TIME: Almanac 1993/TIME Almanac 1993.iso/time/092391/0923130.000

Text File | 1992-08-28 | 7.9 KB | 162 lines

                                                                                HEALTH, Page 60

Is There a Method to Manipulation?


Once scorned as quackery, chiropractic is winning adherents and
respect

By ANDREW PURVIS


    When internist Paul Shekelle was in medical school in the
1970s, the gentle art of chiropractic was widely viewed as bunk:
heir to the tradition of bloodletting and rattlesnake oil. The
American Medical Association's committee on quackery had branded
the practice an "unscientific cult," and medical-school
professors had obediently followed suit. The reluctance of the
so-called back-crackers to submit their technique to the
scrutiny of hard science served only to reinforce the official
scorn. Recalls Shekelle: "They were seen as hucksters and
charlatans trying to dupe the public into paying for useless
care."

    The public, meanwhile, seemed happy to be duped. Millions
of Americans remained devoted to the healers' manipulative
ways. And in recent years that enthusiasm has blossomed. About
1 in 20 Americans now sees a chiropractor during the course of
a year. The number of U.S. practitioners jumped from 32,000 in
the 1970s to 45,000 in 1990.

    Chiropractic has even achieved a certain celebrity cachet.
Quarterback Joe Montana got his brawny back manipulated on
national TV (during the Superbowl pregame show). Cybill Shepherd
grew so attached to her practitioner that she married him.
Overseas, where chiropractic is both more popular and more
widely accepted by doctors, Princess Di regularly gets her regal
back cracked. And Russian ballet stars Vadim Pisarev and Marina
Bogdanova reportedly would not risk an arabesque without a
periodic adjustment.

    Now, almost despite itself, mainstream medicine has
started to take notice. Several authoritative studies have
confirmed that chiropractic-style spinal manipulation is
effective for the treatment of lower-back pain. Leading
physicians now openly discuss the technique, and some are even
referring their own patients to these once scorned colleagues.
Concedes Dr. Shekelle, who directed one of the recent studies:
"Their philosophy of disease is totally foreign to us. But for
some conditions it sure seems to work."

    The growing acceptance was apparent at this year's meeting
of the American Academy of Orthopedic Surgeons, where for the
first time a symposium was held on back manipulation, and about
one-third of surgeons present admitted referring patients for
the technique. Some 30 hospitals around the country now have
chiropractors on staff, and multidisciplinary clinics that offer
both medical and chiropractic care have sprung up in several
urban centers. In addition, a small band of "research"
chiropractors has begun testing the method in carefully designed
clinical trials. "Manipulative medicine," declares Dr. Nortin
Hadler, a rheumatologist at the University of North Carolina,
"is no longer a taboo topic."

    One reason for turnabout is that spinal manipulation has
held up under study, at least for some conditions. In a report
released this July by the Rand Corp., a prestigious research or
ganization in Santa Monica, Calif., a panel of leading
physicians, osteopaths and chiropractors found that
chiropractic-style manipulation was helpful for a major category
of patients with lower-back pain: people who are generally
healthy but who had developed back trouble within the preceding
two or three weeks. Another important study published last
summer in the British Medical Journal compared chiropractic
treatment with outpatient hospital care that included traction
and various kinds of physical therapy. Its conclusion: spinal
manipulation was more effective for relieving low-back aches for
up to three years after diagnosis.

    Such positive findings come despite the fact that no one
is entirely sure how chiropractic manipulation works.
Practitioners assert that they are correcting spinal
"subluxations," which they describe as misalignments of
vertebrae that result in damaging and often painful pressures
on nerves in the spinal cord. Because nerves in the cord connect
to every organ and body part, such misalignments, they say, can
cause problems in the feet, hands and internal organs as well
as the back.

    Most doctors are skeptical of this theory. "Chiropractors
may sound very authoritative," says Chicago rheumatologist
Robert Katz, "but their basic understanding of the
pathophysiology of the spine is simply not there." Chiropractors
respond that they spend at least four years studying the
subtleties of the spine, including exhaustive courses in
anatomy, pathology, biochemistry and microbiology, and are in
fact far more knowledgeable than many medical doctors about this
anatomical region.

    Whatever the benefits of manipulation and massage, many
chiropractors admit that at least some of their success stems
from their attentive manner and holistic approach to disease.
Practitioners tend to discuss a patient's entire life-style,
emphasizing stress reduction, a healthful diet, exercise and
maybe even a change in work habits. Patients love it, especially
after experiencing the sometimes narrow approach of medical
specialists, who may thoroughly examine a body part without a
hint of interest in the human being.

    New York social worker Shoshana Shonfeld, 40, for
instance, was crushed when an orthopedic surgeon told her she
would either have to live with chronic back pain or undergo
radical disk surgery, with no guarantee of success. Then she
found a chiropractor who, she recalls, "did all kinds of
wonderful things." In addition to spinal manipulation, the
practitioner served up a potpourri of health-care advice on
everything from diet to correct posture and toning up muscles
in the stomach and lower back. Now, she says, "my back is almost
perfect. My body feels aligned; it feels straight."

    One study in Washington State found that patients were
significantly more satisfied with their chiropractor's manner
than with their medical doctor's. Patients may even be too
satisfied. One frequent complaint about chiropractors is that
treatment goes on for too long. Patients become dependent on
regular manipulation, and their therapists are all too happy to
accommodate them. Alan Adams of the Los Angeles College of
Chiropractors estimates that perhaps 10% to 15% of his
colleagues are guilty of this.

    While the vast majority of chiropractic patients are
treated for back, neck and shoulder complaints as well as minor
headaches, some 10% seek help for organic diseases of all sorts.
Can manipulation help them? The chiropractic literature is
replete with examples of astonishing cures of ulcers,
hypertension, childhood asthma, blindness and even paraplegia.
But individual case histories prove nothing, and organized
studies are few and far between. Spinal manipulation has been
shown to alter the heartbeat and the acidity of the stomach,
says Peter Curtis, a medical professor at the University of
North Carolina, who studied the technique, "but whether you can
cure a peptic ulcer or angina is another question entirely." The
A.M.A. withdrew its earlier condemnation of chiropractic as a
cult in 1988 -- after federal courts ruled it an unfair
restraint of trade -- but it remains adamantly opposed to broad
application of chiropractic therapy.

    Of course, chiropractic could restrict itself to relieving
back pain and still have its hands full. By some estimates, 75%
of all Americans will suffer from low-back aches at some point
in their lifetime. The annual cost to U.S. society of treating
the ubiquitous ailment was recently tallied at a crippling $24
billion, compared with $6 billion for AIDS and $4 billion for
lung cancer. If spinal manipulation could ease even a fraction
of that financial burden, remaining skeptics might be forced to
stifle their misgivings or get cracking themselves.