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Bernard J. Sussman, MD
Howard University College of Medicine Washington, DC

JAMA. 1975;234(3):271-272.

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To the Editor.—

I take issue with the quality, accuracy, and content of the article by Wiltse et al on chymopapain therapy for lumbar disk disease (231:474, 1975).

1. It is remarkable that Wiltse and colleagues have injected intervertebral disks at the rate of 200 patients per year. Those numbers alone suggest at least some error in diagnosis and a questionable acceptance of the principles of conservative management. Moreover, like most chymopapain advocates, they state no exact criteria for injection other than to insist that they are the same as for surgery, but then fail to define their requirements for surgery. It must be understood that any episode of this disease remits in 85% to 90% of patients within two months irrespective of the type of treatment and that many patients are currently being injected during that period of time. It is also pertinent that the chymopapain method of treatment
   

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