Article from Chicago Tribune (Online) 4 Aug 2009
http://featuresblogs.chicagotribune.com/features_julieshealthclub/2009/08/a-medical-doctors-take-on-chiropractic-care.html

A medical doctor's view of chiropractic care

As both a chiropractor and medical doctor, Dr. Ralph Gay has an unusual perspective on the legendary rift between the two professions. He took some time out of his busy schedule as the director of the Spine Biomechanics Research Group at the Mayo Clinic to shed some light on what chiropractors can do for back pain and to address some common misconceptions for my story, "Chiropractors: Beyond the spine."

Q: Chiros are best known for treating back and neck pain, but some say they can treat all disorders, since "the spine and nerve system is the master system, controlling everything in the body." Please talk a little about whether you think chiropractors can and should be treating conditions such as ear infections, asthma, insomnia and cancer.

A: Traditional chiropractic theory posits that by correcting spinal abnormalities (subluxations) a chiropractor can effect all organs of the body. It is a good theory and there is some experimental work in animals that tends to support the premise. But, there is little evidence in the literature that chiropractic is effective for problems other than musculoskeletal conditions.

Q: How does chiropractic care work?

A: Good question but not a straightforward answer. Why does any form of treatment work?

Q: What are the main criticisms of chiropractic care?

A: The chiropractic profession has taken a lot of criticism during its existence. The criticisms it faces today are often generalizations that are not necessarily based in reality. Some of the common criticisms are:

Chiropractors have an inferior education: Chiropractic has a highly developed educational system that is regulated and standardized to a great degree. Although some portions of a curriculum may lack rigor, most are of good quality. The weakest part of chiropractic education is the clinical post-doctoral period...there is no requirement for an internship or residency prior to licensure as there is in medicine and osteopathy.

Chiropractic does a poor job of self policing: Although state boards regulate chiropractic practice in all 50 states, most chiropractors have a solo practice. This lack of "rubbing shoulders" with colleagues provides little incentive for practitioners with a typical behavior to change.

Chiropractors just want you to keep coming back: There is some truth to this. The chiropractic practice model suggests that multiple treatments over a period of weeks to months is necessary to get a maximal benefit. But this is not unlike physical therapy, acupuncture or massage practice. Although some chiropractors let their business model dictate treatment more than clinical evidence, most limit treatment to what is needed for each individual patient based on their response to care.

Q: How can consumers be sure they find a good chiropractor and what conditions should they consider seeing one for?

A: Chiropractors do a reasonably good job of treating back and neck pain and there is limited evidence that some lumbar radiculopathies (or sciatica) may benefit from their treatment. A good chiropractor will explain why treatment is indicated, and suggest a trial period of treatment (for example 6 to 8 visits) to determine if it is going to help. I suggest that patients beware of chiropractors who suggest initial treatment of more than 3 to 4 weeks duration, lump sum payment, or treatment for a condition that is not related to the spine or other common joints/muscle conditions.

Q: How solid is the evidence behind the efficacy of chiropractic care? Does human touch have a role, even without adjustments?

A: The evidence supporting spinal manipulation for back pain (regardless of who renders it)is very good. The evidence in neck pain is good but less convincing. You must realize that the treatment effect for all types of treatment for back pain is relatively small. Chiropractic treatment of back pain with spinal manipulation has just as much evidence supporting it as any medical treatment for back pain.

Human touch plays a role in all health care encounters where it occurs. These "non-specific" effects are hard to measure in clinical studies.

Q: How did MD’s view chiros five years ago and has that changed? If so, how?

A: I think the medical view of chiropractic is slowly changing. The biggest impediment to change is the lack of interaction between the professions. Medical doctors who refer to chiropractors do so usually because they know the chiropractor personally and trust them to take good care of their patients, not because they have a chiropractic degree.