immunisation, also the possible hazards associated with the process. Thirdly, in terms of clinical significance, and relevance to the patient, is there a problem with use of their comfort levels as a means of evaluation of a method of treatment? Certainly this is not as objective, or as scientific, but in real terms this is very valuable information Fourthly, the constant emnity between "medical" profesionals and chiropractors, plainly evident in your research, is of no benefit to the public, and can opnly be deemed a threat to the scientific evaluation fo chiropractic treatment.
Medical bias exists without good reason 19 June 1999
Huw Richards, specialist registrar orthopaedics Morriston,Swansea Send response to journal: Re: Medical bias exists without good reason	Sir,back pain and rugby players is second only to the link between orthopaedic surgeons and rugby football .Every clinic we see patients with mechanical back pain and invariably they leave disillusioned with the medical profession as we are impotent to treat their needs if there is no obvious surgical target.I have conducted a study of over forty patients who have had episodes of chronic back pain which I`m sure is related to the rigours of playing in the tight five of the rugby scrum and none of them have been helped by the medical profession except for palliative analgesia as they have no specific surgical target. Strangely more than 85% have gained considerable relief from "sports massage" or chiropractic.Doen`t this suggest that GP`s should consider local practitioners who are experienced in manipulative techniques rather than clogging up clinics with recalcitrant "mechanical patients".A sound neurological examination should give them the confidence to do this!