problem with our endorsing (tacitly or otherwise) a profession that too frequently sees patients with serious medical illnesses like asthma, ulcer or cancer as treatable by manipulation of the spine. Recognizing the increasingly powerful political factors involved in professional alliances I believe that CMAJ has done itself a disservice. Drew A. Bednar, MD, FRCSC, FAAOS Assistant professor of orthopedic surgery McMaster University Hamilton, Ont.
I read with interest Dr. Waugh's article and was disheartened and frustrated to be reminded that most physicians still live in the dark ages and are content to remain prejudiced against the chiropractic profession. There is no question that our profession has its share of questionable practitioners, as has the medical profession. However, there are a good number of responsible, ethical chiropractors out there. When patients present to this clinic they are given a full orthopedic and neurologic examination, if required, and are subjected to a thorough history-taking. The chiropractor described in the article apparently practises a form of applied kinesiology, which is an extremely controversial type of diagnosis and treatment. I find Waugh's description of his experience insulting and irresponsible, since it no doubt clouds the view of many CMAJ readers as to what the chiropractic profession is all about. Perhaps in the future if he chooses to write about chiropractors he can consult the Canadian Chiropractic Association. (If I were to write about every irresponsible physician I have been to or my patients have described I would probably fill a large binder.) I think that chiropractors and physicians alike are, for the most part, dedicated, hardworking proJUNE 15, 1992
fessionals. Don't paint us all with ing each other for the betterment the same brush just for the sake of of patient care. sensational journalism. Brian McWhirter, DC Thompson, Man.-
Having read Dr. Waugh's article I am dismayed by his implications. Although he does not conclude this outright, Waugh implies that the assessment he was given represented that at any chiropractor's office, and he therefore concludes that the chiropractic profession has nothing to offer sufferers of low-back pain. If Waugh's description is accurate the assessment was both unsound and incomplete. There are many specialists in medicine - e.g., neurologists, orthopedic surgeons, physiatrists and rheumatologists - to whom patients with low-back pain or other soft-tissue pain are referred. However, the majority of these specialists have no training in the management of pain of softtissue origin. As a physician and student of the management of soft-tissue pain syndromes I have studied the techniques of physiatrists in Montreal and Paris. I have thus become familiar with the medical approach to the assessment of these syndromes and to their treatment, including manipulation. I am certain that most physicians practising medicine, possibly including Waugh, have absolutely no exposure to the science and art of manual medicine and therefore consider practitioners of these techniques to be "alternative health care" providers. There is already a great deal of needless hostility between physicians and chiropractors in most communities in Canada. This article can only foster these sentiments. I believe that it is time for such professionals to begin working together and educat-
Hillel M. Sommer, MD Senior resident Department of Physical Medicine and Rehabilitation University of Manitoba Winnipeg, Man.
I can only bemoan the lost opportunity for the chiropractic profession when Dr. Waugh went for his first chiropractic visit. Great strides are being made in chiropractic research and in the development of standards of care, but it is apparent that there remains a great deal of work to be accomplished. I applaud Waugh for deciding to visit the "enemy camp." Such visits are becoming more and more common, to the betterment of both groups and, more important, to the benefit of our patients. Interprofessional research is also becoming more common; there are chiropractors in the newly constituted study being performed under the auspices of the American Association for Health Care Policy and Reform, a recent RAND study' included multidisciplinary practitioners, and the journal that I edit regularly publishes papers written by medical professionals. With regard to lowback pain, there is considerable debate over the use of most treatments, including laminectomy, fusion and manipulation. Manipulation is still one of the most studied methods. I believe that Waugh's chiropractic physician did not follow a reasonable standard of care and erred in a number of ways. There is no evidence that he performed a physical examination, and for atypical low-back pain that is the least I would expect. No one would treat low-back pain solely on the basis of the results of radiography and computed tomography (CT). Apparently this chiropractor performed simple muscle-testing procedures from CAN MED ASSOC J 1992; 146 (12)
2133
I read with interest Dr. Waugh's article and was disheartened and frustrated to be reminded that most physicians still live in the dark ages and are content to remain prejudiced against the chiropractic profession. There is no question that our profession has its share of questionable practitioners, as has the medical profession. However, there are a good number of responsible, ethical chiropractors out there. When patients present to this clinic they are given a full orthopedic and neurologic examination, if required, and are subjected to a thorough history-taking. The chiropractor described in the article apparently practises a form of applied kinesiology, which is an extremely controversial type of diagnosis and treatment. I find Waugh's description of his experience insulting and irresponsible, since it no doubt clouds the view of many CMAJ readers as to what the chiropractic profession is all about. Perhaps in the future if he chooses to write about chiropractors he can consult the Canadian Chiropractic Association. (If I were to write about every irresponsible physician I have been to or my patients have described I would probably fill a large binder.) I think that chiropractors and physicians alike are, for the most part, dedicated, hardworking proJUNE 15, 1992
fessionals. Don't paint us all with ing each other for the betterment the same brush just for the sake of of patient care. sensational journalism. Brian McWhirter, DC Thompson, Man.-
Having read Dr. Waugh's article I am dismayed by his implications. Although he does not conclude this outright, Waugh implies that the assessment he was given represented that at any chiropractor's office, and he therefore concludes that the chiropractic profession has nothing to offer sufferers of low-back pain. If Waugh's description is accurate the assessment was both unsound and incomplete. There are many specialists in medicine - e.g., neurologists, orthopedic surgeons, physiatrists and rheumatologists - to whom patients with low-back pain or other soft-tissue pain are referred. However, the majority of these specialists have no training in the management of pain of softtissue origin. As a physician and student of the management of soft-tissue pain syndromes I have studied the techniques of physiatrists in Montreal and Paris. I have thus become familiar with the medical approach to the assessment of these syndromes and to their treatment, including manipulation. I am certain that most physicians practising medicine, possibly including Waugh, have absolutely no exposure to the science and art of manual medicine and therefore consider practitioners of these techniques to be "alternative health care" providers. There is already a great deal of needless hostility between physicians and chiropractors in most communities in Canada. This article can only foster these sentiments. I believe that it is time for such professionals to begin working together and educat-
Hillel M. Sommer, MD Senior resident Department of Physical Medicine and Rehabilitation University of Manitoba Winnipeg, Man.
I can only bemoan the lost opportunity for the chiropractic profession when Dr. Waugh went for his first chiropractic visit. Great strides are being made in chiropractic research and in the development of standards of care, but it is apparent that there remains a great deal of work to be accomplished. I applaud Waugh for deciding to visit the "enemy camp." Such visits are becoming more and more common, to the betterment of both groups and, more important, to the benefit of our patients. Interprofessional research is also becoming more common; there are chiropractors in the newly constituted study being performed under the auspices of the American Association for Health Care Policy and Reform, a recent RAND study' included multidisciplinary practitioners, and the journal that I edit regularly publishes papers written by medical professionals. With regard to lowback pain, there is considerable debate over the use of most treatments, including laminectomy, fusion and manipulation. Manipulation is still one of the most studied methods. I believe that Waugh's chiropractic physician did not follow a reasonable standard of care and erred in a number of ways. There is no evidence that he performed a physical examination, and for atypical low-back pain that is the least I would expect. No one would treat low-back pain solely on the basis of the results of radiography and computed tomography (CT). Apparently this chiropractor performed simple muscle-testing procedures from CAN MED ASSOC J 1992; 146 (12)
2133
