Editor's note: This three-part article makes the case against the inclusion of drug prescriptive rights for doctors of chiropractic. Throughout this article, Dr. Klapp refers to the effort to take chiropractic down the path of prescriptive rights as the "drug initiative," while referring to the chiropractors who wish to promote this initiative as "pharma-practors." To comment on this article or the issue in general, submit a 500-word-or-less letter to the editor (editorial@mpamedia.com) and/or contact the author directly (e-mail at end of this article).
The Moral Argument Against Drugs in Chiropractic
In the U.S., 125,000 people die annually from properly prescribed drugs. This doesn't include adverse reactions not resulting in death from properly prescribed drugs, or the deaths and mayhem from improperly administered drugs. Why a doctor of chiropractic would want to participate in and add to the carnage is beyond my comprehension.
According to a November 2011 Centers for Disease Control and Prevention (CDC) report on just one class of prescription drugs, pain-killers (and let's face it, these are likely the drugs that would be most prescribed by DCs if they ever got the chance):
Consider the problem of selective serotonin reuptake inhibitors (SSRIs). Some have suggested these drugs are behind the epidemic of high-school, elementary-school, university, theatre and other atrocious shooting tragedies throughout America in the past couple of decades. I find it disturbingly ironic that the government's response to these shootings is to try to outlaw guns, while the psychotropic drugs causing these horrific events escape even the most minor official scrutiny. This is yet another example of an allopathic response (treating symptoms, not causes) to a serious social problem.
And those are only two classes of drugs! I'm not including for discussion the thousands of other drugs that kill, maim and become addictive. My point is drugs have become a curse, not the blessing they are so often portrayed to be. In the case of the drug initiative in chiropractic, the curse is magnified. Not only do more people suffer, but the chiropractic profession itself will end up paying the ultimate price: extinction.
Chiropractic Has Been Perceived as Drug-Free Since Its Inception
Chiropractic has a "branding" problem to begin with. The public doesn't know what chiropractic really is – which is not surprising, since those of us who practice it don't agree what it is.
Is it spinal manipulation? Is it for back and neck pain? Is it kinesiology? Is it nutritional therapy? Is it physical therapy? Is it for posture correction? Is it for wellness? Is it for subluxation correction? Good questions. If we don't know, how can anyone else? There is one thing we have agreed upon, however, and that is we are drug-free.
The marketplace for chiropractic has been educated from the founding of the profession that it is an alternative to allopathic drugs, surgery and other such solutions. For 118 years, chiropractic has been promoted, practiced and perceived as a drug-free choice.
To be positioned as drug-free in the health care marketplace is not to be underestimated. It's a good thing. People have generally viewed chiropractic as safe. (This positive public perception is the reason our enemies made up the stroke scare. They knew the best way to attack us was by casting doubt about our safety. They've been somewhat successful, but that's a discussion for another time.)
Just as 7-UP successfully became the "Un-cola" to compete with the best-selling cola products, chiropractic has made its name as a distinct alternative to allopathic drugs and surgery. To abandon our drug-free position in the marketplace would be to give up our biggest "unique selling proposition" (USP). A USP is a marketing term that describes what distinguishes you from all of your competitors in the marketplace. Without a USP, you're just more noise. No one notices you or cares about you, or your product or service.
If the drug initiative succeeds, we will surrender our greatest USP and in effect, tell the marketplace: "We are trying hard to be like everybody else so you'll like us." The problem is, the marketplace won't be fooled. It will know we are a third-rate provider of allopathic services and eventually will have no reason to avail themselves of our services. If we think we have a branding problem now, just think of the confusion we would cause if one day we surrendered the best branding feature we've managed to gain in our entire history.
People won't be fooled by the pharmaceutical industry forever. They will eventually catch on to the fraud that it is. When they do, who will be there to receive them and their health care needs? Hopefully, us.
Chiropractors Have Never Had Training in Prescribing Drugs
While the pharma-practors will assert, rightly so, that the training is now happening in some of our chiropractic colleges, this is a perversion of the original and current intent of chiropractic care – to help sick people get well by addressing and correcting the physical, chemical and emotional causes of sickness and disease. But to attempt to turn an untrained profession into knowledgeable, competent and safe prescribers of dangerous substances seems irresponsible and risky. Especially since the MDs and DOs, who are actually educated in such practice, still manage to achieve high rates of error, abuse, hospital admissions, and even mortality as a result.
Some Additional Thoughts About This Issue
What will happen when the first person dies from a chiropractor-prescribed drug? The media will have a field day! We've always been a favorite whipping-boy of the media, but when the first victim of a chiropractor-prescribed drug dies, they will make all previous chiro-bashing seem insignificant.
Think of the questions that will be raised as to why this tragedy happened. The media scrutiny into why DCs were given the right to prescribe without adequate training will be intense. After a few more deaths, the lawsuits (and DCs' professional liability insurance) will proliferate and the judgments will be significant. If our public image isn't already problematic, it certainly won't be any better when the "casualties" mount. Avoiding this issue alone is a great reason to never go down the prescriptive-rights road.
A medical education doesn't prepare you for a chiropractic practice. The drug initiative is what happens when a significant number of our chiropractic colleges train their students to think, act and practice as medical doctors. The problem is, they are not medical doctors. These graduates enter practice ill-prepared to practice the chiropractic scope that exists in all of the states. It's tantamount to bringing a knife to a gunfight. You can't practice one discipline with the training of another. It's outrageous that no one holds these schools accountable for this state of affairs.
I hear constantly of the troubles of the new chiropractic graduates when it comes to being successful. These same new graduates are often the most vocal about changing the scope of practice to match their training, rather than practicing the scope of practice that existed long before they ever dreamed of becoming a chiropractor.
Of course, there are a great number of new graduates who can't make it in practice. They weren't taught the most foundational principles of chiropractic. There are now at least four, and probably more, chiropractic colleges that don't even teach the concept of subluxation to their students.
Which brings me to another big problem in chiropractic and with this drug initiative. Despite the fact that many chiropractic colleges are no longer teaching the concept of subluxation, all 50 state laws refer to the practice of chiropractic as being closely related to addressing the subluxation in some manner. So, can you see how so many new graduates are disillusioned about their profession and their prospects for being successful? They weren't even taught the very concept that chiropractic is legally founded on.
Of course, the schools will claim "academic freedom," or that there is no proof that there is a subluxation, or some other such nonsense. The truth is, 50 U.S. states have laws that say there is a subluxation and I say all of the colleges should be held accountable for teaching it – whether they believe it or not. This alone would go a long way toward improving the probability of success of our new graduates.
Once again, we're dividing the profession over scope of practice. If history teaches us anything, and it apparently doesn't, it's that a divided profession gets nothing done! Yet nothing promises to divide our profession as the drug initiative does. If, for once, we decided we could live with the definition of chiropractic as currently expressed by our 50 state laws, and unify around that, perhaps we could really get something done.
My frustration and anger with the drug initiative centers on this question: :What gives the pharma-practors the right to take over the chiropractic profession and totally change its nature, practice and intent? The answer, of course, is nothing. They have no right to do this, yet they clearly have the audacity, arrogance and hubris to try.
The "elephant in the room." Throughout this entire conversation, no one seems willing to talk about what I consider the "elephant in the room," the AMA and the medical profession. What makes the pharma-practors seriously believe the AMA, with its hatred of and fierce opposition to the chiropractic profession, not to mention its still-formidable lobbying power, will allow the drug initiative to be successful? There is no reason to believe it will let this happen without a serious fight.
Our enemies aren't going to just let us walk in, change a few laws, get prescriptive rights and crash their party. They haven't so far; what makes anyone think it's going to happen if we prescribe drugs?
Pharma-practors have lost their purpose. For this issue to gain the traction it has suggests many chiropractors in our profession have lost their purpose, not to mention their passion for the profession they practice. I acknowledge that when DCs lose their purpose and passion, they often do desperate things to succeed or even survive, but this drug initiative is evidence of a much deeper problem afflicting our profession. I view it as nothing less than a wholesale rejection of the fundamental tenets and philosophies of chiropractic itself.
These doctors are in effect admitting that they do not accept chiropractic as a legitimate, separate, distinct healing art, science and philosophy. They are not only rejecting their own profession wholly and completely, but they are also attempting to commandeer the profession for the purpose of transforming it into another allopathic profession.
The Bottom Line
In my opinion, there is nothing good about this idea. I am sincerely asking all doctors of chiropractic who believe the drug initiative is a good idea (and wish to inflict the damage on this profession I believe it inevitably will) to please save us all the time, money, anguish, aggravation and probably an intra-professional war that will likely last 100 years and don't do it.
If it's your desire to practice like an osteopath, then become one. It will be much easier, faster and far less daunting a task than trying to change chiropractic into something that it's not. I'm asking all of you pharma-practors to give up this horrible idea and learn to live with the chiropractic you signed up for when you became a DC, or leave the profession and leave the rest of us alone. I welcome your comments on this important issue. Please e-mail me at tomklapp@gmail.com.
Part 1 (Aug. 15 issue) and part 2 (Sept. 1 issue) of this article refuted some of the common arguments for allowing prescribing privileges in chiropractic scope of practice.
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