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  • Smart Money Magazine

    Because of the number of requests for copies of the response letter
    to Smart Money Magazine, I am posting it on the list. This letter
    was written by ACA's spokesperson, Dr. Jerome McAndrews.

    December 19, 1996

    Stukrt Emmrich, Editor
    1790 Broadway. 12th Floor
    New York, NY 10019

    Dear Mr. Emmrich:

    I am writing regarding the article "Ten Things Your Chiropractor Won't
    Tell You (even the title tells us of the bias underlying the
    article)," which appeared in the January 1997 issue of SMART MONEY.

    It is all but exhausting to think of responding to each point in what
    is little less than a scurrilous piece of "journalism." Although the
    author of the article - John Protos - was pleasant to deal with, and
    seemed to be pursuing factual information about the chiropractic
    profession in general, the final product shows such an objective was
    either side-tracked by an editor or by his own loss of perspective.

    Yes, the chiropractic profession has problems. Certain of these
    problems were wrongly blown up in the article to proportions
    undeserving of them. To reinforce this journalistic dishonesty,
    outright falsehoods are fed to your readers. Again, it was clear to me
    when I spoke with Eriel Slatten of your offices, who called ostensibly
    to check some "facts," that little if any effort would be made to be
    factual. Even before reading the article, I wrote to the leadership of
    the American Chiropractic Association (ACA) telling them of Eriel's
    clear desire to distort the information contained in it. She seemed
    almost breathlessly hateful of the entire subject of chiropractic and
    had a very difficult time maintaining her composure; in my view a poor
    representative of your respected magazine.

    Where to start.....

    * the recommendation that a chiropractor be selected from the
    membership of the NACM (National Association of Chiropractic

    Good luck. This is a fringe group with a membership of a handful of
    chiropractors (perhaps 30 or less) out of some 55,000 practicing in
    the United States alone. The article says that NACM is among the most
    scientifically grounded groups in the profession. I believe you will
    find it true that this group has not sponsored even one scientific
    study on health care of any kind.

    It may be "cheaper" to go to a chiropractor.

    Might this just as well have said, "It is more cost effective"? The
    use of negative language is more representative of the tabloids.

    * A New England Journal of Medicine-published study shows it is
    somewhat more expensive (at odds with the "cheaper" statement) to go
    to a chiropractor.

    Could it have been pointed out that dozens of scientific studies
    show essential agreement that not only is chiropractic care for
    certain conditions such as back pain about one-half as costly but
    that it is also twice as effective. Neither the New England Journal
    study, nor any other study that shows any agreement with it,
    includes any of the rightly related costs that reasonably should be
    included in such a study: the costs of any hospitalization surgery
    or even medication. When such costs are added into a study of this
    type - the cost of office visits plus the additional costs as
    referred to above - we see that chiropractic care is more "cost

    Osteopaths, orthopedic surgeons and physical therapists provide
    spinal treatments for neck and back pain and you can get these "just
    as easily" as you can from chiropractors.

    The Rand Corporation points out that 94% of all spinal manipulation
    is performed by chiropractors with the other 6% divided among the
    above three groups.

    In addition, in 1993 the Journal of the American Osteopathic
    Association declared manipulation a "dead art" in the osteopathic

    Also.... a scientific study published in the British Medical Journal
    showed chiropractic manipulation to be more effective than that
    performed by either osteopaths or physical therapists.

    Also....... Orthopedic surgeons - and other medical physicians -
    receive zero (0) to four hours of spinal manipulation education
    anywhere in their lengthy training. This compares to the literally
    thousands of hours experienced by chiropractic students in
    accredited colleges (sixteen of them).

    * Even chiropractors who don't explicitly (emphasis added to show the
    nasty little innuendo) claim that spinal manipulation is a cure-all
    often contend that their training enables them to diagnose every
    kind of ailment."

    What does this mean? That we are not so qualified? The authors
    appear to not know what a primary care practitioner is. He or she
    can either diagnose and treat the patient, or diagnose at least to
    the level of the primary medical practitioner and consult with or
    refer to another health care provider. In other words, he or she is
    educated in depth, in the broad scope of health, disease or
    disorder. No primary medical practitioner can do more. They evaluate
    the patient and, when their knowledge suggests a deeper problem,
    they refer them to a secondary or tertiary level practitioner such
    as a radiologist or an oncologist for additional differential
    diagnosis. In point of fact, many, many conditions missed by the
    medical practitioner have been referred back to them by the
    chiropractor who has made a more thorough diagnosis. This is a
    positive factor which has encouraged the working together of medical
    and chiropractic doctors. Patients benefit through the professional
    bridge-building now taking place particularly among the younger
    practitioners and in spite of articles such as the one in question.
    I will be surprised if you do not get a spate of letters from
    medical practitioners who are outraged by the unprofessionalism of
    and the misinformation in, the article.

    Perhaps you would like to assign an editor or journalist to visit
    one or more of the accredited chiropractic colleges. I would be
    happy to work with you toward the end of arranging such a visit(s).

    * A patient's condition (back pain) may have been exacerbated by a

    Unfortunate if true. But chiropractic manipulation - including
    manipulation of the neck - is probably the safest health care
    procedure in recorded history. The Rand Corporation reports the
    chances of a serious adverse incident - in the neck - from
    manipulation are one in one million (l:l,000,000). This compares to
    the chances of acquiring HIV from a blood transfusion of two in one
    million (2:1,000,000). The manipulation would be twice as safe. And
    the Centers for Disease Control considers the nation's blood supply
    as "safe." Chiropractic manipulation of the neck is twice as safe as
    the nation's blood supply. For the lower back, it is 100 times safer

    Compare the above with errors in medical care which cause enough
    deaths, each and every year, to fill a 747 Jumbo Jet every third day
    of the year and having it crash with all aboard killed. There are
    hundreds of thousands killed by mistakes each year.

    * A woman was paralyzed (allegedly) by a chiropractor.

    While the ACA believes any doctor-caused injuries are tragic, the
    odds of such a thing happening are discussed above. Add to this the
    fact that there are a reported 113 such allegations in all of the
    literature with 43 of them supposedly caused by non-chiropractors.
    With chiropractors performing 94% of all manipulation of the spine,
    we can see where the odds for serious injury really lie.

    * It's not true that chiropractors utilize hospitals for their

    I attempted to point out to Eriel that about 150 hospitals now have
    chiropractic staff sections; that this looked like a growing trend.
    Her response: "That is a tiny, tiny percentage of the 65,000
    hospitals in the United States." When I clarified her error for her
    - that there are less than 6,500 such hospitals - she hesitated and
    then said, "That's still a tiny, tiny percentage." She seemed so
    completely uninformed and unable and unwilling to accept any factual

    * Your odds of recovering damages if injured by a chiropractor are

    Why then is it that there are virtually no instances of such failure
    to recover damages? And why is it that chiropractors' malpractice
    insurance premium rates are as little as 5% as high as those of
    orthopedic surgeons? Granted, the orthopedic surgeon's patients are
    at greater risk. But, 95% higher?

    * Fifteen states don't mandate insurance coverage for chiropractic

    This is simply wrong and demonstrates a lack of understanding of the
    issue. 87% of chiropractic services are reimbursable. In any case,
    whatever reimbursement laws do apply, they are no more effective than
    20% since the advent of self-insurance. Employers are interested in
    cost-effectiveness, as I'm sure you know. Thus they tend to include a
    chiropractic benefit in their health plans to get their workers back
    on the job in one-half the time it takes when they are cared for by
    other health care providers.

    All workers' compensation laws include chiropractic benefits.
    Chiropractors care for 43% of all auto accident victims.

    Chiropractic benefits are included - and this figure is rapidly
    increasing - in 50% of HMOs and 46% of PPOs, relatively new
    reimbursement systems in the health care industry.

    * Some chiropractors recommend routine visits.

    Why would such a concept be so foreign to a society that accepts
    without question the notion of an annual medical checkup and a
    semi-annual dental checkup? Bias?

    * Many medical doctors scoff at the idea of vitamins being of help.

    Those that do should read up on the scientific literature on this
    subject and they will change their minds.

    * Some chiropractors have even come to call themselves "doctors."

    State laws regulate the practice of all of the professions, including
    chiropractic and medicine. Such laws, as regarding the chiropractic
    profession, classify chiropractors as doctors, and often, as
    physicians. They are officially licensed as such.

    Granted, there are enough scam artists in the professions to keep us
    all busy for our lifetimes. Some of them should not only be
    de-licensed but should be behind bars. Over-utilizers of their
    services should be reined in. We applaud almost any effort to
    achieve this objective. This applies as well to those who would make
    claims for which they have little or no rational basis.

    But to so distort the picture of an entire profession, a profession
    that primarily is dedicated to helping those in pain or at risk of
    their health, is a disservice to them, their patients and their
    prospective patients. The article in question can only be defended
    under Freedom of the Press; it wouldn't be allowed in any other
    context due to its extensive distortion - seemingly intentional - of
    the truth.

    Thank you for taking the time to read this response.

    Jerome F. McAndrews, D.C.

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