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Chiropractic News Digest #03-04

June 25, 2003

Chiropractic News Digest, edited by Christopher J. Erickson, M.D. and cosponsored by NCAHF and Quackwatch, summarizes scientific and political developments; enforcement actions; and other news relevant to the chiropractic marketplace.

Latest Chiropractic Economics survey released. The latest economic survey of chiropractors has been released. [Sixth Annual Salary and Expense Survey. Chiropractic Economics, May 2003]. The report suggests an increasingly challenging environment for DCs, despite the majority of them reporting that billings and net income are increasing.

Increasing competition among DCs and other alternative providers, along with reform initiatives to limit DC visits may make it increasingly difficult to sustain high patient visit averages, especially in managed care settings. Cervical pillows, chiropractors' most common retail product, are increasingly available through consumer channels. How much more support staff and associates can be squeezed is an open question. The May 2003 issue also cites a 1995 Humana Report that "only one out of 10 doctors of chiropractic will achieve a return on (academic) investment that exceeds .394. Four out of those ten individuals will experience a negative cash flow and have to close their doors." [How to acquire your CEO skills. Chiropractic Economics, May 2003, bonus materials]

Ohio debates eliminating chiropractic from Medicaid. With many states making cuts to their Medicaid program, Ohio may be the next large state to eliminate the coverage for chiropractic, among other services. [Provance J. Spending plan OK'd by Ohio senators. The Blade, June 6, 2003]

Activator use approved in Saskatchewan. The Chiropractic Association of Saskatchewan has terminated a ban on the Activator device. [Bernhardt D. Chiropractors allow use of controversial device. The StarPhoenix (Saskatoon), June 4, 2003] The CAS had a sudden shift when its members voted to lift the ban after four years of legal wrangling. Whether 40+-year veteran and company founder Arlan Fuhr, DC can continue to sell new devices and services exclusively to chiropractors remains to be seen. Unlike the orthotics business where sales are to patients, device sales are tied to practitioners and exiting practitioners can resell old devices.

Fuhr, along with Mr. Kent Greenawalt of FootLevelers, is among a handful of major chiropractic corporate figures who write regular columns (with the reassuringly loyal titles "For the Good of the Order" and "Chiropractic Unity" respectively) for Dynamic Chiropractic. While neither Fuhr nor Activator Methods, Inc are listed among the contributors to the American Chiropractic Association legal fund, FootLevelers has contributed significant financial and organizational resources [Foot Levelers. Foot Levelers seminars to help Legal Action Fund. Chiropractic Economics. August 2001.] Although several orthotics makers already compete outside chiropractic, spring-loaded assistive devices for spinal mobilization might be targeted to other types of practitioners with greater percentages of women. The battle for acceptance of the Activator device further blurs the image of chiropractic as a purely manual therapy, and might establish a precedent whereby such devices are at a minimum not exclusive to chiropractic -- particularly as conflicts over mobilization versus manipulation and range of motion are resolved [Devitt M. Chiropractic Board Fines PT for Performing Spinal Manipulation. Dynamic Chiropractic. February 24, 2003]

Activator Methods Chiropractic Technique is a nonsensical diagnostic and treatment system centered on the notion that leg-length analysis can locate subluxations and determine when to adjust the spine. The adjustments, which are not manipulations, are done with the Activator device, which is a spring-loaded mallot. [Homola S. Activator methods. Chirobase, Dec 10, 2000]

Wisconsin Chiropractic Association sues state. In a move that will likely limit or even decrease the number of chiropractors in the state, the WCA "asks the courts to declare the issuance of licenses to chiropractors who have failed or have not taken the Wisconsin test to be a violation of state law." [Elbow S. Chiropractors sue state, want to use tough test. The Capital Times, May 20, 2003]. Noting surging numbers of DCs, the WCA complains that the National Board of Chiropractic Examiner's test is too easy, for example "allowing license applicants to fail one part but pass the overall exam, while the state test requires applicants to pass each category." The WCA settled charges with the FTC on price-fixing charges in 2000. Wisconsin is home to a large chiropractic corporation model of clinics.

ACA chiropractic ad sponsored by lidocaine remedy maker. The current home page of the American Chiropractic Association has a link to "For Your Health Fact Sheet: Pull Your Weeds, Not Your Back, To Make Your Garden Grow," a fact sheet encouraging gardeners to do some simple prevention, and consult chiropractors with any unspecified persistent pain. The page is sponsored by "Flex-RX™." Among other herbal ingredients the product contains the drug lidocaine, a local anesthetic. With no attached FDA evaluation disclaimer, the makers claim that the product "provides preventative benefits and Icy Hot® does not." The ACA has many endorsement deals that other professional organizations eschew. The guidelines on the ACA website for such endorsements emphasize marketing, retail channels, and royalties, with a single line devoted to unspecified "third-party documentation regarding the product's efficacy and safety."

Employers question New York mandated chiro coverage. A 1,200-business coalition, The Employer Alliance, commissioned a report looking at different mandated coverages in New York [Durr E. Report takes Legislature to task for mandating health insurance benefits. The Business Review (Albany), June 2, 2003]. Mandated chiropractic coverage was cited as a significant component, adding nearly $100 in premiums per policy. According to the report by NovaRest, an Illinois-based actuarial and management-consulting firm, expensive mandates force some companies to drop coverage for employees, or switch to self-coverage solutions. The report may give impetus to a bill in that state that requires cost-analysis prior to any new mandates. Businesses with less than 50 employees are required to cover chiropractic or mental health services. A program launched two years ago for such businesses has been able to cut premiums by an average of 17% and expand eligibility for coverage by excluding the mandated services. [Franczyk A. Small business gets big break on insurance. Business First of Buffalo, June 9, 2003]

WCA blasted for high-volume position paper. The World Chiropractic Association's position paper on high-volume practices was recently critiqued [Perle S. Scientific Misconduct, Error or Willful Ignorance? Dynamic Chiropractic. June 30, 2003]. Citing evidence from the medical literature for complex, usually in-patient medical procedures and aftercare, the WCA position paper concludes:" Based on the clinical experience of numerous doctors of chiropractic, supported by these and other medical research studies, the World Chiropractic Alliance finds strong evidence that the adage "practice makes perfect" may apply -- as it does to many other skills -- to chiropractic adjusting as well." The critique disputes not only the premise of this comparison, but the analysis of such evidence per se: "The World Chiropractic Alliance (WCA) appears to have overstated the results of studies it cites in a position paper on the supposed merits of high-volume chiropractic practices." Beyond procedures per se, general care and consultation were cited in examples of doctor-patient contact time and outcomes, directly controverting the WCA position.

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This page was posted on June 25, 2003.