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Is Chiropractic Care a Visionary Form of Health-Care Reform?
If you’ve ever complained of a terrifically sore neck or lingering back pain, I’ll bet someone suggested that you see a chiropractor. I visit my chiropractor when my recurrent neck pain flares up (as in, when I spend too many hours in front of my computer for too many days in a row), and I know lots of other people who see chiropractors, too. Now research is affirming the efficacy of chiropractic care for a number of conditions, and this trend may be further stoked by changes brought about by health-care reform.
For many complaints, including such varied and seemingly unrelated ones as headaches and digestive distress as well as back and neck problems, chiropractic care can often provide safe, effective and fast-working treatment -- and (unusual for natural therapies) most insurance plans cover it. However, many mainstream medical doctors aren’t fans. Their reasons aren’t always clear but seem to lie somewhere on the spectrum between being worried that chiropractic care is not safe and feeling threatened that good chiropractors may take away many of their patients.
The Time is Right
In a glass-is-half-full kind of way, today’s troubled health-care environment actually presents an opportunity for chiropractors to gain some long overdue respect -- at least that’s a hope that’s currently afloat in the chiropractic community, I heard from Robert A. Hayden, DC, PhD, spokesperson for the American Chiropractic Association. A critical-care nurse for 20 years before becoming a chiropractor himself, Dr. Hayden explained that the nation’s ongoing and pressing concern about health-care costs and treatment efficacy is a good backdrop against which to understand the many ways chiropractic care can help patients.
Why are doctors skeptical? Dr. Hayden told me that one of his regular patients is an orthopedic surgeon -- but another orthopedist in his community won’t accept patient referrals from Dr. Hayden, and a nearby hospital won’t perform MRI scans for his patients. He believes this lack of acceptance is fueled by the very fact that chiropractic does not involve drugs and can be an effective alternative to hospitalization and surgery, which makes it attractive to both patients and the bean counters of health-care costs. The fact that Medicare now covers some chiropractic services enhances its credibility but also adds weight to worries that this natural, less invasive and less expensive alternative will divert health-care dollars away from medical doctors and hospitals.
What Will It Take?
Key to the growing acceptance of chiropractic care is evidence-based research demonstrating that it is safe, clinically effective and cost-efficient. In the latest such effort, funded by Mercer Health and Benefits in San Francisco, Dr. Niteesh Choudry and colleagues reviewed existing literature on the efficacy of chiropractic. Their conclusion is that it works as well as or better than conventional modalities, including exercise programs, drug regimens and surgical intervention, for treating many forms of low back and neck pain, two of the most common medical complaints. Numerous other studies also support the effectiveness of chiropractic treatment for spine and neck issues in particular. For instance, a 2002 study of patients with nonspecific neck pain found that pain was reduced and function improved for 68.3% after seven weeks of chiropractic care, while the success rate for those in the care of general practitioners was only 36%. The patients of chiropractors missed work less frequently and needed less pain medication.
Can It Cause Stroke?
One very specific concern voiced by many medical doctors is that chiropractic neck manipulation has the potential to cause stroke, or -- if done improperly -- even death. The basis for this is a fairly rare and often undiagnosed condition in which the vertebral arteries in the neck are weakened, possibly by high levels of homocysteine. The fear is that in a vulnerable patient, twisting or stretching those arteries during a chiropractic manipulation could cause them to rupture.
To investigate whether this is a real danger, researchers at the University of Calgary (Alberta, Canada) studied vertebral arteries from several recently deceased people and found that it would take nine times the force of a typical chiropractic adjustment to damage these arteries and mobilize plaque. In fact, according to Dr. Hayden, normal head and neck movement present a greater risk than chiropractic manipulation for the kind of weak arteries that are of concern. By that measure, it’s risky to have your hair washed in one of those beauty parlor sinks where you have to lean way back (there’s even a name for this one, "the beauty parlor stroke"), play sports or even to turn your head to complete a turn while driving.
The condition that puts people at risk for this problem is very rare, Dr. Hayden said, noting that the statistics don’t support the level of concern being expressed. He pointed out that chiropractic is so low-risk that practitioners’ malpractice insurance costs only about one-tenth what an MD has to pay -- around $1,300, on average, compared with $10,000 to $20,000 for general physicians.
The Trend Is Good...
Meanwhile though, patients are voting with their feet -- so maybe doctors should try to learn more about chiropractic care rather than stand in the way of progress. The number of chiropractic patients in this country doubled in the two decades from 1982 to 2002, and an estimated 10% of Americans have seen a chiropractor in the past year.
As for me, well, when my neck hurts, I visit my chiropractor... and I feel better. If you’re interested in exploring this form of alternative medical care, you can go to http://www.acatoday.org/search/memsearch.cfm to find an experienced, licensed practitioner in your area.
Robert A. Hayden, DC, PhD, founder and director of Iris City Chiropractic Center, PC, Griffin, Georgia, and spokesperson for the American Chiropractic Association.
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