I have some good news and I have a lot of bad news

I usually try not to gloat more than is necessary, but this latest study is just too hard to not go off on.

In the April 2011 issue of the Journal of Occupational and Environmental Medicine, there is a discussion that basically states that chiropractors are not only preventing patients from seeking medicare care, but they are saving them from it.  The article goes on to point out that the medical procedures that chiropractors are preventing patients from receiving are unproven regarding cost effectiveness and are of “dubious efficacy.”  The article incidentally points out chiropractic’s superiority to traditional medical approaches with regard to Health Maintenance Care in Work Related Low Back Pain and its association with Disability Recurrence, which I think also, happens to be the title of the study, which is why I capitalized it.    

The patients that did not receive traditional medical care such as physical therapy and drugs experienced a lesser likelihood of recurrent disability.  I know, you’re saying a chiropractor wrote this, afraid not.  The author of this study is a medical doctor.  It turns out that he also discovered that the chiropractic group patients had fewer surgeries, used less opioids, and had lower costs for medical care than the other provider groups. (Physical therapy and drugs)

So back to that part about dubious efficacy, does that mean he is talking about drugs and surgery?  In California they have practically outlawed chiropractic in the workers’ compensation system.  And of course, the costs of that system are bankrupting the state.  Each year as the costs go up, the insurance companies target chiropractors who are being paid approximately a whopping 1/10th of 1 percent of the budget.  I am too lazy to actually look up and see how little we are getting paid, but even if that number is a gross exaggeration, it feels about right.  I use to perform utilization review.  Out of every 1,000 cases I saw, one was for a chiropractor.  A chiropractor’s bill in that system usually can’t go over a few hundred dollars, as opposed to a 6 ounce tube of formulated aspirin and capsaicin, which the M.D. can get reimbursed up to a thousand dollars for.  By the way, 6 ounces of capsaicin bought over the counter is about $12.00. (That’s Twelve Dollars not Twelve Thousand.  Until 2003 California would have gladly paid Twelve Thousand dollars if someone had the nerve to ask for it)

In California the patient is not allowed to try a chiropractor until the problem has progressed far beyond the point where any benefit could be derived.  That is because they usually have failed drug therapy, have become severe drug addicts,  have had invasive testing procedures that made the condition worse, and surgeries on the wrong area which has now rendered the patient totally disabled for life.  It’s at this point that they will usually authorize 6 chiropractic treatments.  This is about 5 years after the injury.  The moral of the story is, if you are injured on the job, chances are, you are the doctor’s retirement policy and he has no incentive to help you get better, but has great monetary incentive to make sure you never get well.  The average case I reviewed usually had one prominent fact.  The patient has had hundreds of thousands of dollars worth of care and they are not returning to work many years later.

There are so many things wrong with what I just wrote, but I’ll just point out the worst one.  This new study proving the superiority of chiropractic care was known back in the 70’s from some other study that I can’t recall the name of.  So as I like to do, grinding out the numbers means a lot of money was wasted, and a lot of people suffered needlessly because of severe bias.

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