Title: Necrotizing Fasciitis Due to<i>Photobacterium damsela</i>in a Man Lashed by a Stingray
Abstract: To the Editor: In comparing osteopathic spinal manipulation with standard care for patients with low back pain, Andersson et al. (Nov.4 issue) 1 fail to recognize that many patients may have improvement with minimal or no treatment.This might have been evident had the authors included a control group of patients who received minimal or no intervention for back pain.Cherkin et al. compared the outcomes for patients with low back pain who received physical therapy, chiropractic treatment, or an educational booklet. 2 There was only a marginally better outcome in the physical-therapy and chiropractic-treatment groups than in the booklet group.Improvement with minimal or no treatment would also explain the similar outcomes reported by Carey et al. in their comparison of treatments by primary care practitioners, chiropractors, and orthopedic surgeons. 3 The only substantial differences in the results of these studies seem to be in the area of patient satisfaction and cost.Therefore, it would be erroneous to conclude from the study by Andersson et al. that either standard care or osteopathy is superior to the placebo effect.It is evident that in most cases, back pain resolves over time, regardless of the treatment used.