Joseph J. Sweere, DC, DABCO, DACBOH, FICC
Prescription Rights: Be Careful What You Wish For (Part 2)
Editor's Note: Part 1 of this article ran as a digital exclusive in the July issue.
Some chiropractors hold the view that if given the authority to prescribe drugs, they would also have the right to counsel patients to modify or stop the use of at least some of the drugs prescribed by other professionals. Such authority assumes he chiropractor has adequate professional training and expertise to safely and responsibly assume this role.
However, I believe that even if chiropractors were properly trained and authorized, such practices would be considered highly unethical, with justifiable accusations of professional interference commonplace.
Let Pharmacists Do Their Job
Chiropractic patients and the general public have access to readily available, highly trained, nonmedical providers in their communities who have comprehensive expertise in all drugs, both prescription and over-the-counter – their trusted and caring registered pharmacists. According to occupational employment statistics as of May 2015, 295,620 licensed pharmacists were employed in the U.S.9 There is no indication that a shortage of pharmacists exists.
Pharmacists are well-trained: While bachelor's degrees in pharmacy were once the requirement for entry-level positions, pharmacists are now required to hold Doctor of Pharmacy (Pharm.D) professional degrees. Pharm.D educational programs also incorporate clinical training into their curricula. Through clerkships, students gain practical experience in actual pharmacy settings under the supervision of licensed pharmacists.
Many pharmacists also pursue additional training through residencies or fellowships that last an additional 1-2 years.10 For example, 33 percent of the graduates from the University of Maryland School of Pharmacy in 2015 participated in such training.11
Polypharmacy: A Major Problem
We should also keep in mind each of the prescriptions that contributed to the 218,113 annual deaths attributed to drugs, as reported by Ernst and Grizzle, had been subjected to the rigorous FDA approval process, and were deemed safe and effective. Unfortunately, prescription drugs are not tested in combination. Therein lies the bulk of the problem, since patients are commonly using several drugs simultaneously, often prescribed by a variety of doctors among the various specialties.
According to the American Society of Consulting Pharmacists, this is especially true among seniors, who, as early as 2001, represented just over 13 percent of the population, but consumed 40 percent of all prescription drugs and 35 percent of over-the-counter drugs. On average, individuals 65-69 years of age use nearly 14 prescription drugs per year, while individuals aged 80-84 are prescribed an average of 18 prescriptions per year.12
Keep in mind these numbers represent the average consumption, suggesting many patients in these age groups receive far more prescriptions. Given these figures, the 30-plus prescriptions my 59-year-old cousin was using [referenced in part 1 of this article] no longer seem that incredible.
Some years back, one of my chiropractic colleagues shared an interesting story with me. He mentioned having recently attended a meeting of a civic club that he belonged to and being introduced to a new member. When the person learned my colleague was a chiropractor, his eyes lit up. He explained it was refreshing to meet a doctor who didn't prescribe drugs, since in his profession as a mortician, it was common for him to remove up to 1.5 quarts of undigested pills from the alimentary canal of elderly bodies being prepared for embalming.
Based on my experience and the data presented above, it is my opinion that chiropractors seeking prescription rights are treading on a slippery slope. This scope change would not advance our profession, nor would it be in the best interests of our patients. DCs who wish to engage in the prescription of pharmaceuticals, and are willing to bear the cost and time required for the additional training – as well as the emotional and moral consequences of the dangers they pose for their patients – should pursue licensure in medicine or osteopathy, as some have already done.
There are also chiropractors who have become physician's assistants or advanced nurse practitioners. Each of my DC friends who have chosen one of these options, however, no longer practices under their chiropractic license.
Another option, and one I strongly encourage, is for chiropractors to work for the expansion of collaborative, multidisciplinary health care models wherein each provider leaves their ego at the door and places the patient's needs at the center of the equation. In this way, each clinician can provide the special skills and expertise for which they are most appropriately trained. Doing so would allow the DC to become a vital and respected member of the primary care team of clinicians responsible for optimal patient care.
True Cultural Authority
During the 55 years I have been licensed as a chiropractor, I have never felt a loss of cultural authority because I didn't remove tonsils, fill cavities or prescribe drugs. These necessary clinical activities are simply not what chiropractors do. I believe cultural authority within the healing disciplines is earned on an individual basis, and is attributed to those who humbly and diligently serve their patients to the best of their abilities. This allows all team members to attain excellent clinical outcomes at fair and reasonable cost, gaining the good will and respect of the community in which they serve.
With that said, I urge the chiropractic profession to carefully consider which philosophy of health it wishes to embrace in the care of its patients. If the choice is to align itself with the pharmaceutically driven, highly commercialized allopathic model, it is my conviction we would do so at our own peril.
We must each ask ourselves, what is the wisdom of adding DCs to the list of agents of the market-driven pharmaceutical industry? According to Kantar Media, reporting in the March 2016 Pharma Marketing Blog, the pharmaceutical industry's spending on direct-to-consumer advertising totaled $5.4 billion in 2015 compared to $4.3 billion in 2014, a 19 percent increase. This equals the high mark of $5.4 billion spent in 2006,13 and doesn't include what the industry spends on advertising to doctors and hospitals, nor what is spent on lobbying and malpractice claims.
Regrettably, neither does this data include the above-described $177 billion spent annually on the problems caused by prescribed pharmaceuticals, or the added human suffering and deaths that result from this myopic approach to health care each year.
- The Florida Chiropractic Physician Association, Inc., is the primary organization within chiropractic currently advocating for advanced practice rights, including prescription rights.
- "Is the WCA Trying to Create a New Profession?" Dynamic Chiropractic, March 15, 2016.
- Porter S. "Significant Primary Care, Overall Physician Shortage Predicted by 2025." American Academy of Family Physicians (AAFP News), March 3, 2015.
- Johnson JA, Bootman JL Drug-related morbidity and mortality; a cost-of-illness model. Arch Int Med, 1995;155-1949-56.
- Ernst FR, Grizzle AJ. Drug-related morbidity and mortality: updating the cost-of-illness model. J Am Pharm Assoc, March/April 2001;41(2).
- The Henry J. Kaiser Family Foundation; statistics as of April 2016.
- U.S. and World Population Clock. United State Census Bureau, July 2016.
- FAQ About Today's Podiatrists. American Podiatric Medical Association.
- Occupational Employment Statistics - Employment and Wages, Pharmacists. U.S. Bureau of Labor Statistics.
- Pharmacist: Educational Requirements and Career Summary. Study.com.
- "Pharmacy Students Match With Residency Programs Nationwide." University of Maryland.
- Herzog W, Weller W, Ireys H, Anderson G. Out of pocket medical spending for care of chronic conditions. Health Affairs, 2001;6:267-78.
- "Annual Spending on Direct-to-Consumer Drug Advertising Ties an All-Time High." Pharma Marketing Blog, March 3, 2016.