Research
A Compelling Overview
One of the areas in which chiropractic has faced the most challenge is in what is called “evidence-based” health care. This has emerged out of the desire on the part of insurance companies to reduce their costs and increase their profits. This is most easily done by first refusing to cover certain treatments, and then by reducing the amount they pay for a treatment. The fact that over the last hundred years chiropractic has survived a focused attack from the American Medical Association is unimportant to insurance companies. The fact that chiropractors have survived and thrived because of our patients’ efforts to make and keep chiropractic legal and legitimate is unimportant to insurance companies. The fact that over 30,000 jail terms were served by chiropractors for “practicing medicine without a license” in states that were unwilling to license us, because those chiropractors refused to stop doing what they knew was right for their patients, is unimportant to insurance companies. The fact that there are clinical, though anecdotal, cases of chiropractic helping with every health condition known to man, has little to do with gaining credibility.
Despite the challenges, there is a fast-growing body of research on chiropractic. Much is from overseas from countries like Britain, Australia and Canada, where the health care system is public, and public access to records makes research easier. Some is from the USA despite the fact that research here is mostly funded by pharmaceutical and medical equipment companies that arguably have an active interest in preventing research on an inexpensive, natural, noninvasive treatment. To be fair, the great differences in the way chiropractic is practiced, and the fact that almost every state outlines a different scope of practice for chiropractors, makes research more difficult. Since we cannot agree as a profession on what chiropractic is, it is difficult to design an effective research strategy.
Below are listed some of the most compelling studies on chiropractic and their results. They provide a perspective on the cost, safety and effectiveness of chiropractic.
| Work days lost | ||
| Who | Chiropractic | Medicine |
|---|---|---|
| Western Journal of Medicine | 6.26 | 25.56 |
| Journal of Occupational Medicine | 34.3 | 54.5 |
| FCER Studied 10,000 Worker’s Compensation cases of back injuries in Florida with same or similar Dx | Chiropractic patients had 50% less days off from work | |
| U.S. Department of Labor and Statistics | Four years after a single spinal fusion surgery, 71% of patients had not gone back to work. After multiple surgeries, 95% had not returned to work. | |
| British Medical Journal | “a reduction of 290,000 days of sickness in 2 years” if chiropractic treatment was used in place of medical treatment | |
| Treatment and disability cost | ||
| Source | Chiropractic | Medicine |
|---|---|---|
| College of William and Mary Medical School | If chiropractic care was mandated, it would reduce the cost to treat low back pain | |
| Journal of Occupational Medicine measured cost in Utah work comp cases with the same diagnosis | $68 | $668 |
| University of Richmond Medical costs assessment | If chiropractic care was insured on a level plane with medical care it would result in a decrease in treatment costs | |
| Chiropractic Journal of Australia Disability costs for work injuries in Australia for the same diagnosis | $392 | $1569 |
| British Medical Journal Cost savings in 2 years if low back pain patients were required to see DCs instead of MDs in Britain | $25.5 million in savings | |
| Patient Care Reviewed 6,183 patent files from 2 years of insurance data | $518 | $1020 |
| Journal of Manipulative and Physiological Therapeutics 2-year retrospective analysis of 395.641 patients with the same diagnoses | 53% higher rate of hospitalization in patients who were not under chiropractic care. $1138 more per episode—not including medication costs—with medical care | |
| FCER Compared treatment costs in work comp claims in Florida | Chiropractic treatment costs were 50% less than medical treatment costs | |
| Spine | “Mental health and chiropractic care represented a small percentage of overall costs (0.4% and 2.9%, respectively).” | “The most costly service category was diagnostic procedures (25% of total medical costs), with surgical costs (21%) and physical therapy (20%) representing the next two most costly categories.” |
| U.S. Department of Health (AHCPR) | “Chiropractic and manipulative treatments are at least as effective in the treatment of back pain as medical care.” | |
Treatment and Disability Costs: The Manga Report
A report for the government of Ontario, Canada, used to determine whether chiropractic should be included in their national healthcare program: “If chiropractors were the primary treating doctors for low back pain, there would be decreased hospitalization and disability and a ‘savings of hundreds of millions of dollars’. In fact, it is possible that chiropractors should be the ‘gatekeepers’ for lower back problems.”
Manga Report conclusions
- DCs are more effective for low back pain than MDs.
- No clinical or case control studies showed manipulation to be unsafe for LBP—in fact, it is far safer than medical Tx.
- If DCs were used, Canada would save hundreds of millions of dollars annually.
- Patients were more satisfied with chiropractic care.
- Despite medical disapproval and significant increased out of pocket expenses, chiropractic is growing.
- The Canadian Government should encourage people to shift to chiropractic treatment and consider making DCs the “gatekeepers” for low back pain.
Patient satisfaction
There have been dozens of studies on patient satisfaction regarding treatment by Medical Doctors, Doctors of Chiropractic, physical therapists, massage therapists, and mental health providers.
So far, every study comparing chiropractic care with medical care shows a significantly greater satisfaction with chiropractic. No study yet has shown otherwise.
AHCPR—U.S. Department of Health
- Acupuncture is not effective
- Physical therapy is not cost effective
- Only 1% of cases should receive surgery
- Epidural injections are rarely helpful and only in radicular involvement
- Antidepressant medication is not effective and can be dangerous
- Sclerosing injections are not effective
- Over the counter anti-inflammants are as effective as effective as prescription ones
- Shoe cushioning may be effective
- A few rest days followed by early movement and reintroduction into activity is important
- Manipulation is an effective treatment for low back pain
British Medical Journal
29% more patients improved under chiropractic care than those treated medically. This was measured during the three years after treatment, comparing pain, daily activities of living and satisfaction with their treatment. Chiropractic patients also expressed better sleep and were able to sit for longer periods.
| How safe is medicine? | |
| Journal of the American Medical Association 1998 | 106,000 Americans die each year from drugs prescribed by their MD |
| Journal of the American Medical Association 1998 | Over 2 million Americans become seriously ill each year from reactions to medications prescribed to them by their MD |
| Gerlin Reader’s Digest | 120,000 iatrogenic deaths annually each year in the U.S. 1 in 200 patients die from hospital mistakes |
| New England Journal of Medicine 1999 | 16,500 deaths each year from NSAIDs |
| Journal of Rheumatology 1992 | 1 in 2,500 osteoarthritis patients die each year related to NSAID use |
| NCMIC 2001 | The risk of tetraplegia or death resulting from NSAID use is 160–1,500 times greater than the risk due to manipulation |
| US Department of Labor and Statistics | 2 in 100 mortality rate from spinal fusion surgery |
| How safe is chiropractic? | |
| Journal of the Canadian Chiropractic Association | 1 in 3,846,153 neck manipulations |
| Journal of Manipulative and Physiological Therapeutics 1995 | 1 in 2,000,000 neck manipulations |
| Journal of Manipulative and Physiological Therapeutics 1996 | 1 in 900,000 upper cervical manipulations |
| Canadian Medical Association Journal 2001 | 1 in 5,850,000 neck manipulations |
| Canadian Chiropractic Protective Association | No claims against chiropractors for death or stroke |
| NCMIC 2001 (Chiropractic malpractice insurance carrier) | Only 19 deaths worldwide for a 65 year period, from 1934-1999 |
Most significant fact
Average doctor of chiropractic’s annual malpractice costs: $4,134. Average medical doctor’s annual malpractice costs: $91,203. This speaks to how safe chiropractic is and how rarely chiropractors are sued.
| Safety comparison | |
| Activity | Risk of death per person, per year |
|---|---|
| soccer and football | 1 in 25,000 |
| taking contraceptives | 1 in 5,000 |
| motorcycling | 1 in 50 |
| skiing | 1 in 430,000 |
| drinking one bottle of wine per day | 1 in 13,300 |
| driving | 1 in 5,900 |
| smoking two packs of cigarettes per day | 1 in 200 |
| professional boxing | 1 in 14,300 |
| taking NSAIDs (Advil, Alleve) | 1 in 2,500 |
| hospital stay | 1 in 200 |
| chiropractic manipulation | 1 in 6,842,106 |
