CJA Vol.27 Issue 1Editorial: Publish or Perish—Another View Report from the Seventh Annual Meeting of the Chiropractic
Research The Iowa Plan and the Activities of the Committee on
Quackery Chiropractic Practice: A South African Case
Study Supportive Care: An Important Notion in Third-Party
Payer Cases Citations and References Commentary: Clinical Epidemiology for Excellence in
Chiropractic Practice ABSTRACTS The Iowa Plan and the Activities of the Committee on Quackery J. KEITH SIMPSON In the early part of this century, the American Medical Association, with the aid of the powerful Rockefeller Foundation, was successful in reorganising the health care delivery system within the United States. For the most part, competitors had been eliminated. One exception remained and flourished—chiropractors. In 1962, the Iowa Medical Society, a constituent society of the American Medical Association, through its General Counsel, Robert B. Throckmorton, devised a plan to contain chiropractic in the State of Iowa. This plan was thereafter known as the Iowa Plan. In 1964 the American Medical Association invited Throckmorton to form a Committee on Quackery (COQ) to implement the Iowa Plan within the United States of America. With an overall goal "to contain and eventually eliminate the cult of chiropractic as a health hazard in the United States," the COQ worked diligently for over a decade to achieve its goal. Using the COQ’s meeting minutes as data, this paper investigates aspects of this group’s concerted effort to ‘contain and eliminate’ the ‘health hazard of chiropractic’/ The meeting minutes were analysed using the QSR NUD.IST computer package to create a document database. Individual meeting minutes were read on-line, and each item within the minutes was indexed to the appropriate index node. Node reports were then generated and utilised in the preparation of this paper. It is postulated that the activities of the Committee on Quackery may have been responsible for delaying fuller integration of the chiropractic profession into the health care delivery system in the United States. INDEX TERMS: MeSH: CHIROPRACTIC; POLITICS. OTHER: POLITICAL DOMINANCE; POLITICAL MEDICINE; MEDICAL MONOPOLY. Chiropr J Aust 1997; 27:5-12. Chiropractic Practice: A South African Study JENNIFER R. JAMISON Introduction: American publications have suggested that chiropractic practice is patient-orientated and consistent with an illness behaviour model. Australian studies have suggested that chiropractic clinical behaviour is relational and that formulation of a therapeutic alliance based upon a shared clinical reality is fundamental to chiropractic care. This case study explores chiropractic in South Africa in order to ascertain whether South African practice behaviour conforms to the clinical patterns identified elsewhere.Design: A constructivist inquiry paradigm based upon purposive sampling of practitioners and convenience sampling of patients was used. A case study of 28 patient-practitioner clinical encounters in the clinics of eight South African chiropractors was undertaken. Data was collected by means of practice observation, questionnaires and interviews. Data was managed using inductive analysis and contextual interpretation. Results: Chiropractic care appears to be patient-centred with patients participating and being expected to participate in their health care. The clinical encounter was characterised by the expectation that the patient would respond to therapy with pain serving as a major factor in the construction of shared clinical reality. Overall, patients expressed satisfaction with all stages of their chiropractic care. Discussion: South African chiropractic practice bears a remarkable similarity to that observed in Australia. In this study, creation of a shared clinical reality later expressed in the form of a therapeutic alliance emerged as a fundamental characteristic of chiropractic practice regardless of culture or professional training. Conclusion: It is postulated that the reduction in clinical uncertainty achieved by enhanced awareness of body control from chiropractic clinical care may, in part, account for the universal satisfaction expressed by chiropractic patients. INDEX TERMS: MeSH: CHIROPRACTIC. OTHER: THERAPEUTIC ALLIANCE; PRACTICE BEHAVIOUR. Chiropr J Aust 1997; 27:13-7. Supportive Care: An Important Notion in Third-Party Payer Cases COLIN M. CRAWFORD This paper identifies a recent court case in Canada, where Guidelines for Chiropractic Practice in Canada assisted judicial decision-making, and intermittent supportive care was considered proper under third-party payment, as supportive care is therapeutically necessary, while maintenance care is elective care. A recent case in South Australia is noted, in which proper terminology succeeded in changing the insurer’s attitude to compensation payment. INDEX TERMS: MeSH: CHIROPRACTIC, CANADA; WORKMEN’S COMPENSATION. OTHER: SUPPORTIVE CARE. Chiropr J Aust 1997; 27:18-19. ROLF E. PETERS and MARY ANN CHANCE The writing of citations and references has been identified as a weakness in the publishing of manuscript submitted to the editors of the Chiropractic Journal of Australia. An attempt is made to demystify the task of properly preparing references. INDEX TERMS: MeSH: WRITING; PUBLISHING. Chiropr J Aust 1997; 27:20-4.Commentary: Clinical Epidemiology for Excellence in Chiropractic Practice KEITH H. CHARLTON This is the first in a series of commentaries which address the notion of clinical excellence in chiropractic practice, assisting the clinician to be his/her own agent of change using principles from the field of clinical epidemiology. INDEX TERMS: MeSH: CHIROPRACTIC; CLINICAL EPIDEMIOLOGY. OTHER: CHIROPRACTIC RESEARCH Chiropr J Aust 1997; 27:25-8. |
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