James M Whedon

• DC, MS
• Managing Director at Southern California University of Health Sciences

Introduction: Complementary and integrative health (CIH) therapies are gaining recognition. However, their utilization within the diverse All of Us (AoU) research program remains unexplored. Methods: A cross-sectional study of AoU electronic health record and survey data compared characteristics of adult CIH users and nonusers. General linear mod...

Objective: To evaluate longitudinal cost outcomes of initial treatment strategies for new neck pain (NP) episodes among Medicare beneficiaries. Design: Retrospective cohort study using Medicare Part A, B, and D claims data. Participants: Medicare beneficiaries aged 65-99 years, continuously enrolled in Parts A, B, and D from 2018 to 2021, who exp...

Purpose To compare long-term care escalation encounters among three care patterns for new episodes of neck pain among Medicare beneficiaries. Methods We examined Medicare claims spanning a four-year period for beneficiaries with new episodes of neck pain beginning in 2019. All patients were continuously enrolled under Medicare parts A, B, and D an...

Background: Many clinical practice guidelines for management of pain disorders now favor first-line use of nonpharmacological therapies (NPT). However, Medicare coverage of NPT is limited. Methods: Using a serial cross-sectional design, we examined temporal trends in the utilization and cost of NPT procedures commonly used to treat pain under Medic...

Background The cost of spine-related pain in the United States is estimated at $134.5 billion. Spinal pain patients have multiple options when choosing healthcare providers, resulting in variable costs. Escalation of costs occurs when downstream costs are added to episode costs of care. The purpose of this review was to compare costs of chiropracti...

Objective The objective of this study was to evaluate the relationship between three distinct spinal manipulative therapy dose groups and escalated spine care by analyzing insurance claims from a cohort of patients with low back pain. Methods We compared three distinct spinal manipulative therapy dose groups (low = 1 SMT visits, moderate = 2–12 SM...

Purpose Cervical artery dissection (CeAD), which includes both vertebral artery dissection (VAD) and carotid artery dissection (CAD), is the most serious safety concern associated with cervical spinal manipulation (CSM). We evaluated the association between CSM and CeAD among US adults. Methods Through analysis of health claims data, we employed a...

Background Primary Spine Care (PSC) is an innovative model for the primary management of patients with spine-related disorders (SRDs), with a focus on the use of non-pharmacological therapies which now constitute the recommended first-line approach to back pain. PSC clinicians serve as the initial or early point of contact for spine patients and ut...

Background The burden of spinal pain can be aggravated by the hazards of opioid analgesics, which are still widely prescribed for spinal pain despite evidence-based clinical guidelines that identify non-pharmacological therapies as the preferred first-line approach. Previous studies have found that chiropractic care is associated with decreased use...

Background Cervical artery dissection and subsequent ischemic stroke is the most serious safety concern associated with cervical spinal manipulation. Methods We evaluated the association between cervical spinal manipulation and cervical artery dissection among older Medicare beneficiaries in the United States. We employed case-control and case-cro...

Objective The objective of this study was to compare patients’ perspectives on the use of spinal manipulative therapy (SMT) compared to prescription drug therapy (PDT) with regard to health-related quality of life (HRQoL), patient beliefs, and satisfaction with treatment. Methods Four cohorts of Medicare beneficiaries were assembled according to p...

Objectives The purpose of this study was to compare Medicare healthcare expenditures for patients who received long-term treatment of chronic low back pain (cLBP) with either opioid analgesic therapy (OAT) or spinal manipulative therapy (SMT). Methods We conducted a retrospective observational study using a cohort design for analysis of Medicare c...

Objective The purpose of this study was to examine the feasibility of developing and administering a patient adherence survey to assess self-reported adherence to treatment recommendations from a chiropractic doctor within an academic health center. Methods The survey items were developed by the authors and vetted by the university's students and...

Objective: To develop evidence-based recommendations on best practices for delivery of clinical preventive services by chiropractors and to offer practical resources to empower provider applications in practice. Design: Clinical practice guideline based on evidence-based recommendations of a panel of practitioners and experts on clinical preventive...

Study design: We combined elements of cohort and crossover-cohort design. Objective: The objective of this study was to compare long-term outcomes for Spinal Manipulative Therapy (SMT) and Opioid Analgesic Therapy (OAT) regarding escalation of care for patients with chronic low back pain (cLBP). Summary of background data: Current evidence-bas...

Study design: Retrospective observational study. Objective: Opioid Analgesic Therapy (OAT) and Spinal Manipulative Therapy (SMT) are evidence-based strategies for treatment of chronic low back pain (cLBP), but the long-term safety of these therapies is uncertain. The objective of this study was to compare OAT versus SMT with regard to risk of ad...

Objective Spinal manipulation (SM) is recommended for first-line treatment of patients with low back pain. Inadequate access to SM may result in inequitable spine care for older US adults, but the supply of clinicians who provide SM under Medicare is uncertain. The purpose of this study was to measure temporal trends and geographic variations in th...

Objective The purpose of this study was to examine experiences and attitudes toward care offered by chiropractors and prescription drug therapy offered by medical physicians for patients who have back pain. Methods A cross-sectional survey measured patients with back pain (n = 150) seeking care within an academic primary care setting. A survey ass...

Background Low back pain (LBP) imposes a costly burden upon patients, healthcare insurers, and society overall. Spinal manipulation as practiced by chiropractors has been found be cost-effective for treatment of LBP, but there is wide variation among chiropractors in their approach to clinical care, and the most cost-effective approach to chiroprac...

Objective The objective of this investigation was to compare the value of primary spine care (PSC) with usual care for management of patients with spine-related disorders (SRDs) within a primary care setting. Methods We retrospectively examined existing patient encounter data at 3 primary care sites within a multi-clinic health system. Designated...

Introduction: Complementary health care professionals deliver a substantial component of clinical services in the United States, but insurance coverage for many such services may be inadequate. The objective of this project was to follow up on an earlier single-year study with an evaluation of trends in reimbursement for complementary health care s...

Objective: Utilization of nonpharmacological pain management may prevent unnecessary use of opioids. Our objective was to evaluate the impact of chiropractic utilization upon use of prescription opioids among patients with spinal pain. Design and setting: We employed a retrospective cohort design for analysis of health claims data from three con...

The Academic Collaborative for Integrative Health (ACIH) supports activities and projects in education, clinical care, research and policy that are transforming our health care system into one that creates health and well-being. The Research Working Group (RWG) of ACIH investigated the creation of a directory of researchers that will facilitate col...

Background: Chronic diseases, including heart disease, stroke, cancer, and chronic pulmonary disease are the leading causes of death and disability worldwide. Compounding symptoms and loss of function, people living with chronic disease often experience reduced quality of life (QoL). Various physical and mental practices have been shown to relieve...

Every organization has a culture. Organizational culture is based upon the shared assumptions, vision, strategy, goals, values, behaviors, traditions, and beliefs that strongly influence how people in the organization behave, work together and interact. Investing in the transformation of culture is widely recognized by for-profit organizations as a...

In the article, “Insurance Reimbursement for Complementary Healthcare Services,” we reported that the likelihood of reimbursement for complementary health care services in New Hampshire was significantly lower as compared with services of primary care physicians. The relatively low likelihood of reimbursement for integrative health care suggests th...

Objectives: Mortality rates due to adverse drug events (ADEs) are escalating in the United States. Analgesics are among the drug classes most often associated with occurrence of an ADE. Utilization of nonpharmacologic chiropractic services for treatment of low back pain could lead to reduced risk of an ADE. The objective of this investigation was...

Objective: Pain relief resulting from services delivered by doctors of chiropractic may allow patients to use lower or less frequent doses of opioids, leading to reduced risk of adverse effects. The objective of this investigation was to evaluate the association between utilization of chiropractic services and the use of prescription opioid medica...

Introduction: Insurance reimbursement for clinical services provided by complementary healthcare professionals in the United States likely differs by provider specialty. It is hypothesized that a lower likelihood of insurance reimbursement demonstrates that complementary healthcare services are not utilized to an optimal level and are not financia...

With the advent of new models for payment and delivery of healthcare services, the use of quality measures for continual improvement of clinical healthcare is now an integral feature of medical practice in the United States. However, quality measurement and quality improvement activities are not common practice among integrative health providers. T...

Background: Proponents of bioidentical estrogens claim that they are superior for treating menopausal symptoms, including depressive symptoms. Small trials examining the effects of bioidentical estrogens on depressive symptoms show conflicting results. We conducted a systematic review to assess the effectiveness and safety of bioidentical estrogen...

Racial and ethnic disparities in utilization of chiropractic services have been described at the state level, but little is known about such local disparities. We analyzed Medicare data for the year 2008 to evaluate by ZIP code for utilization of chiropractic services among older adults in Los Angeles County, California. We evaluated for availabili...

Objective: The purpose of this study was to determine whether use of chiropractic manipulative treatment (CMT) was associated with lower healthcare costs among multiply-comorbid Medicare beneficiaries with an episode of chronic low back pain (cLBP). Methods: We conducted an observational, retrospective study of 2006 to 2012 Medicare fee-for-serv...

Objective: Patients who use complementary and integrative health services like chiropractic manipulative treatment (CMT) often have different characteristics than do patients who do not, and these differences can confound attempts to compare outcomes across treatment groups, particularly in observational studies when selection bias may occur. The...

Objective: The purpose of this study was to quantify risk of stroke after chiropractic spinal manipulation, as compared to evaluation by a primary care physician, for Medicare beneficiaries aged 66 to 99 years with neck pain. Methods: This is a retrospective cohort analysis of a 100% sample of annualized Medicare claims data on 1 157 475 benefic...

Study Design. Retrospective cohort studyObjective. In older adults with a neuromusculoskeletal complaint, to evaluate risk of injury to the head, neck or trunk following an office visit for chiropractic spinal manipulation, as compared to office visit for evaluation by primary care physicianSummary of Background Data. The risk of physical injury du...

Objectives: Private insurance plans typically reimburse doctors of chiropractic for a range of clinical services, but Medicare reimbursements are restricted to spinal manipulation procedures. Medicare pays for evaluations performed by medical and osteopathic physicians, nurse practitioners, physician assistants, podiatrists, physical therapists, a...

Background People with vertebral artery dissection may complain of neck pain. Chiropractors treat neck pain with cervical spine manipulation, which is suspected of aggravating undetected vertebral artery dissection, causing vertebrobasilar stroke (VBS). Case-control studies have temporally - but not causally - linked cervical spine manipulation to...

Delays to definitive care are of particular concern in rural trauma systems, where prehospital times are significantly longer than average. We evaluated for differences between transferring hospitals in the total time required to transport patients to definitive care, and analyzed for associations between transport times and outcomes. We employed a...

The purposes of this study were to examine the direct costs associated with Medicare's 2005-2007 "Demonstration of Expanded Coverage of Chiropractic Services" (Demonstration) and their drivers, to explore practice pattern variation during the Demonstration, and to describe scenarios of cost implications had provider behavior and benefit coverage be...

Background context: Concern about improper payments to chiropractic physicians prompted the US Department of Health and Human Services to describe chiropractic services as a "significant vulnerability" for Medicare, but little is known about trends in the use and cost of chiropractic spinal manipulation provided under Medicare. Purpose: To quant...

We report the case of a woman with posttraumatic stress disorder secondary to childhood sexual assault who attempted withdrawal from long-term use of antidepressant medication and experimented with a plethora of different therapies. The complex case history illustrates the potential difficulty of withdrawal from chronic antidepressant medication an...

The purposes of this study were to analyze data from the longitudinal Medical Expenditures Panel Survey (MEPS) to evaluate the impact of an aging population on secular trends in back pain and chronicity and to provide estimates of treatment costs for patients who used only ambulatory services. Using the MEPS 2-year longitudinal data for years 2000...

Background In the United States (US) a shortage of primary care physicians has become evident. Other health care providers such as chiropractors might help address some of the nation’s primary care needs simply by being located in areas of lesser primary care resources. Therefore, the purpose of this study was to examine the distribution of the chi...

Appendix 1. The National Supply of Chiropractors from Three Different Sources, 2002 to 2008. a: No. of State Chiropractic Licenses, Federation of Chiropractic Licensing Boards. b: No. of Chiropractors enrolled with Center for Medicare & Medicaid Services. c: No. of Chiropractors reported in the United States Bureau of Labor Statistic’s Employment M...

Medicare covers chiropractic care, but the health-care community knows little about the demographic characteristics of older adults who use chiropractic services under the Medicare program. Researchers do not know the demographic composition of chiropractic users under Medicare, how the demographics of chiropractic use and rates of use have changed...

In 2005-2007, The Centers for Medicare and Medicaid Services conducted the Demonstration of Expanded Coverage of Chiropractic Services under Medicare in selected counties in five states. The official evaluation showed that the project was essentially budget-neutral in four states. In Illinois however, Medicare expenditures were approximately $50M h...

Purpose Chiropractic care is covered under Medicare, but the scope of services is restricted. The Demonstration of Expanded Coverage of Chiropractic Services under Medi-care projected that expanded services would cost Medicare up to $1.15 billion annually. The potential expansion of chiropractic services under Medicare remains controversial. Advoca...

Study design: Retrospective cross-sectional analysis of administrative data. Objective: To examine the relationship between regional chiropractic supply and both use and utilization intensity of chiropractic services among Medicare beneficiaries. Summary of background data: Numerous studies have documented trends and patterns in the utilizatio...

The purpose of this study was to measure geographic variations in the availability and use of chiropractic under Medicare. A cross-sectional design was used to analyze a large nationally representative sample of Medicare data. Data from a 20% representative sample of all paid Medicare Part B fee-for-service claims for 2007 were merged with files co...

Legislation that supports the establishment of Accountable Care Organizations (ACOs) was recently enacted into law as part of the Patient Protection and Affordable Care Act, and in 2012 the Centers for Medicare and Medicaid Services will begin contracting with ACOs. Although ACOs will play a significant role in reform of the U.S. health care delive...

The appropriate role for chiropractic in US health care has not been established, but third-party payors and public policy makers must make decisions about the appropriate role for chiropractors in health care systems and for the services that chiropractors provide. Appropriateness studies for chiropractic may inform those decisions. The purpose of...

The Medicare Chiropractic Services Demonstration was conducted from 2005 to 2007 in the states of Maine and New Mexico and in selected parts of Illinois, Iowa, and Virginia. The purpose of the demonstration was to evaluate the feasibility and advisability of expanding coverage for chiropractic services under Medicare. Under the demonstration, cover...

The objective of this study was to examine the volume and rate of Medicare Part B claims for chiropractic spinal manipulation longitudinally from 1998 to 2004. A descriptive retrospective analysis was performed on Medicare part B claims from 1998 to 2004 using the Medicare Part B Standard Analytical Variable Length File. Using a 5% random sample of...

Trauma registries may contain records without a codable trauma diagnosis, creating a "data gap" that multiplies the number of invalid registry data fields. We designed an investigation intended to determine the incidence of registry records with noncodable trauma diagnoses, characterize those records, and determine the reasons for inadequate diagno...

We hypothesize that stasis of the cerebrospinal fluid (CSF) occurs commonly and is detrimental to health. Physiologic factors affecting the normal circulation of CSF include cardiovascular, respiratory, and vasomotor influences. The CSF maintains the electrolytic environment of the central nervous system (CNS), influences systemic acid-base balance...

Spinal manipulation is a safe and effective therapy for spinal pain disorders of mechanical origin, and has been identified as a treatment of choice for certain conditions. Chiropractic is the health profession that most commonly delivers spinal manipulation. Chiropractors are highly educated and receive thorough training in spinal manipulation. Ma...

We report on the case of a patient with spinal epidural hematoma (SEH) after spinal manipulative therapy and review features of reported cases of a similar nature. The patient was undergoing Coumadin anticoagulant therapy for atrial fibrillation and presented to the chiropractor complaining of a stiff neck. After cervical manipulation, he developed...