By William Meeker, DC, MPH, FICC

For several years now, many have pointed out that our major clinical intervention, that family of procedures we call adjustments/manipulation, is no longer a “quack” remedy. That designation changed dramatically over a decade ago with the publication of the RAND appropriateness studies, the AHCPR guidelines on back conditions, and a fair number of randomized clinical trials.

Historically, those studies were very powerful in pulling manipulation out of the closet to where it now is – experiencing a great deal more exposure. As a result, we are seeing a renaissance of interest by osteopathic physicians and physical therapists. This in turn has led to a significant increase in the amount of research on manipulation by these professions. They are challenging chiropractic for pre-eminence in this field.

Professions, by definition, “own” their tools and their knowledge. This means that there is a cultural consensus in society that expertise in the use of professional knowledge is invested in a particular profession because that profession knows the most, is the most expert in, and can do the most good for the public with its unique tools. Lawyers know the most about laws because they make laws, study laws and apply laws. You wouldn’t go to a plumber if you had a legal case. Obviously, the situation is analogous for health care.

A citizen should not have any trouble deciding whom to consult for specific kinds of clinical expertise. But the situation for manipulation is becoming increasingly muddy, if the scientific publication record is any indication. We chiropractors do not enjoy an unassailable cultural consensus anymore when it comes to manipulation and adjustments. Chiropractors certainly have some authority by virtue of our history and training, but others are encroaching. We need to recognize that our authority in this area is under concerted and constant attack, and I fear that we may be losing ground.

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By Larry Hand

October 25, 2011 — Critical gaps exist in the evidence for the effectiveness of licensed influenza vaccines in the United States, researchers report in an article published online October 25 in The Lancet Infectious Diseases. Individuals who are at risk for medical complications or people who are aged 65 years or older are especially affected by the gaps, the researchers write.

The researchers conducted a meta-analysis of 31 studies that used laboratory tests to confirm influenza infections. These studies were selected from 5707 studies identified, published over a period of 40 years. The authors found that trivalent inactivated vaccine, which is used for 90% of influenza vaccinations in the United States, is only effective in preventing infection in 59% of healthy adults. They also found live attenuated influenza vaccine, which is not approved for adults who are aged 50 years or older, to be effective in 83% of children aged 7 years or younger, and in 69% of people younger than 65 years.

“The ongoing health burden caused by seasonal influenza and the potential global effect of a severe pandemic suggests an urgent need for a new generation of more highly effective and cross-protective vaccines that can be manufactured rapidly,” write Michael Osterholm, PhD, MPH, from the University of Minnesota, Minneapolis, and lead author of the study, and colleagues. “In the meantime, we should maintain public support for present vaccines that are the best intervention available for seasonal influenza.”

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Additionally, these findings provide further preliminary evidence, beyond that already provided by Terrett, that the inappropriate use of the title chiropractor and term chiropractic manipulation may be a significant source of over-reporting of the link between the care provided by chiropractors and injury.

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