If the chiropractic profession permits the current direction of health care to go unchallenged, we will see the day when chiropractors will be replaced by second-rate medical weekend spinal manipulators and therapists who will bastardize the manipulative art into the gutter. When patients get injured by these substandard practitioners, the media will publicize it as patients being injured by "a chiropractic adjustment" and we'll get the blame. We need to educate and change the course of public thinking on chiropractic, or we will most assuredly be strangled and replaced by inferior imitators. Many different occurrences support this premise. Let's examine a few.
The Canadian Stroke Case
Radio, TV and the press in Canada recently carried some major national publicity on a Saskatchewan patient who suffered a stroke and died following a chiropractic adjustment.
There have been articles in the print media for decades that people can succumb to stroke from neck manipulations, so the public and media reaction was predictable: a mercilessly attack on chiropractic. One of the newspapers referred to chiropractors as "killers."
An inquest was held. The death was attributed to a torn vertebral artery. Because it is not the job of an inquest to determine blame, there was no finding whether the chiropractor was responsible, but the inquest did identify two adjustments which may have contributed to the patient's death.
The Canadian papers did not put the incident into perspective.
There was no mention, for instance, of a review of five million chiropractic adjustments in a chiropractic college clinic that found not one instance of stroke or death.1
There was no mention that the death rate/complication ratio of the commonly sold over-the-counter NSAIDs is 400 times greater than a cervical adjustment.2
No one mentioned the credible government studies from the United States, Canada and Great Britain3-5 that have found that chiropractic is an exceptionally safe, cost-effective and therapeutically preferable treatment for low back pain.
Let's also ignore the fact that in 31 years involving billions of chiropractic adjustments, there have been only 10 cases of death following neck manipulations. Nine of those deaths were caused by MDs,6 even though chiropractors perform 94% of the cervical manipulations/adjustments in America.7 In other words, six percent of the medical manipulators caused 90% of the lethal complications -- a persuasive message for quality care.
The responsibility of educating the public lies with chiropractors. It's never been more vital for their growth and survival. We can't expect the medical profession, drug houses or media to provide a balanced picture of chiropractic.
Being Squeezed Out
Will the direction of our health care see highly skilled chiropractic spinal adjustors gradually being replaced with interiorly trained medical manipulators or therapists? Will chiropractors be gradually forced out of chiropractic, left to drive cabs, sell insurance, work for UPS, and engage in other nonÈhealth care work? These are not the words of a prophet of doom and gloom, but of a deeply involved chiropractor candidly postulating what our future may look like.
Scare Talk?
For those chiropractors that think this is negative and ridiculous scare talk, I suggest they are lambs following the bellwether to the slaughter. Our national chiropractic leadership is acutely attuned to this crisis, acknowledges the danger and needs the support of every chiropractor in the profession.
I have more than 40 years in practice. The decline of the profession won't personally affect me, but what about the young practitioners? What about the students in our colleges? What future awaits them? Our rank and file chiropractors had better wake up to the reality of what's happening before it's too late.
On the Medicare Chopping Block
The November 2nd issue of Dynamic Chiropractic carried the front-page article, "Chiropractic on the Medicare Chopping Block?" It revealed another example of the never ending assault on chiropractic. In 1990, Congress ordered the secretary of HHS to submit a report on the utilization of chiropractic in HMOs. HCFA ignored the congressional mandate. So what else is new? Remember the HEW report?8 HCFA created regulations which permit non-chiropractors to provide spinal manipulation to correct spinal subluxations. If HCFA can circumvent chiropractic's role and create its own regulations in which MDs or physical therapists manipulate the spine under the prescription of MDs and osteopaths, it will put physical therapists at the forefront of spinal manipulation. Chiropractors will be treated like substandard outsiders in the health care they originated. Government guidelines generally become a blueprint for private managed care plans to follow, which will exclude chiropractic care.
Chiropractic's Main Weapon Is Truth!
Unless you think I am a purveyor of negativism, let me make myself clear. No one in chiropractic is more bullish on chiropractic than me. I believe we have a highly impressive story to tell which should rock the entire foundation of health care. On one side I see incredible hypocrisy, dishonesty and fraud which have been the hallmarks of organized medicine. On the other side, I see a magnificent profession which can make a major contribution to health care as only chiropractic can. Our profession suffers the pain of incredible misinformation, public ignorance, indifference and apathy. We need candid and properly communicated media exposure for chiropractic coming simultaneously from many different sources to awaken our society to the importance of our role. This will likely bring objections from medical politicians seeking to retain their monopoly by resisting any change, but nothing is stronger than the truth when it is appropriately delivered from many different sources.
Medical Schools Incorporating Spinal Manipulation
Spinal manipulation is being incorporated into medical school curricula, while physical therapists are lobbying in the various states to get in through the back door to be able to do what we have been ridiculed and condemned for doing for decades. The medical propaganda line will soon be that patients should go to "qualified spinal manipulators affiliated with hospitals" rather than chiropractors.
I have no problem with other professionals learning how to adjust the spine. Imitation is a genuine compliment and verifies that we've been right all along. However, they should go back to school and get the same superior training as a chiropractor before bastardizing the manipulative art.
Hospital Chiropractic
We need chiropractors in hospitals to create a more balanced health care system, one that redirects some of those 80,000 unnecessary disc surgeries being done every year toward chiropractic. There are more than 1,500 unnecessary disc surgeries every week, according to "CBS News." This is a medical atrocity. Where's the outrage? Many Americans may be ignorant or disbelieving of this amazing statistic. They need to hear it over and over from multiple sources until the truth ultimately sinks in. Chiropractors should not only be in hospitals, but be gatekeepers directing the health care traffic. Until this happens, we cannot have the best possible balanced health care system.
The Solution -- A Five-Prong Proactive Program
Chiropractors have frequently been passive and tolerant toward their detractors. Criticisms of medical wrongdoings have often been viewed by chiropractors as "bashing" or being divisive or uncooperative. However, if we see inappropriate or dishonest health care practices, regardless of who is involved, we must stand up for the truth, including being critical and demanding of ourselves. While it makes good sense to encourage friendly cooperation with medical physicians as long as their professional conduct is fair and honest and in the best interest of patients, we can't remain silent and look the other way and ignore inappropriate medical conduct which hurts patients. This brings up the issues of supporting legal actions in court when indicated, becoming more proactive and using the powerful facts that we have at our disposal with the media, press and legislators to redirect public thinking and the course of health care.
#1: Legal Action
Never in the history of chiropractic has it been more vital to have a strong national leadership. With less than 25% of our profession members of a national chiropractic association, I wonder how this profession could have survived this long. We must be doing something right. I'm convinced that chiropractic would not exist today if it wasn't for our chiropractic leadership in Washington. Our ACA leaders realize that what HCFA is doing now can become the death knell for chiropractic and has responded by filing a suit in court against HCFA to force it to deliver a report demanded by Congress on the extent to which chiropractic services are available through Medicare HMOs, and also to block the new HCFA Medicare regulations affecting chiropractic.
I applaud the ACA for the wisdom, courage and commitment to take a strong stand in the courts in this vital area. If this action proves to be successful, this alone will be worth your dues for the next 20 years and more. Even if it is unsuccessful, Congress will then be informed of the misinterpretations placed on its laws by hostile federal agencies working with medically controlled HMOs and insurance companies. New legislation will be sought.
The expense of litigation is far beyond the budget of any chiropractic organization. Hence, chiropractors must support this litigation by sending contributions to the Legal Action Fund/HCFA Lawsuit, P.O. Box 75359, Baltimore, MD.
#2: State Speaker Bureaus -- A Top Priority
We need to initiate speaker bureau programs in every state and train chiropractors how to approach the media and motivate the radio, TV and press to want to interview us. Modern technology allows most interviews to be done by telephone. But chiropractic speaker bureaus do not exist in most states, and where they do, they are not given the priority they deserve. I'm willing to go to any state to help organize speaker bureau programs. There isn't enough money in chiropractic to be able to purchase the kind of massive media exposure we need. The good news is that we can get it free if we initiate speaker bureau programs in every state, learn how to get on the talk shows, educate the public and appropriately respond to any and all questions.
By the way, people love to patronize doctors who are spokes persons. The public views them as being a few notches above the rank-and-file doctor. It's smart business for chiropractors to become good public speakers. They win, and the profession wins.
#3: Involve Our Colleges and Students
Chiropractic colleges need to alert their students of the crisis and get them involved in writing letters, contacting radio, TV and the press. I will be happy to go to any college to speak and spread the word. There is no honorarium, only travel expenses. The colleges are morally obligated to tell their students what they face in the future. The thousands of students in our colleges provide a formidable force to create the multiple exposure that we need to influence public opinion.
#4: Medicine, Monopolies and Malice -- A Weapon of Truth
A powerful weapon that chiropractic has going for it today is the chiropractic story. (Editor's note: Dr. Wilk is the author of just such a book: Medicine, Monopolies and Malice, published by Avery Publishing Group, New York.)
Avery has shown enough confidence in Medicine, Monopolies and Malice to put it on the cover of its catalog alongside its bestsellers. Avery is capable of the right kind of distribution, but it needs the support of the chiropractic profession.
Rudy Shur, an editor at Avery, directed me to write the book in a biographical format to be commercially acceptable. He thought the story would make a great film, and compared it to the movie "Rudy, "about the young Notre Dame football fan who aspired to and did become a member of that football team despite not being Notre Dame "material." The editor was right, because the typical reader response I get is that they cannot put the book down once they start reading. The book also educates the reader about chiropractic with insets and a special appendix that contains the various government, HMO and workers' compensation studies supporting chiropractic's therapeutic superiority and safety.
We are very fortunate to have a publisher of the caliber of the Avery Group enthusiastically supporting us. They deserve our support as well.
#5: Send the "Fax-Facts" Program
I've summarized on two pages the powerful and overwhelming message of chiropractic. You can obtain this two-page summary from me, then call your local radio stations and newspapers and offer to mail or fax them copies. The information provides the outstanding results of chiropractic from major studies. It relates how intellectually dishonest, if not outright fraudulent, it is to isolate chiropractic from more than 99 percent of the hospitals in the country. If the media wants further documentation of these pages, Avery will send them a complimentary copy of my book. We may be able to obtain some great talk show interviews and newspaper articles from these contacts and get them at no cost.
Advise the stations and newspapers that the author is available to do interviews by telephone. I can also appear on television in your area if the local chiropractors sponsor the trip. I do not charge an honorarium to appear on talk show interviews.
Can we make a difference? You bet we can! It's your choice, but I don't like chiropractic's future if we don't act now. We can use the five-prong proactive approach and not only take control but preserve chiropractic for future generations of DC and patients.
References
- Jaskoviak P. Complications arising from manipulation of the cervical spine. Journal of Manipulative and Physiological Therapeutics 1980, p. 213-219.
- Dabbs V, Lauretti W. A risk assessment of cervical manipulation vs. NSAIDs for the treatment of neck pain. Journal of Manipulative and Physiological Therapeutics Oct. 1995; vol. 18, no. 8, p. 530-536.
- Understanding Acute Low Back Problems in Adults, consumer version. Clinical Practice Guideline Number 14, AHCPR Publication No. 95-0644, Rockville, MD, Public Health Service, U.S. Dept. Of Health and Human services, Dec. 1994.
- Manga P, Angus D, Papadopoulos C, Swan W. The Effectiveness and Cost Effectiveness of Chiropractic Management of Low-Back Pain. University of Ottawa, 1993, p. 13.
- Meade TW, Dyer S. Randomized comparison of chiropractic and hospital outpatient management for low back pain from extended follow up. British Medical Journal 1995;311:p. 349-351.
- Kleynhans A. An exhaustive study of medical literature between 1947-1978 dealing with billions of chiropractic adjustments found ten cases of death, nine following medical and only one following chiropractic adjustments.
- Shekelle PG, Adams AH, et al. The Appropriateness of Spinal Manipulation for Low Back Pain. Santa Monica, CA, 1992.
- Independent practitioners under Medicare. HEW secretary report to Congress, December 28, 1968. See pages 35-36, 38, 88-89, 90, Medicine, Monopolies and Malice.
