Medicare data reveals that U.S. wastes half a billion dollars per year on chiropractic

Hold on, you're about to get "adjusted."
Ten days ago, the federal government released a huge data set detailing how it spent $77 billion in Medicare funds in 2012 to over 880,000 health care providers. The release of this data is part of a new transparency effort by the government, which many of us applaud.

The data reveal some troubling things.

Most news organizations focused on who the biggest beneficiaries are: the New York Times described how just 100 doctors received $610 million. A Washington Post story focused on the top 10 Medicare billers, including one ophthalmologist in Florida who was paid $20 million by Medicare, mostly to cover Lucentis, a drug for macular degeneration. The Post pointed out that Medicare would have saved over $10 million if that doctor used Avastin, which is equally effective. “Medicare pays a doctor more for injecting the more expensive drug,” the Post pointed out.

But until now, no one has pointed out another, far more egregious waste revealed by the Medicare data: we are spending a huge amount of money on the highly dubious practice known as chiropractic.

To be precise, the 2012 Medicare data reveals that in 2012, Medicare paid $496 million for chiropractic.

This is a stunning amount. It dwarfs the funding that NIH wastes on alternative medicine through NCCAM, which is itself an egregious waste of money.

Chiropractors are not medical doctors. They primarily treat back pain, but they claim to treat a wide range of other conditions, which some of them believe are related to mis-alignments of the spine, called subluxations. This belief has no scientific basis. Nevertheless, chiropractors have succeeded in convincing the government to cover their treatments through Medicare.  

Now we know how successful they have been: half a billion dollars a year spent “adjusting” the spines of patients, all funded by Medicare.

(And they have recently been lobbying furiously, as I wrote last summer, to force private health care providers to cover chiropractic and other alternative practices under Obamacare.)

But wait, you might ask, don’t chiropractors provide pain relief? And don’t they have medical degrees? Well, on the second question, the answer is that they have special Doctor of Chiropractic (D.C.) degrees, which are given out by just 15 special chiropractic colleges in the U.S. The entire field was invented out of thin air by D.D. Palmer in 1895, and later popularized by his son. In his book-length expose Chiropractic Abuse: An Insider's Lament, chiropractor Preston Long lists "20 things most chiropractors won't tell you," including
  1. "Chiropractic theory and practice are not based on ... knowledge related to health, disease, and health care. 
  2. Many chiropractors promise too much.
  3. Our education is vastly inferior to that of medical doctors."
These are just the first three: you can see the full list in a review of Long's book by physician Harriet Hall, or read the book itself.

Sam Homola, a retired chiropractor, summarized his concerns about chiropractic in an article at Science-Based Medicine. Homola concluded that 
“There is no credible evidence to support the use of spinal manipulation for anything other than uncomplicated mechanical-type back pain and … no evidence at all to support chiropractic subluxation theory.”
Perhaps most alarming, especially given that Medicare is paying for millions of treatments per year, is that chiropractic manipulation can cause a stroke, by causing a tear in a major artery running through the neck. As reported recently in the Journal of Neurosurgery:
Chiropractic manipulation of the cervical spine can produce dissections ... of the vertebral and carotid arteries. These injuries can be severe, requiring endovascular stenting and cranial surgery. In this patient series, a significant percentage (31%, 4/13) of patients were left permanently disabled or died as a result of their arterial injuries.” [Albuquerque et al., J. Neurosurg 2011 115(6):1197-1205]
If this weren’t enough to cause concern, many chiropractors are also anti-vaccine, a problem that is apparently serious enough that some chiropractors themselves have spoken out against the anti-vaxxers in their own ranks.

Over a century ago, D.D. Palmer believed, mistakenly, that he cured a man’s deafness by manipulating his neck. His son built Palmer’s beliefs into a profitable business, but neither of them would have dreamed that the U.S. government would one day spend half a billion dollars per year on chiropractic manipulations. 

If we want to start controlling the cost of Medicare, here’s an easy first step: stop covering chiropractic. We will save $496 million a year, and people’s health will improve.

Raw milk enthusiasts want you to drink a bacterial stew. Yum.

Sometimes it is astonishing how ignorant people can be. Now it's the turn of fans of "raw milk," a new fad that is sweeping the U.S.

I still remember reading milk cartons as a kid, and asking my parents what "pasteurized" meant. While I don't remember exactly what they said, I'm sure they told me that it made the milk safe by killing bacteria. Even as a kid, I understood that bacteria in my milk were probably a bad thing.

Louis Pasteur is one of the most famous scientists in history, and rightly so. In 1862, he invented the process of heating milk to kill the bacteria in it. Pasteurization, as we now call it, has saved millions of lives in the 150 years since. Pasteur also created the first vaccine for rabies. He was a true giant.

Fans of raw milk appear to be stunningly unaware of Pasteur's achievements, and equally ignorant of the dangers of bacterial infections. Many of the health and safety claims for raw milk can be found on sites such as, a site that is chock full of

  • Conspiracy theories: the Government is hiding the truth from you.
  • Denialism: raw milk never hurt anyone, and even protects you against bacteria.
  • Shifting the blame: infections are caused by other contaminated foods, not raw milk.

One of the more chilling facts about is their emphasis on feeding raw milk to infants, who are at the greatest risk of dying from infections.  Their "Campaign for Real Milk" advocates
"universal access to clean raw whole milk from pasture-fed cows, especially access for pregnant and nursing mothers and for babies and growing children."
We have plenty of good science about raw milk. CDC review of infectious disease outbreaks across the U.S. from 1993-2006 found that
Langer et al., Emerging Infectious Diseases 18:3 (2012).
Among other findings, a
"The rate of outbreaks caused by unpasteurized milk (often called raw milk) and products made from it was 150 times greater than outbreaks linked to pasteurized milk."
Dr. Robert Tauxe, an infectious disease specialist at the CDC, debunks some of the myths about raw milk in an article freely available on Medscape. John Snyder and Mark Crislip have both written compellingly about the dangers of raw milk at

If I were being cynical, I might say that the wild-eyed proponents of raw milk deserve whatever infections they get. But their children don't. 3-year-old Kylee Young, who the Washington Post wrote about this past Sunday, didn't deserve to suffer kidney failure and a stroke after her mother fed her raw milk that was infected with E. coli O157:H7. Kylee can no longer walk or talk and needs constant care. Her mother now says
"If I had known what I know now, I would never have fed [raw milk] to my daughter." 
Louis Pasteur and his wife had five children, three of whom died of childhood infections. These tragedies were Pasteur's motivation for studying infectious disease. Thanks to his work 150 years ago, no one today needs to die from drinking unpasteurized milk. The raw milk movement insists, despite the evidence, that they know better.

So go ahead, drink your raw milk and eat a paleo diet too, while you're at it. But don't ask our modern medical system to pay for your treatment when you get sick. And most of all, don't subject innocent children to the unnecessary risks of raw milk.