Articles by JCS
Over the Healthcare Cliff
Chiropractic care, once portrayed as the black sheep of the medical flock,
now comes to the rescue in this epidemic of back pain and rising fiscal problems
JC Smith, MA, DC
With the impending fiscal cliff looming over every aspect of federal spending including Medicare, mounting research shows that the chiropractic profession stands on this precipice to solve one hugely expensive problem.
Although not deadly like heart disease or cancer, back pain is pandemic that currently costs an estimated $267.2 billion annually and will strike most of the 250 million American adults sometime in their lifetime. The daily prevalence alone in the general adult population is estimated at 37%, which equates to 92.5 million people.
As President Barack Obama warned in 2009, “If we do not fix our health care system, America may go the way of General Motors; paying more, getting less, and going broke.”
In fact, his opinion is most evident in spine care. Mark Schoene, editor of an international spine research newsletter, confirmed that “Spinal medicine in the US is a poster child for inefficient spine care.”
Ostensibly, medical spine care has already gone over the fiscal cliff and will soon hit rock bottom unless the intransigent medical profession conforms to the new spine care guidelines that recommend conservative, “hands-on” care like chiropractic before drugs, shots, and surgery.
Back surgery has become a booming business with about 800,000 Americans undergoing back surgery each year, according to the American Academy of Orthopaedic Surgeons. Many experts agree the cost of medical care will be reduced substantially when unnecessary spine surgeries alone are avoided.
The Dartmouth Institute of Health Policy even suggested 30-40% of spinal fusion surgeries (and the associated hospitalization costs) were unnecessary. Considering the estimated cost of back pain is $267.2 billion annually, a 40% reduction would save $106 billion.
This revelation followed an extensive, two-year study released in 1994 by the US Public Health Service’s Agency for Health Care Policy and Research that stunned spine surgeons concerning the rare need—estimated to be only one in 100 cases—for back surgery except in those cases of cancer, fractures, infections, cauda equina, or cases that did not respond after four weeks of conservative care.
Despite this new evidence, from 1994 to 2007, MRIs increased 307%, spinal fusion surgery increased 204%, spinal injections increased 629%, and opiate use increased 423%. Another study found the rate of American spine surgery was at least 40% higher than any other country and more than five-times greater than those in England and Scotland. 
The American study also listed spinal manipulation as a “proven treatment,”  as did studies from Canada and the UK, and recommended it should only be done by a “professional with experience in manipulation.”
Recent news articles have shown the dangers of epidural steroid injections for back pain, such as the 119 deaths of the nearly 13,000 people in 23 states who have suffered from meningitis-tainted epidural steroid injections.
Another example of inefficient spine care is the growing “Hillbilly Heroin” epidemic of narcotic opioid abuse for “pain management” that in 2010 caused 14,800 deaths and untold addictions, including to the unborn.
This proliferation of “pill mills” led Thomas Frieden, MD, director for CDC, to suggest that physicians have supplanted street corner drug pushers as the most important suppliers of illicit narcotics.
The paradigm shift in spine care essentially began in 1990 when MRI research by Scott Boden, MD, now director of the Spine Center at Emory University, debunked the “bad disc” theory when researchers found many people without back pain had herniated or degenerated discs, too.
Richard Deyo, MD, MPH, also agreed that “many of these abnormalities are trivial, harmless, and irrelevant, so they have been dubbed incidentalomas,” equivalent to “finding gray hair” since both are part of the normal aging process.
Gordon Waddell, MD, orthopedist, and author of The Back Pain Revolution, admitted, “Low back pain has been a 20th century health care disaster…back surgery has been accused of leaving more tragic human wreckage in its wake than any other operation in history.”
Not only has back surgery left a human wreckage, it has left a financial one, too. According to The Wall Street Journal's analysis of Medicare claims, spinal fusion procedures cost Medicare $343 million in 1997, escalating to $2.24 billion in 2008—nearly a 400% increase.
In 2010 the North American Spine Society admitted spine fusion should be a last resort and recommended spinal manipulation—5 to 10 sessions over 2 to 4 weeks—should be considered before surgery. In 2011, North Carolina Blue Cross/Blue Shield announced it will no longer pay for spine fusion if the sole criterion is an abnormal disc.
America’s Primary Spine Care Providers
The chiropractic profession, unfairly ostracized by the medical community for decades, now has emerged as a fiscal conservative to champion this call for reducing costs and improving outcomes in spine care.
Chiropractors help over 20 million patients annually and, ironically, they now stand ready to also help the beleaguered medical practitioners, half of who are admittedly burned out and in need of help, when Obamacare introduces 50+ million more patients into the system that will require 100,000 more primary care physicians.
Researchers revealed more inefficiency in that medical primary care physicians are actually the least educated to diagnose and treat musculoskeletal problems. Inexplicably, it was found that 50% of all medical schools do not even teach classes in this subject.
Scott Boden openly admits “Many, if not most, primary care providers have little training in how to manage musculoskeletal disorders.”
Studies have confirmed that most (82%) medical primary care physicians are inept in their training on musculoskeletal disorders, more likely to ignore recent guidelines, and more likely to suggest spine surgery than surgeons themselves.
Considering the millions of patients with back pain seeking care, the implementation of 80,000 chiropractors as America’s primary spine care providers is the logical solution to this dilemma, a concept now encouraged by many experts.
Due to their better academic training, professional expertise, clinical effectiveness, and lower costs, chiropractors stand to help millions of patients and save billions of dollars in wasted medical costs for this epidemic of back pain.
Anthony Rosner, PhD, testified before The Institute of Medicine: “Today, we can argue that chiropractic care, at least for back pain, appears to have vaulted from last to first place as a treatment option.” 
Scott Haldeman DC, MD, PhD, FRCP(C) and Simon Dagenais DC, PhD. A supermarket approach to the evidence-informed management of chronic low back pain. The Spine Journal, vol. 8, Issue 1, January-February 2008, Pages 1-7.
 Text of President Obama’s health-care speech, Jun 15, 2009, by MarketWatch
 The BACKPage editorial vol. 27, No. 11, November 2012.
 Elliott Fisher, MD, on the CBS Evening News, “Attacking Rising Health Costs,” June 9, 2006.
 S Bigos, ibid. p. 8.
 Martin BI, Deyo RA, Mirza SK et al. Expenditures and health status among adults with back and neck problems. JAMA 2008; 299: 656-64
 DC Cherkin, RA Deyo, et al. “An International Comparison Of Back Surgery Rates,” Spine, 19/11 (June 2004):1201-1206.
 SJ Bigos, O Bowyer, G Braea, K Brown, R Deyo, S Haldeman, et al. “Acute Low Back Pain Problems in Adults: Clinical Practice Guideline no. 14.” Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research; (1992) AHCPR publication no. 95-0642.
 P Manga, D Angus, C Papadopoulos, W Swan, “The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low Back Pain,” (funded by the Ontario Ministry of Health) (August, 1993):104
 Meade TW et al., Randomised comparison of chiropractic and hospital outpatient treatment. BMJ. 1990;300 (6737):1431-1437.
 S Bigos, ibid, Patient Guide, (1992):7.
Daniel J. DeNoon, Fungal Meningitis Outbreak: 13,000 Tainted Shots, WebMD, 10/9/2012
 Popular painkillers exploding in U.S. by Chris Hawley, The Associated Press, 4/06/2012
 Centers for Disease Control and Prevention Press Release, CDC Vital Signs: Overdose of Presription Opioid Pain Relievers—United States, 1999-2008; 2011: www.cdc.gov/media/releases/2011/t1101_presecription_pain_relievers.html.
 SD Boden, DO Davis, TS Dina, NJ Patronas, SW Wiesel, “Abnormal Magnetic-Resonance Scans Of The Lumbar Spine In Asymptomatic Subjects: A Prospective Investigation,” J Bone Joint Surg Am. 72 (1990):403–408.
 RA Deyo and DL Patrick, Hope or Hype: The Obsession with Medical Advances and the High Cost of False Promises (2002):191.
 G Waddell and OB Allan, “A Historical Perspective On Low Back Pain And Disability, “Acta Orthop Scand 60 (suppl 234), (1989)
 John Carreyrou and Tom Mcginty, Top Spine Surgeons Reap Royalties, Medicare Bounty, WSJ, December 20, 2010
 Janice Lloyd, Doctor burnout: Nearly half of physicians report symptoms, 8/21/2012, USA TODAY
 AD Woolf, B Pfleger, “Burden of Major Musculoskeletal Conditions,” Bull World Health Organ 81/09 (2003):646-656.
 Matzkin E, Smith MD, Freccero DC, Richardson AB, Adequacy of education in musculoskeletal medicine. J Bone Joint Surg Am 2005, 87-A:310-314
 S Boden, et al. “Emerging Techniques For Treatment Of Degenerative Lumbar Disc Disease,” Spine 28 (2 A Rosner, “Evidence or Eminence-Based Medicine? Leveling the Playing Field Instead of the Patient,” Dynamic Chiropractic, 20/25 (November 30, 2002)003):524-525.
 EA Joy, S Van Hala, “Musculoskeletal Curricula in Medical Education-- Filling In the Missing Pieces, The Physician And Sports Medicine,” 32/11 (November 2004).
 PB Bishop et al., “The C.H.I.R.O. (Chiropractic Hospital-Based Interventions Research Outcomes) part I: A Randomized Controlled Trial On The Effectiveness Of Clinical Practice Guidelines In The Medical And Chiropractic Management Of Patients With Acute Mechanical Low Back Pain,” presented at the annual meeting of the International Society for the Study of the Lumbar Spine Hong Kong, 2007; presented at the annual meeting of the North American Spine Society, Austin, Texas, 2007; Spine, in press.
 SS Bederman, NN Mahomed, HJ Kreder, et al. In the Eye of the Beholder: Preferences Of Patients, Family Physicians, And Surgeons For Lumbar Spinal Surgery,” Spine 135/1 (2010):108-115.
 Donald R Murphy et al., “The Establishment of a Primary Spine Care Practitioner and its Benefits to Health Care Reform in the United States,” Chiropractic & Manual Therapies 2011, 19:17 doi:10.1186/2045-709X-19-17
 Testimony before The Institute of Medicine: Committee on Use of CAM by the American Public on Feb. 27, 2003.