Should TRICARE become TRICHIROPRACTIC?

Should TRICARE become TRICHIROPRACTIC?

It seems alternative medicine is infiltrating into more and more organizations that should be based on science. We have quackademia in medical schools, integrative medicine clinics in hospitals and medical centers, government funding for alternative medicine research and education, coverage of alternative medicine by government and private health insurance, and acceptance of alternative practitioners in the VA and in military hospitals. Two weeks ago I wrote about an ill-advised effort to get naturopathy into the VA. Now it seems chiropractors have been lobbying to give all veterans and TRICARE beneficiaries access to chiropractic care. On the Society for Science-Based Medicine blog, Jann Bellamy has provided the details.

There are several bills pending: S. 398 and H.R. 1170 for the VA and H.R. 802 for TRICARE. There is also a bill (H.R. 542) that would include chiropractors in the National Health Services Corps. The American Chiropractic Association has issued statements in support of those bills. In their statements, they misrepresent what chiropractic is and what it can do.

Here are my objections:

Chiropractic is based on a myth

The chiropractic subluxation. Originally chiropractors were taught that all disease was due to subluxations: displacements of spinal bones causing nerve dysfunction. A recent study by chiropractors themselves concluded:

No supportive evidence is found for the chiropractic subluxation being associated with any disease process or of creating suboptimal health conditions requiring intervention. Regardless of popular appeal this leaves the subluxation construct in the realm of unsupported speculation. This lack of supportive evidence suggests the subluxation construct has no valid clinical applicability.

Chiropractors have nothing unique to offer

They do spinal manipulation therapy, but so do doctors of osteopathic medicine (DOs), physical therapists, and MD physiatrists. They offer other conventional modalities like heat and massage. The whole concept of chiropractic is no longer viable. The minority of chiropractors who have rejected the subluxation concept and are trying to offer evidence-based care offer care that is indistinguishable from what a physical therapist can do; it’s hard to see how they can justify saying they are practicing “chiropractic.”

Chiropractic can be dangerous

Cervical manipulation by chiropractors has been associated with strokes and death. The form of neck manipulation most often used by chiropractors, high velocity, low amplitude thrusts (HVLA), can sometimes tear the delicate lining of the arteries in the neck, causing either immediate bleeding or the formation of a clot that later breaks off and travels to the brain. For neck pain, manipulation is no more effective than gentle mobilization and exercise. Chiropractors frequently use neck manipulation for other medical conditions where there is no evidence that it benefits patients. Half of all patients experience adverse effects from manipulation, ranging from mild temporary discomfort to broken bones, paralysis, and death. The risk of serious complications from cervical manipulation is small, but when there is no proven benefit, no degree of risk is acceptable.

There are other dangers of chiropractic care. Often patients are encouraged to get regular “maintenance” adjustments even when they feel well; these are useless and costly. Many chiropractors discourage conventional medical care; less than half of them support immunization. A large percentage of chiropractors use bogus diagnostic and treatment methods, from applied kinesiology to homeopathy. Since they are not well-grounded in science-based medicine, they tend to be magnets for every new kind of quackery. Some chiropractors treat newborn infants in the delivery room or shortly after in the belief that childbirth causes subluxations. Some of them claim they can cure diabetes. Some chiropractors are trying to gain acceptance as primary care providers or family doctors, a role that their education clearly does not prepare them for.

Chiropractors would not save the government money

The ACA claims that using chiropractors would save money. There is reason to think it would not. In 2000, a House Committee on Veteran’s Affairs Subcommittee on Health reviewed the results of a demonstration program and concluded that incorporation of chiropractic care into the DoD health care delivery model was not advisable. They found that adding chiropractic care increased costs and did not improve patient outcomes.

The ACA aims to benefit chiropractors, not patients

During the 120 years that have elapsed since chiropractic was invented by a grocer and “magnetic healer,” chiropractic has struggled to establish scientific credibility, and it has failed. If there were solid evidence of the safety and effectiveness of chiropractic care, it would have been accepted as part of mainstream medicine and would no longer be considered “alternative medicine.” Since the scientific evidence doesn’t legitimize them, chiropractors can only lobby and try to achieve legitimacy through political action. In their propaganda, they emphasize pain relief and patient satisfaction, in a blatant attempt to get a foot in the door where they don’t belong. Once they are in the system, they would be able to promote all kinds of pseudoscience, offer “maintenance adjustments,” and treat patients inappropriately for non-musculoskeletal conditions.

There is no way to sort the wheat from the chaff

Some chiropractors reject the subluxation concept and try to practice what is essentially evidence-based physical therapy; they have expertise in back care and might well be a valuable addition to the health care team. But others use all kinds of quack diagnostic and treatment methods and undermine conventional medicine. Many of them reject vital public health measures like vaccines and fluoridation. Some chiropractors even reject the germ theory. If the VA and TRICARE are required to admit chiropractors, the law will require them to admit any DC who is licensed to practice. There is no reliable way to distinguish the evidence-based chiropractors from the quacks. This is a recipe for disaster.

Conclusion: Veterans deserve real medicine

In my opinion, providing all veterans and TRICARE beneficiaries with access to chiropractic care would be a mistake. They deserve the best quality, up-to-date medical care. Treatment by chiropractors would turn back the clock. It would provide substandard care and expose patients to risks, and it would waste taxpayer money. Chiropractors offer nothing unique; the treatments they offer that are effective, including spinal manipulation therapy, can be provided by science-based conventional providers such as physical therapists, DOs, and physiatrists. I have sent letters of protest to TRICARE and VA officials. You might want to write your congressmen.

 

 

Posted by Harriet Hall

Harriet Hall, MD also known as The SkepDoc, is a retired family physician who writes about pseudoscience and questionable medical practices. She received her BA and MD from the University of Washington, did her internship in the Air Force (the second female ever to do so),  and was the first female graduate of the Air Force family practice residency at Eglin Air Force Base. During a long career as an Air Force physician, she held various positions from flight surgeon to DBMS (Director of Base Medical Services) and did everything from delivering babies to taking the controls of a B-52. She retired with the rank of Colonel.  In 2008 she published her memoirs, Women Aren't Supposed to Fly.

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