I would like to thank Dr. Jolicoeur for his response to my article.1 In reply I would answer that if a medical doctor told me I had high blood pressure and elevated cholesterol (HBP&EC), I would do the same thing I did in my article – search the recent literature – in an effort to determine what, if anything, should be done about it. In particular, I would look to see if there were differences (i.e., in morbidity and mortality rates) between those with HBP&EC versus without. If there were no differences, then I would be hesitant to act on the information. HBP&EC is however linked with heart disease2–3 but what outcomes can be related to asymptomatic SPOTS?
My search in the area of structural problems of the spine (SPOTS) suggested to me that there were often little or no differences, in the long run, between patients with SPOTS versus without. Personally I do not adjust SPOTS (vertebral misalignment) unless there is evidence that nerve dysfunction is also present. If SPOTS is accompanied by nerve dysfunction, then this would, by definition, be considered a chiropractic subluxation. I do not wait for symptoms either but I admit that the validity of the approach I use (SPOTS + nerve dysfunction) is not well-supported by health outcomes research. Rather than base what we do on catchy slogans, such as structure dictates function, the various approaches we use should be supported by health outcomes research.
