An article, "Chiropractors Seek Alignment in Health Plan," was featured on the front page of the Los Angeles Times, June 21, 1993 edition. The L.A. Times enjoys a daily circulation of 1,138,353. The article was continued on two other pages, with a total coverage of almost one-half page.
The article had some very interesting insight into how chiropractic is perceived by the media and others. Consider the following excerpts:
But the chiropractors appear likely to wage one of the most aggressive and visible battles for inclusion in the reform program. The intensity of their campaign reflects not only the large number of practitioners and their patients, but also the profession's continuing struggle for respectability.It is typical in a newspaper article such as this to use a variety of sources; one pro, one con, and one to add other pertinent information. Consider the comments made by Arthur Caplan:The increasing credibility achieved by chiropractic reflects its success in relieving certain muscular and skeletal problems, especially lower back pain, an affliction that plagues millions of Americans. But there is still widespread skepticism about its effectiveness for other kinds of ailments, particularly those not muscular or skeletal in origin.
Some anecdotal evidence suggests that chiropractic has more widespread applications, but it has not been corroborated by scientific studies.
Chiropractors argue that their emphasis on prevention, and their avoidance of high-cost drugs and surgery, is consistent with the administration's health care philosophy.
Until the final decisions are made, chiropractors are taking no chances. They are lobbying Capitol Hill well in advance of the announcement of the reform package. They are forwarding reams of petitions to the White House generated by individual practitioners, state chiropractic associations, and signed by consumers, urging that the reform proposals preserve their right to choose chiropractic care as a covered service.
"By no means are they (the chiropractors) a force to be taken lightly in the political arena," said Arthur Caplan, director of the University of Minnesota Medical School's Center for Biomedical Ethics. "If you respect consumer choice, then they are doing something right, because there are lots of them, doing very well, and they have lots of loyal clients."Additional information was provided by Michael Lux, special assistant to President Clinton for public liaison:"The medical establishment views them as kooks," Caplan said. "Many doctors believe that chiropractic techniques can give pain relief for joint or muscle problems, but they think the underlying philosophy is total nonsense. The problem chiropractic faces in getting included (in the administration's benefit package) is that people are concerned about the slippery slope. If chiropractic gets in, can Rolfing and aroma therapy be far behind?"
"What we are trying to do in our package is be scientific about what kind of preventive measures and treatments will cost less money in the long run and have a pay back over time," Lux said. "Can we document their claims in any kind of scientific way? If we can, there's a very good chance it will be in the package."The American Medical Association's position was included with several statements from Dr. James Todd, executive vice president of the AMA:"Moreover, services currently covered in many plans stand a good chance of being covered in the reform package," he said.
"That's something we will take a serious look at," Lux said. "We want to have a benefits package that is fairly similar to most people's experience. We don't want to radically veer away from that."
"The AMA is still concerned that chiropractors will attempt to exceed their limited licenses by operating as primary care physicians.The article gave Louis Sportelli, DC, "the last word" to rebut Dr. Todd's comments:"The issue at the moment is their ability to make an appropriate diagnosis," Todd said. "That is fundamental to any medical management. Once a diagnosis is made, there probably are many limited-license practitioners who can participate in care, but we want to make sure that the diagnosis is made by people adequately educated to do it."
"Sportelli counters that chiropractors 'are almost a natural to be primary care providers' because of their whole-body approach, which includes evaluation of diet and other lifestyle behaviors. He insists that their diagnostic ability 'may well exceed' their therapeutic ability."Chiropractors are eminently qualified to make a diagnosis and determine one of three ways patients can be handled," Sportelli said. "Either they belong in the chiropractor's office, or they are outside the realm of the chiropractor and need a specific referral, or we co-manage, either with a specialist or a family physician. Patients may need the best of both. If the whole trend today is toward prevention, no professional emphasizes that more than doctors of chiropractic."
This is the type of balanced presentation that the chiropractic profession has earned. While there may still be the occasional "hit piece," most of the articles will tend to be critical only where the profession's actions appear to be contrary to the needs of the public or suggest irresponsibility.
In many ways, being in the news is better than being ignored. The media only talk about you when you are doing something notable.
Health Magazine Examines the Polarity of the Profession -- But Also Its Devoted Patients, Growing Recognition, Cost-Effectiveness, Standards of Care, and Its Science
An eight-page, in-depth article, "Bones of Contention," appeared in the July/August issue of Health magazine. Staff writer Rick Weiss seeks to answer the question, "Do chiropractors know what they're doing? Does it matter, if it helps?"
Mr. Weiss' basic and entertaining modus operandi was to juxtapose the viewpoints of two chiropractors at opposite ends of the chiropractic spectrum: Dr. Sid Williams, president and founder of Life College, affirming the straight manifesto, and John Triano, DC, MA, National College's director of joint ergonomics and research laboratory, asserting the mixer credo.
The quotes from Drs. Williams and Triano in the article give the reader the impression that if chiropractic were the Grand Canyon, Sid Williams would be on one side and John Triano on the other, separated by the great yawning abyss.
Dr. Williams: "Rigor mortis is the only thing that we can't help."The author gives his assessment of chiropractic's divided house:Dr. Triano: "We know what patients look like, we know they benefit from adjustments, but we still don't have a good grasp of what's really going on."
Dr. Williams: "You're not talking to a quack-charlatan- cultist. ... Don't say I'm against research. But a damned fish peddler figured this out! That's the problem: This thing is so simple, but everybody tries to make it so complicated."
Dr. Triano: People like Sid Williams believe they have the answer, that subluxations are the root of all evil. But there's no evidence that their belief system is true. In fact, there is evidence that the main tenets of chiropractic are not true. But so what? This is how science works."
"... chiropractors have for decades been embroiled in a civil war. On one side are Dr. Sid and his fellow 'straight' chiropractors, who see themselves as the pure conscience of chiropractic tradition. ... On the other side are so-called 'mixers,' who favor blending the principles of chiropractic with those of other healing arts, ranging form herbalism too modern medicine ... less reliance on chiropractic tradition and more on peer-reviewed clinical trials ..."The article views Dr. Williams as a fundamentalist, a man who has "dedicated his life to preserving chiropractic's unorthodox past." Author Weiss sees Dr. Triano as a man trying to bring chiropractic "into the scientific fold"; a "new breed of chiropractors who commit the ultimate blasphemy of suggesting that subluxations may not exist."
While the article paints Dr. Williams as a colorful, engaging figure, which he certainly is, it treats Dr. Triano as a man of science, viewing his "adjustment table from hell" that is wired with $100,000 of force-detector wiring. Dr. Triano has been able to measure the time of an adjustment (.125 seconds) and its force (about 200 pounds).
But the article doesn't dwell solely on two personalities, nor straight vs. mixer. It speaks of chiropractic's "huge following of dedicated patients"; of hospitals increasingly adding DCs to their staffs; of third-party reimbursement by federal programs, workers' compensation, and private insurance; of studies showing chiropractic's importance in relieving low-back pain, and the cost effectiveness of that therapy.
The author further states:
"Anybody who has been to a medical doctor, especially for back pain, know how unsatisfactory such a visit can be."Norman Gevitz, a medical historian at the University of Illinois at Chicago is then quoted:"Surveys indicate that back-pain patients who go to chiropractors are more satisfied with their care than are those who go to medical doctors."
"The insurance companies love chiropractors because for occupational injuries and low-back pain they get their patients back to work sooner."Mr. Gevitz also offers:
"An MD will give a pill, a prescription, but no tactile contact. Chiropractors feel around. They have a nice tactile sense, and patients feel relieved."The question on chiropractic's foundation in science then arises:
"Research is increasing, but here is still very little evidence to support any of what they do," says Dr. Gevitz.Paul Shekelle, MD, principle investigator of the RAND study on low-back pain, retorts:
"There's a lot going on in medicine that is just as unproven as chiropractic."The author notes:
"Add to that chiropractic's excellent safety record (only a handful of serious injuries have ever been reported out of many millions of adjustments), and the question of whether chiropractors have enough science on their side starts to take on a somewhat hollow ring."
The article is further rounded out by a chiropractic historical perspective, and Dr. Keating's bete noire: three chiropractic patient testimonials.
The first patient (labelled the "Occasional User") injured his back when he was 20-years old. After he saw a DC, he "walked out of there like a new human being."
The second testimonial ("The Skeptic") is a young swimmer who slipped by the pool and injured her lumbar area. After more than a year of chiropractic from one DC, she still wasn't better: fed up with excuses, she stopped her therapy. "I think he was just going to milk it for as long as he could," she relates.
Author Weiss offers a good piece of advice:
"Find a chiropractor who is willing to call it quits when adjustments aren't helping and has the wisdom to refer patients to a physician when appropriate."The third patient is the "Convert," who states simply, "... chiropractic adjustments make me feel so good."
The article also notes the "ground breaking conference held in California last year." Mr. Weiss is alluding to, of course, the Mercy Conference:
"... most of the nation's chiropractors have welcomed the resulting document -- especially since the federal government may soon require similar assessments of efficacy before approving reimbursement through Medicaid and Medicare."The author adds:
"But Dr. Sid and his followers are vehement in their opposition to those guidelines, claiming the rules will only get in the way..."The article makes one wonder if chiropractic will ever get out of its own way.
The straights and mixers will never agree philosophically, but chiropractic has demonstrated growth despite divisiveness. The chiropractic politicos fight for broader legislative influence; the chiropractic scientists garner attention and respect with their studies; the chiropractic administrators have the foresight to guide the profession towards standards of care.
And at the root of it all, is chiropractic's ace in the hole -- the power of the adjustment.
Managed Health Care News Reports on Growth of Chiropractic
The June 1993 issue of Managed Health Care News, a magazine with a circulation of roughly 30,000, features chiropractic in its article on the growing popularity of "alternative medicine." In a coup for chiropractic, author Adam Peck quotes Louis Sportelli, DC, former chairman of the board of the American Chiropractic Association (ACA), on the feasibility and cost effectiveness of chiropractic. The article addresses the ever-increasing acceptance of alternative therapies such as chiropractic, acupuncture, hypnosis, and biofeedback.
Thankfully, the unbiased, concise article is one that is well-researched. For example, Mr. Peck provides the statistic reported in the January issue of the New England Journal of Medicine: In 1990 Americans spent $13.7 billion on so-called unconventional therapy. Moreover, 55 percent said they paid the entire cost out of their own pockets. These statistics reflect the dissatisfaction many patients are feeling about allopathic medicine, and the turn toward alternative treatments.
The author notes, "Of the various nontraditional forms of care, chiropractic has made some of the deepest inroads into accepted medicine" and that chiropractic "has won over the public." According to "Unconventional Medicine in the United States," the study published in the January New England Journal of Medicine, patients with back problems form the largest single group of nontraditional therapy users. Those with allergies are the second largest group, and people with arthritis are the third. "Chiropractic addresses both back problems and arthritis," the article states, "making it a major form of unconventional medicine."
The article also outlines the gradual acceptance of chiropractic by HMOs and other provider groups. The chiropractic profession has had to fight to be included under insurance coverage, but its cost effectiveness has been demonstrated, and the results of this good record are beginning to show. "For years, third-party insurance companies were compelled to pay for chiropractic treatment by legislative fiat," the author writes, "but this captive audience has provided the opportunity for chiropractic care to accumulate a track record." The track record apparently won over the Group Health Association of America: according to the article, more than half of the HMOs surveyed in 1990 offer chiropractic coverage as an added benefit.
Studies reflecting the effectiveness of chiropractic have also added credibility to the profession. The Managed Health Care News article mentions the June 1990 British Medical Journal study, and the 1992 Virginia economic assessment. Both studies rate chiropractic favorably, and give credence to the theory that the profession can help to slash bloated health care budgets. The article quotes Louis Sportelli, DC: "All the cost-effectiveness studies showed chiropractic intervention worked twice as effective at half the cost." Dr. Sportelli indicates that economics will become "the great leveler" in health care and that is the reason chiropractic will come out on top. "Those (treatments) that are going to survive are those that are the most feasible, practical and useful," he says.
The one drawback: allopathic medicine is demanding more controlled research. "The medical model is based on the scientific research model, which requires a control on the experiment and requires you to have no bias on the experiment before it's started," says Mary Huff, communications manager for SouthCare Medical Alliance in Atlanta, Georgia. "Some of the [alternative] treatment modalities don't take that view." It is not enough that patients trust their chiropractors -- the people responsible for purchasing insurance must be convinced as well. Ms. Huff continues, "Chiropractors have done a lot of research, but they haven't done enough to get that to the health care payer."
Time will tell what the results of the upcoming research by the National Institutes of Health (HIH)'s Office of Alternative Medicine will bring. "Positive results from NIH would be a step in the direction toward convincing a 'skeptical, conservative physician,'" the article states. Meanwhile, chiropractic has been getting some positive -- and long overdue -- attention.
Chiropractic's world is expanding. The challenges that chiropractic faces are increasing in tandem. With continued research and political awareness, the profession is finding a larger role in health care.
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