“Salute” (Health)
weekly supplement to the national Newspaper
“LA REPUBLICA”

The Chiropractors

When hands are enough to heal.
A still “hidden” medical art.
Other law proposals in Parliament may finally provide standards

BY ANNAMARIA MESSA

They are not “bone-crushers”, or physiotherapists or simple manipulators. They are not medical doctors and do not wish to be considered as such. In their science, part philosophy and part medical art, there are neither drugs nor surgery. Chiropractors are doctors, in the sense that they are regular graduates in chiropractic after five years of university study.

All over the world (except in Italy, Spain, Portugal and Greece) they are «specialist health workers», on an equal footing with doctors and dentists. An army that, with over 100 thousand chiropractors in the USA, comes in second position after family doctors and before dentists. In Europe, there are 2,400 members in the European Chiropractors’ Union (ECU), including 230 in Italy, of which 160 also belong to the AIC, the Italian chiropractors’ association. All of them graduated abroad, at institutes recognised by the WFC, the World Federation of Chiropractors. In Italy, although there is no lack of courses and seminars, none of them are recognised.

Here there is not even a professional register, since there is no specific law. And yet since 1982 chiropractors have been recognised (circular N°. 66/’82) as operators specialised in vertebral manipulation and used in health structures contracted to the national health service. So much so that treatment can be covered by the health service: 35 EURO’s worth of ticket for 10 appointments. “A typically Italian bungle,” comments Eddy Pellissier, president of the AIC since 1995, at the press conference held in the Italian houses of parliament on the proposed new laws for recognition of the profession. “Here they teach the manual skills, but chiropractic training takes a five-year course and 5,000 hours of study. In Italy, you can do it in three weeks. In Sicily, one university offers doctors a 100-hour course: we reported it to the fraud squad, to the revenue officers, to the health ministry, but without any laws, anyone can do whatever they like.”

The courts have never found this to be abusive practice of the medical profession. ”But you have to make a diagnosis,” maintains Pellissier, “make a case history, establish the correct course of treatment, albeit without the use of drugs or surgery, according to the practices of our profession, in order to work properly and not to go against our ethical code. All this is reserved for medics.” And so impostors are on the increase, and when accidents do happen, they reflect upon the category as a whole: «but out of 8 accidents reported, 7 are down to improvised chiropractors».

Research into effectiveness proves positive

The effectiveness of chiropractic, especially for treating lower back pain, has undergone experimental verification, with excellent results. The first studies were published in 1990 and ’95 in the British Medical Journal. The clinical tests, in which patients treated with drugs were compared with patients treated by chiropractic, showed that the latter got better much more rapidly. The results convinced the Clinical Standards Advisory Group to recommend chiropractic for the treatment of back pain.

In 1991 a similar decision was made by the Australian health authorities after local research proved that, as well as being more effective, manual treatment also led to considerable savings in terms of costs.

But watch out for the inexpert ones

Chiropractors claim that the patient, during treatment, risks at most ending up with a cracked rib. But some observations lead to the fear that chiropractic manipulations or adjustments may cause apoplexy. This hypothesis is absolutely denied by Joseph DiDuro, an Italo-American chiropractor who graduated at Palmer, and author of the research illustrated at the recent symposium in Rome, organised by the International Chiropractors Association and presented to the Italian neurology society.

“It is known that, rare as it may be, there is a risk of breaking or blocking the blood vessels that carry blood to the brain. But this danger does not only regard neck movements, nor exclusively chiropractic clinics, where it might happen once in 8 million appointments, in other words once every 1,500 years of a chiropractor’s career! For those who are prone to this pathology, any movement could be fatal, anywhere: at home, getting out of bed, reversing in the car, playing football or talking on the telephone... the risk factor lies in the patient.” And this is proved, says DiDuro, by the very low insurance premiums paid by chiropractors all over the world.

“Research confirms that it is impossible to kill a person with our manoeuvres: you would have to go well outside the range of motion of the joint in order to damage an artery, and no chiropractor has ever been taught to go beyond that range,” comments Daniele Bertamini, president of the Fédération Internationale de Chiropratique Sportive.

Another piece of research, published in the Journal of Vertebral Subluxation Research, belies the link between chiropractic and stroke, and places the accent on the person carrying out the adjustments: often not a qualified chiropractor, but a generic doctor. “You need to know the specific manual pressure in order to correct a spinal malfunction and eliminate any interference and to bring health and well-being. In the wrong hands, the danger is that it will do more harm than good.”

A discipline over a century old, with the spinal column at the centre of our well-being

It’s not just for whiplash, lumbago or orthopedic problems in general. “For most people we are the spine specialists, we just seem to be the alternative to orthopedics, but chiropractic identifies itself as a profession for the health of the individual,” says Daniele Bertamini, president of the Fédération Internationale de Chiropratique Sportive. This discipline has been uniting philosophy and science since 1895, when a Canadian osteopath, David D. Palmer, restored the lost hearing of a patient by working on the imbalances in the spine, and founded Chiropractic as a profession, as well as the first school of chiropractic, the Palmer College in Iowa, now at the head of all the other schools around the world. The basis is the harmonic functioning of the body under the control of the brain, so healing is possible by locating interferences, on a mental, chemical and structural level, between the communication of the central nervous system (brain, spinal cord) and the peripheral and visceral organs. “When there is interference there cannot be health.” Above and beyond symptoms, and even without them, the chiropractor will therefore correct vertebral subluxations, or blocked vertebra in the spine. And so it sometimes happens that one goes to the chiropractor to get treatment for back pain and finds that other chronic problems disappear. For example, a nerve immobilised between the vertebrae can cause problems in any part of the body. By “putting the vertebrae back in place” knowledgeably, the subluxation disappears and the messages from the brain can once again travel correctly to muscles, organs and glands. “It’s not manipulation,” specifies Bertamini, “it’s ‘doing by hand’, from the Greek cheiro = hand and praktikos = done. Health is restored through the good functioning of the nervous system. Signs of disharmony, even without symptoms, can be seen just from a person’s posture, from the way they move through space, from restrictions in movement and from palpation (feel): these elements lead us to a specific diagnosis with which we can then re-establish the functioning of the system and communication between systems.” There is no age limit for chiropractic. “Elderly people need us because our systems avoid drugs and improve the infirmities of old-age,” explains Thomas Rigel, graduate of the National College of Chiropractic in Chicago, based in Rome for 30 years, “osteoporosis creates a specific situation to be borne in mind, but the treatment itself is not particularly traumatic. When we find ourselves with difficult conditions such as lumbago, the chiropractor must ‘navigate’ between the various existing pains, but the adjustment is not painful for people with spine problems.” “It’s also good for the very small, and ideally should be routine,” adds Bertamini. “Some important research done in Denmark on colic in newborns showed that babies who were adjusted by a chiropractor solved their problems in a very short time. Of course, if you just remember that one of life’s main traumas is that undergone in the delivery room: the midwife takes the head of the arriving infant, tilts it, turns it and pulls it... this can bring about incredible interference effects in the newborn child, which cries because it does not feel well.”

The clinics where therapy is paid partly by the National Health Service

In Empoli, as from a month ago, you can go to the ‘Chirotherapy Clinic’ (run by Luigi Gori) at San Giuseppe Hospital (local health authority N°. USL11), which is equipped with a Natural Medicine Centre. The doctors are free-lance and work on a contract. The price to be paid to the hospital is calculated on the basis of the doctor’s fees with a small discount. Similar initiatives have been taken in Turin, Bologna, Florence and Prato.

“A periodical control has been introduced, and the various regions are thus enabled to include the therapies that they consider to be useful to an essential level of health care,” explains Antonio Tomasini, president of the Senate Health Commission. Mario Tassone, president of the parliamentary committee, clarifies: “Given our need to save money, a precise analysis is required of the costs/benefits compared with other types of therapy. With chiropractic, we can save on medication, hospitalisation and surgical operations”.

Half of patients come with back problems

The numbers turning to chiropractic are increasing, according to data provided by the association of chiropractors, despite the confusion regarding regulatory standards and the recent restrictions on health services. Before the introduction of the LEA (essential assistance levels), 57% of patients preferred to go to a chiropractor who held a contract with the national health service, rather than a private one. In 46% of all cases, people go to the chiropractor for back pains. 79% of patients go either after trying in vain to solve the problem with conventional medicine (60%) or for fear of the side-effects of prescribed drugs (18%). 14% continue with both forms of therapy. In Italy you can spend over 130 euros for a first consultation and 65 euros from the second time on, more than elsewhere. In any case, for further information you can call the free-phone number 800.0178.06 or visit the website: www.chiropratica.com. On this site you can also find the proposed laws to regulate the profession, supported by the Association, and the list of courses recognised by the CCE (Council on Chiropractic Education). Among the proposals, number 1131 (29/6/2002), the initiative of the MP Zacchera, for the recognition of chiropractic as a specialist health profession