The Torture of HEAL
I'm writing this letter on behalf of myself and the thousands of students that I believe are going through or have gone through what I feel is sheer torture over the last few years regarding student loans. Of course, I am writing about the terrible injustice imposed upon us by the current HEAL fiasco.
For me, it all started about five years ago. It was the point in my life where I was about to make a career decision. I had tried a lot of different things and none of them had combined all of my interests and desires. A career had to combine several elements. It had to give me freedom, both financial and time. It had to be a career that would be rewarding and of benefit to my fellow man. Chiropractic fit the bill. I had been to many chiropractors and was impressed with the human body's ability to heal itself under the guidance of educated hands.
Having made the decision to become a chiropractic physician, I sought out various colleges, found out the prerequisites, and enrolled in school. I was a high school drop out and had not been to school in about 12 years. Of course, I still had to pay my bills so, like many others, I worked full-time while going to school full-time. I was one of the lucky ones. I had no family to support. Still, I had to sacrifice -- no social life, no extravagant luxuries. I figured this was a small sacrifice to pay for the future that awaited me after completing my chiropractic education.
Finally, the time to enter chiropractic college was drawing near and the excitement I felt is still unrivaled. I had talked to many chiropractors and they all advised me that chiropractic college would be the most difficult time of my life. It didn't phase me; I knew I could handle it.
In September of 1991, I entered Los Angeles Chiropractic College. I didn't have a lot of money when I moved from Salt Lake to Los Angeles (barely enough to make the trip). I had thoroughly checked out the financial aid situation and established a budget that I knew would work. When I arrived at the school on orientation day, I was informed that there was a delay in the HEAL, and I probably wouldn't see any money until early October. I did receive enough money from the GSL and SLS to pay my tuition, buy food for a month, and pay for the necessary books and supplies.
As students, we weren't warned about the possibility of the HEAL not being reauthorized. I'm sure that school officials felt that everything would be okay. As time passed, the threat of not receiving the money filled the backs of our minds and began to fester as we were told that money would be coming in, in just a couple of weeks. In mid October, my money was getting real tight. The word at the financial aid office was that HEAL funds would arrive about the first of November. We were told that emergency funding was available through the school business office. I applied and received enough money to catch up on my current rent and to keep my phone turned on, as well as buy a small amount of food. The rest of my bills had to await the arrival of HEAL funds. We were also told about the availability of a couple of other student loan programs -- the TERI and Excel. I had already checked out the TERI loan before I came to school and knew that due to past credit problems, I was ineligible.
I was extremely HEAL dependent. I had no rich parents and no rich relatives. My parents were able to lend me a small amount from their retirement fund. Time passed and the rumors were flying. "The money is coming, the money will never come, the bill that the reauthorization was attached to was vetoed," we were told. The financial aid office told us that the money would be here about the first of December if congress could get together on a plan before Thanksgiving. Panic started to set in on campus, and the student body officers, as well as the college presidency, tried to reassure us that everything would be okay.
I could no longer handle the pressure of school and the pressure of my financial situation. Indeed this was the most difficult time of my life. I called the office of a couple of congressmen and was told to talk to the office of HHS. The word from that office was less encouraging. They said it could be as long as July 1992 before any HEAL funds were available. They said it was dependent on whether or not congress could come to terms and the possibility that no money would ever become available was now a real threat.
Meanwhile, the school kept encouraging us, telling us that money would come soon, meanwhile encouraging us to apply for other loans -- some did.
The first part of December arrived and still no HEAL money. We were about 13 weeks into the term and the anxiety of trying to find money was starting to grate on my mind like a Chinese water torture. Finally, a definitive answer came. There would be no HEAL money before Christmas. The bills were stacking up, I was behind in my rent, and my credit was once again suffering. At this point I had no choice, I had to leave school. I borrowed some money from the business office and moved back home, to Utah.
I am not bitter about this, and I am not asking anyone to pay my way. I simply want to share with you the frustration that many of us are feeling. We feel cheated. Many of us are thousands of dollars in debt with nothing to show for it but wasted time. The government says that the default rate for chiropractic HEAL is alarming. How will we pay back the thousands of dollars spent on getting as far as we have. We seemed to be stuck in a mode of continual sacrifice. When do the rewards that we all worked so hard for finally come. Many of us left our lives and family behind us. Many of us will have no place to turn. Many of my classmates have made the statement, "This is it, if I don't make it here, I don't know what I'll do. I have worked so long and so hard to get this far that I can't imagine anything else." Many have no lives or jobs to go back to. It's difficult to raise a family and pay back thousands of dollars in student loans working for minimum wage. Some will be fortunate and find good jobs, while others will suffer and eventually wind up as fatalities of the bureaucratic system.
Chiropractic has always been plagued with one problem or another and has always had the courage to fight back and win. What will chiropractic do this time? What can we, as students, do to recapture the dreams we once had. Any suggestions? Is there any light at the end of this dark and gloomy tunnel?
Salt Lake City, Utah
Cutting Insurance Costs in Iowa: Chiropractic the Victim
Do you enjoy your patients having insurance coverage? Can your patients come to you for all the care that they need during the year and know that it will only cost them a few dollars because their insurance will pay for 80 or even 90 percent of the cost? We, in Iowa, thought that since our state had a good insurance equality law that our financial problems were over. They seemed to be, during 1991. I was enjoying the 1991 situation until the last few days of the year. The local industry that has supported my family and has sent my kids through college are now informing their employees that they only get 10 or 15 visits per year, starting in 1992. Other companies have told their employees that their chiropractic coverage is limited to $350 or $500 per year. One company has initiated $2,000 deductible for some salaried employees. These same companies in 1991 covered whatever the patient needed.
This drop in coverage isn't because the scoundrel down the street has been gouging the insurance companies. These are national contracts. Are they doing this because they hate chiropractic in general? No. They want to be able to say they cover chiropractic. Can they get away with doing this? Yes! They can get away with this because of ERISA which is not controlled by state laws. Are they putting these limits on medical care? No!
This situation is entirely precipitated for economic reasons. They need to save money every place they can to survive as a company. As they look back over their contracts with the employees, they are cutting to the minimum, whatever they consider as non-essential. Therefore, chiropractic gets hit hard. They are not taking into consideration that over one-half of the patients that are in the hospital are there because of the results of another medical treatment. Drugs and surgery may temporarily correct one problem but cause even worse and more expensive problems a few years down the road.
We all know that we can save insurance companies and ultimately the employer money over the long run. Every workers' compensation study done has proved this. "The Italian study has shown that people who have been receiving chiropractic care for a period of two years have their absences from work reduced by 75.55 percent and their number of hospitalizations reduced by 87.6 percent. Spinal adjustments proved to be very successful in curtailing health care cost in general, particularly hospital costs, insurance costs, and the loss of productivity caused by absence from work." As a chiropractor we can either help someone or not help them. Unlike medicine, we very seldom cause other problems. We know if insurance companies are interested in cutting costs they need to discourage medical care and encourage chiropractic care.
Discouraging employees from seeking chiropractic care is in no one's best interest. Do those making these changes realize this? No! They are still the victims of the past AMA conspiracy.
What is the solution? I considered going to each of the local companies and talking to the union and the management, but these contracts are state and national.
Thomas A. Rexroth, D.C.
West Burlington, Iowa
Getting Serious about the Science of Chiropractic
For all its 96 years, chiropractors have insisted that chiropractic is a well-developed science. Old Dad Chiro claimed that his clinical practice and patients' results had "proven" his theories.1 B.J. Palmer claimed that his neurocalometer was "the most valuable idea that has ever been given by man for man in the history of the world,"2,3 and based his claims on unpublished experimentation. Scientifically unsubstantiated claims-making by chiropractors in recent years,4,5 seems no less extensive than in the profession's earlier history.
Most recently, the ICA has announced that it has "no higher priority" than to convince governmental policymakers of:
"The compelling scientific record supporting the effectiveness and appropriateness of chiropractic care for a wide range of conditions."6
What purpose does such fantasy rhetoric serve? Does the ICA really believe this delusion? Does the chiropractic profession believe that if we insist on the scientific validity and effectiveness of chiropractic care often enough, the data will somehow spring into existence? Or, do we think we can bluff our way through the policy-setting process, and that we will not be called upon to present the imaginary "compelling scientific record"?
After nearly a century of such nonsense, we continue to be the step-children of the health care industry. When will we get serious about a science of chiropractic? When will we stop pretending?
- Palmer DD: The Chiropractor's Adjustor. 1910, Portland Printing House, Portland Oregon.
- Palmer BJ: The Hour Has Struck. 1924, Palmer School of Chiropractic, Davenport Iowa.
- Keating JC: Introducing the neurocalometer: a view from the Fountain Head. Journal of Canadian Chiropractic Association, 35(3):165-78, 1991.
- Keating JC, Hansen DT: Quackery vs. accountability in the marketing of chiropractic. Journal of Manipulative & Physiological Therapeutics, accepted for publication June 1991.
- Keating JC: Traditional barriers to standards of knowledge production in chiropractic. Chiropractic Technique 2(3):78-85, August 1990.
- Gregg RJ: States look to health provider taxes to fund growing health care costs. Dynamic Chiropractic, 10(4):1,38,41, Feb. 14, 1992.
Joseph C. Keating Jr., Ph.D.
When I read Dr. Charles Krieger's letter in its entirety, my response was, "right on." Dang, Doc, I wish I had written that myself.
John G. Watson, D.C.
Hendersonville, North Carolina
Why Plain Film x-rays?
This letter is in the form of a question rather than a comment. In the last year or so I have read about dozens of malpractice claims settled against doctors of chiropractic for failure to diagnose a prolapsed intervertebral disc (IVD). In most of these cases, a prime factor was the chiropractors' failure to take plain film x-rays of the involved region.
Plain film x-rays are needed when it is felt necessary to rule out fracture, congenital malformation, neoplasm, arthritis, or to evaluate structure, bone density or alignment. Plain film x-rays are not at all reliable in ruling out herniated nucleus pulposus (HNP). It is quite common for an MRI to demonstrate HNP in a disc where disc space is found to be of full height on plain film x-rays. It is also common to find no HNP on an MRI of a disc where disc spacing is found on plain film x-rays to be substantially reduced.
When a chiropractor is sued for malpractice for failure to diagnose HNP, there are many things for which he can be found at fault -- failure to make neurological referral, to order MRI, to order a CAT scan with contrast, etc., but failure to take plain film x-rays should not be one of them. My question is, why are these chiropractors being pilloried in malpractice actions for failure to take plain film x-rays when HNP is involved?
Dennis M. Diggett, D.C.
Mt. Sinai, New York
My name was among those in the acknowledgements for the article "Hygiene Protocol for Treating AIDS Patients." Although I suggested some sources for the authors, I did not see the completed article until it was in print. I feel that it is very possible that readers may be left in some confusion after reading this article.
Persons who have been infected with the HIV virus pose widely varying degrees of risk to others. I feel that the authors should have recognized that dealing with an HIV carrier can be quite different from dealing with those patients who have full-blown or advanced cases of AIDS, with but a short time to live. Seriously ill AIDS patients often have one or more additional infections, whose pathogens are more easily transmitted than the HIV virus. The 17- step protocol described is certainly appropriate for these very active cases of AIDS and was originally developed to deal with such patients when they are ill enough to be hospitalized.
In my opinion, the steps described in the protocol are excessive and inappropriate when an HIV carrier, such as Magic Johnson, comes for routine treatment. It is well-known that the HIV virus is normally transmitted from the body fluids of one individual to the next by sexual activity and reused needles, neither of which are types of contact normally in the chiropractic office nor as part of chiropractic treatment. In daily practice, the chiropractor should consider all patients potential carriers of pathogens and routinely use appropriate measures for protection: i.e., any skin lesions, whether on the patient's body or the practitioner's hands, which would come in contact with another or with the treatment table, which should be covered with a protective barrier. Whenever touching a mucous membrane, the doctor should use latex gloves (double glove if initial inspection shows abnormal condition). Of course, when the doctor has a respiratory infection, a mask should be worn to protect the patient from infection. If about to start a procedure where the patient's body fluids might be sprayed into the air, the doctor should use protective goggles and possibly a mask. Blood drawing needles must be disposed of properly.
There are no guarantees that any procedure will eliminate all risk of infection, even the very thorough protocol presented. The doctor's decision on which protocols to use in any specific situation must result from consideration of the likelihood that the patient is shedding pathogens of any type, in what manner and amounts, the cost effectiveness of the suggested procedure, as well as how much risk he is willing to tolerate. No one formula can adequately address all situations and issues.
Grace E. Jocobs, D.A.
Los Angeles, California
"A Powerful Therapeutic Tool"
I read with interest the article written by Dr. R. Vincent Davis "The Management of Lateral Epicondylitis," in the February 14, 1992 issue of Dynamic Chiropractic. I feel compelled to write about an experience I had:
About a year ago, I attended a seminar titled, "The Management of Pain in the Locomotor System." At that seminar, Dr. L. John Faye discussed the anterior cervical subluxation and demonstrated the detection of and the corrective adjustment for that subluxation. He taught that the correction of the anterior cervical subluxation was unique because of its effects upon the sympathetic nervous system and used the case history format to discuss the application of this adjustment. One such case history dealt with the successful resolution of lateral epicondylitis solely with this adjustive procedure.
I took this information back to the office with me and waited for my next "true" lateral epicondylitis patient to arrive. The case presented as a 60-year-old female with left elbow pain of six months duration. She had previously been treated medically by corticosteroid injection and NSAID pharmacotherapy with minimal relief. After my work-up, her medical diagnosis was that of lateral epicondylitis secondary to cumulative microtrauma from on the job stresses. Upon treatment I palpated for and located the anterior cervical subluxation at the ipsilateral C4-C5 motor unit. I adjusted this subluxation three times over a 10-day period. At that time the patient's pain completely abated.
Obviously, the anterior cervical adjustment cannot be thought of as the adjustment for lateral epicondylitis, but it is another powerful therapeutic tool that we chiropractors possess.
John Thomas Cece, D.C.
Upper Saddle River, New Jersey
Where's a Chiropractor When You Need One?
This is a letter to Edward C. Sullivan, D.C., a copy of which was forwarded to Dynamic Chiropractic for publication.
Dear Dr. Sullivan:
I did what you suggested and it didn't get me anywhere. If the army has osteopaths who give back manipulations they are holding out on me.
I went to sick call during basic training several times and each time inquired about seeing an osteopath. The staff at sick call ignored me or played dumb. I never received a straight answer or an appointment to see one, if they even have one. The clinic here at Fort Jackson, South Carolina is called Troop Medical Clinic, and the Hospital is Montcrief Hospital. All I get is a "run around" at these places. All Troop Medical Clinic does is pronounce your pain to be muscle strain and send you away with Motrin in your pocket and sometimes some Ben-Gay, neither of which help when all you need is a chiropractor or a real doctor. I could have a massive heart attack, and I personally believe that they'd give me Motrin and send me away.
The point of this letter is that the Army doesn't have an osteopath readily available to me, a soldier (previously in basic training) in advanced individualized training (AIT).
I am currently in a massive amount of physical pain, a large extent of which is treatable by chiropractic care.
The Army should have chiropractors in the military service because these ghost osteopaths don't cut the mustard or adjust the back. I anxiously await my first leave so I may fly home for one day, at an expense of $500, just to receive good chiropractic care.
Please share this letter with anyone who can make a difference in this miserable situation.
Pvt. Kathy L. Champion
Fort Jackson, South Carolina
The Cause, Not the Solution
I read the article in the February 4, 1991 issue of Dynamic Chiropractic titled, "The Dichotomy in Chiropractic," authored by Fred Barge, D.C. It would seem that the attitude expressed is apparently the cause and not the solution to the problem he seems to be so concerned about. It would seem to me that by proposing the negative positioning he recommends, many advances made in the last two decades could be jeopardized. The very crazy mixer/straight controversy and those who make it their purpose in life is a dangerous challenge to our professional existence. For anyone to suggest that we were becoming dominated by orthodox medicine or wanting to be so, has lost sight of the recent court battle which our profession fortunately won, and the many other advances in public recognition through the media. If we were to embrace the philosophy of Dr. Barge, I believe we could expect to be relegated by the state legislatures across this country to a technician status, instead of a primary care portal of entry physician. We would then probably lose most of our insurance coverages across the board, and all financial aid now available to our students. This would be a disaster from which we could hardly expect to survive as an organized health care profession. I doubt seriously that any chiropractor in private practice today would relish those consequences. I can observe that Dr. Barge has little use for the National College from his statement referring to 1906, and the plague which has ensued since, alluding to a dissident faction which objected to the D.D. Palmer philosophical concepts. Since I am a 1961 National graduate and have always been aware of the origin of chiropractic art and science, I feel there is nothing to be gained by arguing with a philosophy which is not recognized as viable by the vast majority of our profession.
By spreading this misinformation and negativity to the young practitioner of chiropractic, it breeds mistrust and divisiveness within our numbers. I do not think any chiropractor wants to be labeled a technician or a pawn of the medical establishment. We have a great future ahead of us, and when unity of our profession is finally accomplished, we will have finally reached true maturity. A great many chiropractic patients do not realize any difference in their mixer or straight chiropractic spinal manipulative treatments, so why should we try to establish a difference if there is none. The modalities of diathermy, ultrasound, and electric muscle stimulation which are part of the objection by some practitioners, are used as ancillary adjunctive measures to address muscle spasm, pain or congestion. Use of these natural modalities is merely icing on the cake. If a treatment can be enhanced by their use, why could anyone object? For some individuals who seek advantage by holding back progress, and point a finger at it, are history. Progress is our heritage and unity our destiny, regardless of the doomsavers within our profession. Chiropractic is the profession of the future, and will continue to be the leader in natural healing throughout the U.S. and the world.
Robert C. Tilka, D.C.
Hendersonville, North Carolina