In 1993, the National Board of Chiropractic Examiners published reports based on a three-year study of chiropractic. These reports focused on two surveys: one of approximately 5,000 full-time, licensed U.S. chiropractic practitioners and the other of approximately 600 full-time, licensed Canadian chiropractic practitioners. (A third survey report conducted in Australia and New Zealand will be completed in 1994.) The surveys and their resulting reports are titled Job Analysis of Chiropractic.

Following publication of the Job Analysis of Chiropractic, the NBCE began to receive requests for permission to reproduce certain portions of the reports. In response to those requests, the NBCE has condensed relevant portions and reprinted them in this brochure.

Government and Research Studies on Chiropractic

In recent years, numerous independent researchers and various government agencies have conducted studies which focus on the efficacy of chiropractic treatment. Several of these studies are listed below.

A major study to assess the most appropriate use of available health care resources was reported in 1993. This was an outcomes study funded by the Ontario Ministry of Health and conducted in hopes of sharing information about ways to reduce the incidence of work-related injuries and to address cost-effective ways to rehabilitate disabled and injured workers. The study was conducted by three health economists led by University of Ottawa Professor Pran Manga, Ph.D. The 216-page report of the study is commonly called the Manga Report. The Manga Report overwhelmingly supported the efficacy, safety, scientific validity, and cost-effectiveness of chiropractic for low-back pain. Additionally, it found that higher patient satisfaction levels were associated with chiropractic care than with medical treatment alternatives.

"Evidence from Canada and other countries suggest potential savings of hundreds of millions annually," the Manga Report states. "The literature clearly and consistently shows that the major savings from chiropractic management come from fewer and lower costs of auxiliary services, fewer hospitalizations, and a highly significant reduction in chronic problems, as well as in levels and duration of disability."

A four-phase study conducted in the early 1990s by RAND, one of America's most prestigious centers for research in public policy, science and technology, explored many indications of low-back pain.

In the RAND studies, an expert panel of researchers, including medical doctors and doctors of chiropractic, found that:

--chiropractors deliver a substantial amount of healthcare to the U.S. population.

--spinal manipulation is of benefit to some patients with acute low-back pain.

The RAND reports marked the first time that representatives of the medical community went on record stating that spinal manipulation is an appropriate treatment for certain low-back pain conditions.

A particularly significant study of chiropractic was conducted between 1978-1980 by the New Zealand Commission of Inquiry. In its 377-page report to the House of Representatives, the Commission called its study "probably the most comprehensive and detailed independent examination of chiropractic ever undertaken in any country."

The Commission entered the inquiry with "the general impression ...shared by many in the community: that chiropractic was an unscientific cult, not to be compared with orthodox medical or paramedical services."

By the end of the inquiry, the commission reported itself "irresistibly and with complete unanimity drawn to the conclusion that modern chiropractic is a soundly-based and valuable branch of health care in a specialized area..." Conclusions of the Commission's report, based on investigations in New Zealand, the U.S., Canada, the United Kingdom, and Australia, stated:

--Spinal manual therapy in the hands of a registered chiropractor is safe.

--Spinal manual therapy can be effective in relieving musculoskeletal symptoms such as back pain, and other symptoms known to respond to such therapy, such as migraine.

--Chiropractors are the only health practitioners who are necessarily equipped by their education and training to carry out spinal manual therapy.

--In the public interest and in the interests of patients, there must be no impediment to full professional cooperation between chiropractors and medical practitioners.

A 1988 study of 10,652 Florida workers' compensation cases was conducted by Steve Wolk, Ph.D., and reported by the Foundation for Chiropractic Education and Research. It was concluded that "a claimant with a back related injury, when initially treated by a chiropractor versus a medical doctor, is less likely to become temporarily disabled, or if disabled, remains disabled for a shorter period of time; and claimants treated by medical doctors were hospitalized at a much higher rate than claimants treated by chiropractors."

In 1989, a survey administered by Daniel C. Cherkin, Ph.D., and Frederick A. MacCornack, Ph.D., concluded that patients receiving care from health maintenance organizations (HMOs) within the State of Washington were three times as likely to report satisfaction with care from chiropractors as they were with care from other physicians. The patients were also more likely to believe that their chiropractor was concerned about them.

A workers' compensation study conducted in Utah by Kelly B. Iarvis, D.C., Reed B. Phillips, D.C., Ph.D., and Elliot K. Morris, ID, MBA, compared the cost of chiropractic care to the costs of medical care for conditions with identical diagnostic codes. Results were reported in the August 1991 Journal of Occupational Medicine.

The study indicated that costs were significantly higher for medical claims than for chiropractic claims; in addition, the number of work days lost was nearly ten times higher for those who received medical care instead of chiropractic care.

A 1992 article in the Journal of Family Practice reported a study by D.C. Cherkin, Ph.D., which compared patients of family physicians and of chiropractors. The article stated, "the number of days of disability for patients seen by family physicians was significantly higher (mean 39.7) than for patients managed by chiropractors (mean 10.8)."

A related editorial in the same issue referred to risks of complications from lumbar manipulation as being "very low."

A 1991 report on a workers ' compensation study conducted in Oregon by Joanne Nyiendo, Ph.D., concluded that the median time loss days (per case) for comparable injuries was 9.0 for patients receiving treatment by a doctor of chiropractic and 11.5 for treatment by a medical doctor.

A study by Miron Stano, Ph.D., reported in the June 1993 Journal of Manipulative and Physiological Therapeutics involved 395,641 patients with neuromusculoskeletal conditions. Results over a two-year period showed that patients who received chiropractic care incurred significantly lower health care costs than did patients treated solely by medical or osteopathic physicians.

Following a 1993 study, researchers J. David Cassidy, D.C., Haymo Thiel, D.C., M.S., and W. Kirkaldy-Willis, M.D., of the Back Pain Clinic at the Royal University Hospital in Saskatchewan concluded that "the treatment of lumbar intervertebral disk herniation by side posture manipulation is both safe and effective."

A 1978 study conducted by J. S. Wight, D.C., and reported in the ACA Journal of Chiropractic. indicated that 74.6% of patients with recurring headaches, including migraines, were either cured or experienced reduced headache symptomatology after receiving chiropractic manipulation.

A 12-month study conducted by P.S. Ebrall, BAppSc, and reported in the June 1992 Chiropractic Journal of Australia indicated:

--When chiropractic management was chosen, fewer claimants required compensation and fewer compensation days were taken.

--When medical management was chosen, the average payment per claim was greater and a greater number of patients regressed to chronic status, and the average payment per claim was greater.

A 1991 demographic poll conducted by the Gallup Organization revealed that 90% of chiropractic patients felt their treatment was effective; more than 80% were satisfied with that treatment; and nearly 75% felt most of their expectations had been met during their chiropractic visits.

A study conducted by T. W. Meade, a medical doctor, and reported in the June 2, 1990, British Medical Journal concluded after two years of patient monitoring, "for patients with low-back pain in whom manipulation is not contraindicated, chiropractic almost certainly confers worthwhile, long-term benefit in comparison with hospital outpatient management."

A 1992 study conducted by L.G. Schifrin, Ph.D., provided an economic assessment of mandated health insurance coverage for chiropractic treatment within the Commonwealth of Virginia. As reported by the College of William and Mary, and the Medical College of Virginia, the study indicated that chiropractic provides therapeutic benefits at economical costs. The report also recommended that chiropractic be a widely available form of health care.

A 1992 review of data from over 2,000,000 users of chiropractic care in the U.S., reported in the Journal of American Health Policy, stated that "chiropractic users tend to have substantially lower total health care costs," and "chiropractic care reduces the use of both physician and hospital care."

In 1985, the University of Saskatchewan conducted a study of 283 patients "who had not responded to previous conservative or operative treatment" and who were initially classified as totally disabled. The study revealed that "81% ... became symptom free or achieved a state of mild intermittent pain with no work restrictions" after daily spinal manipulations were administered.

Landmark Legal Decision Supports Chiropractic ~ Further validation of chiropractic care evolved from an antitrust suit which was filed by four members of the chiropractic profession against the American Medical Association (AMA) and a number of other health care organizations in the U.S. (Witk et al v. AMA et al, 1990).

Following 11 years of litigation, a federal appellate court judge upheld a ruling by U.S. District Court Judge Susan Getzendanner that the AMA had engaged in a "lengthy, systematic, successful and unlawful boycott" designed to restrict cooperation between MDs and chiropractors in order to eliminate the profession of chiropractic as a competitor in the U.S. health care system.

Judge Getzendanner rejected the AMA's patient care defense, and cited scientific studies which implied that "chiropractic care was twice as effective as medical care in relieving many painful conditions of the neck and back as well as related musculoskeletal problems."

Since the court's findings and conclusions were released, an increasing number of medical doctors, hospitals, and healthcare organizations in the U.S. have begun to include the services of chiropractors.

In order to become a licensed doctor of chiropractic, an individual must meet stringent testing, academic and professional requirements. Currently, an individual must complete the four major steps shown below in order to become a chiropractic practitioner:

Complete required general college-level studies (Bachelor's degree required by some states)

Obtain a Doctor of Chiropractic degree and complete clinical internship through an accredited four-year chiropractic college program

Pass required National Board or other exams

Meet individual state requirements for licensure

CHIROPRACTIC TRAINING Government inquiries (some of which are described in this brochure), as well as independent investigations by medical practitioners, have affirmed that today's chiropractic academic training is of equivalent standard to medical training in all pre-clinical subjects. High standards in chiropractic education are maintained by the Council on Chiropractic Education (CCE) and its Commission on Accreditation, as recognized by the U.S. Department of Education. Some Chiropractic colleges require a Bachelor's degree before enrollment. A doctor of chiropractic's training generally requires a minimum of six years of college study (two years of which are undergraduate course work) and an internship prior to entering practice. Postdoctoral training in a variety of clinical disciplines and specialties is also available through accredited colleges and specialty councils.

CHIROPRACTIC LICENSING Chiropractic is one of many occupations which are regulated by state licensing agencies. The requirements for chiropractic licensure vary from state to state (and country to country). Some states require a Bachelor's degree as a prerequisite for licensure.

To assist the various regulatory agencies in assessing candidates for licensure, the National Board administers examinations to individuals currently in the chiropractic educational system or who have completed a chiropractic educational program. The National Board also offers an examination designed for previously licensed individuals. A candidate for chiropractic licensure may request that transcripts of scores from National Board examinations be forwarded to licensing agencies which assess eligibility for licensure.

Scores from National Board examinations are made available to licensing agencies throughout the U.S. and in some foreign countries including Canada, the United Kingdom, France and Australia.