Happy New Year! 2001 is here and the new millennium can now begin. The anxiety of Y2K (which, by the way, we haven't heard much about lately) has passed, the presidential election may be over (at the time of this writing, it was not), and the country continues to function. Many people scarcely noticed that the experiment in democracy worked. Despite a hotly contested election, with vote counts and recounts, charges and counter charges, court battles and appeals, and partisan politics at its finest, there were no troops in the streets, no military coup about to take over the White House, and no general about to declare himself ruler of the country.
It's been interesting to observe the media that converged on Florida. Instead of the public outcry focusing on changing the electoral college, perhaps we should be looking at ways to stop the "out of control" media. They create the news, influence the news, and dramatize the news as "infotainment" to increase ratings and dollars for the networks. If there is a tragedy brewing on the horizon, it is the new media, a group that no longer has reports the news in a factual, professional and objective manner.
We can bash the media on one hand for losing objectivity, but that same media, because of growing public pressure, has created a virtual explosion of attention to the issue of complementary and alternative medicine (CAM). This has been a godsend to chiropractic and to the skeptical consumer.
One only has to think back a few decades to when media reports linked "chiropractic and quackery" synonymously, intentionally designed to cast aspersions upon any discipline that was not medical. When vertebral dysfunctions (subluxations) were identified by chiropractors as being potentially harmful to health and spinal adjustments (manipulations) were performed to correct these dysfunctions, the media classified them as figments of chiropractors' vivid imaginations. Think back only a few decades ago when the thoughts and discussions of innate intelligence were tantamount to heresy; when healing concepts of vitalism were relegated to cultists and marginal deviant practitioners, painted by the media as individuals who obviously did not possess the scientific acumen to understand the scientific and mechanistic model of disease. Think back, not too long ago, when the power of prayer was not only shunned by scientific practitioners of the healing arts, but confined to religious services, and even then not explored as completely as possible. Think back to when the power of human touch and the therapeutic value of laughter were scoffed at by the medical establishment and regarded as unscientific - fringe topics for discussion and certainly not for orthodox medicine to discuss.
Yet, as we enter this 21st century, the media has seized upon the concepts of CAM healing and have entered into an almost obsessive fascination with the occult, the metaphysical, the unorthodox, the nonallopathic, the non-traditional, the new age, or whatever term you wish to employ for this healing phenomenon, and the media have taken an entirely new and positive approach to discussion, review, commentary and reporting.
Only a few years ago, there was never a story about chiropractic that did not include a rebuttal by the AMA. No chiropractic article was ever written or reported without containing an opinion from some anti-chiropractic group or AMA-connected spokesperson. The tenor of the article was always to place skepticism and doubt in the mind of the reader and to report and sensationalize often on a singular or bizarre incident with a style than can only be called yellow journalism.
Today, there are stories about rather prestigious cardiologists who hold prayer with their patients before surgery; oncologists who employ visualization and spiritual healing to enhance the body's immune system; and healing centers that employ everything from aromatherapy to Zen and no one is laughing or making mockery of the unorthodox and unconventional practices which have captured the imagination of the media and the public.
What has happened? What is causing this paradigm shift in thinking? What is making the media do a 180-degree turnaround in reporting?
Some of the reasons are obvious. The "baby boomers," all 77 million of them, are unwilling to accept what is said about their health care at face value. They are the generation that wants answers. They have money, motive, opportunity and collective numerical strength to demand changes in the way their health care will be delivered as they grow older. They do not wish to be relegated to rocking chairs at 65, perceive themselves as productive, and expect to live a quality of life that is happy, healthy and ambulatory until they die at a ripe old age. This is quite a shift in thinking from a few generations ago, when 60 was old, and the life expectancy was a few years beyond Medicare retirement age.
Another major influence is the almost "cult" celebrity given to medical doctors on the circuit preaching and teaching about health and the wisdom of the body: Drs. Andrew Weil; Deepak Chopra; Bernie Siegel; Herbert Benson; Larry Dossey; Ronald Glasser; and Candace Perth, to name but a few. In their books, in television interviews and on the high-priced speaking circuit, they talk about the healing wisdom of the body; innate; the spiritual aspect of health and living; nutrition; lifestyle; and the power of thought and prayer. Many listeners are moved to believe, understand and alter lifestyles, and release dogmatic beliefs held for generations. It's been a paradigm shift in health care thinking.
The credibility of this movement is supported and bolstered by prestigious institutions investigating new nonallopathic healing phenomena. Instead of reducing the belief system to cultism, these institutions are approaching the understanding with scientific inquiry designed to help understand why these seemingly metaphysical or vitalistic procedures work. The scientific aspect of this movement becomes more significant as individuals from prestigious institutions, e.g., Harvard and Stanford, begin to host conferences on complementary and alternative medicine. Drs. David Eisenberg; Kenneth Pelletier; William Haskell; Wayne Jonas; Brian Bergman; and James Gordon all attempt to place an emphasis on the scientific evaluation of complementary and alternative approaches, and do not discard or categorically reject any healing approach. Rather, this group has given credibility and the cloak of respectability to all kinds of therapeutic encounters-from shaman to spirituality, from aromatherapy to acupuncture, from the power of prayer to the power of care-and have placed these time-honored therapies into a holding pattern until they can be scientifically evaluated and clinically employed based on empirical evidence.
Then there is the chiropractic influence of more than 100 years of existence - a profession that has at its core a vitalistic concept of the human body, coupled with a strong focus on the innate. Chiropractic is undoubtedly the largest and best organized of all the health care professions that did not fall under the medical umbrella. It is largely because of this fact, and long-term opposition and bitter political battles with chiropractic, that the profession is often "left at the altar" while acupuncture, massage, homeopathy, naturopathy and Oriental medicine are asked for their "hand in marriage" by the medical establishment.
Why? It's because chiropractic is not a procedure that can be incorporated easily into an "integrated" medical facility. It is not an "add-on" procedure that can be listed like a smorgasbord menu of selections for the CAM du jour. Because chiropractic truly represents a vitalistic profession that has survived the vicious onslaught of political medicine and has now become a formidable force in the healthcare field, the medical opposition is again rearing its ugly head.
What will happen as we begin 2001? There are many who say the profession is doomed; others claim that our heritage has been stolen; and still others are looking to change models and find the one that they believe offers the most return. Others tend to focus on a survival and growth strategy for tomorrow. Chiropractic, as a profession, is not going away!
Chiropractic is not going to be destroyed from within (which is the biggest fear of many), or from those outside, the profession who have maintained their most aggressive fight against chiropractic achieving its rightful place in the health care delivery system. We have fought with the tenacity that is the envy of most professions. Chiropractic has proven itself to be very satisfying to patients for a myriad of reasons. Chiropractic is cost-effective, but we must validate that concept with solid data to support what every rational chiropractor knows instinctively. Chiropractic care has been demonstrated to provide a cost shifting to occur because people utilizing chiropractic care have reported less hospitalization, less pharmaceutical use, less disability and a higher satisfaction with quality-of-life issues.
Again, these concepts are well-known empirically, but now need to be validated with solid, defensible data. The movement toward wellness, and the escalation of health care costs out of control, make it imperative to document these concepts.
Can we prove all of the speculation we know as practitioners? Not yet, but the evidence is overwhelming to the practitioner and now needs to be validated. Fortunately, we have those who can do it. That brings me to another challenge facing the profession: chiropractic researchers, that small group of unsung heroes who toil in the vineyards of research, largely unappreciated by many in the profession.
These able and dedicated DCs look at other professions that honor and respect their research community, while chiropractic often tends to find ways to demoralize and demean their efforts. These individuals are not often seen on the platforms of conferences and organizational meetings because "who wants to hear dry researchers talk." Yet, despite their meager funding and limited numbers, they have amassed a wealth of data to advance the profession beyond the most vivid of imagination of any DC only 25 years ago.
The essence of this article is simply this: Chiropractic as a health care profession has withstood the test of time; has garnered significant research data to begin to substantiate its value; has interested individuals from other professions to begin to research what chiropractic does and why. It has withstood the test of the public demand and has met the needs of the public to where the demand from the public for chiropractic services will not be diminished as we move forward, but will be escalated because of a new and changing paradigm of health and disease.
The media, while "out of control" on many other issues, has brought an incredible awareness about chiropractic and CAM to the forefront, and for that we should be appreciative. There are more favorable stories about chiropractic now than we could count in the past 40 years. There is less "cultism" and "deviant practitioner" status attributed to those who perform a health care procedure that is not considered valid by orthodox medicine. There are more stories and articles about the shortcomings of allopathic medicine, ranging from the IOM report to the challenges of conflicts of interest by researchers who publish in medical journals.
Legislators are sensitive to the will of the people, and the will of the people has been resoundingly positive toward chiropractic. What we need to do as a profession is quite clear. We need to refrain from those activities that only a few actually engage in, but collectively cast a negative light upon the entire profession and which cause the media to report these stories, such as involvements in scams and money schemes which make front page headlines. The profession must continue to forge new areas for research. Thanks to FCER, the Consortium, NIH and the Office of Complementary and Alternative Medicine, and NCMIC, many research initiatives are underway as we enter 2001. This aspect of the profession appears to be heading in the proper direction, and will improve with each passing year.
The media is a powerful weapon and can be a formidable ally or foe in our fight for equality, parity, fairness and recognition. The profession must be constantly on the alert to what it says and does or as single individuals, because the media can use the event, and they will, to demonstrate either the credibility or the untrustworthiness of the profession. We are no longer insulated from the world and each of our colleagues must recognize that what one individual does can have an enormous impact on our collective image. We must, as a profession, let those few who proclaim to be spokespersons for us and discredit us know that we will no longer tolerate their destructive antics and unfounded motives. They know who they are-and so does the majority of the profession.
We do not need to undertake any brilliant strategy for the future success of chiropractic. We need only maintain our current positive direction to advance beyond our wildest dreams. The profession can and will survive, and each DC can help by not remaining silent, by not allowing silence to be viewed as support. Each DC must take a more active part in helping advance the profession, by association and participation in those groups and areas that are designed to advance the profession. We must also let those who would discredit this profession know that they will no longer be supported.
Those famous words spoken by Joseph Janse,DC, on many occasions crystallize the essence of this article:
Each snowflake must share in the responsibility of the avalanche.
Best wishes for a healthy and prosperous new year.
Louis Sportelli,DC
Palmerton, Pennsylvania
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