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Join us in documenting the effects of
spinal manipulative therapy on Asthma
Introduction
I
AM WRITING TO YOU to ask for your support for a multicenter clinical
trial by a highly qualified research team that will document the
effects of spinal manipulative therapy in the management of asthma
that we would like to fund. This particular study, at a cost of
approximately a quarter of a million dollars, is taking place in
Australia, known as the asthma capital of the world because of the
high rate of asthma in that country.
This
project, conducted by researchers at Macquarie University in Sydney
with 420 subjects, follows on the heels of preliminary observations
which suggest that chiropractic management of spinal dysfunction in
asthmatic subjects reduces symptoms, anxiety and cortisol levels. It
is important to note:
-
This
is the first time that a chiropractic research
investigation of this scale has emphasized the global symptoms
which we believe have more to do with the experience and prognosis
of asthma than any of the research investigations conducted thus
far.
-
Another
first — This research undertaking will include an
appropriate control group of patients who will attend healthcare
centers but not receive chiropractic or any other type of contact
procedure during the 6-week intervention period.
-
Follow-up measurements
for
up to one year will monitor global, pain, wellness and spirometric
scales in addition to stress, immunoglubulin [IgA], cortisol, and
biological fluid viscosity measurements.
In other words, the most comprehensive spectrum to date of
indicators of asthma function will be tracked.
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Building on Previous Study
This
project far exceeds what was observed in an earlier, more restricted
clinical trial that received extremely limited funding from our
Foundation.1 This previous trial focused primarily on lung function
tests and use of a bronchodilator in children for up to 4 months
following treatment. Although symptom improvement was observed in both
treatment and control groups, the differences between the two did not
appear to be statistically significant. What
is important to realize in this instance is that the
"control" group received soft-tissue massage, distraction,
and palpation to multiple regions of the body. Soft tissue massage has
itself been demonstrated to produce profound improvements in asthma
symptoms and lung function in children.2
As
in any research endeavor, our sophistication grows with experience and
data obtained—and the entire clinical research world now has come to
the realization that so-called sham or mimic
procedures involving physical methods of healthcare intervention need
to be approached with extreme caution. From the results that we have
only just recently seen, sham procedures involving contact may be
prone to misinterpretation, and as such, may inappropriately dismiss
as "placebo effects" much of what actually occurs in a
practitioner’s office. Consequently, the perceived
"negative result" of this earlier study (that had a
disproportionately large public exposure from its publication in The
New England Journal of Medicine) is in critical need of updating—which
is possible with our new proposed study.
We have a particularly good opportunity to accomplish this
objective with the planned Australian clinical trial, in which preliminary
results already seem to suggest a positive effect of
chiropractic management.
There is no question that asthma has to be regarded as a serious
health concern in the United States:
-
Over 17,000,000
Americans suffer from asthmatic symptoms, the number more than
doubling since 1988.
-
The disease is the leading cause of school absence in the United
States, with the prevalence rates in children under 5 years of age
increasing 160% from
1980-1994.3
-
Even more ominous is a recent report which suggests that in
early childhood the odds ratio for asthma occurrence increases
up to 4-fold with antibiotic use, the risk
apparently being dose-dependent. 4
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Why Now?
Here
are 5 reasons why your contribution to FCER for the asthma study is of paramount
importance now:
-
It concerns a condition
that, unlike back pain, is actually life-threatening and
thus has the potential to inflict tragedy upon every American
family;
-
It concerns a condition that expands the chiropractic
scope of practice to more current and realistic
boundaries, supported by years of case reports and preliminary
observations;
-
It answers the
methodological problems from the recent asthma trial
which gained wide publicity through its publication in The New
England Journal of Medicine but is in fact a deeply flawed and
potentially misleading investigation;
-
It allows a research endeavor to go forward without further
delay in what is most likely a limited "window
of opportunity" for chiropractic to secure a viable place in the
healthcare market; and
-
It represents an opportunity to make your voice heard
in our continuing effort to represent your profession with hard,
indisputable facts in today's competitive healthcare delivery system.
Won’t
you help us fund this indispensable trial? Any amount will help!
Please join us at this extremely critical time as we direct our
healthcare system in the direction that will most efficiently, safely,
and economically affect us all.
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Note:
You may not realize that, until 25 years ago, chiropractic research
was vastly underdeveloped and appeared to some as an oxymoron. In
1975, a conference at the NIH concluded that "There are little
scientific data of significance to evaluate this [chiropractic's]
clinical approach to health and to the treatment of disease."5
From that time onward, both clinical and basic research have advanced
to the point at which [i] over 40 randomized clinical trials comparing
spinal manipulation with other treatments in the management of back
pain have been published in the scientific literature,6,7
[ii] meta-analysis and systematic reviews attesting to the support of
spinal manipulation in the management of back pain8,9
have also appeared, and [iii] multidisciplinary panels representing
the governments of the United States,10
Canada,11 Great Britain,12
Sweden,13 Denmark,14
Australia,15 and New Zealand16
have expressed similar recognition of the robust evidence base in
support of spinal manipulation for managing low back conditions.
By providing support for over 175 research projects and 150
individuals engaged in postgraduate study, FCER can claim primary
responsibility for this good fortune. In fact, virtually all of the
first government grants awarded for chiropractic research [essentially
nonexistent prior to 1993] were made possible by earlier studies that
were funded by FCER.
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References:
1Balon
J, Aker PD, Crowther ER, Danielson C, Cox PG, O'Shaugnessy D, Walker
C, Goldsmith CH, Duku E, Sears MR. A comparison of active and
simulated chiropractic manipulation as adjunctive treatment for
childhood asthma. New England Journal of Medicine 1998;
339(15): 1013-1020.
2Field
T, Henteleff T, Hernandez-Reif M, Martinez E, Mavunda K, Kuhn C,
Schanberg S. Children with asthma have improved pulmonary functions
after massage therapy. Journal of Pediatrics 1998; 132(5):
854-858.
3The
Integrative Medicine Consult 1999; 1(1): 120, 122.
4Wickens
K, Pearce N, Crane J, Beasley R. Antibiotic use in early childhood and
the development of asthma. Clinical and Experimental Allergy
1999; 29: 766-771.
5Goldstein
M [ed]: Monograph No. 15. The research status of spinal manipulation, U.S.
Department of Health, Education, and Welfare, Washington, DC, February
3-4, 1975.
6Koes
BW, Assendelft WJJ, van der Heijden GJMG, Bouter LM. Spinal manipulation
for low-back pain: A updated systematic review of randomized clinical
trials. Spine 21(24): 2860-2871.
7van
Tulder M, Koes BW, Bouter LM. Conservative treatment of acute and chronic
nonspecific low back pain: A systematic review of randomized controlled
trials of the most common interventions. Spine 1997;22(18): 2128-2156.
8Anderson
R, Meeker WC, Wirick BE, Mootz RD, Kirk DH, Adams A. A meta-analysis of
clinical trials of spinal manipulation. Journal of Manipulative and
Physiological Therapeutics 1992; 15(3): 181-194.
9Shekelle
PG, Adams AH, Chassin MR, Hurwitz EL, Brook RH. Spinal manipulation for
low-back pain. Annals of Internal Medicine 1992; 117(9): 590-598.
10Bigos
S, Bowyer O, Braen G, et al. Acute low back pain in adults. Clinical
practice guideline No. 14. AHCPR Publication No. 95-0642. Rockville, MD:
Agency for Health Care Policy and Research, Public Health Service, U.S.
Department of Health and Human Services. December 1994.
11Manga
P, Angus D, Papadopoulos C, Swan W. The effectiveness and
cost-effectiveness of chiropractic management of low-back pain. Ottawa,
Ontario, CANADA: Pran Manga & Associates, Inc., University of Ottawa,
1993, pp 65-70.
12Rosen
M. Back pain. Report of a Clinical Standards Advisory Group Committee on
back pain. May1994, London: HMSO.
13Commission
on Alternative Medicine, Social Departementete, Legitimization for Vissa
Kiropraktorer, Stockholm, SOU [English Summary] 1987; 12: 13-16.
14Danish
Institute for Health Technology Assessment: Low-back pain, frequency,
management, and prevention from an HTA perspective. Danish Health
Technology Assessment 1999; 1(1).
15Thompson
CJ. Second Report, Medicare Benefits Review Committee, Canberra,
AUSTRALIA: Common wealth Government Printer, June 1986, Chapter 10
[Chiropractic].
16Hasselberg
PD. Chiropractic in New Zealand, Report of A Commission of Inquiry.
Wellington, NEW ZEALAND: Government Printer, 1979.
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