Our top story in this issue traces its history to December 1994 when the Agency for Health Care Policy and Research (AHCPR) released its Acute Low Back Problems in Adults guidelines. The chiropractic profession had long awaited the findings of this federally-funded multidisciplinary panel. What would the panel say about chiropractic? Could the profession point to the guidelines as a multidisciplinary sanction of the value of the chiropractic adjustment?
The day the guidelines were released, there was a press conference and coverage on the national evening news: heady stuff for ol' back care to get national air time alongside the usual coverage of natural disasters, murder/mayhem, and the latest cause c³lèbre and entertainment news.
The guideline panel, while not exactly effusive about the adjustment (it never mentioned the word chiropractic), did give a moderately warm, if narrow, nod to manipulation: ("Manipulation can be helpful for patients with acute low back problems without radiculopathy when used within the first month of symtpons.")
While chiropractic had some reason to cheer, the AHCPR was vilified by some members of the medical establishment for playing down the role of surgery for acute low back pain. And of course any recommendation for manipulation was anathema to most MDs. Great political pressures were soon brought to bear upon the agency to justify its guidelines, and indeed to justify the other guidelines the AHCPR was planning.
Stoically, the AHCPR moved forward on plans to develop headache guidelines. This was certainly more exciting news, as chiropractic patients often report headache relief. But by 1996, the AHCPR had been pressured out of the guidelines business. The headache guidelines weren't completely dead, though. The project was retooled; the budget cut; the scope narrowed to migraine conditions; and it was transferred to the Center for Clinical Health Policy Research at Duke University.
The evidence reports from Duke have now been updated on both cervicogenic and tension-type headaches, thanks to the Foundation for Chiropractic Education and Research (FCER), and the funding of the National Chiropractic Mutual Insurance Company (NCMIC). The new report, Evidence Report: Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache, is now available from the FCER. It updates and releases much of the information on treatment alternatives for tension-type and cervicogenic headache, the kind of information the AHCPR sought to release before it was stifled. The FCER notes: "Chiropractic is buoyed by substantial evidence in this report as to its efficacy in the management of both tension-type and cervicogenic headaches."
Dollars and Cents
A consistent phone inquiry that we've received over the years has been: "How much do chiropractors make?" That's about as broad a question as asking how much lawyers or sales people make, but everyone is interested in money, so the question is understandable. Invariably, we have fallen back on giving callers the latest figures from the ACA's annual practice survey. On the front page of this issue, you'll find the "Summary of the 2000 ACA Professional Survey on Chiropractic Practice" by Patricia Jackson. You'll get all kinds of useful information about chiropractic practices, but to cut to the chase, the survey reports that the median gross for 2000 was $220,000; median practice expenses were $120,000; and individual net income was $81,500.
The other informative resource we rely on for particulars about chiropractic practice in the U.S., is the Job Analysis of Chiropractic (www.nbce.org/nbce).
A Word from Your Leaders
On the front page of this issue, you will see the familiar face of Chester Wilk,DC, chiropractic's most recognized plaintiff. Dr. Wilk is one of five DCs selected by you as leaders of "Our Virtual Chiropractic Association" (OVCA). In this issue, and the subsequent four, we will give each leader front-page placement to discuss his visions for chiropractic and how he would lead our "virtual" association.
College Matters
Dr. Guy Riekeman, president of Palmer College in Davenport, Iowa, has also been appointed president of Palmer West in San Jose, California (see http://www.chiroweb.com/archives/19/06/13.html) As a leader in chiropractic education, it's appropriate that Dr. Riekeman's column in this issue (see page 26) speaks to the importance of "standards for chiropractic competency and licensure that can be applied nationwide." Dr. Riekeman is referring to the action of the California Board of Chiropractic Examiners to force three chiropractic colleges to comply with its definition of how physical therapy is taught in the curriculum.
Dr. Riekeman remarks that this issue is really about "manipulation by individual states of educational curricula and standards."
P.S. We're Moving
No, we're not asking you to help us move! After more than 17 years in our building by the beach, Dynamic Chiropractic's publisher, MPAmedia, will be taking over a new building to give our burgeoning staff about twice the elbow room. Sadly, it will cut back on some of our favorite beach activities: digging for sand crabs with the "Bay Watch" lifeguardesses, and pushing beached whales off sand bars, but sacrifices have to be made.
We'll move March 30 to April 2. The office will be closed during the move, but the publication won't miss a beat. Our websites (ChiroWeb and ChiroFind) will not be affected. Email sent to Dynamic Chiropractic during the shutdown will be stored. Our new mailing address as of March 30:
Dynamic Chiropractic
5406 Bolsa Avenue
Huntington Beach, CA 92649-1021
Stephen Kelly
Managing Editor
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
Spearheaded by burgeoning scientific and clinical research literature, psychedelics have reached a level of media coverage and popular interest that has not been seen for over half a century. By “psychedelics,” we are referring to the unique class of substances that includes psilocybin (the active compound found in so-called “magic mushrooms”), LSD, dimethyltryptamine (DMT), ayahuasca, 5-MeO-DMT, and mescaline – each of which occurs in the natural world (except for LSD, which is a semi-synthetic compound).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
