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 2000: Chiropractic "Only Proven Effective Treatment" for Chronic Whiplash
A study in the Journal of Orthopaedic Medicine not only points out the superiority of chiropractic care for chronic whiplash patients, but also provides insight into which chronic whiplash patients respond best to chiropractic care. Researchers divided 93 chronic whiplash patients into three groups: patients with restricted range of neck movement but no neurological deficit (Group 1); patients with neurological symptoms and restricted range of neck movement (Group 2); and patients with severe neck pain but a full range of motion and no neurological symptoms (Group 3).
The patients underwent an average of 19.3 adjustments over the course of 4.1 months. The patients were then surveyed and their improvement in terms of symptom grades reported as follows:
Group 1: 24% were asymptomatic, 24% improved by two symptom grades, 24% improved by one symptom grade, and 28% showed no improvement.
Group 2: 38% were asymptomatic, 43% improved by two symptom grades, 13% improved by one symptom grade, and 6% showed no improvement.
Group 3: 0% were asymptomatic, 9% improved by two symptom grades, 18% improved by one symptom grade, 64% showed no improvement, and 9% got worse.
"Our results confirm the efficacy of chiropractic, with 69 of our 93 patients (74%) improving following treatment," stated the study authors. "The results from this study provide further evidence that chiropractic is an effective treatment for chronic whiplash symptoms. However, our identification of a group of patients who fail to respond to such treatment (Group 3), highlights the need for a careful history and physical examination before commencing treatment."
May 2000: NBCE Embraces Change
An intense atmosphere pervaded the annual meeting of the National Board of Chiropractic Examiners (NBCE) on May 5. The meeting seemed to be a continuation of the call for change first voiced by the NBCE delegates a year ago at the annual meeting in Philadelphia.
At this year's meeting, elections were held for district directors in two of the five NBCE districts: District 3 (Northeast) and District 5 (Southeast). Vernon Temple, DC (District 3) and Rick Murphree, DC (District 5), both "reform candidates," won.
The next hot item on the agenda was the bylaws changes recommended by the directors. The delegates had requested "meaningful changes" from the NBCE directors at the last annual meeting. When the district directors presented the bylaws amendments, many delegates did not believe they were "meaningful enough." This motivated some of the delegates to draft their own bylaw amendments and give much greater authority to the delegates.
After almost two hours of debate, discussion, and a number of complicated motions, the director-proposed bylaw amendments passed by a narrow margin, followed by a motion from the delegates requesting that the bylaws committee review the issues presented in the delegate-proposed bylaws and other bylaw issues for possible additional amendments at next year's meeting. Throughout the entire process, the debate was extremely passionate, but also professional and well-mannered.
The first meeting of the "new" NBCE Board of Directors was held the following day; typically, this is a brief, privately held meeting, during which the at-large directors and new officers are elected. At this year's meeting, there were three at-large director seats up for election. The directors elected were: Peter Ferguson, DC - three-year term; D. Brent Owens, DC - two-year term; and Lawrence Gerstein, DC - one-year term. Directors also elected the following officers to serve on the executive board:
- Chair: Frank Hideg, DC
- President: Peter Ferguson, DC
- Vice President: James Badge, DC
- Secretary: Vernon Temple, DC
- Treasurer: Jerry Blanchard, DC
Even with three new directors all talking reform, there is still much work to be done. Most of the controversial issues are still waiting to be addressed by the new NBCE Board, including excessive net income, excessive director travel expenses, electronic testing, combining tests, and delegate authority and access to information.
September 2000: ACA Files Lawsuit Against Trigon Blue Cross/Blue Shield
The American Chiropractic Association (ACA), the Virginia Chiropractic Association (VCA), five doctors of chiropractic, and 18 chiropractic patients filed suit on Aug. 18 in U.S. district court against the largest managed health care company in the state, Trigon Blue Cross/Blue Shield (BC/BS), et al.
The suit alleges racketeering, extortion, mail fraud, antitrust and other state and federal law violations. The lawsuit contends Trigon imposed a $500 cap on spinal manipulation that principally penalizes chiropractic patients; reimbursed DCs 40 percent less than MDs for the same or similar services; paid DCs the lowest-level treatment code possible, even when higher-level treatment was performed; and has refused to reimburse for the services of CAs. The suit further alleges Trigon has directed patients away from chiropractic by "denigrating chiropractic treatment" through "unreasonably limiting the coverage of chiropractic treatment under health care plans it administers."
For more than two years, the ACA and VCA have been trying to resolve these inequities, but their efforts have been rebuffed by Trigon and the BC/BS association. In a May meeting with Trigon representatives, the ACA reported that Trigon clearly indicated there would be no change in its policy toward chiropractic.
"This lawsuit is by far the most signifi cant legal action ever taken by our profession against the insurance industry," noted ACA President Dr. James Mertz. VCA President Dr. Douglas Cox said chiropractic patients in Virginia have been "cheated by obvious discriminatory practices of the defendants," and that BC/ BS has been "conspiring with managed care bureaucrats and medical doctors to keep the chiropractic profession down."
ACA General Counsel George McAndrews will lead the legal effortagainst Trigon, et al. Mr. McAndrews was the lead attorney in Wilk, et al., v. AMA, et al., and is currently directing the ACA's Medicare suit against the U.S. Department of Health and Human Services.
November 2000: Congress Passes Historic Chiropractic Legislation
Culminating nearly a decade of joint lobbying efforts by the ACA and the Association of Chiropractic Colleges (ACC), and the positive results of the Chiropractic Military Demonstration Project at bases across the country, the U. S. Congress passed historic legislation mandating chiropractic care be made available to all active duty personnel in the United States armed forces. According to the legislation:
(1) Not later than March 31, 2001, the Secretary of Defense shall complete development of a plan to provide chiropractic health care services and benefits, as a permanent part of the Defense Health Program (including the TRICARE program), for all members of the uniformed services who are entitled to care under section1074(a) of title 10, United States Code.
(2) The plan shall provide for the following: Access, at designated military medical treatment facilities, to the scope of chiropractic services as determined by the Secretary, which includes, at a minimum, care for neuromusculoskeletal conditions typical among military personnel on active duty.
The legislation, formally known as the Fiscal Year 2001 Defense Authorization Act (H.R.4205), becomes law once it is signed by President Clinton, an action expected to occur within a matter of days.
ACA Chairman Dr. J. Michael Flynn called passage of the legislation the biggest chiropractic legislative victory in 26 years. "A whole new health care system - one of the largest in the nation - will now be opened up to the chiropractic profession. For the first time, all active duty military personnel will be guaranteed access to a permanent chiropractic benefit," Dr. Flynn stated. "Most importantly, we have achieved inclusion on a broad-scope basis and have successfully avoided a very narrow Medicare-like benefit."
H.R.4205 requires full implementation of the benefit be phased in over a five-year period throughout all three service branches of the military. When completed, all active duty personnel stationed in the U.S. and overseas are to have access to the chiropractic benefit. The legislation further requires the DoD to develop, by March of 2001, a full "implementation plan" to ensure the benefit is adequately provided.
"The remarkably focused Oversight Advisory Committee and the doctors of chiropractic at the 13 demonstration sites provided an outstanding service to our nation's military and to the chiropractic profession," commented Dr. Kenneth Padgett, president of the ACC.
December 2000: Training MDs to Adjust Offers "Little Extra Benefit," Study Says
The long-awaited study of teaching MDs how to adjust spines was finally published in the Nov. 15 issue of Spine. The results, while not surprising, are important to review and consider, as they bear a number of lessons.
The study was designed to "determine whether training primary care physicians in techniques of limited manual therapy would result in improved outcomes for their patients with acute low back pain." The authors trained 31 primary care MDs in "a sequence of eight standard manual therapy techniques." Two hundred and ninety-five patients were randomized into two treatment groups. One group received "enhanced care." The other group received "enhanced care with manual therapy." The main outcome measures included the "Roland-Morris functional disability scale measured over time and patient-reported time to functional recovery, time to complete recovery, and satisfaction with care."
The results and conclusions were not unexpected. No differences were found in Roland-Morris scores over time, mean functional days to recovery, days absent from work or patient satisfaction. More patients receiving manual therapy completely recovered after the first visit, compared with the control group (8% vs. 6%). Patients who received more intense manual therapy (four or more maneuvers) had a more rapid return to functional recovery (7.8 days) than those who received less intense manual therapy (11.1 days).
Limited training in manual therapy techniques offers very modest benefits compared with high-quality (enhanced) care for acute low back pain. The reasons for the very modest benefits of manual therapy are apparent in the approach taken by the authors. An intensive training course was developed to train the MDs, consisting of "two full days of educational and skill workshops, one month apart, with a later refresher session (18 hours in total)." The MDs were "encouraged to practice the manipulation techniques in their own practices until the clinical trial began approximately three months later."
The authors warned that "the physicians were not experts in manual therapy" and these results "should therefore not be generalized to the effectiveness of manual therapy performed by expert practitioners." However, they concluded that the "addition of limited manual therapy (to the training of physicians) offers little extra benefit."
