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June 2012

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• Chiropractic is "High Quality" Care for Military According to Report
• Low-Dose Aspirin Risks Seem to Outweigh Gains
• Chiropractic Care for the Aging Population in the United Kingdom
• Trigeminal Neuralgia Helped with Chiropractic - A Case Report
• Research Shows Chiropractic as a Cost-Effective, Value-Based Benefit Option
• Major Trends in the U.S. Health Economy Since 1950

A piece of legislation passed by the U.S. congress on May 18, 2012 made strong pro-chiropractic statements while recognizing the benefits of chiropractic care for the men and women serving in the military. The original bill, numbered HR 4310, and titled the  National Defense Authorization Act for Fiscal Year 2013, not only spoke to the benefits of chiropractic care for the military, but also noted that chiropractors are presently not paid at parity for their professional services as compared to other professionals who care for the military.

The language of the portion of the bill that addresses chiropractic is as follows:

Comptroller General Report on Chiropractic Health Care Professionals.

The committee understands that for more than a decade, the Department of Defense has provided high-quality chiropractic health care services to Active Duty military personnel at military treatment facilities throughout the world. Today, chiropractic health care continues to be a key benefit for the men and women of the Armed Force as a result of increased incidences of musculoskeletal injuries sustained in combat. However, the committee is concerned by disparities in pay and job classifications that have resulted in chiropractors receiving lower wage rates than health care providers with either comparable or less training, skill sets, and health care responsibilities for patients in military treatment facilities. There-fore, the committee directs the Comptroller General of the United States to conduct a study and submit the findings to the Senate Committee on Armed Services and the House Committee on Armed Services by April 1, 2013, on the wage rates for chiropractors with-in the Department of Defense as compared to health care providers with either comparable or less training, skill sets, licensure and certification requirements, and health care responsibilities.

The committee mentioned in the above bill is the  U.S. House of Representatives Committee on Armed Services, who helped prepare the bill for the full congress.

The original legislation requiring  chiropractic care be available to members of the military was passed in the year 2000. However, implementation of the law has been slow with many military personnel not being given access without severe hardships. Today, however, there are doctors of chiropractic  working at 42 VA medical centers and at 60 Department of Defense facilities around the world.

In a May 25, 2012 release from the president of the American Chiropractic Association, Dr. Keith Overland comments on the desire of chiropractors to serve military personnel, "It is the profession’s honor to be a part of the health care system that treats veterans. America’s heroes do not have to suffer in silence with the common neuromusculoskeletal ailments associated with their service."

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The above is the headline of a HealthDay article published on June 5, 2012 in the Health section of US News and World Reports. The article is based on a study published in the Journal of the American Medical Association (JAMA) on June 6, 2012 showing that low-dose aspirin usage was associated with increased risk of major gastrointestinal or cerebral bleeding episodes.

The study authors suggest that any benefit in possibly preventing heart disease could be offset by the risk that the serious bleeding could cause. Study author, Dr. Antonio Nicolucci, head of the department of clinical pharmacology at nonprofit biomedical research organization Consorzio Mario Negri Sud in Santa Maria Imbaro, Italy commented, "Aspirin is not effective in protecting a person from a first cardiac event, a heart attack or stroke." He continued, "In addition, taking aspirin has significant risks, and thus shouldn't be part of primary prevention unless you're at moderate to high risk of heart disease."

The study used a very large sample of people following 186,425 individuals who were using low dose aspirin daily, and comparing them to an equal number of people who were not using aspirin. Over a 5.7 year period the researchers recorded over 6900 cases of major bleeding events which included gastrointestinal bleeding and intracranial hemorrhage. In that same time frame, the group that did not use aspirin had less than half that amount of bleeding incidents.

Dr. Thomas Schwenk, dean of the University of Nevada School of Medicine, commented in an interview for WSL from Chicago, "No preventive approach is without risk. If the benefits are barely measurable but the risks are real and possibly greater, then the decision making may shift against the use of aspirin."

In their conclusion, the study authors point out that the facts show that the risks of bleeding offset any potential benefit low dose daily aspirin may have given by saying, "In conclusion, weighing the benefits of aspirin therapy against the potential harms is of particular relevance in the primary prevention setting, in which benefits seem to be lower than expected based on results in high-risk populations."

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A paper published in the April 2012 issue of Frontiers in Physiology from the United Kingdom, looked at chiropractic care for the growing elderly population in the UK. The paper titled, "Chiropractic Treatment as a Primary Care Intervention for Better Musculoskeletal Health in the Aging Population in the United Kingdom", reviewed many areas where chiropractic can help the aging population.

The paper, written at the McTimoney College of Chiropractic, Abingdon, Oxfordshire, UK, by chiropractic doctors Adrian Hunnisett and Christina Cunliffe, starts off by noting, "Many countries, including the UK, find themselves with an increasingly aging population." They continue, "The number of people in the UK aged over 75 is set to double over the next 25 years."

The authors of the paper point out that aging is commonly associated with an increased incidence of developing a wide variety of conditions, the most prevalent being the decline in musculoskeletal function and mobility. The authors comment, "In order to maintain a state of independent living, it is vitally important for the individual to be able to maintain general function for as long as possible. This has a significant effect on perceived quality of life, particularly in the much older age groups."

The chiropractic approach to helping the elderly offers a unique service. Drs. Hunnisett and Cunliffe state, "The aim of chiropractic care in the elderly population is to restore function where possible and to arrest, or at least slow down, the degenerative processes that occur with aging." They go on to explain this unique approach by saying, "Chiropractic is an holistic intervention with chiropractic adjustments as the core concept of the treatment. It focuses on relationships between structure and function of the musculoskeletal and nervous systems and how these preserve and restore health."

In the conclusion of their paper, the authors review the overall future of chiropractic in the UK noting that increased awareness by other health practitioners about chiropractic will play a vital role in the public receiving the chiropractic care they need. The authors conclude, "Chiropractors are themselves well positioned to play a pivotal role in the health promotion, disease intervention, and geriatric care strands of primary healthcare. Chiropractic services are safe, health-effective, and cost–effective and enjoy high patient satisfaction."

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A study published in the Journal of Upper Cervical Chiropractic Research, on May 31, 2012 documents a case of a patient being helped with Trigeminal Neuralgia (TN) through chiropractic care. The study starts off by reporting that TN is considered one of the most debilitating facial pain syndromes. TN usually causes very severe facial pain over one side of the upper jaw area, usually on the right side.

The authors of the study point out that the pain of TN is so severe that it is often referred to as "the suicide disease" because people who suffer from this very painful disease often contemplate suicide, and as many as half of the people who have had TN for 3 years or more committed suicide.

In this case a 54-year-old man came to the chiropractor with right-sided facial pain for a five year period. The man had been diagnosed with TN four years earlier by a neurologist. The neurologist had the patient undergo a cranial MRI which ruled out any tumor or lesion as the underlying cause of his TN. He was given the drug carbamazepine which he reported helped to reduce the intensity of the pain, but did not reduce the frequency or duration of the attacks.

The man described the pain as being like an electrical shock which was aggravated by things as minor as talking, chewing, touch, wind, and sometimes was even triggered spontaneously.  Each of his episodes lasted from a fraction of a second to a minute and would occur between 100 and 200 times per day. Five years prior he rated his pain as a 5 out of 10, and currently he rated the pain as a full 10 out of 10.

A chiropractic examination was performed along with spinal x-rays. A determination was made that the top bone in his spine, the atlas, had rotated and was "subluxated". A specific course of corrective chiropractic care was then initiated.

The patient returned the day after his first adjustment and reported that both the intensity and duration of his attacks had decreased and he gave a current rating of his pain as 6 out of 10. One month after care the patient reported that he was no longer experiencing any TN attacks and he was able to discontinue his medication. The study records that twelve weeks following his initial visit the patient still hadn't experienced any pain attacks.

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A news release issued on May 22, 2012, by the Foundation for Chiropractic Progress (F4CP) notes that a growing body of evidence shows that chiropractic is an affordable choice within emerging value-based health plans and may represent a significant advancement in cost and clinical effectiveness.

The release cites a research study in the Journal of Manipulative and Physiological Therapeutics, titled, "A Hospital-Based Standardized Spine Care Pathway: Report of a Multidisciplinary, Evidence-Based Process".  The evidence shows that, "...of 402 low back pain patients treated exclusively by doctors of chiropractic at the low back pain program implemented at Jordan Hospital in Plymouth, Mass., achieved successful clinical outcomes in an average of 5.2 visits at the low cost of $302 per case, while maintaining satisfaction rates above 95 percent."

Additionally, the study showed that the participants self-reported pain and disability scores were reduced by about 70 percent over the course of just a few weeks. 

The F4CP release also pointed out that one insurance company has already started promoting more affordable and effective care by noting, "Highmark Inc., an independent licensee of the Blue Cross and Blue Shield Association, recently introduced a new health plan that utilizes incentives to further engage employees in their healthcare. Specifically, employees are encouraged to better understand less invasive, less costly approaches, such as chiropractic care, before considering more costly and clinically variable procedures, like back surgery and/or knee/hip replacements."

"Research continues to accumulate in support of value-based approaches to inclusion of chiropractic services in employer health benefits design," stated Bruce Sherman, MD, former medical director, Whirlpool Corporation and contributing author of Outcomes-Based Contracting- The Value-Based Approach for Optimal Health with Chiropractic Services. "As employers expand their approach to implementing value-based plans, these additional findings increasingly demonstrate the potential value that inclusion of chiropractic services may provide."

Gerard W. Clum, DC, a spokesperson for the F4CP and an academic leader within the chiropractic profession for nearly three decades, summed up the trend by saying, "This is an exhilarating time for the (chiropractic) profession as employers seek to implement benefit plans with more valuable fundamentals. I expect that, as employers learn more about value-based plans with chiropractic, they will be pleased with the potential results – better outcomes, less costs and increased patient satisfaction."

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A very revealing article on health care expenditures appeared in the March 15, 2012 issue of the New England Journal of Medicine.  The article looks at the spiraling costs of health care in the U.S. over the last 60 years and puts them into perspective. 

The article's author, Victor R. Fuchs, Ph.D., offers a sobering warning by saying, "The rapid growth of health expenditures is one of the most important economic trends in the United States in the post–World War II era. It has implications for the financial viability of federal and state governments and has resulted in stagnation of wages in most industries."

Fuchs points out that in 1950, health expenditures accounted for only 4.6% of the gross domestic product (GDP) in the U.S. By the year 2009 health care costs had risen to take up 17% of the GDP. This is compared to most other countries which presently range from 9% to 11% of their respective GDPs.

To put this percentage into perspective, Fuchs notes that healthcare takes up a larger percentage of the economy than all of manufacturing, or all of wholesale and retail trade, or finance and insurance, or agriculture, mining, and construction combined.

In his report, Fuchs compared the costs of health care adjusting the amounts to take inflation into account so that all amounts were reported in 2009 dollars. Even with the inflation adjustment it is noted that the average per capita cost for healthcare in the US was $405 in 1950,  $2050 in 1980, and has risen to $6807 by 2009. The percentage of these expenses paid by the patient in these same time frames dropped from 56% in 1950 to 27% in 1980, and down to 14% by 2009. 

The article cites two basic reasons for the increase in costs. These are insurance, and an increase in technology with the specialization that is attributed to technology. Fuchs states, "There is a positive-feedback loop between new technology and the spread of health insurance: new technology stimulates the demand for insurance, and the spread of insurance stimulates the demand for new technology."

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