Correspondence with the author, Dr. Bove

This section was compiled by Frank M. Painter, D.C.
Send all comments or additions to:   Frankp@chiro.org

My first letter to Dr. Bove

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From: Frank M. Painter, D.C.
To: Geoffrey Bove, D.C., Ph.D.
Cc: Projects@chiro.org;  CHIRO-NEWS;  CHIROSCI-LIST;  Dr. John Amaro;
Raymond Brodeur;  David Chapman-Smith;  Dr. Arthur C.Croft;  Dana Lawrence
DrRichP@4icpa.org;  Cheryl Hawk, D.C.;  Craig Liebenson;  Bill Meeker, D.C.;
Robert D. Mootz, D.C;  Ed Owens;  Dr. Howard Vernon
Subject: Spinal manipulation fails in episodic tension-type headaches (ETTH) study???
Date: Wednesday, November 11, 1998 11:33 AM


Dear Dr. Bove, Listers, and friends from the research community,


Below are AMA's abstract, and an additional article from the AMA "Science News Update", on a study of 75 people who received 8 "treatments" in 4 weeks and failed to respond...even though they admit that both groups reduced in symptoms and drug reliance.

Strangely, the placebo group received laser treatment to the neck and back. It is unclear, when they state they used a "a placebo laser treatment "...does that mean the laser was a fake, or was it an operational laser, which they considered a "neutral" treatment?

I am in the midst of John Amaro's acupuncture classes right now, and they state that laser is a useful treatment at acupuncture points. Perhaps the laser and manipulation both got similar results (and both did get results) because they are both effective treatments.

I usually see someone 3 (or more) times the 1st week, reducing (usually) to 2X/week for week 2-4, thus the 9-12 visits. Some get more, few get less than 9. Perhaps this study suggests that I could see HA patients less frequently and still get some measurable results?

It's my hope that Dr. Bovee will sign onto chirosci-list (send a note to majordomo@silcom.com, and write "subscribe chirosci-list") and share his insight with us. I also request that he (and anyone else who posts me and/or the lists) give me permission to publish his/their comments at our non-commercial website (URL below) so that the rest of the profession may benefit from this exchange.

Thanks for your attention to this matter...I look forward to the exchange.

Frank M. Painter, D.C.

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His first response

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From: Geoffrey Bove, D.C., Ph.D.
To: Frank M. Painter, D.C.
Cc: Projects@chiro.org;  CHIRO-NEWS;  CHIROSCI-LIST;  Dr. John Amaro;
Raymond Brodeur;  David Chapman-Smith;  Dr. Arthur C.Croft;  Dana Lawrence;
DrRichP@4icpa.org;  Cheryl Hawk, D.C.;  Craig Liebenson;  Bill Meeker, D.C.;
Robert D. Mootz, D.C;  Ed Owens;  Dr. Howard Vernon
Subject: Spinal manipulation fails in episodic tension-type headaches (ETTH) study???
Date: Wednesday, November 11, 1998 12:01 PM


Dear Dr. Painter and others,

I am glad to address such comments, at least in brief, especially now before I get a lot of requests, which are appearing on my server at an alarming rate. My goal is to clarify not the results that we published, but to dispel inaccuracies in interpretation. Most inquiries have demonstrated a lack of understanding of scientific design.

Dr. Painter writes:
> Strangely, the placebo group received laser treatment to the neck and back.
> It is unclear, when they state they used a "a placebo laser treatment
> "...does that mean the laser was a fake, or was it an operational laser,
> which they considered a "neutral" treatment?
> I am in the midst of John Amaro's acupuncture classes right now, and they
> state that laser is a useful treatment at acupuncture points. Perhaps the
> laser and manipulation both got similar results (and both did get results)
> because they are both effective treatments.

We cited a paper that demonstrated that laser light therapy could be expected to have no more effect than placebo. It was an operational laser. Stating in a class that laser works for whatever is not enough. Current facts point to laser as a placebo, by definition -- it has been evaluated using sound methods.

But, this was not at all our point. Our study showed that manipulation did not augment treatment for ETTH. Believe me, we tried to look at the data from many angles.

I suggest that people read the paper (and the entire JAMA issue) before critisizing it. Our study asked one question and delivered one answer, a hallmark of good science. In my presentation, as in the paper, we stressed that chiropractors do more than manipulation, and that chiropractic treatment has been shown to be somewhat beneficial for ETTH and VERY beneficial for cervicogenic headache. The message was that people should go to chiropractors with their headaches, for diagnosis and management.

Regarding the mailing list, I was on it a few years ago briefly, but after a week decided to terminate the subscription. I am a researcher who cannot spend 10-20 hours a week looking at these things, let alone assist the plethora of chiropractors with research ideas that are not in a position, nor are willing to put themselves in a position, to perform research.

Sincerely,

Geoffrey
--

Geoffrey Bove, DC, PhD
Beth Israel Deaconess Medical Center
Department of Anesthesia and Critical Care
330 Brookline Ave., Dana 721
Boston, MA 02215
phone: 617 667 0641
fax: 617 667 1500
email: gbove@bidmc.harvard.edu

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My 2nd letter to him

Thanks for your speedy response, Dr. Bove

I am not a subscriber, so I don't have the full-text article for review. I did forward this to several friends in research and in the "journal" business for the reason of clarification. It is the community response which enlightens.

I apologize that I don't have research regarding the use of lasers in acupuncture, but I am sure Dr. Amaro can add that bit to the "mix" My only point is that certain practitioners consider this an intervention, not a placebo. Research will clarify, if it hasn't already.

I can't read Chinese, and I expect much of that laser-as acupuncture-therapy research may be in that language. I am still but an "egg" in this new undertaking of acupuncture.

Please don't consider that question/comment (regarding the laser as neutral) as a criticism (in the pejorative sense, at least), because it's not my interest to "put you down". In fact, I want to thank you for engaging in research to begin with! I spent as much time as possible in Palmer's research department when I was at school (90-93), and continue to participate in their "Practice-based" research projects. I have the highest respect for this generally under-paid and under-appreciated group. But I have no qualms about asking questions or "crossing swords"...after all, researchers are not "gods".

Following your suit, I am forwarding (to all), and will take your forward (to all) as a permission to re-publish this on our website, unless you write back asking me not to. If not, please advise if you'd prefer to write a more formalized commentary, which I will also gladly put on the page.

I did the same thing when the New England Journal of Medicine articles on asthma and low back pain came out. I will enclose the URL so you can see how I managed the reportage.

RESEARCH: NEW CHALLENGES FOR CHIROPRACTIC

Check out the New England Journal of Medicine articles,   press releases and responses from the Research and Academic Community

Hopefully, you will see the value in having all the information in one place. Our site sees about 900+ DC's per day, so it will be appreciated!

Thanks for your attention to this matter, and look forward to further dialog.

Frank M. Painter, D.C.
Frankp@chiro.org

Check out the LINKS section @
http://www.chiro.org/LINKS/

and the Chiropractic Resource Organization @
http://www.chiro.org

Whatever you can do, or dream you can, begin it.
Boldness has genius, power, and magic in it.
--Goethe

"Medicine is now a high risk industry, like aviation.
But, the chance of dying in an aviation accident
is one in 2 million, while the risk of dying from a
medical accident is one in 200!"
---Dr. Leape of the Harvard School of Public Health

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His 2nd response

Dear Frank,

Perhaps it would be best for you to ask a specific question and I'll prepare a specific response, in conjunction with my coauthor. I do thank you for your thoughts, and think that in addition to to answering the questions, the page will dissuade a lot of people from contacting me, as they will get their answers from your page.

I am overly busy right now with all of this, as you can imagine. I want to get back to my rats, who ask few questions.

Sincerely,

Geoff

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