Looking Back: 1994

By Editorial Staff

As we celebrate our 25th anniversary as the definitive news and information source for the chiropractic profession, we look back at the important events as reported in DC since 1983, while also looking forward to the future. Throughout 2008, we will feature a review of the top headlines in chiropractic for a given year, along with an article on the future of chiropractic authored by an influential member of the profession.

February 1994: Million-Dollar Canadian Research Grant

Dr. David Cassidy, research director in the Department of Orthopedics at the University of Saskatchewan, will lead a study on the natural history and prognostic variables affecting the outcome of whiplash injuries in the province. Funding for the study comes courtesy of the Saskatchewan Government Insurance (SGI), which spent approximately 87 million dollars on whiplash injuries in 1993. The grant from SGI allots $1 million for the five-year research project.

When interviewed by Dynamic Chiropractic about the upcoming study, Dr. Cassidy explained: "We are in the process of setting up a whiplash assessment unit at the Royal University Hospital. We will be conducting a large, population-based cohort study on whiplash injuries. We are particularly interested in the natural history of, and the prognostic variables for, disability and whiplash.

"To date, we really don't know about the epidemiology of whiplash. For example, we don't know what percentage of whiplash patients will recover quickly and how many will go on to have disability. There have been several studies on this, but most of them suffer from sample-selection bias and really don't give us good information. Since we will be doing a population-based study, we should have good information on recovery after whiplash.

"[In addition,] probably most people who have whiplash don't need treatment, because most of them recover in a very short time. Therefore, what we want to do is find out who is at risk of having trouble after whiplash so we can target treatment toward those people. There are few studies on treatment outcomes for whiplash. We want to look at the efficacy of all treatments for whiplash injury patients."

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March 1994: First Latin American Congress of Chiropractic

The Mexican resort of Cancun will be the site of the first Latin American Congress of Chiropractic May 25-28, 1994. This prestigious event will be highlighted by the appearance of Dr. Eduardo Henrique De Rose (from Brazil), director of the Anti-Doping Commission of the International Olympic Committee and vice president of the Fédération Internationale de Médecine Sportive. Dr. De Rose will speak on the "Interrelationship Between Sports Chiropractic and Sports Medicine" and "Anti-Doping in Sports."

Other highlights of this historic event include the 3rd International Interdisciplinary Chiropractic Seminar and chiropractic reports from Latin American countries such as Mexico (Dr. Enrique Benet Canut), Venezuela (Dr. Luis Valera), Panama (Dr. Alfredo Orilliac), Uruguay (Dr. Arturo Berhouet-Puig) and Spain (Dr. Robert Gevers).

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September 1994: Chiropractors Treat One-Third of All Back Pain Patients

A two-year structured survey of 8,000 people in randomly selected North Carolina households revealed that chiropractors are treating a much higher percentage of back pain patients than previously thought. The research was headed by Timothy Carey, MD, MPH, associate professor of medicine at the University of North Carolina in Chapel Hill.

Dynamic Chiropractic sat down with Dr. Carey recently to find out more about these important survey findings. According to Dr. Carey, "This was part of a series of studies funded by the Agency for Health Care Policy and Research (AHCPR). We looked at both the prevalence of back pain and examined which providers low back pain patients chose to see, if anyone. The second component of our study was an examination of the clinical course of patients and the health care utilization of patients after they were seen by a number of different types of providers.

"Our early studies looked at how often back pain occurred and the types of providers seen. Back pain is very common, which is not too surprising. We found that slightly over 11 percent of the population had back pain that bad over the course of a year. About two-thirds of those people had acute back pain and one-third had chronic back pain. We found that 60 percent of individuals with acute back pain don't see anyone for their pain.

"Of those who seek care, most see an MD. About 39 percent of those with back pain sought care, 24 percent sought care initially from an allopathic physician 13 percent from a chiropractor, and two percent from other providers. So of those who sought care, 62 percent sought care from an allopathic physician, and 33 percent from a chiropractor. People who had prolonged or severe pain or sciatica were more likely to seek care."

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September 1994: Britain Passes Chiropractors' Act

By Ian Hutchinson, DC, president of the British Chiropractic Association

In 1990, I took over as chairman of the BCA Parliamentary Committee and began frequent meetings with the department of health. They advised that to gain legislation, three things had to happen: All groups of chiropractors had to support it, statutory regulation (licensing) should have the support of the medical profession, and registration would have to be preceded by a report making recommendations for legislation.

The King's Fund agreed to sponsor a Working Party under the chairmanship of Sir Thomas Bingham. This Working Party, consisting of chiropractors, medical practitioners and one lay person, met over a period of 18 months before issuing its report, which recommended the statutory regulation of chiropractors (licensing) and set out a practical means of this happening.

Unlike in the U.S., the act makes no attempt to define chiropractic or scope of practice. Essentially, the act enables legislation that creates a General Chiropractic Council. This council then oversees the registration of chiropractors (licensing) and the promotion and development of the profession. The act also provides for professional self-regulation.

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October 1994: State Farm Guilty of Discriminating Against DCs

On Sept. 20, 1994, Judge John Ryan issued his ruling on State Farm Insurance's petition for judicial review. He found that State Farm had violated insurance equity laws and that its actions constituted unfair claims practices.

The Indiana Commissioner of Insurance had received a complaint from the Indiana State Chiropractic Association that State Farm was discriminating against chiropractors in paying claims. The Insurance Commissioner issued a warrant to a private firm to conduct a market examination of State Farm. The examiners initially tried to review files at the offices of Professional Evaluation Service (PES), a firm that reviewed most of State Farm's chiropractic claims, but PES refused to allow the examination team to review its files and threatened legal action.

To obviate protracted litigation with PES, the examination team did not pursue its efforts to reviews files at PES, but instead did an onsite examination of State Farm's files. The examiners found "virtually no evidence of non-chiropractic claims in the fire/auto sample being sent to outside review organizations, even though some of the non-chiropractic claims had practice patterns with high utilization of modalities and extended lengths of treatment." The claims for chiropractic services in the fire/auto sample were "sent to an outside review organization (usually PES) more frequently than claims for services performed by non-chiropractors."

After hearings on Sept. 11, 1992 and Nov. 6, 1992, the Indiana insurance commissioner issued its Final Order on Feb. 7, 1994: "State Farm is hereby ordered to immediately reimburse chiropractors for services under any insurance contract on an equal basis with physicians and other health care providers ... and to establish and use written guidelines, approved by the Department of Insurance, for the review of claims involving services performed by chiropractors."

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