If in the unlikely possibility that some of you have not heard about the AHCPR, this was the U.S. government panel that established guidelines which gave the nod to spinal manipulation: "Manipulation can be helpful for patients with acute low back problems without radiculopathy when used within the first month of symptoms." It means that medical physicians, hospitals, HMOs, and any other forms of insurance will be advised that the treatment of choice is spinal manipulation for most acute low back pain. It also provides a very strong case against any medical physician who disregards those guidelines and later has an unhappy patient who may have had surgery before considering spinal manipulation. We need to get the truth out to the media through every avenue available to us. Make no mistake, this profession is on its way in a big-time fashion.
Not only is this a very exciting time for us, but an extremely hazardous one. Until recent years, our profession has not been given much consideration. More often than not we've been a nonentity in the eyes of legislators, health care providers, insurers, hospitals, HMOs, and the like. The New Zealand report began the chain of honest investigation into chiropractic. Britain followed with the Mead et al., study, Canada with its Manga report, and the U.S. with the RAND study. Suddenly, we find ourselves in the proverbial spotlight. I have no doubt that some health care providers are looking at us with great envy wishing they had what we had. But the greatest danger is how our profession handles its new responsibility. We are like the proverbial monkey climbing up the flagpole: When we were at the bottom no one really paid much attention to us, but the higher up we get the more our bottom is exposed and the cleaner it must be.
This profession needs to adjust itself to the new demands placed upon it from its higher profile. We need to adopt strict guidelines in every state which are fair and equitable to both doctors and patients. The state chiropractic associations need to put top priority on these guidelines if they already haven't. Failure to do so will invite the state to do it for us, which will be to the loss of patients and doctors. The states simply do not have the qualifications to do it as well as us.
Every profession has individuals within its ranks who will exploit people unfairly, chiropractic is no exception. If we don't take firm actions in every state we will have individuals who will embarrass our entire profession. We can very quickly be categorized as a worthy therapeutic profession but not capable of policing itself adequately. I'm not just referring to the kooks and crackpots who subscribe to bizarre ideas (even though they are few in number), but to the outright crooks who do things which are fraudulent. Every chiropractor in the country should be on the lookout for these people and do the honorable thing: turn them into the fraud division of the state or Federal Bureau of Investigation.
I've heard the expression "live and let live" and "brother against brother" stated by some of the advocates to their dishonest practices. This is not turning brother against brother, it is turning the criminal and frauds over to the appropriate authorities and cleaning up the profession. I'm not suggesting that this profession is plagued with many of these people, but even one is one too many. And it is unrealistic to believe that any profession is so pure that it doesn't need a watchful eye by its members. Failure to take action when knowing it exists is allowing yourself to become involved in a conspiracy of silence.
State associations need to have the courage to take firm stands and proudly tell the media, the states' attorneys, the insurance companies, and everyone else that they mean business. They need to stop worrying about losing members with this policy; who wants them anyway if they drop out on this basis?
The same applies to our colleges. They need to have the courage to renounce and sever any ties with cultists or unethical exploiters. Don't worry about losing the financial support of some of them. The colleges don't need that kind of financial support by giving up their principles. No one should sell their soul for money.
I am talking about some good old-fashioned common sense and logic. And if we don't as a profession, have the common sense to address this firmly and with absolute commitment this rising missile can thoroughly self-destruct. We had better wake up and smell the coffee.
Chester Wilk, DC
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