Sign of the Times, or New Way of Life?

The growing trend over the past few years of patients opting to seek "alternative" health care treatments in lieu of visiting medical doctors has left many in the chiropractic profession feeling optimistic.

But this much publicized shift in health care has been taken very much to heart by the medical profession. And that new-found hope of chiropractors and other "alternative" practitioner may turn to bitterness as the "ownership" of alternative health care is contested by the medical profession.

Consider the latest media blitz by the medical profession in Life and Time magazines. Both focus on the growing interest in alternative therapies, but both magazines showcase medicine as the premier provider.

That's Life?

The September 1996 issue of Life featured the article, "See Me, Feel Me, Touch Me, Heal Me" (lifted from the rock-opera "Tommy" by The Who). The author, George Howe Colt, sets the stage:

"It is no secret that during the past few years an increasing number of Americans have been turning to alternative medicine: swallowing echinacea pills to forestall the flu, doing tai chi to lower stress, undergoing acupuncture to ease chronic pain. What's news is that their doctors are joining them: A recent survey of family physicians found that more than half regularly prescribe alternative therapy or have tried it themselves. "Practices once thought to be the province of snake-oil salesmen are turning up in bastions of medical orthodoxy. Thirty-four of this country's 125 medical schools -- including Harvard, Yale and Johns Hopkins -- now offer courses in alternative medicine."

"Even the American Medical Association, which two decades ago declared it 'unethical' for its members to associate with chiropractors, grudgingly passed a resolution last year suggesting that its 300,000 members 'become better informed regarding the practices and techniques of alternative or unconventional medicine.'"

Mr. Colt describes the experiences of a number of individuals looking for better health through alternative therapies, including his own experiences:

"Like most Americans, I was raised to believe in doctors the way I believed in policemen and firemen -- a holy trinity of authority figures in whom I placed unquestioning faith. As I grew older, I'd nod politely as friends described their infatuation with homeopathy and acupuncture. But when it came to the bottom line of my own health, I still wanted someone in a white coat who had an MD diploma on his wall."

"Then my back went out for the third time. When bed rest failed to banish the pain, my orthopedist ran me through thousands of dollars of x-rays, MRIs and bone scans. He told me I had a herniated disk and that surgery was unwarranted. There was nothing he could do for me. When I mentioned the word 'chiropractor,' a nauseated look passed over his face, and when I asked about acupuncture he made a dismissive gesture. My 10-minute consultation was over. But my pain continued, and over the following year it seemed as if my entire self -- husband, father, writer, six feet tall, 170 pounds -- had been reduced to a quarter-inch gelatinous disk between the L-4 and L-5 vertebrae. I realized for the first time that physicians might not be the alpha and omega after all. Yet I still had a deep mistrust of the irrational gobbledygook that overflowed from the faddist magazines I picked up free at my health-food store. My interest in alternative medicine did not ignite until I learned that MDs were getting involved. Perhaps I could have my cake and eat it too. But how, exactly, did this integrative stuff work? Bringing along my aching back and a dose of skepticism, I set off to explore what some believe to be the future of American medicine."

Unfortunately, the article focuses on how medical doctors are embracing alternative therapies as part of the "integrative medicine movement." The author even offers some suggestions as to why:

"There is a buzz in the air, a feeling that people here are participating in an important issue at a defining time. Physicians engage in passionate discussions about the 'paradigm shift,' the 'medical revolution' and the 'healing partnership' between doctor and patient. But as often as I hear the phrase 'patient-centered care,' I also hear 'market share' and 'piece of the medical pie.' Insurance company reps and HMO aides circulate purposefully among the doctors. Nattily dressed young salesmen pitch nutritional supplements, homeopathic remedies and vitamin sprays ('Keep the body's energy level and immune system at a maximum with a simple quick spritz four or more times daily!').

"One would like to think this physician interest is the result of raised consciousness, but some doctors are undoubtedly moved as much by the wallet as by the spirit."

Amusingly enough, chiropractic's old nemesis, Steven Barrett, MD, along with another familiar foe, Howard Jarvis, PhD, of the National Council Against Health Fraud, both take shots at alternative therapies delivered by MDs:

"Steven Barrett, a retired psychiatrist, board member of the National Council Against Health Fraud and self-described 'quackbuster,' calls Chinese medicine diagnostics 'loony as hell' and homeopathy 'complete nonsense -- not even worth testing.' He believes that MDs gullible enough to be drawn into alternative therapies should be delicensed.

"One of the most serious criticisms is that practitioners of alternative medicine may miss a severe illness that only conventional medicine can effectively address, a hazard that would certainly be lessened by the involvement of MDs like Sam Benjamin. But other skeptics see physician involvement as a kind of Trojan horse via which questionable techniques are being sneaked into the medical canon. 'When MDs use these kinds of irrational nonsensical techniques, it may confuse their patients and set them up for further reliance on quacks,' says William Jarvis, an educator and founder of the National Council Against Health Fraud."

Chiropractic was passed over within this alternative medicine assessment. The entire article could have been written around chiropractic: the stories of the patients who choose alternative medicine "after years of standard medicine have failed to help them," the unique focus on the patient, and the value of "touch." But, not surprisingly, that wasn't the focus.

Chiropractic was only mentioned twice, just in passing. This was a story exploring the potential benefits of alternative medicine offered by medical doctors:

"In the course of my explorations for this story, I decided to volunteer my own back -- back pain is the most common complaint of people who seek alternative therapy -- as a research subject for about a dozen alternative therapies. Almost all are performed or recommended by an MD."

Ahead of Our Time?

A "special issue" of Time magazine (Fall 1996) titled, "The Frontiers of Medicine," tells the reader more about how medicine has advanced into the "alternative therapies" arena. All of the expected alternative treatments are covered: acupuncture, homeopathy, relaxation techniques, etc. Where the Life magazine story all but ignored chiropractic, in Time's article, "Challenging the Mainstream," author John Langone made these comments:

"Chiropractors, long the whipping boys of the medical establishment, are licensed to practice in all 50 states, their services covered by Medicare, Medicaid, workers' compensation and, in all but 10 states, private insurers."

"Chiropractic and massage, two of the three alternative therapies most used by Americans (along with relaxation techniques), provide another component many patients feel is lacking in high-tech medicine: touching, as both a curative and an extension of compassion."

"Although chiropractic clearly has its drawbacks (notably its stubborn insistence that spinal misalignments cause or underlie most ailments, including those far afield from the backbone), its use of vertebral manipulation has proved useful not only in treating acute low-back pain and other muscular and neurological problems but also in comforting patients who appreciate the deft way skilled chiropractors use their hands. (Osteopaths, licensed physicians whose education is essentially the same as that of MDs also include manipulative therapy in their treatments)."

While the article did show some balance, it left the reader looking at "alternatives" as the long lost child of medicine:

"The alternative movement has progressed from offbeat practitioners and adventurous patients to the medical establishment itself, as well as a growing number of health insurers."

"'Medicine is a three-legged stool,' says Harvard's Benson. 'One leg is pharmaceuticals, the other surgery, and the third is what people can do for themselves. Mind-body work is an essential part of that.'"

What was most interesting was the article's immediate focus on the financial appeal of alternative therapies:

"The trend is easily measurable in dollars and cents. A third of adult Americans, most of whom consult medical doctors as well, spend an estimated $13.7 billion a year out of their own pockets on a bewildering array of break-away treatments, including chiropractic, colonic irrigation, meditation, homeopathy, naturopathy, hypnotherapy, music therapy, folk medicine, guided imagery and Shiatsu massage. More than 1,000 homeopathic medicines are sold over the counter, along with a bewildering variety of vitamins, minerals, herbal remedies, fat burners, passion promoters and bee pollen."

But perhaps the attention to the financial benefits of alternative medicine is not so surprising considering the advertising mix in this particular special issue of Time. The going rate for a nationally circulated, four-color, full page advertisement in Time magazine is a hefty $156,000. A black-and-white ad is a mere $107,000, with two-color ads costing $134,000.

In Time's special issue, there were 27 full page ads (19 four-color, one two-color, and seven black and white ads) by drug companies. Health care companies like Blue Cross ran one four-color ad and two two-color ads. The only other ad in the entire issue was one from the Ad Council. In addition, an eight-page, two-color booklet, Health Tips & Resource Guide, was inserted by the largest drug advertiser.

Assuming no discounts, simple math calculates the advertising income from drugs for this special issue at $3,847,000, with another $424,000 from the health care companies, a total of $4,271,000 (not to mention the eight-page booklet).

As the health care marketplace continues to evolve, with business playing a greater role, chiropractic will be challenged in ways unimaginable 20 years ago. Chiropractic has withstood the numerous attacks of political medicine. The "If you can't beat 'em, join them" strategy brings new challenges to our efforts to remain a distinct profession.