Chiropractic

Here at Safer Health Care we try to focus on positive interventions and encourage patients and physicians to question. We have specifically avoided the chiropractic- allopathic schism in health care.

Unfortunately the British Chiropractic Association (BCA) has forced us to ask some serious questions. Dr Simon Singh allegedly libelled the chiropractors according to a suit filed by the BCA against Singh.

The ruckus began when Singh noted that the BCA supports “bogus” therapies. Surely chiropractic as practiced by many chiropractors has some benefit in the care of musculoskeletal pain and injuries. Yet the BCA and many chiropractors (on both sides of the Atlantic) promote manipulations for organic illness such as lupus or asthma. Singh’s concern relates primarily to the complete lack of meaningful evidence for the use of chiropractic in these other illnesses.

We agree with Singh. All physicians- chiropractic, osteopathic, and allopathic must be willing to subject their treatments to the scrutiny of scientific rigor. Barring such scrutiny we become charlatans.

Patients should always ask about the science in their treatment. Make your physician explain in simple, lay terms what the therapy might legitimately be expected to do for you. It’s not science for the physician to simply describe his/her own experience- that’s not science.

It’s your health. Take charge and take care.

Back Pain

We’ve been away for a while but we’re back.

Readers recall that we’ve frequently written about conflicts of interest in the doctor-patient relationship. Conflicts arise anytime a physician’s judgment is altered by personal gain.

Our concerns have been validated again in a recent study published in the Archives of Internal Medicine (ARCH INTERN MED VOL 169 (NO. 10), MAY 25, 2009 ).

Study finds overuse of imaging in back-pain care more for nonclinical reasons than because the diagnostic tool was required. Overuse for imaging of uncomplicated lower-back pain was associated with incentives based on patient satisfaction, the type of doctor and the size of the practice. Medicaid patients treated in practices that relied more heavily on government revenue (typically those patients with less-desirable reimbursement for physicians) received less-rapid and less-advanced imaging for lower-back pain. Small and solo practices, and family and general practitioners also ordered fewer advanced imaging tests for their patients, according to a report by researchers at the Center for Studying Health System Change.

The interesting part for those of us who study this from a policy perspective is that the patients who had apparent “underuse” probably had proper management. The physicians’ incentives for overuse probably led to excessive use of imaging in the other groups.

When your doctor wants to do a test you should always ask:
1) Can you (the doctor) interpret the results?
2) Will the results change my therapy or offer new options?
3) Will the results or changed therapy let me live longer?
4) Will the results or changed therapy help me live better?

It’s your health. Take charge and take it seriously.