When the Agency for Health Care Policy and Research (AHCPR) released its guideline on acute low-back pain just a little more than a year ago, its endorsement of spinal manipulation was tantamount to an endorsement of chiropractic and a major blow to the allopaths. Now, the medical profession has apparently taken the old adage, "If you can't beat 'em, join 'em," to heart, at least insofar as chiropractic is concerned.
It stands to reason that if the same allopaths who were threatened by the AHCPR Guideline are able to incorporate spinal manipulation into their practices, they can create one-stop shopping for the providers of managed care and eliminate the need for doctors of chiropractic.
Thanks to the Freedom of Information Act, we have learned that this is exactly what is happening. A $1.35 million study headed by Timothy Carey, MD, MPH, and funded by Health and Human Services (HHS) will, "determine whether allopathic physicians can effectively integrate manual therapy, including spinal manipulation, into primary care practice." In other words, after years of condemning chiropractic health care, they now plan to bring spinal manipulation into the mainstream of allopathic medicine.
According to the proposal, "Even if immediate chiropractic referral is an effective strategy in the treatment of acute low back pain, it is unlikely to become a dominant strategy to the public. Primary care physicians may be reluctant to refer out to other providers such a common problem as acute low back pain. Managed care initiatives, to become more common in the future, have attempted to encourage increased management of problems by primary care physicians without referral."
Clearly, the needs of the patients are secondary to the needs of the practitioner. It also should act to remind us all that the real victims of health care turf wars are the patients. Spinal manipulation is a safe and effective procedure in the hands of a skilled professional. However, poorly trained practitioners, whatever their degree qualifications, could put patients at risk.
The August 1995 issue of the Journal of Manipulative and Physiological Therapeutics published a study that examined this very issue. It concluded, "... our data suggest that skill at SMT may be procedure-dependent. Skilled performance in one procedure does not ensure skill in a second. This information has direct relevance to current systems of training in the techniques of manipulation and suggests that weekend seminar training, relying on transfer of existing skill to newly-learned procedures may be inadequate to ensure safe or effective practice."
Yet, in addressing the training to be administered to doctors within Carey's study, the proposal suggests, "Courses have been developed to teach spinal manipulation to allopathic physicians and physical therapists. These courses generally last one to two days."
Wide dissemination of this study, once completed, is a certainty. Because HHS is the funding source, and because Carey has already established a name for himself with the recent publication of a flawed study in The New England Journal of Medicine concluding that medical primary care is more cost-effective than chiropractic care, publication of this study is all but ensured in a major peer-reviewed journal.
Doctors of chiropractic receive the most education and the most practical experience in spinal manipulation. To offer patients a watered-down, quasi-medical substitute for quality chiropractic care is a real tragedy, but it may be a reality.
The Foundation for Chiropractic Education and Research will remain dedicated to fighting for chiropractic by providing high quality, relevant research that will help chiropractic maintain its uniqueness and supremacy in the art and science of the adjustment. Your continued support of FCER is imperative in this battle and those that loom ahead.
Mary Johnson
FCER director of communications
Arlington, Virginia
