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Commentary in Response to JVSR Article

Journal of the American Chiropractic Association, Dec 2004 by McGregor, Marion, Triano, John J, Adams, Alan, Lawrence, Dana

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There are well-known and well-regarded procedures for dealing with both causation and intervention.The author and reviewers of the paper have completely ignored both. That makes it quite clear why the magazine in which it was published is not indexed, since it does not meet any reasonable standard of quality in scientific publishing.

No conclusions can or should be drawn from the material provided. Rather, it is evidence of the need in our profession to expend greater effort in training our clinicians regarding critical thinking skills and the basics of clinical research, and the critical appraisal of the literature. After all, the purpose of good research is to protect against fooling ourselves, first.

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Respectfully submitted,

Marion McGregor, DC, MSc

John J. Triano, DC, PhD

Although the study by Elster attempts to answer the three objectives outlined in the abstract of the paper, it falls short because of a number of problems.

1)The author asserts that there is a causal link between MS and PD and trauma-induced upper-cervical injury. While numerous reports suggest a possible association between these diseases and head and neck trauma, the findings are considered controversial because of the difficulties of recall bias, accuracy of diagnosis, and the long duration of time between injury and the onset of MS and PD. Certainly, the criteria of causation are far from being met based on the available evidence. (Evans,AS. Causation and disease. A chronological journey. Am J Epidemiol, 1978; 108:249-257)

2) The article does not provide information on how the diagnosis of MS and PD were made in the subjects and whether they were based on acceptable diagnostic criteria. For example, was the diagnosis of MS based upon the Poser or McDonald criteria?

3) The article does not provide sufficient evidence or adequate references related to the reliability, validity, and diagnostic discrimination of the tests used to identify upper-cervical subluxations and resulting neuropathology.

4) The use of unvalidated outcome measures with ambiguous meanings confounds the findings of this study when standardized approaches are available (e.g., PDQ-39 and the MSFC).

5) The author does not describe adequately the limitations of this retrospective study design and the limitation of generalizing the results of this study.

Alan Adams, DC, MS

Simply put, this study has no conclusions that can be supported by any data.Virtually everything is uncontrolled and is based on case history alone.Thus, it is in that sense retrospective, but without any cautions that the author is going back in time to find exactly what she wants to find.The readers have no way of determining how the presence of MS or PD was diagnosed, and no confirmation that these diagnoses are correct. The patients were simply asked if they had suffered any trauma, and since this is a leading question, I am sure that many responded that they did; this is a recall bias and leading the patient. So many people recalled accidents that this evaluation attempt is meaningless.

Health Care Industry

Commentary in Response to JVSR Article

Journal of the American Chiropractic Association, Dec 2004 by McGregor, Marion, Triano, John J, Adams, Alan, Lawrence, Dana

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