Kaiser Permanente excludes cervical manipulation

News that Kaiser Permanente Mid-Atlantic States and Mid-Atlantic Permanente Medical Group had revised their Chiropractic Manipulation Medical Coverage Policy to exclude cervical Chiropractic Manipulative Treatment (CMT) brought a wave a criticism from DCs, and applause from chiropractic critics who still maintain that chiropractic is linked to strokes.

The revised policy states, "Chiropractic manipulation of the cervical spine is associated with vertebral artery dissection and stroke. The incidence is estimated at 1.3-5 events per 100,000 manipulations. Given the paucity of data related to beneficial effects of chiropractic manipulation of the cervical spine and the real potential for catastrophic adverse events, it was decided to exclude chiropractic manipulation of the cervical spine from coverage."

The World Chiropractic Alliance responded by sending the company a copy of its position paper on chiropractic and strokes, and a vast amount of scientifically documented information that dispels the notion that chiropractic is in any way linked to carotid and vertebral artery dissection. "The WCA has been distributing this information ever since the myth about chiropractic and stroke began, and we'll continue to make sure we counter this campaign of misinformation," stated WCA founder and CEO Terry A. Rondberg, DC.

The new exclusion is only one of many in KP's "Chiropractic Manipulation Medical Coverage Policy" (available in full online at The Chiropractic Journal and World Chiropractic Alliance sites).

"The fact that the company continues to view chiropractic as manipulation and medicine clearly indicates that they're ignorant about the character of chiropractic," Dr. Rondberg noted. "It's ironic in that they lump us in with medicine yet at the same time tell policy holders that chiropractic is available only to those who have a 'complementary and alternative medicine rider' in their policies."

Other exclusions include supportive and palliative care, maintenance care, care for anything but musculoskeletal issues, care for asymptomatic patients, care for children under 12 years old (which KP considers as experimental/investigational), and extremity adjusting, among others.

"There are so many exclusions that the policy in itself is a good argument for transitioning to a cash practice," Rondberg commented.

Some chiropractic opponents applauded KP's change in policy. Washington, DC, lawyer Michael A. Abelson issued a statement saying he "applauded" the decision. “We now have a reputable medical organization, Kaiser, which has acknowledged that there is a real potential for a catastrophic event caused by an upper neck manipulation, and that the risk outweighs the benefit."

Abelson specializes in malpractice cases and boasts, on his website, that he "has successfully handled chiropractor malpractice cases resulting in stroke," and further tells readers: "Cervical manipulation or neck adjustment techniques employed by chiropractors can be unreasonably dangerous, with the devastating consequence of stroke." He also maintains the "Chiropractic Stroke Victims" site, which contains such anti-chiropractic rhetoric as this assessment of chiropractic education: "Chiropractors receive training at small independent schools, usually called colleges, that are not part of major academic universities. The admissions standards are much less rigorous than admission to medical, nursing or dentistry school and there is no admissions test or requirement that applicants have a college degree." His site also links to the Chiropractic Stroke Awareness Group, which has spearheaded much of the anti-chiropractic campaign in the Northeast.

"The only real recourse we have against such misinformation is to flood the Internet with the truth about the safety and efficacy of chiropractic," Rondberg said. "I urge every doctor of chiropractic to download copies of documented evidence proving the fallacy of the stroke connection from the WCA website and copy it to their own sites. They should also print flyers to hand to patients who might be frightened away from using chiropractic because of this negative publicity. In the end, the truth will win out and the public will know that chiropractic is the safest and most effective health care system available. They'll also know that it isn't a means of providing 'manipulative medicine' for musculoskeletal condition but a neurologically based system for optimizing the body's innate healing and restorative capability."

(Dr. Terry A. Rondberg is founder and CEO of the World Chiropractic Alliance and publisher of The Chiropractic Journal. His reports on other health and wellness news appear on www.terryarondberg.com, www.terryrondberg.com.)