The Role of Chiropractic as We Approach the Year 2000 and Beyond
By Chester Wilk, DCWhen we ask ourselves what role chiropractors should play in the coming years, it evokes a wide variety of answers. Although there are many vital roles to consider, we'd be hard-pressed to exclude any or choose one over the other among those listed below. Let's discuss each of them.
Preserve the Unique Identity of Chiropractic
Chiropractors have established themselves as drugless physicians who rely primarily on spinal adjusting as their treatment, to improve the quality of life of the patient by assisting the body to heal and maintain itself in a good state of health. Whatever supportive measures we utilize toward this goal, they are secondary to spinal adjusting. We are structural biomechanics. It's an identity that is viewed with envy by other members of the health care professions, who would like to enjoy this image much that some even try to emulate spinal adjusting. We not only need to preserve our unique identity for future generations of chiropractors, but need to reinforce it by continuing to be the very best that we can be as physicians who adjust the spine.
Preserve the Scope of Practice
Some chiropractors are willing to compromise the scope of chiropractic by limiting themselves to the care of low-back pain and headaches. They may do it to avoid the criticism of "playing it safe" and confining themselves to ailments where chiropractic dramatically excels with clinically-based outcome studies. However, we cannot limit chiropractic to such a narrow role, because it is not a scientifically correct posture to close doors on research without evaluating and determining the real potential of any treatment.
We need to accurately define our role in health care without creating public confusion or criticism. The best way is to clarify that we do not treat ailments in the usual sense, but that we treat patients for their ailments, and that our scope can vary from patient to patient, from ailment to ailment, and from time to time. We help the patient's body to help itself. This is not splitting hairs or being evasive; we simply cannot be more specific. This approach explains our scope of health care in a logical and reasonable manner that no objective observer can fault, and is acceptable to the scientific community and the courts. By following this approach we will not close any doors on the potential of chiropractic health care, which will prevent our adversaries from claiming with any credibility that we overstep our limits in treating patients.
Maintain a Rational Balance in Health Care
The pharmaceutical industry spends a billion dollars a month advertising and promoting drugs. Our society is overmedicated and overoperated on. There are 80,000 unnecessary disc surgeries being performed annually, according to "CBS News." A Yale New Haven Hospital Study found that 100,000 people die annually from medication reactions, while other studies say that this figure is far too low. In a blue ribbon hospital study, Dr. Virgil Slee found that approximately a thousand people die every week from unnecessary surgery. We see medical/surgical promotion too often take precedence over objectivity and balance. Major national publications have written articles on how medicine is losing the battle against bacteria because they mutate and become more resistant to antibiotics. It is especially irresponsible when they are used on patients with viral conditions, since antibiotics are medically proven to be ineffective against viruses.
There are tissue-eating bacteria afflicting our society today for which there is only one known antibiotic capable of killing them. What will happen if these bacteria mutate and become resistant to the only remaining antibiotic? Medical treatments are creating a serious doctor-caused crisis. We need to stress improving the quality of life and the natural resistance of the human body through chiropractic care, which eliminates the potential of bacterial mutation and iatrogenic reactions.
Chiropractors have a major responsibility to help our society maintain some semblance of a rational balance and objectivity in health care. I cringe whenever I hear a chiropractor suggest that we should incorporate drugs into chiropractic. Not only would this dilute and undermine the basic principle of chiropractic health care, but it would represent a major step backward for rational health care in a society that is already overmedicated and overoperated.
Chiropractors are not opposed to the rational use of drugs, but have spoken out against excessive and abusive overutilization. For this reason, we have been accused of opposing drugs in general.
Osteopathy has suffered after incorporating drugs into its curriculum. Moreover, society has suffered by a less-balanced health care system. Not long ago, some osteopathic schools actually abandoned spinal manipulation by making it an elective subject. I visited an osteopathic school, and the attitude I saw exhibited by the osteopaths and their patients could not approach the enthusiasm I have seen in chiropractic colleges. The osteopathic school appeared depressed and run by frustrated medical wannabes. We have a wonderful profession in chiropractic, but we need to keep it drugless and oriented on spinal adjustment. This is where we get our real strength and unique identity.
Our Role as Physician, Teacher and Educator
A physician is a teacher in the finest sense of the word, and it is imperative that chiropractors assertively embrace this role. While medical doctors benefit from a billion-dollar-a-month pharmaceutical advertising campaign, the chiropractic profession is not privy to such extravagant promotion. We are the only ones who can accurately and effectively promote chiropractic and level the playing field in health care. While it is true that medicine has the advantage of big money promoting it, we have something far more important--we have truth on our side!
I doubt that we can find one chiropractor out of a hundred who will agree that our current health care system is being practiced in a completely honest, objective and well-balanced manner in America. How can it be? A U.S. government study using two hundred of our nation's leading pain, then published guidelines urging all physicians to refer patients for spinal manipulation as the best treatment for many of these ailments. Yet four months later, the AMA published its own so-called guidelines/treatment options for low-back pain, which excluded any reference to spinal manipulation! Something is extremely wrong with this scenario.
In my opinion this is fraud by omission, exclusion, isolation and polarization. I showed these facts to numerous lawyers, and all of them felt that my position had genuine merit. You can call it what you want, but in my opinion it is plainly fraud. Furthermore, the impressive findings of the U.S. government study by the Agency for Health Care Policy and Research are reinforced by government studies from Canada, Great Britain, and New Zealand. Apparently all of this overwhelming clinical evidence means nothing to the closed-minded policies of the AMA, which may end up injuring patients.
We need to tell it like it is when we see wrong being committed, but we also need to educate the public on what is right and what role chiropractic must play in the years to come. It is our moral and ethical obligation as physicians and teachers.
The Role of Science in Chiropractic
Western civilization requires that every health care profession be committed to establishing a scientific basis for its existence. Certainly chiropractic is no exception, yet we need to recognize that science is not synonymous with truth; it is no more than an effort to find the truth. For example, science "proved" that the C-123 transport jet would not be able to get off the ground and fly. Indeed, it not only flies but can carry tanks and trucks. It would be absurd to suggest that the plane cannot fly if you see it in the sky overhead. Too many critics of chiropractic refuse to look at the obvious. It would be equally absurd to deny the results of scientifically controlled clinical outcome studies of any treatment that science cannot totally explain. We must acknowledge and respect the fact that it works and then strive to explain why. This is what is meant when they say that technology precedes science.
The Role of Champions of Truth and Objectivity in Health Care
On the surface it would appear that this honorable and altruistic role is quite easy. After all, all we have to do is just candidly speak out the truth. In fact, it is one of the most difficult and challenging roles to attain and maintain. It takes a special kind of courage and commitment to be totally truthful. Honest critics will often be attacked and vilified. Our adversaries may say that our criticism is "the same old chiropractic versus medicine" controversy and will obfuscate the truth by saying we are "bashing" or being hostile, divisive and uncooperative. To some doctors, cooperating and working together means looking the other way when they do something stupid or dishonest. It's not an easy position to take, but we must do it, for the sake of our patients and to do what we know is right.
To prevail in this matter, the public needs to hear the same message repeated from hundreds of different sources until it becomes accepted by the public. There is actual truth and then there is what the public perceives as the truth. Too often, physicians choose to take the easy way out Championing the truth is a two-way street. It also means being truthful to ourselves. We cannot be critical of medical abuses while looking the other way if our own members conduct themselves dishonestly. We have a fine code of ethics and need to see that it is honestly observed by our members. Nothing can devastate a profession more lethally than if its members allow it to decay from within. We need to assertively and willingly cooperate with any state and federal authorities to see that our members conduct themselves in an honest and honorable manner deserving of our profession.
It takes courage and wisdom to acknowledge to ourselves when we make mistakes (and we all do), yet we will be doomed to repeat these mistakes over and over again if we don't face up to them, and when we do we will always make them for the first time. As the old saying goes, we either learn from our past mistakes in history or we are doomed to repeat them.
The many positive facts that we have going for chiropractic combined with the disgraceful polarization we see in health care are so unbelievable and outrageous at times that many people will have a difficulty in accepting them as factual, especially when our society has been heavily programmed toward drugs and surgery. How can we address and prevail in this challenge?
This can be accomplished by the formation of chiropractic speaker bureaus in every state, making them the single most important project in each state, recruiting chiropractors and training them on how to approach and effectively communicate to the media, and speak repetition, a high profile and the same message coming from hundreds of different sources are the real keys to success. The impact it can have on every chiropractic practice from a standpoint of insurance relations, legislation and public opinion and acceptance can be profound. The speaker bureau program can become the hub that addresses and corrects many of the problems facing chiropractic for decades. This is the only cost-effective and logical approach that can level the playing field. And lest we forget, we have the most potent weapon of all. It is called truth!
The Role Model in Health Care
What the chiropractic profession has been able to accomplish with its magnificent college facilities (appraised by a leading medical expert as superior to medical schools), its clinical and scientific research projects (in spite of neglect by the same agencies that give billions to medical research), our fine quality of care and standard of care guidelines, and our code of ethics guidelines, reflect a strong commitment to excellence. These accomplishments are truly inspirational. We have often been our own toughest critics, which speaks all the more of our dedication to excellence. I don't know of any group of healers who have accomplished more and fought more heroically to prove to the world that they are worthy of serious consideration and respect as healers. This is not to say that we are perfect, but we certainly have earned some real respect and bragging rights.
The chiropractic profession is a great role model that has shown to the world what can be accomplished by its commitment to excellence. Adversity often makes people rise to the occasion and become all the better for it. I think that this has been the hallmark of chiropractic. Chiropractic is truly more than a health care profession that works in harmony with everyone it touches; it is a magnificent way of life. The public needs to know this truth, and we need to make them aware of it.
Chester A. Wilk, DC
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