Dear Dr. Swartz:
I have recently received the announcement regarding the American Back Society meeting in San Francisco.
I am sorry that I won't be able to support your organization or your meeting if this trend continues. I think it is a serious mistake to include these practioners in your program, now or in the future.
End of a letter from another world, one stuck in the past. The response of Dr. Swartz, who is also an orthopedic surgeon, provides a measure of how things are changing. It reads as follows:
Dear Doctor:
The American Back Society was founded and established as an interdisciplinary group of health care professionals specializing in back and neck care. We feel it is important for all back care providers to have an opportunity for excellent educational programs, and we also feel that all of the members of the back care community should have an opportunity to learn what each of the other disciplines are doing, as well.
We feel that the medical community would find it valuable to be aware of what osteopaths, physical therapists, occupational nurses, physiatrists, chiropractors, and many others are doing, as we feel that it would enhance one's own knowledge and skills. In particular, it would also help each of us understand when and to whom to refer certain types of cases, with the best interests of the patient in mind.
We feel that this process will ultimately result in improved back care; the public, therefore, would be the ultimate beneficiary.
Chiropractic education, like educational programs in the other professions, has been improving and becoming wider in scope. Chiropractic graduates, over the past few years, have been demonstrating an increasing knowledge of biomechanics, exercise physiology, spinal pathology, etc., and chiropractic meetings have been including a much wider scope of subject material and speakers from the medical community and other professions. Many other large spinal meetings, both national and international, have been including chiropractors in their programs. There is currently a multi-center research program going on between a very prestigious orthopedic department in the east and a chiropractic school in the west.
A recent independent trial for the British Medical Journal reported the effectiveness of chiropractic, i.e., management of acute and chronic back pain, together with the Lancet editorial suggesting medicine must take a new look at chiropractors.
Our president, Dr. William Kirkaldy-Willis, has been working closely for several years with a research associate, Dr. David Cassidy, who is a chiropractor, and they have authored a very significant paper on the subject of manipulation.
We feel it is important to recognize that a great many people in this country receive chiropractic care and that there is a great level of patient satisfaction among them. Not everybody who goes to a chiropractor is satisfied, but then we can say that about all of the other back care professionals, including we orthopaedic surgeons. Not all chiropractors have similar knowledge, skills, and techniques, but then we could also say that about all of the other health care professionals, and again, about we orthopaedists.
I feel that I should point out that we do not endorse health care practitioners who fall below the standard of care among their peers, whether they be chiropractors or orthopaedists or any other back care professionals.
Our recent surveys have revealed that a significant number, and sometimes a majority, of those attending our chiropractic special events and workshops are orthopaedists.
We feel that there is much to be learned about back pain. At this time we are probably still in the early stages of development on this subject. Most of us can use as much assistance as is available; of course with the welfare of the patient in mind.
I would like to personally extend an invitation to you to attend our fall symposium ..., and would like to offer you a complimentary registration for the entire program. I would hope that you might take the opportunity to attend some of the chiropractic workshops and special events. After that, I would be most delighted to meet with you and share your feelings and thoughts on the subject.
Independent of the above response by Dr. Swartz, a distinguished member of the ABS board of directors, Scott Haldeman, M.D., Ph.D., D.C., also replied in a way that you will find interesting.
Dear Doctor:
Dr. Swartz recently referred a letter from you to the American Back Society regarding the inclusion of chiropractors on their program. I was somewhat surprised at your concern about their inclusion into the program.
I assume you have similar concerns about the North American Spine Society which is made up of 85 percent of spine surgeons, as they had 3 chiropractors presenting papers at their last meeting in Monterey. I assume you also have similar concerns about the International Society for the Study of the Lumbar Spine which has had at least half a dozen papers presented by chiropractors on their program. As a matter of fact, the next American Academy of Orthopedic Surgery has a symposium on manipulation which will be primarily a discussion of chiropractic as they provide the majority of manipulative treatments in North America. One of the speakers in that program happens to have a chiropractic degree.
It appears to me that if you maintain your current unwillingness to participate in a program that includes chiropractic speakers, that you would be virtually eliminating your attendance at any scientific spine meeting in North America.
I do hope you would look more closely at some current scientific research within the chiropractic field including two chiropractic journals that are indexed through Index Medicus and the various papers published by chiropractors in Spine. There is no question that many chiropractors still have a way to go before they fulfill all scientific criteria, but there are none of us in the field who can state everything we do has been proven scientifically.
The American Back Society is one of the best forums for the presentation of various points of view and for debate. It is through meetings such as the American Back Society that any unscientific dogma is currently being adhered to by any member of the health care sciences, including chiropractors, can be addressed, debated and educed to a minimum. I hope you will reconsider your decision not to attend the American Back Society meeting. ...
Dr. Haldeman and Dr. Swartz will join other international leaders from medicine, surgery, physicial therapy, and -- yes -- chiropractic, to conduct the Spring Symposium on Back Pain, Toronto, Canada, May 1-5, 1991.
For information on the American Back Society and the meeting in Toronto, write me: American Back Society, 2647 East 14th Street, Suite 401, Oakland, California 94601.
Robert Anderson, M.D., Ph.D., D.C.
Daly City, California