Help Me Understand ... Please!

Lately, there has been the hint of a suggestion that the chiropractic profession should consider straying from the course it has followed for the last 101 years. Possibly, the motivation behind this suggestion is managed care's often negative impact on chiropractic practices. The suggestion to the profession is that chiropractors should be allowed to prescribe over-the-counter (OTC) drugs.

To an outside observer who is oblivious to health care issues, this might seem like a logical step. If you hired a marketing consultant, you would be advised that one solution for lower reimbursement rates is to add on new services, thus allowing you to reach a broader customer base, and diversify your income.

But the benefits must always exceed the cost, and in this case they don't.

Let's look at what is happening. Patients come to you for chiropractic care. While they may ask you about the effects various OTC and prescription drugs would have on their care, they know that chiropractic is a drugless profession. Your patients may chose to buy their aspirin, naproxen, ibuprofen, and acetaminophen over-the-counter, or see their MD for a prescription drug. Should one of many adverse drug reactions take place, the subsequent lawsuit is between your patient, their lawyer, the drug company and the MD who prescribed the drug.

With the ability to prescribe over-the-counter drugs, this scenario changes significantly:

Patients would come to you for chiropractic care and their OTC drug prescription. The patients would buy their aspirin, naproxen, ibuprofren, and acetaminophen along with any prescription drugs prescribed by their MD. Should they experience asthma, bronchospasm, renal papillary necrosis, direct cell toxicity, chromosome abnormalities, phototoxicity, death or any of the other potential side effects from OTC drugs, the lawsuit would be between the patient's lawyer, the drug company, their MD, and you.

Guess who is most likely to lose?

Imagine the fun of comparing your expertise in drug therapy with that of a seasoned MD who writes prescriptions for a third of his patients. Try as you might to show your proficiency, your chiropractic college course work would outweigh any expertise you might gain at a weekend pharmaceutical seminar.

But the drug companies would love you. Every time they faced a lawsuit from a person who chose to take their OTC drugs, they would go looking for a potentially prescribing DC to try to hang the liability on.

And think of the disservice this would be to the chiropractic patient (including yours truly). With gastrointestinal problems ranging at the 10% level for over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs)¹ and acetaminophen (responsible for 4,000-5,000 kidney failures each year),² the risk of cervical adjustment would be the least of patients' worries.

The question these DCs should be asking themselves is: "How much more money can I make if I can prescribe OTC drugs when the patient doesn't need my prescription to buy them, and has been doing so all of their adult life?"

The answer is obvious.

The real irony in this entire issue is that the same marketing consultants that would tell DCs to get into prescribing over-the-counter drugs are advising MDs to get into nutrition, alternative medicine and wellness.

Go figure.

References

1. Fowler PD. Aspirin, paracetamol and non-steroidal anti-inflammatory drugs -- a comparative review of side effects. Med Tox 1987;2:338-366.
2. Perneger TV, Whelton PK, Klag MJ. Risk of kidney failure associated with the use a acetaminophen, aspirin and nonsteroidal anti-inflammatory drugs N Engl J Med 1994;331: 1675-1678.