The thought is so disgusting it's hard to see the logic behind it. The notion is so out of character with the fundamental basis of chiropractic it's difficult to understand. And the danger is so great it's urgent that every chiropractor step forward. Is it AIDS? No. Is it thousands of new students competing for your patients? No. Is it a new managed care scheme? No. It's the growing faction within chiropractic that wants to see an expansion of chiropractic into the dispensing of pharmaceuticals!
It's hard to believe, but in more and more states there has been a movement that is vocal and increasingly adamant demanding the "right" to administer certain drugs and potions. These can be powerful and politically savvy chiropractors who see the direction towards drugs as the ultimate in one-stop patient service. Others apparently seek ways to blur the distinction between medicine and chiropractic in the hopes of gaining acceptance, validation, or income. Whatever the motive, it is vitally important that every chiropractor reject these moves and maintain the purity of chiropractic. There are four reasons why:
Chiropractors aren't trained to administer drugs. As a practical matter, current chiropractic training doesn't cover the prescription of drugs. If it were legal, you can be sure weekend seminar courses would spring up to answer the demand. Learning the use and contraindications of the typical handful of commonly prescribed drugs would probably be relatively easy. But that would be like thinking that knowing how to move bones is all it takes to become a chiropractor!
Perhaps one of the motives for the inclusion of drugs in the chiropractic repertoire is to remove a perceived barrier to chiropractors being "gatekeepers" in a managed care arena. Either you are a masochist who enjoys the already intrusive amounts of paperwork and accountability to third parties, or you simply despise your low malpractice insurance premiums. Which is it?
Prescribing drugs smells of the Faustian deal osteopaths must have made with medicine.
Chiropractic doesn't need any more enemies. As this movement gains momentum from chiropractors who haven't a clue of the potential long range damage, it will awaken a sleeping dog that lost much of its bite when the Wilk et al. case settled in federal court. If you think the medical community will sit back and allow chiropractic intrusion into their domain, you're either self-administering some controlled substances, crazy, or both.
Remember those chiropractic forefathers who went to jail for "practicing medicine without a license?" In all too many states, the very laws that enabled chiropractic to co-exist with medicine specifically included assurances of the fundamental difference between medicine and chiropractic and a respect for those boundaries. Attempting to modify this arrangement, even in the most subtle way will unleash an attack that will make the Wall Street Journal article, the ABC "20/20" television story, and the Consumer Reports profile look like endorsements for chiropractic!
What if the shoe were on the other foot? What if the medical profession decided it wanted to add spinal adjustments to its little black bag of tricks. How would you feel about that?
Even with the apparent "successes" of certain medicines and the consumer convenience offering pharmaceuticals would bring, chiropractic would invite the wrath of a well-funded adversary that is simply waiting for an excuse to don the boxing gloves again.
Chiropractic philosophy rejects the use of drugs. Some might think this is the weakest argument, but I think it's one of the strongest. Those who reject the Ten Commandments simply because they are old or have fallen under the spell of scientism may find this perspective the most difficult to understand.
Chiropractic was founded on several fundamental truths that in our haste to become accepted, validated, or simply make car payments, are easily overlooked. You know, like the power that made the body heals the body. Like, doctors don't heal, only the body (without interference) can heal itself. Like, chiropractors treat the person, not the disease. Like, chiropractors treat the cause, not the symptoms. While it may seem expedient, the use of drugs goes against everything chiropractic has stood for since 1895.
If you truly want to administer drugs and you see it as the key to patient satisfaction and the salvation of your practice, there's a wonderful way you can do it without bastardizing chiropractic or tampering with the scope of practice laws. It is so elegant and so obvious that it's easy to overlook: become a medical doctor!
If becoming a medical doctor requires too much work, then maybe you're not as committed to this precept as you thought. Perhaps like your patients, you want results the easy way, without personal responsibility or effort.
If you want to prescribe drugs, this also might be a good year to dance on Harvey Lilliard's and D.D. Palmer's graves.
Chiropractic must remain separate and distinct. State legislatures and even the federal government have already admonished the profession when it presents diverse and conflicting points of view. Some states have as many as three and four different chiropractic associations, societies, and splinter groups, plus an alarming number of apathetic doctors who don't participate at all. When these different lobbyists show up at the capitol, the wisest legislators throw up their hands and require the profession to get its act together and present a unified message. Good advice.
Worse, when you combine medicine with chiropractic you confuse patients. Like the chiropractor who administers physical therapy in the absence of sufficient patient education, patients are unsure whether the "shock therapy" or the doctor's adjustments are the cause of their health restoration. Blurring this difference, simply hoping the patient will make the chiropractor the hero in the whole pain relief experience, is an egotistical and obscene motive that reveals true insecurity.
Maybe the real root of this movement is the notion that results alone are king. Perhaps it is simply playing out the age old question of the ends justify the means. Or is the administering of a drug to speed up, slow down, or numb the body simply a misguided attempt to please and be liked by the patient?
As the practice of chiropractic becomes increasingly challenging, you'll see continued efforts to drift towards the belief that prescribing drugs will save chiropractic. And while it might save an individual practice, it will destroy chiropractic. Treating symptoms such as the lack of new patients or the lack of validation and acceptance is a bankrupt idea. Trumpeting it as a way to serve patients better is a dangerous game of self-deception.
William Esteb, DC
Colorado Springs, Colorado
William D. Esteb has been a patient and advocate of chiropractic since 1981. In 1989 he teamed up with Dr. Robert Jackson to supply patient education resources through Back Talk Systems, Inc.
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