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

The Wilk anti-trust case against the AMA and 20 other named medical groups revealed that the AMA Plan was to:

• Undermine Chiropractic schools

• Undercut insurance programs for Chiropractic patients

• Conceal evidence of the effectiveness of Chiropractic care

• Subvert government inquires into the effectiveness of Chiropractic, and

• Promote other activities that would control the monopoly that the AMA had on health care

• They even threatened their own ranks: any MD who taught in our schools, or performed research with chiropractors, or accepted a referral from, or made a referral to a chiropractor, would lose their hospital privileges, leaving them unable to treat patients.

while, all along, they knew that:

There also was some evidence before the Committee that chiropractic was effective – more effective than the medical profession in treating certain kinds of problems such as workmen’s back injuries. The Committee on Quackery was also aware that some medical physicians believed chiropractic to be effective and that chiropractors were better trained to deal with musculoskeletal problems than most medical physicians.
(Opinion pp. 7)

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By Daniel Redwood

When new research, research reviews or practice guidelines support our current beliefs and practices, enthusiasm comes easily. When the 2007 medical practice guidelines on low back pain (LBP) jointly prepared by the American Pain Society and the American College of Physicians recognized spinal manipulation as the only non-pharmacologic method providing “proven benefits” for acute LBP and as one of several methods (including exercise, rehabilitation, acupuncture and yoga) proven effective for chronic LBP, the American Chiropractic Association and doctors of chiropractic (DCs) everywhere welcomed this as a long-overdue recognition of the value of our primary treatment methods.

But when research challenges our assumptions, our responses are understandably mixed. Such findings, if confirmed in multiple studies, may create pressure to change our practice patterns or threaten reimbursement from insurance companies. Like members of other health professions, DCs do not find such developments pleasant. How we and members of other health professions respond to such research says a great deal about who we are, how fully we practice what we preach, and the depth of our commitment to providing the best possible care to our patients.

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University of Pittsburgh Medical Center Health Plan mandates conservative care before even considering surgery for chronic Low Back Pain cases.

By Peter W. Crownfield

The University of Pittsburgh Medical Center (UPMC) Health Plan, a health maintenance organization affiliated with the university’s School of Medicine, has adopted landmark guidelines for the management of chronic low back pain.

As of Jan. 1, 2012, candidates for spine surgery must receive “prior authorization to determine medical necessity,” which includes verification that the patient has “tried and failed a 3-month course of conservative management that included physical therapy, chiropractic therapy, and medication.”

Surgery candidates also must be graduates of the plan’s LBP health coaching program. The program features a Web-based decision-making tool designed to help plan members “understand the pros and cons of surgery and high-tech radiology.” It is the first reported implementation of such a policy by a health care plan.

Putting a Clamp on the Soaring Rates of Spine Surgery

According to the December 2011 issue of the UPMC Health Plan Physician Partner Update, which informed participating providers of the new guidelines and the rationale for their implementation, “We feel strongly that this clinical initiative will improve the quality of care for members who are considering low back surgery, and that it will facilitate their involvement in the decision-making process.”

The update also noted, “Surgical procedures for low back surgery performed without prior authorization will not be reimbursed at either the specialist or the hospital level.”

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By Claire Johnson, DC, MSEd and Lori Byrd, MS

The United States is currently experiencing a health care crisis. Much of the current health care system focuses limited resources on the treatment of disease, and very few resources are aimed at primary and secondary prevention.

Although 70 percent of factors influencing health are environmental and behavioral, and only 10 percent of the factors attributed to health are associated with access to health care, the actual reimbursement for health services accounts for 96 percent of the $2.3 trillion spent each year. [1] Thus, we need to take a closer look at health care reform and how doctors of chiropractic will approach this changing landscape.

In March 2010, the Patient Protection and Affordable Care Act was law signed into law. The intention of the act is to put “in place comprehensive health insurance reforms that will hold insurance companies more accountable, lower health care costs, guarantee more health care choices, and enhance the quality of health care for all Americans.” [2] However, it is not exactly clear how this will be done or if the promised goals will be met, especially during this time of reduced funding and economic crises.

Chiropractic is one of the largest complementary and alternative medicine professions, and one of the largest licensed health care professions in the United States. [3-4] It is considered to be a holistic and wellness-oriented profession, traditionally not using drugs or surgery to help patients maintain health. Care typically incorporates wellness, lifestyle and prevention approaches with patient management, and focuses on the body’s natural ability to heal itself. Services provided by doctors of chiropractic have demonstrated high patient satisfaction, cost-effectiveness and parity compared to other types of care for similar conditions.

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Paul E Dougherty, Cheryl Hawk, Debra K Weiner, Brian Gleberzon, Kari Andrew, Lisa Killinger

There are a rising number of older adults; in the US alone nearly 20% of the population will be 65 or older by 2030. Chiropractic is one of the most frequently utilized types of complementary and alternative care by older adults, used by an estimated 5% of older adults in the U.S. annually. Chiropractic care involves many different types of interventions, including preventive strategies. This commentary by experts in the field of geriatrics, discusses the evidence for the use of spinal manipulative therapy, acupuncture, nutritional counseling and fall prevention strategies as delivered by doctors of chiropractic. Given the utilization of chiropractic services by the older adult, it is imperative that providers be familiar with the evidence for and the prudent use of different management strategies for older adults.

Introduction:

By Daniel Redwood, D.C., professor, Cleveland Chiropractic College

©2010 Cleveland Chiropractic College – Kansas City and Los Angeles

Chiropractic Research & Practice

State of the Art

Since chiropractic’s breakthrough decade in the 1970s — when the U.S. federal government included chiropractic services in Medicare and federal workers’ compensation coverage, approved the Council on Chiropractic Education (CCE) as the accrediting body for chiropractic colleges, and sponsored a National Institutes of Health (NIH) conference on the research status of spinal manipulation — the profession has grown and matured into an essential part of the nation’s healthcare system.

June 29, 2011 — A federal appeals court in Cincinnati, Ohio, today placed its constitutional stamp of approval on the linchpin of the embattled Affordable Care Act (ACA): the requirement that individuals either obtain health insurance coverage or pay a penalty.

Today’s decision is the first one on the federal appellate level regarding the healthcare reform law passed last year. So far, 2 federal district judges have declared the so-called individual mandate unconstitutional, saying that Congress has no right under the constitution’s commerce clause to regulate an individual’s economic “inactivity.” In contrast, 3 other federal district judges have agreed with the position of the Obama administration that uninsured “free riders” are indeed active participants in the healthcare marketplace, receiving free or subsidized services when needed, and driving up premiums and healthcare costs for others in the process.

The various district cases are now making their way through the federal appellate courts, with their final destination being the US Supreme Court.

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David Chapman-Smith, the Secretary-General of the World Federation of Chiropractic (WFC), is a New Zealand-born attorney who now resides in Toronto, Canada. Chapman-Smith’s introduction to chiropractic came when he represented the New Zealand Chiropractic Association before that nation’s Commission on Inquiry into Chiropractic in the late 1970s. The Commission’s report was the world’s first major independent evaluation of chiropractic and set the stage for many later advances.

For Chapman-Smith, the whirlwind years of the New Zealand Commission were a prelude to what has become a career-long mission on behalf of chiropractic. He has served the WFC since its inception in the late 1980s and is widely recognized as the world’s leading non-chiropractor advocate for the profession.

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By Donald M. Petersen Jr., BS, HCD(hc), FICC(h), Publisher

As 2010 comes to a close, it is important to look ahead to see what we can do as a profession to brighten the future of chiropractic. Among the many bits of information that have come across my computer monitor of late is a very interesting article by John Weeks of The Integrator Blog, “an organizer-writer in the emerging fields of complementary, alternative and integrative medicine since 1983.” [1] The article points out that the American Medical Association (AMA) has owned the current procedural terminology (CPT) codes for more than 40 years.

The benefits of this ownership are probably much greater than you realize. Basically, they amount to the following:

• Control:   By owning the CPT codes, the AMA effectively keeps a lid on what doctors of chiropractic (not to mention nurses, optometrists, acupuncturists, doctors of naturopathy, etc.) can be reimbursed for. None of the other health care professions is able to create new codes that are more reflective of what they do (and should be reimbursed for) without saying “AMA, may I?”

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Chiropractic is a health care profession that focuses on the relationship between the body’s structure—mainly the spine—and its functioning. Although practitioners may use a variety of treatment approaches, they primarily perform adjustments (manipulations) to the spine or other parts of the body with the goal of correcting alignment problems, alleviating pain, improving function, and supporting the body’s natural ability to heal itself.

Key Points

• People seek chiropractic care primarily for pain conditions such as back pain, neck pain, headache, and extremity (e.g., hand or foot)
• In the United States, chiropractic practitioners must meet the licensing and continuing education requirements of the state in which they practice. All states require practitioners to complete a Doctor of Chiropractic degree program at a properly accredited college.

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November 16, 2010 — In the Congressional changes that just took place Nov. 2, 2010, the chiropractic profession lost several longstanding advocates, but fortunately retained a greater number of allies.

There have been numerous statements about using the appropriations process to “de-fund” health reform implementation and also talk of outright repeal of some or all of the law’s provisions. The outcome of the 2010 Congressional elections notwithstanding, the prospects of any legislative repeal of any of the provisions of the Patient Protection and Affordable Care Act are minimal to impossible (it would take 60 votes in the U.S. Senate to pass and 67 Senate votes to override a Presidential veto).

There will be two so-called “Lame Duck” sessions before the new Congress is sworn in. During that time, it is logical to assume that the Democratic majority in both houses will use this limited time to clean up as much unfinished business on their agenda as possible.

Among issues to top concern to chiropractic are:

• Senate passage of Rep. Bob Filner’s chiropractic veterans legislation: Thanks to the courageous and determined efforts of Rep Bob Filner (D-CA), HR 1017 passed the U.S. House of Representatives on May 24, 2010.

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This newly published (Oct 2) study in Spine Journal compared family physician-directed usual care with evidence-based clinical practice guidelines (CPGs) (which includes reassurance and avoidance of passive treatments, acetaminophen, 4 weeks of lumbar chiropractic spinal manipulative care, and return to work within 8 weeks) on patients with acute low back pain. [1]

Evidence-based clinical practice guidelines (CPGs) for the management of patients with acute mechanical low back pain (AM-LBP) have been defined on an international scale. Multicenter clinical trials have demonstrated that most AM-LBP patients do not receive CPG-based treatments. To date, the value of implementing full and exclusively CPG-based treatment remains unclear. To determine if full CPGs-based study care (SC) results in greater improvement in functional outcomes than family physician-directed usual care (UC), a two-arm, parallel design, prospective, randomized controlled clinical trial using blinded outcome assessment was designed. Treatment was administered in a hospital-based spine program outpatient clinic. Patients were assessed by a spine physician, then randomized to SC (reassurance and avoidance of passive treatments, acetaminophen, 4 weeks of lumbar CSMT, and return to work within 8 weeks), or family physician-directed UC, the components of which were recorded.

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Department of Neurology, University of California, Irvine, United States and the Department of Epidemiology, School of Public Health, University of California, Los Angeles, United States

Thanks to the Clinical Chiropractic (March 2010) for access to this article!

The past 20 years has seen a marked increase in the amount of research into the epidemiology, diagnosis, and treatment of disorders associated with the spine, especially back and neck pain. The therapeutic benefit of spinal manipulation for back and neck pain is no longer seriously questioned and there are growing research efforts to look into the impact of this treatment approach on other conditions, especially certain types of headache. At the same time, we are in a serious healthcare debate that is, amongst other issues, focusing more attention on cost containment and preventative heath care.

The research support for spinal manipulation has resulted in the situation where chiropractors are generally accepted as valuable members of the healthcare team. The acceptance of chiropractic has resulted in a debate within the profession concerning the future role it wishes to play within this team. There are three roles that chiropractors could potentially fulfill in the future and each requires consideration.

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As the prospects for meaningful healthcare reform grow murkier by the day, it’s helpful to remember why we started this discussion in the first place. It wasn’t so we could socialize the U.S. healthcare system, and it wasn’t so we could create death panels, or make it easier for insurance and drug companies to practice their trades.

It was so we could help people like Hollywood resident Lisa France, 42, who does her best to stay healthy. She exercises regularly, does yoga, does Pilates. She has no medical problems to speak of and no preexisting conditions.

But when France recently applied for individual coverage offered by Anthem Blue Cross, she received a letter saying that her monthly premium would be 25% higher than expected because she sees a chiropractor from time to time.

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