Critical chiropractor, inept publisher

The P.R.E.S.T.O.N. Protocol for Back Pain: The Seven Evidence-Based Practices for Living Pain Free, by Preston H. Long. PublishAmerica: Baltimore, 2006. 84 pp. ISBN 1-4241-0684-2. Paperback, $14.95.

I really, really wanted to recommend The P.R.E.S.T.O.N. Protocol for Back Pain, but I cannot. It is full of excellent information that I wish could be widely disseminated, but the author was betrayed by an incompetent publisher.

Preston Long, PhD, is one of a rare breed: chiropractors who can think critically, understand the scientific method, and limit their practice to evidence-based treatments. His previous book, The Naked Chiropractor: Insider's Guide to Combating Quackery and Winning the War against Pain, recounted how he questioned and rejected much of what he was taught in chiropractic school. This new book describes the best evidence for what works in the treatment of back pain, and is meant to be a self-help manual that will preclude the need for most patients to seek professional treatment of any kind.

He offers excellent advice under the chapter headings P.R.E.S.T.O.N.: Placebo, Reassurance, Evidence-Based Medicine, Spinal Manipulation, Therapy, Occupation, and Natural History. He explains that most episodes of back pain will resolve in a short time with no treatment at all. Simple comfort measures can be tried at home using ice, heat, exercise, and analgesics. He stresses that remaining active is the best thing to prevent chronic disability, and that the patient's attitude is important. Fear and avoidance behavior can cause pain to become chronic, and patients who dislike their jobs are less likely to recover. He suggests that three factors might be used to predict outcome: whether the patient flosses regularly, whether he wears a seat belt consistently, and whether he enjoys his job.

There are errors on almost every page: errors of spelling, errors of grammar, fragments, missing references and improperly cited references, inconsistent punctuation, and even missing quotation marks.

Almost any published book contains a few errors, but this is beyond the pale. It is apparent that no proofreading was done, and that not even a spell-checker was employed.

The Houston Veterans Affairs Medical Center is the "Houston Infections Administration Medical Center," acetaminophen is acetametaphen, Ecuador is Equador, Dr. Lundberg becomes Lunberg, and the Cochrane Reports Cochran Reports. Even the misspellings are inconsistent. He refers to a "le phage" surgical treatment; I was unable to find any such thing. The most egregious error is "The old adage of pre rom non nosier, first do no more, must always be borne in mind." I imagine he meant primum non nocere which means first do no harm.

The writing descends into incoherent confusion in places. As an exercise in editing, see if you can make sense out of the following two paragraphs and rewrite them more clearly:

   A Scottish Naval surgeon by the name
   of James Lind tried to control scurvy
   for the British Navy, as it was a huge
   problem back then, by watching the
   sailors that received oranges and
   lemons versus those that did not. This
   pioneer study pretty much controlled
   scurvy by 1814. Watching that the
   soldiers who received a lemon or an
   orange did not develop scurvy, and
   the ones who did not receive the fruit,
   did develop the disease.

   As in the United States, Lind's
   work did not take fruition immediately.
   It took approximately forty to
   forty-five years before it was actually
   totally received by the pertinent
   authorities. His research took place
   on May 20, 1747, and even though
   there were positive outcomes, the
   forty-two-year lag occurred and initially
   it didn't have any impact on the
   medical opinion in Britain. Actually,
   the Naval Board rejected the fact that
   sailors required fruit on long voyages.

I can't do it. I can't even figure out where the forty-two years he cites came from. I would expect this level of writing from a junior high school student, but not from a professional with a doctorate. And I find it hard to believe that anyone in the publishing industry could read this and restrain his red pencil.

There is solid content in this book, and a great deal of useful information. I suppose a reader could learn a lot from it; but it takes more effort than it should to make sense of many passages. It certainly doesn't inspire confidence in a reader with no prior knowledge of the subject. It gives the impression that the author isn't thinking clearly and is terminally careless (or dyslexic).

The publisher is PublishAmerica, an organization that apparently will publish anything. It claims to not be a "vanity" press, since it doesn't charge authors a fee and actually pays them a one dollar advance. However, it leaves publicity and marketing pretty much up to the author himself, and prints books only on an on-demand basis. Many complaints have been lodged against it (a sampling can be found at www.absolute write.com/forums/showthread.php ?t= 1 0211). A group of authors tested Publish America by collaborating on "the worst book ever written." When they submitted it, they were immediately offered a contract.