Last night President Obama’s held a prime time press conference to push his health care reform agenda. When asked by a reporter what the average American was going to have to give up in order to have meaningful reform the President replied:

“They are going to have to give up paying for things that don't make them healthier.”

I could hear the collective “Amen” being shouted from the entire chiropractic profession across the country.

As you probably already know, the reform the President wants is in real trouble. The Republicans don’t want it, the Democrats don’t want it and Americans may not even want it. The chiropractic profession of course just wants to be included. You have to know that any hope of real reform is over when the AMA supports it. Of course they only supported it once they were promised that those 40% in Medicare cuts would be taken off the table.

Throughout Obama’s press conference there were repeated references, buzzwords, and phrases regarding prevention, wellness, outcomes, etc. Prevention and wellness even enjoys prominent display in the AMA’s talking points about health system reform. The health outcomes movement that started back in the 70’s has made prime time. Prevention and wellness are no longer words used only during Wednesday night lay lectures in chiropractic offices.  

The problem of course is evidence. In fact while the AMA promotes prevention and wellness they do so based on evidence. The hard facts are that when it comes to evidence for prevention and wellness the well is pretty dry. From cancer screenings to early interventions we are just not at a point where the evidence overwhelmingly shows its cost effective or even life saving.

And where there are pockets of change such as chronic disease management programs, the problem is a viable financial model. One hospital system recently reported that they had excellent results with a disease management program – reduced hospitalizations, reduced medication errors, reduced mortality and morbidity. They cancelled the program. They cancelled it because the program was so successful that the hospital was losing money and if it continued they would have to shut down the hospital.

You see, we are not ready for real reform. Health care is 16% of the GDP of this country and making a change to something that big isn’t going to be easy and is not going to happen overnight. According to the health policy and outcomes experts I speak to, this whole current effort is a blip in the 20 year overhaul of the health care system in this country. I have not spoken to one expert that says it’s going to happen without a major crisis. In fact, it seems the coming unwinding of health care is going to make the financial crisis look like a Sunday drive. Most have told me that it is going to have to implode and rebuild. Whatever anyone thinks about Obama and his policies – he does recognize the problem and he is trying to tell people how dire the situation is. His proposed solutions are another story.

And what of chiropractic?  

According to the ACA’s website in their section on Health Reform:

Doctors of chiropractic employ a non-surgical and non-pharmaceutical approach to health care that utilizes “spinal manipulation” to treat a range of neuro-musculoskeletal conditions. (The range of conditions treated typically includes: back pain, neck pain, pain in the joints of the arms or legs, and headaches and other spinal-related maladies -- conditions that the vast majority of Americans will experience one or more times during their lives).

Subluxation is of course not included.

Yes – they mention wellness and prevention in other places but the above is the focus. In fact, the ACA is not alone as some 40 organizations, groups and businesses within chiropractic told Obama just this in a “unified” document produced by the group:

But what level of evidence is there that we prevent neck pain, back pain or pain in the joints of the arms or legs? What literature that does exist on the topic generally says we maybe make people feel better a week sooner than if they did nothing. And some systematic reviews of the manipulation literature suggest we don’t even do that.

But that’s what the leadership in this profession has done – put all its eggs in the one basket of pain. And we let them do that.

I suggest that instead of worrying about whether we are included in this - no reform reform - of health care – that we instead focus on the real issue. The lack of research supporting the basic premises of the profession. Its widely “believed” by the vast majority of chiropractors that a person under chiropractic care from birth (or even prior) will enjoy better health outcomes throughout their life. How about gathering some evidence for that? And while we’re at it lets make sure we are seeing if there is a correlation between those health outcomes and the degree to which the person is subluxated and what the costs savings are.

Then in 20 years when the system has really fallen apart maybe this time we’ll have some real evidence for how we affect people’s lives.

Or we could do more low back pain research?

As always I look forward to your feedback, comments and suggestions.

Regards,
Matthew McCoy DC, MPH
matthewmccoy@comcast.net
Editor – Journal of Pediatric, Maternal & Family health – Chiropractic
http://www.chiropracticpediatricresearch.net