Dr. Richard McIlmoyle BSc, DC, PgCPain
BIG PHARMA and The Almighty Adjustment
Updated: Jan 12, 2020
It is not an uncommon narrative about “BIG PHARMA” that they do not research cures for things like cancer because there is more money on ongoing treatment. I have heard this narrative supported on many occasions by my fellow chiropractors, especially those that hold a strong belief in the ability of spinal manipulative therapy aka “the adjustment” to help with conditions beyond the neuromusculoskeletal.
How ironic is it that Chiropractors may be committing the same “crimes” they accuse pharma companies of doing?
The bulk of research into low back pain supports reassurance, some manual treatment and movement.
You could suggest that, similar to “BIG PHARMA” and cancer, Chiropractors/Physiotherapists ignore or are unaware of the research that LBP, the big money maker in many practices, will likely resolve with time.
Perhaps the high volume of treatment (3 times a week for the first few weeks) is completely unnecessary. What if we just need to reassure and wait until natural history brings about resolution. It could be argued that the frequent initial treatments provide an analgesic effect through mechanisms such as:
·The ritual of treatment
·Reassurance that they are actively seeking treatment
·They are taking action to help themselves
·Having a doctor interacting with them and providing care
·The effect of the treatment itself
All the treatment happens while, perhaps… time “heals all wounds”
Would chiropractors be comfortable supporting a study that included a group treated 3 times a week for 2 weeks, 2 times for 2 weeks (10 times in 4 weeks), and another randomized group treated 3 times in 4 weeks, and yet another 2 times in 2 weeks.
Let’s see the outcomes??? I’m curious…
What would the response be?
Would there be cries of injustice from practitioners if the results were consistent with the hypothesis that patients did not need that much treatment?
Would there be revelation that perhaps low back pain is a normal part of life and, for most people, it will resolve…in time??????
Sacrilege??? I don’t know. Can we ask these questions? They go through my mind.
There is an economic implication in my profession and with other manual therapists. I try to treat as ethically as I know how, and they do too, but what would it mean for them if they were exposed to this hypothesis and it was supported by research? What if less treatment had equal outcomes, or even better outcomes? Would there be backlash, because the bottom line is going from 10 x visit fee to 2 x visit fee??? That would be anywhere from hundreds to thousands of dollars less per patient. Would health care providers be willing to take that hit in the pocketbook?
This treads onto the idea presented in my friend, Eric's blog “Ethics vs Economics”.
Can we still be economically stable while treating people in pain with an understanding that we should probably do fewer treatments.
Most of the premise here is involved with acute episodes of low back pain, but could possibly be extrapolated into treatment of persistent pain as well.