Several months ago I noticed a couple of friends going to
the chiropractor on a regular basis and tried to talk them into trying a yoga
class instead. They said they were too
old and stiff for yoga, a typical response, and besides, Medicare paid for the
chiropractor. I wasn’t sure this was
correct, but let it go.
Recently though, I ran across a fact sheet from the
government and learned the following: “Spinal manipulation is a covered service
under Medicare. However, maintenance care is not considered by Medicare to be
medically reasonable and necessary, and is not reimbursable by Medicare. Only
acute and chronic spinal manipulation services are considered active care and
may, therefore, be reimbursable.” It
went on to define maintenance therapy, which sounded exactly like what my
friends were getting. Of course, I don’t
have all the information and may be wrong, or the chiropractor may be violating
the law.
From what I have read most chiropractors are honest and
sincere. They and their patients believe
that treatment of subluxations in the spine provides relief from pain and other
back problems. Likewise Medicare
recognizes subluxation as a problem that calls for medical attention. But this in itself may be a problem.
One of many skeptical sources shares a different
view. “According to classical
chiropractic, a ‘subluxation’ is a misalignment of the spine that allegedly
interferes with nerve signals from the brain. However, there is no scientific
evidence for spinal subluxations and none have ever been observed by medical
practitioners such as orthopedic surgeons, neurosurgeons, or radiologists. On
May 25, 2010, The General Chiropractic Council (GCC), a UK-wide statutory body
with regulatory powers, issued the following statement: The chiropractic vertebral subluxation
complex is an historical concept but it remains a theoretical model. It is not
supported by any clinical research evidence that would allow claims to be made
that it is the cause of disease or health concerns.” It’s like a metaphor that American professionals
and their patients take seriously.
Besides proper coding and billing, chiropractors must also
be careful about the results they promise. Some have advertised that spinal manipulation
can improve general health, cure many different diseases, cure children of earaches,
autism, and asthma, and prevent spinal degeneration. None of these claims have any scientific
backing.
Then there are the cases of unethical behavior like this one
in Utah where the doctor was disciplined for financially abusing two patients
and failing to cooperate with board investigations among other offenses. But ethical failings happen in every
profession.
In short, it is smart to be skeptical about the benefits of
a visit to the chiropractor. Maybe yoga,
physical therapy or some other stretching routine will yield the same
benefits. Maybe most of the effect is
placebo, based on a belief it will work.
All I know is that when I do a weekly review of medical articles,
information about an investigation of problems with one chiropractor or another
– ethics, false claims, and other problems – appears quite often.
(For a comprehensive scientific critique of the practice,
see this YouTube video. But I know many will read this or even view the video and still ignore facts that don't agree with a worldview they don't want to change.)
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