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Scott Haldeman DC, MD, PhD, FRCP(C), FAAN, FCCP(C) Dr. Haldeman has contributed to research on neurological theories, diagnosis, and non-surgical treatment of spinal disorders for over 30 years. Currently, he holds appointments as Adjunct Professor, Department of Epidemiology, School of Public Health, University of California, Los Angeles, Clinical Professor in the Department of Neurology at the University of California, Irvine, and as Adjunct Professor in the Research Division at the Southern California University of Health Sciences. He is Past President of the North American Spine Society and the North American Academy of Manipulative Medicine. He currently holds the positions of President of the American Back Society and Chairman of the Research Council of the World Federation of Chiropractic. |
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He is the Section Editor for The Spine Journal, and sits on the editorial boards of seven other journals. He presides over The Bone and Joint Decade 2000 to 2010 Task Force on Neck Pain and Its Associated Disorders. Dr. Haldeman has published over 140 articles or book chapters, over 60 scientific abstracts, and has authored or edited 6 textbooks. He is certified by the American Board of Neurology and Psychiatry and is a Fellow of the Royal College of Physicians of Canada as well as the College of Chiropractic Sciences of Canada. A resident of Santa Ana, California, he maintains an active clinical practice. A. Presentation: The importance of an Appropriate Evidence-based Approach to Patients with Spinal Pain. What does the Scientific Literature Tell us? The delivery of healthcare is going through one of the most wrenching changes in its long history. There is a rapid movement from empirical care based on the experience and training of clinicians to an evidence based practice model. There is a growing industry that is conducting and analyzing research on all clinical diagnostic and treatment protocols. No-where is this pressure felt more than in the field of back and neck pain where the costs have been increasing exponentially while the impact of the increased amount of care on back pain on society appears to be minimal. This is beginning to be felt in clinical practice. In various states in the US and elsewhere around the world there is legislation either being formulated or that has passed that demands that treatment that is paid for have some evidence in support of its value. This is likely to spread to private and government healthcare systems over the next few years. Increasingly patients are also demanding sufficient information to make their own treatment decisions. Clinical scientists and epidemiologists are in the process of developing sophisticated scientific methods of conducting research and evaluating the quality of such clinical trials. It is essential that clinicians treating patients become familiar with the information that can reliably be extracted from clinical case series, cohort studies of patients and controlled clinical trails. It is also essential that there be an awareness of the amount of evidence that exists for any treatment being offered and that clinicians have the ability to argue in favor of the delivery of services that their patients need. Without knowledge and understanding by clinicians of the meaning of evidence based medicine this revolution in healthcare delivery could be used as a means of denying care rather than improving the quality of care. This presentation will discuss some of the current research that is leading to a logical and systematic evidence based approach to patients with spinal pain and the manner in which the scientific literature is impacting the delivery of care to patients with spinal pain. The role chiropractors can play in delivery of such care and the justification for manipulation, other non-surgical treatment methods and the indications for surgery will be reviewed.
Chiropractic has undergone considerable change over the past 100 years. The spread of chiropractic around the world, the advancement of its educational institutions, its acceptance and integration within mainstream healthcare and the increased research on its theory and practice efficacy are some of the most prominent and visible changes. These changes have required individual chiropractors and their professional associations to rethink their role in the delivery of care. This has recently come to the forefront of the chiropractic profession with the convening of an International Task Force on Identity by the World Federation of Chiropractic. The attempt to redefine chiropractic and establish an identity for the profession that can be promoted amongst government and public agencies and used to educate the public on the role chiropractic might play in their health care requires a detailed understanding of the history of chiropractic and the manner in which other professions and research societies have impacted the evolution of chiropractic thinking and the image of chiropractic. It has been my privilege to have been associated with chiropractic for my entire life in one or other capacity. I have also served as president of three national spine societies and been active in teaching and research within the mainstream medical institutions. This personal odyssey through periods when chiropractic required considerable faith and a strong belief system, was totally rejected by governments and mainstream health care professionals, through the early stages of research and communication with scientists and other clinicians to the present day level of acceptance will be explored. An argument will be made that chiropractic is irreversibly linked
to the spine and that it is this linkage that is fueling a worldwide
grassroots movement and becoming an effective public identity for
chiropractic within health care services. The evolution of chiropractic
into a mainstream health care profession remains elusive in certain
settings but understanding the factors that are influencing this
evolution is essential if chiropractic is to assume a well-defined
identity.
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