valuable as both a standard medical treatment and as an
alternative form of medicine. There may very well be some
scientific justification in the manipulation of the spine because
almost every nerve in the body runs through the spinal cord.
Chiropractors maintain that they can treat illness by adjusting
the vertebra of the spinal column to relieve nerve and muscle
tension(Wallis,1991). This position may, at first, seem
contradictory but with further analysis and explanation, it will
become clear that it is a supportable premise. “The visits to
practitioners of alternative therapy in 1997 exceeded the
projected number of visits to all primary care physicians in the
United States by an estimated 243 million; visits to
chiropractors and massage therapists accounted for nearly half of
all visits to practitioners of alternative therapies” (JAMA,
1998).
As an example, a simple on-the-job back strain could be
treated in several ways. The simplest and seemingly least costly
treatment would be for the employee to go home and rest in bed.
However, this form of treatment may actually keep the employee
away from work for the longest period of time which would make
the cost factor to the employer higher in the long run due to
Worker’s Compensation premium costs and the costs associated with
replacing the injured employee such as sick leave benefits and
the costs of providing substitute employees.
The more traditional treatment would be for the employee to
seek treatment from an urgent care facility or from a family
physician. Treatment would generally require X-rays, an MRI or a
CAT scan to assist the physician in diagnosing the source of the
injury. Depending on the nature and severity of the injury,
surgery and rehabilitation through physical therapy may be
required to resolve the injury. Otherwise, in the case of a
minor injury, cold packs, pain medication and rest may be
appropriate treatment. Costs for traditional physician treatment
are generally very high. For example, a standard MRI will cost
at least a thousand dollars. Referral to an Orthopedic Surgeon
and subsequent treatment including possible surgery, medication
and subsequent physical therapy can cost tens of thousands of
dollars and extended periods of lost work time. All of the
medical plans that I examined provide full coverage, less
applicable deductibles or co-payments, for the cost of most forms
of treatment with the exception of those considered to be
experimental.
A third alternative may be acupuncture treatment. The
acupuncturist may or may not be licensed to provide or order X-
ray, MRI or CAT scans. If not, the treatment may be the
traditional acupuncture treatment. Rest is generally
recommended. Generally, the cost of acupuncture is covered,
subject to deductibles and co-payments, by most health plans with
the exception of Kaiser-Permanente.
The fourth and most appropriate treatment, in my opinion, is
chiropractic. A chiropractor has the ability to order or to
provide X-ray examinations as well as to order MRI’s or CAT scans
as necessary. In the event that structural damage such as a
ruptured disc or fracture exists, the chiropractor would refer
the employee to an orthopedic physician. However, if the injury
is due to a subluxation, the chiropractor would typically perform
an adjustment to the spine or other form of manipulative therapy
to realign the spine and remove nerve interference and to relieve
pain and discomfort. The chiropractor may also prescribe cold
packs, rest and, in some cases, physical therapy. The initial
examination, which include: the patient’s history and
assessment, X-rays, spinal adjustment, and recommendations for
improving of making changes in their lifestyle to promote a
healthier life (nutrition, massage therapy, exercise, rest,
etc.). The initial examination costs a few hundred dollars,
which is covered by Blue Cross and Health Net less the
deductibles and co-payments. Follow up exams include spinal
adjustments and recommendation or advice on questions pertaining
to the treatment and your lifestyle. The cost of these exams
usually cost around fifty dollars per visit, which Blue Cross
covers the full amount after the deductible has been paid; Health
Net requires a co-payment of ten dollars per visit up to thirty
visits per year, and Kaiser doesn’t cover any of the expenses of
chiropractic care. According to an article in Kiplinger’s
Personal Finance Magazine, “An initial visit to a chiropractor
could cost $40 to $80, plus the cost of x-rays; follow-ups are
around $40 to $60. Insurance laws in most states require insurers
to reimburse for treatment by chiropractors if they reimburse for
comparable treatment by M.D.’s, and coverage is mandated in
Delaware, Maryland, New Mexico and North Dakota. There is no
requirement in Oregon, Utah and Vermont. Self-insured plans are
exempt from the state-mandated-benefit laws. Also, according to
Don White of the Health Insurance Association of America,
insurers are “much more willing to pay than they used to be” when
alternative therapies are recommended by a doctor after
conventional methods fail”(Clark,1993).
Chiropractic is not without its own set of risks just as
other forms of traditional medicine. Ian Coulter, Ph.D.
identified those risks and facts as follows:
“chiropractors perform more than 90 percent of spinal
manipulations (manipulation is the generic, non specific
medical term for adjustment); the risk of complication with
cervical (neck) adjustments is 6.39 per 10 million
adjustments; the risk of complication with lumbar (low back)
adjustments is 1 in 100 million adjustments. The risk of
complication in some common medical procedures and
medications were not as good: the risk of complication with
the use of NSAIDS (aspirin, tylenol, ibuprofen, etc.) is 3.2
in 1,000; and the risk of complication in cervical spine
surgeries is 15.6 in 1,000. By way of commentary, there has
been a lot of news coverage concerning the dangers of
Chiropractic care over the past few years. This article
clearly points out that Chiropractic procedures are
significantly safer than many common medical procedures. For
the best reflection of how safe Chiropractic is, ask your
Chiropractor how much his/her malpractice insurance costs.
Then ask your medical doctor the same question. The
difference will surprise you.” (Chiropractic America, 1999).
The preceding procedures treat injuries and the pain
associated with the injury in widely differing manners. It is
also important to consider how each form of treatment personally
affects the individual. Obviously, the less invasive the
treatment, the quicker the recovery. Pain control is another
serious consideration. Simply resting may be adequate in some
instances but if a serious injury exists, the long term result
may be negative. Surgery generally generates substantial pain
which requires pain control medication which, in some instances,
can become addictive. In contrast, acupuncture causes very
little, if any, discomfort and may provide a long term solution.
“Acupuncture is most often used to treat pain, and is also used
for ailments such as hypertension and gastrointestinal disorders.
Needles placed on points on the body are said to transmit
impulses to the brain and then to the affected organ. An initial
visit might cost $225; follow-ups run about $75, including a
supply of Chinese herbal medicines, which are part of an
acupuncturist’s treatment”(Clark,1991). However, chiropractic
would be my first choice for treatment because of the immediate
nature of the relief this form of medicine provides. It provides
for safety in that prior to a subluxation adjustment, the
chiropractor would use X-rays to determine the efficacy of this
form of treatment. If a structural injury exists, such as a disc
problem or fracture, the chiropractor would be at liberty to
refer the patient to a physician. Otherwise, chiropractic is
neither invasive nor uncomfortable. In a report released in July
1991 by the Rand Corporation, a prestigious research organization
in Santa Monica, California,
“…a panel of leading physicians, osteopaths and
chiropractors found that chiropractic style manipulation was
helpful for a major category of patients with lower-back
pain: people who are generally healthy but who had developed
back trouble within the preceding two or three weeks. By
some estimates, 75 percent of all Americans will suffer from
low back aches and pains at some point in their lifetime.
The annual cost to U.S. society of treating the ubiquitous
ailment was recently tallied at a crippling 24 billion
dollars, compared with $6 billion for AIDS and $4 billion
for lung cancer. If spinal manipulation could ease even a
fraction of that financial burden, remaining skeptics might
be forced to stifle their misgivings or get cracking
themselves”(Purvis,1991).
In almost all cases, drugs are discouraged so that drug reactions
and addictions are never an issue as a result of treatment.
It is recognized in almost all medical circles that many
illnesses are generated by the mind. “A growing number of doctors
around the country have become more open to alternative
approaches, looking particularly at the way that body, mind and
life-style interact. Andrew Weil, a Harvard-trained M.D. and
author of The Natural Mind, practices this sort of holistic’
medicine in Tuscon”(Wallis,1991). Stress from many sources
including work and family is the cause of many maladies. That is
why it seems very curious that some health organizations ignore
the positive aspects of some or all forms of alternative
medicine. On one hand, the medical community recognizes the
mental side of medicine and then they summarily ignore forms of
treatment that people believe in and that result in healing
whether the source is medical or physical. It seems to be a
territorial response to what the medical community perceives to
be a threat to its existence. Dr. Saper, a neurologist,
“…confirms that lowering a patient’s stress level, with
relation techniques or simply encouraging trust in the doctor,
can be healing. Research suggests that stress triggers the
release of chemical messengers from the brain that suppress the
immune system; relaxation would therefore revive the immune
response”(Wallis,1991). However, the trend seems to be towards
acceptance of alternative medical practices. A telephone poll of
500 American adults was taken from TIME/CNN on October 23, 1991
by Yankelovich Clancy Shulman that contained three questions
about their use of alternative medicine. The results of the
survey were: 31 percent of the poll sought medical help from a
chiropractor, 6 percent sought help from an acupuncturist, 5
percent went to an herbalist, 3 percent visited a homeopathic
doctor, and 2 percent sought help from a faith healer. When those
who had sought medical help from alternative medicine providers
where asked if they would go back to an alternative doctor, 84
percent of them said yes, and only 10 percent answered no, with
the 6 percent of not sures’ being omitted. Among those who had
not sought help from a practitioner of alternative medicine, 62
percent said that they would consider seeking medical help from
an alternative doctor if conventional medicine failed to help
them(Wallis, 1991).
If a high percentage of illnesses are truly psychological
and if these people believe that these forms of alternative
medicine will cure them, then the insurance companies should
provide coverage for them. Ultimately this is cost effective
because in comparison to cost of other forms of medical
treatment, alternative medicines are much less expensive. By
providing coverage for alternative medicine, society should in
fact increase their health either physiologically and/or
psychologically, which will in turn decrease the number of
illnesses and health care premiums will decrease. Maintaining
wellness is a emerging focus of both employers and HMO’s. Use of
at least 1 of 16 alternative therapies during the previous year
increased from 33.8 percent in 1990 to 42.1 percent in 1997.
This shows that society is accepting alternative medicine on an
ever increasing basis. Alternative therapies were used most
frequently for chronic conditions, including back problems,
anxiety, depression and headaches. Also, more than half of these
visits were paid for out-of-pocket, that is health insurance
would not or did not pay for the cost of treatment (JAMA, 11/98).
Incidently, more and more insurance companies are providing
coverage due to member demand. Therefore members who believe in
treatment through alternative medicine should make a concerted
effort to make their demands heard. One study, conducted in
England, found that “for patients with low-back pain in whom
manipulation is not contraindicated, chiropractic almost
certainly confers worthwhile, long-term benefit in comparison to
standard hospital outpatient management.” An extended follow-up
of the same patients found that chiropractic patients continued
to fair better than their medically treated counterparts (Meade,
1431-7). “At three years the results confirm the findings of an
earlier report that when chiropractic or hospital therapists
treat patients with low back pain as they would in day to day
practice those treated by chiropractic derive more benefit and
long-term satisfaction than those treated by hospitals”(Meade,
349-51).
Cost-containment is of vital importance, especially to those
that must pay out-of-pocket for their medical treatments.
According to the JAMA: “The majority of people who saw
alternative therapy practitioners paid all the costs out-of-
pocket in both 1990 (64.0%) and 1997 (58.3%).” Even so, the
trend is apparent. More and more people are turning to
alternative therapies. It must be remembered that the AMA has a
vested interest in the results of such a trend and therefore
would be inclined to put the best “spin” on the survey. “In
1990, a full third of respondents who used alternative therapy
did not use it for any principal medical condition. From these
data, we inferred that a substantial amount of alternative
therapy was used for health promotion or disease prevention. In
1997, 42% of all alternative therapies used were exclusively
attributed to treatment of existing illness, whereas 58% were
used, at least in part, to prevent future illness from occurring
or to maintain health and vitality.” The AMA is apparently
recognizing the fact that many people use alternative therapies
not only to cure but to prevent illness and to improve health.
This is a revealing statement for the medical community to make.
The article goes on to say that: “As alternative medicine is
introduced by third-party payers as an attractive insurance
product, it would be unfair for individuals without health
insurance and those with less expendable income to be excluded
from useful alternative medical services or consultation (eg,
professional advice on use or avoidance of alternative
therapies).” (JAMA, 1998). The AMA is actually recognizing the
value of alternative medicine when it refers to them as:
“…useful alternative medical services….” In fact, the most
impressive statement made by the AMA was: “An increasing number
of US insurers and managed care organizations now offer
alternative medicine programs and benefits. The majority of US
medical schools now offer courses on alternative medicine.”
The Journal of the American Medical Association in a study
conducted by the Stanford Center for Research in Disease
Prevention concluded that: “Research both in the United States
and abroad suggests that significant numbers of people are
involved with various forms of alternative medicine. However,
the reasons for such use are, at present, poorly understood.”
The study went on to say: “Three hypotheses were tested. People
seek out these alternatives because (1) they are dissatisfied in
some way with conventional treatment; (2) they see alternative
treatments as offering more personal autonomy and control over