At least once in just about everyone's childhood, there came a time when your mother asked you why you did something foolish. You may have been drinking fingernail polish or jumping in front of cars to hear their brakes squeal, but you probably remember the incident or the stories that were told as you grew older.
Lacking a viable response, you may have answered that "Billy did it, too." To which your mother logically replied, "If Billy jumps off a bridge, does that mean you have to jump off it with him?" Before you could come up with an intelligent answer, you probably found yourself at the wrong end of some sort of corporal punishment.
As I write this article (Oct. 4, 2012), people in Tennessee, North Carolina, Florida, Virginia and Maryland have contracted a rare form of meningitis, with people in 18 additional states potentially impacted. This meningitis outbreak has (as of this hour) killed four people with at least 27 in critical condition.1 [Click here for current outbreak information from the CDC.]
The fungal infection can cause "massive tissue death in the brain stem, inflammation in the blood vessels" and even stroke. Some of those are expected to pull through; some are not. Others will be six months to a year in recovery. Authorities expect to "see many more cases spread across the country." This appears to be a similar scenario to another outbreak of fungal meningitis that occurred 10 years ago, but this is on a much larger scale.2-4
This type of meningitis didn't spread from contact with people who had it. These people were apparently infected when they received a steroid injection for their back pain. While officials are not making any firm statements about the source of the outbreak, they suspect a compounding pharmacy that has since ceased operations, closed its doors, taken down its Web site and stopped answering the phone. Because no one knows the scope of the outbreak, the hospitals involved have their PR people making guarded statements. The medical doctors have not yet been interviewed.
What makes this entire tragedy ironic is the poor evidence that these steroid injections would have relieved their back pain in the first place. As Dr. Warren Hammer stated in his article on the topic last year, "the evidence recommending steroid injections is still unclear." Dr. Hammer cited a seminal study and quoted an editorial from the British Medical Journal that stated, "Thirty-five controlled studies on the subject have failed to provide a definitive answer regarding the efficacy of epidural steroid injections and it is unlikely that future trials will do so."5-7
The above brings into question the wisdom of seeking the right to inject nutritional supplements, steroids or other substances into patients. This debate has been front and center in several states over the years, with heightened emotions on both sides.8-9 The reality is that anytime you break the skin (let alone inject into the spine) and introduce any substance into the body, you run the risk of also introducing bacteria, fungus, poisons and other dangerous contaminants as well. This was the situation last year in Alabama, when nine people died and another 10 became ill when they were "given an intravenous nutritional supplement that investigators have found was contaminated by bacteria."10
For almost 120 years, chiropractors have practiced a very conservative form of care that has an extremely remote chance of harming our patients. Decisions to add injection and prescription rights change our risk profile. And while this will likely have an actuarial impact on our malpractice insurance, how that can impact our practices is the issue at hand.
If you ask most MDs about the prognosis for their patients, they will tell you that most patients get better, some don't and some die. This is their reality and they have been trained to accept it. I think most DCs would find that environment a hard way to practice. I would. The current outbreak of meningitis is an opportunity to stop and consider just how far this profession wants to go in the effort to expand our scope toward the medical model. The same question should be asked about your practice specifically.
In the time it took to write this article, one more person died, 13 more people were hospitalized and one more state reported casualties from the outbreak. Tomorrow will likely be even worse. If one of these tragedies involved your patient and their condition was the result of your decision to inject steroids, would you still feel good about being a doctor of chiropractic?
References
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
