Addison

Allen

Arlington

Bedford

Carrolton

Cedar Hill

Colleyville

Colony

Coppell

Dallas

DeSoto

Duncanville

Euless

Farmes Branch

Flower Mound

Fort Worth

Frisco

Garland

Grand Prairie

Grapevine

Haltom City

Hurst

Irving

Keller

Lewisville

Mansfield

McKinney

Mesquite

N. Richland Hills

Plano

Richardson

Rockwall

Rowlett

Southlake

History of Chiropractic

The art of joint manipulation has been practiced for thousands of years. Hippocrates, The Father of Medicine (460-370 BC), describes manipulative procedures in his monumental work known as the Corpus Hippocrateum.

Other historical records indicate that the beneficial effects of spinal corrections have been recognized and utilized by health care providers in many societies even before the time of Socrates who advised, 'If you would seek health,look first to the spine.'

Galen (130-202 AD) earned the title 'Prince of Physicians' when he relieved the paralysis of the right hand of Eudemas (a prominent Roman scholar) by careful manipulation of his neck.

During the Middle Ages, the art of manipulation was practiced by bonesetters. This art was passed from generation to generation and was practiced in most communities in Europe, North Africa, and Asia by practitioners who learned their skills by apprenticeship.

This photo, depicting neck manipulation, was copied from China as early as, 940 AD.

Daniel David Palmer, D.C. The Father of Chiropractic

The birth of Chiropractic, as a distinct healing profession, occurred in 1895. The founder of Chiropractic was Daniel David Palmer (1844-1913), a Canadian born in Port Perry, Ontario. While practicing as a magnetic healer in Davenport, Iowa, he delivered the first known chiropractic adjustment to a misaligned vertebrae in the neck of Harvey Lillard, and restored his lost hearing. D.D. Palmer did not claim to be the first to restore a malpositioned vertebrae, but the first to use the specific, short lever technique that he called Chiropractic (derived from the Greek words meaning 'done by hand') to 'rack' the vertebrae back into normal position.


D.D. Palmer founded the first college of Chiropractic in Davenport, Iowa during that same year of 1895. He believed that "if every bone, every nerve, and all the blood vessels were just right, there would be nothing wrong" with the body. He also said that "disease is the effect or result of some part of the body being disarranged (the vertebrae)". Thus we find the inception of the philosophical principles of Chiropractic that spinal health is vital for overall wellness.

History of
Dr. Daniel David Palmer - The Father of Chiropractic
and
Dr. Bartlett Joshua Palmer - The Developer of Chiropractic

"I have never considered it beneath my dignity to do anything to relieve human suffering"

The boys' parents, Thomas and Catherine were forced to leave Canada in 1856 after the failure of Thomas' grocery business. So, taking their four other children, the Palmers returned to the States and left David and Thomas J. in Port Perry. This put an end to the boys' education and the two children went to work in Charles Frederick's match factory. It is unclear whether the boys lived on their own at this time or with their grandparents, but either way, it was a difficult life for the boys.

In 1865, the boys decided to rejoin their family in the States. They had little money but managed to pay their way by working at a number of odd jobs. D.D. took a teaching position upon reaching Iowa and soon married for the first of five times. In the 1880s, D.D. became interested in spirituality and the works of Paul Caster, a magnetic healer. Theory behind magnetic healing proposed that a magnetic field surrounded the human body and minor illnesses could be cured by influencing this force. D.D. moved to Davenport Iowa in the late 1880s. By 1887, he was known as a vital healer and soon became popular enough to open a 14 room infirmary.

D.D. Palmer's own words describing his magnetic healing practice...

"In 1886 I began as a business. Although I practiced under the name of magnetic, I did not slap or rub, as others. I questioned many M.D.s as to the cause of disease. I desired to know why such a person had asthma, rheumatism, or other afflictions. I wished to know what differences there were in two persons that caused on to have certain symptoms called disease which his neighbor living under the same conditions did not have...In my practice of the first 10 years which I named magnetic, I treated nerves, followed and relieved them of inflammation. I made many good cures, as many are doing today under a similar method."

As the above quotation states, Palmer was interested in finding the true cause(s) of disease. He wanted to know why two people who lived in the same house, drank the same water, breathed the same air and often had the same parents, could have two dramatically different constitutions, one being healthy and free of disease and the other sickly. Palmer felt that there must be something other than environmental factors influencing an individuals health. His theory, was that this internal factor was the function of the nervous system. On September 18, 1895, D.D. Palmer would have the chance to prove his theory.

September 18, 1895

D.D.'s account of the first spinal adjustment is as follows : "Harvey Lillard a janitor in the Ryan Block, where I had my office, had been so deaf for 17 years that he could not hear the racket of a wagon on the street or the ticking of a watch. I made inquiry as to the cause of his deafness and was informed that when he was exerting himself in a cramped, stooping position, he felt something give way in his back and immediately became deaf. An examination showed a vertebrae racked from its normal position. I reasoned that if the that vertebra was replaced, the man's hearing should be restored. With this object in view, a half-hour's talk persuaded Mr. Lillard to allow me to replace it. I racked it into position by using the spinous process as a lever and soon the man could hear as before. There was nothing "accidental" about this, as it was accomplished with an object in view, and the result expected was obtained. There was nothing "crude" about this adjustment; it was specific."

Palmer felt that Lillard's hearing loss was due to a blockage of the spinal nerves which control the inner ear. This nerve blockage, in Palmer's estimation, was caused by a irritation of the spinal nerves by a misaligned vertebrae. When Palmer corrected the misalignment by pushing the vertebrae back into place, the nerve pathways were reopened and thus Lillard's hearing was restored. Today we know that the mechanism involved with spinal misalignments (The Vertebral Subluxation Complex) is much more complicated than originally postulated by Palmer. However, Palmer's basic concept of nervous system interference adversely effecting health has held true over the last 100 years.

The term "chiropractic" was first coined by D.D. Palmer's close friend, the Reverend Samuel H. Weed. The term chiropractic was taken form the two Greek words:

Cheir (Chiro), Meaning "Hand"

Praxis (Practic), Meaning "Practice"

Thus chiropractic means "Done by Hand"

With his new healing art, Palmer became very popular and his office was filled with the discarded crutches and canes of his patients.

In 1898 Palmer took on his first chiropractic student. That fist year there was one student, in 1899 there were three and four in 1902. The course was six months in duration and cost $500. Among those four students in 1902 was D.D.'s twenty year old son Bartlett Joshua Palmer (know as B.J.). It is also interesting to note that five of D.D.'s first fifteen students were either M.D.s or D.O.s.

Despite this success, Palmer was mired in controversy. He had been charged by the state of Iowa for practicing medicine without a license and was jailed. Later D.D. was arrested on the same charge in Santa Barbara, California but was never jailed there. Though his school was popular, Palmer soon found himself in heavy debt as competing schools came on the scene.

In 1906, Palmer was again charged by the state for practicing without a certificate, and was found guilty. The sentence was a fine or 105 days in jail.

During his incarceration in Iowa, D.D.'s son B.J. took over the administration of the school and his wife Mabel Heath Palmer became heavily involved in both teaching anatomy and in the school's operations.

Dr. B. J. Palmer - The Developer of Chiropractic

Controversy

Palmer's Legacy

Chiropractic's Cost Effectiveness

The Manga Study

A Study to Examine the Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain
by
1. Pran Manga, Ph.D. 1
2. Douglas E. Angus, M.A.2
3. Costa Papadopoulos, MHA3
4. William R. Swan, B.Comm.4

August 1993
1. Professor and Director, Masters in Health Administration Program, University of Ottawa; and President, Pran Manga and Associates Inc., Ottawa.
2. Adjunct Professor, University of Ottawa and Project Director, The Cost-Effectiveness of the Canadian Health Care System, Queen's - University of Ottawa Economic Projects. Health Care Consultant and Associate of Pran Manga and Associates, Inc. Consultant in Health Care Economics.

The support of the Ministry of Health, Government of Ontario, which solely funded the project, is gratefully acknowledged. The views and opinions expressed in this report are those of the authors only, and should not be attributed to the MHA Program, University of Ottawa, the Ministry of Health or the Ontario Chiropractic Association.

EXECUTIVE SUMMARY

The Magna Report, commissioned by the Ontario Ministry of Health and prepared by highly respected health economists at the University of Ottawa, represents the largest and most thorough analysis of the scientific literature on low back pain ever. It clearly demonstrates that chiropractic management of low back pain is more effective, more cost effective and produces higher levels of patient satisfaction than other forms of management. The report recommends that chiropractic services in Ontario be fully funded by OHIP and be fully integrated into the health care system, including hospitals. The following is a summary of the report.

INTRODUCTION

The serious fiscal crisis of all governments in Canada is compelling them to contain and reduce health care costs. It has brought a new and unprecedented emphasis on evidence-based allocation of resources, with an overriding objective of improving the cost-effectiveness of health care services.

The area of low-back pain (LBP) offers governments and the private sector an excellent opportunity to attain the twin goals of greater cost-effectiveness and a major reduction in health car costs. Today LBP has become one of the most costly causes of illness and disability in Canada - a phenomenon which does not appear to be generally appreciated or understood in medical and government circles in Canada. Studies on the prevalence and incidence of LBP suggest that it is ubiquitous, probably the leading cause of disability and morbidity in middle- aged persons, and by far the most expensive source of workers' compensation costs in Ontario - as indeed in most other jurisdictions.

Much of the treatment of LBP appears to be inefficient. Evidence from Canada, the USA, the UK and elsewhere shows that there are conflicting methods of treatment, many with little - if any scientific evidence of effectiveness, and very high costs of treatment. Despite this, levels of disability from LBP are increasing.

In the Province of Ontario LBP is managed mostly by physicians and chiropractors, with physiotherapists also playing a significant role. While medical services are fully insured under Medicare, chiropractic care services are only partially covered. LBP patients incur the highest out-of-pocket expenses for chiropractic services. Virtually no out-of-pocket expenses are incurred for medical treatment, with the exception of drugs, and out-of-pocket expenses incurred for physiotherapy services fall somewhere in between the two.

Medical physicians, chiropractors, physiotherapists and an assortment of other professionals together offer about thirty-six therapeutic modalities for the treatment of LBP. In this study we focused principally on the effectiveness and cost effectiveness of chiropractic and medical management of LBP.

FINDINGS

F1. On the evidence, particularly the most scientifically valid clinical studies, spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for LBP. Many medical therapies are of questionable validity or are clearly inadequate.

F2. There is no clinical or case-control study that demonstrates or even implies that chiropractic spinal manipulation is unsafe in the treatment of low-back pain. Some medical treatments are equally safe, but others are unsafe and generate iatrogenic complications for LBP patients. Our reading of the literature suggests that chiropractic manipulation is safer than medical management of low-back pain.

F3. While it is prudent to call for even further clinical evidence of the effectiveness and efficacy of chiropractic management of LBP, what the literature revealed to us is the much greater need for clinical evidence of the validity of medical management of LBP. Indeed, several existing medical therapies of LBP are generally contraindicated on the basis of the existing clinical trials. There is also some evidence in the literature to suggest that spinal manipulations are less safe and less effective when performed by non-chiropractic professionals.

F4. There is an overwhelming body of evidence indicating that chiropractic management of low-back pain is more cost-effective than medical management. We reviewed numerous studies that range from very persuasive to convincing in support of this conclusion. The lack of any convincing argument or evidence to the contrary must be noted and is significant to us in forming our conclusions and recommendations. The evidence includes studies showing lower chiropractic costs for the same diagnosis and episodic need for care.

F5. There would be highly significant cost savings if more management of LBP was transferred from medical physicians to chiropractors. Evidence from Canada and other countries suggests potential savings of many hundreds of millions annually. The literature clearly and consistently shows that the major savings from chiropractic management come from fewer and lower costs of auxiliary services, much fewer hospitalizations, and a highly significant reduction in chronic problems, as well as in levels and duration of disability. Workers' compensation studies report that injured workers with the same specific diagnosis of LBP returned to work much sooner when treated by chiropractic physicians than by medical physicians. This leads to very significant reductions in direct and indirect costs.

F6. There is good empirical evidence that patients are very satisfied with chiropractic management of LBP and considerably less satisfied with physician management. Patient satisfaction is an important health outcome indicator and adds further weight to the clinical and health economic results favoring chiropractic management of LBP.

F7. Despite official medical disapproval and economic disincentive to patients (higher private out-of-pocket cost), the use of chiropractic has grown steadily over the years. Chiropractors are now accepted as a legitimate healing profession by the public and an increasing number of medical physicians.

F8. In our view, the constellation of the evidence of: the effectiveness and cost-effectiveness of chiropractic management of low-back pain. the untested, questionable or harmful nature of many current medical therapies. the economic efficiency of chiropractic care for low-back pain compared with medical care. the safety of chiropractic care. the higher satisfaction levels expressed by patients of chiropractors,
together offers an overwhelming case in favor of much greater use of chiropractic services in the management of low-back pain.

F9. The government will have to instigate and monitor the reform called for by our overall conclusions, and take appropriate steps to see that the savings are captured. The greater use of chiropractic services in the health care delivery system will not occur by itself, by accommodation between the professions, or by actions on the part of the Workers' Compensation Board and the private sector generally.

RECOMMENDATIONS

Our recommendations for reform include the following:

R1. Current policy discourages the utilization of chiropractic services for the management of LBP. There should be a shift in policy to encourage and prefer chiropractic services for most patients with LBP.

R2. Chiropractic services should be fully insured under the Ontario Health Insurance Plan, removing the economic disincentive for patients and referring health providers. This one step will bring a shift from medical to chiropractic management that can be expected to lead to very significant savings in health care expenditure, and even larger savings if a more comprehensive view of the economic costs of low-back pain is taken.

R3. Chiropractic services should be fully integrated into the health care system. Because of the high incidence and cost of LBP, hospitals, managed health care groups (community health centers, comprehensive health organizations, and health service organizations) and long-term care facilities should employ chiropractors on a full-time and/or part-time basis. Additionally such organizations should be encouraged to refer patients to chiropractors.

R4. Chiropractors should be employed by tertiary hospitals in Ontario. Hospitals already employ chiropractic in the United States with good effect. Similar recommendations have been made recently by government inquiries in Australia and Sweden, and following government funded research in the U.K. and other countries. Unnecessary or failed surgery is not only costly but also represents low quality care. The opportunity for consultation, second opinion and wider treatment options are significant advantages we foresee from this initiative which has been employed with success in a clinical research setting at the University Hospital, Saskatoon.

R5. Hospital privileges should be extended to all chiropractors for the purposes of treatment of their own patients who have been hospitalized for other reasons, and for access to diagnostic facilities relevant to their scope of practice and patients' needs.

R6. Chiropractors should have access to all pertinent patient records and tests from hospitals, physicians, and other health care professionals upon the consent of their patients. Access should be given upon the request of chiropractors or their patients.

R7. Since low-back pain is of such significant concern to workers' compensation, chiropractors should be engaged at a senior level by Workers' Compensation Board to assess policy, procedures and treatment of workers with back injuries. This should be on an interdisciplinary basis with other professional, technical and managerial staff so that there is early development of more constructive relationships between chiropractors, physicians, physiotherapists and Board staff and consultants. A very good case can be made for making chiropractors the gatekeepers for management of low-back pain in the workers' compensation system in Ontario.

R8. The government should make the requisite research funds and resources available for further clinical evaluation of chiropractic management of LBP, and for further socioeconomic and policy research concerning the management of LBP generally. Such research should include surveys to obtain a better understanding of patients' choices, attitudes and knowledge of treatments with respect to LBP. The objective of these surveys should be better information for health policy, program planning and consumer education purposes.

R9. Chiropractic education in Ontario should be in the multidisciplinary atmosphere of a university with appropriate public funding. Chiropractic is the only regulated health profession in Ontario without public funding for education at present, and it works against the best interests of the health care system for chiropractors to be educated in relative isolation from other health science students.

R10. Finally, the government should take all reasonable steps to actively encourage cooperation between providers, particularly the chiropractic, medical and physical therapy professions. Lack of cooperation has been a major factor in the current inefficient management of LBP. Better cooperation is important if the government is to capture the large potential savings in question and, it should be noted, is desired by an increasing number of individuals within each of the professions.

Prestigious Health Journal Publishes Study Citing Chiropractic's Cost Effectiveness

First contact chiropractic care for common low back conditions costs substantially less than traditional medical treatment and "deserves careful consideration" by managed care industry executives concerned with controlling health care spending, according to a new study published in the prestigious Medical Care journal.

The study, titled "Chiropractic and Medical Costs of Low Back Care," is the latest data resulting from an ongoing "Medstat Cost of Care Project" funded by the American Chiropractic Association (ACA). Published in the March 1996 issue of the highly respected journal, the report by Miron Stano, Ph.D., professor of economics & management at Oakland University's School of Business Administration, and Monica Smith, D.C., a doctoral candidate at St. Louis University's School of Public Health, concludes, "The lower costs for episodes in which chiropractors serve as initial contact providers along with the favorable satisfaction and quality indicators for patients suggest that chiropractic deserves careful consideration in gatekeeper strategies adopted by employers and third-party payers to control health care spending."

Through the study, researchers analyzed the insurance claims of 6,183 patients who, over a two-year period, visited either a medical doctor or a chiropractor for nine of the most common lumbar and low back conditions. The total average payments for patients who visited medical doctors were nearly twice as much as the payments for chiropractic patients $1,020 for medical patients compared to $518 for chiropractic. The total average outpatient payments were also significantly higher for medical patients than for those who first visited a doctor of chiropractic $598 for medical patients vs. $477 for chiropractic patients. Much of the savings was the result of lower rates of hospitalization and other inpatient costs.

Among other conclusions, the study also found:

• Chiropractors' effectiveness as future neuromusculoskeletal gate-keepers deserves "careful consideration."
• Cost effectiveness studies on alternatives to medical treatment that exclude chiropractic care "are neglecting a substantial component of the health services market for many such conditions."
• In light of the growing importance consumers are placing on "non-medical" treatment and on chiropractic in particular more research on chiropractors' ability to function as primary care givers is important.
• Because approximately 8 percent of health care costs in the United States are the result of back and joint conditions, "the need to evaluate alternative therapies for back problems becomes especially important in light of the high costs, failure of many medical interventions, concerns about inappropriate surgery and hospitalization, and growing recognition of the efficacy of spinal manipulation for low back pain."

The Medstat long-term cost comparison research project is being conducted by independent, university-affiliated researchers using a private claims database representing over 400,000 patients. The project has resulted in the publication of ten major research reports, in numerous citations in health care industry literature and in the use of its findings by an untold number of private, state and federal agencies.

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