Dear Editor,

The claims made by Steven Salzberg in his contributed article to Forbes, “Medicare Data Reveal $564 Million Wasted On Chiropractors And Osteopathic Manipulation,” suggests that spinal manipulation performed by doctors of chiropractic is ineffective in the management of pain from injured or aching backs is inaccurate and refuted by evidence-based research.

A 2018 systemic review and meta-analysis report cites spinal manipulation – most often performed by a doctor of chiropractic who earns seven years of higher level education – and mobilization as likely to reduce pain and improve function for patients with chronic low back pain, with manipulation appearing to produce a larger effect than mobilization. Doctors of chiropractic perform 94 percent of all spinal manipulations.

In November 2017, Harvard Medical School published, “Where to turn for low back pain relief,” which recommends chiropractic care to “relieve back pain, improve function, and help the body heal itself.”

The American College of Physicians (2017) Guidelines published in the Annals of Internal Medicine present evidence and provide clinical recommendations on noninvasive management for low back pain. The guideline emphasized conservative noninvasive treatments for acute, subacute and chronic low back pain. In Recommendation 1 of the guideline, it states, “…clinicians and patients should select non-pharmacological treatment with superficial heat, massage, or acupuncture or spinal manipulative therapy.”

With any effective treatment modality, there is minimal risk that must be considered. That being said, a 2016 systematic review of the literature on cervical artery dissection following spinal manipulative therapy (SMT) found no causal link between the two. These findings are consistent with previous studies which have concluded that increased risks of vertebrobasilar artery system (VBA) stroke associated with both chiropractic and primary care are likely due to patients seeking care because they are experiencing symptoms of headache and neck pain due to ongoing VBA dissection.

There is no validity behind Salzberg’s statement which alleges that no scientific evidence exists to support the value of chiropractic care. In addition to the safety and effectiveness documented, the management of low back pain initiated with a doctor of chiropractic saves up to 40 percent on health care costs in comparison to care initiated through a medical doctor.

Researchers estimate that chiropractic care may reduce the number of Medicare patient visits to primary care medical physicians for back and/or neck pain, resulting in $83.5 million in annual savings.

To insinuate that $545 million was “wasted” on chiropractic care provides your readership with a misrepresentation of a valued pain management and general wellness approach that is proven to yield improved clinical and cost-effective outcomes, coupled with high patient satisfaction scores.

According to the 2016 Gallup-Palmer College of Chiropractic Annual Report: Americans’ Perceptions of Chiropractic, “nearly 62 million adults in the U.S. saw a chiropractor in the last five years — with an estimated 35.5 million going in the last 12 months alone. Adults who saw a chiropractor in the last five years are generally very positive about their experience.”

With more than 115 people a day dying from an opioid-related overdose, your audience of more than 6 million individuals deserves to be presented with accurate information about safe, effective and drug-free approaches, such as chiropractic care, to manage pain.

Guidelines published May 2017 in the Canadian Medical Association Journal strongly recommend non-pharmacologic therapy, including chiropractic, before using opioid therapy for chronic non-cancer pain. Guideline Recommendation 10 provides for “…a coordinated multidisciplinary collaboration that includes several health professionals whom physicians can access according to their availability (possibilities include but are not limited to: a primary care physician, a nurse, a pharmacist, a physical therapist, a chiropractor, a kinesiologist, an occupational therapist, an addiction medicine specialist, a psychiatrist and a psychologist).

For more evidence-based research, download “Chiropractic: A Safe and Cost-Effective Approach to Health.”


Sherry McAllister, DC, M.S (Ed)., CCSP
Executive Vice President, Foundation for Chiropractic Progress