I am a strong believer in original chiropractic philosophy that places a strong emphasis on the body's intrinsic (innate) healing wisdom and far less reliance on band-aids like drugs and surgery.

But how does the science behind chiropractic actually work toward that goal of achieving true healing? Dr. Alex Vasquez has written an enlightening two-part article that explains the "nuts and bolts" of the science of chiropractic, both past and present, and describes its true value to your health. Dr. Vasquez is one of the pioneers of the profession as he will likely be the first chiropractor to actually have N.D and M.D. degrees. He obtained his ND from Bastyr University and is scheduled to start an M.D. medical school next year.

By Alex Vasquez, DC, ND

Introduction to the Chiropractic Profession--Past and Present

Chiropractic was founded as a healthcare profession in 1895 by Daniel David Palmer, based on the premise that the body had an innate healing ability and this healing ability could be compromised if there were nerve impingement obstructing the flow of nerve impulses.

Nerve impingement and obstruction was described as being caused by subluxations -- that is, subtle displacements of vertebrae in the neck and back. It is important to note that while spinal manipulation ("adjustments") have been an important clinical tool for chiropractic physicians, Doctors of Chiropractic are physicians who consider man as an integrated being and give special attention to the physiological and biochemical aspects including structural, spinal, musculoskeletal, neurological, vascular, nutritional, emotional and environmental relationships.

As research and science have progressed, we now have a much better understanding of neurologic function and the actions of spinal manipulation.

As primary care providers with specialized training in musculoskeletal medicine, chiropractic physicians typically play a dual role in clinical practice on a daily basis, generally striving to simultaneously accomplish two related goals in each patient:

1. Promoting overall wellness and professionally supervised, patient implemented preventive healthcare.

2. Alleviating acute and chronic musculoskeletal pain.

Both of these goals are important given the tremendous financial and social impact of musculoskeletal pain and the progressive deterioration of Americans' health. At any given time, nearly 30 percent of the American population suffers from musculoskeletal pain, joint swelling, or limitation of movement (1), and approximately one of every seven visits to a primary healthcare provider (14 percent of the total) is for the treatment of musculoskeletal pain or dysfunction. (2)

Resulting in more than $100 billion in U.S. healthcare costs each year, back pain is one of the most prevalent medical problem in the U.S., the leading cause of long-term disability and the second leading cause of restricted activity and the use of prescription and non-prescription drugs. (3)

The preventive healthcare and wellness promotion advocated and implemented by chiropractic and naturopathic physicians is now more important than ever since the health of the American population is consistently and progressively declining: obesity and diabetes are "ever-growing" epidemics among children and adults (4,5), infant mortality has recently increased for the first time in 40 years (6), and self-reported health status and health-related quality of life among adults are declining. (7)

In the 25 years between 1975 and 2000, the incidence of cancer increased significantly, and the number of people diagnosed with cancer is expected to double in the next several decades. (8) Despite these negative health trends, America spends more on healthcare than does any other nation -- an unprecedented $1.55 trillion, which is roughly 15 percent of the U.S. gross domestic product. (9)

From the perspective of cost-effectiveness, the healthcare system in America, currently dominated and "led" by the allopathic medical community, delivers a very poor return on investment, and it appears that assertive wellness promotion and increased utilization of chiropractic and naturopathic healthcare may provide improved outcomes and decreased overall healthcare costs. (10,11)

A Reasonable "Alternative" to Drugs and Surgery

Numerous adverse effects are produced as a direct result of medical/pharmaceutical management of benign musculoskeletal pain. According to a 1998 review by Singh (12):

Conservative calculations estimate that approximately 107,000 patients are hospitalized annually for nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) complications and at least 16,500 NSAID-related deaths occur each year among arthritis patients alone. The figures for all NSAID users would be overwhelming, yet the scope of this problem is generally under-appreciated.

More recently, following the withdrawal of the arthritis drug rofecoxib (Vioxx) in late September 2004, Topol (13) extrapolated that as many as 160,000 adverse cardiovascular events (including stroke, myocardial infarction and death) may have resulted from:

• The collusion of Merck's intentional failure to withdraw what was known for years to be a dangerous drug.

• The FDA's failure to enforce regulatory standards to protect the public.

• The overutilization of Vioxx by the medical profession, which was well informed of the lethality of this drug for several years (14) before Merck's confessionary and belated withdrawal of the drug.

Soon thereafter, several other so-called "anti-inflammatory drugs" such as valdecoxib (Bextra) (15), celecoxib (Celebrex) (16), and naproxen (Aleve) (17) were likewise associated with excess cardiovascular injury and death.

Although the advertising-induced feeding frenzy on Celebrex made it the most successful drug launch in U.S. history with more than 7.4 million prescriptions written within its first six months (18), within 2 years of its release, evidence linking the drug to increased cardiovascular events (including death) was accumulating (19). This drug has since been linked to a wide range of adverse effects such as membranous glomerulopathy and acute interstitial nephritis (20), acute cholestatic hepatitis (21) and toxic epidermal necrolysis. (22,23)

When compared with a placebo in cardiac surgery patients, Bextra/valdecoxib is associated with a three- to four-fold increased risk of heart attack, stroke and death (24). Currently, 7 million arthritis patients, many of whom are already at high risk for cardiovascular disease, are being treated with this drug. (25)

Poor Preparation

Allopathic medical education has recently been described as "woefully inadequate" in preparing medical doctors for the diagnosis and treatment of musculoskeletal conditions (26). These deficits stem from the paucity of didactic and clinical training provided to medical students in musculoskeletal diagnosis and treatment.

In their 2004 review published in Physician and Sportsmedicine, Joy and Van Hala (27) describe the formal training of a sample of 85 recent medical graduates:

The average time spent in rotations or courses devoted to orthopedics during medical school was only 2.1 weeks. One-third of these examinees graduated without any formal training in orthopedics. As would be expected, these data suggest that limited educational experience contributes to poor performance.

In 1998, Freedman and Bernstein (28) published a landmark study in Journal of Bone and Joint Surgery wherein they administered a validated musculoskeletal competency examination to 85 recent medical graduates who had begun their hospital residency. Eighty-two percent of these medical doctors failed to demonstrate basic competency on the examination, leading the authors to conclude, "We therefore believe that medical school preparation in musculoskeletal medicine is inadequate."

They repeated their study in 2002. This time, the examination questions, which had previously been validated by orthopedic specialists, were validated by directors of internal medicine departments. Their conclusions stated, "According to the standard suggested by the program directors of internal medicine residency departments, a large majority of the examinees once again failed to demonstrate basic competency in musculoskeletal medicine on the examination. It is therefore reasonable to conclude that medical school preparation in musculoskeletal medicine is inadequate." (29)

Most recently, in February 2005, Matzkin et al (30) administered a standardized test of musculoskeletal competency to 334 medical students, residents and staff physicians. The conclusion from their study reads as follows: "Seventy-nine percent of the participants failed the basic musculoskeletal cognitive examination. This suggests that training in musculoskeletal medicine is inadequate in both medical school and nonorthopaedic residency training programs."

Insufficient training in musculoskeletal management might be expected to produce negative clinical consequences and an increased reliance on stereotypic and simplistic treatments such as the overutilization of so-called "anti-inflammatory" drugs, rather than personalized and comprehensive ones. Furthermore, such a high level of incompetence among recently graduated medical doctors in basic musculoskeletal assessment may represent a public health risk to patients seeking care.

The overutilization of surgical treatments for musculoskeletal disorders also places an unjustified burden on the nation's healthcare system. For example, arthroscopic knee surgery is performed on at least 225,000 middle-aged and older Americans each year at a cost of several billion dollars to Medicare, the Department of Veterans Affairs and private insurers (31) yet the results are no better than those obtained from placebo. (32)

In their 2003 review of the literature on this topic, Bernstein and Quach (33) concluded, "Arthroscopy for degenerative conditions of the knee is among the most commonly employed orthopedic procedures, but its effectiveness (like the effectiveness of many surgical operations) has never been proven in prospective trials."

Dr. Vasquez, DC, ND, is the author of Integrative Orthopedics, a textbook for doctors.

Footnotes

Continued in Part 2

Related Articles:

Why Chiropractic?

Happy Birthday Chiropractic!

Vitalism--Turn Your Power On!

Two Tried-and-True Tips for Pain Relief

Six Tips to Choosing a Wellness Chiropractor

The Evolving Science of Chiropractic Philosophy