Here’s some good news from my favorite Blogger, Daniel Redwood, DC:

November 20, 2009

The Senate Democrats’ blended bill contains the nondiscrimination language championed by Senators Tom Harkin (D-IA) and Christopher Dodd (D-CT), along with a couple of other steps forward.

Here’s today’s report from the American Chiropractic Association:

Reid’s Reform Bill Includes ACA Supported Provider Non-Discrimination Provision

Of specific interest to the chiropractic profession, is the fact that Reid’s bill includes an important federal provider non-discrimination provision the inclusion of which was strongly advocated by the ACA. The provision, found in Section 2076 of the measure, would apply to ERISA and other health insurance plans, and is intended to serve as an important protection aimed at preventing insurance plans from discriminating against entire classes of non-MD health care providers, including DCs, based solely on their state license or certification. The inclusion of the provision in the Reid bill was primarily championed by Senator Tom Harkin (D-Iowa), current Chairman of the Senate HELP Committee and Senator Chris Dodd (D-Conn). The inclusion of the provision in Reid’s bill means the chiropractic profession will not have to launch what would likely be an uphill battle to insert the provision via the amendment process on the floor of the Senate. With respect to provision, ACA’s main mission now, is to work to ensure that the provision remains included in the final floor amended bill, assuming one is successfully voted out of the Senate. It is important to note that the recently House passed version of the heath reform bill (HR 3962) does not contain an identical provision, but does contain an important non-discrimination provision that seeks to maintain the applicability of state-enacted provider non-discrimination laws. The ACA will lobby for inclusion in any final bill to be enacted by Congress of both the House and Senate provider non-discrimination provisions.

Chiropractic Included in Other Provisions:

Continue reading …

Musculoskeletal problems (NMS) in children are associated with both physical and psychologic consequences, and they can become barriers for participation in physical activity and sports, resulting in negative consequences for the individual’s health throughout life.

A recent study in Germany involved interviewing children (and their parents) to determine what percentage of them had NMS copmplaints. [1] The results of the study was quite surprising:

• Of the 749 children and adolescents, 622 (83%) had experienced pain during the preceding 3 months

• 30.8% of the children and adolescents stated that the pain had been present for >6 months

The reported complaints were:

• 60.5% had recurrent headaches

• 33.6% complained of limb pain

• 30.2% complained of back pain

This is a serious problem. Insufficient levels of physical activity may lead to muscle weakness and bone fragility, [2] decreased oxygen throughput, decreased arterial size, increased clottability and altered blood lipid levels, metabolic inefficiency, decreased glut transporters, obesity, type 2 diabetes, and immunologic decay. [3]

This is a powerful reason for chiropractors to educate their communities about the benefits of chiropractic care. The most recent edition of JMPT reports an incidence level for headaches and neck pain of 40% in the children they examined [4], and they found that cervical joint dysfunction was a significant finding among those preadolescents complaining of neck pain and/or headache, as compared to those who did not have it.

The worst finding of this study was that there was a significant difference between the reporting of neck pain between the parents and childs reporting. It seems that of the children who reported pain, only a small fraction of their parents seemed to be aware of it.

You may want to review our Pediatrics Section for more information of value.

I hope you will find these articles of interest.

REFERENCES:

1. Pain among children and adolescents: restrictions in daily living and triggering factors
Pediatrics 2005 (Feb); 115 (2): e152-62

2. Peripheral bone mineral density and different intensities of physical activity in children 6-8 years old: the Copenhagen School Child Intervention study
Calcif Tissue Int 2007 (Jan); 80 (1): 31-8

3. A conceptual framework of frailty: a review
J Gerontol A Biol Sci Med Sci 2002 (May); 57 (5): M283-8

4. Recurrent Neck Pain and Headaches in Preadolescents Associated with Mechanical Dysfunction of the Cervical Spine: A Cross-Sectional Observational Study With 131 Students
J Manipulative Physiol Ther 2009 (Oct); 32 (8): 625-34

I just read a fascinating article from the January edition of the Journal of the American Board of Family Medicine, as it documents the massive increase in costs for medical management of chronic back pain, while no significant increases in patient outcomes or disability rates have been observed, and increases in post-intervention complications (including death) are on the rise.

Thanks to Dan Murphy, D.C. for emphasizing these points!

I just ran across this remarkable page about chiropractic, located (of all places) on the University of Minnesota website. I hope you will find this of interest:

Is Chiropractic Complementary, Alternative, or Mainstream?

Chiropractic may seem mainstream because of physician referrals and the frequent role of chiropractic in interdisciplinary teams in settings such as rehabilitation centers. Furthermore, visits to a chiropractor are commonly reimbursed by most health insurance plans.

But chiropractic is still considered a complementary and alternative form of healthcare because it is not regulated by medical practice statutes. Chiropractic is not currently taught in public universities along with medical or nursing schools and does not include pharmaceuticals or surgery in its care of patients.

How is it complementary?

Today chiropractic most often shares a complementary role with conventional medicine. Many people seek chiropractic care based on referral from informed health professionals who understand the unique skills and perspective of the chiropractor in caring for perplexing problems.

Doctors of Chiropractic (DC) may also be members of an interdisciplinary team. Interdisciplinary practices are now becoming more common in a variety of settings, with chiropractors, medical doctors, physical therapists and others working as partners in occupational health, sports medicine teams, and rehabilitation centers.

In this role, chiropractors may provide the primary intervention of manual therapy to normalize joint function in patients recovering from injuries, or they may work cooperatively, for example by providing manual therapy and nutritional guidance for patients undergoing chemotherapy.

How is it alternative?

The roots of chiropractic are distinctly alternative to the conventional allopathic system of medicine. Chiropractic has a unique philosophy that stresses the body’s innate intelligence and focuses on preventive care as a means to sustained health and quality of life.

Recent cooperation with academic medicine has been troubling to some within the chiropractic profession, suspicious of the growing cooperation with medicine in practice and research. Purists embrace the founding principle of hands-only care and reject modified approaches. Most chiropractors in practice today, however, appreciate the important roles of multiple modes of care for patients.

What’s the bottom line?

So chiropractic fits all the labels in some respects! It seems “mainstream” because it is one of the most commonly used “complementary” therapies and is regularly reimbursed by insurance.

On the other hand, it retains its own unique philosophy of care and the central role of the chiropractic adjustment in its regimen of care. Thus, chiropractic remains both a complementary practice and an alternative healthcare system.

References:
Chapman-Smith, D. A. (2000). The chiropractic profession: Its education, practice, research and future directions. West Des Moines, IA: NCMIC Group Inc.

Expert Contributor: Larry Kuusisto, PhD, DC

Arlington, Va. — Fri. Oct. 2, 2009 —   After months of intensive negotiations between the American Chiropractic Association (ACA) and Blue Cross Blue Shield Association (BCBSA), doctors of chiropractic are once again designated as “physicians” in the BCBSA Federal Employee Plan (FEP), the world’s largest health plan and one that President Obama has identified as a template for future health care reform. The 2010 FEP benefits brochure confirms the change.

The American Chiropractic Association is the nation’s leading chiropractic organization representing more than 15,000 doctors of chiropractic and their patients.

Where is the money going? A couple of recent articles on the Dynamic Chiropractic website provide the answer.

End of an Era: FCER Decides on Self-Liquidation announces that “The Foundation for Chiropractic Education and Research (FCER) will self-liquidate, meaning the organization will cease operations after serving the chiropractic profession for more than 60 years. The FCER Board of Trustees made the difficult decision after numerous efforts to find another organization that could take over the foundation’s efforts on behalf of the profession.
When interviewed FCER President Dr. Charles Herring said that over the years, large contributors have not continued supporting FCER at the level they once did and the current economic crisis that began to emerge in late 2008 has resulted in significant decreases in individual membership renewals. This has made FCER unsustainable from a financial standpoint.”

On the other hand, another article in Dynamic Chiropractic, Foundation for Chiropractic Progress Receives Record Pledge Support reports that “a $500,000 donation from Standard Process highlighted the record financial support received by the Foundation for Chiropractic Progress (FCP) at the Florida Chiropractic Association 2009 national convention and expo in Orlando.
All told, the foundation received approximately $650,000 in pledges, including the surprise donation from Standard Process, which will be staggered over the next five years.”

The mission of the Foundation for Chiropractic Progress is “To increase the public awareness of the benefits of chiropractic.” I’m all for that but perhaps we could channel some of those funds back into research thereby increasing our credibility and making chiropractic an ‘easier sell’.

The news media has been having a LOT of fun reporting on the Congressional Health Care Overhaul lately, so I will too.

Chiropractic’s *scientific critics* state we don’t have the kind of statistics they (grin) rely on, so we shouldn’t toot our own horn like they do. Hmmm? Well, let’s take a closer look at them. Here’s some amazing scienticic statistics about modern medicine:

1. The total number of iatrogenic deaths caused by conventional medicine is an astounding 783,936 deaths per year at a cost of $282 billion dollars. That is a mind-boggling 2147 people killed every day. That’s as if 7 jumbo jet planes crashed every day. That’s a 9-11 incident, happening every other day…FOREVER. God help us all. [1]

2. A report by the British Medical Journal correlated a strike by medical doctors with lower death rates during the strike. Hmmm?

3. Recent surveys suggest that “45% Of Doctors (MDs) Would Consider Quitting If Congress Passes Health Care Overhaul.” [3]

So, if we put that all those facts together, supporting Congress’s new Health Care Plan could reduce the medical population by up to 45%, thus significantly reducing the incidence of medically-induced iatrogenic illness and death, and all the money that would save could help to pay for the new Plan.

And, perhaps with some of those savings, they might consider adding conservative chiropractic care as another cost-saving option. [4, 5]

REFERENCES

1. http://www.chiro.org/LINKS/FULL/Death_By_Medicine.html

2. http://tinyurl.com/lzdq7a

3. http://www.investors.com/NewsAndAnalysis/Article.aspx?id=506199

4. http://www.chiro.org/LINKS/Cost_Effectiveness.shtml

5. http://www.chiro.org/LINKS/Safety.shtml

Association of NJ Chiropractors Brings Class Action Suit against Aetna for Post Payment Audit Practices

The Association of New Jersey Chiropractors (ANJC), one of the largest chiropractic state associations in the nation, today announced that it has filed a lawsuit against Aetna seeking nationwide relief on behalf of chiropractors and other healthcare professionals.

The ANJC retained the law firm of Buttaci & Leardi, LLC, in concert with the renowned class action law firm of Pomerantz Haudek Grossman & Gross LLP, to investigate and file the lawsuit, which challenges Aetna s improper recoupment demands on chiropractors and other healthcare providers. The action alleges that Aetna s post-payment audit process is violative of the Employee Retirement Income Security Act of 1974 ( ERISA ), and further alleges that Aetna s post-payment audit process and its pre-payment claim review process violate the Racketeer Influenced and Corrupt Organizations Act ( RICO ). The action also attacks Aetna s clinical policy bulletins that are used to deny services retroactively.

Continue reading …

Source Quad-Cities Online
Posted Online: Sept. 10, 2009

Palmer Receives HRSA Grant Award to Study Co-Management of Older Adults With Low Back Pain by M.D.s and D.C.s

(Davenport, IOWA) The U.S. Health Resources and Services Administration (HRSA) has awarded a three-year grant for approximately $1.3 million to the Palmer Center for Chiropractic Research (PCCR) for a study called Co-Management of Older Adults With Low Back Pain by Medical Doctors and Doctors of Chiropractic. Throughout this project, PCCR researchers will be collaborating with researchers at the Genesis Quad Cities Family Medicine Residency Program; the College of Public Health at the University of Iowa; the University of Iowa Carver College of Medicine; the University of Iowa Center on Aging; and the College of Health Professions at Thomas Jefferson University, Philadelphia, Pa.

Continue reading …

Source Risk and Insurance Online

Individuals with musculoskeletal disorders who received chiropractic care or physical therapy had lower health care costs and were less likely to have surgery than employees who did not receive those services, according to a recent report.

The findings come from a one-year pilot program designed by Wellmark Blue Cross and Blue Shield to measure patient quality of care. Researchers concluded that significant clinical outcomes and health care cost reductions were attributable to the use of chiropractic and other physical medicine services. Overall, 89 percent of all individuals receiving physical medicine services reported improvement of at least 30 percent within 30 days.

The 2008 pilot — an ongoing quality improvement program for Iowa and South Dakota physical medicine providers — analyzed data on care provided by 238 chiropractors, physical therapists and occupational therapists to 5,500 Wellmark members with MSDs. Wellmark utilized Triad Healthcare to help administer the program and collaborated with the company to collect data and measure outcomes. Triad also analyzed the chiropractic and physical therapy utilization data for the pilot and has continued to administer the program in 2009.

Supporters of chiropractic treatment praised the findings, saying that the cost-effectiveness of the method has been documented in several studies.

Glenn Manceaux, president of the American Chiropractic Association, pointed to a study published in a 2005 issue of the Journal of Manipulative and Physiological Therapeutics that found chiropractic and medical care have comparable costs for treating chronic low-back pain, with chiropractic care producing significantly better outcomes. In addition, a study published in a 2003 edition of Spine medical journal found that manual manipulation provides better short-term relief of chronic spinal pain than a variety of medications, he said.

“Especially during the health care reform debate, it’s important that chiropractic and other conservative care methods are taken into serious consideration as a cost-effective alternative to the utilization of expensive surgery and hospital-based care,” he said.

Why is the FCER being disbanded?

I contacted them a few days ago, wondering about the publication of any papers from the Asthma study we had helped to fund, and received a post from Sheila Stielow, stating: “I’m not sure if you are aware but FCER is closed. This is a very recent decision”. I wrote back asking what she meant by their being closed, but I have yet to hear back from her.

FCER, founded in 1944, is (was?) the oldest and most respected chiropractic research-funding institution in the world. Since 1980, FCER has funded grants, fellowships, and residencies totaling approximately $11 million.

There is no more hotly debated topic in our profession than the huge variety of answers to the question:

Enjoy!

You may enjoy reviewing this FULL TEXT article from the Archives of Physical Medicine and Rehabilitation, because Chiropractic scored the highest in reducing pain of 16 different modalities that were tested.

The authors wrote: Pain is a symptom that most clinicians would not typically associate with chronic Neuromuscular Disease (NMD). Most major texts on NMD do not list pain as a symptom of these diseases. However, and consistent with previous research in other samples of persons with NMD our findings indicate that pain is a common problem in many patients with NMDs.

This paper is an eye-opener because it found that it found that chiropractic scored the highest in pain relief (7.33), scoring higher than nerve blocks (6.75), opioid analgesics (6.37), muscle relaxants (5.78), massage (5.48), acupuncture (5.29), ibuprofen (5.22), and hypnosis (5.00).

The complete list of the 16 techniques they tested is available.

Editorial Commentary:

The medical “debate” has been going on for years…is spinal adjusting (a.k.a manipulation) effective for Low Back Pain? The original Meade study (British Medical Journal 1990) demonstrated that chiropractic was much more effective for LBP than conventional medical care.

In 1993 the province of Ontario, Canada hired the esteemed health care economist Pran Manga, PhD to examine the benefits of chiropractic care for low back pain (LBP) and to make a set of recommendations on how to contain and reduce health care costs.

His report A Study to Examine the Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain cited research demonstrating that: (1) chiropractic manipulation is safer than medical management for LBP;   (2) that spinal manipulation is less safe and effective when performed by non-chiropractic professionals;   (3) that there is an overwhelming body of evidence indicating that chiropractic management of low-back pain is more cost-effective than medical management;   (4) and that there would be highly significant cost savings if more management of LBP was transferred from medical physicians to chiropractors.

He also stated that “A very good case can be made for making chiropractors the gatekeepers for management of low-back pain in the Workers’ Compensation System in Ontario.

Continue reading …

For those who have forgotten, or for those who never knew, organized medicine spent decades and millions of dollars trying to discredit and destroy chiropractic. Today the vestiges of this suppression are still found on fringe web sites that ignore the body of peer-reviewed research supporting chiropractic care.

You may also explore the depths of medical arrogance in this in-depth review of the Wilk case.