The chiropractic profession has been on the receiving end of another political assault, masquerading as science. The first is the tired, old stroke story. As long as journalists are willing to keep printing this junk, the neurologists will keep churning it out. They have attempted to invert reality. One of chiropractic's strengths is the safety of the care we provide. The only way to negate this in the public mind is with the sort of intellectual sleight-of-hand employed by the neurologists.

The sheer volume of inquiries I have received since this hit the press indicates that many chiropractic patients are asking their D.C.s about this. Thankfully, these "studies" are easy to refute. Those seeking "intellectual ammunition," are directed to the WCA Position Paper, and my article, "Adjustments, strokes, and errors in medicine. See: http://www.worldchiropracticalliance.org/positions/stroke.htm and http://www.worldchiropracticalliance.org/tcj/2000/jul/jul2000kent.htm

The Journal of Vertebral Subluxation Research devoted an entire issue to the subject. Visit http://www.jvsr.com

The second volley, however, is of our own doing. More correctly, it is the result of positions taken by certain political factions in our profession who have attempted to equate manipulation with chiropractic adjustment, and position chiropractic as limited branch of medicine engaged in the treatment of a narrowly defined array of neuromusculoskeletal conditions. The fruit of this approach is the adverse publicity generated by Dr. Assendelft's latest paper, and the growing acceptance of chiropractic by medical prescription.

The paper I am referring to is "Spinal manipulative therapy for low back pain. A meta-analysis of effectiveness relative to other therapies." [1] Meta-analysis is a technique that involves reviewing existing studies. It is not the actual performance of clinical trials. The technique has been criticized, but the merits (or lack thereof) meta-analysis is not our biggest problem.

The paper is about spinal manipulative therapy for low back. The conclusion was that "There is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low back pain." Of course, this statement is blatantly false. To say that there is "no evidence" supporting the premise that SMT is more effective than other treatments is untrue. Some studies have reached this conclusion. To claim that there is "no evidence" demonstrates a smug arrogance that has no place in scientific discourse. One favorable paper is all that is needed to falsify such an overly broad statement.

However, even this is not the reason why this paper is so problematic. The paper is not about chiropractic. It addresses spinal manipulative therapy. The problem is equating the two.

Before the ink was dry on the Assendelft paper, the popular press sprung into action. A headline in the Tuesday, June 3 issue of The Wall Street Journal [2] states that the, "Chiropractic benefit is questioned. Manipulating the spine appears no more effective in treating back pain than alternatives." Did you catch the magician's misdirection? In the headline, chiropractic care was equated with spinal manipulation.

Why? Because some of our politicians and researchers felt that if we clung to the coattails of "manipulation" research, it would be easier to sell ourselves to lawmakers. This folly began three decades ago, when the language of the Medicare was crafted using the term "manual manipulation of the spine" to "correct a subluxation..." This set the stage for our current problems with Medicare. Since the term "manual manipulation" was used rather than "chiropractic adjustment," administrators have interpreted the statute to our detriment, enabling other providers to be reimbursed for the "chiropractic" benefit in Medicare. This colossal blunder is why the ACA is now suing the Federal government. Strangely, the ACA strongly supports using the term manipulation, claiming, "Spinal manipulation therapy is a chiropractic science." [3]

The irony in this is that it is the ACA that has proposed and supported legislation that characterizes chiropractic services as the treatment of neuromusculoskeletal disorders, without specific mention of our unique service, adjustment of vertebral subluxations. Subluxation is not explicitly mentioned in the Department of Defense bill. The result of this is chiropractic by medical prescription. According to the director of the Air Force's program, "the medical doctor makes an initial diagnosis and then refers the patient to a chiropractor for additional care." [4] By positioning chiropractors as one of many providers engaged in the treatment of neuromuscusuloskeletal disorders, we are now but one of many competing purveyors of "manipulation."

To safeguard the future of chiropractic, it is imperative that we establish a clear identity as a separate and distinct profession, providing a unique service not available from other providers. Legislative language must be clear and unambiguous. We must ensure that chiropractic adjustment of vertebral subluxation be explicitly included in any legislation relating to chiropractic care. Furthermore, we must also be certain that the application of chiropractic care not be limited to persons with musculoskeletal disorders, and that patients have direct access to chiropractic without a medical prescription or referral.

1. Assendelft WJJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG: "Spinal manipulative therapy for low back pain. A meta-analysis of effectiveness relative to other therapies." Annals of Internal Medicine 2003;138(11):871-881.

2. Rundle RL: Chiropractic benefit is questioned. Manipulating spine appears no more effective in treating back pain than alternatives. The Wall Street Journal, 6/3/03.

3. http://www.amerchiro.org/pdf/spinal_manipulation_policy.pdf

4. http://www.chiroweb.com/archives/21/02/02.html