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Change: Healthy and Inevitable
As I read the second part of "The Case Against Drugs in Chiropractic" by Dr. Klapp [Sept. 1 DC], I could not help but remember the little girl who appeared on a YouTube video telling her dad to "worry about yourself." What impressed me the most about this article is the condescending attitude representative of this group in our profession that professes ownership of chiropractic, and its vitriolic hatred of any colleague who does not agree with its myopic vision of our profession.
These self-appointed guardians of our beloved profession may have good intentions, but harm our standing in our society and interfere with our progress as a profession in the highly competitive healing arts. Chiropractic is part of the healing arts professions, and our integration into the mainstream health care system depends in great part on our own internal tolerance. It is very difficult to integrate a profession into our health care system with contradicting scopes of practice and constant bickering among its members.
Yes, a drugless and nonsurgical solution is desperately needed by the American public, but it is probably not doctors of chiropractic who will have patient access to provide these services, despite being the best trained and philosophically aligned. These nondrug and nonsurgical services are increasingly being provided by MDs, DOs and DPTs, while access to the patient population for DCs continues to shrink. For as long as I can remember, the American public's utilization of chiropractic has hovered at around 10 percent, without significant improvement. Why?
If a business analyst were given this data, he/she may objectively determine there is probably a misalignment between the American public's perception of its health care needs and the chiropractic product being offered to meet these needs. At present, chiropractic services continue to be considered non-vital in the health care industry, even though insurance-plan administrators are eager to find measures to reduce costs and improve their memberships' health. Medical directors of major insurance companies continue to place utilization-review vendors who will ultimately ration chiropractic services, despite all the data supporting the effectiveness of these services. Why?
In my opinion, the public, health care industry and most of the scientific community continue to associate chiropractic services with the generally rejected subluxation theory of disease, which is promoted by some to be the sole expression of what chiropractic is. Under this narrow definition, we will remain not only separate and distinct, but also ostracized and out of favor from the rest of the health care system and its patients.
It is worthwhile noting that the few integration examples of our profession, like in the Veterans Administration, have been extremely difficult to adopt and allow only the use of chiropractic as a musculoskeletal condition treatment, without any mention as to the subluxation theory of disease.
Therefore, the chiropractic profession should recognize this disconnect with the public and be tolerant of its members who strive to provide the services the American public wants. This professional evolution is necessary to be able to adapt to the needs of the American public and its health care system. The people of New Mexico have medically underserved areas and wish DCs to be part of the solution to meet their needs. The chiropractors in New Mexico have decided to undergo advanced training to meet those needs. Why should other chiropractors outside of New Mexico feel they have the moral right to oppose them?
This "pressure cooker" of opinions relating to what chiropractic is, or is not, needs an escape valve. Other professions, like medicine, law, engineering etc., have adopted specialized courses of study that allow different subject matters to fulfill the inclinations of its members and the needs of the public. It is reasonable to have chiropractors pursue advanced studies and certifications to meet their inclinations and provide the additional services needed by the public in this time of physician shortages.
In 1910, the American medical profession was forever changed into the dominating force it is today by the application of the Flexner Report, commissioned by the Carnagie / Rockefeller foundations. The foundations changed medical schools by providing funds only for those adopting a strict scientific medical model, based on chemistry and surgery, and joining formal university systems. The foundations also promoted stricter entrance and licensing requirements. Similarly, the chiropractic profession is probably in need of its own internal re-engineering if it ever wants to be a relevant force in American health care.
Many doctors of chiropractic already recommend medicinal plants and supplements to their patients as part of their practices. The addition of a pharmacology formulary as an advance practice, for some, is a natural progression and not as foreign as some may imply. This progression is a matter of choice, similar to how some physicians decide to advance their practices in the field of surgery, while others want to remain family-medicine physicians, pathologists or psychiatrists.
Professional change is healthy and inevitable. Our nation is experiencing an increase in the elderly population and a predicted shortage of physicians to meet these health care needs. We should not continue to dismiss our colleagues who want to address these needs with hateful name-calling and intolerance. Instead, we should create the specialization vehicle whereby our different philosophical trends could branch out into specialties and preserve our unity.
I respectfully say "worry about yourself" to those colleagues who feel morally superior and want to impose their views to limit the professional development of other chiropractors.
Robert Jusino, DC, JD, MPH
Our Scope of Practice Needs to Change
Klapp has no clue what he writes about. No doubt he made his fortune when times were good for the profession. What about those who came after? Because the long and short of it is that the student default rate of chiropractic dwarfs all other health care professions combined!
The demand is for medication and surgery. Medication and surgery work; and insurance companies pay for it. Why should chiropractors be left without these tools?!
There is no demand for chiropractic adjustments. Besides, adjustments any fool can do, as evidenced by massage therapists and physical therapists doing manipulation at a higher rate every day.
The "Mercedes '80s" are gone. Time to adapt to save the profession, because as it stands now, it is disappearing from the Earth.
If I knew that chiropractic was full of people like Dr. Klapp, no way would I have chosen to become a chiropractor. As it stands now, I am in tons of debt without the resources and motivation to become an osteopath or any other kind of real health care practitioner.
If Klapp wants to do the profession a service, dissuade as many people from chiropractic as possible and let them know the odds are against them. There are no jobs for them to become successful. They have to be an extremely astute and manipulative business person to make a good go of it in this day and age ... a skill set that would make a person successful in any other field, anyway, so why should they choose chiropractic and the debt it will incur?!
Until the scope of practice changes for the better, whereby chiropractors can prescribe meds, do medical procedures and be real doctors, I do dissuade as many people as possible from the chiropractic profession.
Michael Farr, DC
Chiropractic Physicians Deserve to Be Accurately Informed
The full spectrum of doctors of chiropractic across the United States have appreciated the clinical and practice-management articles you have published over several decades; as well as the balance and fairness of coverage pertaining to chiropractic political matters, which includes scope-of-practice issues.
Over the past few years, there have been no less than 10 articles published in your newspaper regarding why the practice of chiropractic dare not include the use of chiropractic pharmacotherapy agents. We enthusiastically look forward to our "equal time" to publish the same amount of "pro"-chiropractic pharmacotherapy articles within your newspaper, so chiropractic physicians across the country can be accurately informed about the issue. Thank you in advance for your fair attention to this matter.
Michael Taylor, DC, DABCI, APC, FI
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