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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.

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]

Why Now?

Here are 5 reasons why your contribution to FCER for the asthma study
is of paramount importance now:

1. It concerns a condition that, unlike back pain, is actually life-threatening and thus has the potential to inflict tragedy upon every American family;

2. 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;

3. 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;

4. 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;

5. 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.

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 pain [8, 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 Zealand [16] 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:

¹ Balon J, et al.
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 Manipulative Therapy
A Workshop held at the National Institutes of Health, February 2-4, 1975.
U.S. Department of Health, Education, and Welfare,
Washington, DC, February 3-4, 1975

⁶ Koes BW, Assendelft WJJ, van der Heijden GJMG, Bouter LM.
Spinal manipulation for low-back pain:
A updated systematic review of randomized clinical trials
Spine (Phila Pa 1976) 1996 )Dec 15); 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.

¹⁰ Bigos 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.
May 1994, 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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