Neither Complementary nor Alternative
Dear Editor:
I found Dr. Sportelli's article "CAM integration or Chiropractic CAMouflage?" (DC, June 18, 2001) very interesting. Personally though, I do not share his view of where chiropractic fits in the grand scheme of things. In particular, I do not view chiropractic as either a "complementary" nor as an "alternative" form of health care. To use these terms indicates that chiropractic is complementary , or alternative to something - and that "something" can only be one thing- medicine. Chiropractic is not a complement to medical care for the spine - it is the indicated treatment.
Dr. Sportelli quotes Dr. Samuel Benjamin, director of the Center for Complementary and Alternative Medicine at State University of New York, who states that the most commonly used CAM therapies are "herbal medicine; massage; megavitamins; self-help groups; folk remedies; energy healing; and homeopathy."
While Dr. Sportelli is offended that chiropractic is not included in this list, I personally am happy that it is not. Consider by comparison the following list: medicine, dentistry, chiropractic and optometry. As chiropractors, would we not be better off gaining recognition within this mainsteam group of four evidence-based established core professional groups? Why would we want to position chiropractic within a group of transient, poorly researched lay medical fads with theories so wacky that chiropractic philosophy looks conservative by comparison?
I much prefer to view chiropractic as a stand-alone, separate and distinct health profession. Like a dentist or an optometrist, I am neither alternative, nor complementary to medical care for the conditions I treat. If you have a subluxation, you need an adjustment. That is what I do, and nothing else except an adjustment will do for you what an adjustment will. I don't compete with root canals or heart by-pass surgery. As far as "energy healing," I don't know what it is, and I don't care!
Chiropractic is not best suited to the hospital environment, although it should be available there. I see us delivering chiropractic care in hospitals not as medical subservient, or as CAM providers, but as doctors of chiropractic.
P.G. Bickert,DC
Kelownu, British Columbia
Canada
"... an excellent time to find out what chiropractors really do ..." Dear Editor:
I just received your June 18, 2001 issue, and read the article titled "APTA Claim Rights to Correct a Subluxation."
Your article goes on to recite the authority for chiropractors to treat under Medicare. It is the Social Security Act Amendment of 1972, Section 1861 (r). That section (see DC, June 18, front page) states, "chiropractors are authorized to treat by "means of manual manipulation of the spine (to correct a subluxation demonstrated by x-rays to exist)."
I am on the continuing education faculty of two chiropractic colleges. I know for a fact that most, if not all of the radiological departments of the chiropractic colleges, teach that "a subluxation cannot be seen or measured on x-rays." Of course, I strongly disagree with both statements. However, this is the teaching of the chiropractic colleges. Perhaps Mr. Francis Mallion, CEO of APTA, has been attending classes taught by our radiological departments in chiropractic colleges.
It would appear that Mr. Mallion has also attended some philosophy and clinical classes in chiropractic colleges. He has learned how to change the meaning of words, phrases and terms to fit his argument just as chiropractors do, using the dictionary as a last resort.
My question is: Are the radiological departments in our colleges teaching the truth, or are they lying to the students? In the event they are telling the truth, it would appear that the clinical departments in our colleges, and all chiropractors that treat Medicare patients (and do not demonstrate subluxations to exist on x-rays or correct subluxations) are practicing fraudulently.
In the event that radiological departments are telling the truth and chiropractors do not correct subluxations or demonstrate the subluxations on x-rays, then what do chiropractors do? How are they different than physical therapy?
If chiropractors are actually measuring and demonstrating that subluxations do exist on x-rays and our treatments actually correct the subluxations, presumably provable by the same measurements on post-treatment x-rays, then it appears logical that the burden of proof should be on the physical therapists to match the same quality of clinical procedures.
It appears that it is "put up or shut up" time for the chiropractic and the physical therapy professions. If chiropractic procedures are scientific, this would be an excellent time to prove it. If the physical therapy profession can match our scientific proof, then they have a point and could probably not be excluded. However, if they could not match our demonstration and measurement of subluxation on x-rays, and could not match our correction of subluxations demonstrated by measurements on post-x-rays, then it should be obvious that they would, by their inability, exclude themselves.
Would it not be easier to clean up our act and prove what we really do, rather than pay large legal fees that prove nothing? This claim by APTA demonstrates that we are very vulnerable. If we should win this battle in court, we have proven nothing, and we can look forward to more and more challenges.
Chiropractors can't continue to have it both ways. This appears to be an excellent time to find out what chiropractors really do, rather than have attorneys and the courts tell us.
Burl Pettibon,DC
Gig Harbor, Washington
"Their hypocrisy stinks to high heaven!" Dear Editor:
I enjoyed your recent article in Dynamic Chiropractic regarding PT's declaration of war on DCs. I pose the following questions:
- How is it that PTs suddenly have expertise in something (adjusting/manipulation) that they, with AMA political medicine, denounced for decades as "outright quackery?"
- How is it that PTs suddenly have expertise to perform something that they were not trained to do?
- How would PTs like it if chiropractic suddenly announced that it includes the practice of physical therapy?
- How would medicine like it if we invaded its turf in similar fashion?
Their hypocrisy stinks to high heaven! Before they attempt to steal chiropractic, they owe us DCs a big apology, mainly to the people they have damaged by acting in conjunction with medicine, to make chiropractic unavailable to those who have needed it during the last several decades!
Keep up the good work!
Jerry Anderson, DC
Winchester, TN
"...spitting on poor D.D.'s grave" Dear Editor:
I am writing in regard to the Chiropoll results published in the May 2001 issue of Dynamic Chiropractic. It is interesting that the resulting percentages are nearly identical to a similar poll of which results were presented in a relicensing seminar about 20 years ago. The polarization appears immutable.
It is unfortunate that the question was not "Do you believe in subluxation as a basis of disease? If not, then on what basis?" I would guess that two percent of those who answered "no" to subluxation would have been aware of D.D. Palmer's dystonia as the basis of disease. To quote: "Life is the expression of tone. In that sentence is the basic principle of chiropractic." D.D. further said, "Tone is expressed in functions," and "the cause of disease is any variation of tone."
What was D.D.'s response to B.J.'s espousing malstructure instead of malfunction as the basis? D.D. said: "B.J. now has full swing and is swinging away from the chiropractic line. He has wrenched the whole affair from me. I am dejected and discouraged. I hope the subluxationists realize they are spitting on poor D.D.'s grave."
What D.D. proposed made chiropractic a distinct profession while, I fear, what B.J. proposed may make chiropractic an extinct profession as indicated by Dr. Winterstein's reports of the actions of some renegade ICA members.
It is, again, unfortunate that most of those who responded "no" to subluxation have ejected their warp drive core with nothing to replace it and are left adrift. They need to talk to the two percent that have the replacement.
One poll taker said, "Chiropractors who do not believe in basic principle should get out of our profession." He revealed himself. The poll shows that the "our" he is referring to is the minority opinion.
We live in a democracy based on majority rule. It would seem appropriate for him to get out of the profession and the U.S.
Bryan Siegel,DC
Lynbrook, New York
"We should be bigger than this insurance circus!" Dear Editor:
I have been petitioning ASHP for two years to be allowed on the panel of providers. I have sent in a formal patient petition with over 200 names - patients who have health plans they are not able to use in my office. I even went as far as to sic my attorney on them but all they did was "turn and grunt" their indifference. Through all of this I came to an important conclusion - I'm much better off. I have the freedom to practice my principles, instead of lowering my standards of care.
A new patient presented to my office with a health plan for which I have been a provider for five years. We thought it would be business as usual, but how could I have known what enlightenment I would receive from this seemingly innocuous transaction?
It was a point-of-service (POS) plan administered by ASHP, and because I was a contracted provider with the actual insurer I was allowed to receive reimbursement. So began my journey into the world of managed care organization middle-mania. Now, I know that there are many chiropractors who deal with this each day, and I'm sure I look like a real freshman, but honestly, if I had to deal with that kind of micro-management as a regular part of compensation, I know I wouldn't have the sparkle in my eye that I do now.
Yet, aside from the obvious hassles of payment delays and reductions in fees, I found something else which disturbed me deeply. It was the idea that a fellow chiropractor was employed to review the "treatment" plan I submitted. This chiropractor then determined what would be allowed and what would be left on the "cutting room floor." I have seen this type of thing before in dealing with workers compensation cases, but I somehow was not prepared for the ASHP company chiropractor. I don't know why. Maybe it's because I am an idealistic doctor who still believes in solidarity in the chiropractic profession. Perhaps it has something to do with the idea that ASHP is chiropractic MCO with a chiropractor as an executive vice president. However could it be that I can't envision B.J. supporting a mess like this?
I understand that when a third party is paying the bills it wants to know what it is paying for and appreciates a reasonable guess at how long it will take to resolve. However to be micromanaged by one of my own profession is distasteful at best. This experience felt like my chiropractic college clinic days when I had to have my treatment plan signed off by the clinic doctor before I could set the ailing patient's atlas.
I feel sad for chiropractic. We should be bigger than this insurance circus! Others in health care are starting to do what chiropractors have had to do since 1895 - have a largely cash patient base. A recent survey by the Association of American Physicians and Surgeons revealed that 66.2 percent of MDs will retire early rather than keep facing the HMO/Medicare "nightmare." Medical doctors, like Thomas Mueller in Everett, Washington, are stirring up the ranks of medicine and orienting them toward a boycott of third-party payors. Cash is back by necessity.
As chiropractors we are in a unique position. It is precisely because of the HMO debacle that we have survived in a cash medium. I know that my patients with prohibitive plans are very willing to pay cash.
Is it possible to garner the strength of the past? Shouldn't we get back to basics and stand together as a profession? Some say that B.J. Palmer's philosophy is an antiquated relic of a bygone age. I don't think so. I think his edicts are as timeless as the "innate" concept itself. Despite the eccentricity of the man, therein shines a wisdom for the new millennium chiropractor. If we would have picked up the pieces after his death and forged ahead as a unified body, perhaps I wouldn't have my treatment plan redlined by a fellow professional in a cubicle in Southern California; then again, maybe not.
I, too, might be an antiquated relic, but I'm one on purpose, and I could wish nothing better for our entire profession than to be dancing with the dinosaurs.
Reference
Physicians burn out on regulations. Jon Dougherty, published on World Net Daily.com, May 11th, 2001.
Bradley Osgood,DC
Petaluma, CA
"Nothing, not anything, can or will be able to replace the adjustment!" Dear Editor:
In the June 4, 2001 issue of your publication I found two letters in the "We Get Letter and Email" section that were prompted by Dr. Daryl Wills, the president of the Nebraska Board of Chiropractic Examiners and currently ACA vice-president, who recently wrote a letter regarding conditions in our state that prompted some responses from Dr. Jim Winterstein of the National University of Health Sciences (NUHS).
I would like to address Dr. Alan Post's letter, "The Cavalry Has No Clothes." I am a member of the Nebraska Chiropractic Physicians Association. I have always thought it a misnomer. There are a growing number of "principled" chiropractors who are disgruntled with the NCPA and started a pseudo-state organization, the Chiropractic Education Organization, as happened in Rhode Island. When the issue of statutory nomenclature arose in our state, I and a minority of DCs voiced our disapproval. A straw vote at the NCPA spring convention showed that six of 250 attendees took issue with the nomenclature of state statutes.
Disapproval has nothing to do with parity of scope of practice, but identity. By allowing ourselves as chiropractors to be called physicians is to be swept under the allopathic rug, much as the osteopaths did early last century and are now all but lost. They lost their identity. Osteopaths themselves do not know who they are. Chiropractors are beginning to sound as if they do not know who they are (à la NUHS and the Southern California University of Health Sciences).
We must position ourselves as unique. Why? We are unique! Nothing, not anything, can or will be able to replace the adjustment! Chiropractors detect and remove subluxations. Any modalities or nutrition or emotional work done should be to support the adjustment and eliminate the cause of the subluxation (three Ts).
Chiropractors must hold onto the adjustment, even if 62.2 percent of ChiroPoll respondents do not believe the subluxation to be a major cause of disease. No other health care profession or ancillary procedure does this. None! Physiatrists; physical therapists; massage therapists; osteopaths; and even MDs have all tried unsuccessfully. Chiropractic is not duplicated by any other field. Adjusting subluxations defines chiropractic. Patients know that and they like it.
Identity is based on definition. Dorland's Medical Dictionary describes a physician as "an authorized practitioner of medicine, as one graduated from a college of medicine or osteopathy and licensed by the appropriate board." The American Chiropractic Association defines chiropractic as "that science and art which utilizes the inherent recuperative powers of the body and the relationship between the musculoskeletal structures and the functions of the body, particularly of the spinal column and the nervous system, in the restoration and maintenance of health." The scope of chiropractic practice does not include the prescription of pharmaceuticals or the performance of surgery (except in Oklahoma). The late Dr. Virgil Strang stated in 1984, "The chiropractor offers one service - only one - which is not duplicated by any other branch of the healing arts. That most distinctive, valuable, and potent service is the detection and removal of subluxations that are causing abnormal functioning of the nervous system." D.D. Palmer's opinion: "But the expression, a chiropractic physician, or a physician chiropractor, is the joining of two words of opposite meaning." He also stated: "Chiropractors assent to nothing that is allopathic." Drugs and surgery have a definite merit, but do not belong within the scope of chiropractic's therapy.
In the same vein, the term "chiropractic medicine" is not a misnomer. Dorland's defines medicine as "the art and science of the diagnosis and treatment of disease and the maintenance of heath." Chiropractors do not diagnose or treat disease. It is not in our scope of practice. Chiropractors detect and remove subluxations.
The name change is an affront to the identity of chiropractic. We are chiropractors, and even doctors of chiropractic, but are not chiropractic physicians. There seems to be a nationwide, even worldwide movement, to change the public's perception of chiropractic. Some states have a board of chiropractic medicine (Florida, Rhode Island). The two words together are an oxymoron. Chiropractic adjustments do not regulate the body like pharmaceuticals do. Chiropractors do not administer any physics, therefore we cannot be physics, and therefore, we cannot be physicians. Chiropractic is distinct from medicine, except that both are healing arts. The distinction should be maintained. State statutes reflect this fundamental difference, and focus legislative efforts toward identity.
That brings me to Dr. Clifton Kirton's letter: "This is a matter of personal and professional responsibility." The only differential diagnosis that I feel fully qualified to make about a patient's condition is whether or not it is of a chiropractic nature. If the patient presents with an ailment that is not directly related to a vertebral subluxation complex, then they should be referred to the proper health care provider. In the referenced article, the patient's symptomology was attributed to an old injury. The patient's complaints were alleviated and the objective findings were satisfactory to Dr. O'Connor for dismissal. The patient appeared to have had a favorable response to her chiropractic care. I probably would have done the same thing in a similar situation. As we all know, sometimes the first symptom of an MI is death.
In defense of the "pompous, pontificating idealogies," the reason they closely guard the "late 19th century dogma" is because of mandated hours. In Nebraska, roughly 350 chiropractors are in active practice, and are required to have 30 continuing education hours every two years, 18 of which are mandated in several categories. The worry comes from Nebraska's wide scope of practice laws that allow qualified chiropractors to practice nearly any way they prefer. If some docs want to do blood tests, gynecology, proctologic exams, colonics, acupuncture, or other nonchiropractic services in our offices, then they are welcome to do so. However, they must have the proper training and certification. I do not want mandated hours in acupuncture, colonics or gynecology to ensure that I have the education that my scope of practice allows for, even though I do not use any of those procedures in my practice. The "progressive chiropractic physicians" forget that just because the scope of practice allows for a procedure doesn't mean that every DC wants to do it or is qualified to do it. Those nonchiropractic services fall into the category of primary health care, but that does not make the chiropractor a physician (unless there is case law of which I am not aware, Medicare excluded).
Jeffrey Groene,DC
Schuyler, Nebraska
