Nonprescription Drugs: Should We or Shouldn't We?

First of all, let me state that as the son (and grandson) of a chiropractor, my understanding of chiropractic is that we are a nondrug, nonsurgical profession. This is how it was practiced by my father and grandfather, and this is what I expect as a chiropractic patient.

That having been made clear, a growing opinion within the chiropractic profession at large suggests that the inclusion of the right to "prescribe" over-the-counter (OTC) drugs can benefit both the chiropractic patient and the doctor of chiropractic. When questioned, some have suggested that prescribing OTC drugs is not necessarily contrary to the foundational principles of chiropractic. (Huh? Again, just in case you missed my original point, this is not my understanding of chiropractic. However, like all of us, I must be willing to at least hear the arguments made by other DCs in our continuing effort to define ourselves.)

The latest example of this growing belief can be found in a research paper published in the European Journal of Chiropractic.¹ In this study, three questionnaires were mailed to all doctors of chiropractic practicing in Switzerland. The second questionnaire asked about the prescribing of OTC drugs. It should be noted that since 1995, chiropractors in Switzerland have been able to prescribe OTC drugs that are arthritic or analgesic in nature from a list provided in their regulation. The costs of these OTC drugs are reimbursed to patients when prescribed by DCs.

The survey asked three questions (responses follow):

1. "Do you prescribe the medication appearing on lists C and D as stipulated in the presently valid regulation?" (Yes - 61%; No - 39%)
2. "Do you consider our limited privilege on drug prescription is an advantage for the profession?" (Yes - 82%; No - 18%)
3. "Do you think that the profession should aim at extending the limited privilege to some specialities of list B?" (Yes - 76%; No - 24%)

Some will point to these results and suggest that the Swiss are successful using OTC drugs, so U.S. DCs will be as well. However, others will point to these results and say that OTC drugs are the quickest way to lose our identity and slide into the quagmire of becoming drug pushers.

A survey published earlier this year examined the attitudes of DCs in the United States toward OTC drugs and a number of other issues.^2,3 This survey also asked three questions:

1. "Should chiropractors be permitted to write prescriptions for over-the-counter medicines?" (Yes - 54.3%; No - 45.7%)
2. "Should chiropractors be permitted to write prescriptions for musculoskeletal medicines?" (Yes - 48.8%; No - 51.2%)
3. "Should chiropractors be permitted to write prescriptions for all medicines (including controlled substances)?" (Yes - 11.4%; No - 88.6%)

The investigators further examined these results according to other criteria concerning the respondents (bivariate findings). It seems that DCs are more or less likely to desire OTC prescription rights depending on a number of factors. (The percentage of each category that responded in favor of OTC prescription rights appears below.)

 

• Male - 56.8%, Female - 48.4%
• Bachelor's degree or more - 56.9%; No bachelor's degree - 51.5%
• DCs who were chiropractic patients prior to chiropractic college - 53.9%; those who weren't - 57.7%
• DCs who see 99 or less weekly patient visits - 60.7%; 100-149 weekly patient visits - 48.9%; 150 visits or more - 50.3%
• DCs with annual net income of $99,999 or less - 56.6%; annual net income of $100,000-$149,999 - 51.5%; $150,000 and more - 51.4%
• DCs with 10 years or less in practice - 54.8%; 11-20 years in practice - 52.2%; 21 or more years in practice - 57.7%
• Broad-scope DCs - 77.1%; Middle-scope - 53.5%; Focused-scope (straight) - 17.6%
• National graduates - 75.4%; Palmer graduates - 42.0%; Life graduates - 33.3%

The above should cause us to realize that this is an issue that needs to be discussed openly and honestly. But because I am not a practicing doctor of chiropractic, I am not able to address some of these issues effectively. Therefore, I am requesting a well-written, one-page comment any DC who feels strongly about this issue, either way. The goal is to feature as many thought-provoking comments as possible, so needed discussion can ensue. (Out of consideration, I will withhold my own opinion until others can be expressed.)

Like many other issues, this one won't go away. We need to debate the merits and see why prescription rights are becoming increasingly popular. Thank you for your consideration of this important issue.

References

1. Robert J. The multiple facets of the Swiss chiropractic profession. European Journal of Chiropractic 2003, 50:199-210.
2. How Chiropractors Think and Practice. McDonald, Durkin, Iseman, Pfefer, Randall, Smoke, Wilson. Institute for Social Research, 2003.
3. New study finds unity in chiropractic. Dynamic Chiropractic, June 2, 2003. www.chiroweb.com/archives/21/12/19.html.

DMP Jr.