Robert D. Mootz, D.C.
**Comments in red by Stephen Barrett, M.D. A. The Origin and Evolution of Chiropractic Belief Systems The chiropractic perspective on health and disease emphasizes two fundamental characteristics. (1) a testable principle suggesting that the structure and condition of the body influences how the body functions and heals and (2) an untestable metaphor that asserts that the mind-body relationship is instrumental in maintaining health and in healing processes. Even though early chiropractors characterized these perspectives on health as unique (Palmer, 1910), the conceptualization of the relationship between “life” and “matter” actually began with the early Greek philosophers (Hall, 1969, pp. 18-20). In fact, the origins of traditional “chiropractic philosophy” can be found within the classical philosophic disciplines (e.g., metaphysics, ontology), which attempted to explore the “nature …
**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 …
Chapter VII: Chiropractic in the Health Care System Robert D. Mootz, DC; William C. Meeker, DC, MPH; Cheryl Hawk, DC, PhD**Comments in red by Stephen Barrett, M.D.Chiropractic occupies a unique position in the United States health care system. It is the most widely disseminated indigenous American system of healing and the most frequently used type of alternative health care in the United States (Gaucher-Peslherbe, 1995; Eisenberg, 1993). Its steadily increasing acceptance and use by the public, third- party payers, and the Federal government indicate that chiropractic is no longer the “marginal” or “deviant” profession it was once considered to be (Wardwell, 1952). In recent years, a number of outside observers have suggested that the profession has now entered the health care mainstream (Coile, 1995a, 1995b; …
**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. One hundred years ago, the founder of the chiropractic profession, D. D. Palmer, reportedly used spinal manipulation to r estore a deaf janitor’s hearing. A series of events following this dramatic incident ultimately led to the establishment of what is now one of the largest health care professions in the United States. From its beginnings, this new profession eschewed more invasive treatments in favor of spinal adjusting (or manipulation) as its central approach to care. During much of its first century of existence, chiropractic was shunned by the medical profession and remained on the fringe of mainstream health care. In fact, as recently as 1980, the American Medical Association’s Principles of Medical Ethics proscribed any associations between physicians …
Editors Daniel C. Cherkin, PhD Senior Scientific Investigator Center for Health Studies Group Health Cooperative of Puget Sound Seattle, Washington Robert D. Mootz, DC Associate Medical Director for Chiropractic Department of Labor and Industries Olympia, Washington Other Contributors Alan H. Adams, DC Vice President of Professional Affairs Los Angeles College of Chiropractic Whittier, California Ian D. Coulter, PhD Professor, School of Dentistry, UCLA Health Consultant, RAND Professor of Research Los Angeles College of Chiropractic Los Angeles, California Cheryl Hawk, DC, PhD Associate Professor Palmer Center for Chiropractic Research Palmer College of Chiropractic Davenport, Iowa Gail A. Jensen, PhD Associate Professor Institute of Gerontology Department of Economics Wayne State University Detroit, Michigan William C. Meeker, DC, MPH Director of Research Palmer Center for Chiropractic Research Palmer …
This study, written by seven chiropractors and four other contributors, was sponsored by the Agency for Health Care Policy and Research and published by the National Technical Information Service (NTIS) in September 1997 as a 140-page report. Although the report contains valuable information about the chiropractic marketplace, it says almost nothing about the profession’s shortcomings. Printed copies (Order Number PB98-111693) can be obtained from NTIS for $31 plus $5 postage by calling (800) 553-6847 or (703) 605-3000. To enable proper interpretation of this report, I am publishing it on Chirobase with my comments added in red type. — Stephen Barrett, M.D. Contributors Foreword I. A Brief History of Chiropractic II. Chiropractic Belief Systems III. Chiropractic Training IV. Supply, Distribution, and Utilization of Chiropractors in the …
**Comments in red by Stephen Barrett, M.D. A. Presenting Problems and Diagnoses Two studies of national scope have tried to describe what chiropractors actually do in practice. The first was a national survey of over 5,000 practicing chiropractors (Christensen, 1993), which asked what conditions patients presented with or had concurrently. The second, using data collected from the office records of a cluster sample of chiropractors, looked at the presenting symptoms the chiropractors recorded in charts and at diagnoses recorded for insurance purposes (Hurwitz, 1998). Both studies collected data in the early 1990s. These studies allow for a comparison between what chiropractors indicate they do in response to a survey and what they actually record for specific patients in their office records. The patient conditions that chiropractors …
