... the best interests of the profession clearly demand a
spirit of cooperation amongst our various factions.
Dear Editor:
After reading the column, "A View from the Field," of the 25 Feb.
1994 issue of Dynamic Chiropractic, I felt compelled to make a
response. The column, subtitled "Drugs-R-Us," was submitted by Dr.
John Hofmann, DC, FICA. Dr. Hofmann takes issue with efforts to
include the dispensation of pharmaceuticals within the practice of
chiropractic. I do not take issue with his view that the inclusion
of drugs within the scope of practice would be a serious mistake.
I also believe that he is correct in his characterization of this
movement towards drugs being comprised of a very small minority of
the profession (he referred to "a few" or "several" people).
However, several aspects of Dr. Hofmann's article are quite
disturbing. The original premise was somehow turned into an ICA
vs. ACA diatribe, replete with the aspects of misinformation now
familiar to us from the history of our continuing conflict with the
AMA. Included are the erroneous generalization of the
characteristics of a small group (pro-drug) to a larger nonrelated
group (ACA); the employment of "rumors" as substantiating evidence;
attribution to unnamed parties (thus prohibiting verification);
implementation of "straw-man" arguments; and outright misstatement
of fact. It is disheartening that the lessons some of us learned
from Wilk et al., center on efficient techniques of propaganda
rather than the need for unity.
At this time the best interests of the profession clearly demand a
spirit of cooperation amongst our various factions. Our opponents
in the medical community can only be heartened by efforts to
further divide and weaken chiropractic from within. I will be
alert in the future; if the comments of those like Dr. Hofmann come
to typify the ICA as a whole, I may be driven to the conclusion
that the interests of the profession may actually be best served by
allowing my ICA membership to lapse when I graduate.
Robert Ward
Associated Student Body President
Los Angeles College of Chiropractic
Whittier, California
"... proud to be on the same team ..."
Dear Editor:
Congratulations and thank you for adding Dr. John Hofmann to your columnists. He gives a refreshing breath of fresh air to the many viewpoints that are expressed in you paper.
We (chiropractic) owe a great deal to Dr. Hofmann and the tireless work he has done on behalf of all of us. Chiropractic is growing and the truth is coming out thanks to people like him. He has served and continues to serve above and beyond the call of duty and I'm proud to be on the same team with John.
Great choice!
Murray Galbraith, DC, FICA
Temecula, California
Czechoslovakia's Chiropractic Roots Dear Editor:
Concerning Craig Morris,' "Chiropractic Goes to Slovakia" (Feb. 11, 1994), I would like to offer more background information than given in this paper. While it is true that both Professor K. Lewit and Prof. V. Janda are respected practitioners in the field on manual therapy as well as renowned authors on the subject, chiropractic was introduced in Czechoslovakia long before these two medical doctors found their inspiration by observing a chiropractor practicing in Prague in the early 1950s. It is to their credit of course that they always acknowledged the fact.
Chiropractic was introduced in that country in the early 1920s by Albina Michaelova-Capova. Together with her son, also a doctor of chiropractic, they practiced in Prague. The advent of World War II, then the communist era, may have wiped out the souvenir of these chiropractic pioneers. But as the Centennial draws close, it is only fitting that they should be remembered too, alongside other pioneers the world over. It is though (but it has not been confirmed by adequate research yet) that they were Palmer graduates (98 percent of those practicing in Europe were). Perhaps Dr. C.E. Morris might care to research this little aspect of chiropractic history in his wife's country. I am sure that either Dynamic Chiropractic and/or Chiropractic History would be glad to publish the outcome.
Pierre-Louis Gaucher-Peslherbe, DC, PhD
Vouvray sur Loire, France
Suffix it to Say
Dear Editor:
Over the past few months, I have seen a number of letters by those who find the term "chiropractor" distasteful and less than professional. They prefer we call ourselves doctors of chiropractic or chiropractic physicians. I would like to point out that the use of professional "nicknames" is not uncommon. When was the last time you heard a woman say she was going to see her doctor of gynecology or her gynecological physician. Terms like gynecologist, orthopedist, dentist, neurologist, urologist, internist, osteopath, etc., are used much more commonly than the more "proper" term that they represent. Of course, "chiropractor" does not have the prized "ist" ending. Maybe we should change to chiropodist, chiropractist, or maybe even spinologist.
Gregory Baker, DC
Chatsworth, Georgia
"Why should we be content with just this limited scope of practice...?"
Dear Editor:
"Chiropractic Scope of Practice, Part I" sent me scrambling to my "stuff-to-be read" pile. After reading the entire article in JMPT I found it to be well written and thought provoking. While Dr. Nelson's points are well taken, I must admit that I would like to see all visceral conditions that may be musculoskeletally related continue to be maintained in our scope of practice.
It is not a good idea to claim low back pain as our only area of expertise. Just because this position is acceptable to the medical establishment and easily claimed by us does not justify giving up the other areas in which we excel.
For example, if a visceral condition is caused by spinal subluxation should the chiropractor not be the first provider of service? If the patient with a visceral condition is not able to be helped with chiropractic care alone then include medical care in the treatment plan. If patients with visceral conditions can be relieved of the condition through chiropractic care they will not need the more costly and less effective medical care. Chiropractic should be the first treatment applied in such cases.
Naturally, we need research performed in a comprehensive manner to demonstrate the effectiveness of chiropractic care for visceral conditions. With such research the cost effectiveness, effectiveness of treatment, patient satisfaction, etc., can be compared to other treatment choices. If chiropractic can be shown to be more cost effective then it will be the treatment of choice in future health care plans.
Yes, the Manga report has helped establish chiropractic as the treatment of choice for low back pain. Why should we be content with just this limited scope of practice when we are also effective in the treatment of other conditions ... including some visceral conditions?
Most chiropractors know how effective chiropractic can be in the treatment of a condition like asthma when combined with proper nutritional support. I could not bear to see a child suffer, knowing that I may have been able to help. My moral obligation is to help all humanity with all ailments that I possibly can.
Just because the research has not kept pace with the proficiency of chiropractic care does not allow us to give up areas of chiropractic practice that has been demonstrated to be beneficial to mankind. Public perception of chiropractic to date, medical establishment acceptance of chiropractic to date, nor third party payer willingness to pay for chiropractic services to date does not entitle us to ignore the suffering people that we have the power to help. This is a moral issue as well as a cost and acceptance issue.
Chiropractors have fought long and hard to get as far as we have. We cannot give up now and accept less for mankind when we have so much more to offer than relief from low back pain.
Dale Heil, DC
Baltimore, Maryland
Too Hard on the Medical Profession? Dear Editor:
After reading your Dynamic Chiropractic paper for the past several years I felt it was time to write.
Your paper has condemned the medical profession time and time again. Your editorials seem to give the picture that medicine is a practice that limits itself to prescribing analgesics and performing unwarranted back surgery.
Believe it or not, medicine is much more than that, and without reservation I can say that medication has increased the quality of life for many individuals. To give just a few examples, L-Dopa (editor's note: levodopa) for Parkinson's, digitalis for heart failure, beta-blockers for hypertension and post MI arrhythmia, hydrocortisone for RA and transplant rejection, neuroleptics for schizophrenia, antibiotics for infection, and edrophonium (anticholinesterase) for myasthenia gravis. Even a simple operation such as an appendectomy for a patient with acute appendicitis could be the difference between life and perforation of the appendix with subsequent peritonitis, sepsis, and death. As with all treatment strategies, the benefits must be weighed against the cost.
There are diseases that medicine and surgery can help, such as neoplasm (benign or malignant), diabetes, congenital anomalies, epilepsy, kidney failure, and even trauma patients just to mention a few, and I feel the above mentioned have little to do with the scope of chiropractic and the subluxation complex.
I think your paper should use more caution in its critique of the medical profession especially when the critique is based on presumption and not knowledge.
P.S. Your paper is informative and quite fun to read.
Kerry Filler, DC (and 3rd year medical student)
Uppsala, Sweden
Editor's note: Life is chemistry, but not everyone welcomes levodopa or anitcholinesterase drugs flowing through their veins (to use two of your examples). When administering levodopa for Parkinson's, the Physicians' Desk Reference warns, in part:
"Other serious adverse reactions are mental changes including paranoid ideation and psychotic episodes, depression with or without development of suicidal tendencies, and dementia. A common but less serious effect is nausea. Less frequent adverse reactions are cardiac irregularities ... anorexia, vomiting, and dizziness.
Concerning anticholinesterase drugs, the Physicians' Desk Reference warns: "Whenever anticholinesterase drugs are used for testing, a syringe containing 1 mg of atropine sulfate should be immediately available to be given in aliquots intravenously to counteract severe cholinergic reactions which may occur..."
Thanks, but no thanks.
