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"A Long Time Coming"

Dear Editor:

This letter to the profession has been a long time coming. It is no wonder chiropractors still hear the phrase "I wouldn't go to a chiropractor..." spoken by friends and family.

I just had a patient see a new chiropractor. The patient had moved away from my area and was looking for someone closer to her new residence. She responded to one of those "free" evaluations. Being a self-supporting college student, she figured she might save a bit with a free evaluation. After he initial workup by the "new" chiropractor, it was determined that she needed to be seen and treated three times per week for two months, and two times per week for another 12 months, and then once a week for the rest of her life. And before treatment could start, she would have to come up with cash in advance for the first year's treatment!

My experience with this young woman as a patient was that she needed occasional chiropractic. Activities of daily living and the bad postural habits typical of students cause her to develop occasional low back pain, which typically responds to treatment within two to three visits. This young woman has no spinal developmental defects, no degenerative disc or joint disease, no history of significant trauma, and no significant intrinsic postural defects. What was this new chiropractor planning to do with all that treatment?

I am reminded of the phrase attributed to one of the Gonsteads: "Find it, fix it and leave it alone." I believe the only one who may benefit from all this treatment to the young woman is the chiropractor selling the program! I can picture the treatment scenario - the patient comes into a "busy" practice and is seen for two to three minutes. She has some joints manipulated and cavitated, whether they need it or not, and then is told to return in three days for more of the same. This patient enters the "chiropractic black hole," never to be heard from again.

A portion of our profession is masterful at speaking out of both sides of its mouth. On one hand, we want to boast about how chiropractic gets people well more cost-effectively than other modalities, yet some in our profession use philosophy, deceit and intimidation to oversell chiropractic "treatment plans." There is not one study, not one shred of evidence, suggesting that more chiropractic is better than less. There are no outcome studies that suggest that long-term treatment programs benefit patients more than conservative treatment plans. There is no evidence that regular chiropractic prevents or reverses subluxation degeneration.

The chiropractic profession has spent its share of time poking fun at the inconsistencies and nonsense found in allopathic medical care. But chiropractic is equally inconsistent in its practice and principles. Many of chiropractic's tenets and practices do not even conform internally to chiropractic's own logic. The chiropractic profession is often its own worst enemy. A significant segment of our profession lacks the maturity that I believe should be present in a learned profession. Unfortunately, this less mature part of the profession does as much damage to our image as the great chiropractors do good.

It appears that many in this profession believe there is little incentive to get people better efficiently, but instead, to see how many patient visits we can get. What's your patient visit average? How long before the patient becomes tired of these methods and worn out on chiropractic? Where's the measure of efficiency? Where are the outcome measures? Which chiropractors are the skillful/artful/talented ones, and who are the greedy hackers? I wonder how many of the chiropractors who sell these ridiculous extensive treatment programs would fall for the same themselves. Rarely do I hear chiropractors discussing interesting cases and what they did to help the patient. What I do hear is constant talk about how many patient visits they get per week, etc.

Then there is the chiropractic double-speak: "Oh, I'm not trying to fix any problem, I'm correcting subluxation to improve the overall health of the patient." Why then is the chiropractor billing the insurance company and using diagnostic codes? And where is the outcome measure showing that all this treatment actually benefited the patient?

I wrote this letter a year ago and put it on the back burner, but I recently retrieved it after another patient who lives about an hour from my office met a similar fate when seeking a chiropractic office closer to his home. He wound up back in my office with a horror story about his experience with a DC who was more interested in his financial resources than his spine. Luckily, the patient's prior experience with me led him back to my office, rather than giving up on chiropractic completely. Unfortunately, some patients are so turned off that our profession never hears from them again. Often, we hear that people are told by family, friends and medical professionals not to go to a chiropractor. Frankly, I wouldn't go, either, considering how much B.S. some chiropractors spread.

Steven E. Downs, DC, DABCO
York, Maine

Dear Editor:

I think Don Petersen brings up a great point: "Where Are the New Leaders?" [Report of My Findings, June 17 issue] But, from where I sit, I know the future of chiropractic is in great hands. Working at Palmer West, I have had the opportunity to see several future leaders of our profession in action. They are not yet running in the same circles that the current leaders are, but they are about to make their presence felt. Actually, the future leaders/current student leaders I have seen in action are so good that I think we will be in very good hands.

Bill Updyke, DC
Associate Clinical Prof.,
Palmer Chiropractic College West
Chair, Calif. Chiropractic Assn. Dept. of Governmental Affairs