January 22, 2008
Jim Crow Still Alive
Every year on the remembrance of MLK, Jr., I recall his poignant speech that states to judge a man by the content of his character and not by the color of his skin.
While I applaud his effort to end racial segregation/discrimination, as a health care provider, I must admit that a discriminatory attitude still exists in Georgia’s hospitals and in many health care programs, but it’s not concerning the treatment of black patients or the discrimination against black MDs. Unlike racial segregation, it is still politically-correct to discriminate against doctors of chiropractic.
The public may be unaware that segregation still exists in Georgia’s public hospitals until patients ask for a chiropractor to treat them. As well, workers’ compensation programs and the military health services routinely discriminate against DCs despite state and federal laws that give patients legal access to chiropractors. Sadly, a Jim Crow attitude still very much exists in the medical field that discriminates against DCs and segregates them outside the mainstream healthcare delivery system and our public hospitals. Indeed, it is the last bastion of segregation that goes unnoticed by the media. (The refusal to print this letter only serves to justify my belief that media/medical bias toward chiropractors still exists today.)
For example, did you know that not one DC is on any medical staff at any hospital in middle Georgia? All other health care disciplines are on staff, but not one DC. The medical society still bars its biggest competitor by denying staff privileges to DCs despite a federal court decision that directly prohibits public hospitals from discriminating against chiropractors. For the uninitiated, in 1987 the Northern District Court of Illinois, Judge Susan Getzendanner in the case of Wilk et al. v. AMA et al. ruled in favor of the chiropractic plaintiffs that the AMA and their associated medical groups conducted an illegal boycott of doctors of chiropractic from public hospitals despite the medical evidence that showed manipulative therapy was more effective than anything the medical world had to offer patients for the epidemic of back pain.
Yet, neither Houston nor Bibb counties have DCs on staff in their local public hospitals. Tell me: Are these two counties somehow exempt from federal law or is this just a ploy to remove the main competitors to spine surgeons? Considering the revenue from spine surgery ranks ahead of heart surgery in many hospitals, a lot of money—an average of $50,000 for a lumbar fusion—would be lost to hospitals if DCs were able to treat these back pain cases before surgery is done. One local orthopedist told me that Macon is now considered the back surgery capital of Georgia and it ranks fourth on the list nationally, so any effort to decrease spine surgeries will be met with strong resistance locally.
In terms of scientific research on this epidemic of back pain, every major study done in Europe, England, Canada and the US have all concluded the same—that for the vast majority of back problems, spinal manipulative therapy is preferred over back surgery. In fact, in 1994 the US Public Health Service’s Agency on Health Care Policy and Research conducted an extensive two-year study on acute low back pain in adults and listed spinal manipulation as a “Proven Method.” It also stated that “Surgery has been found to be helpful in only one in 100 cases of low back problems.” Yet spine fusions have tripled in the last few years despite a 70% failure rate!
In regards to the Military Health Services, the same Jim Crow attitude exists locally at RAFB. Despite former President Clinton signing into law HR 5408 for fiscal year 2001 calling for chiropractic health care for members on active duty, not one active military personnel locally has been referred to DCs. As well, President Bush signed into law in 2003 a similar bill allowing vets to receive chiropractic care through the DVA, but as yet not one vet has received care due to the stonewalling by Dublin VA hospital personnel despite the requests of many of my own patients. Indeed, the military medical stonewall is still very high and forces patients to live in pain or seek ineffective spine surgery.
In light of evidence-based research that has shown spine fusions have a 70% failure rate with a high rate of recidivism and the average hospital bill exceeding $34,000 each, excluding physician fees, I would think that the public, patients, and employers who foot this bill should be outraged if they knew these facts, which they certainly don’t. To be sure, the discrimination against chiropractors in our hospitals is a very expensive problem facing all Georgians.
Just recently in The New England Journal of Medicine, spine researcher Richard Deyo, MD, in his article, “Spinal-Fusion Surgery—The Case for Restraint,” mentioned “spinal-fusion operations rose by 77% between 1996 and 2001…the financial incentives for surgeons, hospitals…may have synergistic effects…the market for spinal implants and devices is estimated to be $2 billion a year, with an annual growth rate of 18 to 20 percent…yet there is no acceptable evidence of the efficacy of any form of fusion for degenerative lumbar spondylosis, back pain, or instability.” Obviously his expert advice has fallen on deaf ears locally.
According to research study from Johns Hopkins Medical School titled Unintentional and Musculoskeletal Injuries Greatest Threat to Military Personnel, “…in all three branches of the service, injuries and musculoskeletal conditions still adversely affected the health of service members and troop readiness more than any other single diagnosis.”
Obviously our local hospitals, workers’ comp programs, and the military medical corps still have an outdated Jim Crow attitude about chiropractic care despite the laws, overwhelming scientific research, governmental recommendations, and positive clinical outcomes that show the superiority of spinal manipulation for the majority of back problems. Not only has this archaic attitude thwarted the efforts of chiropractors to help patients with back pain, but it also has led to higher costs for all medical insurances, WC premiums to employers, and TRICARE for taxpayers who must foot the high costs of medical care, especially ineffective spine surgeries and the resulting disability claims.
Since our consumer society is built on the concept of free enterprise on a level playing field and now that evidence-based health care supports the most cost and clinically-effective treatments, the boycott of chiropractic care in these health care delivery programs is deplorable, illegal, and immoral to the suffering patients who are victimized into ineffective, unnecessary and expensive spine surgeries.
Here is a clear cut example that discrimination is still rampant in Georgia within these health care systems, costing millions of dollars in ineffective treatments and patient disability. So, just when will society judge chiropractors by their good work and not by the prejudices from yesteryear?
JC Smith, MA, DC
Smith Spinal Care Center
Warner Robins, GA