Evidence and Politics in the Medical World

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As you may not be aware, low back pain is the most expensive health problem in the United States.

It was deemed important enough that efforts were made by the government to get some guidelines for treating low back pain, but the medical profession would not provide any.


Therefore, the Agency for Health Care Policy and Research (under the U.S. Department of Health and Human Services) was formed. This multidisciplinary panel formulated a Clinical Practice Guideline called Acute Low Back Problems in Adults: Assessment and Treatment, Dec. ’94. Significant in the recommendations was “manipulation” for “nonspecific low back symptoms.” That may sound like cautious praise for a chiropractic modality but it was sufficient to provoke a group of medical orthopedic surgeons to pressure their congress people to stop the AHCPR from doing any more clinical guidelines. That’s raw political power. The American Medical Association subsequently issued its own identical guidelines with one exception, no mention of “manipulation.” That’s audacity.

It’s a shame too. Another huge health problem is headaches and a panel was formed to investigate appropriate clinical practice. The M.D.s involved knew of this project and were in a big hurry to have it stopped. It was, but then the Duke University picked up the project with private funding and continued to publication. Incidentally, cervicogenic (meaning starts in the neck spine) headaches are the most common type.

”Chiropractic Highly Effective for Cervicogenic Headaches”

A multidisciplinary panel of 19 experts convened by Duke University Evidence-Based Practice Center in Durham, NC, has concluded that chiropractic adjustments are a highly effective solution to cervicogenic headache. The new report, which reviewed over 2,500 studies on headache treatments (including several on chiropractic), picked up where the never-published Agency for Health Care Policy and Research (AHCPR) investigation left off.

According to the report, “Manipulation appeared to result in immediate improvement in headache severity when used to treat episodes of cervicogenic headache when compared with an attention-placebo control.

“Furthermore, when compared to soft-tissue therapies (massage), a course of manipulation treatments resulted in sustained improvement in headache frequency and severity.”

“Compared to other physical treatment methods (including physiotherapy, acupuncture, and electrical stimulation), the evidence supporting chiropractic appears to be more robust,” noted the Federation of Chiropractic Education and Research’s news release on the study.

Duke University Evidence-based Practice Center – March 6, 2001. https://www.fcer.org

Do you remember not reading about this huge revelation on the front pages of the Wall Street Journal or seeing it on 20/20? Exactly. What do you think would have happened to those huge primetime pill popper P.R. campaigns if this kind of information were to make it to the light of day?

Oh, another detail. About a decade ago, it was projected that in a decade or so, Degenerative Osteoarthritis would be the #1 cause of disability in the United States. That day is here and it is so. Can you see the connection between not taking care of spinal problems that cause low back pain, headaches and other common maladies; and subsequent deterioration into a crippling Arthritic condition after a few years?

Good gracious folks, this is the 21st century. How long will so many of you put up with antiquated, inappropriate, even dangerous healthcare? All choices are yours.

”’Rik Cederstrom, a licensed Chiropractor in Hawaii, has a Bachelors in Biology from the University of California at Santa Cruz and a Doctorate in Chiropractic from Western States Chiropractic College in Portland, Oregon. He approaches his patients’ health from a wholistic point of view, including nutrition, exercise and lifestyle, focusing on spinal correction. Send questions and comments to him at:”’ mailto:Dr_Rik_DC@juno.com