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THE CHIROPR ACTIC REPORT www.chiropracticreport.com Editor: David Chapman-Smith LL.B. (Hons.) March 2005 Vol. 19 No. 2 THE CHIROPRACTIC PROFESSION Basic Facts, Independent Evaluations, Common Questions Answered “The chiropractic profession is assuming ing the UK,2 US,3 Denmark4 and New its valuable and appropriate role in the Zealand,5 and most recently European health care system in this country and guidelines,6 have endorsed the traditional around the world. As this happens the chiropractic approach to management professional battles of the past will fade by recommending spinal manipulation and the patient at last will be the true and early activity for most patients. The winner.” expert panels for these guidelines, pre- Wayne Jonas, MD, Director (1995-1998), dominantly medical experts, have also Office of Alternative Medicine, US included chiropractors. National Institutes of Health, Bethesda, Large multicentre trials supported by the MD.1 British Medical Research Council and published by the British Medical Journal A. INTRODUCTION have reported that chiropractic manage- ment and skilled manipulation are more HIROPRACTIC (Greek: treatment by hand) arose as a separate profes- effective and cost-effective than usual or C 7, 8 sion in the United States in the 1890s. In best medical care. A UK Royal College of General Practitioners’ guideline for the Table 1 that era of heroic medicine many alterna- tive disciplines emerged—chiropractic management of back pain, developed in Recent Developments in the Chiropractic World has been the strongest survivor. partnership with the British Chiropractic • In the US, new federal legislation during 2002 Association, recommends to GPs that, in to 2004 has introduced and funded chiropractic Through to the 1950s the chiropractic the absence of certain red flags, they con- services in the military and veterans’ administra- profession remained in its early develop- tion health care systems, and expanded services for sider referrals of patients with back pain ment stages—it was isolated, controver- 9 seniors under Medicare. The President’s hospital, for skilled manipulation. sial, and largely North American. In the the National Naval Medical Center in Bethesda, b) Neck Pain and Headache. Multidisci- now has a Chiropractic Department. 1960s and 1970s controversy remained, 10 but the foundations were being laid for plinary expert panels in Canada, and the • Last year a major California study of 1.7 million 11 members of an HMO demonstrated that adding broader mainstream acceptance of the US have reviewed the current evidence a chiropractic benefit reduced overall health care profession, foundations such as: on risks and benefits and specifically costs for plan members.45,46 recommended cervical manipulation and • Surveys continue to report that chiropractic is the • Educational standards and licensing mobilization for many patients with com- most popular form of complementary medicine in examinations similar to medicine. (In mon categories of head and neck pain, the US—used annually by approximately 10% of many U.S. states chiropractors and medi- including motor vehicle accident victims US adults, principally for back and neck pain and cal doctors sat the same basic science headache and the impact of these spinal problems with Grades I-III whiplash-associated on overall health. examinations for licensure). disorders. • In the UK a Medical Research Council multi- • The first significant research texts and There is now a clear anatomical basis for centre trial has just demonstrated that it is both scientific journals. effective and cost-effective for back pain patients headache arising from dysfunction in the receiving “best medical care” to also receive chiro- • Legal recognition and regulation in all cervical spine, (cervicogenic headache), practic manipulation.8 US states and in various other countries. this being direct connective tissue bridges • New evidence-based European Guidelines for 2. Today, more than 100 years after its between the dura and the muscles and the management of patients with acute and chronic birth, chiropractic is taught and practised ligaments in the upper cervical spine, 12 back pain confirm earlier national guidelines in several countries in supporting skilled spinal throughout the world and the profes- and good RCT evidence of the effective- manipulation as a recommended first line approach sion has earned broad acceptance for its ness of chiropractic management. 13 6 to treatment. services, including its central art of spinal c) General acceptance by medicine and • Following the Lannoye Report to the European adjustment or manipulation. Evidence of nursing. In 1997 the World Federa- Parliament in 1997, those countries in Europe that this includes: had not at that time recognized and regulated the tion of Chiropractic, the international practice of chiropractic are moving to do so – most a) Back Pain. Since the 1990s evidence- body representing national associations recent legal recognition being in Belgium, France based national clinical guidelines for the of chiropractors in 80 countries, was and Portugal. management of back pain, sponsored by granted official relations by the World continued on page 2 governments in many countries includ- Health Organization (WHO) and WHO’s Main Article continued from page 1 “the relationship between the medical • In the past year the World Health Organization and chiropractic professions worldwide The Chiropractic Report is an international review (WHO), as part of its formal strategy promoting of professional and research issues published six the sound development and use of traditional and has become increasingly one of mutual times annually. You are welcome to use extracts complementary medicine in national health care respect and collaboration.” The Interna- from this Report. Kindly acknowledge the source. systems, has prepared guidelines concerning mini- tional Council of Nurses and the World Subscribers may photocopy the Report or order mum standards of chiropractic education. 49 Federation of Public Health Associations additional copies (.80 cents each – minimum of 20 • In the UK both accredited chiropractic schools copies plus shipping) for personal, non-commercial offered similar letters of support. The use in association with their practices. However, are now affiliated with public universities – the neither the complete Report nor the majority or Anglo-European College of Chiropractic with the WFPHA’s largest member, the American Public Health Association, had by then whole of the leading article may be reproduced in University of Bournemouth, and the Welsh Insti- any other form without written permission. tute of Chiropractic with the University of Glamor- established a formal Division of Chiro- Subscription: for rates and order form, see page 8. gan – and students from throughout the European practic in recognition of the now signifi- For information or orders visit Community are eligible for government funding cant role of chiropractors in public health www.chiropracticreport.com for their studies. At the University of Southern or telephone 416.484.9601, fax 416.484.9665 Denmark in Odense chiropractic students now programs. Today there are chiropractors email: [email protected] do their clinical training at the in-patient and out- at Harvard teaching hospitals and at the Editorial Board patient clinics at the Funen Spinal Unit, the major US National Institutes of Health. spinal care hospital in Southern Denmark. In Latin Daniele Bertamini DC, Italy America there are new university-based chiroprac- What is the status and role of the chiro- Alan Breen DC PhD, England tic schools in Brazil (2) and Mexico, with others Peter Gale DC, United States practic profession in health care systems Scott Haldeman DC MD PhD, United States soon to open in Argentina and Chile. in 2005? This Report now presents Donald J. Henderson DC, Canada • In Canada chiropractic scientists, Greg Kawchuk, basic facts, the findings of government Reginald Hug DC, United States DC PhD of the University of Alberta and Mark inquiries—in a world too full of un- William Kirkaldy-Willis MD, Canada Erwin, DC PhD of the University of Toronto have Dana Lawrence DC, United States been awarded federally funded Canada Research researched opinions and partisan claims, Miriam A. Minty DC, Australia Chairs. There are now three chiropractic scientists the best government inquiries present Michael Pedigo DC, United States with appointments at the University of Toronto the most reliable evidence—and then Lindsay Rowe MAppSc(Chiropractic) MD, DACBR, School of Medicine – Dr. Erwin, Dr. David Cas- FCCR, FACCR, FICC, DRACR, Australia sidy and Dr. Pierre Coté. answers common questions that arise Louis Sportelli DC, United States Aubrey Swartz MD, United States • In the Middle East, countries that have recently when other professionals discuss chiro- established licensing laws for chiropractic practice practic. Changes of mailing instructions should be sent to are Cyprus, Iran and the United Arab Emirates The Chiropractic Report, 203–1246 Yonge Street, (UAE). Toronto, Ontario, Canada M4T 1W5, B. BASIC FACTS telephone 416.484.9601, fax 416.484.9665. For references see page 8. 3. Chiropractic is now the third largest Printed by Harmony Printing Limited, 416.232.1472. primary contact health care profession Copyright © 2005 Chiropractic Report Inc. in the western world after medicine and ISBN 0836-144 Table 2 dentistry. There are approximately 70,000 CURRENT U.S. MEDICAL POLICIES