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From: sm@cadre.ARPA
Newsgroups: net.med
Subject: Re: Once again (natural <-> conventional)
Message-ID: <452@cadre.ARPA>
Date: Wed, 12-Jun-85 09:03:45 EDT
Article-I.D.: cadre.452
Posted: Wed Jun 12 09:03:45 1985
Date-Received: Thu, 13-Jun-85 20:30:23 EDT
References: <983@cbdkc1.UUCP> <450@cadre.ARPA> <1652@amdahl.UUCP>
Reply-To: sm@cadre.ARPA (Sean McLinden)
Distribution: na
Organization: Decision Systems Lab., University of Pittsburgh
Lines: 158

In article <1652@amdahl.UUCP> ems@amdahl.UUCP writes:

>I can say for myself that going to a chiropractor will
>fix the problem when I have a nerve pinch of the cervical
>nerves.  (Somewhere arround C5 or C7.  Hurts like the devil
>when the vertibrae munges the nerve.)  This happens about once
>every 2 years for me.  $15 or so and ten minutes later it doesn't
>hurt.  Cure cancer?  I doubt it.  Fix kidney problems?  I'm
>skeptical.  Stop a pain in the neck? 100%  The medical approach?
>A laminectomy that costs about $1200 dollars and works in
>50% of cases with significant risk of paralisis to the patient.
>(I worked in medical records on an orthopaedic ward while going
>to school.  This was the practice on the ward then, though for
>minor cases traction was used.  Still several hundred dollars...)
>
>Most MD's I have talked to called Chiropractors Quacks. Period.
>This destroyed my faith in MD's as I *KNEW* that it worked
>for me.  Regularly and reliably.

The issue is not as simple as whether or not spinal manipulation "works"
(whatever that means: does it make you feel better? does it "cure" you?),
a number of studies has shown that there is demonstrable relief of symptoms
following these procedures. The problem lies in our lack of understanding
as to why there is this effect (ignoring, for a moment, last week's Lancet
article which compared chiropractic technique with placebo). The importance
in understanding the "whys" lies in the fact that in addition to the reported
successful treatments, there is a group of people in whom manipulation
results in serious and even permanent loss of some motor/sensory function
(possibly even paralysis). Because of this, the position of the organized
medical community is that risk/benefit ratio is too high to recommend/support
chiropractic treatment of injury and or pain.

Note that this is not the same as saying that there is "no benefit". The
benefit to some (even many), has been studied extensively (more so by this
medical community of whom you are so suspicious than by the chiropractic
industry), as has other techniques such as acupuncture. This research has
led to a greater understanding of the causes and management of pain and
from this, new treatments are likely to arise. Hopefully some of these
treatments will have a lower risk/benefit ratio than does spinal
manipulation.

We should also note that one of the most studied and least understood
symptoms of patient illness is pain. The reasons for this are obvious,
since there is no good standard for measuring the pain that the patient
experiences except to listen to the patient's own description. When the
pain can be correlated to a physical abnormality noted on an x-ray or
via a test, a treatment may be suggested. In the absence of that knowledge
treatment may be strictly empiric and multiple treatments may be proposed
and tried before one is found to work. In the area of chronic pain,
especially, NO effective intervention may be found and treatment is shifted
toward altering the patient's ATTITUDE toward the chronic pain (with the
understanding that it is the PERCEPTION of the pain as well as the stimulus,
itself, which debilitates the patient. 

The point, of course, is that it is not sufficient to be satisfied with
knowing how to treat someone without understanding why the treatment works.
Case in point is the anti-seizure drug Depakene (Valproic Acid). This
drug was first used as a solvent in the preparation of many other drugs
some of which were used to treat seizure disorders. As a result of a number
of studies done on the treatment of seizures using various drugs a pattern
of Depakene efficacy was noted which resulted in the isolation of this
drug as the effective agent. This knowledge prevented a number of people
from receiving ineffective and potentially dangerous therapy. So too with
studies of all treatments (including diet in cancer and arthritis and
the use of spinal manipulation in chronic pain), what is needed is an
understanding of the mode of action of these treatments in order to
minimize side-effects and improve efficacy. The attitude (and with some
justification), of the medical profession is that the practitioners of
chiropractic therapy do little in the way of purusing this type of self-
examination (largely because it would not be in their best intertests
to do so).

>There is a book I would like your comments on.  It is
>'The Arthritics Cookbook'.  It is written by an MD.
>I have forgotten his name, but he was of Chinese extraction.
>At mid 30's he was having severe arthritus.  He followed medical
>dogma and go nowhere.  He then turned to diet.  He was cured.
>At 26 I had problems with joints starting to ache and creak in
>the cold.  My family had a history of arthritic problems.  I
>got the book.  It worked for me.  I can *RELIABLY* produce joint
>problems by eating very large amounts of beef.  And just as
>reliably cure them by reducing beef consumption to less than
>1 pound per week.  None of my family members has ever been
>counciled by a physician to look to diet to help arthritic problems.
>

I can *RELIABLY* produce kidney failure by jogging too much. What
does that prove, that no one should jog? The point is not that YOU
have observed something (although much information has come from
isolated observations of that sort), but whether or not I in Pittsburgh
can recommend a low beef diet to my patients on the basis of anecdotal
information. Obviously not. You might, then, say that I should at least
ADVISE my patients that there are other people with experiences which
do not agree with accepted practice so that they may explore for themselves.
My repsonse would be that there are almost 1500 medical journals published
on a weekly basis and a whole host of other sources with which it would
be impossible to keep up. This is the reason why the medical profession
has practice standards committees so that each of us can inform ourselves
about some little aspect of that large picture in the hopes of enlightening
others and being, ourselves, enlightened.

>I have found that beef and yogurt both have to be reduced.  This
>method has worked reliably for many other people (basically it is
>to go to a fish, rice, and veggy diet for a while.  Then add in
>foods to see which ones cause trouble).
>
>The point?  That using a poor aproximation of clinical trials (sample
>of one or two) has worked for discovery of solutions for some people.
>(Hold the re-re-re-explanation of study technique and valid sample size.
>I said a *poor* aproximation ...  I know how it should be done).
>The other point?  That despite the fact that something can be
>so easily shown to work, the MD establishment turns a blind eye
>on both chiropractic technique and diet as medicine.
>

Thats Bulltwinkies! Medical, pharmaceutical, and grovernmental agencies
spend billions of dollars each year in the study of all sorts of treatments
for all types of diseases. MOST of these studies are performed by qualified
M.D.s and Ph.D.s who have been trained within this system that you are
criticizing. There was, at one time, a government subsidized study to test
ALL known naturally occuring substances for anti-tumor efficacy (never
completed because the cost and difficulty proved to be overwhelming).
You will not find this volume of research being done at the chiropractic
centers of which you speak, (although I suspect a lot of business and
marketing research goes on there). Again, the bottom line is that for
economic as well as legal and ethical reasons, we would be hard pressed
to justify the treatment of a particular illness based purely on anecdotal
information.

>Maybe I have a low grade allergy to beef.  I don't know the
>mechanism.  I do know that it is *NOT* mental, as I have been
>surprised to find some foods that I had expected to be OK cause
>trouble for me.  (Beef extract in soups is a killer).
>
>So why hasn't this book had more impact?  It is even written
>by an MD.  Could it be that it flies in the face of established
>dogma, and so is not acceptable?
>

Let's get our terms correct! You suspect adherence to dogma as a cause
for this malady, but it is dogma (adherence to an opinion or tenet without
justification), of which you would like the medical profession to take note.
If anything, the "problem" is just the opposite. The practice of medicine
as it applies to the population at large should be based on a rigorous
understanding of the causes and treatments of disease (whenever possible),
and of the response of a significant proportion of the affected population
to the proposed therapy. Anything short of this would be a disservice
to the population to which we are responsible. 

Or, perhaps, we could do away with our academic medical institutions and
train at Waldenbooks, instead. I could prescribe the "Jane Fonda Workout"
($12.95), the "Scarsdale Diet" ($7.95) "Stalking the Wild Asparagus"
(now $3.50 in softcover) and recommend you watch "Good Morning America"
to get daily updates from their medical reporter...


S. McLinden