To the Editor:

Dr. Robert D. Gillette's article in the July/August issue [“‘Problem Patients’: A Fresh Look at an Old Vexation”] was very informative and helpful.

However, I do take exception to his including hands-on therapy, such as chiropractic and massage therapy, in the same category as getting a pet. Dr. Gillette states there is little evidence these therapies offer more than palliative value.

As a licensed chiropractor for 16 years and a board-certified family physician, I've seen many studies that point to chiropractic being far more than a palliative procedure. The Agency for Health Care Policy and Research and the RAND Corporation did in-depth studies that found chiropractic had far more success with outcome measures and patient satisfaction for the treatment of low back pain than any other form of treatment.

I write this to be informative not antagonistic. Many physicians form opinions based on what they read, so I hope we can help each other and our patients by stating our opinions more objectively.

Author's response:

I did not intend to disparage palliative treatment when that's all we have to offer, but we should think clearly about what we're doing. I've been unable to locate any scientifically bulletproof support for your position, but in all fairness you should be given an opportunity to provide some citations that will prove me wrong. The studies cited should show benefits, in comparison to control subjects, that are objectively measurable by disinterested observers at least six months after the intervention.