The following facts facilitated this decision:
- Extensive reform of the health care system appears inevitable, with the very real possibility that most health care will be managed by the year 2000.
- There is currently a crisis in primary care in the United States.
- There is a growing interest among Americans in alternative holistic health care.
- Chiropractic can qualify as a primary care provider within a wellness/holistic paradigm.
- Chiropractic must define its scope of practice.
- The chiropractic profession needs data from various kinds of scientific studies to further its legislative, governmental, and public relations agenda to insure its inclusion in whatever health care system emerges in the years ahead.
These assumptions resulted in two major goals in the FCER strategic plan that we believe will enhance chiropractic's status. Goal I: funding research to evaluate chiropractic's role as a clinically and cost effective primary health care profession, operating within a holistic paradigm. Goal II: foster the development of the research and education capacity within the chiropractic colleges to insure that chiropractors will qualify as primary care physicians.
One of the first things FCER has done to help the profession cope with the primary care issue is to change the emphasis on the kinds of research it will fund. In the past, FCER focused almost entirely on funding research on chiropractic treatments of low back pain. This was appropriate, as back pain comprises the majority of what most chiropractors treat.
The time has come for more emphasis to be placed on understanding how effective chiropractic is in the treatment of internal disorders. Is chiropractic effective in treating such things as hypertension, PMS, dysmenorrhea, colic, asthma, and enuresis? Does chiropractic preventive maintenance help the immune system to ward off disease? Are chiropractic patients who undergo regular maintenance care healthier than the general population? These questions must be answered. This is especially true today, as chiropractic and other health care providers are staring down the gun barrel of managed competition.
Because of FCER's efforts, research is already in place that investigates some of these questions. A $360,000 clinical trial to evaluate the effects of chiropractic spinal manipulation on dysmenorrhea is under way at National College of Chiropractic under the direction of well-known researcher Patricia Brennan, PhD. Two headache trials have been funded by FCER at Northwestern College of Chiropractic, with PMS and colic studies that are likely to be funded in the weeks ahead.
FCER is also interested in evaluating chiropractic treatment of sports-related and other peripheral joint injuries. A carpal tunnel study at Northwestern College of Chiropractic will soon be funded by FCER.
Economic studies are also of great importance to FCER and the future of the profession. Two such studies, partially funded by FCER, are available from our Staying Well division in Des Moines, Iowa. Known as the Virginia Studies, these investigations by economists at the College of William and Mary and the University of Richmond reveal chiropractic to be highly cost effective for the treatment of certain conditions. The studies are especially important to the profession as we enter the managed competition era which is heavily cost driven. More studies of this kind are needed to make the case for chiropractic's overall cost effectiveness and help to insure inclusion in managed care programs.
High priority is also being given by FCER to studies which will help the profession formulate compelling positions to influence lawmakers and policymaking bodies. A first step in this direction was taken with the publication of the highly acclaimed booklet, Chiropractic: A Primary Care Gatekeeper, by Arnold E. Cianciulli, MS, DC, FICC, FACC. This essay makes a strong case for chiropractors acting as primary care providers. Although it is well-reasoned and draws from valid data concerning chiropractic education and training, it may be viewed by some on the outside as not completely unbiased. An evaluation of the primary care gatekeeper issue by an outside, respected organization that has a strong track record on policy issues is needed. FCER is currently exploring such a possibility.
It has long been known that chiropractic health care is of great importance to rural populations. Unfortunately, there have been no surveys or studies to substantiate its role in rural America. Here is another area in which more research is needed to provide data to influence policymakers. Any statements about chiropractic's ability to assume primary care responsibilities in rural and medically underserved areas must be documented and substantiated to withstand criticism from a threatened medical community.
Finally, FCER has strengthened its ties within field doctors. Recently, our Research Director Anthony Rossner, PhD, met with a chiropractic physician in Florida who has successfully treated some 200 cases of otitis media in collaboration with a pediatrician. FCER hopes that by working with this doctor, one or more articles may be published based on these case studies.
Dr. Rosner is also working with several other field doctors to review important data that might eventually be published. This kind of information could become of great importance to chiropractic in securing primary care status.
FCER is dedicated to responding to the needs of the chiropractic profession in a changing health care environment. By working hand in hand, we can help to build a secure future based on the scientific principles of chiropractic and supported by research. Your support is needed to keep this future alive.
Stephen R. Seater, CAE
Executive Director, FCER
Arlington, Virginia
Click here for more information about Stephen R. Seater.