Articles by JCS
Chiropractors Cry Foul
JC Smith, MA, DC
The chiropractic profession is mad as hell and acting up. After a century of abuse, the third-largest health profession in the United States consisting of 55,000 practitioners apparently is tired of sitting in the back of the medical bus, being ignored by the mainstream medical profession and misrepresented by most of the media, and they’re letting people know of their frustrations.
They also claim billions of dollars are being wasted on unnecessary and ineffective back treatments leaving thousands of patients disabled from failed back surgeries that could have been prevented by using chiropractors instead.
Chiropractors claim their care—spinal manipulation—for most spinal problems has been proven to be faster, safer, cheaper with longer lasting results according to many worldwide researchers, including a federal guideline issued by the US Public Health Service. The findings of this 1994 comprehensive study by a 23 member panel of medical experts headed by an orthopedic surgeon stunned the medical profession so much so that the orthopedic society filed an unsuccessful injunction to prohibit its release. The panel’s extensive two-year study of 4,000 articles from the National Library of Medicine gave the chiropractic profession its first ever stamp of approval by the federal government. Nonetheless, chiropractors say this report has been virtually ignored in medical circles.
Not only is spinal manipulation now listed in the federal guideline as a “Proven Treatment,” but the panel shocked the medical profession when it also stated that back surgery was effective in only one in 100 cases of low back problems. The panel also stated that most treatments rendered by physical therapists gave short-term relief at best and were also expensive, and the panel warned patients about the side-effects of drugs for low back pain. Traditional chiropractors typically adjust spinal “subluxations” (slight joint misalignment/dysfunction) by use of their hands to remove pressure on spinal joints, nerves and disks, thereby reducing pain, swelling and spasm.
This change of opinion about low back pain treatments didn’t come as a surprise the chiropractic profession. Chiropractors have long claimed that most back pain occurs from misalignment or dysfunction of the 137 joints in the spinal column. In fact, recent MRI medical research has shown disk abnormalities in patients with no back pain, making experts conclude that disk pathologies are not the cause of most back pain. In other words, chiropractors have long held that you don’t slip disks, but you do slip joints, which explains why spinal manipulation has worked so well to help suffering patients while disk surgery has failed in most cases.
Yet little progress for chiropractic’s inclusion in mainstream medical care has resulted from these exhaustive studies, which confuses most chiropractors. With healthcare costs skyrocketing and the overall failure of drugs and back surgeries, many chiropractors feel their treatments could lower these escalating costs, and recent statistics support their contention.
Currently, back problems are the second-leading reason for patient visits to all doctors, and back pain is the third-leading reason for hospital admissions and the leading reasons for surgeries. Low back pain is the leading cause of disability for those under 45, second overall only to vascular disease for all Americans. Many experts estimate the costs resulting from back treatments and disability costs range upwards to $75 billion dollars alone in the US, and over $100 billion worldwide. Most shocking to chiropractors is that US surgeons do four times more back surgeries than any other country. And this is the bane of their dilemma.
Chiropractors are scratching their heads in disbelief over this covert boycott of chiropractic services in light of the supportive research, governmental guideline and the potential cost-savings. Even a 1987 federal court antitrust decision that supposedly ended the AMA’s boycott of chiropractors in hospitals and elsewhere has not resulted in much progress with less than 200 of over 5,000 hospitals that now have DCs on staff.
More recently, OSHA has raised concerns over the epidemic of musculo-skeletal disorders (MSDs) plaguing the workplace. Neck pain, wrist pain and low back pain are the main MSDs according to workers’ compensation studies, yet chiropractic care has been virtually excluded as an alternative to the typical medical methods of drugs and surgery despite the admitted failure of these medical procedures to curb this growing problem. Although these MSDs are commonly joint disorders that respond well to manipulation according to chiropractors, they remain out of the loop of many workers’ compensation panels of providers.
Another paradox facing the chiropractic profession is their limited role in the treatment of whiplash injuries. A recent study published in the Journal of Orthopedic Medicine concluded that chiropractic care is the “only proven effective treatment” for whiplash with 74% of acute whiplash patients citing improvement. Yet many attorneys refuse to refer their clients to chiropractors, instead referring clients to surgeons, and many insurance companies discourage the use of chiropractic care for auto accident victims. Again, the chiropractors scratch their heads in disbelief.
In light of the growing trend of Americans to use alternative health care according to a Harvard Medical School survey done by Dr. David Eisenberg who revealed that Americans made more visits in 1997 to non-MDs (629 million) than to MDs (388 million), chiropractors question why the medical establishment and insurance industry have not embraced its treatments as the public obviously has. Considering the trillion dollar outlay annually for medical services, the fact that many insurance companies have either excluded or limited chiropractic care in their core benefits confuses both the chiropractic profession and the public as to why this less expensive and more effective treatment isn’t included to lower the huge costs and to expedite patient suffering.
Chiropractors claim the answer rests with the bottom line of the medical cartel. Although lowering healthcare costs would seemingly be an attractive incentive for insurance companies to incorporate “alternative” care like chiropractic, the opposite actually seems to be true in the jaundiced world of healthcare.
Chiropractors claim free enterprise simply doesn’t exist in the healthcare industry. Although an open marketplace with competitive forces exists in much of the economy to offer better services/products at lower prices, the marketplace of healthcare apparently works on a different premise. In mainstream healthcare many ulterior motivations act to prohibit more cost-effective measures such as chiropractic. Without rigorous competition at work, chiropractors note that mainstream medical procedures aren’t exposed to outside competition since the medical society controls all hospitals and administrative positions in government and the insurance industry. Indeed, they argue that any new technology or competition from non-MDs finds it very difficult to be included in mainstream medicine whether it’s chiropractic, chelation therapy for vascular ailments, herbal therapy or acupuncture.
Aside from the anti-competitive nature of medicine to exclude all competitors, chiropractors also complain that other “perverse” economic forces also exist solely in the world of healthcare that no other industry finds. Monopolistic control of services along with inflated prices would be objectionable to antitrust regulators in normal industry, but the powers-to-be in the medical cartel enjoy this insulated environment and escalated costs with the blessings of Congressmen who received over $8 million in contributions in the first half of last year alone from the medical political action committee, AMPAC. On the other side, the American Chiropractic Association contributed a mere $100,000 to 85 legislators on Capitol Hill for the entire year.
As well, the health care insurance industry spent more on lobbying than anyone else, shelling out $95.5 million as Congress debated whether to impose new regulations on managed care health plans. Apparently the medical and insurance industries enjoy their monopolistic control, and are willing to spend whatever it takes to keep things just the way they are, despite new research findings, federal guidelines or patients’ rights.
Despite the call to lower healthcare costs, chiropractors cite an inherent irony in this situation. It appears if insurance companies pay out more for back surgeries, in turn, they can charge higher premiums, so there’s more money for everyone involved. Hospitals prefer to fill a bed with a surgical patient instead of a chiropractic patient inasmuch as the huge costs of surgery far outweigh the lower costs of spinal manipulation. Likewise, attorneys funnel many auto accident victims to surgeons knowing the settlement will start at $25,000. Indeed, the motivation of profit prohibits the utilization of safer, cheaper, quicker care from chiropractors or other alternative health care providers.
Chiropractors note that few doctors or insurance administrators today question the clinical efficacy of chiropractic care for most MSDs. Too much recent research has proven that spinal manipulation is far superior to anything the medical world has to offer for the majority of back pain. Instead, their resistance to integrate chiropractic care into the hospitals, workers’ compensation programs and personal injury work stems from their desire to maintain their profitable monopolistic marketplace.
Chiropractors also cry foul about the misrepresentation of their profession by the media. TV news shows repeatedly report on maverick chiropractors who abuse the system with unjustified services or unethical practice gimmicks. Meanwhile, chiropractors note rarely has any TV show or newspaper complimented chiropractors for the many positive cases they have helped with the 22 million patients they treat naturally to overcome their pain or to avoid surgery.
Sensationalism seems to rule the media’s mind when it comes to reporting about chiropractic, often to the point of showing an obvious medical bias quoting well-known chiropractic detractors. Indeed, many chiropractors believe this media bias has kept much of public in the dark about their care with anecdotal scare stories of isolated cases rather than showing the benefits chiropractors have to offer the public.
But the chiropractic profession is fighting back. The American Chiropractic Association has filed a federal lawsuit against Sec. Donna Shalala of the HHS contending her department has conspired with the AMA to boycott chiropractic care in Medicare with exclusionary policies. The ACA has also successfully lobbied Congress to facilitate chiropractic’s expanded role in VA hospitals and Champus after a successful three-year “demonstration” of chiropractic services at a handful of military bases. And a recent two-year chiropractic publicity effort was aimed at projecting to the public a clearer image of chiropractors’ education and scope of practice.
While chiropractors have seen some legislative progress, they admit that they will always face an uphill battle fighting the medical mainstream that stands to lose some market share if and when chiropractic reaches full inclusion into the healthcare delivery system. Despite a century of existence, the chiropractic profession remains a mystery science profession to many Americans who have been misinformed and confused about this alternative health care profession. The chiropractic profession hopes this will improve as it enters its next century of existence, but until then chiropractors will continue to cry foul whenever they encounter the remnants of the medical cartel and media bias that has shrouded their profession with limited access to patients and a tainted public image.
Only time will tell if their cry will be heard or continued to be given short shrift. But if Americans want an alternative to drugs and back surgeries, chiropractors stand ready to offer a viable solution, naturally.