Chiropractic Integration - The integration in government & hospitals

In 1994, the Agency for Health Care Policy and Research (AHCPR), a branch of the U.S. Department of Health and Human Services, recommended spinal manipulation as an initial form of therapy for low back sufferers, finding it both “safe and effective.” [4] The statement by AHCPR was based on its scientific review of all the accumulated evidence on spinal manipulation. Spinal manipulation is the primary form of treatment performed by doctors of chiropractic. In fact, doctors of chiropractic perform 94 percent of all spinal manipulative therapy in the United States. [5]

More recently, a study released in 2001 by the Center for Clinical Health Policy Research at Duke University concluded that spinal manipulation resulted in almost immediate improvement for cervicogenic headaches, or those that originate in the neck, and had significantly fewer side effects and longer-lasting relief of tension-type headache than a commonly prescribed medication. [6] Other positive studies include a 1993 report prepared for the Ontario Ministry of Health that found that chiropractic care is “the most effective treatment” for low back pain and that it “should be fully integrated in the government’s health care system,” [7] and a study published in the 1995 British Medical Journal that found that for long-term low back pain, “Improvement in all patients at three years was about 29% more in those treated by chiropractors than in those treated by the hospitals.” The study continued, “The beneficial effect of chiropractic on pain was particularly clear.” [8]

Chiropractic care has been successfully integrated on into today’s health care system. For example, the prestigious Texas Back Institute (TBI), the largest, freestanding spine specialty clinic in the United States of America, [9] at one time included only surgeons and other MDs. Then, nearly 15 years ago, when TBI’s medical doctors discovered chiropractic’s success with low back pain, they hired their first doctor of chiropractic. Now, according to published articles, about 50 percent of the Institute’s patients see a chiropractor first when beginning their treatment. Chiropractic care is included at the attending physician's office on Capitol Hill, at the internship program at Bethesda, Maryland’s, National Naval Medical Center as well as at the Complementary and Alternative Medicine (CAM) Center at the National Institutes of Health.

For example, Baratz claimed during a program that “hundreds of people” are paralyzed each year from chiropractic neck manipulation. Not only is this incorrect assessment completely unfounded, it boldly ignores the scientific literature on the topic. A study by the Rand Corporation found that a serious adverse reaction from cervical (neck) manipulation may occur less than once in 1 million treatments. [10] Studies have also shown that these rare adverse reactions more frequently occur after visits to health care professionals who are inexperienced or inadequately trained in spinal manipulation, rather than to licensed doctors of chiropractic. [11] A more recent article in the Canadian Medical Association Journal found only a 1-in-5.85-million risk that a chiropractic adjustment of the neck may result in vertebral artery dissection. [12]

The ACA believes that patients have the right to know about the health risks associated with any type of treatment, including chiropractic. However, health care consumers should be aware that the risks associated with chiropractic treatment are infinitesimally low

[4] Bigos S, Bowyer O, Braen G, et al. Acute low back problems in adults. Clinical practice guidelines no. 14 AHCPR Pubilcation No. 95-0642. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services. December 1994.
[5] Shekelle, et al. The appropriateness of spinal manipulation for low back pain: project overview and literature review. RAND, R-4025/1-CCR, 1991.
[6] McCrory DC, Penzlan DB, Hasselbad V, Gray RN. Evidence report: Behavioral and physical treatments for tension-type and cervicogenic headache. Des Moines, IA: Foundation for Chiropractic Education and Research, 2001.
[7] Manga P, Angus D, Papadopolous C, Swan W. A study to examine the effectiveness and cost-effectiveness of chiropractic management of low back pain. Kenilworth Publishing, Richmond Hill, Ontario, 1993.
[8] Meade T, Dyer S, Browne W, Townsend J, Frank A. Randomized comparison of chiropractic and hospital outpatient management for low back pain: results from an extended follow up. British Medical Journal 1995; 311:349-351.
[9] Texas Back Institute: About us. Retrieved June 5, 2002, from http://www.texasback.com/index.html
[10]Hurwitz EL, Aker PD, Adams AH, Meeker WC, Shekelle PG. Manipulation and mobilization of the cervical spine. A systematic review of the literature. Spine 1996; 21: 1746 59.
[11] Terrett AGJ. Misuse of the literature by medical authors in discussing spinal manipulative therapy injury. Journal of Manipulative and Physiological Therapeutics 1995; 18(4): 203-210.
[1] NCAHF's History. Retrieved June 5, 2002, from http://www.ncahf.org/about/history.html
[2] Inglis BD, Fraser B, Penfold BR. Chiropractic in New Zealand report: commission of inquiry into chiropractic. 1979; 105-106.
[3] About PBS. Retrieved June 5, 2002, from http://www.pbs.org/insidepbs/

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