Daniel C. Cherkin, Ph.D.

**Comments in red by Stephen Barrett, M.D. A. Synopsis of Monograph In the past several decades, chiropractic has undergone a remarkable transformation. Labeled an “unscientific cult” by organized medicine as little as 20 years ago (Getzendaner, 1987), chiropractic is now recognized as the principal source of one of the few treatments recommended by national evidence-based guidelines for the treatment of low back pain, spinal manipulation (Bigos, 1994). **This is a very misleading statement. The Bigos report, published by the Agency for Health Care Policy and Research (AHCPR), states that spinal manipulation may be effective against acute low-back pain. That conclusion was based primarily on research done by medical doctors and physical therapists, not chiropractors. It has been estimated that chiropractors administer over 90% of the …

**Comments in red by Stephen Barrett, M.D. A. Sources of Reimbursement for Chiropractic Services Although many patients still pay out-of-pocket for chiropractic services, most now have insurance that pays part of the cost. The two best sources of information about payment for chiropractic services are the annual survey of the members of the American Chiropractic Association (who comprise roughly 25 percent of all the licensed chiropractors in the U.S.) and a recent study of chiropractic utilization in five geographic areas of the U.S. (Goertz, 1996; Hurwitz, in press). The ACA had 12,252 members (excluding students) as of November 1, 1996 (Goertz, 1996b). This represents roughly 25 percent of the 50,000 chiropractors believed to be licensed in the United States (Cooper, 1996).The 1995 ACA data describe the …