Good morning, everyone. My name is David Shurtleff. I’m the Deputy
Director for NCCAM, and it’s my pleasure this
morning to welcome and introduce Dr. Richard Deyo
as our speaker for NCCAM’s second integrative
medicine lecture for 2014. Dr. Deyo is the Kaiser
Permanente Professor of Evidence-Based Family Medicine
in the Department of Family Medicine at Oregon Health
and Sciences University, Portland, Oregon. Before joining OHSU in 2007,
Dr. Deyo was the Co-Director, Center for Cost and
Outcomes Research at the University of
Washington, Seattle. Dr. Deyo has a longstanding
interest and is a recognized leader in research in the study
of the clinical interventions and treatment of back pain. He has published
extensively on the topic, with over 300 publications,
and has been a member of the Federally funded panel that
wrote guidelines for the care of acute low-back pain problems,
and he is currently deputy editor of the journal Spine. So, as we all know,
according to the IOM, chronic pain affects
approximately 100 million American adults–more than the
total affected by heart disease, cancer, and diabetes combined. Pain also costs the nation up
to $635 billion each year in medical treatment
and lost productivity. So, clearly a huge public-health
crisis we face in thinking about and treating pain. So today Dr. Deyo will present
his research that has examined complementary health care
approaches such as massage and acupuncture for the
treatment of back pain, and the title of his
presentation is “Manipulating the Pain: Chiropractic and Other Alternative
Treatments for Back Pain.” So please welcome Dr. Deyo. [APPLAUSE] DR. RICHARD A. DEYO: Well,
thank you and good morning. It’s really a pleasure and a
privilege for me to be here. I appreciate the invitation to
come and talk a little bit about the research that we’ve been
doing in the great Pacific Northwest having to do with
a variety of treatments for chronic back pain but
complementary and alternative treatments in particular. I thought what I would do is
spend a couple of slides just talking about what I think
are some of the sources of the mistrust and skepticism
that mutually exists between complementary and
alternative practitioners and the regular
medical profession. I’ll talk then about some of the
methodologic challenges that we faced in trying to study complementary and
alternative treatments. And then I’ll go into a
discussion of some of the randomized trials that
we’ve done in Seattle, primarily with my colleagues
at Group Health Cooperative, that have focused on
chiropractic care, acupuncture, and massage, which
are in fact the most common complementary and alternative
treatments for back pain. And then I’ll talk a little
bit about some of the cost implications at least of
these kinds of treatments. The origins of chiropractic go
back to the late 1800s when D. D. Palmer, who was a
magnetic healer in the Midwest, claimed to have cured a
janitor’s deafness by manipulating his neck. Palmer subsequently went on to
coin the term “chiropractic”, dealing with therapy by hand,
and he founded the first school of chiropractic in 1897. Palmer and the early
chiropractors came to believe that 95 percent of all diseases were caused by
misaligned vertebrae. And as a result, they actually
rejected the germ theory, and a consequence of that of
course was that they rejected the notion of vaccines
and drugs and so forth, and basically were rejecting a
lot of the emerging science that I think now is well accepted. Even today, you see what some
would consider to be extravagant claims for treating things
like congestive heart failure or diabetes by
chiropractic manipulation, and I’m going to avoid that
argument and just focus on back pain, which is really still
the most common problem that’s addressed by chiropractors. The animosity between the
conventional medical world and the chiropractic world
probably peaked in the 1960s when the American Medical
Association formed a Committee on Quackery that
was really largely devoted to eliminating the
chiropractic profession. And in turn, the JAMA editor
at the time was dubbed by the chiropractors a “medical
Mussolini” for his efforts to try to eliminate chiropractic. So you can appreciate there was
plenty of ill will to go around, and I’d argue that’s
changed substantially over the last 10 or 20 years. The origins of acupuncture
go back much, much further. Maybe 1000 B.C. are the first
records that we have of something that looks like acupuncture
probably in China. It was postulated that there
were these meridians with a flow of life energy that existed and
are depicted in illustrations like this one. But there’s really been no
known anatomical basis for these meridians. Nonetheless, acupuncture
surged in popularity after Nixon visited China in 1972 and had acupuncture
demonstrated for him. And again, there are sometimes
claims that seem to many extravagant, such as major
open-heart surgery being done just under
acupuncture anesthesia, a claim that apparently has
been substantially exaggerated.

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