On March 18, 1992 at 6 p.m., ABC's "World News Tonite" featured a segment on manipulation under anesthesia (MUA) performed by chiropractors. The segment consisted primarily of film footage and interviews originally conducted for the "20/20" segment which aired on February 21, 1992 (please see "Chiropractic Finally Airs on 20/20" in the March 13, 1992 issue). When combined with the chiropractic segment aired on "Good Morning America" on February 27, 1992 (please see "Good Morning America Reports on Chiropractic" in this issue), that brings the total number of nationally televised segments on some facet of chiropractic to three in less than a month. Unfortunately, this segment was not as positive as the other two.
The story began with a patient being wheeled into an operating room on a gurney. Her chiropractor, in mask and gown, proceeded to adjust her neck as the nurses and the anesthesiologist looked on. Timothy Johnson, M.D., the medical editor for both "World News Tonite" and "20/20", began by explaining: "Patients with back pain who have not responded to non-surgical treatment, like standard manipulation and physical therapy, are brought into hospitals for three days. Each day they are taken to an operating room and given anesthesia so that their spines can be manipulated with much more force than typical office manipulation."
The patient is next shown in her hospital room telling of the relief she finally found in her MUA treatment. She is next shown in a department store moving freely, trying on clothes. But Dr. Johnson warns: "But success stories like this don't prove a treatment works." He goes on to say: "To prove a treatment is effective, unbiased scientific studies are needed. No such studies for manipulation under anesthesia have ever been done."
Next, a small piece of an interview with Al Adams, D.C., was presented with Dr. Adams stating in an incomplete sentence: "There are no randomized controlled trials and I think this is why we are interesting in evaluating the procedure...." While there has been some research conducted, there have not been randomized controlled trials conducted.
The cost of these MUAs is quoted at $8,000-$12,000. Of course most of this goes to the hospital and staff. One hospital administrator admitted that MUAs accounted for almost 10% of their gross revenue. The treating DC receives approximately $300 per treated area, i.e., cervical, thoracic, lumbar etc., with sometimes three areas manipulated in a single treatment.
"World News Tonite" contacted some of the major insurance companies and discovered that they would not pay for MUAs. In addition, Blue Cross/Blue Shield of Texas (BC/BS) stated that they had found no scientific evidence for MUAs. In addition, BC/BS apparently surveyed 50 spinal surgeons on the safety and effectiveness of MUA. The respondents to the survey stated they didn't perform the procedure, there weren't any valid medical indications, and MUAs were potentially dangerous.
Alf Nachemson M.D., the renowned orthopedic surgeon from Goteborg, Sweden was also consulted. He expressed great concern over the exposure to "multiple dangers" of patients whose bodies no longer provided resistance to painful and dangerous movement. Dr. Nachemson added that this procedure has been abandoned by the rest of the world.
Dr. Johnson concluded with a statement that reflected the slant of the entire program: "Properly done manipulation for some kinds of low back pain is slowly gaining acceptance as a legitimate treatment. But manipulation under anesthesia appears to be an example of what our health care system does not need: another group of practitioners driving up costs with unproven and possibly dangerous procedures."
It is intriguing to hear a medical editor attempt to demonstrate that chiropractors are guilty of something that MDs have been show guilty of many times: utilizing unproven procedures to increase income while endangering the patient to what may be unnecessary procedures.
Has there been enough research in this area to make manipulation under anesthesia a procedure that should be offered to the public at a fee? Should we first conduct the research on volunteers? Is the promise of higher fees and operating room glamour blinding our vision? Are the necessary protocols and safeguards in place to protect chiropractic patients who believe in us partly because they couldn't get what they needed from the medical profession?
To answer these and other questions, Dynamic Chiropractic has asked well known chiropractic researcher John Triano, M.A., D.C., to review the "World News Tonite" segment, consider the issues, and present the profession with a "researchers" point-of-view. Be watching for Dr. Triano's insightful review of this aspect of our profession in the next two issues.
