Editor's note: Below is a letter to the deputy assistant secretary of defense from Craig Benton, D.C., and the response he received.
December 14, 1992
Edward D. Martin, MD
Deputy Assistant Secretary
(Professional Affairs and Quality Assurance)
Office of the Assistant Secretary of Defense
The Pentagon
Washington, D.C. 20301
Dear Dr. Martin:
President George Bush has signed the 1993 Defense Authorization Act. Section 505 of this bill authorizes the Secretary of Defense to commission doctors of chiropractic in the military health care system.
Testimony during the House and Senate subcommittees on this issue revealed the extensive use of chiropractic health care, by military personnel, during he Persian Gulf conflict and also during the Vietnam War. Academician's also testified about the abundance of scientific research published in mainline, peer-reviewed medical journals, on the effectiveness of spinal manipulation for specific ailments. Scott Haldeman, M.D., D.C., Ph.D. stated, "It is no longer possible for an informed individual to state that there is no scientific basis for chiropractic theories."
In November of this year, the Guidelines for Chiropractic Quality Assurance and Practice Parameters was published and mailed to every licensed doctor of chiropractic in the country. This national guideline was developed by a consensus panel of DCs from around the nation. This national chiropractic standards of practice and quality assurance will answer any questions or concerns about the manner in which chiropractic should be practiced.
Dr. Martin, during testimony the DOD was unaware of the evidence of chiropractic effectiveness and quality assurance. With this information brought to light to DOD, I would like to find out what the DOD's current position is in relationship to the commissioning of doctors of chiropractic in the U.S. Military.
A prompt response would be appreciated.
Craig R. Benton, D.C.
Lampasas, Texas
Craig Benton, D.C.
105 N. Key Ave.
Lampasas, TX 76550 Dear Dr. Benton:
Thank you for your letter to Dr. Martin regarding chiropractors in the Armed Forces.
The treatment of musculoskeletal ailments within the military is well-accomplished by medical physicians, osteopathic physicians, and physical therapists pursuant to well-established standards of quality control in professional training and clinical practice. Comprehensive medical evaluation and treatment are available both during armed conflict such as Operation Desert Storm and during our peacetime mission. Osteopathic physicians are widely distributed throughout the military medical treatment facilities providing comprehensive health care that includes specialized manipulation therapy as medically indicated. Physical therapy provides further manual therapy capability through established mobilization techniques under the conventional standards of medical practice.
The National Defense Authorization Act for fiscal year 1993 authorized the Department of Defense to appoint chiropractors as commissioned officers in the medical departments of the military services. However, the Department of Defense is facing a considerable force reduction. Therefore, to commission chiropractors who have a limited and narrowly focused scope of practice, is believed to be a manpower and financial expenditure that cannot be supported in the military health care system.
I trust this information is helpful to you.
John F. Mazzuchi, Ph.D.
Deputy Assistant Secretary (Acting)
Washington, D.C.
"National Health Care: A Frightening Thought" Dear Editor:
I read your paper cover to cover (well, most of it) every issue. Thank you for producing this professional paper.
Of everything I have ever seen on your pages, the editorial, "National Health Care: A Frightening Thought," is the most important, timely, and wise piece ever published. (Editor's note: Dr. Gemmer is referring to a letter to the editor printed on page 5 in the January 15, 1993 issue).
Please reprint it on the front page where it belongs.
Erwin R. Gemmer, D.C.
Everett, Washington
"Anecdote Us" Dear Editor:
I would like to respectfully disagree with Dr. Joseph Keating's opinion ("DC," December 18, 1992) that "We don't need more anecdotes."
It may be true that anecdotes are meaningless for chiropractic research and will not help to generate the hard data needed to "convince" the scientific community and third-party payers that chiropractic has a place in health care. But it doesn't necessarily follow that clinical experiences, written by chiropractors for other chiropractors and published in an intraprofessional news source, are "steps in the wrong direction: backwards."
It's unfortunate, in fact, that the term "anecdote" has to be attached to such a report, for the word has become almost synonymous with "joke," both within and without the scientific community. In science, "anecdotal evidence" is that which is "based on hearsay rather than a systematic collection of data" (Taber's Cyclopedic Medical Dictionary).
If a doctor in a busy practice discovers that a certain adjustment or treatment has a particular effect on a particular diagnosis or pathology in a sizeable number of patients, he may wish to share that information with his colleagues. However, he may not have the desire and/or the know-how to produce a case study for a peer-reviewed journal. What are his options? 1) Keep the information to himself. 2) Take a course or seminar on how to write case studies, at considerable time and expense. 3) Give seminars on his "discovery, making a mint and ensuring his retirement before researchers can prove or disprove the procedure.
Most chiropractors choose No. 1. More and more are choosing No. 3. There should be another option: a place where practitioners can share their successes with other practitioners without extreme burden of scientific proof. In other words, "anecdotes."
We're not talking "advertising fluff" or "testimonials." We're talking a forum for sharing clinical information without having to pass that information before a board of academics who may know nothing about the procedures described. We're talking about the "You know, this seems to work a lot of the time in my office" type of information that busy doctors are eager to hear about and perhaps even try.
Most doctors I know couldn't care less if a particular treatment is given the blessing of the scientific community -- if it gets patients better faster. If the "anecdote" is shared and tried and seems to work in a number of cases, then the researchers can do their thing and find out why and how often the treatment works.
Given the psychosomatic nature of pain and disease, science will never be able to give the practitioner anything other than odds or percentages. Nothing works all the time. Anything (medicine, chiropractic, prayers, and crystals) can work sometimes. That's not "unscientific." That's fact.
Therefore, as progressive professionals, we should be allowed a forum for dissemination of clinical information uncensored by the political opinions of the chiropractic and/or medical establishment. Let it be up to the forum editors to reject the ridiculous (I can cure headaches by holding a picture of BJ against the left temple while humming "Blest be the tie that binds.")
So, please, Mr Petersen, give us that forum. Anecdote us. If that makes us "unsophisticated boobs," so be it. Who knows, even Dr. Keating may be able to gather a pearl of wisdom from among the garbage.
Leon E. Grumling, D.C.
Norco, California
No, No, a Thousand Times No -- ah, Make that a Million
Dear Editor:
The Association for Chiropractic Advancement has mounted a campaign to pressure you, the ACA, and Texas Chiropractic College to endorse the use of prescription pharmaceuticals by chiropractors.
A million times no! We are chiropractors, not MDs. MDs use medicine to treat symptoms, we chiropractors restore bodies to normal functioning by eliminating subluxations.
Imagine a campaign to pressure Harvard Medical School to offer a Clinical Chiropractic Certification course.
If your judgment is that a patient needs medicine, refer him to a medical doctor -- they're the experts in that field. We are the experts in removing nerve interference through chiropractic adjustments. Better a first rate chiropractor than a second-rate MD.
No pharmacology!
Allen Caplan, D.C.
Rio Piedras, Puerto Rico
Editor's note: See the article "The Survey Says..." by the president of the president of the Association for Chiropractic Advancement (AFCA) in this issue.
We the Gatekeepers Dear Editor:
I has been on my mind for years now. The exact same thing that you describe in your recent editorial in the January 15, 1933 issue.
Chiropractors should be primary care physicians at all levels of the health care system. We should be involved with trauma cases involving spinal cord injury and rehabilitation. We should be the gatekeepers of insurance company claims and HMOs. Chiropractors should treat 99 percent of the population for acute, chronic, and preventive care.
Now it is time to take the next step to make your dream a reality. I can envision your ideals in place by the year 2000 if you help me find several special people willing to put their money up for the greater cause of securing chiropractic's future in the health care system.
Can you help?
Michael J. Miller, D.C.
Hill City, Kansas
Dual Fee Structures Dear Editor:
Your article titled, "Are You Listening?" in Dynamic Chiropractic, January 29, 1993 issue, really struck home. It has been discouraging to watch practitioners shoot themselves in the foot with their "dual fee structure."
I entered practice in the late '70s, before the golden years of insurance hit the state of Pennsylvania. Distinct memories of Blue Cross coverage in the early '80s is probably the most poignant of those memories. Doctors of chiropractic were talking of the new prosperity as they would raise their rates for insurance patients. The talk of Cadillacs, swimming pools, and the golden calf brought them to dizzying heights. Gone were the normal fee structures, recommendations for the patients' needs, and what we viewed as rational chiropractic care.
Unfortunately, a practice management group I was involved with temporarily moved me to a two fee structure. He suggested I bring in spinolators (with pictures of dollar bills coming out of the machine) to help build up my case average. Don't get me wrong, if the patient needs adjunctive care according to the individual doctor's belief, they should receive it. Luckily enough both a friend of mine and also a patient were insurance claims adjustors. They had inquired why my cash patients and insurance patients were charged differently, and seemingly on different treatment frequencies. Understandingly, it was embarrassing trying to not only rationalize it, let alone explain it.
Don't get me wrong, we still have some weak chinks in my office's armor. As my practice evolves and grows, some of the growth pains are not pleasant. One change for the better is that if you are a cash patient or an insurance patient, the frequency and the charge is identical. Granted, arrangements are made similar to an orthodontic office payment structure, but there is no difference. For those of you who are plundering and sacking the insurance industry, you are being watched and records are being kept. The common phrase I hear from doctors is that I am going to get mine while I can, because it is going to be gone soon. Just remember that new changes will be sweeping through the health care system, and how can we explain two fee structures and NOOPE systems, etc., without embarrassment.
Mr. Petersen, we may not agree on some things, but thank you for your courage in writing on one of our skeletons in the closet.
Stephen J. Pennell, D.C.
Pittsburgh, Pennsylvania
Pony Express Rides Again Dear Editor:
It would be an act of kindness if someone would alert the pony express to send a rider to La Crosse, Wisconsin to tell Dr. Barge that we are in the 20th century and heading for the 21st century.
I have often wondered what omnipotent force appointed Dr. Barge as the overseer of the chiropractic profession. He represents a small minority in the profession that want to practice hands only, one cause, one cure. He accuses Dr. J. Winterstein of graduating chiropractic physicians at the National College, and I think that he would plead guilty to that charge.
A profession must evolve and grow as the accredited colleges are doing, or stagnate like the unaccredited colleges are doing.
Jack Braun, D.C
Redwood City, California
