In the midst of all the health care confusion, chiropractic seems to be trying to decide what road to take. Many want to pick one of two directions: 1) add the use of prescription medications; 2) remain adjustment only. Here, there are still two divisions: limited to musculoskeletal conditions (and some of these are only low back pain), and adjusting the vertebral subluxation complex (VSC) which causes all sorts of diseases. There is a third road, a road less traveled between these two extremes. It is beneficial and profitable. It could allow DCs to actually be primary care providers.
In a fall 1993 issue of Tomorrow's Health, with what was called "the greatest array of pioneering researchers ever assembled," a quote read, "For many health problems, orthodox medicine is your best treatment. Sometimes in fact, alternative medicine adds very little. But for other problems, alternative therapies offer remedies that are years ahead of traditional medicine: 1) coronary heart disease; 2) hypertension; 3) diabetes; 4) chronic fatigue syndrome; 5) cancers that are resistant to chemotherapy; 6) learning disabilities; 7) seizure syndromes; 8) pre-menstrual syndrome; 9) menopausal syndrome; 10) multiple sclerosis; 11) enlarged prostate; and 12) headache."
Chiropractic training provides basic tools that could help many of these people. DCs could have solid practices with good incomes that are based on helping people in need. If what we did was effective, we would probably be covered by insurance; if not, many/most patients would be willing to pay out-of-pocket for much needed relief. However, good diagnosis and supportive measures beyond an adjustment for VSC would be necessary. Like everyone, insurance companies want to get the most for their money. Good diagnostics make sure you know what is wrong, can later measure if you are making progress, and know when you are done. However, it may seem to many that DCs are almost opposed to good diagnoses. Lack of an in-depth physical exam, blood work, and equipment to evaluate visceral findings, not to mention lack of taking a good history, almost punctuates the profession.
Is it because many DCs have never felt how important it is to do a good diagnosis? In school, the feeling in most of the classes that had to do with diagnosis seemed to be: "OK, today we are going to pretend to read a blood sample so we can pass boards. Of course, none of us ever plan to really do it, so feel free to take a nap." Like child abuse, sloppy attitudes about patient health have perpetuated themselves as one generation of chiropractors returns to teach the new generation.
If you had an instructor who had diagnosed a heart problem before, not only would you learn to read an EKG, but more importantly, you would feel the importance of doing such a thing. The training of the ACA Council on Internal Disorders and Family Practice (CFP) by Dr. Cessna lets you feel the importance of doing these tests because of the countless lives saved. Colleges should have diagnostic equipment in the clinics, not just in the classrooms. Students should be taught to do EKGs, for example, when anyone is a smoker, has pain radiating into the chest, is experiencing paresthesia down their left arm, family history, etc. The CFP also provides protocols for treating these people.
Without proper evaluation, mistakes are possible/probable. If a mechanic just opened your car's hood and started fixing things, how comfortable would you be? Wouldn't you want him to figure out what was wrong first? A DC might have a patient with low back pain caused by a visceral problem, but they have done no differential evaluation before telling them, with great practice management flair), "I'll accept your case, Mrs. Jones. It will take 50 visits."
I'm not saying an adjustment might not help a heart problem or gallbladder problem. I have seen clinical evidence. I have seen studies indicating it may be effective. But to an outsider (patient, third-party payor), determining what is wrong is the best way to tailor the treatment to the individual in appropriate terms. Besides, how can we prove the effectiveness of our care if we don't have hard copy data to demonstrate what has happened?
Maybe many DCs fear the responsibility of diagnosis and management. However, it can be done with the ACA-CFP concepts. Is it too easy to have people bend their heads front and back, declare it a "sprain/strain syndrome," and wait for payment from insurance?
Maybe DCs don't want to take the time. It is hard to do a urine analysis that takes two minutes when you normally adjust eight people in that time. When you see 400 people a day, it's hard to find time to take a pee, let alone look at someone else's. Consider that a $50 container of UA strips will yield a $950 profit if you charge just $10 a test.
In the past year, I have diagnosed: an acute heart attack and sent the patient to the hospital; urinary tract infections; Wolff-Parkinson-White syndrome in a 16 year-old boy that had left-sided thoracalgia (that an MD had missed); cholecystitis; undiagnosed and uncontrolled diabetes; severe hypothyroidism using a standard blood test in a woman that her primary physician (who was a board certified endocrinologist) missed. The woman with hypothyroidism became pregnant after years of trying as soon as the problem was treated. She was happy. There is little that anyone could say to convince me that chiropractors "diagnosing" is not a benefit to the patients' lives or to our business.
Maybe some are afraid that these alternative treatments don't work. In truth, what is considered alternative is often what is recommended. For UTIs, even JAMA has recommended cranberry juice. JAMA1 stated drugs and surgery are not curative of heart disease; diet, exercise and lifestyle are. Niacin has shown to be 33% stronger than drugs for lowering cholesterol.2 A DC can make a difference in the #1 killer in the U.S. (heart disease), and it would involve less change (in school, practice, laws) than adding drugs.
This is true of other conditions. For patients with adult onset diabetes, diet, exercise and supplements have shown to be effective. For patients with chronic fatigue, Western medicine offers little. Often the cause is linked to virus. Lauric acid3,4,5 has proven to be an effective anti-viral compound. I have seen Epstein-Barr virus levels drop 400% on blood tests in six weeks on a patient who had been under medical care for 1 1/2 years with no change. GLA6 and proteases7,8 have shown to be effective pain killers and anti-inflammatories. Three words that link these treatments are "safer than drugs."
These treatments should be up our alley. Our philosophy is releasing innate so the body can heal itself. Our philosophy is removing interference of the natural expression of health. There are many types of illness, none due to lack of ibuprofen.
I developed the term "scurvy like" to describe some problems common to Americans. Scurvy was a deadly fact of life on the high seas until fruits and vegetable were added to the diets of sailors. These sources of vitamin C did not treat their disease per se, it eliminated dietary deficiency. The body then healed itself. Scurvy was caused by inadequate diet. Heart problems, cancer, and other conditions have shown to be caused by dietary imbalance.
Many think a chiropractor with diagnostic equipment is playing junior MD. If anything is chiropractic tradition, it is the new, the alternative. The Palmers had one of the first x-ray units. Revolutionary! If we were true to tradition, shouldn't we have had one of the first MRIs at a chiropractic college? The Palmers had some of the earliest devices to analyze heart sounds. DCs should have the latest technology. What is not growing is dead.
Maybe fear about public acceptance holds DCs back. But the lady who complains about a $4 Medicare co-payment will gladly pay $100 for an uncovered blood test. People want quality; that is why someone buys a Lexus. Third-party payment becomes less important. Someone may not pay $100 for an adjustment, but they will for a simple blood tests. I would rather have Medicare pay my diagnostic exams versus manipulative therapy.
In many ways we are like the big well-muscled guy who goes to the beach and is too shy to take his shirt off. Chiropractors have wonderful muscles, but are afraid to flex them. If you have never had someone so impressed with your ability that they tell you that is the best examination they have ever had (and they have been to the Mayo Clinic), someone drive hundreds of miles to see you, or the opportunity to diagnose someone with a condition that MDs have missed, then you are in for a treat -- if you add the CFP type of diagnosis.
We have lobbied ourselves away. If what we were taught in college (how to read and draw blood, make nutritional recommendations, use an EKG, etc.) was chiropractic, then there are states in which it is illegal to practice chiropractic. We see unemployed chiropractors, and in the same state an OT or nurse is doing home visits including blood work on patients, and Medicare/Medicaid pays for it. But the boards have ruled chiropractors can't. Chiropractic is getting whooped in terms of job security.
In Arizona, naturopaths can draw blood, but DCs can't even prick a finger for a QBC. An acquaintance was called before the board to explain why he was practicing what he had learned (i.e., breast exams, EKG's,etc.). He was acquitted, but it is sad; you can almost bet the board have never served their patients this way. Was he turned in by another DC for impressing patients with his thoroughness, thereby stepping on less apt local DCs toes? Maybe because he made more money in one exam (with patient satisfaction) than they did from 12 adjustments (with complaints over co-payments). Some complain of the media and AMA, but nobody is as bad to a DC like another DC scorned.
If we are concerned about a patient's health, wouldn't we do all that we could for them, while still obeying "above all do no harm?" Two thousand people die every week from medication reactions;9 1,000 a week from unnecessary surgery.10 Most ER visits for drug-related emergencies, and most drug-related deaths are from prescription drugs.11 Why feel salvation is found by jumping on the same boat?
America is heading toward general practitioners, away from specialists, toward alternatives to drugs and surgery, away from placating people from ineffective drugs (such as antibiotics for viral sore throats). Chiropractors have been trained to do this. Why haven't we grabbed the spot? Why do acupuncturists and naturopaths have a larger part of NIH funding? How did a profession that started off as an alternative to medicine become an alternative for uncomplicated back pain (as long as treatment is successful within the first 30 days)? Is it because of our association's (and our own) attention to back pain and the ease of third-party payment for this one problem? The mighty oak at some time was just a nut that stood its ground.
People with multiple sclerosis flock to acupuncturists, and people with diabetes go to naturopaths, because they are aware of the dangers of drugs and are unsatisfied with them. Alternative medicine is all the rage, but some DCs want to hop on the stalled boat of drugs and surgeries. Conversely, others want to ignore the benefits of technology and research, and only walk the same old paths.
I feel it goes without saying, but if DCs are not researching acupuncture, they are missing one of the most important oars they will ever get in the water, in terms of patient satisfaction and treatment results. A recent Time magazine special edition had a section on alternative care. Few words were said about chiropractic; whole paragraphs went to Chinese medicine. My personal experience has been that TCM acupuncturists do not in any way, shape or form like DCs. Make no mistake about it, they are gunning for our spot. I could tell you stories of idle chit-chat I overheard while taking the clean needle course at a four year acupuncture school that would make you feel like a hungry wolf was at your heels. They also have the big picture that customers whose imbalances cause health problems are better than self-limiting problems (sprains). It is a wider piece of pie. They have about three schools to our every one.
Acupuncture works with innate/universal intelligence removing interference, letting the body heal itself so it fits "straight." It is a modality so it fits the "mixer." It fits into our philosophy and training, contrary to what a acupuncturist might say to us or to an insurance provider panel. I have seen the curricula of several acupuncture schools and their actual needle training is about 100 hours. They are also starting to train better in Western diagnosis. A friend of mine who lived in Taiwan for 14 years (graduating from Taijung medical school) said decisively that in this country, "Philosophical acupuncture is taught in the four year schools, not clinical acupuncture. Great for philosophy -- not for getting sick people well. DCs are ahead in terms of clinical acupuncture."
This is not DCs vs. naturopaths/acupuncturists/MDs. It is about assuming our rightful position. Like Simba in "The Lion King," we need to remember who we are and not try to be who everyone wants us to be. Ours is a profession with a proud history that now graduates students that don't know who Harvey Lillard was. We are a profession with a history of innovators that now prefers not to do anything new, but allows others to define us. Chiropractic may become a VSC only profession. Since we would not diagnose anything, we would need a referral from an MD to make sure there was nothing else wrong. This would be prudent, although unfortunate. I would not want to wait for the first patient some MD had determined had a true VSC, not just a simple sprain that any PT could fix. Naturopaths, MDs and acupuncturists can recommend nutrition and manipulate the spine (don't worry, they do not include any specificity, such as adjusting a VSC).
Many see the VSC as our salvation; others see drugs and medicinal interventions as our only chance for integration. Others see a road less taken, a middle road. The idea of removing interference and allowing the body to heal itself is alive and well (and rational). Can chiropractors learn and apply enough to take the middle path? If this is best for the patient, do we not owe it to them, and to ourselves?
R. Lindsay Anglen, DC
Mount Vernon, Missouri
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?
