Chiropractic Authors in the Medical Literature

Science and Medicine, a respected medical journal founded by Scientific American in 1994 (independent since 1996) has published an introduction to chiropractic philosophy, science, history and clinical practice by Tedd Koren, DC. It appears to be the first time that a major medical journal has published a comprehensive paper on chiropractic written by a chiropractor.

Dr. Koren's article is simply titled "Chiropractic"¹ and appeared in the September/October 1999 issue.

"Dr. Koren's paper is probably the single most intelligible article on chiropractic that I have found to date," appraised John Young,MD,Phd, editor of Science and Medicine. Dr. Young is an adjunct professor in the laboratory of cellular physiology and immunology at Rockefeller University in New York. Dr. Young added that the article "gives a flair of legitimacy that will make physicians ponder why they have not come across this topic earlier."

While we suspect that most MDs have often come across "this topic," it's encouraging that the article received such warm praise.

Dr. Koren said he hoped his paper would "stimulate other professionals to explore" chiropractic. "It was an honor to have been asked to contribute to Science and Medicine and to work with its editor and publisher," he added.

Hospital Topics

James Lehman,DC, made news in Dynamic Chiropractic in our May 10, 1991 issue when New Mexico's leading HMO, Lovelace, a 120,000-member HMO, integrated chiropractic into its network. Dr. Lehman and Edward Sweetser,MD, vice president and chief medical officer of Lovelace, were responsible for bringing chiropractic to the HMO.

How has chiropractic fared at Lovelace over the years? That is what a paper in the spring 1999 issue of Hospital Topics assessed. Hospital Topics, a trade journal designed for health care professionals and managers, published "Can Medicine and Chiropractic Practice Side-by-Side? Implications for Healthcare Delivery."² Dr. Lehman is one of the co-authors of the article and is believed to be the first chiropractor published in Hospital Topics. The other authors were a physician executive in Chicago, Illinois; a professor and dean of a university school of management; and a research director of ambulatory care administration in Denver, Colorado.

The article is basically a report card on chiropractic at the HMO. The "overall cost effectiveness of chiropractic services compared with competing medical care services could not be addressed," the authors stated. The odds of chiropractic flourishing and succeeding in this HMO "experiment" were thwarted from the beginning. There were only two chiropractors for the prepaid patients. The DCs were overwhelmed with patients, and, not surprisingly, there was turnover in the chiropractic staff. The HMO then stacked the deck further against success by creating "a more stringent set of guidelines for chiropractic referrals and treatment as part of its overall effort to control use and costs," which brought about "significant decreases in the use of chiropractic services...."

Further, the radiological procedures ordered by the chiropractors, even though in accordance with approved guidelines, were "almost uniformly denied for payment."

Despite these abysmal conditions, there were bright spots.

Seventy-eight percent of the HMO's general internists ordered some chiropractic care for their patients; more than half of the doctors of neurology, neurosurgery, orthopedics, occupational medicine and podiatry also referred; and even 24 percent of the emergency room and urgent care doctors referred.

The paper concluded that the trial established that:

1. Physicians are willing to refer patients to refer patients to chiropractors when they perceive it to be in their patients' interest.

    

2. Physicians are satisfied with the results of chiropractic care of their patients.

    

3. Many physicians have little or no objection to receiving a competent and personable chiropractor as their professional colleague.

    

4. Under these cooperative conditions, chiropractors can design a mode of practice that enables them to cross-refer patients to physicians.

    

5. Patients like the seamless aspects of having chiropractors and physicians in the same health care system.

    

6. Patient expectations on being able to use chiropractic services increase significantly when these services are available within an integrated delivery system.

The conclusion of the authors: "These findings should prove fruitful to other managed care systems that are addressing the issue of chiropractic care."

References

1. Koren, T. Chiropractic. 1999 Science & Medicine 6(5), 42-45. Editor's note: Copies of Dr. Koren's article can be obtained by contacting Science and Medicine at (800) 888-0028.

    

2. Pasternak D; Lehman J; Smith H; Piland N. Can medicine and chiropractic practice side-by-side? Implications for healthcare delivery. 1999 Hospital Topics 77(2): 8-17.

Editor's note: Copies of this paper can be obtained by contacting Bell & Howell Information and Learning at (800) 521-0600 ext. 3781. For international orders, call (734) 761-4700.