As we celebrate our 25th anniversary as the definitive news and information source for the chiropractic profession, we look back at the important events as reported in DC since 1983, while also looking forward to the future. Throughout 2008, we will feature a review of the top headlines in chiropractic for a given year, along with an article on the future of chiropractic authored by an influential member of the profession.
January 1999: Eisenberg Study Documents Rise in Alternative Care
The results of a 1991 telephone survey by David Eisenberg, MD, and colleagues, woke up the health care community. Thirty-six percent of the respondents said they'd been to an alternative provider in 1990, a far higher use of unconventional therapies than previously reported. Expenditures for alternative therapies in 1990 were $13.7 billion, $10.3 billion of which was paid out-of-pocket. Seven years later, a second survey by Eisenberg, et al., show the trend toward alternative therapy use is still growing.
The percentage of the U.S. population that uses alternative care increased from 33.8 percent (60 million people) to 42.1 percent (83 million people). The probability of an alternative care user seeing an alternative practitioner increased from 36.3 percent (22 million people) to 46.3 percent (39 million people). Annual visits to alternative practitioners grew from 427 million to 629 million, nearly double the number of visits to all primary care physicians (386 million). Overall, estimated expenditures for alternative care providers increased from $14.6 billion to $21.2 billion.
Looking at chiropractic usage, the changes were not as dramatic, but still quite positive. The percentage of the population that used chiropractic in the past year grew from 10.1 percent to 11 percent. The average number of visits per patient dropped, but the total number of visits increased sharply from 904.8 to 969.1 (per 1,000 population), almost one visit per person.
January 1999: ACA Suit Against HCFA Critical to Chiropractic's Future
The gist of the lawsuit filed by the American Chiropractic Association (ACA) against the Health Care Financing Administration (HCFA) is to stop new Medicare Part C regulations from being implemented. Those regulations will give physical therapists and other providers (in place of chiropractors) a federal mandate to do adjustments. Because many states use the Medicare model in private-sector managed care plans, the chiropractic domain of the adjustment may be supplanted by PTs and MDs in managed care plans across the country.
"Medicare Part C could eventually accomplish what the AMA conspiracy failed to: contain and eventually eliminate the chiropractic profession," warned ACA Executive Vice President Garrett Cuneo.
The estimated cost of the suit is anywhere from $300,000 to $5 million. No chiropractic group alone can take on the federal government. The National Chiropractic Mutual Insurance Company (NCMIC) has contributed $50,000 to the lawsuit.The National Association of Chiropractic Attorneys (NACA) has pledged to contribute to the lawsuit, apparently the first time NACA has helped fund a chiropractic lawsuit. The Connecticut and Kansas chiropractic associations each have donated $5,000 toward the lawsuit, and the South Dakota Chiropractic Association also has contributed.
July 1999: CMCC Awarded $1 Million for Headache Study
The Canadian Memorial Chiropractic College (CMCC) has received a $1 million research grant from the Ontario Ministry of Health to conduct a randomized clinical trial comparing chiropractic and medical treatments for tension headaches.
Howard Vernon, DC, FCCS(C), associate dean of the CMCC research department, noted several interesting aspects of the research: A placebo will be used in both the drug therapy and the chiropractic treatment components, and the researchers also will look at the effects of the combination of medical and chiropractic treatments. Dr. Vernon noted the study "provides an opportunity for cooperative research between the medical and chiropractic professions."
The study will take three years to complete and involve approximately 350 people from the Toronto environs. Subjects will be randomly grouped to receive combinations of real or simulated chiropractic care versus low doses of amitriptyline for 14 weeks: four weeks of medication only and then 10 weeks of medication and chiropractic treatments, three times weekly. Subjects will be monitored for one year after treatment.
November 1999: Arthritis Patients Use, Are Satisfied With Chiropractic Care
A study published recently in the Annals of Internal Medicine has found 63 percent of people who visited a rheumatologist for osteoarthritis, rheumatoid arthritis and fibromyalgia conditions also sought some form of complementary and alternative medicine (CAM). Chiropractic was not only the most sought-after form of CAM for those patients, but also was perceived as one of the most effective forms of therapy for these conditions.
The authors recruited patients from six locations: three university practices and three private rheumatology practices. Seventy-three percent of patients who had tried chiropractic care (33 of 45) found it to be helpful, placing chiropractic second, percentage-wise, behind spiritual healing. Special diets ranked third, followed by acupuncture, salves, electrical stimulators and herbal therapies.
An additional aspect of this study was the effort to determine why these arthritic patients chose CAM and why they did or didn't inform their medical physician. Interestingly enough, only 45 percent of the patients told their physicians about CAM use for their arthritic conditions. But it also was refreshing to see 71 percent of the rheumatologists say it was "OK" for their patients to use CAM.
December 1999: Chiropractic Effective for Infantile Colic?
A randomized, controlled clinical trial on colic compared chiropractic adjustments to daily doses of dimethicone and concluded: "Spinal manipulation has a positive short-term effect on infantile colic."
The Danish National Health Service recruited 50 infants meeting the criteria for colic. Infants were randomly assigned to receive dimethicone daily for two weeks or spinal manipulation for two weeks by a local chiropractor. The 25 infants under chiropractic care received motion palpation to locate "articulations" found primarily in the upper- and mid-thoracic area. Infants in the chiropractic group received an average of 3.8 adjustments.
The dimethicone group would have fared much worse than these results suggest if not for the dropout rate of the medicated group. All 25 infants in the manipulation group completed the 13 days of treatment, but there were nine dropouts in the dimethicone group. To quote the authors: "By excluding data from the dropouts, we are excluding more severe cases from the dimethicone group, and this has the effect of making that group appear better than it actually was."
The authors make another comment that speaks directly to the issue: "Spinal manipulation is normally used in the treatment of musculoskeletal disorders, and the results of this trial leave open two possible interpretations. Either spinal manipulation is effective in the treatment of the visceral disorder infantile colic or infantile colic is, in fact, a musculoskeletal disorder, and not, as normally assumed, visceral. This study does not address this issue."
