A study conducted in the United States involving 395,641 patients with one or more of 493 neuromusculoskeletal conditions was undertaken to compare the health care costs of patients who have received chiropractic treatment to those treated solely by medical or osteopathic physicians. The results showed that “patients receiving chiropractic care experienced significantly lower health care costs … (with) total cost differences on the order of $1000 over the 2-year period …” The report concluded that”… these preliminary results suggest a significant cost-saving potential for users of chiropractic care.” The report of the study also suggests the need to re-examine insurance practices and programs relative to chiropractic coverage (Stano 1993).

The Florida study on workers’ compensation claims, previously cited in reference to back pain, found that “the estimated average total cost of care, computed across all the major categories of treatment cost, was substantially higher for medical patients compared with chiropractic patients…” The authors of the study included that chiropractic care is more cost-effective in the treatment of work-related back injuries than standard medical care (Wow 1988).

A 1988 workers’ compensation study conducted in Utah assessed the total cost per case of chiropractic care versus medical care for conditions with identical diagnostic codes. The results indicated that costs were significantly higher for medical claims than for chiropractic claims, In addition, the number of work days lost for those receiving medical care was nearly 10 times higher than for those who received chiropractic care (Jarvis, Phillips, and Morris 1991).

A comparison of the cost of chiropractic care versus the cost of medical care for various health conditions (predominantly low-back pain, spinal-related sprains, strains, dislocations, arthritis, and disc disorders), revealed that “chiropractic is a lower cost option for several prominent back-related ailments … If chiropractic care is insured to the extent other specialists are stipulated, it may emerge as a first option for patients with certain medical conditions. This could very well result in a decrease in overall treatment costs for these conditions” (Dean and Schrnidt 1992).

A review of data from over two million users of chiropractic care in the United States was reported in the Journal of American Health Policy. Initial analysis indicated that “chiropractic users tend to have substantially lower total health care costs” and “chiropractic care reduces the use of both physician and hospital care” (Stano et al. 1992).

A workers’ compensation study conducted in Oregon (1990) evaluated the loss of working time incurred by chiropractic (DC) and medical (MD) claimants with disabling low-back work-related injuries. Authors of the study concluded that “the median time loss days for cases with comparable clinical presentation (severity) was 9.0 for DC cases and 11.5 for MD cases. Chiropractic claimants had a higher frequency of return to work with one week or less of time loss.” (Nyiendo 1991).

A study, published in 1992, compared the cost-effectiveness of chiropractic care to medical care in the commonwealth of Virginia. The report of the study indicated that chiropractic:

1. has minimal cost-increasing effects on insurance and may in fact reduce insurance costs.

2. provides important therapeutic benefits at economical costs.

This study also recommended that chiropractic care be a widely available form of health care, and noted that it is a growing and widely used component of the health care sector (Schifrin 1992).

In 1987, following 11 years of legal action, a federal appellate court judge ruled that the AMA had engaged in a “lengthy, systematic, successful and unlawful boycott” designed to restrict cooperation between MDs and chiropractors in order to eliminate the profession of chiropractic as a competitor in the United States health care system. During the preceedings it was shown that the AMA attempted to :

1. Undermine Chiropractic schools

2. Undercut insurance programs for Chiropractic patients

3. Conceal evidence of the effectiveness of Chiropractic care

4. Subvert government inquires into the effectiveness of Chiropractic

5. Promote other activities that would control the monopoly that the AMA had on health care

(This was upheld by the 7th United States Circuit Court of Appeals.)

The AMA offered a patient care defense; however, data from Workmen’s Compensation Bureau studies served to validate chiropractic care. Specifically, studies comparing chiropractic care to care by a medical physician were presented which showed that chiropractors were “twice as effective as medical physicians, for comparable injuries, in returning injured workers to work at every level of injury severity.”

The settlement of the suit included an injunctive order in which the AMA was instructed to cease its efforts to restrict the professional association of chiropractors and AMA members. The AMA was also ordered to notify its 275,000 members of the court’s injunction. In addition, the American Hospital Association (AHA) sent out 440,000 separate notices to inform hospitals across the United States that the AHA has no objection to allowing chiropractic care in hospitals.

Since the court findings and conclusions were released, a growing number of medical doctors, hospitals, and health care organizations in the United States have begun including the services of chiropractors.

• Chiropractors with the Doctor of Chiropractic degree should become registered practitioners and be brought within the national insurance system.
• The university-level training of DCs is equivalent to Swedish medical training.
• DCs have competency in differential diagnosis and should be regulated on a primary care basis.
• Measures to improve cooperation between chiropractors, registered medical practitioners and physiotherapists are vital to the public interest.

“We entered into our inquiry in early 1978. We had no clear idea what might emerge. We knew little about chiropractors. None of us had undergone any personal experience of chiropractic treatment. If we had any general impression of chiropractic it was probably that shared by many in the community: that chiropractic was an unscientific cult, not to be compared with orthodox medical or paramedical services. We might well have thought that chiropractors were people with perhaps a strong urge for healing, who had for some reason not been able to get into a field recognized by orthodox medicine and who had found an outlet outside the fringes of orthodoxy.

“But as we prepared ourselves for this inquiry it became apparent that much lay beneath the surface of these apparently simple terms of reference. In the first place it transpired that for many years chiropractors had been making strenuous efforts to gain recognition and acceptance as members of the established health care team. Secondly, it was clear that organized medicine the New Zealand was adamantly opposed to this on a variety of grounds which appeared logical and responsible. Thirdly, however, it became only too plain that the argument had been going on ever since chiropractic was developed as an individual discipline in the late 1800’s, and that in the years between then and now the debate had generated considerable more heat than light.

“By the end of the of the inquiry we found ourselves irresistibly and with complete unanimity drawn to the conclusion that modern chiropractic is a soundly-based and valuable branch of the health care in a specialized area…”

Specific conclusions of the Commission’s report, based on investigations in New Zealand, the United States, Canada, the United Kingdom, and Australia, were as follows:

• Modern chiropractic is far from being an “unscientific cult”
• Chiropractic is a branch of the healing arts specializing in the correction by spinal manual therapy of what chiropractors identify as biomechanical disorders of the spinal column. They carry out spinal diagnosis and therapy at a sophisticated and refined level.
  Chiropractors are the only health practitioners who are necessarily equipped by their education and training to carry out spinal manual therapy.
• General medical practitioners and physiotherapists have no adequate training in spinal manual therapy, though a few have acquired skill in it subsequent to graduation.
• Spinal manual therapy in the hands of a registered chiropractor is safe.
• The education and training of a registered chiropractor are sufficient to enable him to determine whether… the patient should have medical care instead of or as well as chiropractic care.
• Spinal manual therapy can be effective in relieving musculo-skeletal symptoms such as back pain, and other symptoms known to respond to such therapy, such as migraine.
• In a limited number of cases where there are organic and/or visceral symptoms, chiropractic treatment may provide relief, but this is unpredictable, and in such cases the patient should be under concurrent medical care if that is practicable.
• Although the precise nature of the biomechanical dysfunction and… the precise reasons why spinal manual therapy provides relief have not yet been scientifically explained, chiropractors have reasonable grounds based on clinical evidence for their belief that symptoms of the kind described above can respond beneficially to spinal manual therapy.
• In the public interest and in the interest of patients there must be no impediment to full professional cooperation between chiropractors and medical practitioners.

Subsequent to the New Zealand Inquiry, the Australian Federal Minister of Health requested that a Committee be formed to consider extending the scope of (government-funded) Medicare benefits for certain services, including chiropractic.

The Committee accepted all of the findings of the New Zealand commission, and also noted the “significant shift in the last decade in attitude … towards the issue of scientific research” in chiropractic. It also recommended funding for chiropractic in hospitals and other public institutions, and endorsed greater philosophical unity in chiropractic.

In recent years, the Canadian and United States governments have begun requiring that health professionals provide guidelines for use in assessing the appropriateness of care. In an attempt to address this requirement, 33 chiropractors in North America were invited to participate in a conference held in early 1992 at the Mercy Center in Burlingame, California. A publication released in early 1993 entitled, Guidelines for Chiropractic Quality Assurance and Practice Parameters, related the proceedings of that conference.

During April 1993, the Canadian Chiropractic Association sponsored a conference in Toronto to establish clinical guidelines for chiropractic standards of care in Canada. The participating members included chiropractors from various chiropractic organizations throughout Canada. Results of this conference will be published in a report scheduled for release at the end of 1993.

A survey in the province of Ontario revealed that a majority of MDs in family practice (62%) were referring patients to chiropractors. Nearly half of these MDs (42.3%) had been referring patients for the past 1-5 years, with the referral rate being slightly higher among MDs who had graduated before 1960 (60%) and between 1960 and 1980 (63%) than for those who had graduated in the past 10 years (53.8%). In addition, the study revealed that 9.5% of these MDs had received chiropractic care themselves (Patel-Christopher 1990).

A Gallup poll conducted in the United States and reported in March of 1991 examined the attitudes and behaviors of both users and nonusers of chiropractic services. Of the users of chiropractic services:

1. 90% felt chiropractic treatment was effective;

2. more than 80% were satisfied with their treatment;

3. nearly 73% felt most of their expectations had been met during their visits;

4. 68% would see a chiropractor again for treatment of a similar condition;

5. 30% would likely see a chiropractor again for other conditions.

Of the non-users of chiropractic services:

6. 62% indicated they would see a doctor of chiropractic for a problem applicable to chiropractic treatment;

7. 23% reported that someone in their household had been treated by a chiropractor, and nearly 80% of those were satisfied with that treatment.

A 1983 survey of North Dakota residents, also conducted by the Gallup Organization, indicated that awareness and use of chiropractic services in the state were very high. Nearly 100% of the residents had heard of chiropractors, and almost half of the residents (49%) reported that they had been examined or treated by a chiropractor at some time. One in six residents (17%) had seen a chiropractor in the past year.

• spinal manipulation is a recommended treatment for acute low back problems in adults;
• conservative treatment such as manipulation should be pursued — in most cases — before surgical interventions are considered;
• prescription drugs such as oral steroids, antidepressant medications and colchicine are not recommended for acute low back problems.

Other research in which Dr. Freeman is involved includes a paper soon to be published in the Journal of Musculoskeletal Pain that shows absolutely no connection between the amount of damage to a vehicle and to a person involved in the same rear-impact collision. ”If you are injured, whether the vehicle sustains no damage or is totaled, there is a one-in-three chance you will have chronic pain. It doesn’t matter how much-or how little-damage there is to the vehicle.