Articles by JCS
Time to Crow
By J.C. Smith, MA, DC
After sitting in the back of the health care bus for nearly a century, the chiropractic profession suddenly may be catapulted into the driver's seat. The new federal guidelines on low back pain basically concluded that back surgeries were out and chiropractic spinal manipulation was in. While this decision by a panel of experts sent shock waves through the medical community, on the other hand this report should send every chiropractor to the nearest mountain top to shout for joy. Indeed, this federal panel's decision can be viewed as the Emancipation Proclamation for the chiropractic profession.
In fact, the chiropractic victory is a tribute to the thousands of practitioners and their millions of patients who have withstood a century of persecution, degradation, and ridicule to now be vindicated by the truth. It's a story that is about more than only its science and practice, it is the saga of people who have carried a torch to help sick people get well naturally, despite incredible resistance and seemingly insurmountable odds. Without at doubt, it's time for every chiropractor to crow!
While the 1990s have been a turning point for the chiropractic profession, the last few years have been particularly difficult for the medical profession. Not only did President Clinton and Congress debate a health care reform that threatened the monopolistic control of the American Medical Association over our country's health care delivery system, other revelations from within the medical world also caused great concern for the medical profession. Once considered a fourth branch of government, the medical profession has finally had its hallowed pedestal pulled out from beneath its professional feet.
The New England Journal of Medicine, the bible of the medical world, shook the foundation of the medical monopoly itself with two reports -- one that confirmed that Americans made more office visits to "alternative" practitioners than to MDs as well as another article which stunned their surgeons when orthopedic MRI studies revealed that ruptured disks may not be the cause of back pain, their long-held belief that has led to an epidemic of failed back surgeries. It's one thing for chiropractors to question the basic premise of the medical world, but when The New England Journal of Medicine agrees, the crack in the medical foundation may be bigger than most people think.
This trail of bad events for the medical establishment didn't stop there. The Ontario Ministry of Health issued in 1994 the Manga Report endorsing chiropractic care rather than medical care to manage their costly back pain epidemic which received wide-reporting in the press. When USA Today printed its story with the headline: "Report: Spinal manipulation is best," political medicine cringed. Apparently the researchers discovered what chiropractors have always known: The disk model is out and the joint model for back pain is in.
If this wasn't enough of a shock for the AMA, another blow came in December of 1994 when the U.S. Public Health Service announced its long-awaited report on low back pain guidelines. The headlines read:
"Federal panel's guidelines for back care endorse chiropractic"
"Report: surgery often not necessary for sudden back pain"
The Agency for Health Care Policy and Research (AHCPR) rated spinal manipulation superior to medical care in the management of back pain, and even stated that only one in 100 back surgeries was necessary for acute low back pain. And this came from a panel of 23 experts headed by an orthopedic surgeons who reviewed over 3,900 scientific papers on the subject of back pain management.
This trend of bad tidings began a few years ago with the legal setbacks for the AMA as well as other scientific findings that undermined their position. The prestigious RAND Corporation in 1991 completed a two-year literature review of low back pain management, and agreed that spinal manipulation was effective for many back problems. The British Research Council in 1990 released an in-depth, 10-year analysis of back pain and likewise concluded that chiropractic was twice as good clinically as medicine in this area. In the legal arena, the U.S. Supreme Court refused to hear the appeal by the AMA in the Wilk et al. vs. AMA et al. anti-trust case which found political medicine guilty of conspiracy and prohibited their boycott of chiropractors in our nation's hospitals, which knocked the medical hospital administrators off their pedestals too.
Not only has government and scientific research now verified the clinical superiority of chiropractic care over medical care for similar problems, the AHCPR guidelines could literally turn the entire back pain industry upside-down. When the national and state health care delivery systems institute these new low back pain guidelines, the chiropractic profession could finally take a paramount position instead of its traditional back-seat in the health care bus. When the paradigm shift occurs from medical to chiropractic management of our nation's back attack epidemic, all Americans will benefit with reduced costs, pain, and suffering. The savings alone could greatly reduce the current $20 billion spent on failed surgeries and ineffective drugs by switching to the chiropractic model of manipulation and life-style modification.
Politically, this trend towards chiropractic took a giant step when President Regan requested in his 1984 budget to include doctors of chiropractic in the military. After years of debate and delays by the AMA inside the Department of Defense (DOD), President Bush in his last month in office signed into law the final bill which would commission chiropractors as officers in the medical corps as well as include chiropractic treatment in CHAMPUS. During the Health Care Reform debates, the AMA and insurance industry took another blow politically when the House Ways and Means committee passed the "any willing provider" resolution which would enable any licensed health professional to be included in any health insurance program, thereby breaking the medical profession's monopolistic stranglehold on covered treatments.
Never in the annals of medical history has the AMA been attacked by their own people and political supporters to this extent. It's one thing for the medical monopolists to be criticized by non-MD practitioners like chiropractors, but it's another issue when Congress, the U.S. Public Health Service, and the AMA's own scientific researchers challenge them. For too long the AMA has had its own way in all medical matters and now for them to be subject to government control, market competition, and scientific criticism is a totally new reality. Perhaps America is awakening from decades of a medical stupor about health care matters that has lead to a health care crisis unprecedented in the world.
America is now only learning what the chiropractic profession has long known: the mismanagement of back pain cases in our nation's health care system. In fact, at the AHCPR press conference that released the startling results about low back pain, the American Chiropractic Association spokesman, Dr. Robert Morton, simply said, "What chiropractors have known for 100 years and what millions of Americans have long known is that chiropractic works!" Perhaps it's now time for the rest of Americans to learn about the chiropractic profession.
In fact, the trend toward chiropractic care was already on the upswing long before the researchers realized it. Once considered mainly an underground health care profession working on the margins of respectability, new light has revealed that "alternative" medicine is one the rise. The New England Journal of Medicine reported a study done in 1990, "Unconventional Medicine in the United States" by David Eisenberg, MD, et al. The results stunned the medical establishment when they revealed that one-third of all Americans sought care from "alternative" doctors and therapists. Not only did these Americans seek "alternative" care from the mainstream allopathic medical doctors, they actually made 425 million visits to chiropractors, massage therapists, acupuncturists, nutritionists, among others. This huge number shocked the medical establishment because during the same period patients utilized MDs for 388 million visits. Apparently "alternative" isn't so alternative anymore!
Another interesting fact about the demographics of the one-third of Americans using unconventional health care was that the majority was college educate, upper middle class consumers. These patients were not uninformed, uneducated subjects being naively led by scam artists, as the medics would have you believe. These were patients who made an informed decision decision to seek care that they believed would best solve their health needs. The fact that this large minority of Americans sought alternative care to mainstream medicine should be a warning signal to political medicine that despite their monopolistic control of the health care system, many intelligent people still seek different solutions than drugs and surgeries for their health needs.
From being considered a relatively small fish in a very big medical pond, chiropractors and other natural health care providers enjoy more popularity than ever before. Not only were there more office visits to non-MD practitioners, these patients also spent comparable out-of-pocket money -- $10.3 billion -- to non MDs compared to $12.8 billion for all hospitalizations. Despite insurance discrimination, people are willing to pay for this natural health care themselves. The most common ailments sought by these patients were for back pain, headaches, insomnia, anxiety, and depression. Apparently Americans have learned that not all health problems can be solved with drugs and surgery, and they are willing to pay for natural methods despite their lack of medical insurance coverage.
The new federal guidelines not only gave the chiropractic profession reason to crow, it also should give notice to the medical antagonists it's time for them to eat a little crow. After decades of medical domination that included dirty tricks, dirty politics, and dirty attitudes toward chiropractic, the new guidelines emphatically told the medical profession that chiropractic was right. I hope this revelation will open up a new era of cooperation between the medical and chiropractic worlds for the benefit of all patients who have long called for the best of both worlds. I applaud those chiropractic patients who have withstood the medical discrimination and economic disincentives to support their chiropractor but also who have fought for their right to have a freedom of choice in their health care decisions. Indeed for many reasons it's time for every doctor and patient of chiropractic to crow for many reasons.