Douglas R. Briggs, DC, Dipl. Ac. (IAMA), DAAPM, EMT
Over the past few years, I have seen more and more ads for "miracle" health care tools. Catalogs come in the mail with all sorts of elixirs, poultices, tablets, wraps, braces, supports and jewelry that are guaranteed to bring happiness, health and prosperity. Now, charlatans were around long before P.T. Barnum, but they still have an appeal to the general public. As health care providers, it is our obligation to provide valid care and informed advice to our patients.
When a patient comes in with a brochure about a special orthotic that is going to "erase" their bunions or a mysterious juice that is going to "cure" their diabetes – alarms should go off. (I'm not picking on specific products, just potential questionable claims.) Once they present you with this type of information, you are complicit in its use. You need to be aware of what your patients are doing and be very clear what your opinions are. In short, whether you're recommending for or against the use of a health care product or service, rely on critical thinking to form an opinion based upon the facts, not the hype.
It is wonderful to be motivated by a sincere desire to help your patients. Unfortunately, sincere desires are insufficient; one must have clarity throughout the process of investigating and adopting a new or different system of diagnosis and/or treatment.
It is almost scary what gets paraded out under the umbrella of "alternative medicine" these days. Everyone should be careful about miraculous claims of success. Regardless of one's personal enthusiasm, claims, dedication or diligence, take a step back and listen, digest, and critically analyze the information presented so that you can make an educated assessment.
Be aware. Be skeptical. Be willing to look past the superficial. Being open-minded means that a person is willing to look at new options – just make sure you do with critical thinking. Don't be so open-minded that your brains leak out. Critical thinking is important when you evaluate a style of therapy or a protocol of treatment. We are all representatives of our profession – what we do reflects on each other. Everyone must work to keep the standards of practice high.
Here's a good example of critical thinking. I have Neti pots in my office, I use one, and many of my patients do as well. But have you ever tried to explain one to a person who has never used one? You are telling them to pour salt water up their nose! (Insert your favorite brain enema joke here.) Now, sinus irrigation is wonderful, and in my part of the country (East Coast), the air has a lot of particulate matter – lots of allergens. Neti pots are fantastic. It may sound like a weird treatment, but I can explain the rationale for using sinus irrigation to clear debris from the sinus cavities. At the same time, I have had patients ask me about a "water pik"-type device that essentially claims to do the same thing. Egads! Aggressively forcing water up your nose is not going to clean the sinuses, and can potentially cause more tissue damage. I think this is an excellent example of "just because you can do something, doesn't mean you should."
Several years ago, Subhuti Dharmananda put out a great article through the Institute for Traditional Medicine. To paraphrase, there are many good, valid healing arts to be learned from. There are also many "trendy fads" in the realm of alternative medicine. The warning is that there are physicians who carefully study the medical tradition, observe the moral precepts, work hard and benefit their patients to the greatest extent possible, especially by teaching the patients to help themselves. On the other hand, there are a growing number of "healers" who superficially study the literature, ignore the moral precepts, work only as hard as needed to gain the money they desire, and take credit for any patients who improve while dismissing any suggestion of failure.
Of course, we can also extend this argument to any number of companies. I recently received an e-mail from a colleague with the header, "An Astonishing Find That Fails to Surprise." According to the e-mail article, researchers have found that 100 percent of industry-sponsored studies recently presented at the annual scientific meeting of a medical professional society reported findings that support product use (Finucane TE, Boult CE. Association of funding and findings of pharmaceutical research at a meeting of a medical professional society. Am J Med, 2004;117:842–845).
The article then asks: "With compelling evidence that the knowledge base produced by commercially sponsored research is biased, with evidence that physicians do not reliably detect bias in information presented to them, with no evidence that bias in individual studies is reliably detected and discounted, and with repeated examples of manufacturers using potentially biased evidence largely to promote sales ... what commercially supported research can be trusted?" Ouch.
Comments like this should make all of us more aware. We are judged by the company we keep. Be careful what you endorse and promote through your practice. Products that promise quick results and an "alternate revenue stream" should immediately be suspect.
I greatly appreciated a recommendation made at a recent seminar. The speaker advised that if you provide a product to a patient – say a cervical collar – then you should include a physical copy of a clinical reference for that treatment option in your file with the day notes and the script. An extra step, perhaps, but one that gives credibility to your treatment plan and validates your course of action.
We must learn to think outside the chiropractic bubble in terms of health care in general. Ultimately, it is the patient we take care of, not the insurance companies, attorneys or other doctors. Be very clear about the services you provide and why you choose them. Chiropractic deserves every bit of respect that any other health profession does, but that respect comes with a level of responsibility. Don't compromise good care for the sake of a sales gimmick or fast buck.
