Up to 85 percent of Americans will have low back pain at sometimes in their lives, and accounts for an estimated $50 billion annually in health care costs. As a doctor of chiropractic, I have known this to be true for many years, as this is a study that has been repeatedly demonstrated over time with the same results. Its impact on current health care dollars simply reiterate in tough economic times that the average patient with low back pain perhaps cannot afford not to see a chiropractor.

Once again, with insurance costs escalating annually, and the terrible truth of limited benefits-unreasonable co-pays, deductibles, and limitations on health insurance policies, chiropractic allows for considerable value when or nation is attempting to reform its health care system and contain considerable costs.

Michigan has been in the throws of economic chaos for the last few years. All indicators are that it will not be much better anytime soon. This leaves a bad taste in patient’s mouths when it comes to healthcare. Too many times I hear the statement, “What do you mean I have a $40 co-pay, or a $1500 deductible? I never use to pay a dime to go to the doctor!” I think my generation has become accustomed to the historical insurance parameter of little to no out-of-pocket care. It has left the impression for weal or woe, that people believe that they shouldn’t have to pay for healthcare. Now, it costs considerable money from the patient to see their family doctor, chiropractor, or specialist. Let us break it down.

Health Insurance: Remember these jingles:”Like a good neighbor,” or “You’re in good hands.” Though the preceding jingles don’t necessarily equate to healthcare, you don’t quite feel that health insurance companies put you first anymore. Why is that? Because like most corporations, their primary interest has become profit reports, and happy stock holders. Even the nonprofit companies are recording huge profits, and paying million dollar bonuses to their CEO’s. With the internet and multimedia reporting, it is hard to discern where credibility lies, but one report suggested nearly 800 billion dollars last year in health insurance profits and administrative fees. That is better than 60% of our national debt. So when we see annual increases in insurance premiums in the vicinity of 11-16%, escalating deductibles and co-pays we can be sure of one thing: Insurance companies are charging more and paying less. I guess we can chalk this up to old fashioned greed. The problem is that many of the advisory board members to the large corporate insurance companies are judges, legislators, and stock holders. Conflict of interest you ask? I think so. Medicare has reported an annual 3% margin (give or take minimal error). One would think that the private sector could reasonably perform close to that. Don’t misunderstand me, I am not in favor of national healthcare for a plethora of reasons: quality of care, tax burden, choice of care, gatekeepers for portal of entry, and many other ill-defined parameters to the current Obama bill. Most importantly, it is absurd to think that a bean counter will determine what is the proper healthcare, and instruct the doctor on what he can or cannot do. There is a great book that clarifies much of this: The Awakening of a Surgeon, by David H. Janda, MD. At this point, it appears that national healthcare will never see funding. This is probably a profound blessing. Let us face it, the private sector is failing miserably. Our country regulates housing and agriculture. It is time to put limits on profits and administrative costs in the health insurance market.

Pharmaceuticals: One study reflected a 27 cent markup on the penny. That translates to an average 2700% profit margin by big pharma. Why can we go on-line, buy drugs from Canada (that were synthesized in the United States), and buy them for a third of the cost? Our Lawmakers allow the FDA to be run by the CEO’s and Board members of big Pharma. More conflict of interest? Greed? Probably both. Profits are more important than the health of America’s citizens. I believe that Big Pharma should make great profits, but reasonable profits. Again, more regulation on this essential industry is the probable medium to reasonable care.

Physicians: There is an old riddle that goes as follows: “You see a rich doctor, a poor doctor, and Santa Clause standing on a street corner. They all look down at the same time and see a $20 bill. Who gets it? The answer wittingly states, “The rich doctor, because everyone knows that Santa Clause and poor doctors don’t exist.” Pretty funny when you think about it, but it clearly states the perception on doctors and their income. It seems that there is a sizable portion of the population resent the physician’s income. I am sure a considerable amount of surgeons, specialists, and medical entrepreneurs make sizable incomes, but one needs to put in perspective the amount of investment and sacrifice a physician makes to become licensed. The average physician puts in 12 years of education with undergraduate, medical school, internship, and residency. The average physician will graduate with a student loan balance in excess of $275,000 (which is incidentally more than most mortgages). Physicians sacrifice many years and begin their careers worth huge debt. The earn their respectable incomes. We are already seeing a trend where medical school enrollment is declining and in certain areas of the country, a shortage of primary care physicians. In addition, the Obama administration is launching an increase to government branched employees, linked to the IRS to audit doctors, for the sole purpose or recovering “over payments.” The last report I have read estimates that between 3-4% of physicians commit Medicare fraud. However, on recovery audits, they will demand over five times that amount returned. The federal employee costs to the taxpayers may be higher than the actual recovery. Now, our government plans to punish the other 96% of physicians, by making the documentation and paper trail so extensive, doctors will lose actual time in patient care, or be force to hire otherwise unnecessary staff to help with the documentation.

On the other hand, doctors are under the gun to document and be very careful on how they give patients financial breaks when circumstances warrant it. We often are grateful for a physician that portrays warmth and compassion. Many caregivers will work with patients on financial concerns, albeit on a limited basis. Doctors must establish financial limitation, a need for care, a diagnosis, terms and plan of treatment. If a doctor (or healthcare establishment) fails on any of these, they may be accused of multiple fees (which is illegal). Recently I had a patient come in without of state insurance through which I was not networked. Our staff couldn’t reach a representative of the insurance that date. The patient was sure that they had coverage, however they were not aware of the provisions in their plan. We later discovered that the patient only had in network coverage for chiropractic, but with a huge co-pay. The patient expressed concern over costs, so we were able to offer special consideration to the patient that was half our original fee and less than the in network co-pay. However, the patient believed there was an agenda to the terms of care. I explained that they could terminate care immediately if they were not satisfied. They were not appeased by this and refused to the terms of care. I was forced to charge the patient my customary fees. In turn, they angrily called me greedy, evil, etc. Physicians are increasingly faced with the quandary of keeping a positive image while being forced to charge their patients greater out-of-pocket expense. Most conscientious physicians will attempt to work with patients if they have the control to make that an option. Many physicians associate in corporate healthcare systems. They do not have the authority to compromise their fees. Those that do, must be wary of the cost of maintaining practice. I bring this to light because there is a “front-line” we face in the healthcare delivery system. We must pick our battles together as doctor and patient. Until then, the only winners are the health insurance industry, big pharma, and the legislators that protect them.

Most recently, (this last weekend), a middle-aged patient had exhibited moderate pain in the low back, abdominal pain, and pain in the low (right) pelvis. Due to varying circumstances, she went to a local hospital ER where she was examined: imaging studies of her abdomen, where they subsequently gave her a plethora of pain killers, muscle relaxers, and NSAIDs. They sent her home and instructed her to make an appointment with a neurologist. She came to my office with an imaging study report and a generic handout on Lumbar Radicular Pain that the hospital had given to her. I noted two things: The imaging study noted only a cyst on the liver (which did not correlate with the patient’s pain), and a diagnosis of lumbar radicular pain (a pinched nerve). Nowhere was the spinal level indicated, nor was there any correlation with her symptoms. There were no test results, nor imaging studies of the spine indicated. What was indicated near the end of the handout, was the statement: “spinal manipulation is not recommended. It can increase the degree of disc protrusion.” Not only was this an absurd statement, it bordered legal and ethical boundaries. Every study that I have read in my career (without exception) that considers the etiology of disc derangement, spinal manipulation was not only the treatment of choice (where surgery was not indicated), it had the best long term recovery of any option. Also, when patients seek spinal manipulation for non-disc issues, there are usually indications that such procedures should still be performed in their presence:

Lewit, K. Manipulative Therapy in Rehabilitation of the Motor System. 1985

“Many of the questions frequently asked can be answered easily: what about spondylosis, disc prolapse, scoliosis, juvenile osteochondrosis, spondylolisthesis, osteoporosis, or ankylosing spondylitis? The answer is straight forward: these conditions do not form the basis for manipulative therapy. Nevertheless, if in such conditions movement restriction (blockage) is found and considered harmful, then it should be treated with adequate manipulative techniques.”

In short, an adjustment (spinal manipulations) should be performed where ever it is warranted, and though studies may be manipulated to say whatever the researcher wants it to say, spinal manipulation is a safe, effective measure against disc herniation. We need to ask the question to ourselves as patients, and to our physicians as treaters: what is best for my health? Always be wary of a physician or establishment that discourages other options and opinions, and do not accept the written word merely because it is written.

Remember, this is indeed about you.

When the bills passed the Legislature, they were given “immediate effect” by both chambers, meaning that our scope becomes law the minute the Governor signs them. However, this does not mean that doctors of chiropractic can immediately begin performing and billing for all the procedures, tests, and other services contained in the bills.

The bills give rulemaking authority regarding the new services to the Michigan Department of Community Health, working in conjunction with the Michigan Board of Chiropractic and utilizing nationally recognized standards within the profession to determine exactly which testing procedures and other services are allowed under the bills.

This legislative change will broaden chiropractic in Michigan so that we may practice according to our education, and bring us in line with the scopes of practice of the other 49 states. It should open up procedures such as ultra sound, electrical muscle stimulation, other physical therapies, as well as many new diagnostic measures. It will be some time however before the MDCH rules on these matters.

Congratulations to the MAC and their hard won efforts!

Finally this article states that the dangers of chiropractic may be justified by the fact that they can relate nearly 14 injuries to children in the 100 plus years of chiropractic. I would venture to say that in the US alone, more than that are maimed or killed in physician’s office each day. Of course it can be argued as apples and oranges. The truth speaks loudly that even though any health related procedure has a degree of risk, chiropractic is still one of the safest forms of health care today. In the article written in “Parents,” DR Hewitt cites the “Journal of Manipulative Physiological Therapeutics” – found that 94% of 316 colicky infants had a satisfactory result after two weeks of spinal manipulation, but goes on to conclude that: Injuries from spinal manipulation are extremely rare or remarkably underreported. With over nine million children seeing chiropractors annually, No medical therapy could stand up to that safety record. Many pediatricians will soon begin to realize that they themselves will attain much higher levels of success if they would just listen once in a while and work with the chiropractor. Afterall, it is about the kids. Isn’t it?

” We found strong associations between PCP (primary care physician ) visits and subsequent VBA stroke,” the study states. “A plausible explanation is that the patient with head and neck pain due to vertebral artery dissection seek care for symptoms, which preceed more than 80% of VBA strokes. In short, there was no difference in the percentage of incidence between chiropractors (who perform manipulation) and primary care physicians (who do not). The study concluded: “We found no evidence of excess risk of VBA stroke associated with chiropractic care.”

Sources: Cassisy, J. et.al. “Risk of Vertebralbasilar Stroke and Chiropractic Care,” Spine, Volume 33, Number 4S, ppS176-S183, copyright 2008, Lippincott Williams &Wilkins

Now, I will be the first to admit that this isn’t about chiropractic, or chiropractors. This isn’t about politics. This is about maintaining reasonable health care for the masses. Healthcare in the United States biggest downfall is its accessibility. I believe that we need to find an answer that US citizens may receive quality medical treatment, and more importantly, the choice to have whatever care you choose, including chiropractic. This cannot become an end-justify-the-means answer. If it is, even if we win, we lose. Look at some of the provisions of the current administration’s health provisions of the 1,000 page proposal:

.Admission: your health care will be rationed. .All non-US citizens, illegal or not, will be provided with free healthcare services.

.Taxpayers will subsidize all union retiree and community organizer health plans.

.All private healthcare plans must conform to government rules to participate in a Healthcare Exchange.

.No company can sue the government for price-fixing. No “judicial review” is permitted against the plan.

.An employer MUST auto-enroll employees into the government-run public plan.

.Government mandates establishment of outcome-based measures: i.e., rationing.

Just a few of many provisions are spelled out, or at least mentioned. They outline more government control, and a general watering down of current healthcare measures. There is no improvement in medical care. Gatekeepers who have never seen the patient will be dictating both the quality and quantity of care. I find it curious that ranking government officials are exempt from this governmental plan in favor of their own. Will they still cover chiropractic for government officials? This indeed would bear irony if the insurance elite would become our elected officials. Though the scope of this article is to ascertain and predict the future of chiropractic, it is difficult to hold onto the promise of a bright future when the quality of health care in general is bleak.

Chiropractic, like conventional medical care needs to return to basics. We need a little less emphasis on dollars and cents, and a little more on humanity, compassion, and the power of the adjustment. However, economics dictate the absolute necessity of the financial health of caregivers so that they remain in practice. The great uniqueness of chiropractic is what makes it successful and viable. For example, a recent worker’s comp study and chronic work disability compared chiropractic to conventional care among 1,885 workers. Disability was more than twice as common in workers who didn’t see chiropractic. The economic impacts of lost work time alone is greatly significant. What we lose in a budget cut is greater than what we save, not to mention both the quantity and quality of life.

Finally, where we fail the most in this is that we are consumed with treatment costs reductions, and we disregard prevention and patient education. It begins with caring for our bodies and living proper lifestyles. It is unfortunate, but in the end we may have to individually take control of our lives and health again. Entitlements and watered down treatment aimed at saving a buck, may force us to reconsider what it is to be healthy.

Perhaps, chiropractic will be that beacon of health, and rise from the ashes of the bean-counters!

In the recent Stanley Cup series, he documents the return of Pavel Datsyuk to the ice after missing several games to injury:

” He was rusty at first, and a mortal version of himself even later. But his presence was like a chiropractic adjustment for the Wings; it put steam in their stride.”

We all know what happened in that series. You lament as a Red Wing fan and elate as a Penguin fanatic. Yet Mr. Abom’s words echo the greatness of both the power of chiropractic and an NHL icon.

As chiropractor’s and patient’s of chiropractors, we seldom see or hear about the adjustment in a positive light. Most articles are laden with controversy, and most big screen references are excuses for a joke. From one of the first appearances of an adjustment on the Little Rascals and, the unusual chiropractic portrayals in the “Naked Man” and “Jacob’s Ladder”, to the bashing of chiropractic in “Two and a Half Men”, chiropractic occasionally becomes misunderstood. Yet Mitch recognizes potential, and there are none greater than chiropractic.

With the widespread use of marketing in healthcare, there is an increased awareness for the options available to the potential patient. This began with the FDA scoring a marketing victory that permitted the advertisement of drugs on television. You can find everything from cholesterol statins, erectile dysfunction, and sleep aids, not to mention, a host of side-effects. This awareness brings into the equation, a mindset where patients proceed to their physician and demand certain drugs. This can become a fundamental question of ethics for the challenged physician: Can I prescribe this medication? Is it safe to prescribe this medication? If I don’t prescribe this medication, will the patient go somewhere else and get it? This is the target of Big Pharma, to sell their drugs. It is very unfortunate that most often the economics of healthcare today will dictate the practice. Several years ago I read a study where specialty hospitals will perform various surgeries (many of which are unnecessary) far more often then those facilities that do not bear a distinction of specialty, because it is their “bread and butter.” This unfortunate revelation in healthcare is widely scattered throughout all the disciplines and facilities. Chiropractic is no different.

Which leads me to chiropractic and spinal decompression. We are observing a relatively new phenomenon in chiropractic. Though the spinal decompression modality began as a chiropractic entity in its use, it has limited spread to neurology and physical therapy. “If ya’ can’t lick ‘em, join ‘em” is an applicable after thought when other disciplines star using chiropractic methodology. Its inception is probably less than a decade old, and its proliferation into the chiropractic community is somewhere in the neighborhood of a half dozen years. Not to mention that spinal decompression is basically a computerized version traction, therefore its practical origins are physical therapy. I have read more than one article where a physical therapist was more than a little put-out by the chiropractic profession for claiming this procedure. Spinal decompression has undergone a similar exposure pattern as drugs and television, and conversely the chiropractor is faced with the same ethical question of treatment. When the spinal decompression equipment bursts onto the scene, it began with the large, bulky, but impressive DRX. These machines were in excess of $90,000 and many times the chiropractic physician was forced into an expensive marketing package for many thousands of dollars. This would involve a saturation campaign of cable infomercials and full page newspaper ads. This has expanded into radio and non-subscription television. People began flocking for the new treatment at the chiropractor’s office. This of course, brings to the table, many more ethical questions.

First, it has been well documented and published that chiropractors may forego proper assessment on their patients for spinal decompression. That is to say that economic precedent takes over: the chiropractor has such a high overhead from the historical cost of these machines and marketing packages, that they throw as many people as they can into the program, so that they can pay for all this equipment. Many chiropractors are charging $200 per session, or $4000 per plan. It is also apparent that there is a possibility of injuring patients without proper assessment.

Second, pain and fear are powerful motivations. When people enter a doctor’s office and are faced with the possibility of surgery, or are in tremendous pain, it is not uncommon for the treating physician to emphasize the downside of their condition as an alarmist. People who are in a great deal of pain are often not rational and pay the money before discussing other possible options. When we deal with a treatment plan that is (for the most part) not covered by insurance, the doctor has a responsibility to make the plan as reasonable as possible. How good is any treatment, if it is not accessible to those who need it most? The treating physician is ethically obligated to assess and present the treatment options to the patient, so that they may make an educated and informed decision.

Third, physicians need to market themselves accordingly. This means that they should not oversell their product and represent it accurately. Terms like “miracle cure,” or “modern miracle” should make you wary. Many modern chiropractors flock the “sheeple” right in for something that they claim will instantly eliminate their worst back dilemma. In the reporting of spinal decompression studies, it is much too early to determine its long term effectiveness. Many of these reports are twenty or more years in the making, and there is much disparity between early reports. Remember, no form of healthcare is 100% effective in its approach. I have seen various numbers over the years on the success of chiropractic care with diagnosed disc issues, with the most prevalent percentage being around 83%. I think this seems close to the success that I have seen in my practice, though this conflicts with the recent Consumer Report’s article of very satisfied patients at 59%. Spinal decompression may well take us into the 90% category with an increased success rate in the worst cases (of all those that do not require surgery).

Finally, there is no data on the longevity of spinal decompression. Once again, the methodology is simply too new. There may some speculation that in successful cases, and in the absence of new, significant trauma, there may be no more need for an additional exhaustive treatment plan in the course of a patient’s life. I find this highly unlikely. There are too many mitigating factors to consider, and though many people may enjoy years of success with spinal decompression, I find that “the more degenerated a spine” is, the least likely it is to have considerable longevity.

When you seek a chiropractor, find one with a good reputation, who uses established, recognized techniques. If the doctor uses spinal decompression, one should consider what other services they offer. I am hearing repeatedly of the disturbing trend that chiropractors are discontinuing their spinal adjusting and only performing decompression. Why would a trained and licensed health professional give up seven or more years of higher education to limit themselves to this procedure? I can think of only two reasons: they were either not very good at adjusting the spine, or the spinal decompression practice has become too lucrative for them to ignore. Also be weary of the doctor who changes everything that they do, for this new “miracle cure.” Spinal decompression is just a tool, and a good one at that, but it is not a replacement for what has made chiropractic great over the past 100 years!