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RE: March 2009 |
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| Topic Review |  | |
Christina
Basic Member
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| 30 Mar 2009 09:57 PM |
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March 2009
CLEAR Institute Monthly Newsletter
Chiropractic Leadership, Educational Advancement, & Research
March 2009 Newsletter Content
Hard Questions about Scoliosis Surgery
CLEAR Institute on Facebook!
Respecting the CLEAR Trademark
Hard Questions Raised about Scoliosis Surgery
In a paper recently published in the prestigious scientific journal Spine entitled, "Is the Spine Field a Mine Field," researchers raised some hard questions about the true effectiveness of many new devices & surgeries which are introduced & marketed in the United States. They note that, "over the past decade, the rate of some spinal procedures being performed in North America and Europe has greatly increased." This fact is supported by an article published in the Journal of Pediatric Orthopedics, which states, "The most common procedures in each of these years studied were, in order of incidence, scoliosis... [T]he incidence of surgery for scoliosis... increased over the past two decades."
However, very little research has been performed to determine if patients are truly benefiting from this operation. Returning to the first article, the authors mention that, "a rapid increase in fusion rates followed the approval of new surgical implants, but was not associated with evidence of improved effectiveness." Consumer Reports recently listed spinal surgery as the number one most overused treatment.
On page 424 of volume 34, number 5, in Spine, a table is listed which addresses many common myths about the methods by which new devices & surgeries are evaluated & regulated. One myth that is discussed is that a new device must be better than an old one in order to be approved. In reality, "No comparison with competing devices is required for approval; a new device may be equally effective, more effective, or less effective than alternatives." Ineffective devices are not recalled, but rather, "Devices are recalled only for safety problems and not for accumulating evidence of poor efficacy." Finally, many people believe that surgical procedures are regulated by the FDA, when in fact, "No procedures are regulated by the FDA."
It is a fact that a randomized controlled trial (RCT) - which is commonly considered to be the pinnace of evidence - to evaluate the effectiveness of scoliosis surgery has never been done. Researchers seeking to evaluate if patients with scoliosis & Duchenne muscular dystrophy could benefit from this operation were forced to conclude, after reviewing over 400 articles, that, "...there were no randomized controlled clinical trials available to evaluate the effectiveness of scoliosis surgery." (Cheuk DKL, Wong V, Wraige E, Baxter P, Cole A, N'Diaye T, Mayowe V. Surgery for scoliosis in Duchenne muscular dystrophy. Cochrane Database of Systematic Reviews 2007, Issue 1)
A similar result is obtained when one attempts to search for RCT's on brace treatment. A team of Dutch researchers note that, "the effectiveness of bracing patients with IS has not yet been convincingly established due to a lack of RCTs." (BMC Musculoskelet Disord. 2008; 9: 57.)
Both scoliosis surgery & scoliosis bracing have existed for decades, and the resources of the many organizations which promote these methods as effective treatments for scoliosis are considerable.
CLEAR Institute is committed to publishing research to validate the effectiveness of the advanced, biomechanical chiropractic treatment & physical rehabilitation protocols that we teach. The problems & limitations of applying evidence-based medicine to an easily-observable spinal deformity were made apparent in another recent article. Some of the key points were: "An evidence-based approach should ideally be prospective and include both objective measures as well as patient assessment. The most easily achieved are radiographic parameters and patient assessments. Ideally, studies should enroll patients consecutively and have close to 100% follow-up with complete data collection and a specific set of hypotheses. Funding sources are problematic. There might be a role for industry, the Scoliosis Research Society, and the NIH." (Spine, Volume 32, Number 19S, pp S135–S139)
Addressing these concerns & implementing a well-designed study to objectively determine whether scoliosis can truly be corrected in the long-term without resorting to bracing or surgery is one of the top priorities of this non-profit organization in 2009. It is very possible that a RCT will be published on CLEAR's method of scoliosis correction before the first RCT on scoliosis surgery makes it to print.
CLEAR Institute on Facebook!
CLEAR Institute has recently established a Facebook page! If you have a Facebook account, we encourage you to join our fanbase and learn more about the doctors & patients involved with CLEAR Institute. Simply go online to Facebook, and perform a search for "CLEAR Institute" to find us. Included on this new page are several pictures & videos showing people as they undergo CLEAR treatment for their scoliosis, and stories & testimonials of their experiences. Please take a moment to check out this new page, and let us know what you think by leaving a message on the wall.
An Important Message on Respecting the CLEAR Trademark
CLEAR™ Institute’s focus is on putting the patient’s needs first. Every decision that we make focuses on our collectively providing the best possible care to people suffering from the debilitating effects of scoliosis. Practicing doctors on the CLEAR™ advisory board have created (and we have adopted) standardized treatment protocols to further this goal. We also know that certain equipment increases the ability of the chiropractic doctor to treat scoliosis effectively. In the same manner, doctors on the advisory board have recommended (and we have adopted) a list of equipment that is necessary to effectively treat scoliosis. After considerable thoughtful planning, we created the CLEAR™ Standard Treatment and Intensive Treatment certifications based on the adopted treatment protocols and equipment listing.
On a typical day we receive several calls from people suffering from scoliosis. As we take these call one of the things that has distressed us the most is hearing from a patients who tell us that they are receiving CLEAR™ care and their Cobb Angle got worse, or they have received CLEAR™ care for several months and only obtained a few degrees of improvement. In every case, the doctor was not following the full CLEAR™ protocol, and possessed only a few pieces of equipment, if any. It is our desire to see that every patient who learns about CLEAR™ receives the best possible care.
For this reason, doctors may not call their treatment protocols CLEAR™ protocols unless they have achieved and maintained CLEAR™ standard treatment or Intensive Care status. Doctors who misrepresent the CLEAR trademark are damaging their reputations, CLEAR Institute’s reputation, and the reputation of the chiropractic profession. Legally and ethically, this cannot be tolerated. A full list of the recommended CLEAR treatment protocols, treatment plans, and current CLEAR certified doctors is available on our website. If you are aware of abuse or misuse of the CLEAR trademark, please take the time to contact us at 1-866-520-4270, ext 1, or care@clear-institute.org. With your help, we can confidently guarantee that every person with scoliosis who undergoes CLEAR treatment receives the best possible care, and achieves the best possible results.
"Sometimes when I consider what tremendous consequences come from little things, I am tempted to think there are no little things."
-Bruce Barton (1886-1967)
Advertising executive
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Permission freely granted to copy & distribute this information without financial gain.
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