We Get Letters & E-Mail

In a United Effort, We Need a United Message

Dear Editor:

The comments made by Richard Duenas, DC, in a recent letter to the editor ("The Foundation's White Paper Needs an Adjust-ment," April 9, 2012 issue) in response to the research presented in a white paper sponsored by the Foundation for Chiropractic Pro-gress deserves a response. The foundation's paper, "The Role of Chiropractic Care in the Patient-Centered Medical Home (PCMH)" utilizes the strongest evidence-based research to date relative to chiropractic care, to present and articulate the valuable role doctors of chiropractic (DCs) can play within a PCMH. Not only does the report validate the role of DCs as PCMH participants, but it also ad-dresses the ability, where provided for in legislation, for the DC to lead a PCMH effort.

The paper in question does not address scope of practice in any way. It does not suggest or imply a limitation of scope or an ex-pansion of scope. It does, however, focus on the area in which effectiveness data of a clinical and financial nature exist.

The foundation's paper presents DCs with an explanation of an area of opportunity. It also addresses some of the elements that cause the opportunity to now be appealing not only to chiropractors, but also to other providers involved in the PCMH. The econom-ics of the PCMH are a game-changer. Not all PCMH entities will open their arms to chiropractic, any more than all chiropractors will welcome the opportunity to be involved in these structures.

The people who appreciate the mechanics and the economics of the PCMH process, such as the Medical Group Management As-sociation and the American Journal of Managed Care, are growing in number and importance. This new understanding and respect for the chiropractic profession's contribution comes as a direct result of the foundation's paper.

Furthermore, the paper advances chiropractic education and supports the main mission – mentioned by Dr. Duenas – of all DCs: to provide patients with the opportunity to access chiropractic care as a routine part of their first-line health care choices.

For years, there has been a host of biases and misunderstandings surrounding the chiropractic profession. With the foundation's well-organized and credible papers, the mainstream establishment in health care is taking notice and including chiropractic care in their discussions. The foundation is living up to its mission of raising chiropractic awareness – and is making significant progress.

One point Dr. Duenas made that we fully support is that all organizations representing the profession should be united in this ef-fort to stand up for their inclusion within the emerging health-care delivery system. However, Dr. Duenas overlooked one key compo-nent: In a united effort, we need a united message. The foundation's white paper provides the profession with a universal, evidence-driven document that, if used properly, can result in opportunities for patients to have greater access to the valuable services of a doctor of chiropractic.

Gerard Clum, DC
Mike Flynn, DC
Spokespersons, Foundation For Chiropractic Progress

Research Is Confirming Much of What We Were Taught

Dear Editor:

I am responding to the recent letter from a DC who proposed changing chiropractic because of his practice struggles over the past 30 years. ["Why Am I Still Struggling?" Jan. 29 We Get Letters] I suspect his position is not unique. I challenge this doctor and others to investigate the literature. Medicine is focusing on spinal function. Jeffrey Saal, MD, in his presidential address to the North American Spine Society said, "Improving patient function must be the credo of care."

There are multiple studies in Spine, the European Spine Journal, and other credible publications regarding abnormal nerve-muscle-joint function in spines. Dan Murphy called Panjabi of Yale's research in the European Spine Journal "the most accurate description of the vertebral subluxation complex from a medical perspective." Malik Slosberg documents multiple studies showing the ability of adjustments and exercise to provide subjective and objective improvement of the various components of spinal dysfunction.

It is quite possible to have a very satisfying, successful traditional chiropractic practice. It's not easy. Life isn't. Times have changed and we should always strive to keep up with the current research and apply it to our patients. From my perspective, today's medical literature is confirming much of what we were taught at Palmer in the mid-1970s. I am sorry this doctor's experience has been different.

R. Tyler Given, DC
Poway, Calif.

Philosophy Supports Evidence-Based Principles and Practices

Dear Editor:

I am saddened by Dr. Lynn's letter in the Feb. 12, 2012 issue. He seems dejected and struggling, and blames philosophy and lack of prescription rights. Dr. Lynn claims that 70 percent of chiropractors "can't make a living at it." He infers that without the benefit of medications, it is ridiculous to treat pain; and he reasons that prescription rights might help feed our families and do what we are trained to do, help people in pain.

His issue is not new. I find it to be the fault of our colleges. Dr. Lynn believes that the "philosophy" he was taught failed his shoulder (injury). He suggests we "ditch the philosophy, except for its historical significance." I think there are two issues involved here that are pervasive in our profession: a misunderstanding of the definition of philosophy and a lack of respect for the potential of our distinguished profession.

I lecture on philosophy because it is so important to health care. The definition of philosophy is the love of knowledge. It in-volves studying, questioning and advancing the science, ethics, techniques, politics, logic and, yes, even the metaphysics of a profes-sion. Some seem to think it is only a metaphysical dogma. Unfortunately, Dr. Lynn and others seem to have their own "dogma," which is a closed-minded view and is the reason we need philosophy. It is to evaluate, tear down and rebuild the principles logically with credence and substance.

Our schools need to teach more philosophy so graduates can enter practice confident that they are at the top of their field in health care. Remember that a "PhD" is the top of the education ladder, not the bottom. I find it odd that the only fields which do not have PhDs in their curriculum are medicine, law and modern chiropractic. (Remember, chiropractic had the "PhC" degree until the 1960s.) I believe it is because those professions want the image of their "doctorate" degree to be the pinnacle. But all programs should – and most do – include the study of philosophy.

In today's practice, there is no reason you can't use therapies on an extremity injury along with cervical and/or extremity ad-justments, which is the evidence-based approach, and is philosophically sound. (I should note that according to Dr. Lynn, his shoul-der apparently got better without medication.)

As for his estimate that 70 percent of chiropractors are having difficulty making a living, I believe that is a gross exaggeration. I'm sure some are struggling, but I know that the confident, philosophically sound doctors are doing very well, even in this tough economy. And many get regular referrals from MDs because they refer patients to them for help when medications are warranted. I know I do and many DCs in my association (Georgia Chiropractic Association) do.

Again, I hold our colleges responsible if graduates do not understand what philosophy is about. It advances our profession and builds confidence in our principles. It is not just for historic purposes. It is not about dogmas. Philosophy supports evidence-based principles and practices.

Jeff Smith, DC
Brunswick, GA.

Dynamic Chiropractic encourages letters to the editor to discuss issues relevant to the profession and/or to respond to a previously published article. Submission is acknowledgement that your letter may be published in print and/or online. Please submit your letter to editorial@mpamedia.com; include your full name, degree(s), as well as the city and state in which you practice.