Chiropractic.

The chiropractic is a health care profession that offers and purveys a distinctive treatment act. When reduced to its methodology, the chiropractic is hard pressed to demonstrate effectiveness. But as a treatment act, it has gained wide acceptance. The challenge raised in this discussion relates to the "moral hazard" of including the chiropractic treatment act in more general health insurance policies.

Is lupus a syndrome or a disease?

Does it matter whether we call lupus a disease or a syndrome? Because both conditions can be rigorously defined, this has little effect on uniformity of entry criteria for clinical trials. However, because diseases are the product of a single pathophysiologic mechanism, and syndromes are not, whether lupus is a disease or a syndrome does have broad ramifications. For example, looking for the "cause" or the "cure" for lupus involves a disease-specific conceptual framework, whereas, for syndromes we investigate risk factors and treatment modalities. On the basis of current laboratory data, we contend that lupus is a syndrome and only has candidate status as a disease. This helps to explain heterogeneity in results of studies of therapeutic agents and laboratory investigations of etiology. Patients, funding organizations, and lay support groups need to be aware of this distinction to reduce unrealistic expectations.

Coping with arm pain in the workplace.

Regional arm pain is a ubiquitous, remittent, and intermittent predicament of life. There is no evidence that arm use in a fashion that is familiar and usually comfortable, inside or outside the workplace, increases the incidence of regional arm pain. Therefore, coping with this morbidity, not avoiding it, is prerequisite to healthfulness. When one systematically examines the reasons a worker may find coping prohibitive, task demands are not the common denominator. Psychosocial factors such as work organization and interpersonal relationships predominate.

Fibromyalgia, chronic fatigue, and other iatrogenic diagnostic algorithms. Do some labels escalate illness in vulnerable patients?

Contemporary medicine has the sophistication to identify the clinical settings in which the hunt for a diagnosis can be harmful to a patient's health. Which patients are best served by a prolonged search for a cause? Why has the disease-illness paradigm backfired for so many patients? Dr Hadler challenges readers to look at the difficult questions linked with diagnostic labels that might teach patients to stay sick.

Back pain in the workplace. What you lift or how you lift matters far less than whether you lift or when.

In spite of more than 50 years of concerted effort to diminish task demand, the incidence of compensable back injuries has not wavered. Before we persist for another 50 years in the quest for the "right way to lift," we should consider recent multivariate clinical investigations that suggest alternative approaches. Because task context is at least as important as task content in this regard, it follows that including regional backache under the rubric of "compensable injury" demands reconsideration. Likewise, rather than pursuing the "right way to lift," the more reasonable and humane quest might be for workplaces that are comfortable when we are well and accommodating when we are ill.

Work incapacity from low back pain: the international quest for redress.

Disabling back pain plagues industrialized societies. Generally redress adheres to a Prussian paradigm that those injured at work are more deserving than those who have worked but can no longer do so because of diseases not related to work. Those who never have worked are least entitled. A comparison of the way the Prussian paradigm behaves in different cultures is instructive and daunting; no generalizable solution has emerged. It is time to cast off the Prussian paradigm. It is clinically unsound and, judging from the experience of the past century, ethically flawed.