Dr. John Triano: Thinking Outside the Box

John Triano, DC, PhD, is not your everyday chiropractor. Dr. Triano concurrently treats patients in a clinical setting; conducts musculoskeletal research; promotes chiropractic through public relations projects; develops guidelines for managed care organizations; and presents to spinal-health practitioners in other fields. Clearly, Dr. Triano has a profoundly positive impact on the chiropractic profession.

For this reason, Dynamic Chiropractic proudly presents Dr. John Triano as its 2002 Person of the Year.

So, what is it about Dr. Triano that makes him so successful? He thinks outside of the conventional chiropractic box. His self-described "cross-training" background, due to a willingness to diversify his education to multiple areas, helps make him extraordinary. Dr. Triano, a clinician and researcher at the multispecialty Texas Back Institute (TBI), says that more DCs would benefit from branching out to learn about other forms of spinal care. This willingness to operate outside conventional norms by collaborating with other spinal care professionals is helping the public understand chiropractic. Dr. Triano's research adds credibility to chiropractic methods, and his efforts to spread the word of chiropractic expand the support of the profession.

His modesty, particularly for one so accomplished, proves he also acts outside the box. When he was selected as the doctor of chiropractic to evaluate the Milliman USA health care guidelines on chiropractic, he simply said, "I want to provide a fair representation of the evidence of chiropractic services, and hopefully create a more fair understanding of the natural history of spine problems."

Even with his research, his work treating patients at TBI and a variety of other projects, Dr. Triano still managed to write an article for DC in 2002 (published in the February 25 issue and available online at www.chiroweb.com/archives/20/05/17.html) that focused on chiropractic maintaining control of the realm of spinal manipulation.

Later, in June, Biography magazine printed a positive article on chiropractic, thanks to Dr. Triano's advice. "Back on Track: Dr. John Triano and the Power of Chiropractic Medicine" featured advice on proper posture and lifting techniques, and also focused on general background information on chiropractic (DC, July 15, 2002).

On October 31, at the North American Spine Society's (NASS) comprehensive session on spinal manipulation, Dr. Triano co-moderated with fellow researcher Scott Haldeman, DC, PhD, MD (DC, December 16, 2002). More than 2,400 NASS members and other attendees (orthopedic surgeons, neurosurgeons and physical medicine/rehabilitation specialists in particular) learned from Dr. Triano and others about the benefits of spinal manipulation. Dr. Triano specifically discussed chiropractic diagnoses, and indications and contraindications to treatment.

In November, DC reported that Dr. Triano had been selected to review Milliman USA's chiropractic guidelines, which were released the following month; he was the first doctor of chiropractic ever included on Milliman's multidisciplinary review team. The American Chiropractic Association (ACA), which was instrumental in placing a chiropractor on the review team, noted the importance of Dr. Triano's willingness to accept the position. "Dr. Triano was key [to the agreement]," said John Gentile, DC, chair of the ACA Insurance and Managed Care Committee.

Clarifying his success revising the chiropractic portion of the guidelines, Dr. Triano stated, "Overall, substantial gains were made to move the [Milliman] guidelines from their previous unrealistic and indefensible position in violation of the literature to a fair representation of the literature."

The Milliman Care Guidelines are one tool insurance and managed care companies use for reliable information on health procedures and therapies for their reimbursement policies. Richard Liliedahl, MD, chief medical officer for M&R Care Guidelines (a division of Milliman USA), said that Triano was the perfect DC for the position as a reviewer. "I think Dr. Triano is impressive because of his credentials and experience... We're excited to work with him. We think this relationship will be a great one," Dr. Liliedahl said.

In an interview published in the November 4 issue of DC (www.chiroweb.com/archives/20/23/07.html), Dr. David Zieve, MD, editor of the Milliman Care Guidelines, also praised Dr. Triano: "He works in a large multidisciplinary environment, he's still seeing patients and he's done lots of research and published many papers. I think the attractive part of working with him is his eminence in the field, and his skill and knowledge. He brought academic and practical input to the guidelines. These are good, solid guidelines."

The guidelines should be invaluable to doctors of chiropractic. "If the guides, as released to subscribers by MR [Milliman USA], reflect the process I experienced and are used by subscribers as MR recommends, the DC can expect a realistic opportunity to provide trial therapy and, where medical necessity is evident, an opportunity to have continuity of care for the patient who is responding," Dr. Triano asserted.

In the past, Dr. Triano has also been active in guideline development for the Agency for Health Care Policy and Research (AHCPR), the Mercy Guidelines, the North American Spine Society and the American Academy of Orthopaedic Surgeons.

Triano's accomplishments in 2002 culminated in a collaboration with American Airlines. All this month (January 2003), the airline will feature an audio interview with Dr. Triano on its "Executive Lifestyles Channel." Approximately 23,000 American Airlines flights will offer the interview to travelers; as a result up to three million people will have the chance to learn about the benefits of chiropractic while in flight (DC, November 30, 2002).

Elizabeth Montgomery, the executive producer of American Airlines' Sky Radio Network, commented that Dr. Triano and the Texas Back Institute, through the interview, "are ushering in the future of back pain treatment by integrating traditional medicine with chiropractic and holistic care." She added, "Our passengers need to know what options are available to them as patients, and we hope that others in the medical field will follow their lead."

DC's 2002 Person of the Year is not Dr. Triano's first award. In 1998, the American Board of Chiropractic Rehabilitation named him "Physician of the Year."

John Triano graduated from Logan College of Chiropractic in St. Louis, Missouri, in 1973. He also holds a PhD in spine biomechanics from the University of Michigan, and was the first DC on the staff of the Texas Back Institute, where he treats almost 900 patients each year. He is a member of the American Society of Biomechanics, and has served as a back-injury consultant for the U.S. Department of Labor, the RAND Corp. and the AHCPR.

Dr. Triano sets a fine example for all doctors of chiropractic. His personal success and contributions to the profession underscore the importance of thinking outside of the box.