June 2006

An adjustment a day ... for life

by Dr. David A. Jackson

A new research study ‑‑ presented at the American College of Cardiology annual meeting and simultaneously published online in The New England Journal of Medicine  ‑‑  concluded that people who might someday suffer from hypertension might be able to prevent it by taking the drug Atacand every day for the rest of their lives.

That was the story widely reported in the print and broadcast media a couple of months ago and the news was greeted with excitement and enthusiasm. According to a WebMD article posted on numerous websites including CBS News: "If it (the one‑a‑day drug strategy) pans out in future research, it promises a host of rewards, says researcher Stevo Julius, MD, ScD, an emeritus professor of cardiovascular medicine at the University of Michigan Medical Center in Ann Arbor." The research, incidentally, was funded by AstraZeneca, maker of Atacand and a WebMD sponsor.

The research subjects didn't even have hypertension. They had prehypertension, with systolic blood pressure readings of 130‑139 and a diastolic reading of 89 or lower or a systolic pressure of 139 or lower and a diastolic pressure of 85 to 89.

Yet, the researchers concluded, as the WebMD article announced: "If you're one of the millions of Americans whose blood pressure is creeping above normal, take note. A new study suggests the blood‑pressure‑lowering drug Atacand may be able to delay the development of full‑blown hypertension."

All you have to do is take drugs every day for the rest of your life. Chances are, insurance will pay for the medication and no one will question whether it's "medically necessary."

At the same time, chiropractors are being accused of committing health care fraud if they see a patient more than a dozen or so times. If we see a patient 24 times ‑‑ no matter what the situation or health of the patient ‑‑ Medicare investigators say there is a 100% chance that the care is "medically unnecessary."

The exact wording of the government report was this: "When chiropractic care extends beyond 12 visits, it becomes increasingly likely that individual services are medically unnecessary. Services provided among the first 12 [visits] in a course of treatment to a particular beneficiary by the same chiropractor were approximately 50 percent likely to be medically unnecessary. That likelihood increased to approximately 67 percent for services between the 13th and 24th and to 100 percent for services beyond the 24th."

Why is it that the medical profession can even consider putting a person on a daily regimen of drugs supposedly to prevent a disease that may or may not occur while chiropractors are subject to huge fines for health fraud if we adjust someone twice a week for two months in order to improve that person's general health and well‑being?

The reason is that the medical profession ‑‑ or more precisely, the drug industry ‑‑ can point to "research" published in The New England Journal of Medicine and similar journals to impress the public and the government. chiropractors, on the other hand, cannot reference any equally impressive research conducted on the impact of long‑term chiropractic care on general health.

Almost all studies conducted by chiropractic colleges (which have up to now conducted almost all of the major chiropractic research) have focused primarily on chiropractic as a medical treatment for back pain, headaches or specific diseases like PMS and asthma. They have restricted themselves to short‑term relief; few studies involve more than 12 chiropractic "treatments." 

There have been a few research studies that have tried to look beyond the short‑term effects of chiropractic and focus, instead, on long‑term wellness care.

Robert Blanks, PhD and his colleagues published the results of the largest retrospective assessment ever made of subluxation‑based chiropractic care on self‑related health, wellness and quality of life. Their study, which involved more than 2,800 patients, was able to establish a strong connection between persons receiving Network care and self‑reported improvement in health, wellness and quality‑of‑life. Not only were the patients extremely satisfied with their care (95% said their expectations had been met, and 99% wanted to continue care) but there appeared to be no "maximum" level of benefit. In other words, the more chiropractic adjustments they received, the better they felt.

The research was published in the Journal of Vertebral Subluxation Research (JVSR) and might have had a significant impact. Unfortunately, there is a small but powerful group within the profession that has done everything in its power to destroy  JVSR's reputation as a legitimate scientific journal since it focuses on vertebral subluxation. Rather than use JVSR research as a way to validate chiropractic, they prefer to support only research validating "chiropractic medicine."

Dr. Blank's research wasn't unique. Other research, including studies conducted by Dr. Ian Coulter and Dr. R.L. Rupert, tried to shine the scientific light on long‑term chiropractic care. Their reports were published in Topics in Clinical Chiropractic and Journal of Manipulative and Physiological Therapeutics, respectively. Neither involved a very large group of patients, however (the Rupert study included only 311 patients) and neither was a clinical study.

They were all steps in the right direction, but we, as a profession, need to go miles further if we are to prove the effectiveness of long‑term chiropractic care and save people from the fate of lifelong daily drug taking.

How many of you feel that regular chiropractic care has the potential to prevent or reduce hypertension in many people? Would being subluxation‑free help patients avoid not only the effects of high blood pressure but the lifetime sentence of having to take drugs every day for the rest of their lives?

I think chiropractic can be at least as effective as Atacand in preventing hypertension and want chiropractic research to prove me right. But there's only one research program taking place right now that's even looking into the topic: RCS (Research & Clinical Science). Since we don't have a billion‑dollar drug company paying for the study, chiropractors around the country are doing it themselves. It's the only way we can hope to prove chiropractic's role in long‑term wellness care.

If we don't do this research, we'll be letting down our profession and all the patients who look to us for an alternative to the daily dose of drugs.

(Dr. David A. Jackson is chief executive officer of Research and Clinical Science ‑‑ RCS ‑‑ a private sector research program exploring issues of subluxation correction and chiropractic care as they relate to health and wellness. Previously, he served as president of the Chiropractic Leadership Alliance and Creating Wellness Alliance and was owner/operator of several private practice offices in California and Idaho that specialized in high‑volume, family wellness‑based care. For more information on RCS, call 800‑909‑1354 or 480‑303‑1694, or visit the RCS website at www.rcsprogram.com. Doctors of chiropractic may log on to a special limited‑access area of the site by using the username DC1 and password RESEARCH.)