New Year Resolutions: Maybe Some New Thoughts for `99 Are in Order
By Louis Sportelli, DCIt gets to be quite a challenge to write articles every month that are timely and relevant to issues of the day. The challenge becomes even greater when your deadline for the article is a month before it is published. How much can happen in the interim to make your comments irrelevant is always a big fear for writers of contemporary articles.
Since this will be the first column in the 1999 New Year edition of Dynamic Chiropractic, I thought perhaps there would be a value to offer some reflections on where our society is going and how our values may be systematically eroding with each year, depending, of course, on your point of view. We witness everyday the insidious destruction of core values and beliefs artfully crafted as politically correct views or enlightened attitudes of open-mindedness. Yet with each passing day, we also notice intangible signs of societal decline and the undermining of core value systems.
I was reading some editorials bemoaning the stark realities of how we have been assuaged into complacency by the simple passage of time and familiar platitudes utilized as a mantra to appease a void when basic core values are missing. Ken Rich wrote about some of these missing and changing values in a recent article which are worth repeating:
Then there was Pastor Joe Wright, who recently addressed the Kansas Senate with a stirring prayer. Paul Harvey aired the prayer on radio and received more than 5,000 calls supporting the pastor's view. What the good pastor did was simply take on issues which have become so commonplace today that society has become desensitized to their significance. The pastor's comments were so on target in light of the scandals in Washington and the support for personal freedom at the expense of the greater good for everyone that he apparently hit a sensitive cord for many Americans. A few comments from Pastor Wright will give a flavor of how his speech impacted the Kansas Senate.
Pastor Wright continues to take on some sensitive issues of the day. Kudos to Pastor Wright and Ken Rich for bringing these issues to the consciousness for us to at least confront our own sense of right and wrong.
It is fascinating how the incredible power of words and the expression of clear thought can often alter the course of history. Yet as we begin to develop the annual and enduring tradition of making our new year's resolutions, perhaps it might be prudent for each of us to reflect on what is happening in our world of chiropractic and consider the insidious lure of "acceptance" and ignore the potential and eventual price which will be paid for a lack of unwavering "resolve."
What I am referring to more specifically is: "What are we?"
This question has taken on more significance in the past year than in most of the previous three decades. In the 1960s, when chiropractic was not considered relevant to the health care system, the profession (chiropractic) was either not considered at all or considered quackery (disguised as worthless spinal manipulation). Chiropractic had nothing to fear at this stage because no one was paying serious attention to this group of health professionals no matter what they called themselves.
As the next decade rolled around, significant advancements in legislative/ educational/professional status thrust the chiropractic profession into a quasi-acceptable, although dubious, status. The approval of licensure in all states, recognition by the United States Department of Education (USDE) with their approval of the Council on Chiropractic Education (CCE), chiropractic Medicare inclusion (albeit limited) and a growing trend in valid research "suggesting" some value to the concepts of manipulation championed by the chiropractic community began to accumulate and foster an awareness of chiropractic that was unprecedented.
Then the world exploded in the '90s and researchers (within and outside the chiropractic community) began to validate the benefits of spinal manipulation (a.k.a. adjustments) for at least some conditions such as low back pain. The movement of wellness, lifestyle, nutrition and psychosocial factors flourished as an aging population looking to trade rocking chairs for rollerblades completely dismantled the pedestal which medicine had occupied for the entire century.
Suddenly the media began the never-ending avalanche of complementary and alternative medicine articles written by younger journalists who understood the issues of choice, had little need to deify medicine, and utilized alternative healthcare as an equally acceptable healthcare decision for their personal healthcare needs. It appeared as if the floodgates of an insatiable interest in alternative healthcare had been broken through and could not be stopped. In every magazine, newspaper and television program, stories began appearing about acupuncture, homeopathic remedies, vitamins, aromatherapy, biofeedback, mind-body connections, meditation, therapeutic touch, and massage, to name but a few. Conspicuous by its absence or lack of preeminence in all of this media frenzy was chiropractic.
Harvard Medical School is hosting its third annual symposia on complementary and alternative medicine and the attendance continues to be outstanding. Seventy-five medical colleges instituted courses on complementary and alternative medicine into their curriculum. Prestigious journals, whose pages only a decade ago would have self-destructed if the "C" word (today that word is chiropractic, not cancer) were included in their table of contents, are now publishing specific topic journals almost exclusively dedicated to complementary and alternative medicine. Try as I might, I cannot help myself ... the lure is too strong ... I must name them -- the Journal of the American Medical Association (JAMA), the New England Journal of Medicine (NEJM) and the Annals of Internal Medicine (Annals) -- all have devoted considerable space and demonstrated interest in alternative and complementary medicine.
Conspicuous by its complete absence or lack of prominence or significance in this entire discussion is chiropractic. David Eisenberg, MD, commented that "chiropractic is the elephant in the room that no one sees." How true.
Where does all this lead, and what is the point of our new year's resolution? Well, part of the debate as we enter into the millennium is the answer to the question: what are we? Are weï primary? Are we limited? Are we a combination of all?
If chiropractic does not soon begin to crystallize the response to the question of "what are we" and "what role do we play," the profession may soon be relegated to a technique, an adjunct, an accessory, or even a "prescribed" service that one can obtain from the now dominant medical health care system.
Are we alternative? Perhaps, in some instances where there is very little or no strong evidence to suggest otherwise, we may very well be alternative. Especially in those cases where medical intervention is weighed against the risk-benefit ratio and the decision leans toward greater risk, such as in otitis media, one would offer chiropractic care (please note I did not say one specific adjustive thrust and nothing else) as a panoply of services ranging from chiropractic adjustments, nutritional advice and lifestyle management intervention, to counseling, as an alternative health care option to the traditional allopathic intervention.
On the other hand, for back pain, neck pain and cervicogenic headaches, chiropractic is not an alternative but rather the therapeutic intervention of choice. In this case, we are not alternative but a primary care option which is based upon significant evidence. It may be strange for chiropractic to now have enough data to suggest that all other interventions for back pain are "alternative" and chiropractic management is "mainstream!" That is not to say that other interventions will not be needed when chiropractic initial interventions do not resolve the problem. The percentage of individuals will be small compared with the vast majority that will be helped by the intervention of choice ... chiropractic. This is the kind of revolutionary thinking and resolve which must be made by the chiropractic profession if we are to retain ownership of the direction and destiny of chiropractic's future.
Perhaps each of us should make a new year's resolution to focus on the real threats to our profession, threats which are dangerous because the profession can be lulled into a false sense of security in thinking that we have arrived, when in reality the arrival has been "mainstream medicine" which seeks to dominate the complementary and alternative market --without the inclusion of chiropractic. Part of the problem may very well hinge on the terms we elect or select to be identified with as the new millennium draws near. With each ensuing year, the alternative movement has gained momentum. As ironic as this may be, the chiropractic profession has been caught in "no man's land." By the alternatives, chiropractic is viewed as mainstream and therefore it is questioned as to why it has an interest in this newly found phenomenon called alternative medicine. By mainstream medicine, chiropractic is not mainstream and therefore is not considered as equal participating providers (particularly in the benefits area) and we are really not quite alternative, so the question comes back to us again: "What are we?"
We must be very careful not to be lulled into believing that "we" (chiropractic) are leading the alternative movement. We must be careful not to be lulled into believing that "we" (chiropractic) have been accepted into mainstream (particularly by allopathic medicine). Again, the question, "What are we?" We need a focused awareness of the potential problems acceptance has brought. Are we now suffering from another form of "exclusion," only this time excluded from alternative and mainstream healthcare and thus no place for the orphan chiropractic to call home? I hear so often, "Look, everyone is talking about chiropractic," and I must rephrase it and state, "No, everyone is talking about alternatives, i.e., acupuncture, homeopathic, massage, and on occasion by default chiropractic is mentioned."
This change in thinking will not occur by happenstance or evolution, but rather by a revolution in the thinking process of each and every DC in the world. A revolution that recognizes the movement toward the paradigm of wellness that chiropractic has espoused for more than 100 years should be owned and credited to chiropractic. Unless we determine the direction for the future of chiropractic by answering the question, "What are we?", chiropractic is in jeopardy of extinction.
My new year's resolutions will be to continue to find the positive advancements the profession has made; to write about them in the "In the Court of Public Opinion" column; and to help bring about an awareness of the recognition chiropractic is receiving counterbalanced against the potential loss to the profession which can occur as a result of complacency and apathy.
I am hopeful that the chiropractic community is more tuned than ever to the need to seek the common ground of understanding and recognize the inherent strength of adopting this position. We can recognize differences as professional and political issues which must eventually be resolved by evolution and data, not by self-destruction and internal strife.
In 1999, there will be opportunities and challenges confronting the chiropractic profession. How we react to them as individuals and organizations will ultimately determine the impact on the public. We have reached a very critical time for personal responsibility to emerge with value-driven principles seeking to enhance the needs of the profession first.
What are we? That question must be answered in the new year. There is much to think about as we enter 1999!
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