tise. Royal College examiners are expected to use a standard approved by the Royal College to judge the success or failure of a candidate. Licensing authorities recognize this standard as one of -the qualifications for licensure. Certification by either the College of Family Physicians of Canada or the Royal College in addition to licensure by the Medical Council of Canada will be the accepted standard in all provinces. Provincial licensing authorities will continue to grant licensure to those applicants who have not obtained certification but otherwise meet the specific qualifications for that province. Stan T. Bain, MD President Federation of Medical Licensing Authorities of Canada Ottawa, Ont.
Chiropractic manipulation
transcutaneous nerve stimulation. At the end of my visit I was, frankly, disappointed. I felt slightly better, but I had expected a miracle cure. However, I just had to be a little more patient: 24 hours later, after 3 months of misery, my pain was gone. And he only charged me $10, not $36. Since then I have continued to consult with my acquaintance about various sporting injuries. He never tells me to just rest and take anti-inflammatory drugs. He treats my pain using methods of treatment available to medical doctors, such as transcutaneous nerve stimulation and ultrasonography. He evaluates the cause of the injury and works with me on prevention. Perhaps Waugh's chiropractor does not have the same clinical skills as mine does. But then, that happens in medicine as well doesn't it? David Murphy, MB, ChB, FRCPC Shanty Bay, Ont.
I think that, by implication, Dr. Waugh's comments suggest that chiropractic may have actually helped him with his hip pain visited a chiropractor (Can Med (What exactly is hip pain?) and Assoc J 1992; 146: 762). Although that $11 from the Ontario Health the article was written humorous- Insurance Plan and $36 of overly it does leave the impression billing were thereby well spent. that all chiropractors are quacks, Certainly, there is a wellwhich is certainly not the case. spring of ignorance and a defiI too experienced several ciency in most of our training months of pain; mine was due to a programs on the issue of back back injury. I was horrified that pain, and that may account for the only advice I received from an some of Waugh's equivocal exorthopedic colleague was to "take perience with physicians. My Aspirin until your ears ring, and if training at McGill University gave that doesn't work we could con- me licence to practise general sider myelogram and a laminect- medicine just over a decade ago omy." I felt sure that there had to with virtually no organized expobe some method of pain manage- sure to the problem of back pain, ment between Aspirin and sur- and my orthopedic certificate was gery. granted from a Canadian training I contacted an acquaintance program that, again, gave me virwho is a chiropractor. He saw me tually no experience in the diagnoon a Saturday morning, examined sis or management of such pain, me, took x-ray films, manipulated other than the occasional intermy spine and treated me with vention for fracture. I t is unfortunate that Dr. Douglas Waugh had such a negative experience when he
2132
CAN MED ASSOC J 1992; 146 (12)
The whole field of spinal pathology and back pain is a very new one, riding on the tail of the recent explosive growth in ortho-
pedic information. Spine, the foremost journal of spinal pathology (in my and others' opinion), only started to publish in 1974, and most practitioners have had no exposure to it or its like: most of the organized spinal societies were founded after 1974. In a nutshell, Waugh's physician was probably not trained to diagnose or treat back pain. That is a fault of our health care training and licensing institutions. I take issue, however, with Waugh's implication that chiropractic has cured him and is therefore to be supported. There is an increasingly well defined body of data to suggest that most acute back pain is related to softtissue injury and has a benign natural history not requiring intervention. If there is a 95% probability that an acute "flat-on-yourback" pain will be resolved without major sequelae by 6 months there is a pretty good chance that chiropractic will make you feel better if you spend your time and money on it in the interim. Until chiropractors can produce highquality prospective and independently analysed clinical data to support the lasting benefit of their intervention for anything other than the symptoms associated with nonspecific soft-tissue injury (which would get better anyway) I think that society has a problem in pouring dollars in that direction. As a practising spinal surgeon I have no problems at all with my patients seeing or being treated by chiropractors. I do not prescribe it because I do not have evidence of a lasting benefit in my patients with chronic pain, but most chiropractors are reasonable people practising something along the lines of physical medicine, and their methods are quite safe. As a physician I do have a professional LE 15 JUIN 1992
Chiropractic manipulation
transcutaneous nerve stimulation. At the end of my visit I was, frankly, disappointed. I felt slightly better, but I had expected a miracle cure. However, I just had to be a little more patient: 24 hours later, after 3 months of misery, my pain was gone. And he only charged me $10, not $36. Since then I have continued to consult with my acquaintance about various sporting injuries. He never tells me to just rest and take anti-inflammatory drugs. He treats my pain using methods of treatment available to medical doctors, such as transcutaneous nerve stimulation and ultrasonography. He evaluates the cause of the injury and works with me on prevention. Perhaps Waugh's chiropractor does not have the same clinical skills as mine does. But then, that happens in medicine as well doesn't it? David Murphy, MB, ChB, FRCPC Shanty Bay, Ont.
I think that, by implication, Dr. Waugh's comments suggest that chiropractic may have actually helped him with his hip pain visited a chiropractor (Can Med (What exactly is hip pain?) and Assoc J 1992; 146: 762). Although that $11 from the Ontario Health the article was written humorous- Insurance Plan and $36 of overly it does leave the impression billing were thereby well spent. that all chiropractors are quacks, Certainly, there is a wellwhich is certainly not the case. spring of ignorance and a defiI too experienced several ciency in most of our training months of pain; mine was due to a programs on the issue of back back injury. I was horrified that pain, and that may account for the only advice I received from an some of Waugh's equivocal exorthopedic colleague was to "take perience with physicians. My Aspirin until your ears ring, and if training at McGill University gave that doesn't work we could con- me licence to practise general sider myelogram and a laminect- medicine just over a decade ago omy." I felt sure that there had to with virtually no organized expobe some method of pain manage- sure to the problem of back pain, ment between Aspirin and sur- and my orthopedic certificate was gery. granted from a Canadian training I contacted an acquaintance program that, again, gave me virwho is a chiropractor. He saw me tually no experience in the diagnoon a Saturday morning, examined sis or management of such pain, me, took x-ray films, manipulated other than the occasional intermy spine and treated me with vention for fracture. I t is unfortunate that Dr. Douglas Waugh had such a negative experience when he
2132
CAN MED ASSOC J 1992; 146 (12)
The whole field of spinal pathology and back pain is a very new one, riding on the tail of the recent explosive growth in ortho-
pedic information. Spine, the foremost journal of spinal pathology (in my and others' opinion), only started to publish in 1974, and most practitioners have had no exposure to it or its like: most of the organized spinal societies were founded after 1974. In a nutshell, Waugh's physician was probably not trained to diagnose or treat back pain. That is a fault of our health care training and licensing institutions. I take issue, however, with Waugh's implication that chiropractic has cured him and is therefore to be supported. There is an increasingly well defined body of data to suggest that most acute back pain is related to softtissue injury and has a benign natural history not requiring intervention. If there is a 95% probability that an acute "flat-on-yourback" pain will be resolved without major sequelae by 6 months there is a pretty good chance that chiropractic will make you feel better if you spend your time and money on it in the interim. Until chiropractors can produce highquality prospective and independently analysed clinical data to support the lasting benefit of their intervention for anything other than the symptoms associated with nonspecific soft-tissue injury (which would get better anyway) I think that society has a problem in pouring dollars in that direction. As a practising spinal surgeon I have no problems at all with my patients seeing or being treated by chiropractors. I do not prescribe it because I do not have evidence of a lasting benefit in my patients with chronic pain, but most chiropractors are reasonable people practising something along the lines of physical medicine, and their methods are quite safe. As a physician I do have a professional LE 15 JUIN 1992
